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Sample records for wrist diagnostic performance

  1. Magnetic resonance imaging of the wrist: Diagnostic performance statistics

    International Nuclear Information System (INIS)

    Hobby, Jonathan L.; Tom, Brian D.M.; Bearcroft, Philip W.P.; Dixon, Adrian K.

    2001-01-01

    AIM: To review the published diagnostic performance statistics for magnetic resonance imaging (MRI) of the wrist for tears of the triangular fibrocartilage complex, the intrinsic carpal ligaments, and for osteonecrosis of the carpal bones. MATERIALS AND METHODS: We used Medline and Embase to search the English language literature. Studies evaluating the diagnostic performance of MRI of the wrist in living patients with surgical confirmation of MR findings were identified. RESULTS: We identified 11 studies reporting the diagnostic performance of MRI for tears of the triangular fibrocartilage complex for a total of 410 patients, six studies for the scapho-lunate ligament (159 patients), six studies for the luno-triquetral ligament (142 patients) and four studies (56 patients) for osteonecrosis of the carpal bones. CONCLUSIONS: Magnetic resonance imaging is an accurate means of diagnosing tears of the triangular fibrocartilage and carpal osteonecrosis. Although MRI is highly specific for tears of the intrinsic carpal ligaments, its sensitivity is low. The diagnostic performance of MRI in the wrist is improved by using high-resolution T2* weighted 3D gradient echo sequences. Using current imaging techniques without intra-articular contrast medium, magnetic resonance imaging cannot reliably exclude tears of the intrinsic carpal ligaments. Hobby, J.L. (2001)

  2. Diagnostic Performance of the Extensor Carpi Ulnaris (ECU) Synergy Test to Detect Sonographic ECU Abnormalities in Chronic Dorsal Ulnar-Sided Wrist Pain.

    Science.gov (United States)

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo

    2016-01-01

    The extensor carpi ulnaris (ECU) tendon synergy test is a simple and unique diagnostic maneuver for evaluation of chronic dorsal ulnar-sided wrist pain, which applies isolated tension to the ECU without greatly stressing other structures. This study aimed to investigate the diagnostic performance of the ECU synergy test to detect ECU abnormalities on sonography. Forty affected wrists from 39 consecutive patients with chronic dorsal ulnar-sided wrist pain that continued for greater than 1 month were examined with the ECU synergy test and sonography. The sensitivity, specificity, positive predictive value, and negative predictive value of the ECU synergy test to detect ECU abnormalities were evaluated. We compared the results of the ECU synergy test between groups with and without ECU abnormalities and also compared the ages, sexes, and symptomatic durations of the patients between groups with positive and negative ECU synergy test results and between the groups with and without ECU abnormalities. The sensitivity, specificity, positive predictive value, and negative predictive value were 73.7%, 85.7%, 82.4%, and 78.3%, respectively. There was significant difference in the ECU synergy test results between the groups with and without ECU abnormalities (P synergy test could be a useful provocative maneuver to detect ECU abnormalities in patients with chronic dorsal ulnar-sided wrist pain. © 2016 by the American Institute of Ultrasound in Medicine.

  3. Diagnostic performance of three-dimensional MR maximum intensity projection for the assessment of synovitis of the hand and wrist in rheumatoid arthritis: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Li, Xubin, E-mail: lixb@bjmu.edu.cn [Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Reseaech Center for Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060 (China); Liu, Xia; Du, Xiangke [Department of Radiology, Peking University People' s Hospital, Beijing 100044 (China); Ye, Zhaoxiang [Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Reseaech Center for Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060 (China)

    2014-05-15

    Purpose: To evaluate the diagnostic performance of three-dimensional (3D) MR maximum intensity projection (MIP) in the assessment of synovitis of the hand and wrist in rheumatoid arthritis (RA) compared to 3D contrast-enhanced magnetic resonance imaging (CE-MRI). Materials and methods: Twenty-five patients with RA underwent MR examinations. 3D MR MIP images were derived from the enhanced images. MR images were reviewed by two radiologists for the presence and location of synovitis of the hand and wrist. The diagnostic sensitivity, specificity and accuracy of 3D MIP were, respectively, calculated with the reference standard 3D CE-MRI. Results: In all subjects, 3D MIP images yielded directly and clearly the presence and location of synovitis with just one image. Synovitis demonstrated high signal intensity on MIP images. The k-values for the detection of articular synovitis indicated excellent interobserver agreements using 3D MIP images (k = 0.87) and CE-MR images (k = 0.91), respectively. 3D MIP demonstrated a sensitivity, specificity and accuracy of 91.07%, 98.57% and 96.0%, respectively, for the detection of synonitis. Conclusion: 3D MIP can provide a whole overview of lesion locations and a reliable diagnostic performance in the assessment of articular synovitis of the hand and wrist in patients with RA, which has potential value of clinical practice.

  4. MDCT arthrography of the wrist: Diagnostic accuracy and indications

    International Nuclear Information System (INIS)

    De Filippo, Massimo; Pogliacomi, Francesco; Bertellini, Annalisa; Araoz, Philip A.; Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna; Corradi, Maurizio; Costantino, Cosimo; Zompatori, Maurizio

    2010-01-01

    Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.

  5. MDCT arthrography of the wrist: Diagnostic accuracy and indications

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    De Filippo, Massimo [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy)], E-mail: massimo.defilippo@unipr.it; Pogliacomi, Francesco [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Bertellini, Annalisa [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Araoz, Philip A. [Department of Radiology, Division of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (United States); Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Corradi, Maurizio; Costantino, Cosimo [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Zompatori, Maurizio [Department of Radiological and Histopathological Sciences, Policlinic S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna (Italy)

    2010-04-15

    Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.

  6. The Diagnostic Utility of Midcarpal Anesthetic Injection in the Evaluation of Chronic Wrist Pain

    OpenAIRE

    Bell, S. Josh; Hofmeister, Eric P.; Moran, Steven L.; Shin, Alexander Y.

    2007-01-01

    The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip strength were compared to the presence of intracarpal pathology as confirmed by wrist arthros...

  7. Case Report: SPECT/CT as the New Diagnostic Tool for Specific Wrist Pathology.

    Science.gov (United States)

    Linde, Musters; Ten Broek, M; Kraan, G A

    2017-01-01

    Single photon emission computed tomography has been introduced as a promising new diagnostic tool in orthopaedic pathology since the early 90'. Computed tomography, the combined with SPECT, gives insight in the specific sight of wrist pathology. Literature already supports introduction of SPECT/CT in wrist pathology, but clinical application is lagging. A 40yr old patient reported first in 2004 with persisting pain after a right distal radius fracture. Several diagnostics and operative interventions were performed, all unsuccessful. Because of the persisting pain a SPECT-CT was performed which showed a cyst in the hamate bone, which was successfully enucleated. The patient was finally pain free at recent follow-up. With a QDash-score of 43 and a PRW (H) E-DLV-score of 58/150. In this case report, SPECT/CT proved a very sensitive diagnostic tool for specific pathology of the wrist. It offered precise localisation and thereby the clinically suspected diagnosis was confirmed and the patient successfully treated.

  8. Design of a Magnetic Resonance-Safe Haptic Wrist Manipulator for Movement Disorder Diagnostics

    NARCIS (Netherlands)

    Bode, Dyon; Mugge, Winfred; Schouten, Alfred C.; van Rootselaar, Anne-Fleur; Bour, Lo J.; van der Helm, Frans C. T.; Lammertse, Piet

    2017-01-01

    Tremor, characterized by involuntary and rhythmical movements, is the most common movement disorder. Tremor can have peripheral and central oscillatory components which properly assessed may improve diagnostics. A magnetic resonance (MR)-safe haptic wrist manipulator enables simultaneous measurement

  9. Bone SPECT-CT: An additional diagnostic tool for undiagnosed wrist pain.

    Science.gov (United States)

    Shirley, R A; Dhawan, R T; Rodrigues, J N; Evans, D M

    2016-10-01

    Diagnosis of wrist pain can be difficult to determine with clinical examination and conventional imaging techniques alone. Bone SPECT-CT (single-photon emission tomography with computerized tomography) is a hybrid imaging technique that overlays functional bone scintigraphy in tomographic/3D mode with conventional CT. Data from the two modalities are complementary; areas of abnormal bone metabolism can be localized with anatomical precision, hitherto lacking in conventional bone scans, while structural information from the CT scan further embellishes the diagnostic information. Over the last 6 years, one surgeon (David Evans) has used bone SPECT and later bone SPECT-CT as an additional line of investigation. This is a series of 21 consecutive patients with wrist pain that could not be diagnostically resolved with the usual combination of history, examination, and conventional imaging, and therefore underwent bone SPECT-CT. Clinical and imaging findings, management, and outcomes of these cases are discussed to explore the potential role of this hybrid functional modality in hand and wrist surgical practice. Copyright © 2016. Published by Elsevier Ltd.

  10. Wrist arthroscopy

    Science.gov (United States)

    Wrist surgery; Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release ... You might need wrist arthroscopy if you have one of these problems: Wrist pain . Arthroscopy allows the surgeon to explore what is causing your wrist ...

  11. Use of the mini C-arm for wrist fractures - Establishing a diagnostic reference level

    International Nuclear Information System (INIS)

    Love, G. J.; Pillai, A.; Gibson, S.

    2008-01-01

    The establishment of diagnostic reference levels (DRLs) for all typical radiological examinations became mandatory following the implementation of the Ionising Radiations (Medical Exposure) Regulations Act 2000. At present, there are no national dosage guidelines in the UK regarding use of fluoroscopy in orthopaedic trauma. The increasing popularity of the mini C-arm image intensifier amongst surgeons has led to concerns regarding use of ionizing radiation by personnel who have not been trained in radiation protection. It is therefore essential to have formal protocols for use of the mini C-arm to comply with the law and to maintain safe clinical practice. It is attempted to provide dose data for wrist fracture manipulations that may be used as a basis for setting a DRL for this procedure. Screening times were recorded for 80 wrist manipulations in a fracture clinic setting using a mini C-arm image intensifier. A DRL was set using the third quartile value for screening time. The median screening time for wrist fractures was 20 s with a range from 1 to 177 s. The third quartile value for screening time was 34 s. This value can be used as a provisional DRL for wrist fracture manipulations. The DRL is a quantitative guide for the optimisation of radiological protection. IR(ME)R 2000 states that if it is consistently exceeded by an individual operator or a piece of equipment, investigation and remedial action must be taken. We recommend that trauma units establish their own local DRLs for common procedures as made mandatory by legislation. (authors)

  12. Effect of wrist cooling on aerobic and anaerobic performance in elite sportsmen.

    Science.gov (United States)

    Krishnan, Anup; Singh, Krishan; Sharma, Deep; Upadhyay, Vivekanand; Singh, Amit

    2018-01-01

    Body cooling has been used to increase sporting performance and enhance recovery. Several studies have reported improvement in exercise capacities using forearm and hand cooling or only hand cooling. Wrist cooling has emerged as a portable light weight solution for precooling prior to sporting activity. The Astrand test for aerobic performance and the Wingate test for anaerobic performance are reliable and accurate tests for performance assessment. This study conducted on elite Indian athletes analyses the effects of wrist precooling on aerobic and anaerobic performance as tested by the Astrand test and the Wingate test before and after wrist precooling. 67 elite sportsmen were administered Wingate and Astrand test under standardised conditions with and without wrist precooling using a wrist cooling device (dhamaSPORT). Paired t -test was applied to study effect on aerobic [VO 2 (ml/min/kg)] and anaerobic performance [peak power (W/kg) and average power (W/kg)] and Cohen's d was used to calculate effect size of wrist precooling. After wrist precooling, significant increase of 0.22 ( p  = 0.014, 95% CI: 0.047, 0.398) in peak power (W/kg) and 0.22 ( p  effective in aerobic performance. Wrist cooling effect size was smaller in VO 2 (Cohen's d  = 0.21), peak power (Cohen's d  = 0.31) and it was larger in average power (Cohen's d  = 0.71). Results show wrist precooling significantly improves anaerobic than aerobic performance of elite sportsmen.

  13. Wrist arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, S.G. (Dept. of Diagnostic Radiology, University Hospital, Linkoeping (Sweden))

    1993-03-01

    The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congential perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC. (orig.).

  14. Evaluation of wrist arthroscopy outcomes in patients with chronic wrist pain

    Directory of Open Access Journals (Sweden)

    Reza Shahryar Kamrani

    2015-01-01

    Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.

  15. [Cinematography, a new diagnostic procedure in evaluation of the injured painful wrist joint].

    Science.gov (United States)

    Werber, K D; Wuttge-Hannig, A; Hannig, C

    1990-01-01

    By the X-ray Cineradiografie we are able to examine and to judge the dynamic of the wrist bones by 50 pictures/sec. in comparison to one another and also depending on their ligaments. We did an investigation of 170 patients with painful wrist. With the method we were able to make up a clear diagnosis and to propose the therapy. I.e.: If consecutive shortening of the radius after distal radius fracture resulting ingruency of the wrist joint is relevant, or a scaphoid pseudarthrosis is fixed elastically, or a scaphoic dissociation is effective. The variations were shown in comparison to normal circumstances.

  16. Diagnostic values of bone scintigram for painful disorders of the hand and the wrist

    International Nuclear Information System (INIS)

    Ogura, Kazuhisa; Yamauchi, Yasuo; Kusunose, Koichi; Sugiyama, Masaru; Honjou, Yuji

    1998-01-01

    From April 1993 to April 1997, 43 patients underwent bone scintigraphic examination for various painful conditions in the hand and the wrist joint. Three hours after an intravenous injection of 740 MBq of TC-99m HMDP, wrist scintigram was obtained. Of 18 patients with ulnar wrist pain, 12 patients had positive scan. The accumulation pattern in the five cases of ulnocarpal abutment syndrome showed different patterns. Slight difference of the accumulation between the ulnar head and the ulnar styloid process was well differentiated. Each carpal bone could be well identified, but when two bones were overlapping as in the triquetrum and the pisiform, additional physical findings were helpful. Six patients showed negative scan. The two patients with positive triangular fibrocartilage (TFC) tear but with negative bone scan showed no bony involvement, whereas those with TFC tear and positive scan were the ones having some bony disorders such as ulnocarpal abutment syndrome. Of 25 patients with wrist pain other than ulnar pain, 14 patients had positive scan. The remaining 11 patients who had negative scan included three patients with occult ganglion, two with wrist sprain and six with various disorders. (K.H.)

  17. Diagnostic values of bone scintigram for painful disorders of the hand and the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Ogura, Kazuhisa; Yamauchi, Yasuo; Kusunose, Koichi; Sugiyama, Masaru; Honjou, Yuji [Juntendo Univ., Tokyo (Japan). School of Medicine

    1998-02-01

    From April 1993 to April 1997, 43 patients underwent bone scintigraphic examination for various painful conditions in the hand and the wrist joint. Three hours after an intravenous injection of 740 MBq of TC-99m HMDP, wrist scintigram was obtained. Of 18 patients with ulnar wrist pain, 12 patients had positive scan. The accumulation pattern in the five cases of ulnocarpal abutment syndrome showed different patterns. Slight difference of the accumulation between the ulnar head and the ulnar styloid process was well differentiated. Each carpal bone could be well identified, but when two bones were overlapping as in the triquetrum and the pisiform, additional physical findings were helpful. Six patients showed negative scan. The two patients with positive triangular fibrocartilage (TFC) tear but with negative bone scan showed no bony involvement, whereas those with TFC tear and positive scan were the ones having some bony disorders such as ulnocarpal abutment syndrome. Of 25 patients with wrist pain other than ulnar pain, 14 patients had positive scan. The remaining 11 patients who had negative scan included three patients with occult ganglion, two with wrist sprain and six with various disorders. (K.H.)

  18. Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists.

    Science.gov (United States)

    Neubauer, Jakob; Benndorf, Matthias; Reidelbach, Carolin; Krauß, Tobias; Lampert, Florian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Fiebich, Martin; Goerke, Sebastian M

    2016-01-01

    To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures. As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT. Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = radiography (P radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.

  19. Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study

    Directory of Open Access Journals (Sweden)

    Sandini Giulio

    2009-12-01

    Full Text Available Abstract Background In the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life. Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion of the different DoFs (degrees of Freedom. Methods The IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE, Abduction/Adduction (AA and Pronation/Supination (PS. Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns. Results Three stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the

  20. Development and performance of a new prosthesis system using ultrasonic sensor for wrist movements: a preliminary study

    Science.gov (United States)

    2014-01-01

    Background The design and performance of a new development prosthesis system known as biomechatronics wrist prosthesis is presented in this paper. The prosthesis system was implemented by replacing the Bowden tension cable of body powered prosthesis system using two ultrasonic sensors, two servo motors and microcontroller inside the prosthesis hand for transradial user. Methods The system components and hand prototypes involve the anthropometry, CAD design and prototyping, biomechatronics engineering together with the prosthetics. The modeler construction of the system develop allows the ultrasonic sensors that are placed on the shoulder to generate the wrist movement of the prosthesis. The kinematics of wrist movement, which are the pronation/supination and flexion/extension were tested using the motion analysis and general motion of human hand were compared. The study also evaluated the require degree of detection for the input of the ultrasonic sensor to generate the wrist movements. Results The values collected by the vicon motion analysis for biomechatronics prosthesis system were reliable to do the common tasks in daily life. The degree of the head needed to bend to give the full input wave was about 45° - 55° of rotation or about 14 cm – 16 cm. The biomechatronics wrist prosthesis gave higher degree of rotation to do the daily tasks but did not achieve the maximum degree of rotation. Conclusion The new development of using sensor and actuator in generating the wrist movements will be interesting for used list in medicine, robotics technology, rehabilitations, prosthetics and orthotics. PMID:24755242

  1. Complications of wrist arthroscopy.

    Science.gov (United States)

    Ahsan, Zahab S; Yao, Jeffrey

    2012-06-01

    The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Wrist Pain

    Science.gov (United States)

    ... at a keyboard, take regular breaks. When you type, keep your wrist in a relaxed, neutral position. An ergonomic ... of Nondiscrimination Advertising Mayo Clinic is a not-for-profit organization ...

  3. Wrist Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Fractures Email to a friend * required fields ...

  4. Wrist Sprains

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Sprains Email to a friend * required fields ...

  5. Wrist Arthroscopy

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Arthroscopy Email to a friend * required fields ...

  6. Standardisation of the MRI image evaluation in the diagnostics of rheumatoid arthritis within the wrist and metacarpophalangeal joints

    International Nuclear Information System (INIS)

    Kapuscinska, K.; Urbanik, A.; Wojciechowski, W.

    2009-01-01

    Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease of the connective tissue, which results in disability and earlier death. Thus it is very important to recognise this pathologic condition as early as possible, to lessen and delay its consequences. Currently, magnetic resonance imaging is the best imaging modality, depicting every stage of this disease and allowing for monitoring of the treatment response. The process of standardisation is needed in assessing MR pictures. The aim of this article was to present the MR protocols of hand and wrist MR examinations for rheumatologic demand and standards of results, according to worldwide OMERACT RAMRIS 2002 and supplemented by tenosynovitis system. (authors)

  7. Intervention randomized controlled trials involving wrist and shoulder arthroscopy: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Although arthroscopy of upper extremity joints was initially a diagnostic tool, it is increasingly used for therapeutic interventions. Randomized controlled trials (RCTs) are considered the gold standard for assessing treatment efficacy. We aimed to review the literature for intervention RCTs involving wrist and shoulder arthroscopy. Methods We performed a systematic review for RCTs in which at least one arm was an intervention performed through wrist arthroscopy or shoulder arthroscopy. PubMed and Cochrane Library databases were searched up to December 2012. Two researchers reviewed each article and recorded the condition treated, randomization method, number of randomized participants, time of randomization, outcomes measures, blinding, and description of dropouts and withdrawals. We used the modified Jadad scale that considers the randomization method, blinding, and dropouts/withdrawals; score 0 (lowest quality) to 5 (highest quality). The scores for the wrist and shoulder RCTs were compared with the Mann–Whitney test. Results The first references to both wrist and shoulder arthroscopy appeared in the late 1970s. The search found 4 wrist arthroscopy intervention RCTs (Kienböck’s disease, dorsal wrist ganglia, volar wrist ganglia, and distal radius fracture; first 3 compared arthroscopic with open surgery). The median number of participants was 45. The search found 50 shoulder arthroscopy intervention RCTs (rotator cuff tears 22, instability 14, impingement 9, and other conditions 5). Of these, 31 compared different arthroscopic treatments, 12 compared arthroscopic with open treatment, and 7 compared arthroscopic with nonoperative treatment. The median number of participants was 60. The median modified Jadad score for the wrist RCTs was 0.5 (range 0–1) and for the shoulder RCTs 3.0 (range 0–5) (p = 0.012). Conclusion Despite the increasing use of wrist arthroscopy in the treatment of various wrist disorders the efficacy of arthroscopically

  8. Arthroscopic Wrist Anatomy

    National Research Council Canada - National Science Library

    Taylor, Nathan

    2004-01-01

    .... Arthroscopy of the wrist is now a primary method of evaluating and treating many intra-articular wrist conditions including triangular fibrocartilage complex tears, chondral injuries, distal radius...

  9. Wrist arthrography: a simple method

    Energy Technology Data Exchange (ETDEWEB)

    Berna-Serna, Juan D.; Reus, Manuel; Alonso, Jose [Virgen de la Arrixaca University Hospital, Department of Radiology, El Palmar (Murcia) (Spain); Martinez, Francisco; Domenech-Ratto, Gines [University of Murcia, Department of Human Anatomy, Faculty of Medicine, Murcia (Spain)

    2006-02-01

    A technique of wrist arthrography is presented using an adhesive marker-plate with radiopaque coordinates to identify precisely sites for puncture arthrography of the wrist and to obviate the need for fluoroscopic guidance. Radiocarpal joint arthrography was performed successfully in all 24 cases, 14 in the cadaveric wrists and 10 in the live patients. The arthrographic procedure described in this study is simple, safe, and rapid, and has the advantage of precise localisation of the site for puncture without need for fluoroscopic guidance. (orig.)

  10. Wrist Injuries in Elderly Women

    DEFF Research Database (Denmark)

    Wrange, Erik Kristian Maurice; Brix, Lau

    Keywords Extremities, Musculoskeletal bone, Trauma, Conventional radiography, MR, Outcomes analysis, Acute, Osteoporosis Aims and objectives The purpose of this study was to compare diagnostic X-rays and MRI of the injured wrist in female patients aged 50 years or more. Methods and materials Fift...

  11. Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management

    International Nuclear Information System (INIS)

    Romaniuk, C.S.; Butt, W.P.; Coral, A.

    1995-01-01

    Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral post-traumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18-55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown. (orig.)

  12. Double-compartment wrist arthrography

    International Nuclear Information System (INIS)

    Quinn, S.F.; Pittman, C.; Belsole, R.; Greene, T.L.; Rayhack, J.; Clark, R.A.; King, P.S.

    1987-01-01

    Seventy patients with clinical wrist problems were studied with double-compartment wrist arthrography. Midcarpal and radiocarpal compartment arthrograms were obtained in all patients. Digital subtraction technique was used to subtract out contrast from the first compartmental injection. Digital technique also allowed a dynamic record of each injection, which helped determine sites of intercompartmental communication. Postarthrography exercises recorded on videotape were performed after each injection. There were 34 normal studies. Abnormalities in the other 36 patients included: scapholunate communication (n = 9), lunatotriquetral communication (n = 6), communication with tendon sheaths (n = 4), communication with distal radioulnar compartment (n = 14), abnormal synovium process (n = 9), and communication through the radial or ulnar collateral ligament (n = 3). Double-compartment wrist arthrography may provide additional information for complex problems of the wrist

  13. Radiologic evaluation of wrist arthrography

    International Nuclear Information System (INIS)

    Park, Yang Hee; Seong, Hyeun Lim; Yang, Jae Beom; Park, Chan Sup; Lee, Sang Seun

    1991-01-01

    Wrist arthrography allows direct visualization of the cartilage and synovial structure not seen in plain film. Arthrography of the wrist is valuable in evaluating patients with persistent wrist pain and limitation of motion after trauma. Wrist arthrography was performed in the evaluation of 30 patients with rheumatoid arthritis (2 cases), ganglions (12 cases), and wrist trauma (16 cases), and contrast media was injected in radiocarpal joint. The arthrographic findings were analyzed, and the results were as follows: In 16 patients with wrist trauma, 12 cases (75%) of compartment communication was seen including communication with distal radioulnar joint (44%), midcarpal joint (69%), and common carpometacarpal joint (63%). Of the total 30 patients, the pisiform-triquetral joint communicated with the radio carpal joint in 9 cases (30%). In 16 patients with trauma, the findings of post-traumatic arthritis included tendon communication (50%), irregular synovium (31%), and rupture of the joint capsule (25%). There was no lymphatic filling. Of 3 scaphoid fracture patients without bony callus formation, fibrous union was verified in one patient and nouncion in 2. O 12 patients with ganglion, communication between the ganglion and radiocarpal joint was seen in 2 cases and no communication in 10 cases

  14. Diagnostic colonoscopy: performance measurement study.

    Science.gov (United States)

    Kuznets, Naomi

    2002-07-01

    This is the fifth of a series of best practices studies undertaken by the Performance Measurement Initiative (PMI), the centerpiece of the Institute for Quality Improvement (IQI), a not-for-profit quality improvement subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC) (Performance Measurement Initiative, 1999a, 1999b, 2000a, 2000b). The IQI was created to offer clinical performance measurement and improvement opportunities to ambulatory health care organizations and others interested in quality patient care. The purpose of the study was to provide opportunities to initiate clinical performance measurement on key processes and outcomes for this procedure and use this information for clinical quality improvement. This article provides performance measurement information on how organizations that have demonstrated and validated differences in clinical practice can have similar outcomes, but at a dramatically lower cost. The intent of the article is to provide organizations with alternatives in practice to provide a better value to their patients.

  15. Trends in wrist arthroscopy

    NARCIS (Netherlands)

    Obdeijn, Miryam C.; Tuijthof, Gabrielle J. M.; van der Horst, Chantal M. A. M.; Mathoulin, Christophe; Liverneaux, Philippe

    2013-01-01

    Background Wrist arthroscopy plays a role in both the diagnosis and the treatment of wrist pathology. It has evolved in the last three decades. Questions The present status of wrist arthroscopy was investigated by answering the following questions: -What is its current position in the treatment

  16. Performance diagnostic system for emergency diesel generators

    International Nuclear Information System (INIS)

    Logan, K.P.

    1991-01-01

    Diesel generators are commonly used for emergency backup power at nuclear stations. Emergency diesel generators (EDGs) are subject to both start-up and operating failures, due to infrequent and fast-start use. EDG reliability can be critical to plant safety, particularly when station blackout occurs. This paper describes an expert diagnostic system designed to consistently evaluate the operating performance of diesel generators. The prototype system is comprised of a suite of sensor monitoring, cylinder combustion analyzing, and diagnostic workstation computers. On-demand assessments of generator and auxiliary equipment performance are provided along with color trend displays comparing measured performance to reference-normal conditions

  17. Methodology for quantitative evaluation of diagnostic performance

    International Nuclear Information System (INIS)

    Metz, C.

    1981-01-01

    Of various approaches that might be taken to the diagnostic performance evaluation problem, Receiver Operating Characteristic (ROC) analysis holds great promise. Further development of the methodology for a unified, objective, and meaningful approach to evaluating the usefulness of medical imaging procedures is done by consideration of statistical significance testing, optimal sequencing of correlated studies, and analysis of observer performance

  18. Diagnostics and performance evaluation of multikilohertz capacitors

    International Nuclear Information System (INIS)

    McDuff, G.; Nunnally, W.C.; Rust, K.; Sarjeant, J.

    1980-01-01

    The observed performance of nanofarad polypropylene-silicone oil, mica paper, and polytetrafluoroethylene-silicone oil capacitors discharged in a 100-ns, 1-kA pulse with a pulse repetition frequency of 1 kHz is presented. The test facility circuit, diagnostic parameters, and the preliminary test schedule are outlined as a basis for discussion of the observed failure locations and proposed failure mechanisms. Most of the test data and discussion presented involves the polypropylene-silicone oil units

  19. Design and characterization of the OpenWrist: A robotic wrist exoskeleton for coordinated hand-wrist rehabilitation.

    Science.gov (United States)

    Pezent, Evan; Rose, Chad G; Deshpande, Ashish D; O'Malley, Marcia K

    2017-07-01

    Robotic devices have been clinically verified for use in long duration and high intensity rehabilitation needed for motor recovery after neurological injury. Targeted and coordinated hand and wrist therapy, often overlooked in rehabilitation robotics, is required to regain the ability to perform activities of daily living. To this end, a new coupled hand-wrist exoskeleton has been designed. This paper details the design of the wrist module and several human-related considerations made to maximize its potential as a coordinated hand-wrist device. The serial wrist mechanism has been engineered to facilitate donning and doffing for impaired subjects and to insure compatibility with the hand module in virtual and assisted grasping tasks. Several other practical requirements have also been addressed, including device ergonomics, clinician-friendliness, and ambidextrous reconfigurability. The wrist module's capabilities as a rehabilitation device are quantified experimentally in terms of functional workspace and dynamic properties. Specifically, the device possesses favorable performance in terms of range of motion, torque output, friction, and closed-loop position bandwidth when compared with existing devices. The presented wrist module's performance and operational considerations support its use in a wide range of future clinical investigations.

  20. Education in wrist arthroscopy

    NARCIS (Netherlands)

    Obdeijn, M.C.

    2014-01-01

    The subject of this thesis is an initiative for improving the education of residents in surgical skills and knowledge by using the current technical possibilities. The choice of wrist arthroscopy was driven by the fact that novel techniques have recently been developed within hand and wrist surgery

  1. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple.

    Science.gov (United States)

    Gitto, Salvatore; Messina, Carmelo; Mauri, Giovanni; Aliprandi, Alberto; Sardanelli, Francesco; Sconfienza, Luca Maria

    2017-02-01

    Wrist ligaments are crucial structures for the maintenance of carpal stability. They are classified into extrinsic ligaments, connecting the carpus with the forearm bones or distal radioulnar ligaments, and intrinsic ligaments, entirely situated within the carpus. Lesions of intrinsic and extrinsic ligaments of the wrist have been demonstrated to occur largely, mostly in patients with history of trauma and carpal instability, or rheumatoid arthritis. Ultrasound allows for rapid, cost-effective, non-invasive and dynamic evaluation of the wrist, and may represent a valuable diagnostic tool. Although promising results have been published, ultrasound of wrist ligaments is not performed in routine clinical practice, maybe due to its technical feasibility regarded as quite complex. This review article aims to enlighten readers about the normal sonographic appearance of intrinsic and extrinsic carpal ligaments, and describe a systematic approach for their sonographic assessment with detailed anatomic landmarks, dynamic manoeuvres and scanning technique. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. MRI of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dick, Elizabeth A. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)], E-mail: dickelizabeth@hotmail.com; Burnett, Carole; Gedroyc, Wladyslaw M.W. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)

    2008-08-15

    Magnetic resonance imaging of the wrist is increasingly recognised as the imaging modality of choice in wrist disorders as image resolution improves and clinicians realise its potential. Consequently the ability to confidently interpret such imaging will become more important to both general and musculoskeletal radiologists. This article reviews current optimal imaging protocols and describes common abnormalities with a particular emphasis on less well understood topics such as intercalated segment instability, the triangular fibrocartilage complex and carpal tunnel syndrome.

  3. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction

    Energy Technology Data Exchange (ETDEWEB)

    Strobel, Klaus [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Kantonsspital Luzern, Roentgeninstitut/Nuklearmedizin, Luzern (Switzerland); Steurer-Dober, Isabelle; Huellner, Martin W.; Sol Perez Lago, Maria del; Veit-Haibach, Patrick; Tornquist, Katharina [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Silva, Angela J. da [Advanced Molecular Imaging, Philips Healthcare, San Jose, CA (United States); Bodmer, Elvira; Wartburg, Urs von; Hug, Urs [Lucerne Cantonal Hospital, Division of Hand and Plastic Surgery, Lucerne (Switzerland)

    2014-03-15

    To evaluate the feasibility and performance of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. This prospective study included 28 wrists of 27 patients evaluated with SPECT/CT arthrography and MR arthrography. Iodine contrast medium and gadolinium were injected into the distal radioulnar and midcarpal joints. Late-phase SPECT/CT was performed 3.5 h after intravenous injection of approximately 650 MBq {sup 99m}Tc-DPD. MR and SPECT/CT images were separately reviewed in relation to bone marrow oedema, radionuclide uptake, and tears in the scapholunate (SL) and lunotriquetral (LT) ligaments and triangular fibrocartilage complex (TFCC), and an overall diagnosis of ulnar impaction. MR, CT and SPECT/CT imaging findings were compared with each other, with the surgical findings in 12 patients and with clinical follow-up. The quality of MR arthrography and SPECT/CT arthrography images was fully diagnostic in 23 of 28 wrists (82 %) and 25 of 28 wrists (89 %), respectively. SPECT/CT arthrography was not diagnostic for ligament lesions due to insufficient intraarticular contrast in one wrist. MR and SPECT/CT images showed concordant findings regarding TFCC lesions in 22 of 27 wrists (81 %), SL ligament in 22 of 27 wrists (81 %) and LT ligament in 23 of 27 wrists (85 %). Bone marrow oedema on MR images and scintigraphic uptake were concordant in 21 of 28 wrists (75 %). MR images showed partial TFCC defects in four patients with normal SPECT/CT images. MR images showed bone marrow oedema in 4 of 28 wrists (14 %) without scintigraphic uptake, and scintigraphic uptake was present without MR bone marrow oedema in three wrists (11 %). Regarding diagnosis of ulnar impaction the concordance rate between CT and SPECT/CT was 100 % and reached 96 % (27 of 28) between MR and SPECT/CT arthrography. The sensitivity and specificity of MR, CT and SPECT/CT arthrography were 93 %, 100 % and 100 %, and 93 %, 93 % and 93

  4. Imaging diagnostics of the wrist: MRI and Arthrography/Arthro-CT; Bildgebende Diagnostik des Handgelenkes: MRT und Arthrographie/Arthro-CT

    Energy Technology Data Exchange (ETDEWEB)

    Klein, H.M.; Balas, R.; Neugebauer, F. [Radiologische Gemeinschaftspraxis, Betzdorf (Germany); Vrsalovic, V. [Handchirugie, Marienhospital Siegen, Siegen (Germany)

    2002-02-01

    Purpose: To evaluate the use of magnetic resonance imaging (MRI) compared with arthrography and arthro-CT (AG/ACT) in patients with wrist pain. Methods: MRI and arthrography/arthro-CT (AG/ACT) of the wrist joint were retrospectively evaluated in 346 patients over a three-year period. Imaging findings were correlated to surgical results (n=78) or clinical course in an at least 6-month follow-up. Results: For tears of the triangular fibrocartilage, arthrography, arthro-CT, and MRI demonstrated a sensitivity and specificity of more than 0.96. Only the positive predictive value was superior for arthrography/arthro-CT (0.99 and 0.98, respectively) compared with MRI (0.94). Arthrography was superior for functional diagnosis of scapho-lunate ligament tears (n=25). Ulno-lunate and ulno-triquetral ligament defects were demonstrated more exactly by arthrography. Traumatic osseous defects, particularly scaphoid fractures (n=33) and avascular necrosis (n=17), were better diagnosed using MRI. Conclusion: For suspected lesions of the triangular fibrocartilage complex, AG/ACT is slightly more reliable than MRI. However, MRI was found to be highly accurate in diagnosing TFC tears, and is superior to AG/ACT in detecting traumatic and vascular lesions of the wrist. (orig.) [German] Ziel: Die Untersuchung der diagnostischen Aussagekraft von Magnetresonanz-Tomographie (MRT), Arthrographie (AG) und Arthro-CT (ACT) bei Erkrankungen des Handgelenkes. Methodik: Insgesamt 346 Untersuchungen des Handgelenkes wurden fuer einen dreijaehrigen Beobachtungszeitraum retrospektiv ausgewertet. Es wurden 211 MRT, 151 Arthrographien (AG) und 126 Arthro-CT (ACT) durchgefuehrt. Alle Diagnosen wurden operativ (n=78) oder durch den klinischen Verlauf in einer 6-monatigen Nachbeobachtung gesichert. Ergebnisse: Fuer die Diagnostik von Laesionen des diskoulnaren Komplexes lag die Sensitivitaet und Spezifitaet von AG, ACT und MRT ueber 0,96. Lediglich der positive Vorhersagewert differierte, allerdings nicht

  5. NMR findings in patients after wrist trauma with a negative plain radiographs

    International Nuclear Information System (INIS)

    Markuszewski, Maciej; Kraus, Alexandra; Studniarek, Michał; Zawadzka, Anna

    2012-01-01

    The purpose was to assess the prevalence and location of the injuries of the carpal bones and soft tissue of the wrist on NMR in patients with negative radiographs. A total of 89 patients (9–81years) were consecutively examined after wrist trauma. Radiograms were performed in four projections: AP, PA, oblique and lateral. In 63 cases of negative radiographs and persistent clinical problem, simplified NMR (T1,T2, STIR; in coronal plane) was conducted with a 1.5 Tesla magnet. Results were evaluated by two independent observers. A positive X-ray result was stated when at least one observer suggested bone fracture. The MR images were viewed for detection of possible bone fracture, bone edema and soft tissue injuries. Cohen’s kappa coefficient was calculated to assess the quality of chosen criteria by means of agreement between both observers and both methods. As many as 26 X-ray studies were classified as positive. Substantial agreement between independent observers was found (kappa=0.63). In 17 cases out of 63 with two negative wrist radiogram, the NMR result was positive (19%). The most frequently fractured or injured bone was scaphoid (10 cases) and distal radius (5 cases). Fair agreement was found between X-ray and NMR studies (kappa=0.37) due to different diagnostic information received in both methods. Simplified NMR imaging of the wrist proved to be strongly efficient in the detection of pathological changes in injured wrists

  6. ARTHROSCOPIC FOR TREATMENT OF WRIST PATHOLOGIES

    Directory of Open Access Journals (Sweden)

    I. O. Golubev

    2018-01-01

    Full Text Available Diagnostics and treatment of wrist joint pathologies still remain one the key problems in hand traumatology and orthopaedics. Extremal sports availability as well as new options for recreation transportation means only sustains the statistics of such injuries. On the other hand, the technological improvements allowed to develop precise optics for surgeries on small joints. Possibilities of minimally invasive closer visualization at magnification substantially changed not only the approach to treatment of wrist joint pathology but also allowed to describe types of lesions unknown earlier. The authors describe basic principles of wrist joint arthroscopy and features of its application in various injuries: scaphoid fractures, intraarticular fractures of distal radius metaepiphysis, triangular fibrocartilage complex injuries.

  7. Role of MR imaging in chronic wrist pain

    International Nuclear Information System (INIS)

    Zanetti, Marco; Saupe, Nadja; Nagy, Ladislav

    2007-01-01

    Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienboeck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain. (orig.)

  8. Role of MR imaging in chronic wrist pain

    Energy Technology Data Exchange (ETDEWEB)

    Zanetti, Marco; Saupe, Nadja [University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Nagy, Ladislav [University Hospital Balgrist, Department of Orthopedic Surgery, Zurich (Switzerland)

    2007-04-15

    Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienboeck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain. (orig.)

  9. Tuberculous Tenosynovitis Presenting as Ganglion of Wrist

    Directory of Open Access Journals (Sweden)

    Shahaji Chavan

    2012-01-01

    Full Text Available Tuberculosis (TB is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. A 57 years old male presented with swelling over the left wrist since 3 years Three swellings over dorsal aspect of the left wrist Soft in consistency Non tender Non compressible Mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigations were normal. Ultrsonography showed giant cell tumor of Extensor Digitorum sheath. X-ray: soft tissue swelling and MRI was suggestive of extensor tendon sheath extraskeletal synovial Koch’s, or giant cell tumor of tendon sheath. Excision of swelling was planned and intraoperatively, rice bodies were seen inside it. Histopathological examination showed caseous necrosis with granuloma formation. Patient was put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise. Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with extensive curettage lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia.

  10. The diagnostic odds ratio: a single indicator of test performance

    NARCIS (Netherlands)

    Glas, Afina S.; Lijmer, Jeroen G.; Prins, Martin H.; Bonsel, Gouke J.; Bossuyt, Patrick M. M.

    2003-01-01

    Diagnostic testing can be used to discriminate subjects with a target disorder from subjects without it. Several indicators of diagnostic performance have been proposed, such as sensitivity and specificity. Using paired indicators can be a disadvantage in comparing the performance of competing

  11. Malaria Laboratory Diagnostic Performance: Case studies of two ...

    African Journals Online (AJOL)

    Advantages of rapid diagnostic tests when compared with microscopy are simple to perform, fast, low ... The study was conducted to establish the performance of laboratory diagnosis of malaria in local Malawi .... Government of Malawi.

  12. Positioning of the wrist for scaphoid radiography

    International Nuclear Information System (INIS)

    Toth, Ferenc; Sebestyen, Andor; Balint, Lehel; Mester, Sandor; Szabo, Gyorgy; Nyarady, Jozsef; Weninger, Csaba; Angyal, Miklos; Lovasz, Gyorgy

    2007-01-01

    Purpose: The purpose of this cadaver study was to determine the ideal position of the wrist for scaphoid radiography. Materials and methods: Four cadaver wrists were rotated around their longitudinal axis in 15 deg. increments and exposures were taken. Seven postero-anterior images were taken as well. Thus, 18 images of each wrist were available for assessment. Views were determined in which the main anatomic regions of the scaphoid were visualized undistorted. The size and localization of the overlap of other carpal bones were also evaluated. Finally, views with the best visualization of anatomic landmarks were selected. The results of these three investigations were compared to literature data. Results: We consider the following four images the most valuable in the diagnostic imaging of scaphoid bone: (1) Postero-anterior view in ulnar deviation of wrist and fist position of the hand; (2) oblique view in 60 deg. of pronation; (3) oblique view in 60 deg. of supination; (4) lateral view. Conclusion: We concluded that our four views are sufficient for proper radiographic evaluation of the scaphoid

  13. Methodology for evaluation of diagnostic performance

    International Nuclear Information System (INIS)

    Metz, C.E.

    1992-01-01

    Effort in this project during the past year has focused on the development, refinement, and distribution of computer software that will allow current Receiver Operating Characteristic (ROC) methodology to be used conveniently and reliably by investigators in a variety of evaluation tasks in diagnostic medicine; and on the development of new ROC methodology that will broaden the spectrum of evaluation tasks and/or experimental settings to which the fundamental approach can be applied. Progress has been limited by the amount of financial support made available to the project

  14. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple

    International Nuclear Information System (INIS)

    Gitto, Salvatore; Messina, Carmelo; Mauri, Giovanni; Aliprandi, Alberto; Sardanelli, Francesco; Sconfienza, Luca Maria

    2017-01-01

    Highlights: • US allows for rapid, cost-effective, and non-invasive assessment of wrist ligaments. • Knowledge of landmarks and dynamic manoeuvres is basic for a systematic examination. • A sequential approach is effective, timesaving and feasible in clinical practice. - Abstract: Wrist ligaments are crucial structures for the maintenance of carpal stability. They are classified into extrinsic ligaments, connecting the carpus with the forearm bones or distal radioulnar ligaments, and intrinsic ligaments, entirely situated within the carpus. Lesions of intrinsic and extrinsic ligaments of the wrist have been demonstrated to occur largely, mostly in patients with history of trauma and carpal instability, or rheumatoid arthritis. Ultrasound allows for rapid, cost-effective, non-invasive and dynamic evaluation of the wrist, and may represent a valuable diagnostic tool. Although promising results have been published, ultrasound of wrist ligaments is not performed in routine clinical practice, maybe due to its technical feasibility regarded as quite complex. This review article aims to enlighten readers about the normal sonographic appearance of intrinsic and extrinsic carpal ligaments, and describe a systematic approach for their sonographic assessment with detailed anatomic landmarks, dynamic manoeuvres and scanning technique.

  15. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple

    Energy Technology Data Exchange (ETDEWEB)

    Gitto, Salvatore, E-mail: sal.gitto@gmail.com [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano (Italy); Messina, Carmelo [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano (Italy); Mauri, Giovanni [Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese (Italy); Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141 Milano (Italy); Aliprandi, Alberto [Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese (Italy); Sardanelli, Francesco [Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese (Italy); Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano (Italy); Sconfienza, Luca Maria [Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano (Italy); Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano (Italy)

    2017-02-15

    Highlights: • US allows for rapid, cost-effective, and non-invasive assessment of wrist ligaments. • Knowledge of landmarks and dynamic manoeuvres is basic for a systematic examination. • A sequential approach is effective, timesaving and feasible in clinical practice. - Abstract: Wrist ligaments are crucial structures for the maintenance of carpal stability. They are classified into extrinsic ligaments, connecting the carpus with the forearm bones or distal radioulnar ligaments, and intrinsic ligaments, entirely situated within the carpus. Lesions of intrinsic and extrinsic ligaments of the wrist have been demonstrated to occur largely, mostly in patients with history of trauma and carpal instability, or rheumatoid arthritis. Ultrasound allows for rapid, cost-effective, non-invasive and dynamic evaluation of the wrist, and may represent a valuable diagnostic tool. Although promising results have been published, ultrasound of wrist ligaments is not performed in routine clinical practice, maybe due to its technical feasibility regarded as quite complex. This review article aims to enlighten readers about the normal sonographic appearance of intrinsic and extrinsic carpal ligaments, and describe a systematic approach for their sonographic assessment with detailed anatomic landmarks, dynamic manoeuvres and scanning technique.

  16. Current role of multidetector computed tomography in imaging of wrist injuries.

    Science.gov (United States)

    Syed, Mohd Arif; Raj, Vimal; Jeyapalan, Kanagaratnam

    2013-01-01

    Imaging of the wrist is challenging to both radiologists and orthopedic surgeons. This is primarily because of the complex anatomy/functionality of the wrist and also the fact that many frequent injuries are sustained to the hands. On going developments in multidetector computed tomography (MDCT) technology with its "state of the art" postprocessing capabilities have revolutionized this field. Apart from routine imaging of wrist trauma, it is now possible to assess intrinsic ligaments with MDCT arthrography, thereby avoiding invasive diagnostic arthroscopies. Postoperative wrist imaging can be a diagnostic challenge, and MDCT can be helpful in assessment of these cases because volume acquisition and excellent postprocessing abilities help to evaluate these wrists in any desired plane and thinner slices. This article pictorially reviews the current clinical role of MDCT imaging of wrist in our practice. It also describes arthrography technique and scanning parameters used at our center. Copyright © 2013 Mosby, Inc. All rights reserved.

  17. Simulation-Driven Development and Optimization of a High-Performance Six-Dimensional Wrist Force/Torque Sensor

    Directory of Open Access Journals (Sweden)

    Qiaokang LIANG

    2010-05-01

    Full Text Available This paper describes the Simulation-Driven Development and Optimization (SDDO of a six-dimensional force/torque sensor with high performance. By the implementation of the SDDO, the developed sensor possesses high performance such as high sensitivity, linearity, stiffness and repeatability simultaneously, which is hard for tranditional force/torque sensor. Integrated approach provided by software ANSYS was used to streamline and speed up the process chain and thereby to deliver results significantly faster than traditional approaches. The result of calibration experiment possesses some impressive characters, therefore the developed fore/torque sensor can be usefully used in industry and the methods of design can also be used to develop industrial product.

  18. Hand and wrist arthritis of Behcet disease: Imaging features

    International Nuclear Information System (INIS)

    Sugawara, Shunsuke; Ehara, Shigeru; Hitachi, Shin; Sugimoto, Hideharu

    2010-01-01

    Background: Reports on arthritis in Behcet disease are relatively scarce, and imaging features vary. Purpose: To document the various imaging features of articular disorders of the hand and wrist in Behcet disease. Material and Methods: Four patients, four women aged 26 to 65 years, fulfilling the diagnostic criteria of Behcet disease, with imaging findings of hand and wrist arthritis, were seen in two institutions. Radiography and magnetic resonance (MR) imaging were studied to elucidate the pattern and distribution. Results: Both non-erosive arthritis and erosive arthritis of different features were noted: one with non-erosive synovitis of the wrist, one with wrist synovitis with minimal erosion, and two with erosive arthritis of the distal interphalangeal joint. Conclusion: Imaging manifestations of arthritis of Behcet disease vary, and may be similar to other seronegative arthritides

  19. Magnetic resonance arthrography in chronic wrist pain

    International Nuclear Information System (INIS)

    Valeri, G.; Ferrara, C.; Carloni, S.

    1999-01-01

    The purpose of this paper is to investigate the clinical role of Magnetic Resonance Arthrography (MRA) of the wrist in subjects with chronic pain. Thirty-five patients complaining of wrist pain for more than 6 months were submitted to MRI an MRA. All patients received and intra-articular injection of 2-10 mL of a 10 mmol saline solution of Gd-DPTA. The overall diagnostic accuracy rates of MRI and MRA were 40% and 81% respectively, with sensitivity and specificity of 63% and 39% (MRI) and of 82% and 79% (MRA). The conclusion is that compared with MRI, MRA can be considered a useful tool for the visualization of interosseus carpal ligaments and of the triangular fibrocartilage complex. MRA also helps detect injuries in these structures [it

  20. The hand and wrist

    International Nuclear Information System (INIS)

    Wood, M.B.; Berquist, T.H.

    1985-01-01

    Trauma is the most common etiologic factor leading to disability in the hand and wrist. Judicious radiographic evaluation is required for accurate assessment in practically all but the most minor of such injuries. Frequently serial radiographic evaluation is essential for directing the course of treatment and for following the healing process. A meaningful radiographic evaluation requires a comprehensive knowledge of the normal radiographic anatomy, an overview of the spectrum of pathology, and an awareness of the usual mechanisms of injury, appropriate treatment options, and relevant array of complications

  1. Model of critical diagnostic reasoning: achieving expert clinician performance.

    Science.gov (United States)

    Harjai, Prashant Kumar; Tiwari, Ruby

    2009-01-01

    Diagnostic reasoning refers to the analytical processes used to determine patient health problems. While the education curriculum and health care system focus on training nurse clinicians to accurately recognize and rescue clinical situations, assessments of non-expert nurses have yielded less than satisfactory data on diagnostic competency. The contrast between the expert and non-expert nurse clinician raises the important question of how differences in thinking may contribute to a large divergence in accurate diagnostic reasoning. This article recognizes superior organization of one's knowledge base, using prototypes, and quick retrieval of pertinent information, using similarity recognition as two reasons for the expert's superior diagnostic performance. A model of critical diagnostic reasoning, using prototypes and similarity recognition, is proposed and elucidated using case studies. This model serves as a starting point toward bridging the gap between clinical data and accurate problem identification, verification, and management while providing a structure for a knowledge exchange between expert and non-expert clinicians.

  2. Tubercular monoarthritis of wrist

    Directory of Open Access Journals (Sweden)

    Prakash Joshi

    2017-01-01

    Full Text Available Tuberculosis (TB has been a major health concern since decades, and millions continue to be afflicted with this disease. Extrapulmonary sites of TB must not be neglected as there is paucity of systemic manifestations and absence of distinct clinical features which delay its diagnosis and can lead to functional disability and severe infirmities. Osteoarticular TB is an infrequent form of the disease and monoarthritis of the wrist accounts for 1% of all cases of skeletal involvement. Hereby, we report a 45-year-old female patient with history of progressive pain and swelling of right wrist joint which is refractory to analgesics and anti-inflammatory drugs. She was diagnosed to have tubercular monoarthritis after synovial fluid analysis and radiographic findings. Standard antitubercular treatment for 6 months was given. The joint was salvaged after 9 months from the start of the treatment. Pain and swelling of joint were subsided and joint was rehabilitated with full range of motion and weight bearing.

  3. Acoustic detection in superconducting magnets for performance characterization and diagnostics

    OpenAIRE

    Marchevsky, M.; Wang, X.; Sabbi, G.; Prestemon, S.

    2014-01-01

    Quench diagnostics in superconducting accelerator magnets is essential for understanding performance limitations and improving magnet design. Applicability of the conventional quench diagnostics methods such as voltage taps or quench antennas is limited for long magnets or complex winding geometries, and alternative approaches are desirable. Here, we discuss acoustic sensing technique for detecting mechanical vibrations in superconducting magnets. Using LARP high-field Nb3Sn quadrupole HQ01 [...

  4. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

  5. Storage phosphor radiography of wrist fractures: a subjective comparison of image quality at varying exposure levels

    Energy Technology Data Exchange (ETDEWEB)

    Peer, Regina; Giacomuzzi, Salvatore M.; Bodner, Gerd; Jaschke, Werner; Peer, Siegfried [Innsbruck Univ. (Austria). Inst. fuer Radiologie; Lanser, Anton [Academy of Radiology Technicians, Innsbruck (Austria); Pechlaner, Sigurd [Department of Traumatology, University Hospital, Innsbruck (Austria); Kuenzel, Karl Heinz; Gaber, O. [Department of Anatomy and Histology, University Hospital, Innsbruck (Austria)

    2002-06-01

    Image quality of storage phosphor radiographs acquired at different exposure levels was compared to define the minimal radiation dose needed to achieve images which allow for reliable detection of wrist fractures. In a study on 33 fractured anatomical wrist specimens image quality of storage phosphor radiographs was assessed on a diagnostic PACS workstation by three observers. Images were acquired at exposure levels corresponding to a speed classes 100, 200, 400 and 800. Cortical bone surface, trabecular bone, soft tissues and fracture delineation were judged on a subjective basis. Image quality was rated according to a standard protocol and statistical evaluation was performed based on an analysis of variance (ANOVA). Images at a dose reduction of 37% were rated sufficient quality without loss in diagnostic accuracy. Sufficient trabecular and cortical bone presentation was still achieved at a dose reduction of 62%. The latter images, however, were considered unacceptable for fracture detection. To achieve high-quality storage phosphor radiographs, which allow for a reliable evaluation of wrist fractures, a minimum exposure dose equivalent to a speed class of 200 is needed. For general-purpose skeletal radiography, however, a dose reduction of up to 62% can be achieved. A choice of exposure settings according to the clinical situation (ALARA principle) is recommended to achieve possible dose reductions. (orig.)

  6. Amsterdam wrist rules: A clinical decision aid

    Directory of Open Access Journals (Sweden)

    Bentohami Abdelali

    2011-10-01

    Full Text Available Abstract Background Acute trauma of the wrist is one of the most frequent reasons for visiting the Emergency Department. These patients are routinely referred for radiological examination. Most X-rays however, do not reveal any fractures. A clinical decision rule determining the need for X-rays in patients with acute wrist trauma may help to percolate and select patients with fractures. Methods/Design This study will be a multi-center observational diagnostic study in which the data will be collected cross-sectionally. The study population will consist of all consecutive adult patients (≥18 years presenting with acute wrist trauma at the Emergency Department in the participating hospitals. This research comprises two components: one study will be conducted to determine which clinical parameters are predictive for the presence of a distal radius fracture in adult patients presenting to the Emergency Department following acute wrist trauma. These clinical parameters are defined by trauma-mechanism, physical examination, and functional testing. This data will be collected in two of the three participating hospitals and will be assessed by using logistic regression modelling to estimate the regression coefficients after which a reduced model will be created by means of a log likelihood ratio test. The accuracy of the model will be estimated by a goodness of fit test and an ROC curve. The final model will be validated internally through bootstrapping and by shrinking it, an adjusted model will be generated. In the second component of this study, the developed prediction model will be validated in a new dataset consisting of a population of patients from the third hospital. If necessary, the model will be calibrated using the data from the validation study. Discussion Wrist trauma is frequently encountered at the Emergency Department. However, to this date, no decision rule regarding this type of trauma has been created. Ideally, radiographs are

  7. [Comparison of invasive blood pressure measurement in the aorta with indirect oscillometric blood pressure measurement at the wrist and forearm].

    Science.gov (United States)

    Saul, F; Aristidou, Y; Klaus, D; Wiemeyer, A; Lösse, B

    1995-09-01

    Indirectly measured blood pressure at the wrist or upper arm was compared with directly measured values in the aortic arch during routinely performed diagnostic cardiac catheterization in 100 patients (31-80 years, mean 59.3 years, 60% males). The noninvasive measurements were carried out by oscillometric devices, NAiS Blood Pressure Watch for measurements at the wrist, and Hestia OZ80 at the upper arm. Systolic blood pressure measured at the wrist was 4.3 +/- 14.1 mm Hg, and the diastolic value 6.0 +/- 8.9 mm Hg higher than when measured at the aortic arch; the difference was significant in both cases. Correlation coefficients were 0.85 for systolic and 0.71 for diastolic blood pressure. In 16% of the patients the systolic blood pressure at the wrist differed more than +/- 20 mm Hg. The diastolic blood pressure at the wrist measured more than +/- 20 mm Hg higher than in the aorta in 5% of the patients. At the upper arm mean systolic values were not different to the aorta. The diastolic pressure was 9.3 +/- 9.8 mm Hg higher in the aorta than at the upper arm. To verify the accuracy of values measured with the NAiS Blood Pressure Watch compared with the standard technique at the upper arm, sequential measurements were made at wrist and ipsilateral upper arm in the same group of 100 patients. The systolic blood pressure at the left wrist was 3.4 +/- 13.3 mm Hg higher and the diastolic pressure 3.8 +/- 9.5 mm Hg lower than at the upper arm. Only 53% of systolic values lay within a range of +/- 10 mm Hg. The correspondence between wrist and upper arm values was better for diastolic blood pressure, the values differing by less than +/- 10 mm Hg in two-thirds of patients. Self-measurement of arterial blood pressure with an oscillometric device at the wrist can be recommended only in individual cases with a difference of simultaneously measured values at the upper arm of less than +/- 10 mm Hg for systolic and diastolic blood pressures. The standard method for indirectly

  8. Kinematics and Dynamics of an Asymmetrical Parallel Robotic Wrist

    DEFF Research Database (Denmark)

    Wu, Guanglei

    2014-01-01

    This paper introduces an asymmetrical parallel robotic wrist, which can generate a decoupled unlimited-torsion motion and achieve high positioning accuracy. The kinematics, dexterity, and singularities of the manipulator are investigated to visualize the performance contours of the manipulator...

  9. Ulnar-sided wrist pain. Part I: anatomy and physical examination

    International Nuclear Information System (INIS)

    Vezeridis, Peter S.; Blazar, Philip; Yoshioka, Hiroshi; Han, Roger

    2010-01-01

    Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain. (orig.)

  10. Resilient actions in the diagnostic process and system performance.

    Science.gov (United States)

    Smith, Michael W; Davis Giardina, Traber; Murphy, Daniel R; Laxmisan, Archana; Singh, Hardeep

    2013-12-01

    Systemic issues can adversely affect the diagnostic process. Many system-related barriers can be masked by 'resilient' actions of frontline providers (ie, actions supporting the safe delivery of care in the presence of pressures that the system cannot readily adapt to). We explored system barriers and resilient actions of primary care providers (PCPs) in the diagnostic evaluation of cancer. We conducted a secondary data analysis of interviews of PCPs involved in diagnostic evaluation of 29 lung and colorectal cancer cases. Cases covered a range of diagnostic timeliness and were analysed to identify barriers for rapid diagnostic evaluation, and PCPs' actions involving elements of resilience addressing those barriers. We rated these actions according to whether they were usual or extraordinary for typical PCP work. Resilient actions and associated barriers were found in 59% of the cases, in all ranges of timeliness, with 40% involving actions rated as beyond typical. Most of the barriers were related to access to specialty services and coordination with patients. Many of the resilient actions involved using additional communication channels to solicit cooperation from other participants in the diagnostic process. Diagnostic evaluation of cancer involves several resilient actions by PCPs targeted at system deficiencies. PCPs' actions can sometimes mitigate system barriers to diagnosis, and thereby impact the sensitivity of 'downstream' measures (eg, delays) in detecting barriers. While resilient actions might enable providers to mitigate system deficiencies in the short run, they can be resource intensive and potentially unsustainable. They complement, rather than substitute for, structural remedies to improve system performance. Measures to detect and fix system performance issues targeted by these resilient actions could facilitate diagnostic safety.

  11. MRI features in de Quervain's tenosynovitis of the wrist

    International Nuclear Information System (INIS)

    Glajchen, N.; Schweitzer, M.

    1996-01-01

    De Quervain's stenosing tenosynovitis of the first dorsal extensor component is traditionally diagnosed clinically but may be encountered when performing MRI of the wrist. A retrospective review of wrist MR images was performed in cases where the diagnosis of de Quervain's synovitis was suggested (n=5). Imaging findings were correlated with clinical findings in four cases and with wrist arthroscopy in one case. Increased thickness of the extensor pollicus brevis and abductor pollicis longus tendons was the most reliable finding on MRI, being present in all cases. Peritendinous edema was also a reliable finding. Surrounding subcutaneous edema and increased intratendinous signal were less reliable findings in confirmed cases of de Quervain's disease. De Quervain's tenosynovitis may be encountered when performing MRI of the wrist. Increased tendon thickness and peritendinous edema are the most reliable imaging findings. (orig.)

  12. Ganglion cysts in the paediatric wrist: magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer; Bartlett, Murray [Royal Children' s Hospital, Medical Imaging Department, Melbourne, VIC (Australia)

    2013-12-15

    The majority of published literature on ganglion cysts in children has been from a surgical perspective, with no dedicated radiologic study yet performed. Our aim was to assess the magnetic resonance (MR) imaging appearance of ganglion cysts in a series of paediatric MR wrist examinations. Ninety-seven consecutive paediatric MR wrist examinations were retrospectively reviewed for the presence of ganglion cysts. Only those studies with wrist ganglia were included. Cysts were assessed for location, size, internal characteristics and secondary effect(s). Forty-one ganglion cysts (2-32 mm in size) were seen in 35/97 (36%) patients (24 female, 11 male), mean age: 13 years 11 months (range: 6 years 3 months-18 years). The majority were palmar (63.4%) with the remainder dorsal. Of the cysts, 43.9% were related to a wrist ligament(s), 36.6% to a joint and 17.1% to the triangular fibrocartilage complex. Of the patients, 91.4% had wrist symptoms: pain (n=29, 82.9%), swelling (n=7, 20%) and/or palpable mass (n=4, 11.4%); 71.4% patients had significant additional wrist abnormalities. Ganglion cysts were frequently found in children referred for wrist MRI. (orig.)

  13. Performance Assessment as a Diagnostic Tool for Science Teachers

    Science.gov (United States)

    Kruit, Patricia; Oostdam, Ron; van den Berg, Ed; Schuitema, Jaap

    2018-04-01

    Information on students' development of science skills is essential for teachers to evaluate and improve their own education, as well as to provide adequate support and feedback to the learning process of individual students. The present study explores and discusses the use of performance assessments as a diagnostic tool for formative assessment to inform teachers and guide instruction of science skills in primary education. Three performance assessments were administered to more than 400 students in grades 5 and 6 of primary education. Students performed small experiments using real materials while following the different steps of the empirical cycle. The mutual relationship between the three performance assessments is examined to provide evidence for the value of performance assessments as useful tools for formative evaluation. Differences in response patterns are discussed, and the diagnostic value of performance assessments is illustrated with examples of individual student performances. Findings show that the performance assessments were difficult for grades 5 and 6 students but that much individual variation exists regarding the different steps of the empirical cycle. Evaluation of scores as well as a more substantive analysis of students' responses provided insight into typical errors that students make. It is concluded that performance assessments can be used as a diagnostic tool for monitoring students' skill performance as well as to support teachers in evaluating and improving their science lessons.

  14. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis. 888.3810 Section 888.3810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer prosthesis...

  15. Acoustic detection in superconducting magnets for performance characterization and diagnostics

    International Nuclear Information System (INIS)

    Marchevsky, M; Wang, X; Sabbi, G; Prestemon, S

    2013-01-01

    Quench diagnostics in superconducting accelerator magnets is essential for understanding performance limitations and improving magnet design. Applicability of the conventional quench diagnostics methods such as voltage taps or quench antennas is limited for long magnets or complex winding geometries, and alternative approaches are desirable. Here, we discuss acoustic sensing technique for detecting mechanical vibrations in superconducting magnets. Using LARP high-field Nb3Sn quadrupole HQ01, we show how acoustic data is connected with voltage instabilities measured simultaneously in the magnet windings during provoked extractions and current ramps to quench. Instrumentation and data analysis techniques for acoustic sensing are reviewed. (author)

  16. Acoustic detection in superconducting magnets for performance characterization and diagnostics

    CERN Document Server

    Marchevsky, M.; Sabbi, G.; Prestemon, S.

    2013-01-01

    Quench diagnostics in superconducting accelerator magnets is essential for understanding performance limitations and improving magnet design. Applicability of the conventional quench diagnostics methods such as voltage taps or quench antennas is limited for long magnets or complex winding geometries, and alternative approaches are desirable. Here, we discuss acoustic sensing technique for detecting mechanical vibrations in superconducting magnets. Using LARP high-field Nb$_{3}$Sn quadrupole HQ01 [1], we show how acoustic data is connected with voltage instabilities measured simultaneously in the magnet windings during provoked extractions and current ramps to quench. Instrumentation and data analysis techniques for acoustic sensing are reviewed.

  17. Kinematics of Hooke universal joint robot wrists

    Science.gov (United States)

    Mckinney, William S., Jr.

    1988-01-01

    The singularity problem associated with wrist mechanisms commonly found on industrial manipulators can be alleviated by redesigning the wrist so that it functions as a three-axis gimbal system. This paper discussess the kinematics of gimbal robot wrists made of one and two Hooke universal joints. Derivations of the resolved rate motion control equations for the single and double Hooke universal joint wrists are presented using the three-axis gimbal system as a theoretical wrist model.

  18. Ulnar-sided wrist pain. II. Clinical imaging and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Atsuya; Souza, Felipe [Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); Vezeridis, Peter S.; Blazar, Philip [Brigham and Women' s Hospital, Department of Orthopaedic Surgery, Boston, MA (United States); Yoshioka, Hiroshi [Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); University of California-Irvine, Department of Radiological Sciences, Irvine, CA (United States); UC Irvine Medical Center, Department of Radiological Sciences, Orange, CA (United States)

    2010-09-15

    Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed. (orig.)

  19. The post-arthro-CT of the wrist: clinical evaluation

    International Nuclear Information System (INIS)

    Scheurecker, G.

    2001-03-01

    To compare the diagnostic effectiveness of post-arthro-CT (PACT) and 3-compartment wrist arthrography (AG) both separate and combined versus wrist arthroscopy for scapho-lunate ligament (SLL), luno-triquetral ligament (LTL) and triangular fibrocartilage (TFC) defects and chondromalacia of the carpal bones. Material and methods: In 58 patients (16-69 years) the affected wrist was examined initially by conventional 3-compartment wrist arthrography with digital subtraction technique during injection followed by digital stress images. Afterwards spiral arthro-CT was performed in the semi-coronal and axial plane with 1 mm slice thickness and secondary true-coronal and sagittal reconstructions. Within 1 month arthroscopy was performed in general anesthesia utilizing standard joint entry points combined with routine digital picture archiving. All examinations were evaluated for SLL, LTL and TFC defects, PACT and AS for ChM too. Results: AG versus AS: The following detection rates were observed (AG and AS positive/AG negative - AS positive/AG positive - AS negative/ AG and AS negative): SLL: 16/8/0/34, LTL: 13/4/8/33, TFC: 28/5/1/24. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 67/100, LTL 76/80, TFC 85/96. PACT versus AS: The following detection rates were observed (PACT and AS positive/PACT negative - AS positive/PACT positive - AS negative/ PACT and AS negative): SLL: 18/6/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM: 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 75/100, LTL 88/80, TFC 94/92, ChM 57/87. AG+PACT versus AS: The following detection rates were observed (AG+PACT and AS positive/AG+PACT negative - AS positive/AG+PACT positive - AS negative/ AG+PACT and AS negative): SLL: 19/5/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity

  20. The post-arthro-CT of the wrist: clinical evaluation

    International Nuclear Information System (INIS)

    Scheurecker, G.

    2001-03-01

    To compare the diagnostic effectiveness of post-arthro-CT (PACT) and 3-compartment wrist arthrography (AG) both separate and combined versus wrist arthroscopy for scapho-lunate ligament (SLL), luno-triquetral ligament (LTL) and triangular fibrocartilage (TFC) defects and chondromalacia of the carpal bones. Material and methods: in 58 patients (16-69 years) the affected wrist was examined initially by conventional 3-compartment wrist arthrography with digital subtraction technique during injection followed by digital stress images. Afterwards spiral arthro-CT was performed in the semi-coronal and axial plane with 1 mm slice thickness and secondary true-coronal and sagittal reconstructions. Within 1 month arthroscopy was performed in general anesthesia utilizing standard joint entry points combined with routine digital picture archiving. All examinations were evaluated for SLL, LTL and TFC defects, PACT and AS for ChM too. Results: AG versus AS: the following detection rates were observed (AG and AS positive/AG negative - AS positive/AG positive - AS negative/ AG and AS negative): SLL: 16/8/0/34, LTL: 13/4/8/33, TFC: 28/5/1/24. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 67/100, LTL 76/80, TFC 85/96. PACT versus AS: the following detection rates were observed (PACT and AS positive/PACT negative - AS positive/PACT positive - AS negative/ PACT and AS negative): SLL: 18/6/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM: 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity (%) values: SLL 75/100, LTL 88/80, TFC 94/92, ChM 57/87. AG+PACT versus AS: the following detection rates were observed (AG+PACT and AS positive/AG+PACT negative - AS positive/AG+PACT positive - AS negative/ AG+PACT and AS negative): SLL: 19/5/0/34, LTL: 15/2/8/33, TFC: 31/2/2/23, ChM 20/15/3/20. Using AS as the 'gold standard' this translates into following sensitivity (%) and specificity

  1. Statistical evaluation of diagnostic performance topics in ROC analysis

    CERN Document Server

    Zou, Kelly H; Bandos, Andriy I; Ohno-Machado, Lucila; Rockette, Howard E

    2016-01-01

    Statistical evaluation of diagnostic performance in general and Receiver Operating Characteristic (ROC) analysis in particular are important for assessing the performance of medical tests and statistical classifiers, as well as for evaluating predictive models or algorithms. This book presents innovative approaches in ROC analysis, which are relevant to a wide variety of applications, including medical imaging, cancer research, epidemiology, and bioinformatics. Statistical Evaluation of Diagnostic Performance: Topics in ROC Analysis covers areas including monotone-transformation techniques in parametric ROC analysis, ROC methods for combined and pooled biomarkers, Bayesian hierarchical transformation models, sequential designs and inferences in the ROC setting, predictive modeling, multireader ROC analysis, and free-response ROC (FROC) methodology. The book is suitable for graduate-level students and researchers in statistics, biostatistics, epidemiology, public health, biomedical engineering, radiology, medi...

  2. Wrist loading patterns during pommel horse exercises.

    Science.gov (United States)

    Markolf, K L; Shapiro, M S; Mandelbaum, B R; Teurlings, L

    1990-01-01

    Gymnastics is a sport which involves substantial periods of upper extremity support as well as frequent impacts to the wrist. Not surprisingly, wrist pain is a common finding in gymnasts. Of all events, the pommel horse is the most painful. In order to study the forces of wrist impact, a standard pommel horse was instrumented with a specially designed load cell to record the resultant force of the hand on the pommel during a series of basic skills performed by a group of seventeen elite male gymnasts. The highest mean peak forces were recorded during the front scissors and flair exercises (1.5 BW) with peaks of up to 2.0 BW for some gymnasts. The mean peak force for hip circles at the center or end of the horse was 1.1 BW. The mean overall loading rate (initial contact to first loading peak) ranged from 5.2 BWs-1 (hip circles) to 10.6 BW s-1 (flairs). However, many recordings displayed localized initial loading spikes which occurred during 'hard' landings on the pommel. When front scissors were performed in an aggressive manner, the initial loading spikes averaged 1.0 BW in magnitude (maximum 1.8 BW) with an average rise time of 8.2 ms; calculated localized loading rates averaged 129 BW s-1 (maximum 219 BW s-1). These loading parameters are comparable to those encountered at heel strike during running. These impact forces and loading rates are remarkably high for an upper extremity joint not normally exposed to weight-bearing loads, and may contribute to the pathogenesis of wrist injuries in gymnastics.

  3. A randomized single blind crossover trial comparing leather and commercial wrist splints for treating chronic wrist pain in adults

    Science.gov (United States)

    Thiele, Jill; Nimmo, Rachel; Rowell, Wendy; Quinn, Stephen; Jones, Graeme

    2009-01-01

    Background To compare the effectiveness of a custom-made leather wrist splint (LS) with a commercially available fabric splint (FS) in adults with chronic wrist pain. Methods Participants (N = 25, mean age = 54) were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Canadian Occupational Performance Measure (COPM) and Jamar dynamometer by an observer blinded to treatment allocation. Results Both styles of wrist splint significantly reduced pain (effect size LS 0.79, FS 0.43), improved hand function and increased grip strength compared to baseline (all p leather splint compared to the commercially available splint. Conclusion Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction. PMID:19843345

  4. Compressed sensing approach for wrist vein biometrics.

    Science.gov (United States)

    Lantsov, Aleksey; Ryabko, Maxim; Shchekin, Aleksey

    2018-04-01

    The work describes features of the compressed sensing (CS) approach utilized for development of a wearable system for wrist vein recognition with single-pixel detection; we consider this system useful for biometrics authentication purposes. The CS approach implies use of a spatial light modulation (SLM) which, in our case, can be performed differently-with a liquid crystal display or diffusely scattering medium. We show that compressed sensing combined with above-mentioned means of SLM allows us to avoid using an optical system-a limiting factor for wearable devices. The trade-off between the 2 different SLM approaches regarding issues of practical implementation of CS approach for wrist vein recognition purposes is discussed. A possible solution of a misalignment problem-a typical issue for imaging systems based upon 2D arrays of photodiodes-is also proposed. Proposed design of the wearable device for wrist vein recognition is based upon single-pixel detection. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  5. Study of the performance of diagnostic radiology instruments during calibration

    International Nuclear Information System (INIS)

    Freitas, Rodrigo N. de; Vivolo, Vitor; Potiens, Maria da Penha A.

    2008-01-01

    Full text: The instruments used in diagnostic radiology measurements represent 8 % of the tested instruments by the calibration laboratory of IPEN annually (approximately 1600 in 2007). Considering that the calibration of this kind of instrument is performed biannually it is possible to conclude that almost 300 instruments are being used to measure the air kerma in diagnostic radiology clinics to determine the in beam values (in front of the patient), attenuated measurements (behind the patient) and scattered radiation. This work presents the results of the calibration of the instruments used in mammography, computed tomography, dental and conventional diagnostic radiology dosimetry, performed during the period of 2005 to 2007. Their performances during the calibrations measurements were evaluated. Although at the calibration laboratory there are three available series of radiation quality to this type of calibration (RQR, N and M, according to standards IEC 61267 and ISO 4037-1.), the applications can be assorted (general radiology, computed tomography, mammography, radiation protection and fluoroscopy). Depending on its design and behaviour , one kind of instrument can be used for one or more type of applications. The instruments normally used for diagnostic radiology measurements are ionization chambers with volumes varying from 3 to 1800 cm 3 , and can be cylindrical, spherical or plane parallel plates kind. They usually are sensitive to photon particles, with energies greater than 15 keV and can be used up to 1200 keV. In this work they were tested in X radiation fields from 25 to 150 kV, in specific qualities depending on the utilization of the instrument. The calibration results of 390 instruments received from 2005 to 2007 were analyzed. About 20 instruments were not able to be calibrated due to bad functioning. The calibration coefficients obtained were between 0.88 and 1.24. The uncertainties were always less than ± 3.6% to instruments used in scattered

  6. Static dosimetry space image in which urology diagnostics are performed

    International Nuclear Information System (INIS)

    Banduka, M.S.; Vasic, D.D.

    2002-01-01

    Background. The effects of the dispersed radiation described theoretically imply complex picture of interaction of the photon beam with the patient's body, as well as its dispersion on other structures. Basic theoretical laws of this phenomenon are highlighted, thus giving the opportunity to model the effect in total. Material and methods. The measurements of the absorbed dose in the air give isodose curves that show distribution of the radiation dose. For the urological procedures standard urological diagnostic methods were being used. Results. Through a large series of measuring, we got the distribution of the radiation dose in space, where urology diagnostics is being made using the X-ray. The parameters determining this picture are the most frequent ones in the total number of 20 random cases taken in General Hospital in Doboj, Bosnia and Herzegovina. Conclusions. Static dosimetric picture of the space (radiation zone) in the general sense is useful before all for organisation of the diagnostic procedures utilising ionised radiation. Obtained in any way, this picture enables an insight into the three-dimensional distribution of the dosage on the basis of which it is possible to correct the organisation of the diagnostics being performed under these conditions. The values of the radiation dosage show it is necessary to use the protecting means prescribed by law. For more frequent exposure, it would be useful to make a dynamic dosimetric picture for professional exposure and assessment of the radiation risk of these persons. (author)

  7. Social humanoid robot SARA: development of the wrist mechanism

    Science.gov (United States)

    Penčić, M.; Rackov, M.; Čavić, M.; Kiss, I.; Cioată, V. G.

    2018-01-01

    This paper presents the development of a wrist mechanism for humanoid robots. The research was conducted within the project which develops social humanoid robot Sara - a mobile anthropomorphic platform for researching the social behaviour of robots. There are two basic ways for the realization of humanoid wrist. The first one is based on biologically inspired structures that have variable stiffness, and the second one on low backlash mechanisms that have high stiffness. Our solution is low backlash differential mechanism that requires small actuators. Based on the kinematic-dynamic requirements, a dynamic model of the robot wrist is formed. A dynamic simulation for several hand positions was performed and the driving torques of the wrist mechanism were determined. The realized wrist has 2 DOFs and enables movements in the direction of flexion/extension 115°, ulnar/radial deviation ±45° and the combination of these two movements. It consists of a differential mechanism with three spur bevel gears, two of which are driving and identical, while the last one is the driven gear to which the robot hand is attached. Power transmission and motion from the actuator to the input links of the differential mechanism is realized with two parallel placed identical gear mechanisms. The wrist mechanism has high carrying capacity and reliability, high efficiency, a compact design and low backlash that provides high positioning accuracy and repeatability of movements, which is essential for motion control.

  8. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    International Nuclear Information System (INIS)

    Tehranzadeh, Jamshid; Ashikyan, Oganes; Anavim, Arash; Shin, John

    2008-01-01

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The ''rheumatoid'' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of

  9. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, Jamshid [University of California, Department of Radiological Sciences, Irvine (United States); University of California Medical Center, Department of Radiological Sciences R-140, Orange, CA (United States); Ashikyan, Oganes; Anavim, Arash; Shin, John [University of California, Department of Radiological Sciences, Irvine (United States)

    2008-05-15

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The 'rheumatoid' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with

  10. Peripheral occlusive vascular disease: Diagnostic performance of MRA and DSA

    International Nuclear Information System (INIS)

    Krug, B.; Kugel, H.; Harnischmacher, U.; Heindel, W.; Altenburg, A.; Fischbach, R.; Schmidt, R.

    1995-01-01

    In 59 patients with arterial flow disturbances 2-D inflow sequence of the abdominal and lower leg arteries were prospectively obtained on a 1.5 T MR-imager and were compared with additional DSA examinations. Supplementary Phase Contraste RSE ('Rapid Sequential Excitation') sequences were carried out in 29 patients. MRA and DSA angiograms were evaluated in random order by 4 readers using a questionnaire. The assessment of image quality were evaluated by variance analysis. Diagnostic performance of MRA and DSA was assessed by comparison of the readers' diagnostic assessments with reference diagnoses established by a radiologist and a vascular surgeon with full knowledge of all data concerning a patient. Image quality of inflow MRA was considered inferior to i.a. DSA (p [de

  11. Methodology for quantitative evalution of diagnostic performance. Project III

    International Nuclear Information System (INIS)

    Metz, C.E.

    1985-01-01

    Receiver Operation Characteristic (ROC) methodology is now widely recognized as the most satisfactory approach to the problem of measuring and specifying the performance of a diagnostic procedure. The primary advantage of ROC analysis over alternative methodologies is that it seperates differences in diagnostic accuracy that are due to actual differences in discrimination capacity from those that are due to decision threshold effects. Our effort during the past year has been devoted to developing digital computer programs for fitting ROC curves to diagnostic data by maximum likelihood estimation and to developing meaningful and valid statistical tests for assessing the significance of apparent differences between measured ROC curves. FORTRAN programs previously written here for ROC curve fitting and statistical testing have been refined to make them easier to use and to allow them to be run in a large variety of computer systems. We have attempted also to develop two new curve-fitting programs: one for conventional ROC data that assumes a different functional form for the ROC curve, and one that can be used for ''free-response'' ROC data. Finally, we have cooperated with other investigators to apply our techniques to analyze ROC data generated in clinical studies, and we have sought to familiarize the medical community with the advantages of ROC methodology. 36 ref

  12. Detailed Performance Assessment for the ITER ECE Diagnostic

    Science.gov (United States)

    Rowan, W.; Austin, M.; Houshmandyar, S.; Phillips, P.; Beno, J.; Bryant, A.; Ouroua, A.; Weeks, D.; Hubbard, A.; Taylor, G.

    2017-10-01

    One of the primary diagnostics for electron temperature (Te) measurement on ITER is based on the detection of electron cyclotron emission (ECE) Here we describe the predicted performance of the newly completed ECE diagnostic design by quantitatively following the emission from the plasma to the instruments and including the calibration method to assess accuracy. Operation of the diagnostic at 5.3 T is the main interest here but critical features of the emission spectra for 2.65 T and 1.8 T will be described. ECE will be collected by two very similar optical systems: one a radial view, the other an oblique view. Both measurements are used for Te while the oblique view also allows detection of non-thermal distortion in the electron distribution. An in-vacuum calibration source is included in the front end of each view to calibrate out the effect of any degradation of in-vessel optics. Following collection, the emission is split into orthogonal polarizations and transmitted to the detection instruments via waveguides filled with dry nitrogen, a choice that simplifies construction and analysis. Near the instruments, a switchyard is used to select which polarization and view is detected by each instrument. The design for the radiometer used for 5.3 T will be described in detail. Supported by PPPL/US-DA via subcontract S013464-H to UT Austin.

  13. Computational Biomechanics of the Wrist Joint

    CERN Document Server

    Nazri Bajuri, Mohd

    2013-01-01

    This book presents an analysis of the stress distribution and contact stresses in severe rheumatoid wrist after total wrist arthroplasty. It assesses and compares the load transfer throughout the joint and contact pressure at the articulations. The data obtained from this study is of importance as this provide greater evidence to the benefits of total wrist arthroplasty in rheumatoid arthritis patients.

  14. X-Ray Exam: Wrist

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español X-Ray Exam: Wrist KidsHealth / For Parents / X-Ray Exam: ... Muscles, and Joints Broken Bones Getting an X-ray (Video) X-Ray (Video) View more Partner Message About Us ...

  15. Wrist ultrasound analysis of patients with early rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    J.A. Mendonça

    2011-01-01

    Full Text Available In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS and gray scale ultrasound (GSUS with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP. The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546, GSUS of right wrist and swelling of left wrist (r = 0.511, PDUS of right wrist and pain in left wrist (r = 0.436, PDUS of right wrist and C-reactive protein (r = 0.466. Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

  16. A study comparing MRI with clinical examinations on wrists with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Wang Jun; Niu Jinliang; Xie Weina; Song Zhizhen; Zheng Jie; Ma Qiang

    2004-01-01

    Objective: To study the appearances of rheumatoid arthritis (RA) on MRI, and compare MRI with clinical examinations on wrists with RA. Methods: Fifty patients, fulfilled 1987 American Rheumatism Association (ARA) revised criteria, and 10 age-matched healthy controls entered the study. T 1 -weighted spin echo, short time inversion recovery (STIR) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were performed in the coronal planes. MRl, plain wrist radiographs, clinical date, including swollen joint, patient global assessment (AIMS), and laboratory examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score. Results: In 50 patients, all had pannus on MRI of wrists, 38 patients had enhanced signal intensity for pannus, 21 patients had bone marrow edema, 37 patients had joint effusion, and 37 patients had bone erosions. There were significant difference in the ESR, HAQ, AIMS as well as swollen joint count between patients with bone marrow edema and patients without bone marrow edema (P 2 =5.06, P=0.025; χ 2 =5.59, P=0.018). Number of patients with MRI erosion of wrists was associated with the number of patients without MRI bone marrow edema of wrists (χ 2 =5.11, P=0.024). Conclusion: MRI can find the appearances of wrists with RA. Comparing MRI with clinical examinations on wrists with RA, authors can assess and evaluate the role of MRI on RA

  17. Snapping wrist due to multiple accessory tendon of first extensor compartment

    Directory of Open Access Journals (Sweden)

    S. Dhiyaneswaran Subramaniyam

    2018-01-01

    Conclusion: There are various causes for snapping wrist syndrome. Multiple accessory tendon can also cause snapping as shown in this case report. Moreover am presenting this case to highlight the diagnostic failure with non dynamic radiological investigation and to consider multiple accessory tendon as differential diagnosis for snapping wrist syndrome. Also suggest dynamic study could be a better choice of investigation to diagnosis snapping syndrome. First compartment tunnel release with few accessory tendon slip tenotomy gives good result.

  18. Impacts of dairy diagnostic teams on herd performance.

    Science.gov (United States)

    Weinand, D; Conlin, B J

    2003-05-01

    This study evaluated impacts of educational diagnostic teams of consultants used to transfer technology to dairy farms. Herd management performance changes were measured by comparing Dairy Herd Improvement data from 38 project farms to data from herds that were geographical contemporaries. The value of focused goals for effecting change was also assessed. Interviews provided producers' perception of project outcomes and insight on organization and conduct of dairy diagnostic teams. Changes observed in project herds were small compared with controls with tendencies for increased herd size and improved milk production per cow. Focused goals had greater impacts on increasing herd size, milk per cow, first lactation peak milk, reducing age at first calving, and percentages of cows with subclinical mastitis. Time, money, facility limitations, labor, and alternative priorities were the most cited constraints to implementing changes. Satisfaction scores of producers were significantly related to the degree that team recommendations were followed. Improved attitudes, quality of life, and financial well-being were benefits listed by a majority of producers from participation in the project. If similar projects were to be offered, 83% said they would participate again, and 69% indicated they would pay at least some of the costs. Project farms served as demonstration farms for 1930 other producers in their respective locales, resulting in a multiplier effect of original advice given by consultant teams. Suggestions by farmer participants for improvements in dairy diagnostic teams included needs for at least some unbiased team members, more frequent meetings, more follow-up on recommendations, and consistency of recommendations with family goals.

  19. 30 CFR 250.520 - When do I have to perform a casing diagnostic test?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false When do I have to perform a casing diagnostic... Operations Casing Pressure Management § 250.520 When do I have to perform a casing diagnostic test? (a) You must perform a casing diagnostic test within 30 days after first observing or imposing casing pressure...

  20. Study for the design method of multi-agent diagnostic system to improve diagnostic performance for similar abnormality

    International Nuclear Information System (INIS)

    Minowa, Hirotsugu; Gofuku, Akio

    2014-01-01

    Accidents on industrial plants cause large loss on human, economic, social credibility. In recent, studies of diagnostic methods using techniques of machine learning such as support vector machine is expected to detect the occurrence of abnormality in a plant early and correctly. There were reported that these diagnostic machines has high accuracy to diagnose the operating state of industrial plant under mono abnormality occurrence. But the each diagnostic machine on the multi-agent diagnostic system may misdiagnose similar abnormalities as a same abnormality if abnormalities to diagnose increases. That causes that a single diagnostic machine may show higher diagnostic performance than one of multi-agent diagnostic system because decision-making considering with misdiagnosis is difficult. Therefore, we study the design method for multi-agent diagnostic system to diagnose similar abnormality correctly. This method aimed to realize automatic generation of diagnostic system where the generation process and location of diagnostic machines are optimized to diagnose correctly the similar abnormalities which are evaluated from the similarity of process signals by statistical method. This paper explains our design method and reports the result evaluated our method applied to the process data of the fast-breeder reactor Monju

  1. The Usefulness of Dynamic Cine-Arthrography for Wrist Instability as Correlated with Arthroscopic Palmer Classification

    Energy Technology Data Exchange (ETDEWEB)

    Kim TaeYeon; Lee, Guen Young; Kim, Baek Hyun; Park, Jong Woong; Seo, Bo Kyoung; Cha, Sang Hoon [Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of)

    2011-05-15

    To introduce dynamic cine-arthrography and compare it with MR arthrography in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears, based on arthroscopic findings. A total of thirty-eight wrists of 38 patients who had undergone both dynamic cine-arthrography and MR arthrography were enrolled. Dynamic cinearthrography was performed after puncture of the radiocarpal joint by slow injection of contrast under continuous fluoroscopic guidance during passive wrist exercise. We obtained 1.5- or 3-T MR arthrography with fat-suppressed T1-weighted coronal and axial images. We evaluated scapholunate and lunotriquetral ligaments and triangular fibrocartilage complex tears according to the Palmer classification system. Based on the arthroscopic findings, we compared the diagnostic values between the two examinations using Kappa values. The overall sensitivity and specificity of diagnosis of intrinsic ligament tears was similar between dynamic cine-arthrography and MR arthrography (scapholunate ligament: sensitivity 66.7% vs. 80%, specificity 100% vs. 95.7%, lunotriquetral ligament: sensitivity 75.0% vs. 75.0%, specificity 94.1% vs. 91.2%). For triangular fibrocartilage complex tears, all diagnostic values were the same (sensitivity 96.4%, specificity 100%). The inter-examination agreement was substantial to perfect (kappa value 1.000). Dynamic cine-arthrography is valuable in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears compared to MR arthrography.

  2. Scramjet Performance Assessment Using Water Absorption Diagnostics (U)

    Science.gov (United States)

    Cavolowsky, John A.; Loomis, Mark P.; Deiwert, George

    1995-01-01

    Simultaneous multiple path measurements of temperature and H2O concentration will be presented for the AIMHYE test entries in the NASA Ames 16-Inch Shock Tunnel. Monitoring the progress of high temperature chemical reactions that define scramjet combustor efficiencies is a task uniquely suited to nonintrusive optical diagnostics. One application strategy to overcome the many challenges and limitations of nonintrusive measurements is to use laser absorption spectroscopy coupled with optical fibers. Absorption spectroscopic techniques with rapidly tunable lasers are capable of making simultaneous measurements of mole fraction, temperature, pressure, and velocity. The scramjet water absorption diagnostic was used to measure combustor efficiency and was compared to thrust measurements using a nozzle force balance and integrated nozzle pressures to develop a direct technique for evaluating integrated scramjet performance. Tests were initially performed with a diode laser tuning over a water absorption feature at 1391.7 nm. A second diode laser later became available at a wavelength near 1343.3 nm covering an additional water absorption feature and was incorporated in the system for a two-wavelength technique. Both temperature and mole fraction can be inferred from the lineshape analysis using this approach. Additional high temperature spectroscopy research was conducted to reduce uncertainties in the scramjet application. The lasers are optical fiber coupled to ports at the combustor exit and in the nozzle region. The output from the two diode lasers were combined in a single fiber, and the resultant two-wavelength beam was subsequently split into four legs. Each leg was directed through 60 meters of optical fiber to four combustor exit locations for measurement of beam intensity after absorption by the water within the flow. Absorption results will be compared to 1D combustor analysis using RJPA and nozzle CFD computations as well as to data from a nozzle metric

  3. Malignant renal cysts: Diagnostic performance and strong predictors at MDCT

    International Nuclear Information System (INIS)

    Kim, Dae Yoon; Kim, Jeong Kon; Cho, Kyoung-Sik; Min, Gyeong-Eun; Ahn, Han-Jong

    2010-01-01

    Background: Utilization of multidetector-row CT (MDCT) is anticipated to improve the diagnostic accuracy and reliability for determining malignant cysts. Purpose: To assess the diagnostic accuracy, interobserver agreement, benefit of consensus reading, and strong predictors of malignancy in determining malignant cystic renal masses at MDCT. Material and Methods: Two radiologists independently rated the probability of malignancy at MDCT in 72 benign and 53 malignant cysts. The accuracy and interobserver agreement for determining malignant cysts were evaluated. The strong predictors of malignancy were determined, and in patients with interobserver disagreement for determining malignant cysts, consensus readings were performed. Results: Az value of the two readers was 0.905-0.936 and the sensitivity and specificity were 85-89% and 83-93%, respectively. The overall interobserver agreement for determining the malignant cyst was good as the κ value was 0.696 (% agreement, 61% (76/125)). Thickened irregular wall, thickened irregular septa, and enhancing soft tissue component were strong predictors for malignancy with both readers. In the 17 patients with interobserver disagreement for determining malignant cysts, the sensitivity was improved from 38-63% to 89% by the consensus reading. Conclusion: At MDCT, some false negative decisions for determining malignant cysts can be corrected by consensus reading, and thickened irregular septa, thickened irregular wall, and enhancing soft tissue component are the strong predictors of malignant cysts

  4. Penetrating Colorectal Injuries: Diagnostic Performance of Multidetector CT with Trajectography.

    Science.gov (United States)

    Dreizin, David; Boscak, Alexis R; Anstadt, Michael J; Tirada, Nikki; Chiu, William C; Munera, Felipe; Bodanapally, Uttam K; Hornick, Michael; Stein, Deborah M

    2016-12-01

    Purpose To determine the diagnostic performance of multidetector computed tomography (CT) with trajectography for penetrating colorectal injuries. Materials and Methods This institutional review board-approved and HIPAA-compliant study was a 6-year blinded retrospective review by two independent readers of 182 consecutive patients who preoperatively underwent 40- or 64-row multidetector CT for penetrating torso trauma below the diaphragm and had surgically confirmed findings. Colorectal perforation was present in 42 patients. Trajectory analysis with postprocessing software was used for all studies. Additional signs evaluated were rectal contrast agent leak, collections of extruded fecal material, mural defect, wall thickening, abnormal enhancement, free fluid or stranding, and free air. The quality of the colorectal contrast agent administration was recorded. Sensitivity, specificity, predictive values, areas under the receiver operating characteristic curves (AUCs), and Cohen κ were determined. Results In patients with rectal contrast agent administration (n = 151), AUCs were 0.90-0.91, which indicated excellent accuracy. Trajectory was sensitive (88%-91%). For single wounds (n = 104), sensitivity of trajectory was 96% for both readers, but was only 80% for multiple wounds (n = 47). Contrast agent leak was highly specific (96%-98%), but insensitive (42%-46%). Improved diagnostic performance was observed in patients with poor colonic distension or opacification. Accuracy remained high (AUC, 0.86-0.99) in the group without rectal contrast agent administration (n = 31). Conclusion Trajectory had excellent sensitivity, while rectal contrast agent leak was specific but insensitive. Sensitivity of trajectory was lower for multiple wounds. Accuracy remained high in patients without rectal contrast agent administration. © RSNA, 2016.

  5. Severe psychogenic tremor of both wrists in a 13-year-old girl treated successfully with a customized wrist brace: a case report

    Directory of Open Access Journals (Sweden)

    Schafflhuber Caroline

    2011-04-01

    Full Text Available Abstract Introduction Psychogenic movement disorders in childhood have been little researched. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed. Case presentation A 13-year-old Caucasian girl with tremor in both wrists, severe enough to prevent her from attending school, was sent to our hospital. After a complete neurological and psychiatric examination, in-patient child-psychotherapeutic treatment was started, with careful consideration given to both chronic and acute stress factors which constitute her performance and exam anxiety in school as well as the girl's parents' conflicted relationship. With the aid of a customized wrist brace our patient was able to go to school and write despite the presence of a marked tremor, which in turn reduced her avoidance behavior and exam anxiety. By the end of her in-patient treatment, the tremor was still noticeable, but markedly reduced in severity (reduction 80%. Two weeks after she was discharged from hospital, the tremor had completely disappeared. Conclusion After careful clinical diagnostics, this kind of dissociative disorder should be treated appropriately with age-adapted cognitive-behavioral therapy to achieve positive and lasting benefits.

  6. The Influence of Time Pressure and Case Complexity on Physicians׳ Diagnostic Performance

    Directory of Open Access Journals (Sweden)

    Dalal A. ALQahtani

    2016-12-01

    Conclusions: Time pressure did not impact the diagnostic performance, whereas the complexity of the clinical case negatively influenced the diagnostic accuracy. Further studies with the enhanced experimental manipulation of time pressure are needed to reveal the effect of time pressure, if any, on a physician׳s diagnostic performance.

  7. A feasibility study on age-related factors of wrist pulse using principal component analysis.

    Science.gov (United States)

    Jang-Han Bae; Young Ju Jeon; Sanghun Lee; Jaeuk U Kim

    2016-08-01

    Various analysis methods for examining wrist pulse characteristics are needed for accurate pulse diagnosis. In this feasibility study, principal component analysis (PCA) was performed to observe age-related factors of wrist pulse from various analysis parameters. Forty subjects in the age group of 20s and 40s were participated, and their wrist pulse signal and respiration signal were acquired with the pulse tonometric device. After pre-processing of the signals, twenty analysis parameters which have been regarded as values reflecting pulse characteristics were calculated and PCA was performed. As a results, we could reduce complex parameters to lower dimension and age-related factors of wrist pulse were observed by combining-new analysis parameter derived from PCA. These results demonstrate that PCA can be useful tool for analyzing wrist pulse signal.

  8. Diagnostics

    DEFF Research Database (Denmark)

    Donné, A.J.H.; Costley, A.E.; Barnsley, R.

    2007-01-01

    of the measurements—time and spatial resolutions, etc—will in some cases be more stringent. Many of the measurements will be used in the real time control of the plasma driving a requirement for very high reliability in the systems (diagnostics) that provide the measurements. The implementation of diagnostic systems...... on ITER is a substantial challenge. Because of the harsh environment (high levels of neutron and gamma fluxes, neutron heating, particle bombardment) diagnostic system selection and design has to cope with a range of phenomena not previously encountered in diagnostic design. Extensive design and R......&D is needed to prepare the systems. In some cases the environmental difficulties are so severe that new diagnostic techniques are required. The starting point in the development of diagnostics for ITER is to define the measurement requirements and develop their justification. It is necessary to include all...

  9. Trigger wrist caused by avascular necrosis of the capitate: a case report.

    Science.gov (United States)

    Matsui, Yuichiro; Kawamura, Daisuke; Kida, Hiroaki; Hatanaka, Kanako C; Iwasaki, Norimasa

    2018-03-27

    Trigger wrist is a rare condition first described by Marti in 1960, and various causes have been reported. The condition mostly occurs with finger flexion and extension, and rarely with flexion and extension of the wrist itself. Avascular necrosis of the capitate is also a rare condition, first described by Jönsson in 1942. While some reports of this condition have been published, little is known about its etiology. Therefore, no established treatment exists. We report a case of trigger wrist caused by avascular necrosis of the capitate. A 16-year-old right-handed male who was a high school handball player was referred to our department from a nearby hospital 5 months after the onset of pain in the dorsal aspect of the right wrist, with an unknown cause. At the previous hospital, imaging findings led to a diagnosis of avascular necrosis of the capitate, and conservative treatment with a wrist brace did not improve the pain. At the initial visit to our department, the patient was noted to have a painful trigger wrist that was brought on by wrist flexion and extension. Preoperative imaging findings led to a diagnosis of trigger wrist caused by capitolunate instability secondary to avascular necrosis of the capitate. We performed a partial excision of the proximal capitate with tendon ball interposition. Two years after surgery, the patient's clinical outcome was favorable, with no recurrence of wrist pain or triggering. Both trigger wrist and avascular necrosis of the capitate are rare disorders. When a patient presents with painful triggering at the wrist, surgeons must bear in mind that avascular necrosis of the capitate may result in this phenomenon. We recommend partial excision of the proximal capitate with tendon ball interposition for the treatment of this lesion.

  10. Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis.

    Science.gov (United States)

    Shim, Jae Woo; Park, Min Jong

    2017-11-01

    Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Kinematic control of robot with degenerate wrist

    Science.gov (United States)

    Barker, L. K.; Moore, M. C.

    1984-01-01

    Kinematic resolved rate equations allow an operator with visual feedback to dynamically control a robot hand. When the robot wrist is degenerate, the computed joint angle rates exceed operational limits, and unwanted hand movements can result. The generalized matrix inverse solution can also produce unwanted responses. A method is introduced to control the robot hand in the region of the degenerate robot wrist. The method uses a coordinated movement of the first and third joints of the robot wrist to locate the second wrist joint axis for movement of the robot hand in the commanded direction. The method does not entail infinite joint angle rates.

  12. Diagnostics for Evaluating Performance of NSTX Liquid Lihium Divertor

    Science.gov (United States)

    Kaita, R.; Kugel, H.; Kallman, J.; Leblanc, B.; Paul, S.; Roquemore, A. L.; Skinner, C.; Soukhanovskii, V.; Maingi, R.; Ahn, J.-W.; Wilgen, J.; Allain, J.-P.; Taylor, C.

    2009-11-01

    A Liquid Lithium Divertor (LLD) is being installed on NSTX to investigate particle control and power handling with liquid lithium as plasma-facing component (PFC). The LLD is expected to provide a low-recycling plasma-facing component (PFC). To study the effects of such a PFC on plasma performance, a variety of edge measurements are required. Since its surface is highly reflective at visible wavelengths, a Lyman-alpha detector array will be used to monitor the recycling. To understand changes in edge transport, electron temperature and density measurements will be made with Langmuir probes mounted in PFC's near the LLD, and the edge sightlines of a multipoint Thomson scattering system. A frequency-scanning reflectometer will also provide scrapeoff layer electron density profiles. The LLD response to heat loads will be examined with infrared cameras and thermocouples. Diagnostics are also needed to measure the erosion and codeposition of lithium. They include quartz deposition monitors and a retractable probe for exposing samples to the plasma.

  13. CT-based three-dimensional kinematic comparison of dart-throwing motion between wrists with malunited distal radius and contralateral normal wrists

    International Nuclear Information System (INIS)

    Lee, S.; Kim, Y.S.; Park, C.S.; Kim, K.G.; Lee, Y.H.; Gong, H.S.; Lee, H.J.; Baek, G.H.

    2014-01-01

    Aim: To compare motion of the capitate, scaphoid, and lunate in wrists with a malunited distal radius and contralateral normal wrists during dart-throwing motion (DTM) by three-dimensional kinematic studies using computed tomography (CT) images. Materials and methods: CT was performed simultaneously on both wrists in six patients with a unilateral distal radius malunion at three stepwise positions simulating DTM. Using volume registration technique, the kinematic variables of helical axis motion of the capitate, scaphoid, and lunate were calculated and compared between both wrists. The helical motion of the capitate was also evaluated in a scaphoid- and lunate-based coordinate system. Results: Among the average rotation and translation of the scaphoid, lunate, and capitate during DTM, only the average rotation of the capitate was significantly different between the uninjured (88.9°) and the injured (70°) wrist (p = 0.0075). Rotation of the capitate relative to the scaphoid (26.3° versus 37.8°, p = 0.029) or lunate (39.2° versus 59.3°, p = 0.028) was smaller in the malunited wrist. The centres of helical axis motion of the three carpal bones were located more dorsally and radially in the injured wrist. Conclusions: The present study showed that decreased DTM in wrists with a distal radius malunion resulted from decreased midcarpal motion. The present study of the capitate, scaphoid, and lunate in wrists with distal radius malunion might be the first to present a 3D kinematic analysis of the effect of distal radius malunion on the carpal bones

  14. Erosion or normal variant? 4-year MRI follow-up of the wrists in healthy children

    Energy Technology Data Exchange (ETDEWEB)

    Avenarius, Derk F.M. [University of Tromsoe, Faculty of Health Sciences, Tromsoe (Norway); University Hospital of North Norway, Department of Radiology, Tromsoe (Norway); Ording Mueller, Lil-Sofie [Oslo University Hospital, Department for Radiology and Intervention, Oslo (Norway); Rosendahl, Karen [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Department of Clinical Medicine K1, Bergen (Norway)

    2016-03-15

    A large proportion of healthy children have wrist changes on MRI, namely carpal depressions, findings that have been described as pathological in children with juvenile idiopathic arthritis. We performed follow-up imaging in a cohort of healthy children to evaluate carpal surface depressions over time, focusing on the presence of overlying cartilage as a potential discriminator between normal variants and true erosions. 74 of the initial cohort of 89 healthy children (83%) had a re-scan of their wrists using the same protocol, including coronal T1 and fat-saturated T2 sequences. A cartilage-selective sequence was added for this study. We registered number and location of bony depressions and presence of overlying cartilage. The total number of carpal depressions increased by age group and over time; their location was unchanged in 370 of 487 (76%) carpal sites and 91 of 117 (78%) metacarpal sites. In total, 426 of the 1,087 (39.2%) bony depressions were covered by cartilage, with a decreasing percentage by age (P = 0.001). Normal appearances during growth, such as bony depressions, should not be mistaken for pathology. There must be additional findings to support a diagnosis of disease. A cartilage sequence may add to the diagnostic image analysis. (orig.)

  15. MR imaging of the triangular fibrocartilage of the wrist

    International Nuclear Information System (INIS)

    Golimbu, C.N.; Firooznia, H.; Rafii, M.; Melone, C.; Leber, C.

    1988-01-01

    Magnetic resonance (MR) imaging of the wrist was performed in 25 patients who had pain or localized soft-tissue swelling in the ulnar side of the wrist. T1-weighted coronal images were obtained in all patients. In addition, coronal or axial images with T2-weighted or fast-field-echo sequences were obtained in 16 of these patients. MR imaging demonstrated tears of the triangular fibrocartilage of the wrist in 13 patients. Twelve of these tears were confirmed at surgery. In one patient, the triangular fibrocartilage was found at surgery to be stretched and folded on itself but not torn. This represents the one false-positive MR image in this group of patients. In 12 patients, the symptoms could be explained by a diversity of MR abnormalities, such as aseptic necrosis of carpal bones, subluxation of distal radioulnar joint, and synovitis of the tendon sheaths. MR imaging offers the advantage of investigating the triangular fibrocartilage of the wrist in a noninvasive manner; it may be used as a screening method in patients considered for surgery

  16. MRI of the wrist and hand

    International Nuclear Information System (INIS)

    Reicher, M.A.; Kellerhouse, L.E.

    1990-01-01

    Magnetic resonance imaging (MRI) is becoming the preferred technique for evaluating a wide range of wrist and hand disorders and has a crucial role in planning arthroscopic and nonarthroscopic wrist surgery. This book details the capabilities of MRI for detecting wrist, hand, and finger pathology; provides a complete understanding of examination techniques, imaging protocols, and anatomy; and contains nearly 400 clear, sharp scans and numerous line drawings showing examination techniques, anatomic structures, and pathologic findings. After an introductory review of MR physics, the book describes state- of-the-art MRI techniques and explains the rationale for selecting imaging protocols. A complete MRI examination of a normal wrist is presented, along with a multiplanar atlas of cross-sectional wrist anatomy

  17. Intersection Syndrome: The Subtle Squeak of an Overused Wrist.

    Science.gov (United States)

    Skinner, Thomas M

    2017-01-01

    Patient histories that include wrist pain can be pivotal in the distinction between intersection syndrome (IS) and the more common de Quervain's tenosynovitis (DQT). Presented here is a 26-year-old pregnant woman with a history of rowing who developed left radial/dorsal wrist pain and a rubbing/squeaking sensation. Nine months of conservative DQT therapy and a landmark-guided corticosteroid injection failed to relieve her symptoms. An in-clinic ultrasound showed tenosynovitis at the intersection of the first and second compartments, confirming a diagnosis of IS. She found immediate relief with ultrasound-guided saline hydrodissection, the injection of saline into the intercompartmental space to reduce adhesions. Both DQT and IS are overuse injuries caused by repetitive wrist extension, as occurs in rowing, and either condition can worsen after pregnancy. Distinguishing the subtleties between DQT and IS can be challenging. Close attention to the patient's description of the pain can guide treatment, potentially expediting recovery. In addition, saline hydrodissection can be both a diagnostic tool and a potentially therapeutic alternative to steroid injections for such tendinopathies. © Copyright 2017 by the American Board of Family Medicine.

  18. Initial experience with 3D isotropic high-resolution 3 T MR arthrography of the wrist.

    Science.gov (United States)

    Sutherland, John K; Nozaki, Taiki; Kaneko, Yasuhito; J Yu, Hon; Rafijah, Gregory; Hitt, David; Yoshioka, Hiroshi

    2016-01-16

    Our study was performed to evaluate the image quality of 3 T MR wrist arthrograms with attention to ulnar wrist structures, comparing image quality of isotropic 3D proton density fat suppressed turbo spin echo (PDFS TSE) sequence versus standard 2D 3 T sequences as well as comparison with 1.5 T MR arthrograms. Eleven consecutive 3 T MR wrist arthrograms were performed and the following sequences evaluated: 3D isotropic PDFS, repetition time/echo time (TR/TE) 1400/28.3 ms, voxel size 0.35x0.35x0.35 mm, acquisition time 5 min; 2D coronal sequences with slice thickness 2 mm: T1 fat suppressed turbo spin echo (T1FS TSE) (TR/TE 600/20 ms); proton density (PD) TSE (TR/TE 3499/27 ms). A 1.5 T group of 18 studies with standard sequences were evaluated for comparison. All MR imaging followed fluoroscopically guided intra-articular injection of dilute gadolinium contrast. Qualitative assessment related to delineation of anatomic structures between 1.5 T and 3 T MR arthrograms was carried out using Mann-Whitney test and the differences in delineation of anatomic structures among each sequence in 3 T group were analyzed with Wilcoxon signed-rank test. Quantitative assessment of mean relative signal intensity (SI) and relative contrast measurements was performed using Wilcoxon signed-rank test. Mean qualitative scores for 3 T sequences were significantly higher than 1.5 T (p < 0.01), with isotropic 3D PDFS sequence having highest mean qualitative scores (p < 0.05). Quantitative analysis demonstrated no significant difference in relative signal intensity among the 3 T sequences. Significant differences were found in relative contrast between fluid-bone and fluid-fat comparing 3D and 2D PDFS (p < 0.01). 3D isotropic PDFS sequence showed promise in both qualitative and quantitative assessment, suggesting this may be useful for MR wrist arthrograms at 3 T. Primary reasons for diagnostic potential include the ability to make reformations in any

  19. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture.

    Directory of Open Access Journals (Sweden)

    Su-Ya Lee

    Full Text Available The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP, radial deviation (RD, and ulnar deviation (UD. The root mean square (RMS of the electromyographic signal in the extensor digitorum communis (EDC, normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.

  20. An audit of diagnostic tests performed in medical microbiology, and ...

    African Journals Online (AJOL)

    Clinical audit is an important tool for reviewing and improving the quality of service in clinical laboratories. This is a three year audit of diagnostic test carried out in Medical Microbiology and Immunology laboratories of University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. The objectives were to document and ...

  1. MRI features in de Quervain`s tenosynovitis of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Glajchen, N. [Mount Sinai Hospital, New York, NY (United States). Dept. of Radiology; Schweitzer, M. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology

    1996-01-01

    De Quervain`s stenosing tenosynovitis of the first dorsal extensor component is traditionally diagnosed clinically but may be encountered when performing MRI of the wrist. A retrospective review of wrist MR images was performed in cases where the diagnosis of de Quervain`s synovitis was suggested (n=5). Imaging findings were correlated with clinical findings in four cases and with wrist arthroscopy in one case. Increased thickness of the extensor pollicus brevis and abductor pollicis longus tendons was the most reliable finding on MRI, being present in all cases. Peritendinous edema was also a reliable finding. Surrounding subcutaneous edema and increased intratendinous signal were less reliable findings in confirmed cases of de Quervain`s disease. De Quervain`s tenosynovitis may be encountered when performing MRI of the wrist. Increased tendon thickness and peritendinous edema are the most reliable imaging findings. (orig.)

  2. A comparison of MRI and wrist arthrography in the diagnosis of TFC injury

    Energy Technology Data Exchange (ETDEWEB)

    Shionoya, Kaori; Nakamura, Ryogo; Imaeda, Toshihiko [Nagoya Univ., Aichi (Japan). Branch Hospital; Tsunoda, Kenji; Makino, Naoki

    1995-08-01

    The present study compared the diagnostic usefulness of magnetic resonance imaging (MRI) and wrist arthrography in triangular fibrocartilage (TFC) injuries. The subjects were 102 wrists with arthroscopically confirmed presence or absence of TFC perforation. TFC perforation was present in 35 and 47 wrists and absent in the other 67 and 55 wrists on arthrography and MRI, respectively. Using arthroscopy as the reference standard, arthrography for the detection of TFC perforation had a sensitivity of 85% and a specificity of 100%. All 6 false negative cases on arthrography had scarring adhesions of the TFC in the wrist. On the other hand, the sensitivity and specificity of MRI were 73% and 72%, respectively. An accuracy was 94% for arthrography and 73% for MRI. It was difficult to detect qualitative TFC injury and the presence or absence of TFC perforation on MRI. Arthrography is thus superior to MRI in both sensitivity and specificity. The complementary use of arthrography and MRI is considered to increase the diagnostic accuracy. (S.Y.).

  3. Wrist arthrography: The value of the three compartment injection technique

    Energy Technology Data Exchange (ETDEWEB)

    Levinsohn, E.M.; Coren, A.B.; Palmer, A.K.; Zinberg, E.

    1987-10-01

    Arthrography of the wrist was performed on 50 consecutive patients with obscure post-traumatic wrist pain by injecting contrast separately into the radiocarpal joint, midcarpal compartment, and distal radioulnar joint. When distal radioulnar joint and midcarpal compartment injections were added to the standard radiocarpal injection, many significant unsuspected abnormalities were identified. Of the 25 triangular fibrocartilage complex abnormalities identified, six (24%) were found only with the distal radioulnar joint injection. Of the 29 abnormal communications between the midcarpal compartment and the radiocarpal joint, ten (35%) were found only with the midcarpal injection. Similarly, five of 29 (17%) of the abnormal radiocarpal-midcarpal communications would have been missed if a midcarpal injection alone had been performed. These findings indicate that separate injections into the radiocarpal joint, midcarpal compartment, and distal radioulnar joint are needed to identify a large number of abnormalities not seen with injections into one compartment alone.

  4. The effect of arm and wrist supports on the load of the upper extremity during VDU work

    NARCIS (Netherlands)

    Visser, B.; de Korte, E.; van der Kraan, I.; Kuijer, P. [=P. Paul F. M.

    2000-01-01

    To evaluate the effectiveness of arm and wrist supports in reducing the workload during computer work. Female subjects (n=10) performed computer work in conditions with arm or wrist supports and in a condition without supports. Sustained muscle tension in the trapezius muscle is a risk factor for

  5. The effect of arm and wrist supports on the load of he upper extrimity during VDU work

    NARCIS (Netherlands)

    Visser, B.; de Korte, E.; van der Kraan, I.; Kuijer, P.

    2000-01-01

    Objective. To evaluate the effectiveness of arm and wrist supports in reducing the workload during computer work. Design. Female subjects (n=10) performed computer work in conditions with arm or wrist supports and in a condition without supports. Background. Sustained muscle tension in the trapezius

  6. Forward and inverse kinematics of double universal joint robot wrists

    Science.gov (United States)

    Williams, Robert L., II

    1991-01-01

    A robot wrist consisting of two universal joints can eliminate the wrist singularity problem found on many individual robots. Forward and inverse position and velocity kinematics are presented for such a wrist having three degrees of freedom. Denavit-Hartenberg parameters are derived to find the transforms required for the kinematic equations. The Omni-Wrist, a commercial double universal joint robot wrist, is studied in detail. There are four levels of kinematic parameters identified for this wrist; three forward and three inverse maps are presented for both position and velocity. These equations relate the hand coordinate frame to the wrist base frame. They are sufficient for control of the wrist standing alone. When the wrist is attached to a manipulator arm; the offset between the two universal joints complicates the solution of the overall kinematics problem. All wrist coordinate frame origins are not coincident, which prevents decoupling of position and orientation for manipulator inverse kinematics.

  7. The Impact of Gas Turbine Component Leakage Fault on GPA Performance Diagnostics

    Directory of Open Access Journals (Sweden)

    E. L. Ntantis

    2016-01-01

    Full Text Available The leakage analysis is a key factor in determining energy loss from a gas turbine. Once the components assembly fails, air leakage through the opening increases resulting in a performance loss. Therefore, the performance efficiency of the engine cannot be reliably determined, without good estimates and analysis of leakage faults. Consequently, the implementation of a leakage fault within a gas turbine engine model is necessary for any performance diagnostic technique that can expand its diagnostics capabilities for more accurate predictions. This paper explores the impact of gas turbine component leakage fault on GPA (Gas Path Analysis Performance Diagnostics. The analysis is demonstrated with a test case where gas turbine performance simulation and diagnostics code TURBOMATCH is used to build a performance model of a model engine similar to Rolls-Royce Trent 500 turbofan engine, and carry out the diagnostic analysis with the presence of different component fault cases. Conclusively, to improve the reliability of the diagnostic results, a leakage fault analysis of the implemented faults is made. The diagnostic tool used to deal with the analysis of the gas turbine component implemented faults is a model-based method utilizing a non-linear GPA.

  8. Extrinsic wrist ligaments: prevalence of injury by magnetic resonance imaging and association with intrinsic ligament tears.

    Science.gov (United States)

    Taneja, Atul K; Bredella, Miriam A; Chang, Connie Y; Joseph Simeone, F; Kattapuram, Susan V; Torriani, Martin

    2013-01-01

    The objective of this study was to determine the prevalence of extrinsic wrist ligament injury by magnetic resonance imaging and its association with intrinsic ligament tears. We reviewed conventional magnetic resonance images performed over a 5-year period from adult patients in the setting of wrist trauma. Two musculoskeletal radiologists examined the integrity of wrist ligaments and presence of bone abnormalities. In a cohort of 75 subjects, extrinsic ligament injury was present in 75%, with radiolunotriquetral being most frequently affected (45%). Intrinsic ligament injury was present in 60%. Almost half of subjects had combined intrinsic and extrinsic ligament injury. Bone abnormalities were seen in 69%. The rate of extrinsic injury was higher in subjects with bone injury (P = 0.008). There is high prevalence of extrinsic ligament injury in the setting of wrist trauma, especially in the presence of bone abnormalities, with combined injury of intrinsic and extrinsic ligaments in about half of cases.

  9. Wear particles and osteolysis in patients with total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula

    2014-01-01

    PURPOSE: To determine whether the amount of polyethylene debris in the interphase tissue between prosthesis and bone in patients with total wrist arthroplasty correlated with the degree of periprosthetic osteolysis (PPO); and to investigate the occurrence of metal particles in the periprosthetic...... tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO. METHODS: Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow......-up. Serial annual radiographs were performed prospectively for the evaluation of PPO. We collected blood samples for white blood cell count, C-reactive protein, and metallic ion level. RESULTS: A radiolucent zone of greater than 2 mm was observed juxta-articular to the radial component in 4 patients...

  10. Sensor Selection for Aircraft Engine Performance Estimation and Gas Path Fault Diagnostics

    Science.gov (United States)

    Simon, Donald L.; Rinehart, Aidan W.

    2016-01-01

    This paper presents analytical techniques for aiding system designers in making aircraft engine health management sensor selection decisions. The presented techniques, which are based on linear estimation and probability theory, are tailored for gas turbine engine performance estimation and gas path fault diagnostics applications. They enable quantification of the performance estimation and diagnostic accuracy offered by different candidate sensor suites. For performance estimation, sensor selection metrics are presented for two types of estimators including a Kalman filter and a maximum a posteriori estimator. For each type of performance estimator, sensor selection is based on minimizing the theoretical sum of squared estimation errors in health parameters representing performance deterioration in the major rotating modules of the engine. For gas path fault diagnostics, the sensor selection metric is set up to maximize correct classification rate for a diagnostic strategy that performs fault classification by identifying the fault type that most closely matches the observed measurement signature in a weighted least squares sense. Results from the application of the sensor selection metrics to a linear engine model are presented and discussed. Given a baseline sensor suite and a candidate list of optional sensors, an exhaustive search is performed to determine the optimal sensor suites for performance estimation and fault diagnostics. For any given sensor suite, Monte Carlo simulation results are found to exhibit good agreement with theoretical predictions of estimation and diagnostic accuracies.

  11. Exercise echocardiography or exercise SPECT imaging? - A meta-analysis of diagnostic test performance

    NARCIS (Netherlands)

    Fleischmann, KE; Hunink, MGM; Kuntz, KM; Douglas, PS

    1998-01-01

    Context.-Cardiac imaging has advanced rapidly, providing clinicians with several choices for evaluating patients with suspected coronary artery disease, but few studies compare modalities directly. .-To review the contemporary literature and to compare the diagnostic performance of exercise

  12. Development of a computerized system for performance monitoring and diagnostics in nuclear power plants

    International Nuclear Information System (INIS)

    Chou, G.H.; Chao, H.J.

    1995-01-01

    An on-line computerized system for thermal performance monitoring and diagnostics has been developed at the Institute of Nuclear Energy Research (INER). It was the product of the ChinShan plant performance Monitoring, Analysis and Diagnostics Expert System (CS-MADES) project sponsored by Taiwan Power Company (TPC). The system can carry out turbine performance monitoring and analysis during normal operation, and yield diagnostic results of component degradation after finding out the missing generation problems. Three subsystems were generated to support the whole system framework. They are Test Data Processing Subsystem (TDPS), On-line Monitoring and Analysis Subsystem (OMAS), and Thermal Performance Diagnostics Expert System (TPDES). Some visible benefits have been gained so far through the prototype system installed at the Chinshan nuclear power station

  13. Radiologically occult scaphoid and wrist fractures. Preliminary results in comparison of 0.2-T and 1.0-T units

    International Nuclear Information System (INIS)

    Breitenseher, M.J.; Trattnig, S.; Happel, B.; Bankier, A.; Rand, T.; Imhof, H.; Gaebler, C.; Kukla, C.

    1997-01-01

    The study was performed to determine the diagnostic value of different MR systems and field strengths in patients with occult scaphoid and wrist fractures. Twelve patients with clinical suspicion of a scaphoid fracture but normal plain radiographs were examined by MRI. A dedicated 0.2-T unit (Esaote) and a 1.0-T unit (NT10, Philips) were used. Coronal T1W-SE, STIR, and T2*W-GE sequences were obtained with both systems. Images were evaluated for a bone marrow abnormality, a trabecular or cortical fracture line, and were compared to the 6-week follow-up radiographs. Seven wrist fractures were found at 0.2 T and 1.0 T, proven in the follow-up radiographs. A bone marrow abnormality was present in all seven fractures on both systems. Trabecular and cortical fracture lines were visualized at 0.2 T in four cases and at 1.0 T in seven cases. Low-field MR imaging at 0.2 T and mid-field MR imaging at 1.0 T seem to be equivalent in the diagnosis of a fracture in radiographically occult scaphoid and wrist fractures. In the visualization of fracture details, important for therapeutic and prognostic considerations, 1.0 T seems to be superior. (orig.) [de

  14. ROC Analysis of Diagnostic Performance in Liver Scan

    International Nuclear Information System (INIS)

    Lee, Myung Chul; Moon, Dyuk Hyuk; Koh, Chang Soon; Matumoto, Toru; Tateno, Yukio

    1988-01-01

    To evaluate diagnostic accuracy of liver scintigraphy we analysed liver scans of 143 normal and 258 patients with various liver diseases. Three ROC curves for SOL, liver cirrhosis and diffuse liver disease were fitted using rating methods and areas under the ROC curves and their standard errors were calculated by the trapezoidal rule and the variance of the Wilcoxon statistic suggested by McNeil. We compared these results with that of National Institute of Radiological Science in Japan. 1) The sensitivity of liver scintigraphy was 74.2% in SOL, 71.8% in liver cirrhosis and 34.8% in diffuse liver disease. The specificity was 96.0% in SOL, 94.2% in liver cirrhosis and 87.6% in diffuse liver disease. 2) ROC curves of SOL and liver cirrhosis approached the upper left-hand corner closer than that of diffuse liver disease. Area (± standard error) under the ROC curve was 0.868±0.024 in SOL and 0.867±0.028 in liver cirrhosis. These were significantly higher than 0.658±0.043 in diffuse liver disease. 3) There was no interobserver difference in terms of ROC curves. But low sensitivity and high specificity of authors' SOL diagnosis suggested we used more strict decision threshold.

  15. Radiologic examination and measurement of the wrist and distal radio-ulnar joint

    International Nuclear Information System (INIS)

    Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.; Sahlgrenska Sjukhuset, Goeteborg; Uppsala Univ.

    1986-01-01

    Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles. (orig.)

  16. Radiologic examination and measurement of the wrist and distal radio-ulnar joint. New aspects

    Energy Technology Data Exchange (ETDEWEB)

    Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.

    Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles.

  17. Registration-based Bone Morphometry for Shape Analysis of the Bones of the Human Wrist

    Science.gov (United States)

    Joshi, Anand A.; Leahy, Richard M.; Badawi, Ramsey D.; Chaudhari, Abhijit J.

    2015-01-01

    We present a method that quantifies point-wise changes in surface morphology of the bones of the human wrist. The proposed method, referred to as Registration-based Bone Morphometry (RBM), consists of two steps: an atlas selection step and an atlas warping step. The atlas for individual wrist bones was selected based on the shortest l2 distance to the ensemble of wrist bones from a database of a healthy population of subjects. The selected atlas was then warped to the corresponding bones of individuals in the population using a non-linear registration method based on regularized l2 distance minimization. The displacement field thus calculated showed local differences in bone shape that then were used for the analysis of group differences. Our results indicate that RBM has potential to provide a standardized approach to shape analysis of bones of the human wrist. We demonstrate the performance of RBM for examining group differences in wrist bone shapes based on sex and between those of the right and left wrists in healthy individuals. We also present data to show the application of RBM for tracking bone erosion status in rheumatoid arthritis. PMID:26353369

  18. ROC analysis of diagnostic performance in liver scintigraphy

    International Nuclear Information System (INIS)

    Fritz, S.L.; Preston, D.F.; Gallagher, J.H.

    1981-01-01

    Studies on the accuracy of liver scintigraphy for the detection of metastases were assembled from 38 sources in the medical literature. An ROC curve was fitted to the observed values of sensitivity and specificity using an algorithm developed by Ogilvie and Creelman. This ROC curve fitted the data better than average sensitivity and specificity values in each of four subsets of the data. For the subset dealing with Tc-99m sulfur colloid scintigraphy, performed for detection of suspected metastases and containing data on 2800 scans from 17 independent series, it was not possible to reject the hypothesis that interobserver variation was entirely due to the use of different decision thresholds by the reporting clinicians. Thus the ROC curve obtained is a reasonable baseline estimate of the performance potentially achievable in today's clinical setting. Comparison of new reports with these data is impossible, but is limited by the small sample sizes in most reported series

  19. ROC analysis of diagnostic performance in liver scintigraphy.

    Science.gov (United States)

    Fritz, S L; Preston, D F; Gallagher, J H

    1981-02-01

    Studies on the accuracy of liver scintigraphy for the detection of metastases were assembled from 38 sources in the medical literature. An ROC curve was fitted to the observed values of sensitivity and specificity using an algorithm developed by Ogilvie and Creelman. This ROC curve fitted the data better than average sensitivity and specificity values in each of four subsets of the data. For the subset dealing with Tc-99m sulfur colloid scintigraphy, performed for detection of suspected metastases and containing data on 2800 scans from 17 independent series, it was not possible to reject the hypothesis that interobserver variation was entirely due to the use of different decision thresholds by the reporting clinicians. Thus the ROC curve obtained is a reasonable baseline estimate of the performance potentially achievable in today's clinical setting. Comparison of new reports with these data is possible, but is limited by the small sample sizes in most reported series.

  20. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier......Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007...

  1. Use of wrist albedo neutron dosimeters

    International Nuclear Information System (INIS)

    Hankins, D.E.

    1983-01-01

    We are developing a wrist dosimeter that can be used to measure the exposure at the wrist to x-rays, gamma rays, beta-particles, thermal neutrons and fast neutrons. It consists of a modified Hankins Type albedo neutron dosimeter and also contains three pieces of CR-39 plastic. ABS plastic in the form of an elongated hemisphere provides the beta and low energy x-ray shielding necessary to meet the requirement of depth dose measurements at 1 cm. The dosimeter has a beta window located in the side of the hemisphere oriented towards an object being held in the hands. A TLD 600 is positioned under the 1 cm thick ABS plastic and is used to measure the thermal neutron dose. At present we are using Velcro straps to hold the dosimeter on the inside of the wrist. 9 figures

  2. Thermal diagnostics in power plant to improve performance

    International Nuclear Information System (INIS)

    Meister, H.

    1995-01-01

    The improvement of older power plants by changing poor performing components is a cost effective method to increase the capacity of the units. The necessary information for the detection of components that are to be replaced can be obtained from heat rate and component tests with accuracy instrumentation. The discussed methods and tools provided by ABB Were used with success in several power plants in Europe. These tools are in the process of permanent improvement and can be used in almost any type of power plant. Due to the reasons discussed above, there is a high potential for improvement of a lot of power plants in the next decade. (author)

  3. Thyroid Ultrasound: Change of Inter-observer Variability and Diagnostic Performance after Training

    International Nuclear Information System (INIS)

    Moon, Hee Jung; Kim, Eun Kyung; Kwak, Jin Young; Park, Jeong Seon

    2011-01-01

    To investigate and compare inter-observer variability and diagnostic performance of thyroid ultrasound (US) between a faculty member and observing residents. From October 2007 to June 2009, 18 residents underwent training in thyroid US section. Group 1 included 8 residents that were trained for the first time and group 2 included 10 residents that were trained for the second time. US features of nodules were recorded according to the composition, echogenicity, margin, calcifications, shape, and final assessment by a faculty member and residents, respectively. Following a discussion, a faculty member performed fine needle aspiration. Then, the inter-observer variability and diagnostic performance between a faculty member and residents were investigated and compared for US. In group 1, agreement for composition in resident 1, calcification for residents 5 and 6, and shape for resident 4 were slight, moderate, moderate, and moderate, respectively. In group 2, agreement for composition in residents 1 and 10 were moderate. Substantial or greater agreement was observed more frequently in group 2 than 1. The diagnostic performances for both the faculty and residents were high and not statistically different. Agreement for US features between a faculty and residents as well as diagnostic performance were high. Moreover, diagnostic performance of residents that underwent training a second time of training was higher than residents that underwent training only once

  4. A comprehensive comparison of simple step counting techniques using wrist- and ankle-mounted accelerometer and gyroscope signals.

    Science.gov (United States)

    Rhudy, Matthew B; Mahoney, Joseph M

    2018-04-01

    The goal of this work is to compare the differences between various step counting algorithms using both accelerometer and gyroscope measurements from wrist and ankle-mounted sensors. Participants completed four different conditions on a treadmill while wearing an accelerometer and gyroscope on the wrist and the ankle. Three different step counting techniques were applied to the data from each sensor type and mounting location. It was determined that using gyroscope measurements allowed for better performance than the typically used accelerometers, and that ankle-mounted sensors provided better performance than those mounted on the wrist.

  5. Evaluation Of The Diagnostic Performance Of A Multimedia Medical Communications System.

    Science.gov (United States)

    Robertson, John G.; Coristine, Marjorie; Goldberg, Morris; Beeton, Carolyn; Belanger, Garry; Tombaugh, Jo W.; Hickey, Nancy M.; Millward, Steven F.; Davis, Michael; Whittingham, David

    1989-05-01

    The central concern of radiologists when evaluating Picture Archiving Communication System (PACS) is the diagnostic performance of digital images compared to the original analog versions of the same images. Considerable work has been done comparing the ROC curves of various types of digital systems to the corresponding analog systems for the detection of specific phantoms or diseases. Although the studies may notify the radiologists that for a specific lesion a digital system may perform as well as the analog system, it tells the radiologists very little about the impact on diagnostic performance of a digital system in the general practice of radiology. We describe in this paper an alternative method for evaluating the diagnostic performance of a digital system and a preliminary experiment we conducted to test the methodology.

  6. Effective exposure level and diagnostic performance in endodontic radiography

    International Nuclear Information System (INIS)

    Okano, T.; Wiebe, J.D.; Webber, R.L.; Wagner, R.F.

    1983-01-01

    Image quality is limited by the information capacity of the image-forming system and can be computed from three parameters: contrast, resolution, and noise. These parameters can be combined to yield a single measure which determines the maximum amount of information obtainable from any x-ray system and is called the noise-equivalent number of quanta (NEQ) per unit area. The effects of image quality, expressed as noise-equivalent number of quanta (NEQ) per unit area, on the radiographic performance by dentists reading the position of an endodontic file in a root canal were studied. Three different speed films were used in conjunction with a fixed screen. Components of variance associated with the position of the tooth apex and the tip of an endodontic file in a root canal were compared for the effect of different NEQs and observers. Results show that the standard deviation in locating a file tip and tooth apex may be a linear function of log NEQ. These findings indicate that a significant reduction in exposure would have a relatively small effect on the precision of endodontic distance measurements

  7. Exploring the Knowledge Management Index as a Performance Diagnostic Tool

    Directory of Open Access Journals (Sweden)

    Jakov Crnkovic

    2005-04-01

    Full Text Available The knowledge management index (KMI has been proposed as a parsimonious and useful tool to help organizations gauge their knowledge management (KM capabilities. This may be the first step in understanding the difference between what an organization is currently doing and what it needs to do in order to maintain and improve its performance level. At the macro level, the index enables organizations to compare themselves with each other. At the micro level, it calls attention to areas needing improvement in current and future KM initiatives. In either case, the KMI provides a robust indicator and basis for business decision-making and organizational support and development. This paper presents a holistic approach to KM that relates key knowledge management processes (KMP and critical success factors (CSF needed to successfully implement it. By juxtaposing these processes and success factors, we create Belardo's matrix that will enable us to characterize an organization and estimate the KMI. At the macro level, we used realized KMI values and OP estimates to confirm the positive correlation between the KMI and OP. Additional findings include comparing the current and expected role of KM in organizations and discussion for marginal values of rows (CSF and columns (KM Processes of the proposed matrix.

  8. Smartphone photography utilized to measure wrist range of motion.

    Science.gov (United States)

    Wagner, Eric R; Conti Mica, Megan; Shin, Alexander Y

    2018-02-01

    The purpose was to determine if smartphone photography is a reliable tool in measuring wrist movement. Smartphones were used to take digital photos of both wrists in 32 normal participants (64 wrists) at extremes of wrist motion. The smartphone measurements were compared with clinical goniometry measurements. There was a very high correlation between the clinical goniometry and smartphone measurements, as the concordance coefficients were high for radial deviation, ulnar deviation, wrist extension and wrist flexion. The Pearson coefficients also demonstrated the high precision of the smartphone measurements. The Bland-Altman plots demonstrated 29-31 of 32 smartphone measurements were within the 95% confidence interval of the clinical measurements for all positions of the wrists. There was high reliability between the photography taken by the volunteer and researcher, as well as high inter-observer reliability. Smartphone digital photography is a reliable and accurate tool for measuring wrist range of motion. II.

  9. Risk factors for hand-wrist disorders in repetitive work

    DEFF Research Database (Denmark)

    Thomsen, J. F.; Mikkelsen, S.; Andersen, JH

    2007-01-01

    OBJECTIVES: To identify the risk of hand-wrist disorders related to repetitive movements, use of hand force and wrist position in repetitive monotonous work. METHODS: Using questionnaires and physical examinations, the prevalence and incidence of hand-wrist pain and possible extensor tendonitis...... (wrist pain and palpation tenderness) were determined in 3123 employees in 19 industrial settings. With the use of questionnaires and video recordings of homogenous work tasks number of wrist movements, hand force requirements and wrist position were analysed as risk factors for hand-wrist disorders......, controlling for potential personal and psychosocial confounders. All participants were re-examined three times during a follow-up period of three years. RESULTS: Force but not repetition and position was related to hand-wrist pain and possible tendonitis in the baseline analyses showing an exposure...

  10. A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip.

    Science.gov (United States)

    Rahman, Labib Ataur; Adie, Sam; Naylor, Justine Maree; Mittal, Rajat; So, Sarah; Harris, Ian Andrew

    2013-08-30

    Previous reviews of the diagnostic performances of physical tests of the hip in orthopedics have drawn limited conclusions because of the low to moderate quality of primary studies published in the literature. This systematic review aims to build on these reviews by assessing a broad range of hip pathologies, and employing a more selective approach to the inclusion of studies in order to accurately gauge diagnostic performance for the purposes of making recommendations for clinical practice and future research. It specifically identifies tests which demonstrate strong and moderate diagnostic performance. A systematic search of Medline, Embase, Embase Classic and CINAHL was conducted to identify studies of hip tests. Our selection criteria included an analysis of internal and external validity. We reported diagnostic performance in terms of sensitivity, specificity, predictive values and likelihood ratios. Likelihood ratios were used to identify tests with strong and moderate diagnostic utility. Only a small proportion of tests reported in the literature have been assessed in methodologically valid primary studies. 16 studies were included in our review, producing 56 independent test-pathology combinations. Two tests demonstrated strong clinical utility, the patellar-pubic percussion test for excluding radiologically occult hip fractures (negative LR 0.05, 95% Confidence Interval [CI] 0.03-0.08) and the hip abduction sign for diagnosing sarcoglycanopathies in patients with known muscular dystrophies (positive LR 34.29, 95% CI 10.97-122.30). Fifteen tests demonstrated moderate diagnostic utility for diagnosing and/or excluding hip fractures, symptomatic osteoarthritis and loosening of components post-total hip arthroplasty. We have identified a number of tests demonstrating strong and moderate diagnostic performance. These findings must be viewed with caution as there are concerns over the methodological quality of the primary studies from which we have extracted our

  11. The diagnostic performance of imaging methods in ARVC using the 2010 Task Force criteria

    DEFF Research Database (Denmark)

    Borgquist, Rasmus; Haugaa, Kristina H; Gilljam, Thomas

    2014-01-01

    , fractional area shortening 31 ± 9 vs. 39 ± 9% (P performance was low; sensitivity 50% and specificity 70%, positive predictive value 80% and negative predictive value 37...... evaluation of subtle structural changes in the right ventricle may be unreliable, and the diagnostic performance of CMR compared with echocardiography should be reflected in the guidelines....

  12. Diagnostic Performance of the Intraoral Radiographs on the Interproximal Dental Caries

    International Nuclear Information System (INIS)

    Kim, Soo Ji; Kang, Byung Cheol

    1998-01-01

    The purpose of this study was to evaluated the diagnostic performance of the senior dental students for the proximal dental caries in intraoral radiographs and to compare it with the dental hospital residents, the reference group. It was also investigated the diagnostic performance according to the carious lesion depth. Thirty-five intraoral periapical and bitewing radiographs with 213 proximal surface included in this study were selected from the dental patients at Chonnam National University Hospital. The observers were 181 senior dental students from 5 dental schools and 40 dentists who were second year resident from 5 dental hospitals. They were asked to evaluate the presence ro the absence of the proximal dental caries. The results were as follows : 1. The mean of the hitting rate for the overall observers was 184.51 surfaces and the diagnostic accuracy was 86.62%. 2. The diagnostic performance of the sound proximal tooth surfaces was very high, i.e., 91.5% true negative rate and 8.5% false positive rate. 3. The diagnostic performance of the dentist group was higher than the student group (P 0.001).

  13. Quantitative evaluation of visual detection performance in medicine: ROC analysis and determination of diagnostic benefit

    International Nuclear Information System (INIS)

    Metz, C.E.; Starr, S.J.; Lusted, L.B.

    1976-01-01

    An ROC curve provides an empirical description of the trade-offs which are possible among the various types of correct and incorrect decisions as the human decision-maker varies one or more confidence thresholds. Conventional ROC curves measured in simple decision-making situations can, in some cases, be used to predict human decision performance in more complex situations. By considering both the consequences of the various types of diagnostic decisions and the overhead cost of a diagnostic study, one can use the ROC curve to evaluate the diagnostic usefulness of a study in any particular clinical context. Since the ROC curve describes the possible relationships among the probabilities of the various types of correct and incorrect decisions, it plays a central role in optimizing diagnostic strategies using the general techniques of decision analysis. Applications in radiographic image evaluation are described

  14. A Hybrid Neural Network-Genetic Algorithm Technique for Aircraft Engine Performance Diagnostics

    Science.gov (United States)

    Kobayashi, Takahisa; Simon, Donald L.

    2001-01-01

    In this paper, a model-based diagnostic method, which utilizes Neural Networks and Genetic Algorithms, is investigated. Neural networks are applied to estimate the engine internal health, and Genetic Algorithms are applied for sensor bias detection and estimation. This hybrid approach takes advantage of the nonlinear estimation capability provided by neural networks while improving the robustness to measurement uncertainty through the application of Genetic Algorithms. The hybrid diagnostic technique also has the ability to rank multiple potential solutions for a given set of anomalous sensor measurements in order to reduce false alarms and missed detections. The performance of the hybrid diagnostic technique is evaluated through some case studies derived from a turbofan engine simulation. The results show this approach is promising for reliable diagnostics of aircraft engines.

  15. Ultrasound guided synovial biopsy of the wrist

    NARCIS (Netherlands)

    van Vugt, R. M.; van Dalen, A.; Bijlsma, J. W.

    1997-01-01

    Seven patients (4 female and 3 male, mean age 46) with arthritis of the wrist (n = 7) without known etiology were evaluated. High-definition ultrasound equipment was used for localization of synovial hypertrophy, suitable for ultrasound guided biopsy without risk. A 18-gauge diameter Tru-cut biopsy

  16. PERIMENOPAUSAL WRIST FRACTURE - AN OPPORTUNITY FOR ...

    African Journals Online (AJOL)

    Review of Medscheme's administrative databases to study ... management of a wrist fracture between 1995 and 1998, and ... reviewed dual-energy ... from three general practices in the UK. ... and Torgerson6 estimated the total cost of treating osteoporotic .... us adults from fHANES Ill. / Bone Miner Res 1997; U, 1761-1768.

  17. Radiographic abnormalities of the wrist in adult-onset still disease: Comparison with juvenile chronic arthritis and rheumatoid arthritis

    International Nuclear Information System (INIS)

    Bjorkengren, A.G.; Pathria, M.N.; Terkeltaub, R.; Esdaile, J.; Weisman, M.; Sartoris, D.J.; Resnick, D.

    1987-01-01

    Pericapitate involvement of the wrist has been described as characteristic of adult-onset Still disease, a relatively rare disorder that is often diagnosed by exclusion after extensive and frequently invasive tests. To evaluate the diagnostic value of carpal radiography in cases of adult-onset Still disease, a retrospective blinded analysis of 48 patients, 16 each with adult-onset Still disease, juvenile chronic arthritis, and rheumatoid arthritis, was performed. Pericapitate articular alterations without radiocarpal involvement were found to be frequent in the setting of adult-onset Still disease but distinctly unusual among patients with rheumatoid arthritis. In juvenile chronic arthritis, severe pericapitate involvement was frequent, but generally occurred in conjunction with radiocarpal joint abnormalities

  18. Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist?

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume; Sørensen, Allan Ibsen

    2013-01-01

    -generation total wrist arthroplasty was used as a salvage procedure for wrists with severe arthritis due to traumatic causes. The data were prospectively recorded in a web-based registry. Seven centers participated. Thirty-five cases had a minimum follow-up time of 2 years. Average follow-up was 39 (24-96) months...... procedure and gives results that are comparable to those obtained in rheumatoid cases. Level IV Case series....

  19. Social anxiety disorder diagnostic criteria perform equally across age, comorbid diagnosis, and performance/interaction subtypes.

    Science.gov (United States)

    Crome, Erica; Baillie, Andrew

    2015-01-01

    The prevalence of social anxiety disorder (SAD) is frequently higher in younger age groups and people with other anxiety or mood disorders; however, it is unclear whether these groups have a higher risk for developing SAD or are simply more likely to endorse diagnostic criteria than other people with similar levels of social anxiety. Explicitly testing the assumption all people respond to structured diagnostic interviews in comparable ways (measurement invariance) is essential in ensuring systematic response biases do not create spurious group differences. This research aims to systematically test whether age, comorbidity status, or types of social fears affect responses to a structured diagnostic interview. Responses from 1755 participants in a large-scale survey of mental health in Australia screening into the social phobia/SAD section of the Composite International Diagnostic Interview were used. Three series of multigroup confirmatory factor analyses for categorical data systematically tested for increasingly strict levels of measurement invariance. Overall, patterns of responding to diagnostic criteria were comparable across the groups, supporting assumptions of measurement invariance. Establishment of invariance supports the interpretation of differences between age, comorbidity status, and types of social situations feared as genuine differences in experience as opposed to measurement biases.

  20. Study on Fault Diagnostics of a Turboprop Engine Using Inverse Performance Model and Artificial Intelligent Methods

    Science.gov (United States)

    Kong, Changduk; Lim, Semyeong

    2011-12-01

    Recently, the health monitoring system of major gas path components of gas turbine uses mostly the model based method like the Gas Path Analysis (GPA). This method is to find quantity changes of component performance characteristic parameters such as isentropic efficiency and mass flow parameter by comparing between measured engine performance parameters such as temperatures, pressures, rotational speeds, fuel consumption, etc. and clean engine performance parameters without any engine faults which are calculated by the base engine performance model. Currently, the expert engine diagnostic systems using the artificial intelligent methods such as Neural Networks (NNs), Fuzzy Logic and Genetic Algorithms (GAs) have been studied to improve the model based method. Among them the NNs are mostly used to the engine fault diagnostic system due to its good learning performance, but it has a drawback due to low accuracy and long learning time to build learning data base if there are large amount of learning data. In addition, it has a very complex structure for finding effectively single type faults or multiple type faults of gas path components. This work builds inversely a base performance model of a turboprop engine to be used for a high altitude operation UAV using measured performance data, and proposes a fault diagnostic system using the base engine performance model and the artificial intelligent methods such as Fuzzy logic and Neural Network. The proposed diagnostic system isolates firstly the faulted components using Fuzzy Logic, then quantifies faults of the identified components using the NN leaned by fault learning data base, which are obtained from the developed base performance model. In leaning the NN, the Feed Forward Back Propagation (FFBP) method is used. Finally, it is verified through several test examples that the component faults implanted arbitrarily in the engine are well isolated and quantified by the proposed diagnostic system.

  1. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Boesen, Mikael; Jensen, Karl Erik; Torp-Pedersen, Søren

    2007-01-01

    OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg...... with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased...

  2. Reproducibility of wrist home blood pressure measurement with position sensor and automatic data storage

    Directory of Open Access Journals (Sweden)

    Nickenig Georg

    2009-05-01

    Full Text Available Abstract Background Wrist blood pressure (BP devices have physiological limits with regards to accuracy, therefore they were not preferred for home BP monitoring. However some wrist devices have been successfully validated using etablished validation protocols. Therefore this study assessed the reproducibility of wrist home BP measurement with position sensor and automatic data storage. Methods To compare the reproducibility of three different(BP measurement methods: 1 office BP, 2 home BP (Omron wrist device HEM- 637 IT with position sensor, 3 24-hour ambulatory BP(24-h ABPM (ABPM-04, Meditech, Hunconventional sphygmomanometric office BP was measured on study days 1 and 7, 24-h ABPM on study days 7 and 14 and home BP between study days 1 and 7 and between study days 8 and 14 in 69 hypertensive and 28 normotensive subjects. The correlation coeffcient of each BP measurement method with echocardiographic left ventricular mass index was analyzed. The schedule of home readings was performed according to recently published European Society of Hypertension (ESH- guidelines. Results The reproducibility of home BP measurement analyzed by the standard deviation as well as the squared differeces of mean individual differences between the respective BP measurements was significantly higher than the reproducibility of office BP (p Conclusion The short-term reproducibility of home BP measurement with the Omron HEM-637 IT wrist device was superior to the reproducibility of office BP and 24- h ABPM measurement. Furthermore, home BP with the wrist device showed similar correlations to targed organ damage as recently reported for upper arm devices. Although wrist devices have to be used cautious and with defined limitations, the use of validated devices with position sensor according to recently recommended measurement schedules might have the potential to be used for therapy monitoring.

  3. Effect of radiologists' diagnostic work-up volume on interpretive performance.

    Science.gov (United States)

    Buist, Diana S M; Anderson, Melissa L; Smith, Robert A; Carney, Patricia A; Miglioretti, Diana L; Monsees, Barbara S; Sickles, Edward A; Taplin, Stephen H; Geller, Berta M; Yankaskas, Bonnie C; Onega, Tracy L

    2014-11-01

    To examine radiologists' screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. In an institutional review board-approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [ FPR false-positive rate ], and cancer detection rate [ CDR cancer detection rate ]). Logistic regression was used to assess the association between the volume of recalled screening mammograms ("own" mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and "any" mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0-50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0-50 mammograms, 32% performed the work-up for 51-125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity (P = .039), FPR false-positive rate (P = .004), and CDR cancer detection rate (P women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant

  4. Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

    Science.gov (United States)

    Anderson, Melissa L.; Smith, Robert A.; Carney, Patricia A.; Miglioretti, Diana L.; Monsees, Barbara S.; Sickles, Edward A.; Taplin, Stephen H.; Geller, Berta M.; Yankaskas, Bonnie C.; Onega, Tracy L.

    2014-01-01

    Purpose To examine radiologists’ screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. Materials and Methods In an institutional review board–approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [FPRfalse-positive rate], and cancer detection rate [CDRcancer detection rate]). Logistic regression was used to assess the association between the volume of recalled screening mammograms (“own” mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and “any” mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Results Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0–50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0–50 mammograms, 32% performed the work-up for 51–125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity (P = .039), FPRfalse-positive rate (P = .004), and CDRcancer detection rate (P work-ups for any radiologist yielded significant increases in FPRfalse-positive rate (P = .011) and CDRcancer detection rate (P

  5. Performance Evaluation of Commercial Dengue Diagnostic Tests for Early Detection of Dengue in Clinical Samples

    Directory of Open Access Journals (Sweden)

    Tuan Nur Akmalina Mat Jusoh

    2017-01-01

    Full Text Available The shattering rise in dengue virus infections globally has created a need for an accurate and validated rapid diagnostic test for this virus. Rapid diagnostic test (RDT and reverse transcription-polymerase chain reaction (RT-PCR diagnostic detection are useful tools for diagnosis of early dengue infection. We prospectively evaluated the diagnostic performance of nonstructural 1 (NS1 RDT and real-time RT-PCR diagnostic kits in 86 patient serum samples. Thirty-six samples were positive for dengue NS1 antigen while the remaining 50 were negative when tested with enzyme-linked immunosorbent assay (ELISA. Commercially available RDTs for NS1 detection, RTK ProDetect™, and SD Bioline showed high sensitivity of 94% and 89%, respectively, compared with ELISA. GenoAmp® Trioplex Real-Time RT-PCR and RealStar® Dengue RT-PCR tests presented a comparable kappa agreement with 0.722. The result obtained from GenoAmp® Real-Time RT-PCR Dengue test showed that 14 samples harbored dengue virus type 1 (DENV-1, 8 samples harbored DENV-2, 2 samples harbored DENV-3, and 1 sample harbored DENV-4. 1 sample had a double infection with DENV-1 and DENV-2. The NS1 RDTs and real-time RT-PCR tests were found to be a useful diagnostic for early and rapid diagnosis of acute dengue and an excellent surveillance tool in our battle against dengue.

  6. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    International Nuclear Information System (INIS)

    Golding, Lauren P.; Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn; Gyr, Bettina M.; Gardner, Alison

    2015-01-01

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  7. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    Energy Technology Data Exchange (ETDEWEB)

    Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

    2015-08-15

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  8. MR Imaging and US of the Wrist Tendons.

    Science.gov (United States)

    Plotkin, Benjamin; Sampath, Srihari C; Sampath, Srinath C; Motamedi, Kambiz

    2016-10-01

    The tendons of the wrist are commonly symptomatic. They can be injured, infected, or inflamed. Magnetic resonance imaging and ultrasonography are useful tools for evaluating the wrist. Pathologic conditions of the wrist tendons include de Quervain tenosynovitis, extensor carpi ulnaris tendinopathy, rheumatoid tenosynovitis, infectious synovitis, tendon tears, hydroxyapatite deposition disease, intersection syndrome, tenosynovial giant cell tumor, and fibroma of the tendon sheath. In this article, we review the normal appearance of the wrist tendons, discuss relevant anatomy, and give an overview of common pathologic conditions affecting the wrist tendons. Online supplemental material is available for this article. © RSNA, 2016.

  9. Performance of diagnostic mammography differs in the United States and Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Geller, Berta M; Gard, Charlotte C

    2010-01-01

    in the United States and Denmark. The performance of 93,585 diagnostic mammograms from 180 facilities contributing data to the US Breast Cancer Surveillance Consortium (BCSC) from 1999 to 2001 was compared to that of all 51,313 diagnostic mammograms performed at Danish clinics in 2000. We used the imaging...... workup's final assessment to determine sensitivity, specificity and an estimate of accuracy: area under the receiver-operating characteristics (ROCs) curve (AUC). Diagnostic mammography had slightly higher sensitivity in the United States (85%) than in Denmark (82%). In contrast, it had higher...... specificity in Denmark (99%) than in the United States (93%). The AUC was high in both countries: 0.91 in United States and 0.95 in Denmark. Denmark's higher accuracy may result from supplementary ultrasound examinations, which are provided to 74% of Danish women but only 37% to 52% of US women. In addition...

  10. Systematic reviews of diagnostic tests in endocrinology: an audit of methods, reporting, and performance.

    Science.gov (United States)

    Spencer-Bonilla, Gabriela; Singh Ospina, Naykky; Rodriguez-Gutierrez, Rene; Brito, Juan P; Iñiguez-Ariza, Nicole; Tamhane, Shrikant; Erwin, Patricia J; Murad, M Hassan; Montori, Victor M

    2017-07-01

    Systematic reviews provide clinicians and policymakers estimates of diagnostic test accuracy and their usefulness in clinical practice. We identified all available systematic reviews of diagnosis in endocrinology, summarized the diagnostic accuracy of the tests included, and assessed the credibility and clinical usefulness of the methods and reporting. We searched Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from inception to December 2015 for systematic reviews and meta-analyses reporting accuracy measures of diagnostic tests in endocrinology. Experienced reviewers independently screened for eligible studies and collected data. We summarized the results, methods, and reporting of the reviews. We performed subgroup analyses to categorize diagnostic tests as most useful based on their accuracy. We identified 84 systematic reviews; half of the tests included were classified as helpful when positive, one-fourth as helpful when negative. Most authors adequately reported how studies were identified and selected and how their trustworthiness (risk of bias) was judged. Only one in three reviews, however, reported an overall judgment about trustworthiness and one in five reported using adequate meta-analytic methods. One in four reported contacting authors for further information and about half included only patients with diagnostic uncertainty. Up to half of the diagnostic endocrine tests in which the likelihood ratio was calculated or provided are likely to be helpful in practice when positive as are one-quarter when negative. Most diagnostic systematic reviews in endocrine lack methodological rigor, protection against bias, and offer limited credibility. Substantial efforts, therefore, seem necessary to improve the quality of diagnostic systematic reviews in endocrinology.

  11. Diagnostic performance of traditional hepatobiliary biomarkers of drug-induced liver injury in the rat.

    Science.gov (United States)

    Ennulat, Daniela; Magid-Slav, Michal; Rehm, Sabine; Tatsuoka, Kay S

    2010-08-01

    Nonclinical studies provide the opportunity to anchor biochemical with morphologic findings; however, liver injury is often complex and heterogeneous, confounding the ability to relate biochemical changes with specific patterns of injury. The aim of the current study was to compare diagnostic performance of hepatobiliary markers for specific manifestations of drug-induced liver injury in rat using data collected in a recent hepatic toxicogenomics initiative in which rats (n = 3205) were given 182 different treatments for 4 or 14 days. Diagnostic accuracy of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbili), serum bile acids (SBA), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), total cholesterol (Chol), and triglycerides (Trig) was evaluated for specific types of liver histopathology by Receiver Operating Characteristic (ROC) analysis. To assess the relationship between biochemical and morphologic changes in the absence of hepatocellular necrosis, a second ROC analysis was performed on a subset of rats (n = 2504) given treatments (n = 152) that did not cause hepatocellular necrosis. In the initial analysis, ALT, AST, Tbili, and SBA had the greatest diagnostic utility for manifestations of hepatocellular necrosis and biliary injury, with comparable magnitude of area under the ROC curve and serum hepatobiliary marker changes for both. In the absence of hepatocellular necrosis, ALT increases were observed with biochemical or morphologic evidence of cholestasis. In both analyses, diagnostic utility of ALP and GGT for biliary injury was limited; however, ALP had modest diagnostic value for peroxisome proliferation, and ALT, AST, and total Chol had moderate diagnostic utility for phospholipidosis. None of the eight markers evaluated had diagnostic value for manifestations of hypertrophy, cytoplasmic rarefaction, inflammation, or lipidosis.

  12. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon

    2015-01-01

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  13. Diagnostic performance of 64-slice multidetector coronary computed tomographic angiography in women.

    Science.gov (United States)

    Jug, Borut; Gupta, Mohit; Papazian, Jenny; Li, Dong; Tsang, Janet; Bhatia, Harpreet; Karlsberg, Ronald; Budoff, Matthew

    2012-12-01

    Diagnostic approach to chest pain in women is challenging, but still under-investigated. The purpose of this study was to assess the diagnostic performance of 64-slice multidetector coronary computed tomographic angiography (CCTA) in women with chest pain. We included 606 patients--255 women and 351 men (mean age 61 ± 12 years for both)--who had been referred for a CCTA and an invasive coronary angiography (diagnostic standard) because of chest pain, either as part of clinical work-up in two urban medical centers or as part of the multicenter ACCURACY trial. On a patient-based model, the sensitivity, specificity, and positive predictive value (PPV) and negative predictive value to detect ≥50% and ≥70% stenosis were 98%, 84%, 87%, and 97% and 96%, 83%, 77%, and 97%, respectively, for women and 97%, 83%, 89%, and 95% and 94%, 91%, 90%, and 94%, respectively, for men. There were no statistically significant differences between men and women in diagnostic performance measures except for the PPV of detecting a ≥70% stenosis (P = .007). In women with chest pain, 64-slice multidetector CCTA is at least as sensitive and specific as in men. Our findings suggest that CCTA is a promising diagnostic tool for timely detection and/or exclusion of CAD in symptomatic intermediate-risk female populations.

  14. Towards Modernizing the Characterization of Shock and Detonation Physics Performance via Novel Diagnostics and Tests

    Science.gov (United States)

    Salyer, Terry

    2017-06-01

    For the bulk of detonation performance experiments, a fairly basic set of diagnostic techniques has evolved as the standard for acquiring the necessary measurements. Gold standard techniques such as pin switches and streak cameras still produce the high-quality data required, yet much room remains for improvement with regard to ease of use, cost of fielding, breadth of data, and diagnostic versatility. Over the past several years, an alternate set of diagnostics has been under development to replace many of these traditional techniques. Pulse Correlation Reflectometry (PCR) is a capable substitute for pin switches with the advantage of obtaining orders of magnitude more data at a small fraction of the cost and fielding time. Spectrally Encoded Imaging (SEI) can replace most applications of streak camera with the advantage of imaging surfaces through a single optical fiber that are otherwise optically inaccessible. Such diagnostics advance the measurement state of the art, but even further improvements may come through revamping the standardized tests themselves such as the copper cylinder expansion test. At the core of this modernization, the aforementioned diagnostics play a significant role in revamping and improving the standard test suite for the present era. This research was performed under the auspices of the United States Department of Energy.

  15. Low cut-off values increase diagnostic performance of protein S assays

    NARCIS (Netherlands)

    Mulder, Rene; ten Kate, Min Ki; Kluin-Nelemans, Hanneke C.; Mulder, Andre B.

    Conflicting data have been reported on the accuracy of protein S (PS) assays for detection of hereditary PS deficiency. In this study we assessed the diagnostic performance of two total PS antigen assays, four free PS assays and three PS activity assays in a group of 28 heterozygous carriers of

  16. Development of high performance Schottky barrier diode and its application to plasma diagnostics

    International Nuclear Information System (INIS)

    Fujita, Junji; Kawahata, Kazuo; Okajima, Shigeki

    1993-10-01

    At the conclusion of the Supporting Collaboration Research on 'Development of High Performance Detectors in the Far Infrared Range' carried out from FY1990 to FY1992, the results of developing Schottky barrier diode and its application to plasma diagnostics are summarized. Some remarks as well as technical know-how for the correct use of diodes are also described. (author)

  17. Diagnostic Utility of the Social Skills Improvement System Performance Screening Guide

    Science.gov (United States)

    Krach, S. Kathleen; McCreery, Michael P.; Wang, Ye; Mohammadiamin, Houra; Cirks, Christen K.

    2017-01-01

    Researchers investigated the diagnostic utility of the Social Skills Improvement System: Performance Screening Guide (SSIS-PSG). Correlational, regression, receiver operating characteristic (ROC), and conditional probability analyses were run to compare ratings on the SSIS-PSG subscales of Prosocial Behavior, Reading Skills, and Math Skills, to…

  18. Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists

    International Nuclear Information System (INIS)

    Chang, Chih-Chen; Wong, Yon-Cheong; Wu, Cheng-Hsien; Chen, Huan-Wu; Wang, Li-Jen; Lee, Yu-Hsien; Wu, Patricia Wanping; Irama, Wiwan; Chen, Wei Yuan; Chang, Chee-Jen

    2016-01-01

    Low-dose computed tomography (LDCT) techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed. To compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT) and contrast-enhanced standard dose CT (CE-SDCT) for acute appendicitis among attending and resident radiologists. This retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC) curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI) subgroups and noise using independent T test. Diagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05) for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically signifi@@cant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018) on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not significantly related to BMI or noise. Attending radiologists

  19. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Gideon, P; Sørensen, K

    1995-01-01

    MRI-scores of synovial membrane hypertrophy and bone erosions of the RA-wrist are introduced. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) and conventional radiography (CR) of the wrist were performed in 16 patients with rheumatoid arthritis (RA) and 3 healthy controls. A MRI...

  20. Architectures for wrist-worn energy harvesting

    Science.gov (United States)

    Rantz, R.; Halim, M. A.; Xue, T.; Zhang, Q.; Gu, L.; Yang, K.; Roundy, S.

    2018-04-01

    This paper reports the simulation-based analysis of six dynamical structures with respect to their wrist-worn vibration energy harvesting capability. This work approaches the problem of maximizing energy harvesting potential at the wrist by considering multiple mechanical substructures; rotational and linear motion-based architectures are examined. Mathematical models are developed and experimentally corroborated. An optimization routine is applied to the proposed architectures to maximize average power output and allow for comparison. The addition of a linear spring element to the structures has the potential to improve power output; for example, in the case of rotational structures, a 211% improvement in power output was estimated under real walking excitation. The analysis concludes that a sprung rotational harvester architecture outperforms a sprung linear architecture by 66% when real walking data is used as input to the simulations.

  1. Poor academic performance: A perspective of final year diagnostic radiography students

    International Nuclear Information System (INIS)

    Gqweta, Ntokozo

    2012-01-01

    Introduction: A study was conducted on final year diagnostic radiography students at a University of Technology in Durban. The aim of the study was to investigate the final year diagnostic radiography students' opinions and views on academic performance in order to inform teaching and learning methods. The objectives were: •To explore the students' opinions regarding poor performance. •To identify strategies to improve academic performance. Method: A qualitative, interpretive approach was used to explain and understand the students' lived experiences of their academic performances. A short open ended questionnaire was administered to a cohort of final diagnostic radiography students following feedback on a written assessment. Questionnaire responses were then manually captured and analyzed. Results: Five (5) themes were identified that could possibly be associated with poor academic performance. These themes were, poor preparation, lack of independent study, difficulty in understanding learning content and misinterpretation of assessment questions, inefficient studying techniques as well as perceived improvement strategies. Conclusion: Students identified their inadequate preparation and the lack of dedicated independent studying as the main reasons for poor performance. Students preferred to be taught in an assessment oriented manner. However their identified improvement strategies were aligned with the learner centred approach.

  2. Diagnostic accuracy of mammography readers and their memory performance have no correlation with each other

    International Nuclear Information System (INIS)

    Kok, P.; Cawson, J.N.; Mercuri, V.; Pitman, A.G.; Gledhill, S.; Shnier, D.; Taft, R.; Zentner, L.

    2010-01-01

    Full text: The study aims to determine if any association exists between visual memory performance and diagnostic accuracy performance in a group of radiologist mammogram readers. Materials and Methods: One hundred proven mammograms (23 with cancers) were grouped into 5 sets of 20 cases, with sets being of equal difficulty. Pairs of sets were presented in 5 reads (40 cases per read, order random) to a panel of 8 radiologist readers (either present or past screening readers, with experience range from 20 years). The readers were asked to either 'clear' or 'call back' cases depending on need for further workup, and at post-baseline reads to indicate whether each case was 'new' or 'old' (i .e. remembered from prior read). Two sets were presented only at baseline (40 cases per reader), and were used to calculate the reader's false recollection rate. Three sets were repeated post-baseline once or twice (100 cases per reader). Reading conditions were standardised. Results: Memory performance differed markedly between readers. The number of correctly remembered cases (of 100 'old' cases) had a median of 10.5 and range of 0-58. The observed number of false recollections (of 40 'totally new' cases) had a median of 2 and range of 0-17. Diagnostic performance measures were mean (range): sensitivity 0.68 (0.54-0.81); specificity 0.82 (0.74-0.91); positive predictive value (PPV) 0.55 (0.500.65); negative predictive value (NPV) 0.89 (0.86-0.93) and accuracy 0.78 (0.76-0.83). Confidence intervals (CIs; 95%) for each reader overlapped for all the diagnostic parameters, indicating a lack of statistically significant difference between the readers at the 5% level. The most sensitive and the most specific reader showed a trend away from each other on sensitivity, specificity, NPV and PPV; their accuracies were 0.76 and 0.82, respectively, and their accuracy 95% CIs overlapped considerably. Correlation analysis by reader showed no association between observed memory performance and

  3. Diagnostic Performance of Narrow Band Imaging for Laryngeal Cancer: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Sun, Changling; Han, Xue; Li, Xiaoying; Zhang, Yayun; Du, Xiaodong

    2017-04-01

    Objective To evaluate the performance of narrow band imaging (NBI) for the diagnosis of laryngeal cancer and to compare the diagnostic value of NBI with that of white light endoscopy. Data Sources PubMed, Embase, Cochrane Library, and CNKI databases. Review Methods Data analyses were performed with Meta-DiSc. The updated Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality and potential bias. Publication bias was assessed with the Deeks's asymmetry test. The protocol used in this article has been published on PROSPERO and is in accordance with the PRISMA checklist. The registry number for this study is CRD42015025866. Results Six studies including 716 lesions were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio for the NBI diagnosis of laryngeal cancer were 0.94 (95% confidence interval [95% CI]: 0.91-0.96), 0.89 (95% CI: 0.85-0.92), and 142.12 (95% CI: 46.42-435.15), respectively, and the area under receiver operating characteristics curve was 0.97. Among the 6 studies, 3 evaluated the diagnostic value of white light endoscopy, with a sensitivity of 0.81 (95% CI: 0.76-0.86), a specificity of 0.92 (95% CI: 0.88-0.95), and a diagnostic odds ratio of 33.82 (95% CI: 14.76-77.49). The evaluation of heterogeneity, calculated per the diagnostic odds ratio, gave an I 2 of 66%. No marked publication bias ( P = .84) was detected in this meta-analysis. Conclusion The sensitivity of NBI is superior to white light endoscopy, and the potential value of NBI needs to be validated in future studies.

  4. Decoupling the Wrist: A Cadaveric Experiment Examining Wrist Kinematics Following Midcarpal Fusion and Scaphoid Excision

    Science.gov (United States)

    Nichols, Jennifer A.; Bednar, Michael S.; Havey, Robert M.; Murray, Wendy M.

    2016-01-01

    At the wrist, kinematic coupling (the relationship between flexion-extension and radial-ulnar deviation) facilitates function. Although the midcarpal joint is critical for kinematic coupling, many surgeries, such as four-corner fusion (4CF) and scaphoid-excision four-corner fusion (SE4CF), modify the midcarpal joint. This study examines how 4CF and SE4CF influence kinematic coupling by quantifying wrist axes of rotation. Wrist axes of rotation were quantified in eight cadaveric specimens using an optimization algorithm, which fit a two-revolute joint model to experimental data. In each specimen, data measuring the motion of the third metacarpal relative to the radius was collected for three conditions (nonimpaired, 4CF, SE4CF). The calculated axes of rotation were compared using spherical statistics. The angle between the axes of rotation was used to assess coupling, as the nonimpaired wrist has skew axes (i.e., angle between axes approximately 60°). Following 4CF and SE4CF, the axes are closer to orthogonal than those of the nonimpaired wrist. The mean angle (±95 percent confidence interval) between the axes was 92.6° ± 25.2° and 99.8° ± 22.0° for 4CF and SE4CF, respectively. The axes of rotation defined in this study can be used to define joint models, which will facilitate more accurate computational and experimental studies of these procedures. PMID:27705062

  5. ELBOW AND WRIST INJURIES IN SPORTS

    Science.gov (United States)

    Marmor, Leonard; Bechtol, Charles O.

    1960-01-01

    Any disabling injury of the elbow or wrist should be studied roentgenographically for evidence of fracture which may not be otherwise evident but which may cause permanent disability unless the joint is immobilized for healing. “Tennis elbow” may be treated with physical therapy and analgesic injection but may require splinting or tendon stripping. Elbow sprain can occur in the growing epiphysis but is rare in adults. A jarring fall on the hand may cause fracture or dislocation at the elbow. Full extension of the joint should be restored gradually by active exercise rather than passive or forcible stretching. Fracture at the head of the radius may cause joint hemorrhage with severe pain which can be relieved by aspiration. A displacing fracture at the head of the radius requires removal of the head to prevent arthritic changes. Myositis ossificans contraindicates operation until after it has cleared. Healing of wrist fractures may be facilitated by exercise of the shoulder and elbow while the wrist is still in a cast. Fractures of the navicular bone are difficult to detect even roentgenographically and splinting may have to be done on clinical evidence alone. PMID:14421374

  6. Diagnostic performance of increased overjet in Class II division 1 malocclusion and incisor trauma.

    Science.gov (United States)

    Baccetti, Tiziano; Giuntini, Veronica; Vangelisti, Andrea; Darendeliler, M Ali; Franchi, Lorenzo

    2010-01-01

    The objectives of this study were: 1) to evaluate the associations between an increased overjet (IO) and other dentoskeletal characteristics of Class II division 1 malocclusions in the mixed dentition; 2) to assess whether Class II division 1 malocclusions or rather an increased overjet per se is a risk factor for upper incisor trauma (UIT). A sample of 900 mixed dentition subjects, was observed by clinical inspection, analysis of dental casts, and lateral cephalograms. The diagnostic performance of IO (overjet ≥ 7 mm) was evaluated in relation to other Class II dentoskeletal features (Class II molar and canine relationships, and skeletal Class II relationships). Secondly, the diagnostic performance of IO and of the other Class II dentoskeletal components was tested with regard to the prevalence of UIT. Diagnostic performance was assessed by odds ratio and positive likelihood ratio. The diagnostic performance of IO with regard to the other dentoskeletal components of Class II malocclusions was not significant. The only Class II features associated significantly with an increased risk of UIT was IO. When used as an isolated occlusal feature, IO is not a valid diagnostic indicator for Class II division 1 malocclusions. An increased overjet per se, and not Class II malocclusions, appears to be a significant risk factor for UIT. These findings recommend discrimination between clinical conditions showing an isolated IO from comprehensive Class II malocclusions during diagnosis, analysis of treatment outcomes, and evaluation of the risk of upper incisor trauma. Copyright © 2010 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.

  7. Diagnostic accuracy of 201Tl SPECT·MRI in brain diseases and inter-reader variance of diagnostic performance

    International Nuclear Information System (INIS)

    Machida, Kikuo; Honda, Norinari; Matsumoto, Toru

    1996-01-01

    Fifteen-four studies of 201 Tl brain tumor SPECT were independently interpreted by 9 nuclear medicine physicians with and without reference magnetic resonance images in 2 separate sessions to define an effect of referring images, and inter-observer variations. The physicians were requested to detect foci of abnormal deposits, and to discriminate whether they were malignant or not according to 5-grade scaling of subjective diagnostic confidence. Receiver-operating characteristics (ROC) analysis was performed. Mean sensitivity for presence of lesions (SFP), and sensitivity and specificity for malignancy of 2 01 Tl SPECT were 84, and 53 and 55%, which were changed to 94 and 74 and 55% after referring to the MR images. The SFP was significantly improved (p 201 Tl brain tumor SPECT has moderate sensitivity and specificity for malignancy, which is not improved by addition of anatomical reference images, that additional MR images reduce inter-observer variation of confidence on lesion presence, and that SPECT localization of lesions has great inter-observer variations. (author)

  8. Diagnostic performance and color overlay pattern in shear wave elastography (SWE) for palpable breast mass.

    Science.gov (United States)

    Park, Jiyoon; Woo, Ok Hee; Shin, Hye Seon; Cho, Kyu Ran; Seo, Bo Kyoung; Kang, Eun Young

    2015-10-01

    The purpose of this study is to evaluate the diagnostic performance of SWE in palpable breast mass and to compare with color overlay pattern in SWE with conventional US and quantitative SWE for assessing palpable breast mass. SWE and conventional breast US were performed in 133 women with 156 palpable breast lesions (81 benign, 75 malignant) between August 2013 to June 2014. Either pathology or periodic imaging surveillance more than 2 years was a reference standard. Existence of previous image was blinded to performing radiologists. US BI-RADS final assessment, qualitative and quantitative SWE measurements were evaluated. Diagnostic performances of grayscale US, SWE and US combined to SWE were calculated and compared. Correlation between pattern classification and quantitative SWE was evaluated. Both color overlay pattern and quantitative SWE improved the specificity of conventional US, from 81.48% to 96.30% (p=0.0005), without improvement in sensitivity. Color overlay pattern was significantly related to all quantitative SWE parameters and malignancy rate (pbreast mass, conventional US combine to SWE improves specificity and reduces the number of biopsies that ultimately yield a benign result. Color overlay pattern classification is more quick and easy and may represent quantitative SWE measurements with similar diagnostic performances. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis.

    Science.gov (United States)

    van Dijk, R; van Assen, M; Vliegenthart, R; de Bock, G H; van der Harst, P; Oudkerk, M

    2017-11-27

    Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the 'Quality Assessment of Diagnostic Accuracy Studies Tool' (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory

  10. The diagnostic performance of chronologic age in the assessment of skeletal maturity.

    Science.gov (United States)

    Baccetti, Tiziano; Franchi, Lorenzo; De Toffol, Laura; Ghiozzi, Bruno; Cozza, Paola

    2006-01-01

    The aim of this study was to analyze the relationship between chronologic age the and individual skeletal maturity as assessed by means of the cervical vertebral maturation (CVM) method during the circumpubertal period. The evaluated sample of 600 subjects consisted of 100 subjects (50 males and 50 females) for each of 6 age groups, from 9 years through 14 years of age. Individual skeletal maturity for all subjects was determined by using the CVM method. The relationship between chronologic age and the most prevalent CVM stage at each age group was evaluated statistically by means of indicators of diagnostic test performance that specify the ability of a diagnostic test to identify a condition. The diagnostic performance of chronologic age for the detection of the onset of the adolescent peak in skeletal maturation was very low both in males and in females. In male subjects, the chronologic age of 9 years +/- 6 months presented with strong diagnostic power for the identification of a pre-pubertal stage in skeletal maturation. In female subjects, the chronologic age of 14 years +/- 6 months corresponded with a strong probability of a postpubertal stage in skeletal maturation. In males, chronologic age can identify a pre-pubertal stage of skeletal development, and in females a post-pubertal stage. In both males and females, chronologic age cannot recognize the onset of the adolescent peak in skeletal maturation.

  11. A New Myohaptic Instrument to Assess Wrist Motion Dynamically

    Directory of Open Access Journals (Sweden)

    Mario Manto

    2010-04-01

    Full Text Available The pathophysiological assessment of joint properties and voluntary motion in neurological patients remains a challenge. This is typically the case in cerebellar patients, who exhibit dysmetric movements due to the dysfunction of cerebellar circuitry. Several tools have been developed, but so far most of these tools have remained confined to laboratories, with a lack of standardization. We report on a new device which combines the use of electromyographic (EMG sensors with haptic technology for the dynamic investigation of wrist properties. The instrument is composed of a drivetrain, a haptic controller and a signal acquisition unit. Angular accuracy is 0.00611 rad, nominal torque is 6 N·m, maximal rotation velocity is 34.907 rad/sec, with a range of motion of –1.0472 to +1.0472 rad. The inertia of the motor and handgrip is 0.004 kg·m². This is the first standardized myohaptic instrument allowing the dynamic characterization of wrist properties, including under the condition of artificial damping. We show that cerebellar patients are unable to adapt EMG activities when faced with an increase in damping while performing fast reversal movements. The instrument allows the extraction of an electrophysiological signature of a cerebellar deficit.

  12. A new myohaptic instrument to assess wrist motion dynamically.

    Science.gov (United States)

    Manto, Mario; Van Den Braber, Niels; Grimaldi, Giuliana; Lammertse, Piet

    2010-01-01

    The pathophysiological assessment of joint properties and voluntary motion in neurological patients remains a challenge. This is typically the case in cerebellar patients, who exhibit dysmetric movements due to the dysfunction of cerebellar circuitry. Several tools have been developed, but so far most of these tools have remained confined to laboratories, with a lack of standardization. We report on a new device which combines the use of electromyographic (EMG) sensors with haptic technology for the dynamic investigation of wrist properties. The instrument is composed of a drivetrain, a haptic controller and a signal acquisition unit. Angular accuracy is 0.00611 rad, nominal torque is 6 N·m, maximal rotation velocity is 34.907 rad/sec, with a range of motion of -1.0472 to +1.0472 rad. The inertia of the motor and handgrip is 0.004 kg·m2. This is the first standardized myohaptic instrument allowing the dynamic characterization of wrist properties, including under the condition of artificial damping. We show that cerebellar patients are unable to adapt EMG activities when faced with an increase in damping while performing fast reversal movements. The instrument allows the extraction of an electrophysiological signature of a cerebellar deficit.

  13. An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

    Science.gov (United States)

    Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo

    The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.

  14. 9 CFR 130.17 - User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or...

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for other veterinary... FEES USER FEES § 130.17 User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or at authorized sites. (a) User fees for veterinary diagnostics tests performed at the...

  15. 9 CFR 130.16 - User fees for veterinary diagnostic serology tests performed at NVSL (excluding FADDL) or at...

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for veterinary diagnostic serology tests performed at NVSL (excluding FADDL) or at authorized sites. 130.16 Section 130.16 Animals... USER FEES § 130.16 User fees for veterinary diagnostic serology tests performed at NVSL (excluding...

  16. Evaluation performance of diagnostic methods of intestinal parasitosis in school age children in Ethiopia.

    Science.gov (United States)

    Yimer, Mulat; Hailu, Tadesse; Mulu, Wondemagegn; Abera, Bayeh

    2015-12-26

    Although the sensitivity of Wet mount technique is questionable, it is the major diagnostic technique for routine diagnosis of intestinal parasitosis in Ethiopia. Therefore, the aim of this study was the evaluation performance of diagnostic methods of intestinal parasitosis in school age children in Ethiopia. A cross sectional study was conducted from May to June 2013. Single stool sample was processed for direct, Formol ether concentration (FEC) and Kato Katz methods. The sensitivity and negative predictive value (NPV) of diagnostic tests were calculated in terms of the "Gold" standard method (the combined result of the three methods altogether). A total of 422 school age children were participated in this study. The prevalence of intestinal parasites was high (74.6%) with Kato Katz technique. The sensitivity of Wet mount, FEC and Kato Katz tests against the Gold standard test was 48.9, 63.1 and 93.7%, respectively. Kato Katz technique revealed a better NPV 80.4 (80.1-80.6) as compared to the Wet mount (33.7%) and FEC techniques (41.3%). In this study, the Kato Katz technique outperformed the other two methods but the true values for sensitivity, specificity and diagnostic values are not known. Moreover, it is labor intensive and not easily accessible. Hence, it is preferable to use FEC technique to complement the Wet mount test.

  17. Simulated performance of the optical Thomson scattering diagnostic designed for the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Ross, J. S., E-mail: ross36@llnl.gov; Datte, P.; Divol, L.; Galbraith, J.; Hatch, B.; Landen, O.; Manuel, A. M.; Molander, W.; Moody, J. D.; Swadling, G. [Lawrence Livermore National Laboratory, Livermore, California 94551 (United States); Froula, D. H.; Katz, J. [Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623 (United States); Glenzer, S. H. [SLAC National Accelerator Laboratory, Menlo Park, California 94025 (United States); Kilkenny, J. [General Atomics, San Diego, California 92186 (United States); Montgomery, D. S. [Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States); Weaver, J. [Plasma Physics Division, Naval Research Laboratory, Washington, DC 20375 (United States)

    2016-11-15

    An optical Thomson scattering diagnostic has been designed for the National Ignition Facility to characterize under-dense plasmas. We report on the design of the system and the expected performance for different target configurations. The diagnostic is designed to spatially and temporally resolve the Thomson scattered light from laser driven targets. The diagnostic will collect scattered light from a 50 × 50 × 200 μm volume. The optical design allows operation with different probe laser wavelengths. A deep-UV probe beam (λ{sub 0} = 210 nm) will be used to Thomson scatter from electron plasma densities of ∼5 × 10{sup 20} cm{sup −3} while a 3ω probe will be used for plasma densities of ∼1 × 10{sup 19} cm{sup −3}. The diagnostic package contains two spectrometers: the first to resolve Thomson scattering from ion acoustic wave fluctuations and the second to resolve scattering from electron plasma wave fluctuations. Expected signal levels relative to background will be presented for typical target configurations (hohlraums and a planar foil).

  18. Diagnostic Performance of Mammographic Texture Analysis in the Differential Diagnosis of Benign and Malignant Breast Tumors.

    Science.gov (United States)

    Li, Zhiming; Yu, Lan; Wang, Xin; Yu, Haiyang; Gao, Yuanxiang; Ren, Yande; Wang, Gang; Zhou, Xiaoming

    2017-11-09

    The purpose of this study was to investigate the diagnostic performance of mammographic texture analysis in the differential diagnosis of benign and malignant breast tumors. Digital mammography images were obtained from the Picture Archiving and Communication System at our institute. Texture features of mammographic images were calculated. Mann-Whitney U test was used to identify differences between the benign and malignant group. The receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of texture features. Significant differences of texture features of histogram, gray-level co-occurrence matrix (GLCM) and run length matrix (RLM) were found between the benign and malignant breast group (P  .05). The AUROCs of imaging-based diagnosis, texture analysis, and imaging-based diagnosis combined with texture analysis were 0.873, 0.863, and 0.961, respectively. When imaging-based diagnosis was combined with texture analysis, the AUROC was higher than that of imaging-based diagnosis or texture analysis (P benign and malignant breast tumors. Furthermore, the combination of imaging-based diagnosis and texture analysis can significantly improve diagnostic performance. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ryan K.L.; Ng, Alex W.H.; Tong, Cina S.L.; Griffith, James F. [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince Of Wales Hospital, Shatin (China); Tse, W.L.; Wong, C.; Ho, P.C. [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince Of Wales Hospital, Shatin (China); The Chinese University of Hong Kong, Department of Orthopedics, Prince Of Wales Hospital, Shatin (China)

    2013-09-15

    This study compares the diagnostic performance of multidetector CT arthrography (CTA), conventional 3-T MR and MR arthrography (MRA) in detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist. Ten cadaveric wrists of five male subjects with an average age 49.6 years (range 26-59 years) were evaluated using CTA, conventional 3-T MR and MRA. We assessed the presence of scapholunate ligament (SLL), lunotriquetral ligament (LTL), and TFCC tears using a combination of conventional arthrography and arthroscopy as a gold standard. All images were evaluated in consensus by two musculoskeletal radiologists with sensitivity, specificity, and accuracy being calculated. Sensitivities/specificity/accuracy of CTA, conventional MRI, and MRA were 100 %/100 %/100 %, 66 %/86 %/80 %, 100 %/86 %/90 % for the detection of SLL tear, 100 %/80 %/90 %, 60 %/80 %/70 %, 100 %/80 %/90 % for the detection of LTL tear, and 100 %/100 %/100 %, 100 %/86 %/90 %, 100 %/100 %/100 % for the detection of TFCC tear. Overall CTA had the highest sensitivity, specificity, and accuracy among the three investigations while MRA performed better than conventional MR. CTA also had the highest sensitivity, specificity, and accuracy for identifying which component of the SLL and LTL was torn. Membranous tears of both SLL and LTL were better visualized than dorsal or volar tears on all three imaging modalities. Both CT and MR arthrography have a very high degree of accuracy for diagnosing tears of the SLL, LTL, and TFCC with both being more accurate than conventional MR imaging. (orig.)

  20. Effects of wrist tendon vibration on arm tracking in people poststroke.

    Science.gov (United States)

    Conrad, Megan O; Scheidt, Robert A; Schmit, Brian D

    2011-09-01

    The goal of this study was to evaluate the influence of wrist tendon vibration on a multijoint elbow/shoulder tracking task. We hypothesized that tendon vibration applied at the wrist musculature would improve upper arm tracking performance in chronic stroke survivors through increased, Ia-afferent feedback to the central nervous system (CNS). To test this hypothesis, 10 chronic stroke and 5 neurologically intact subjects grasped the handle of a planar robot as they tracked a target through a horizontal figure-8 pattern. A total of 36 trials were completed by each subject. During the middle trials, 70-Hz tendon vibration was applied at the wrist flexor tendons. Position, velocity, and electromyography data were evaluated to compare the quality of arm movements before, during, and after trials with concurrent vibration. Despite tracking a target that moved at a constant velocity, hand trajectories appeared to be segmented, displaying alternating intervals of acceleration and deceleration. Segments were identifiable in tangential velocity data as single-peaked, bell-shaped speed pulses. When tendon vibration was applied at the wrist musculature, stroke subjects experienced improved tracking performance in that hand path lengths and peak speed variability decreased, whereas movement smoothness increased. These performance improvements were accompanied by decreases in the muscle activity during movement. Possible mechanisms behind improved movement control in response to tendon vibration may include improved sensorimotor integration or improved cortical modulation of spinal reflex activity.

  1. POTENTIALITIES OF DIAGNOSTICS AND DIFFERENTIAL DIAGNOSTICS OF STOMACH DISEASES BY MEANS OF USAGE OF HIGH-PERFORMANCE BLOOD SERUM LIQUID CHROMATOGRAPHY

    Directory of Open Access Journals (Sweden)

    O.P. Alexeeva

    2008-12-01

    Full Text Available 62 patients with the endoscopically and morphologicallyverified diagnosis of the chronic gastritis, 89 patients with the morphologically verified diagnosis of stomach cancer and 43 healthy persons ages 23 to 54 years have been examined. Potentialities of the usage of high-performance blood serum liquid chromatography have been studied for the purpose of diagnostics and differential diagnostics of chronic gastritis and stomach cancer. Blood serum driedextract was investigated by means of"Milichrome A02"chromatograph (Novosibirsk, "Econova" joint-stock company. The chromatograms were treated by the multivahate cluster analysis with the formation of pathologic three-dimensional characteristic state notably differed from the healthy human image. Diagnostic sensitivity of chronic gastritis and stomach cancer acounts for accordingly 92% and 96%. Diagnostic accuracy of the method comes to 94%.

  2. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

    Directory of Open Access Journals (Sweden)

    Asem A. Al-Hiari

    2013-05-01

    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  3. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures

    Science.gov (United States)

    Mondelli, Mauro; Farioli, Andrea; Mattioli, Stefano; Aretini, Alessandro; Ginanneschi, Federica; Greco, Giuseppe; Curti, Stefania

    2016-01-01

    Objective To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales. Methods We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender. Results We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar. Conclusions Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study. PMID:27768728

  4. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures.

    Directory of Open Access Journals (Sweden)

    Mauro Mondelli

    Full Text Available To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS severity scales.We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC, sensitivity, specificity, and likelihood ratios were calculated separately by gender.We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively and males (AUC 0.91 and 0.82, respectively. Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively and males (AUC 0.84 and 0.76, respectively. The results of waist-hip-height ratio AUC were similar.Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study.

  5. Improving the diagnostic performance of lung scintigraphy in suspected pulmonary embolic disease

    International Nuclear Information System (INIS)

    Gleeson, F.V.; Turner, S.; Scarsbrook, A.F.

    2006-01-01

    Aim: to determine the effectiveness of a new imaging algorithm in the investigation of suspected pulmonary embolism (PE). Materials and methods: A new imaging algorithm for suspected PE was introduced following the installation of a multisection computed tomography (CT) machine at our institution. Before its installation, patients with suspected PE were evaluated with ventilation/perfusion (V/Q) scintigraphy. Subsequently, patients were triaged according to chest radiography (CR) and respiratory history to either lung scintigraphy or CT pulmonary angiography (CTPA). Patients with a normal CR and no history of lung disease were evaluated using perfusion (Q) scintigraphy [ventilation (V) scintigraphy was no longer performed]. Patients with an abnormal CR, asthma or chronic lung disease were evaluated using CTPA. All V/Q images in a continuous 3-year period before the introduction of the new imaging algorithm and all Q images performed in a 3-year period after its introduction were retrospectively reviewed. Imaging reports were categorized into normal, non-diagnostic (low or intermediate probability) or high probability for PE. Patients in the later group who subsequently underwent CTPA, were also reviewed. Results: After the policy change the percentage of normal scintigrams significantly increased (39 to 60%; p < 0.001). There was a non-significant increase in the percentage of high probability scintigrams (15 to 18%; p = 0.716). Overall the diagnostic yield of lung scintigraphy improved significantly (54 to 78%; p < 0.001). Conclusion: the diagnostic performance of lung scintigraphy can be improved by careful triage of patients to either Q scintigraphy or CTPA based on clinical history and CR findings. Q scintigraphy remains a valuable diagnostic test in the investigation of suspected PE in carefully selected patients

  6. MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study

    International Nuclear Information System (INIS)

    Ording Muller, Lil-Sofie; Boavida, Peter; Avenarius, Derk; Eldevik, Odd Petter; Damasio, Beatrice; Malattia, Clara; Lambot-Juhan, Karen; Tanturri, Laura; Owens, Catherine M.; Rosendahl, Karen

    2013-01-01

    Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease. We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5-15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI. No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001). Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children. (orig.)

  7. MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study

    Energy Technology Data Exchange (ETDEWEB)

    Ording Muller, Lil-Sofie [University Hospital North Norway, Department of Radiology, Tromsoe (Norway); Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Boavida, Peter [Homerton University Hospital, Department of Radiology, London (United Kingdom); Avenarius, Derk; Eldevik, Odd Petter [University Hospital North Norway, Department of Radiology, Tromsoe (Norway); Damasio, Beatrice [Ospedale Pediatrico Gaslini, Department of Radiology, Genoa (Italy); Malattia, Clara [Ospedale Pediatrico Gaslini, Department of Rhematology, Genoa (Italy); Lambot-Juhan, Karen [Hopital Necker Enfants Malades, Department of Radiology, Paris (France); Tanturri, Laura [Ospedale Pediatrico Bambino Gesu, Department of Radiology, Rome (Italy); Owens, Catherine M. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); UCL, Institute of Child Health, London (United Kingdom); Rosendahl, Karen [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); UCL, Institute of Child Health, London (United Kingdom); Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Department of Surgical Sciences, Bergen (Norway)

    2013-07-15

    Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease. We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5-15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI. No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001). Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children. (orig.)

  8. Prosthesis of the wrist-joint

    Energy Technology Data Exchange (ETDEWEB)

    Feldmeier, C.

    1983-02-25

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.

  9. Prosthesis of the wrist-joint

    International Nuclear Information System (INIS)

    Feldmeier, C.

    1983-01-01

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated. (orig.) [de

  10. Periprosthetic osteolysis after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume

    2014-01-01

    Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose...... of this study was to analyze the prevalence, location, and natural history of PPO following a TWA and to determine whether this was associated with prosthetic loosening. Patients and Methods We analyzed 44 consecutive cases in which a RE-MOTION TWA (Small Bone Innovations Inc., Morrisville, PA, USA) had been...

  11. Wrist-worn pervasive gaze interaction

    DEFF Research Database (Denmark)

    Hansen, John Paulin; Lund, Haakon; Biermann, Florian

    2016-01-01

    This paper addresses gaze interaction for smart home control, conducted from a wrist-worn unit. First we asked ten people to enact the gaze movements they would propose for e.g. opening a door or adjusting the room temperature. On basis of their suggestions we built and tested different versions...... selection. Their subjective evaluations were positive with regard to the speed of the interaction. We conclude that gaze gesture input seems feasible for fast and brief remote control of smart home technology provided that robustness of tracking is improved....

  12. Chest radiography with a shaped filter has no diagnostic advantage: Demonstration by observer performance tests

    International Nuclear Information System (INIS)

    Guilbeau, J.C.; Mazoyer, B.; Pruvost, P.; Verrey, B.; Grenier, P.

    1987-01-01

    The effectiveness of a shaped filter in improving the detection of mediastinal and retrocardiac abnormalities on 140-kV posteroanterior chest radiographs was measured by observer performance testing. The filtered and unfiltered radiographs of 50 patients were randomly selected from 1,000 radiographs obtained from 500 ambulatory or hospitalized patients and were independently read by five observers. Observer performance in detecting abnormalities in the central area was analyzed by receiver operating characteristic (ROC) techniques. The results indicate that the use of a filter has no significant diagnostic advantage, regardless of type or location of lesions over the mediastinum and the retrocardiac areas

  13. The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance.

    Science.gov (United States)

    Hanna, Tarek N; Zygmont, Matthew E; Peterson, Ryan; Theriot, David; Shekhani, Haris; Johnson, Jamlik-Omari; Krupinski, Elizabeth A

    2018-01-20

    The aim of this study was to assess the effect of overnight shifts (ONS) on radiologist fatigue, visual search pattern, and diagnostic performance. This experimental study was approved by the institutional review board. Twelve radiologists (five faculty members and seven residents) each completed two sessions: one during a normal workday ("not fatigued") and another in the morning after an ONS ("fatigued"). Each radiologist completed the Swedish Occupational Fatigue Inventory. During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. Viewing time, diagnostic confidence, and eye-tracking data were recorded. Swedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after ONS (P radiologists were more fatigued with worse diagnostic performance, a 45% increase in view time per case, a 60% increase in total gaze fixations, and a 34% increase in time to fixate on the fracture. The effects of fatigue were more pronounced in residents. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kluijfhout, Wouter P., E-mail: WPKluijfhout@gmail.com [Department of Surgery, University of California San Francisco (United States); Department of Surgery, University Medical Center Utrecht (Netherlands); Pasternak, Jesse D. [Department of Surgery, University Health Network Toronto (Canada); Beninato, Toni; Drake, Frederick Thurston; Gosnell, Jessica E.; Shen, Wen T.; Duh, Quan-Yang [Department of Surgery, University of California San Francisco (United States); Allen, Isabel E. [Department of Epidemiology and Biostatistics, University of California San Francisco (United States); Vriens, Menno R. [Department of Surgery, University Medical Center Utrecht (Netherlands); Keizer, Bart de [Department of Radiology, University Medical Center Utrecht (Netherlands); Hope, Thomas A. [Department of Radiology, University of California San Francisco (United States); Suh, Insoo [Department of Surgery, University of California San Francisco (United States)

    2017-03-15

    Highlights: • CT performs well in localizing pathological parathyroid glands. • Performance of CT is less in patients with inconclusive ultrasound and sestamibi. • Addition of a third contrast phase seems to have little added value. - Abstract: Abstract purpose: To perform a systematic review and meta-analysis of the sensitivity and positive predictive value (PPV) of CT for preoperative parathyroid localization in patients with primary hyperparathyroidism (pHPT), and subsequently compare the different protocols and their performance in different patient groups. Materials and methods: We performed a search of the Embase, Pubmed and Cochrane Library databases to identify studies published between January 1, 2000 and March 31, 2016 investigating the diagnostic value of CT for parathyroid localization in patients with biochemical diagnosis of pHPT. Performance of CT was expressed in sensitivity and PPV with pooled proportion using a random-effects model. Factors that could have affected the diagnostic performance were investigated by subgroup analysis. Results: Thirty-four studies evaluating a total of 2563 patients with non-familial pHPT who underwent CT localization and surgical resection were included. Overall pooled sensitivity of CT for localization of the pathological parathyroid(s) to the correct quadrant was 73% (95% CI: 69–78%), which increased to 81% (95% CI: 75–87%) for lateralization to the correct side. Subgroup analysis based on the number of contrast phases showed that adding a second contrast phase raises sensitivity from 71% (95% CI: 61–80%) to 76% (95% CI: 71–87%), and that adding a third phase resulted in a more modest additional increase in performance with a sensitivity of 80% (95% CI: 74–86%). Conclusion: CT performs well in localizing pathological glands in patients with pHPT. A protocol with two contrast phases seems to offer a good balance of acceptable performance with limitation of radiation exposure.

  15. A simple, high performance Thomson scattering diagnostic for high temperature plasma research

    International Nuclear Information System (INIS)

    Hartog, D.J.D.; Cekic, M.

    1994-02-01

    This Thomson scattering diagnostic is used to measure the electron temperature and density of the plasma in the MST reversed-field pinch, a magnetic confinement fusion research device. This diagnostic system is unique for its type in that it combines high performance with simple design and low cost components. In the design of this instrument, careful attention was given to the suppression of stray laser line light with simple and effective beam dumps, viewing dumps, aperatures, and a holographic edge filter. This allows the use of a single grating monochromator for dispersion of the Thomson scattered spectrum onto the microchannel plate detector. Alignment and calibration procedures for the laser beam delivery system, the scattered light collection system, and the spectrometer and detector are described. A sample Thomson scattered spectrum illustrates typical data

  16. Diagnostic performance of cytology for assessment of hepatic lipid content in dairy cattle.

    Science.gov (United States)

    Fry, M M; Yao, B; Ríos, C; Wong, C; Mann, S; McArt, J A A; Nydam, D V; Leal Yepes, F A; Viesselmann, L; Geick, A; Goldin, K; Jordan, A; Behling-Kelly, E

    2018-02-01

    The objective of our study was to characterize the diagnostic performance of cytology for assessing hepatic lipid content (HLC) in dairy cows by comparing microscopic evaluation of lipid vacuolation in touch imprint slide preparations of liver biopsies with quantitative measurement of triglyceride concentration ([TG]; mg/mg of wet weight) in paired biopsy samples. Our study also sought to compare the diagnostic performance of liver cytology, plasma nonesterified fatty acid concentration ([NEFA]), and plasma β-hydroxybutyrate concentration ([BHB]) derived from a measurement performed on whole blood, for assessing HLC. Chemical extraction of TG from liver tissue remains the gold standard for quantifying HLC, largely because available blood tests, although useful for detecting some types of pathology, such as increased lipid mobilization, ketosis, or hepatocellular injury, are nonspecific as to etiology. Veterinary practitioners can sample bovine liver for cytological evaluation in a fast, minimally invasive, and inexpensive manner. Thus, if highly predictive of HLC, cytology would be a practical diagnostic tool for dairy veterinarians. In our study, liver biopsy samples from Holstein cows (219 samples from 105 cows: 52 from cows 2 to 20 d prepartum, 105 from cows 0 to 10 d in milk, 62 from cows 18 to 25 d in milk) were used to prepare cytology slides and to quantify [TG] using the Folch extraction method followed by the Hantzch condensation reaction and spectrophotometric measurement. An ordinal scale (0-4) based on amount of hepatocellular cytoplasm occupied by discrete clear vacuoles was used by 3 blinded, independent observers to rank HLC in Wright-Giemsa-stained slides. Interobserver agreement in cytology scoring was good. Corresponding plasma [NEFA] and [BHB] measurements were available for 187 and 195 of the 219 samples, respectively. Liver [TG] correlated more strongly with cytology score than with NEFA or BHB, and receiver operating characteristic curve

  17. Diagnostic performances of serum liver enzymes and cytokines in non-alcoholic fatty liver disease

    Directory of Open Access Journals (Sweden)

    Hakan Turkon

    2015-03-01

    Full Text Available Objective:Non-alcoholic fatty liver disease (NAFLD is affecting people worldwide with increasing prevalence. Non-invasive tests are required for both diagnosis and staging of the disease. We aimed to evaluate diagnostic accuracy of routine liver enzymes and cytokines in NAFLD. Methods:A total of 88 cases, aged between 20 and 62 years, were included in the study. Serum ALT, AST, GGT, triglyceride, TNF-alpha, IL-6 and IL-8 were measured in 40 patients with NAFLD and in 48 healthy control patients with similar BMI and demographic characteristics. Diagnostic performances of serum biomarkers for diagnosis of NAFLD were evaluated with ROC analysis. Results:ALT and AST showed good diagnostic performance in predicting patients with NAFLD in the overall group (AUC=0.817; 95% CI[0.721-0.913], AUC=0.815;95% CI[0.718-0.911] respectively but in obese subjects ALT and AST showed poor performance (AUC=0.659;95% CI[0.478-0.841], AUC=0.680; 95% CI[0.498-0.861] respectively. Among cytokines TNF-alpha showed best performance in the diagnosis of NAFLD in both overall group and obese subjects (AUC=0.892; 95% CI[0.824- 0.959], AUC=0.858; 95% CI[0.739-0.977] respectively. The optimal cut off value for TNF-alpha was 10.65pg/ml with a sensitivity of 75% and a specificity of 93% in the overall group. IL-6 and IL-8 showed poor performance. Conclusion: TNF-alpha may be a good parameter for predicting patients with NAFLD. J Clin Exp Invest 2015;6 (1: 16-20

  18. Polish Adaptation of Wrist Evaluation Questionnaires.

    Science.gov (United States)

    Czarnecki, Piotr; Wawrzyniak-Bielęda, Anna; Romanowski, Leszek

    2015-01-01

    Questionnaires evaluating hand and wrist function are a very useful tool allowing for objective and systematic recording of symptoms reported by the patients. Most questionnaires generally accepted in clinical practice are available in English and need to be appropriately adapted in translation and undergo subsequent validation before they can be used in another culture and language. The process of translation of the questionnaires was based on the generally accepted guidelines of the International Quality of Life Assessment Project (IQOLA). First, the questionnaires were translated from English into Polish by two independent translators. Then, a joint version of the translation was prepared collectively and translated back into English. Each stage was followed by a written report. The translated questionnaires were then evaluated by a group of patients. We selected 31 patients with wrist problems and asked them to complete the PRWE, Mayo, Michigan and DASH questionnaires twice at intervals of 3-10 days. The results were submitted for statistical analysis. We found a statistically significant (pquestionnaires. A comparison of the PRWE and Mayo questionnaires with the DASH questionnaire also showed a statistically significant correlation (pquestionnaires was successful and that the questionnaires may be used in clinical practice.

  19. Optimization of Classification Strategies of Acetowhite Temporal Patterns towards Improving Diagnostic Performance of Colposcopy

    Directory of Open Access Journals (Sweden)

    Karina Gutiérrez-Fragoso

    2017-01-01

    Full Text Available Efforts have been being made to improve the diagnostic performance of colposcopy, trying to help better diagnose cervical cancer, particularly in developing countries. However, improvements in a number of areas are still necessary, such as the time it takes to process the full digital image of the cervix, the performance of the computing systems used to identify different kinds of tissues, and biopsy sampling. In this paper, we explore three different, well-known automatic classification methods (k-Nearest Neighbors, Naïve Bayes, and C4.5, in addition to different data models that take full advantage of this information and improve the diagnostic performance of colposcopy based on acetowhite temporal patterns. Based on the ROC and PRC area scores, the k-Nearest Neighbors and discrete PLA representation performed better than other methods. The values of sensitivity, specificity, and accuracy reached using this method were 60% (95% CI 50–70, 79% (95% CI 71–86, and 70% (95% CI 60–80, respectively. The acetowhitening phenomenon is not exclusive to high-grade lesions, and we have found acetowhite temporal patterns of epithelial changes that are not precancerous lesions but that are similar to positive ones. These findings need to be considered when developing more robust computing systems in the future.

  20. Comparative diagnostic performance of multidetector computed tomography and MRI for characterization of pancreatic cystic lesions

    International Nuclear Information System (INIS)

    Moon, Sung Min; Shin, Sang Soo; Park, Jin Gyoon; Jeong, Yong Yeon

    2015-01-01

    To compare the diagnostic performance of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in characterization of pancreatic cystic lesions. We conducted a retrospective study on 34 patients with histopathologically proven cystic pancreatic lesions who underwent both preoperative MDCT and MRI. CT and MRI were independently evaluated for differentiating mucinous vs. non-mucinous lesions, differentiating aggressive vs. non-aggressive lesion, analyzing morphological features, and evaluating specific leading diagnoses. Sensitivity, specificity, and accuracy were determined. Competency assessment of lesional morphology analysis was performed using the kappa values of the 2 tests. The sensitivity, specificity, and accuracy of MRI for differentiating mucinous vs. non-mucinous lesions were higher than CT (p = 0.03). For differentiating aggressiveness, the sensitivity of MRI was better than CT, but the specificity of CT was better than MRI. In evaluation of morphologic features, MRI showed better performance in characterization of septa and wall. Otherwise, the 2 modalities showed similarly good performance. MRI was better than CT in determining a specific diagnosis (58.8% vs. 47.2%, respectively). CT and MRI are reasonable diagnostic methods for characterization of pancreatic cystic lesions. However, MRI enables more confident assessment than CT in differentiating mucinous vs. non-mucinous lesions and characterization of the septa and wall

  1. Ruling out pulmonary embolism in primary care : Comparison of the diagnostic performance of “gestalt” and the wells rule

    NARCIS (Netherlands)

    Hendriksen, Janneke M T; Lucassen, Wim A M; Erkens, Petra M G; Stoffers, Henri E J H; van Weert, Henk C P M; Büller, Harry R.; Hoes, Arno W.; Moons, Karel G M; Geersing, Geert Jan

    2016-01-01

    PURPOSE Diagnostic prediction models such as the Wells rule can be used for safely ruling out pulmonary embolism (PE) when it is suspected. A physician’s own probability estimate (“gestalt”), however, is commonly used instead. We evaluated the diagnostic performance of both approaches in primary

  2. Ruling Out Pulmonary Embolism in Primary Care: Comparison of the Diagnostic Performance of "Gestalt" and the Wells Rule

    NARCIS (Netherlands)

    Hendriksen, Janneke M. T.; Lucassen, Wim A. M.; Erkens, Petra M. G.; Stoffers, Henri E. J. H.; van Weert, Henk C. P. M.; Büller, Harry R.; Hoes, Arno W.; Moons, Karel G. M.; Geersing, Geert-Jan

    2016-01-01

    Diagnostic prediction models such as the Wells rule can be used for safely ruling out pulmonary embolism (PE) when it is suspected. A physician's own probability estimate ("gestalt"), however, is commonly used instead. We evaluated the diagnostic performance of both approaches in primary care.

  3. 9 CFR 130.15 - User fees for veterinary diagnostic isolation and identification tests performed at NVSL...

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for veterinary diagnostic isolation and identification tests performed at NVSL (excluding FADDL) or other authorized site. 130.15... AGRICULTURE USER FEES USER FEES § 130.15 User fees for veterinary diagnostic isolation and identification...

  4. Wrist stability after experimental traumatic triangular fibrocartilage complex lesions

    DEFF Research Database (Denmark)

    Munk, Bo; Jensen, Steen Lund; Olsen, Bo Sanderhoff

    2005-01-01

    The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions.......The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions....

  5. Estimation of Thermal Sensation Based on Wrist Skin Temperatures

    Science.gov (United States)

    Sim, Soo Young; Koh, Myung Jun; Joo, Kwang Min; Noh, Seungwoo; Park, Sangyun; Kim, Youn Ho; Park, Kwang Suk

    2016-01-01

    Thermal comfort is an essential environmental factor related to quality of life and work effectiveness. We assessed the feasibility of wrist skin temperature monitoring for estimating subjective thermal sensation. We invented a wrist band that simultaneously monitors skin temperatures from the wrist (i.e., the radial artery and ulnar artery regions, and upper wrist) and the fingertip. Skin temperatures from eight healthy subjects were acquired while thermal sensation varied. To develop a thermal sensation estimation model, the mean skin temperature, temperature gradient, time differential of the temperatures, and average power of frequency band were calculated. A thermal sensation estimation model using temperatures of the fingertip and wrist showed the highest accuracy (mean root mean square error [RMSE]: 1.26 ± 0.31). An estimation model based on the three wrist skin temperatures showed a slightly better result to the model that used a single fingertip skin temperature (mean RMSE: 1.39 ± 0.18). When a personalized thermal sensation estimation model based on three wrist skin temperatures was used, the mean RMSE was 1.06 ± 0.29, and the correlation coefficient was 0.89. Thermal sensation estimation technology based on wrist skin temperatures, and combined with wearable devices may facilitate intelligent control of one’s thermal environment. PMID:27023538

  6. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India

    Directory of Open Access Journals (Sweden)

    Kiran Pote

    2018-01-01

    Full Text Available Background: Differentiating scrub typhus from other acute febrile illness is difficult due to non specificity of clinical symptoms and relative absence of eschar in Indian population. The diagnosis thus relies mainly on laboratory tests. Antibody based serological tests are mainstay of scrub typhus diagnosis. Here, we evaluated the diagnostic performance of IgM ELISA, IgM IFA and ICT to detect antibodies against O. tsutsugamushi in acute serum of febrile patients. Methodology: The serum samples from 600 randomly selected patients suffering from acute undifferentiated fever were tested by all the three tests mentioned above. We used latent class analysis to generate unbiased results as all the tests for scrub typhus diagnosis are imperfect and none of them can be considered as reference standard. Results: We found that IgM ELISA with cutoff titer 0.5 OD has high diagnostic accuracy (sensitivity 99.9% and specificity 99.15 than IgM IFA (sensitivity 96.8% and specificity 99.7% for scrub typhus diagnosis. ICT used in our study had very high specificity 100% but low sensitivity (38% which would limit its use for acute serum samples. ICT being a screening or point of care test, has to be more sensitive while some compromise with specificity is affordable. Hence, optimal cutoff for ICT should be evaluated under different settings. Conclusion: IgM ELISA being simple and affordable could be an alternative diagnostic test to IgM IFA which is subjective and costly.

  7. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India.

    Science.gov (United States)

    Pote, Kiran; Narang, Rahul; Deshmukh, Pradeep

    2018-01-01

    Differentiating scrub typhus from other acute febrile illness is difficult due to non specificity of clinical symptoms and relative absence of eschar in Indian population. The diagnosis thus relies mainly on laboratory tests. Antibody based serological tests are mainstay of scrub typhus diagnosis. Here, we evaluated the diagnostic performance of IgM ELISA, IgM IFA and ICT to detect antibodies against O. tsutsugamushi in acute serum of febrile patients. The serum samples from 600 randomly selected patients suffering from acute undifferentiated fever were tested by all the three tests mentioned above. We used latent class analysis to generate unbiased results as all the tests for scrub typhus diagnosis are imperfect and none of them can be considered as reference standard. We found that IgM ELISA with cutoff titer 0.5 OD has high diagnostic accuracy (sensitivity 99.9% and specificity 99.15) than IgM IFA (sensitivity 96.8% and specificity 99.7%) for scrub typhus diagnosis. ICT used in our study had very high specificity 100% but low sensitivity (38%) which would limit its use for acute serum samples. ICT being a screening or point of care test, has to be more sensitive while some compromise with specificity is affordable. Hence, optimal cutoff for ICT should be evaluated under different settings. IgM ELISA being simple and affordable could be an alternative diagnostic test to IgM IFA which is subjective and costly.

  8. Diagnostic performance of BMI percentiles to identify adolescents with metabolic syndrome.

    Science.gov (United States)

    Laurson, Kelly R; Welk, Gregory J; Eisenmann, Joey C

    2014-02-01

    To compare the diagnostic performance of the Centers for Disease Control and Prevention (CDC) and FITNESSGRAM (FGram) BMI standards for quantifying metabolic risk in youth. Adolescents in the NHANES (n = 3385) were measured for anthropometric variables and metabolic risk factors. BMI percentiles were calculated, and youth were categorized by weight status (using CDC and FGram thresholds). Participants were also categorized by presence or absence of metabolic syndrome. The CDC and FGram standards were compared by prevalence of metabolic abnormalities, various diagnostic criteria, and odds of metabolic syndrome. Receiver operating characteristic curves were also created to identify optimal BMI percentiles to detect metabolic syndrome. The prevalence of metabolic syndrome in obese youth was 19% to 35%, compared with <2% in the normal-weight groups. The odds of metabolic syndrome for obese boys and girls were 46 to 67 and 19 to 22 times greater, respectively, than for normal-weight youth. The receiver operating characteristic analyses identified optimal thresholds similar to the CDC standards for boys and the FGram standards for girls. Overall, BMI thresholds were more strongly associated with metabolic syndrome in boys than in girls. Both the CDC and FGram standards are predictive of metabolic syndrome. The diagnostic utility of the CDC thresholds outperformed the FGram values for boys, whereas FGram standards were slightly better thresholds for girls. The use of a common set of thresholds for school and clinical applications would provide advantages for public health and clinical research and practice.

  9. MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Zubler, Christoph; Mengiardi, Bernard; Schmid, Marius R.; Hodler, Juerg; Pfirrmann, Christian W.A. [University Hospital Balgrist, Radiology, Zurich (Switzerland); Jost, Bernhard [University Hospital Balgrist, Orthopedic Surgery, Zurich (Switzerland)

    2007-06-15

    The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiographs. (orig.)

  10. Overview of diagnostic performance and results for the first operation phase in Wendelstein 7-X (invited).

    Science.gov (United States)

    Krychowiak, M; Adnan, A; Alonso, A; Andreeva, T; Baldzuhn, J; Barbui, T; Beurskens, M; Biel, W; Biedermann, C; Blackwell, B D; Bosch, H S; Bozhenkov, S; Brakel, R; Bräuer, T; Brotas de Carvalho, B; Burhenn, R; Buttenschön, B; Cappa, A; Cseh, G; Czarnecka, A; Dinklage, A; Drews, P; Dzikowicka, A; Effenberg, F; Endler, M; Erckmann, V; Estrada, T; Ford, O; Fornal, T; Frerichs, H; Fuchert, G; Geiger, J; Grulke, O; Harris, J H; Hartfuß, H J; Hartmann, D; Hathiramani, D; Hirsch, M; Höfel, U; Jabłoński, S; Jakubowski, M W; Kaczmarczyk, J; Klinger, T; Klose, S; Knauer, J; Kocsis, G; König, R; Kornejew, P; Krämer-Flecken, A; Krawczyk, N; Kremeyer, T; Książek, I; Kubkowska, M; Langenberg, A; Laqua, H P; Laux, M; Lazerson, S; Liang, Y; Liu, S C; Lorenz, A; Marchuk, A O; Marsen, S; Moncada, V; Naujoks, D; Neilson, H; Neubauer, O; Neuner, U; Niemann, H; Oosterbeek, J W; Otte, M; Pablant, N; Pasch, E; Sunn Pedersen, T; Pisano, F; Rahbarnia, K; Ryć, L; Schmitz, O; Schmuck, S; Schneider, W; Schröder, T; Schuhmacher, H; Schweer, B; Standley, B; Stange, T; Stephey, L; Svensson, J; Szabolics, T; Szepesi, T; Thomsen, H; Travere, J-M; Trimino Mora, H; Tsuchiya, H; Weir, G M; Wenzel, U; Werner, A; Wiegel, B; Windisch, T; Wolf, R; Wurden, G A; Zhang, D; Zimbal, A; Zoletnik, S

    2016-11-01

    Wendelstein 7-X, a superconducting optimized stellarator built in Greifswald/Germany, started its first plasmas with the last closed flux surface (LCFS) defined by 5 uncooled graphite limiters in December 2015. At the end of the 10 weeks long experimental campaign (OP1.1) more than 20 independent diagnostic systems were in operation, allowing detailed studies of many interesting plasma phenomena. For example, fast neutral gas manometers supported by video cameras (including one fast-frame camera with frame rates of tens of kHz) as well as visible cameras with different interference filters, with field of views covering all ten half-modules of the stellarator, discovered a MARFE-like radiation zone on the inboard side of machine module 4. This structure is presumably triggered by an inadvertent plasma-wall interaction in module 4 resulting in a high impurity influx that terminates some discharges by radiation cooling. The main plasma parameters achieved in OP1.1 exceeded predicted values in discharges of a length reaching 6 s. Although OP1.1 is characterized by short pulses, many of the diagnostics are already designed for quasi-steady state operation of 30 min discharges heated at 10 MW of ECRH. An overview of diagnostic performance for OP1.1 is given, including some highlights from the physics campaigns.

  11. MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls

    International Nuclear Information System (INIS)

    Zubler, Christoph; Mengiardi, Bernard; Schmid, Marius R.; Hodler, Juerg; Pfirrmann, Christian W.A.; Jost, Bernhard

    2007-01-01

    The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiographs. (orig.)

  12. Glaucoma diagnostic performance of GDxVCC and spectralis OCT on eyes with atypical retardation pattern.

    Science.gov (United States)

    Hoesl, Laura Maria; Tornow, Ralf P; Schrems, Wolfgang A; Horn, Folkert K; Mardin, Christian Y; Kruse, Friedrich E; Juenemann, Anselm G M; Laemmer, Robert

    2013-01-01

    To investigate the impact of typical scan score (TSS) on discriminating glaucomatous and healthy eyes by scanning laser polarimetry and spectral domain optical coherence tomography (SD-OCT) in 32 peripapillary sectors. One hundred two glaucoma patients and 32 healthy controls underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, GDxVCC, and SD-OCT measurements. For controls, only very typical scans (TSS=100) were accepted. Glaucoma patients were divided into 3 subgroups (very typical: TSS=100; typical: 99≥TSS≥80, atypical: TSS<80). Receiver operating characteristic curves were constructed for mean retinal nerve fiber layer values, sector data, and nerve fiber indicator (NFI). Sensitivity was estimated at ≥90% specificity to compare the discriminating ability of each imaging modality. For discrimination between healthy and glaucomatous eyes with very typical scans, the NFI and inferior sector analyses 26 to 27 demonstrated the highest sensitivity at ≥90% specificity in GDxVCC and SD-OCT, respectively. For the typical and atypical groups, sensitivity at ≥90% specificity decreased for all 32 peripapillary sectors on an average by 10.9% and 17.9% for GDxVCC and by 4.9% and 0.8% for SD-OCT. For GDxVCC, diagnostic performance of peripapillary sectors decreased with lower TSS, especially in temporosuperior and inferotemporal sectors (sensitivity at ≥90% specificity decreased by 55.3% and by 37.8% in the atypical group). Diagnostic accuracy is comparable for SD-OCT and GDxVCC if typical scans (TSS=100) are investigated. Decreasing TSS is associated with a decrease in diagnostic accuracy for discriminating healthy and glaucomatous eyes by scanning laser polarimetry. NFI is less influenced than the global or sector retinal nerve fiber layer thickness. The TSS score should be included in the standard printout. Diagnostic accuracy of SD-OCT is barely influenced by low TSS.

  13. Wrist Hypothermia Related to Continuous Work with a Computer Mouse: A Digital Infrared Imaging Pilot Study

    Directory of Open Access Journals (Sweden)

    Jelena Reste

    2015-08-01

    Full Text Available Computer work is characterized by sedentary static workload with low-intensity energy metabolism. The aim of our study was to evaluate the dynamics of skin surface temperature in the hand during prolonged computer mouse work under different ergonomic setups. Digital infrared imaging of the right forearm and wrist was performed during three hours of continuous computer work (measured at the start and every 15 minutes thereafter in a laboratory with controlled ambient conditions. Four people participated in the study. Three different ergonomic computer mouse setups were tested on three different days (horizontal computer mouse without mouse pad; horizontal computer mouse with mouse pad and padded wrist support; vertical computer mouse without mouse pad. The study revealed a significantly strong negative correlation between the temperature of the dorsal surface of the wrist and time spent working with a computer mouse. Hand skin temperature decreased markedly after one hour of continuous computer mouse work. Vertical computer mouse work preserved more stable and higher temperatures of the wrist (>30 °C, while continuous use of a horizontal mouse for more than two hours caused an extremely low temperature (<28 °C in distal parts of the hand. The preliminary observational findings indicate the significant effect of the duration and ergonomics of computer mouse work on the development of hand hypothermia.

  14. The paediatric wrist revisited - findings of bony depressions in healthy children on radiographs compared to MRI

    International Nuclear Information System (INIS)

    Avenarius, Derk M.F.; Eldevik, Petter; Ording Mueller, Lil-Sofie; Owens, Catherine M.; Rosendahl, Karen

    2012-01-01

    The presence of erosions is used for diagnosis and monitoring of disease activity in juvenile idiopathic arthritis (JIA). Assessment of carpal bone erosions in children is challenging due to lack of normal references. To define normal appearances of bony depressions in the wrist on radiographs and MRI. MRI and radiography of the wrist were performed in 88 healthy children, 5-15 years of age. We assessed the number of bony depressions within the carpals/proximal metacarpals on both modalities, separately and combined. A total of 75 carpal depressions were identified on radiography compared to 715 on MRI. The number of bony depressions identified radiographically showed no statistically significant difference across age-groups. Within the metacarpals, there was no significant difference between bony depressions identified by MRI or radiography, except at the bases of the second metacarpal. Bony depressions that resemble erosions are normal findings in the wrist in children. MRI identifies more depressions than radiographs in the carpus. Some bony depressions occur at typical locations and should be accounted for when assessing the wrist in JIA to avoid overstaging. (orig.)

  15. Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel.

    Science.gov (United States)

    Balazs, George C; Donohue, Michael A; Drake, Matthew L; Ipsen, Derek; Nanos, George P; Tintle, Scott M

    2015-09-01

    To examine the most common presenting complaints of active-duty service members with isolated dorsal wrist ganglions and to determine the rate of return to unrestricted duty after open excision. Surgical records at 2 military facilities were screened to identify male and female active duty service members undergoing isolated open excision of dorsal wrist ganglions from January 1, 2006 to January 1, 2014. Electronic medical records and service disability databases were searched to identify the most common presenting symptoms and to determine whether patients returned to unrestricted active duty after surgery. Postoperative outcomes examined were pain persisting greater than 4 weeks after surgery, stiffness requiring formal occupational therapy treatment, surgical wound complications, and recurrence. A total of 125 active duty military personnel (Army, 54; Navy, 43; and Marine Corps, 28) met criteria for inclusion. Mean follow-up was 45 months. Fifteen percent (8 of 54) of the Army personnel were given permanent waivers from performing push-ups owing to persistent pain and stiffness. Pain persisting greater than 4 weeks after surgery was an independent predictor of eventual need for a permanent push-up waiver. The overall recurrence incidence was 9%. No demographic or perioperative factors were associated with recurrence. Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision. Therapeutic IV. Published by Elsevier Inc.

  16. Comparative evaluation between cervical vertebral morphology and hand-wrist morphology for skeletal maturation assessment.

    Science.gov (United States)

    Grippaudo, C; Garcovich, D; Volpe, G; Lajolo, C

    2006-05-01

    The aim of the study was to find a correlation between the evaluation of skeletal maturation performed by the study of cervical vertebrae maturation indicators and the evaluation obtained by the hand and wrist maturation indicators. Left hand wrist radiographs and the corresponding lateral cephalograms of 90 patients (48 males and 42 females; aged 6 to 14 years) were paired and a study group of 128 pair of radiographs was obtained, having some patients 2 or more radiographs at different times. Hand and wrist radiographs were evaluated according to the protocol proposed by Grave (scores 0 to 9); corresponding lateral cephalograms were evaluated according to the method reported by Baccetti (scores 1 to 5). Values obtained with the 2 methods were analyzed by Spearman's correlation test. When the values were compared globally in the 2 genders a good correlation was obtained (r=0.795; Pmaturation evaluation by the analysis of cervical vertebrae in laterolateral cephalograms which can substitute the hand and wrist radiograph for the skeletal maturation evaluation in orthodontic diagnosis.

  17. Diagnostic Performance of Ultrasonography for Pediatric Appendicitis: A Night and Day Difference?

    Science.gov (United States)

    Mangona, Kate Louise M; Guillerman, R Paul; Mangona, Victor S; Carpenter, Jennifer; Zhang, Wei; Lopez, Monica; Orth, Robert C

    2017-12-01

    For imaging pediatric appendicitis, ultrasonography (US) is preferred because of its lack of ionizing radiation, but is limited by operator dependence. This study investigates the US diagnostic performance during night shifts covered by radiology trainees compared to day shifts covered by attending radiologists. Appy-Scores (1 = completely visualized normal appendix; 2 = partially visualized normal appendix; 3 = nonvisualized appendix with no inflammatory changes in the expected region of the appendix; 4 = equivocal; 5a = nonperforated appendicitis; 5b = perforated appendicitis) from 2935 US examinations (2161:774, day-to-night) from July 2013 to 2014 were correlated with the intraoperative diagnoses and the clinical follow-up. The diagnostic performance of trainees and attendings was compared with Fisher exact test. Interobserver agreement was measured by Cohen kappa coefficient. Appendicitis prevalence was 25.3% (day) and 22.5% (night). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive vale were 94.0%, 93.7%, 93.8%, 97.9%, and 83.4% during the day and 92.0%, 91.2%, 91.3%, 97.5%, and 75.2% at night. Specificity (P = .048) and positive predictive value (P = .011) differed, with more false positives at night (7%) than during the day (4.7%). Trainee and attending agreement was high (k = 0.995), with Appy-Scores of 1, 4, and 5a most frequently discordant. US has a high diagnostic performance and interobserver agreement for pediatric appendicitis when interpreted by radiology trainees during night shifts or attending radiologists during day shifts. However, lower specificity and positive predictive value at night warrants a thorough trainee education to avoid false-positive examinations. Published by Elsevier Inc.

  18. A Performance Evaluation of Diagnostic X-ray Unit Depends on the Hospitals Size

    International Nuclear Information System (INIS)

    Park, Ju Hun; Im, In Chul; Dong, Kyung Rae; Kang, Se Sik

    2009-01-01

    The purpose of this study is to measure the tube voltage, the tube current/volume, exposure time and exposure dose of diagnostic X-ray unit in each doctor offices, hospitals and general hospitals for evaluating the performance of such device, to learn the method and technology of its measurement and to suggest its importance. Research subjects were total 30 X-ray units and divided into groups of 10 X-ray units each. The tube voltage, the tube current/volume, exposure time and exposure dose were measured using percentage average error, and then reproducibility of exposure dose was measured through calculating coefficient of variation. The results are like followings; The tube voltage correctness examination showed that incongruent devices among total 30 X-ray units were 5 devices (16.7%). The tube current correctness examination showed that incongruent X-ray units were 3 devices (10.0%). The tube current volume correctness examination showed that incongruent X-ray units were 4 devices (13.3%). Finally, according to exposure time correctness examination, incongruent X-ray units were 5 devices (16.7%) and according to reproducibility examination of exposure dose, incongruent X-ray units were 7 devices (23.3%). Above results showed serious problem in performance management based on management regulation of diagnostic X-ray unit; it means that regular checkout and safety management are required, and as doing so, patients will be able to receive good quality of medical service by the reduction of radiation exposure time, image quality administration, unnecessary retake and etc. Therefore, this study suggests that the performance of diagnostic X-ray units should be checked regularly

  19. A Performance Evaluation of Diagnostic X-ray Unit Depends on the Hospitals Size

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ju Hun [Kaya University, Gimhae (Korea, Republic of); Im, In Chul [Gwangju Health College University, Gwangju (Korea, Republic of); Dong, Kyung Rae [Chosun University, Gwangju (Korea, Republic of); Kang, Se Sik [College of Health Science, Catholic University of Pusan, Busan (Korea, Republic of)

    2009-03-15

    The purpose of this study is to measure the tube voltage, the tube current/volume, exposure time and exposure dose of diagnostic X-ray unit in each doctor offices, hospitals and general hospitals for evaluating the performance of such device, to learn the method and technology of its measurement and to suggest its importance. Research subjects were total 30 X-ray units and divided into groups of 10 X-ray units each. The tube voltage, the tube current/volume, exposure time and exposure dose were measured using percentage average error, and then reproducibility of exposure dose was measured through calculating coefficient of variation. The results are like followings; The tube voltage correctness examination showed that incongruent devices among total 30 X-ray units were 5 devices (16.7%). The tube current correctness examination showed that incongruent X-ray units were 3 devices (10.0%). The tube current volume correctness examination showed that incongruent X-ray units were 4 devices (13.3%). Finally, according to exposure time correctness examination, incongruent X-ray units were 5 devices (16.7%) and according to reproducibility examination of exposure dose, incongruent X-ray units were 7 devices (23.3%). Above results showed serious problem in performance management based on management regulation of diagnostic X-ray unit; it means that regular checkout and safety management are required, and as doing so, patients will be able to receive good quality of medical service by the reduction of radiation exposure time, image quality administration, unnecessary retake and etc. Therefore, this study suggests that the performance of diagnostic X-ray units should be checked regularly

  20. Diagnostic performance of dark-blood T2-weighted CMR for evaluation of acute myocardial injury.

    Science.gov (United States)

    Srichai, Monvadi B; Lim, Ruth P; Lath, Narayan; Babb, James; Axel, Leon; Kim, Daniel

    2013-01-01

    We compared the image quality and diagnostic performance of 2 fat-suppression methods for black-blood T2-weighted fast spin-echo (FSE), which are as follows: (a) short T1 inversion recovery (STIR; FSE-STIR) and (b) spectral adiabatic inversion recovery (SPAIR; FSE-SPAIR), for detection of acute myocardial injury. Edema-sensitive T2-weighted FSE cardiac magnetic resonance (CMR) imaging is useful in detecting acute myocardial injury but may experience reduced myocardial signal and signal dropout. The SPAIR pulse aims to eliminate artifacts associated with the STIR pulse. A total of 65 consecutive patients referred for CMR evaluation of myocardial structure and function underwent FSE-STIR and FSE-SPAIR, in addition to cine and late gadolinium enhancement (LGE) CMR. T2-weighted FSE images were independently evaluated by 2 readers for image quality and artifacts (Likert scale of 1-5; best-worst) and presence of increased myocardial signal suggestive of edema. In addition, clinical CMR interpretation, incorporating all CMR sequences available, was recorded for comparison. Diagnostic performance of each T2-weighted sequence was measured using recent (T2, and wall motion. There was a statistically significant difference in sensitivity between the clinical interpretation and each of the T2-weighted sequences but not between each T2-weighted sequence. Although FSE-SPAIR demonstrated significantly improved image quality and decreased artifacts, isolated interpretations of each T2-weighted technique demonstrated high specificity but overall low sensitivity for the detection of myocardial injury, with no difference in accuracy between the techniques. However, real-world interpretation in combination with cine and LGE CMR methods significantly improves the overall sensitivity and diagnostic performance.

  1. Direct MR Arthrography of the wrist in comparison with Arthroscopy: A prospective study on 125 patients

    International Nuclear Information System (INIS)

    Schmitt, R.; Christopoulos, G.; Coblenz, G.; Froehner, S.; Meier, R.; Lanz, U.; Krimmer, H.

    2003-01-01

    Objective: In literature the diagnostic value of MRI for detecting lesions of the carpal ligaments and the TFCC is judged controversially. The aim of the following study is to determine the diagnostic accuracy of direct MR arthrography for depicting and staging of intraarticular lesions of the wrist. Material and methods: One day before undergoing arthroscopy, 125 patients suffering from wrist pain were examined with direct MR arthrography in a prospective and blinded study. A mixture of contrast medium (iodine-containing contrast medium and gadopentetate in relation 200:1) was injected into both radiocarpal and midcarpal joints. The following sequences were acquired on a 1.5T scanner: coronal T1-weighted SE, coronal fat-saturated T1-weighted SE, coronal T1-/T2*-DESS-3D, and sagittal T2*-weighted MEDIC. MRI results were compared with arthroscopic findings using statistical analysis (SEN=sensitivity, SPE=specificity, PPV=positive predictive value, NPV=negative predictive value, ACC=accuracy). Results: In comparison to arthroscopy as the accepted diagnostic gold standard, the following results were found for MR arthrography. Detection of TFCC lesions: SEN 97.1%, SPE 96.4%, PPV 97.1%, NPV 96.4%, ACC 96.8%. Detection of complete tears of the scapholunate ligament: SEN 91.7%, SPE 100%, PPV 100%, NPV 99.1%, ACC 99.2%. Detection of partial tears: SEN 62.5%, SPE 100%, PPV 100%, NPV 94.8%, ACC 95.2%. Detection of cartilage defects: SEN 84.2%, SPE 96.2%, PPV 80%, NPV 97.1%, ACC 94.4%. In total, only three lesions of the lunotriquetral ligament were present. Conclusion: Direct MR arthrographic imaging is well suited for detecting intraarticular lesions of the wrist. The presented diagnostic results of MR arthrography are superior to the results of unenhanced MRI reported in the literature. Direct MR arthrography as a reliable diagnostic tool is strongly recommended if lesions of the scapholunate ligament and the triangular fibrocartilage complex are suspected. In contrast, an

  2. General guidelines about performance specifications for purchasing equipment for x-ray diagnostics, with comments

    International Nuclear Information System (INIS)

    1995-12-01

    These general guidelines are intended to be used as a basis for what requirements are reasonable from a radiation protection point of view and should be part of the contract in connection with the purchase of equipment for x-ray diagnostics. Technical performance requirements are addressed as well as items like documentation, instructions for use and education and training. The guidelines are also useful for the design of quality assurance programs. In the comments in addition to these guidelines legal aspects are noted, including a list of relevant laws, regulations and directives. Standards, both national and international, within the field are referred to with a short description of their content. 40 refs

  3. Measurement of the performance characteristics of diagnostic X-ray systems used in medicine

    International Nuclear Information System (INIS)

    1981-01-01

    A booklet has been produced by the Diagnostic Radiology Topic Group of the Hospital Physicists' Association, providing the basis for exhaustive performance tests on X-ray image intensifier television systems. After a general introduction to the equipment, the parameters which may need to be assessed are outlined in section 1. The measurement techniques and equipment necessary to undertake the measurements are presented in section 2. Specimen data sheets are also presented which the user may find useful to record the data acquired in the field. (U.K.)

  4. General guidelines about performance specifications for purchasing equipment for x-ray diagnostics, with comments

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-01

    These general guidelines are intended to be used as a basis for what requirements are reasonable from a radiation protection point of view and should be part of the contract in connection with the purchase of equipment for x-ray diagnostics. Technical performance requirements are addressed as well as items like documentation, instructions for use and education and training. The guidelines are also useful for the design of quality assurance programs. In the comments in addition to these guidelines legal aspects are noted, including a list of relevant laws, regulations and directives. Standards, both national and international, within the field are referred to with a short description of their content. 40 refs.

  5. Diagnostic performance of sonoelastographic Tsukuba score and strain ratio in evaluation of breast masses

    Directory of Open Access Journals (Sweden)

    Mahmoud Abd Elaziz Dawood

    2018-03-01

    Full Text Available The aim of this prospective study was to evaluate the diagnostic performance of the use of strain index ratio by sonoelastography to differentiate between benign and malignant breast lesions. Patients & Methods: This prospective study including 40 females, complaining of breast masses which were suspicious to be malignant on clinical examination. All patients were submitted to B-mode Ultrasound and sonoelastography. Biopsy as a gold standard and pathological study were done for all breast lesions. Results: US examination of every mass was done and categorized according to BI-RADS categories according to ACR2013, according to US lexicon. Sonoelastography examination with Lesions classification was performed on the basis of a 5-point scoring method proposed by Tsukuba elasticity score. Then measurements of strain ratio were done. Statistical analysis of combination of the three methods was sensitivity of 96.7%, specificity of 100% when we use cut off value of 3–4 in elastography score and ≤3 cut off value of strain ratio. Conclusion: The combined use of strain ratio with Tsukuba score and BI-RADS categorization increased the diagnostic performance in differentiation between benign and malignant breast lesions. Keywords: Elastography, Breast masses, Strain ratio, Ultrasound, BI-RADS classification, Tsukuba score

  6. Diagnostic performance of dual-staining cytology for cervical cancer screening: A systematic literature review.

    Science.gov (United States)

    Tjalma, Wiebren A A

    2017-03-01

    Cervical cancer screening saves lives. Secondary prevention in cervical cancer screening relies on the results of primary cytology and/or HPV testing. However, primary screening with cytology has a low sensitivity, and HPV screening has a low specificity. This means that either cancers are missed, or women are over-treated. To improve performance outcomes, the concept of dual-stain cytology (CINtec ® PLUS Cytology test) has been introduced. In this approach, additional staining with p16/Ki-67 is performed in cases where cytology results are abnormal (LSIL or ASCUS) and/or HPV-positive. Another way to describe this approach might be "diagnostic" cytology. In order to assess the value of this "diagnostic cytology", a systematic literature review was conducted of dual-stain cytology performance across multiple studies until May 2016. In a Belgian screening population (women age 25-65 years), dual-stain cytology was significantly more sensitive (66%) and slightly less specific (-1.0%) than cytology. In the population referred to colposcopy or with abnormal cytology (ASCUS, LSIL), dual-staining showed a significantly higher increase in specificity, and a slightly lower sensitivity than HPV testing. Specificity gains resulted in fewer false positives and an increase in the number of correct referrals to colposcopy. Dual-staining with p16/Ki-67 cytology is an attractive biomarker approach for triage in cervical cancer screening. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Elastography for Thyroid Nodules: The Comparison of Diagnostic Performance on Transverse and Longitudinal Planes

    International Nuclear Information System (INIS)

    Moon, Hee Jung; Kwak, Jin Young; Kim, Eun Kyung

    2012-01-01

    To evaluate the diagnostic performance of elastography for thyroid nodules on the transverse and longitudinal planes. Gray scale ultrasonography (US), elastography on trans- verse and longitudinal planes, and fine needle aspiration biopsy for 78 thyroid nodules (malignant: 34 cases, benign: 44 cases) were performed. According to the Asteria criteria of elastography, scores 1 and 2 were classified as probably benign and scores 3 and 4 were classified as suspicious. Strain ratios on transverse and longitudinal planes were measured. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Az value (under the receiver operating characteristics curve) of elastography on transverse and longitudinal planes were calculated and compared. Scores 3 and 4 were more frequently seen in malignant nodules on the longitudinal plane (p value = 0.007), but not significantly seen on the transverse plane (p value = 0.160). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and the Az value of elastography on the longitudinal plane were higher than those on the transverse plane, although Az values on the transverse and longtudinal planes were not statistically significant. Diagnostic performance of thyroid elastography, especially sensitivity, were higher on the longitudinal plane than the transverse plane

  8. Diagnostic performance of Contrast-enhanced CT in Pyrrolizidine Alkaloids-induced Hepatic Sinusoidal Obstructive Syndrome

    Science.gov (United States)

    Kan, Xuefeng; Ye, Jin; Rong, Xinxin; Lu, Zhiwen; Li, Xin; Wang, Yong; Yang, Ling; Xu, Keshu; Song, Yuhu; Hou, Xiaohua

    2016-01-01

    Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by pyrrolizidine alkaloids(PAs)-containing herbals. Since PAs exposure is obscure and clinical presentation of HSOS is unspecific, it is challenge to establish the diagnosis of PAs-induced HSOS. Gynura segetum is one of the most wide-use herbals containing PAs. The aim of our study is to describe the features of contrast-enhanced computed tomography (CT) in gynura segetum-induced HSOS, and then determine diagnostic performance of radiological signs. We retrospectively analyzed medical records and CT images of HSOS patients (71 cases) and the controls (222 cases) enrolled from January 1, 2008, to Oct 31, 2015. The common findings of contrast CT in PAs-induced HSOS included: ascites (100%), hepatomegaly (78.87%), gallbladder wall thickening (86.96%), pleural effusion (70.42%), hepatic vein narrowing (87.32%), patchy liver enhancement (92.96%), and heterogeneous hypoattenuation (100%); of these signs, patchy enhancement and heterogeneous hypoattenuation were valuable features. Then, the result of diagnostic performance demonstrated that contrast CT possessed better performance in diagnosing PAs-induced HSOS compared with various parameters of Seattle criteria. In conclusion, the patients with PAs-induced HSOS display distinct radiologic features at CT-scan, which reveals that contrast-enhanced CT provides an effective noninvasive method for diagnosing PAs-induced HSOS. PMID:27897243

  9. Comparative Evaluation of the Diagnostic Performance of the Prototype Cepheid GeneXpert Ebola Assay

    Science.gov (United States)

    Jansen van Vuren, Petrus; Grobbelaar, Antoinette; Storm, Nadia; Conteh, Ousman; Konneh, Kelfala; Kamara, Abdul; Sanne, Ian

    2015-01-01

    The Ebola virus disease (EVD) outbreak in West Africa has highlighted an urgent need for point-of-care (POC) assays for the diagnosis of this devastating disease in resource-limited African countries. The diagnostic performance characteristics of a prototype Cepheid GeneXpert Ebola POC used to detect Ebola virus (EBOV) in stored serum and plasma samples collected from suspected EVD cases in Sierra Leone in 2014 and 2015 was evaluated. The GeneXpert Ebola POC is a self-contained single-cartridge automated system that targets the glycoprotein (GP) and nucleoprotein (NP) genes of EBOV and yields results within 90 min. Results from 281 patient samples were compared to the results of a TaqMan real-time reverse transcription-PCR (RT-PCR) targeting the polymerase gene and performed on two real-time PCR machines. Agreement between the three platforms was 100% at cycle threshold (CT) values of ≤34.99, but discordant results were noted between CT values of 35 and 45.The diagnostic sensitivity of the three platforms was 100% in 91 patient samples that were confirmed to be infectious by virus isolation. All three molecular platforms detected viral EBOV RNA in additional samples that did not contain viable EBOV. The analytical sensitivity of the GeneXpert Ebola POC for the detection of NP was higher, and comparable to that of polymerase gene detection, than that for the detection of GP when using a titrated laboratory stock of EBOV. There was no detectable cross-reactivity with other hemorrhagic fever viruses or arboviruses. The GeneXpert Ebola POC offers an easy to operate and sensitive diagnostic tool that can be used for the rapid screening of suspected EVD cases in treatment or in holding centers during EVD outbreaks. PMID:26637383

  10. Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses.

    Science.gov (United States)

    Hoorweg, Beatrijs Bn; Willemsen, Robert Ta; Cleef, Lotte E; Boogaerts, Tom; Buntinx, Frank; Glatz, Jan Fc; Dinant, Geert Jan

    2017-11-01

    Observational study of patients with chest pain in primary care: determination of incidence, referral rate, diagnostic tests and (agreement between) working and final diagnoses. 118 general practitioners (GPs) in the Netherlands and Belgium recorded all patient contacts during  2weeks. Furthermore, patients presenting with chest pain were registered extensively. A follow-up form was filled in after 30 days. 22 294 patient contacts were registered. In 281 (1.26%), chest pain was a reason for consulting the GP (mean age for men 54.4/women 53 years). In this cohort of 281 patients, in 38.1% of patients, acute coronary syndrome (ACS) was suspected at least temporarily during consultation, 40.2% of patients were referred to secondary care and 512 diagnostic tests were performed by GPs and consulted specialists. Musculoskeletal pain was the most frequent working (26.1%) and final diagnoses (33.1%). Potentially life-threatening diseases as final diagnosis (such as myocardial infarction) accounted for 8.4% of all chest pain cases. In 23.1% of cases, a major difference between working and final diagnoses was found, in 0.7% a severe disease was initially missed by the GP. Chest pain was present in 281 patients (1.26% of all consultations). Final diagnoses were mostly non-life-threatening. Nevertheless, in 8.4% of patients with chest pain, life-threatening underlying causes were identified. This seems reflected in the magnitude and wide variety of diagnostic tests performed in these patients by GPs and specialists, in the (safe) overestimation of life-threatening diseases by GPs at initial assessment and in the high referral rate we found. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Use of proficiency samples to assess diagnostic laboratories in France performing a Trichinella digestion assay.

    Science.gov (United States)

    Vallée, Isabelle; Macé, Pauline; Forbes, Lorry; Scandrett, Brad; Durand, Benoit; Gajadhar, Alvin; Boireau, Pascal

    2007-07-01

    Routine diagnosis of animal trichinellosis for food safety and trade relies on a method of artificial digestion to free Trichinella muscle larvae from meat for subsequent identification by microscopy. As part of a quality control system, the French National Reference Laboratory (NRL) initiated ring trials to determine the sensitivity of the test performed in the 72 routine diagnostic laboratories in France. A method was devised to obtain calibrated meat samples containing known numbers of capsules with Trichinella spiralis muscle larvae. This method was based on an incomplete artificial digestion of Trichinella-infected mice carcasses to allow the collection of intact Trichinella capsules. Capsules were placed into a meatball of 100 +/- 2 g of pork and horsemeat to produce proficiency samples. Three categories of samples were prepared: small (3 to 5 capsules), medium (7 to 10), and large (12 to 15). The sensitivity was expressed as the percentage of muscle larvae recovered from each proficiency sample. Reproducibility was tested with ring trials organized between two NRLs (France and Canada), and a reference sensitivity of 84.9% was established. National ring trials were then organized in France, with the 72 routine diagnostic laboratories each receiving four proficiency samples per session. After five sessions, an improvement in the digest test sensitivity was observed. Results at the fifth session indicated sensitivities of 78.60% +/- 23.70%, 81.19% +/- 19.59%, and 80.52% +/- 14.71% muscle larvae for small, medium, and large samples, respectively. This study supports the use of proficiency samples to accurately evaluate the performance of routine diagnostic laboratories that conduct digestion tests for animal trichinellosis diagnosis.

  12. Diagnostic Performance of Self-Assessment for Constipation in Patients With Long-Term Opioid Treatment.

    Science.gov (United States)

    Tafelski, Sascha; Bellin, Felicitas; Denke, Claudia; Beutlhauser, Torsten; Fritzsche, Thomas; West, Christina; Schäfer, Michael

    2015-12-01

    Constipation is a prevalent comorbidity affecting ∼50% of patients with long-term opioid therapy. In clinical routine different diagnostic instruments are in use to identify patients under risk. The aim of this study was to assess the diagnostic performance of an 11-item Likert scale for constipation used as a self-assessment in opioid-treated patients. This trial was conducted as a retrospective cohort study in Berlin, Germany. Patients with long-term opioid therapy treated in 2 university-affiliated outpatient pain facilities at the Charité hospital were included from January 2013 to August 2013. Constipation was rated in a self-assessment using a numeric rating scale from 0 to 10 (Con-NRS) and compared with results from a structured assessment based on ROME-III criteria. Altogether, 171 patients were included. Incidence of constipation was 49% of patients. The receiver-operating characteristic of Con-NRS achieved an area under the curve of 0.814 (AUC 95% confidence interval 0.748-0.880, P < 0.001). Con-NRS ≥ 1 achieved sensitivity and specificity of 79.7% and 77.2%, respectively. The positive predictive value and the negative predictive value were 70.3% and 81.6%, respectively. Overall diagnostic performance of a concise 11-item Likert scale for constipation was moderate. Although patients with long-term opioid therapy are familiar with numeric rating scales, a significant number of patients with constipation were not identified. The instrument may be additionally useful to facilitate individualized therapeutic decision making and to control therapeutic success when measured repetitively.

  13. The SUCCESS model for laboratory performance and execution of rapid molecular diagnostics in patients with sepsis.

    Science.gov (United States)

    Dekmezian, Mhair; Beal, Stacy G; Damashek, Mary Jane; Benavides, Raul; Dhiman, Neelam

    2015-04-01

    Successful performance and execution of rapid diagnostics in a clinical laboratory hinges heavily on careful validation, accurate and timely communication of results, and real-time quality monitoring. Laboratories must develop strategies to integrate diagnostics with stewardship and evidence-based clinical practice guidelines. We present a collaborative SUCCESS model for execution and monitoring of rapid sepsis diagnostics to facilitate timely treatment. Six months after execution of the Verigene Gram-Positive Blood Culture (BC-GP) and the AdvanDx PNA-FISH assays, data were collected on 579 and 28 episodes of bacteremia and fungemia, respectively. Clinical testing was executed using a SUCCESS model comprising the following components: stewardship, utilization of resources, core strategies, concierge services, education, support, and surveillance. Stewardship needs were identified by evaluating the specialty services benefiting from new testing. Utilization of resources was optimized by reviewing current treatment strategies and antibiogram and formulary options. Core strategies consisted of input from infectious disease leadership, pharmacy, and laboratory staff. Concierge services included automated Micro-eUpdate and physician-friendly actionable reports. Education modules were user-specific, and support was provided through a dedicated 24/7 microbiology hotline. Surveillance was performed by daily audit by the director. Using the SUCCESS model, the turnaround time for the detailed report with actionable guidelines to the physician was ∼3 hours from the time of culture positivity. The overall correlation between rapid methods and culture was 94% (546/579). Discrepant results were predominantly contaminants such as a coagulase-negative staphylococci or viridans streptococci in mixed cultures. SUCCESS is a cost-effective and easily adaptable model for clinical laboratories with limited stewardship resources.

  14. Volume perfusion CT imaging of cerebral vasospasm: diagnostic performance of different perfusion maps

    Energy Technology Data Exchange (ETDEWEB)

    Othman, Ahmed E. [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, Aachen (Germany); Eberhard Karls University Tuebingen, University Hospital Tuebingen, Department for Diagnostic and Interventional Radiology, Tuebingen (Germany); Afat, Saif; Nikoubashman, Omid; Mueller, Marguerite; Wiesmann, Martin; Brockmann, Carolin [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, Aachen (Germany); Schubert, Gerrit Alexander [RWTH Aachen University, Department of Neurosurgery, Aachen (Germany); Bier, Georg [Eberhard Karls University Tuebingen, University Hospital Tuebingen, Department for Diagnostic and Interventional Neuroradiology, Tuebingen (Germany); Brockmann, Marc A. [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, Aachen (Germany); University Hospital Mainz, Department of Neuroradiology, Mainz (Germany)

    2016-08-15

    In this study, we aimed to evaluate the diagnostic performance of different volume perfusion CT (VPCT) maps regarding the detection of cerebral vasospasm compared to angiographic findings. Forty-one datasets of 26 patients (57.5 ± 10.8 years, 18 F) with subarachnoid hemorrhage and suspected cerebral vasospasm, who underwent VPCT and angiography within 6 h, were included. Two neuroradiologists independently evaluated the presence and severity of vasospasm on perfusion maps on a 3-point Likert scale (0 - no vasospasm, 1 - vasospasm affecting <50 %, 2 - vasospasm affecting >50 % of vascular territory). A third neuroradiologist independently assessed angiography for the presence and severity of vasospasm on a 3-point Likert scale (0 - no vasospasm, 1 - vasospasm affecting < 50 %, 2 - vasospasm affecting > 50 % of vessel diameter). Perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to drain (TTD) were evaluated regarding diagnostic accuracy for cerebral vasospasm with angiography as reference standard. Correlation analysis of vasospasm severity on perfusion maps and angiographic images was performed. Furthermore, inter-reader agreement was assessed regarding findings on perfusion maps. Diagnostic accuracy for TTD and MTT was significantly higher than for all other perfusion maps (TTD, AUC = 0.832; MTT, AUC = 0.791; p < 0.001). TTD revealed higher sensitivity than MTT (p = 0.007). The severity of vasospasm on TTD maps showed significantly higher correlation levels with angiography than all other perfusion maps (p ≤ 0.048). Inter-reader agreement was (almost) perfect for all perfusion maps (kappa ≥ 0.927). The results of this study indicate that TTD maps have the highest sensitivity for the detection of cerebral vasospasm and highest correlation with angiography regarding the severity of vasospasm. (orig.)

  15. Incorporation of tritium from wrist watches

    International Nuclear Information System (INIS)

    Schoenhofer, F.; Pock, K.

    1995-01-01

    Watches are consumer products and are subject to the regulations that control food and consumer products. Elevated concentrations of tritium were found in the urine of persons who wore wrist watches with luminous dials and plastic cases. High emission of tritium from these watches were observed. In an experiment, a volunteer wore a watch with high emissions and the build-up of the tritium concentration in urine was monitored, as well as the decline after removing the watch. Possible pathways for the incorporation and its mechanism are considered. In spite of the relatively high activity concentrations observed, the dose is negligible. On the other hand, the principle 'ALARA' can be achieved without any costs by simply choosing other types of watches. (author). 12 refs., 2 figs., 2 tabs

  16. Unusual Wrist Tremor: Unilateral Isometric Tremor?

    Directory of Open Access Journals (Sweden)

    Theresa A. Zesiewicz

    2014-01-01

    Full Text Available Background: Tremors may be difficult to classify.Case Report: An 83‐year‐old male presented with an unusual left wrist tremor. The tremor could be reproducibly elicited by making a fist or carrying a weighted object (e.g., a shopping bag, bottle of water of approximately 1 lb or more, and it intensified with heavier weights. The tremor was difficult to classify, although it shared features with isometric tremor.Discussion: This specific presentation of tremor has not been reported previously. We hope that the detailed description we provide will aid other neurologists who encounter this or similar tremors in their clinics.

  17. Reproducibility of wrist home blood pressure measurement with position sensor and automatic data storage

    Science.gov (United States)

    Uen, Sakir; Fimmers, Rolf; Brieger, Miriam; Nickenig, Georg; Mengden, Thomas

    2009-01-01

    Background Wrist blood pressure (BP) devices have physiological limits with regards to accuracy, therefore they were not preferred for home BP monitoring. However some wrist devices have been successfully validated using etablished validation protocols. Therefore this study assessed the reproducibility of wrist home BP measurement with position sensor and automatic data storage. Methods To compare the reproducibility of three different(BP) measurement methods: 1) office BP, 2) home BP (Omron wrist device HEM- 637 IT with position sensor), 3) 24-hour ambulatory BP(24-h ABPM) (ABPM-04, Meditech, Hun)conventional sphygmomanometric office BP was measured on study days 1 and 7, 24-h ABPM on study days 7 and 14 and home BP between study days 1 and 7 and between study days 8 and 14 in 69 hypertensive and 28 normotensive subjects. The correlation coeffcient of each BP measurement method with echocardiographic left ventricular mass index was analyzed. The schedule of home readings was performed according to recently published European Society of Hypertension (ESH)- guidelines. Results The reproducibility of home BP measurement analyzed by the standard deviation as well as the squared differeces of mean individual differences between the respective BP measurements was significantly higher than the reproducibility of office BP (p ABPM (p ABPM was not significantly different (p = 0.80 systolic BP, p = 0.1 diastolic BP). The correlation coefficient of 24-h ABMP (r = 0.52) with left ventricular mass index was significantly higher than with office BP (r = 0.31). The difference between 24-h ABPM and home BP (r = 0.46) was not significant. Conclusion The short-term reproducibility of home BP measurement with the Omron HEM-637 IT wrist device was superior to the reproducibility of office BP and 24- h ABPM measurement. Furthermore, home BP with the wrist device showed similar correlations to targed organ damage as recently reported for upper arm devices. Although wrist devices have

  18. The epidemiology of wrist fractures in older men: the Osteoporotic Fractures in Men (MrOS) study.

    Science.gov (United States)

    Wright, N C; Hooker, E R; Nielson, C M; Ensrud, K E; Harrison, S L; Orwoll, E S; Barrett-Connor, E

    2018-04-01

    There is limited wrist fracture information on men. Our goal was to calculate frequency and identify risk factors for wrist fracture in the Osteoporotic Fractures in Men (MrOS) study. We confirmed that fracture history and certain medications are predictors, and identified novel predictors including markers of kidney function and physical performance. To calculate the incidence of wrist fractures and their risk factors in older community-dwelling men from the US Osteoporotic Fractures in Men (MrOS) study. Using triannual postcards, we identified incident wrist fractures (centrally confirmed by radiology) in men aged ≥ 65. Potential risk factors included the following: demographics, lifestyle, bone mineral density (BMD), selected medications, biomarkers, and physical function and performance measures. Both baseline and time-varying models were adjusted for age, race/ethnicity, MrOS geographic location, and competing mortality risks. We observed 97 incident wrist fractures among 5875 men followed for an average of 10.8 years. The incidence of wrist fracture was 1.6 per 1000 person-years overall and ranged from 1.0 among men aged 65-69 to 2.4 among men age ≥ 80. Significant predictors included the following: fracture history after age 50 [hazard ratio (95% CI): 2.48 (1.65, 3.73)], high serum phosphate [1.25 (1.02, 1.53)], use of selective serotonin receptor inhibitor (SSRI) [3.60 (1.96, 6.63), decreased right arm BMD [0.49 (0.37, 0.65) per SD increase], and inability to perform the grip strength test [3.38 (1.24, 9.25)]. We did not find associations with factors commonly associated with wrist and other osteoporosis fractures like falls, diabetes, calcium and vitamin D intake, and alcohol intake. Among these older, community-dwelling men, we confirmed that fracture history is a strong predictor of wrist fractures in men. Medications such as SSRIs and corticosteroids also play a role in wrist fracture risk. We identified novel risk factors including kidney

  19. A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension.

    Science.gov (United States)

    You, Myung-Won; Kim, Kyung Won; Pyo, Junhee; Huh, Jimi; Kim, Hyoung Jung; Lee, So Jung; Park, Seong Ho

    2017-01-01

    We aimed to evaluate the correlation between liver stiffness measurement using transient elastography (TE-LSM) and hepatic venous pressure gradient and the diagnostic performance of TE-LSM in assessing clinically significant portal hypertension through meta-analysis. Eleven studies were included from thorough literature research and selection processes. The summary correlation coefficient was 0.783 (95% confidence interval [CI], 0.737-0.823). Summary sensitivity, specificity and area under the hierarchical summary receiver operating characteristic curve (AUC) were 87.5% (95% CI, 75.8-93.9%), 85.3 % (95% CI, 76.9-90.9%) and 0.9, respectively. The subgroup with low cut-off values of 13.6-18 kPa had better summary estimates (sensitivity 91.2%, specificity 81.3% and partial AUC 0.921) than the subgroup with high cut-off values of 21-25 kPa (sensitivity 71.2%, specificity 90.9% and partial AUC 0.769). In summary, TE-LSM correlated well with hepatic venous pressure gradient and represented good diagnostic performance in diagnosing clinically significant portal hypertension. For use as a sensitive screening tool, we propose using low cut-off values of 13.6-18 kPa in TE-LSM. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  20. Diagnostic performance of shear wave elastography of the breast according to scanning orientation.

    Science.gov (United States)

    Kim, Solip; Choi, SeonHyeong; Choi, Yoonjung; Kook, Shin-Ho; Park, Hee Jin; Chung, Eun Chul

    2014-10-01

    To evaluate the influence of the scanning orientation on diagnostic performance measured by the mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio on ultrasound-based shear wave elastography in differentiating breast cancers from benign lesions. In this study, a total of 260 breast masses from 235 consecutive patients were observed from March 2012 to November 2012. For each lesion, the mean elasticity value, maximum elasticity value, and fat-to-lesion ratio were measured along two orthogonal directions, and all values were compared with pathologic results. There were 59 malignant and 201 benign lesions. Malignant masses showed higher mean elasticity, maximum elasticity, and fat-to-lesion ratio values than benign lesions (P masses; and mean elasticity, 0.392, for anterior mammary fat. Mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio values were helpful in differentiating benign and malignant breast masses. The scanning orientation did not significantly affect the diagnostic performance of shear wave elastography for breast masses. © 2014 by the American Institute of Ultrasound in Medicine.

  1. Standardized combined cryotherapy and compression using Cryo/Cuff after wrist arthroscopy.

    Science.gov (United States)

    Meyer-Marcotty, M; Jungling, O; Vaske, B; Vogt, P M; Knobloch, Karsten

    2011-02-01

    cryotherapy and compression as integral part of the RICE regimen are thought to improve treatment outcome after sport injuries. Using standardized cryotherapy and compression perioperatively has been reported with conflicting clinical results. The impact of combined cryotherapy and compression is compared to standard care among patients undergoing wrist arthroscopy. fifty-six patients undergoing wrist arthroscopy were assessed, 54 patients were randomized to either Cryo/Cuff (3 × 10 min twice daily) or standard care over 3 weeks. Follow-up clinical visits were at postoperative days 1, 8, and 21. One patient in each group was lost during follow-up. Fifty-two patients were analyzed. Statistics were performed as Intention-to-treat analysis. Outcome parameters were pain, three-dimensional volume of the wrist, range of motion, and DASH score. the Cryo/Cuffgroup had a 49% reduction in pain level (VAS 3.5 ± 0.4 vs. VAS 1.8 ± 0.2 on the 21st postoperative day) when compared to a reduction of 41% in the control group (VAS 5.1 ± 0.6 preoperatively vs. VAS 3.0 ± 0.5 on the 21st postoperative day). Swelling and range of motion were not as significantly different between the two groups as were DASH scores (DASH-score Cryo/Cuff group preoperatively 37.3 ± 3.5 and postoperatively 36.9 ± 3.5; DASH-score control group preoperatively 42.8 ± 4.3 and postoperatively 41.9 ± 4.9). The CONSORT score reached 17 out of 22. there was no significant effect of additional home-based combined cryotherapy and compression using the Cryo/Cuff wrist bandage, following wrist arthroscopy regarding pain, swelling, range of motion, and subjective impairment assessed using the DASH score over 3 weeks in comparison with the control group.

  2. Performance, diagnostics, controls and plans for the gyrotron system on the DIII-D tokamak

    Directory of Open Access Journals (Sweden)

    Ponce D.M.

    2012-09-01

    Full Text Available The DIII-D ECH complex is being upgraded with three new depressed collector gyrotrons. The performance of the existing system has been very good. As more gyrotrons having higher power are added to the system, diagnostics of gyrotron operation, optimization of the performance and qualification of components for higher power become more important. A new FPGA-based gyrotron control system is being installed, additional capabilities for rapid real time variation of the rf injection angles by the DIII-D Plasma Control System are being tested and infrastructure enhancements are being completed. Longer term plans continue to include ECH as a major component in the DIII-D heating and current drive capabilities.

  3. A random forest classifier for the prediction of energy expenditure and type of physical activity from wrist and hip accelerometers

    International Nuclear Information System (INIS)

    Ellis, Katherine; Lanckriet, Gert; Kerr, Jacqueline; Godbole, Suneeta; Wing, David; Marshall, Simon

    2014-01-01

    Wrist accelerometers are being used in population level surveillance of physical activity (PA) but more research is needed to evaluate their validity for correctly classifying types of PA behavior and predicting energy expenditure (EE). In this study we compare accelerometers worn on the wrist and hip, and the added value of heart rate (HR) data, for predicting PA type and EE using machine learning. Forty adults performed locomotion and household activities in a lab setting while wearing three ActiGraph GT3X+ accelerometers (left hip, right hip, non-dominant wrist) and a HR monitor (Polar RS400). Participants also wore a portable indirect calorimeter (COSMED K4b2), from which EE and metabolic equivalents (METs) were computed for each minute. We developed two predictive models: a random forest classifier to predict activity type and a random forest of regression trees to estimate METs. Predictions were evaluated using leave-one-user-out cross-validation. The hip accelerometer obtained an average accuracy of 92.3% in predicting four activity types (household, stairs, walking, running), while the wrist accelerometer obtained an average accuracy of 87.5%. Across all 8 activities combined (laundry, window washing, dusting, dishes, sweeping, stairs, walking, running), the hip and wrist accelerometers obtained average accuracies of 70.2% and 80.2% respectively. Predicting METs using the hip or wrist devices alone obtained root mean square errors (rMSE) of 1.09 and 1.00 METs per 6 min bout, respectively. Including HR data improved MET estimation, but did not significantly improve activity type classification. These results demonstrate the validity of random forest classification and regression forests for PA type and MET prediction using accelerometers. The wrist accelerometer proved more useful in predicting activities with significant arm movement, while the hip accelerometer was superior for predicting locomotion and estimating EE. (paper)

  4. A random forest classifier for the prediction of energy expenditure and type of physical activity from wrist and hip accelerometers.

    Science.gov (United States)

    Ellis, Katherine; Kerr, Jacqueline; Godbole, Suneeta; Lanckriet, Gert; Wing, David; Marshall, Simon

    2014-11-01

    Wrist accelerometers are being used in population level surveillance of physical activity (PA) but more research is needed to evaluate their validity for correctly classifying types of PA behavior and predicting energy expenditure (EE). In this study we compare accelerometers worn on the wrist and hip, and the added value of heart rate (HR) data, for predicting PA type and EE using machine learning. Forty adults performed locomotion and household activities in a lab setting while wearing three ActiGraph GT3X+ accelerometers (left hip, right hip, non-dominant wrist) and a HR monitor (Polar RS400). Participants also wore a portable indirect calorimeter (COSMED K4b2), from which EE and metabolic equivalents (METs) were computed for each minute. We developed two predictive models: a random forest classifier to predict activity type and a random forest of regression trees to estimate METs. Predictions were evaluated using leave-one-user-out cross-validation. The hip accelerometer obtained an average accuracy of 92.3% in predicting four activity types (household, stairs, walking, running), while the wrist accelerometer obtained an average accuracy of 87.5%. Across all 8 activities combined (laundry, window washing, dusting, dishes, sweeping, stairs, walking, running), the hip and wrist accelerometers obtained average accuracies of 70.2% and 80.2% respectively. Predicting METs using the hip or wrist devices alone obtained root mean square errors (rMSE) of 1.09 and 1.00 METs per 6 min bout, respectively. Including HR data improved MET estimation, but did not significantly improve activity type classification. These results demonstrate the validity of random forest classification and regression forests for PA type and MET prediction using accelerometers. The wrist accelerometer proved more useful in predicting activities with significant arm movement, while the hip accelerometer was superior for predicting locomotion and estimating EE.

  5. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist - a pilot study

    International Nuclear Information System (INIS)

    Huellner, Martin W.; Buerkert, Alexander; Schleich, Florian S.; Strobel, Klaus; Veit-Haibach, Patrick; Schuerch, Maja; Hug, Urs; Wartburg, Urs von

    2012-01-01

    Hand and wrist pain is a diagnostic challenge for hand surgeons and radiologists due to the complex anatomy of the involved small structures. The American College of Radiology recommends MRI as the study of choice in patients with chronic wrist pain if radiographs are negative. Lately, state-of-the-art SPECT/CT systems have been introduced and may help in the diagnosis of this selected indication. This retrospective study included 21 patients with nonspecific pain of the hand/wrist. The diagnosis of nonspecific wrist pain was made by the referring hand surgeon based on patient history, clinical examination, plain radiography and clinical guidelines. All patients received planar early-phase imaging and late-phase SPECT/CT imaging as well as MRI. Lesions were divided into major (causative) and minor (not causative) pathologies according to clinical follow-up. Furthermore, oedema-like bone marrow changes seen on MRI were compared with focally increased tracer uptake seen on SPECT/CT images. MRI yielded a quite high sensitivity (0.86), but a low specificity (0.20). In contrast, SPECT/CT yielded a high specificity (1.00) and a low sensitivity (0.71). Oedema-like bone marrow changes were detected in 15 lesions in 11 patients. In ten lesions with bone marrow oedema on MRI, foci of elevated tracer uptake were detected on SPECT/CT. Overall, MRI was more sensitive, but SPECT/CT was more specific in the evaluation of causative pathologies. In this initial comparison, SPECT/CT showed higher specificity than MRI in the evaluation of causative pathologies in patients with nonspecific wrist pain. However, MRI was more sensitive. Thus, SPECT/CT was shown to be a useful problem-solving tool in the diagnostic work-up of these patients. (orig.)

  6. HIV misdiagnosis in sub-Saharan Africa: performance of diagnostic algorithms at six testing sites

    Science.gov (United States)

    Kosack, Cara S.; Shanks, Leslie; Beelaert, Greet; Benson, Tumwesigye; Savane, Aboubacar; Ng’ang’a, Anne; Andre, Bita; Zahinda, Jean-Paul BN; Fransen, Katrien; Page, Anne-Laure

    2017-01-01

    Abstract Introduction: We evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub-Saharan African countries. Methods: In this prospective multisite diagnostic evaluation study (Conakry, Guinea; Kitgum, Uganda; Arua, Uganda; Homa Bay, Kenya; Doula, Cameroun and Baraka, Democratic Republic of Congo), samples from clients (greater than equal to five years of age) testing for HIV were collected and compared to a state-of-the-art algorithm from the AIDS reference laboratory at the Institute of Tropical Medicine, Belgium. The reference algorithm consisted of an enzyme-linked immuno-sorbent assay, a line-immunoassay, a single antigen-enzyme immunoassay and a DNA polymerase chain reaction test. Results: Between August 2011 and January 2015, over 14,000 clients were tested for HIV at 6 HIV counselling and testing sites. Of those, 2786 (median age: 30; 38.1% males) were included in the study. Sensitivity of the testing algorithms ranged from 89.5% in Arua to 100% in Douala and Conakry, while specificity ranged from 98.3% in Doula to 100% in Conakry. Overall, 24 (0.9%) clients, and as many as 8 per site (1.7%), were misdiagnosed, with 16 false-positive and 8 false-negative results. Six false-negative specimens were retested with the on-site algorithm on the same sample and were found to be positive. Conversely, 13 false-positive specimens were retested: 8 remained false-positive with the on-site algorithm. Conclusions: The performance of algorithms at several sites failed to meet expectations and thresholds set by the World Health Organization, with unacceptably high rates of false results. Alongside the careful selection of rapid diagnostic tests and the validation of algorithms, strictly observing correct procedures can reduce the risk of false results. In the meantime, to identify false-positive diagnoses at initial testing, patients should be retested upon initiating antiretroviral therapy. PMID:28691437

  7. An Evaluation of the Performance Diagnostic Checklist-Human Services (PDC-HS) Across Domains.

    Science.gov (United States)

    Wilder, David A; Lipschultz, Joshua; Gehrman, Chana

    2018-06-01

    The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to assess the environmental variables that contribute to poor employee performance in human service settings. Although the PDC-HS has been shown to effectively identify variables contributing to problematic performance, interventions based on only two of the four PDC-HS domains have been evaluated to date. In addition, the extent to which PDC-HS-indicated interventions are more effective than nonindicated interventions for two domains remains unclear. In the current study, we administered the PDC-HS to supervisors to assess the variables contributing to infrequent teaching of verbal operants and use of a timer by therapists at a center-based autism treatment program. Each of the four PDC-HS domains was identified as contributing to poor performance for at least one therapist. We then evaluated PDC-HS-indicated interventions for each domain. In addition, to assess the predictive validity of the tool, we evaluated various nonindicated interventions prior to implementing a PDC-HS-indicated intervention for two of the four domains. Results suggest that the PDC-HS-indicated interventions were effective across all four domains and were more effective than the nonindicated interventions for the two domains for which they were evaluated. Results are discussed in terms of the utility of the PDC-HS to identify appropriate interventions to manage therapist performance in human service settings.

  8. Diagnostic performance of a Lattice Boltzmann-based method for CT-based fractional flow reserve.

    Science.gov (United States)

    Giannopoulos, Andreas A; Tang, Anji; Ge, Yin; Cheezum, Michael K; Steigner, Michael L; Fujimoto, Shinichiro; Kumamaru, Kanako K; Chiappino, Dante; Della Latta, Daniele; Berti, Sergio; Chiappino, Sara; Rybicki, Frank J; Melchionna, Simone; Mitsouras, Dimitrios

    2018-02-20

    Fractional flow reserve (FFR) estimated from coronary computed tomography angiography (CT-FFR) offers non-invasive detection of lesion-specific ischaemia. We aimed to develop and validate a fast CT-FFR algorithm utilising the Lattice Boltzmann method for blood flow simulation (LBM CT-FFR). Sixty-four patients with clinically indicated CTA and invasive FFR measurement from three institutions were retrospectively analysed. CT-FFR was performed using an onsite tool interfacing with a commercial Lattice Boltzmann fluid dynamics cloud-based platform. Diagnostic accuracy of LBM CT-FFR ≤0.8 and percent diameter stenosis >50% by CTA to detect invasive FFR ≤0.8 were compared using area under the receiver operating characteristic curve (AUC). Sixty patients successfully underwent LBM CT-FFR analysis; 29 of 73 lesions in 69 vessels had invasive FFR ≤0.8. Total time to perform LBM CT-FFR was 40±10 min. Compared to invasive FFR, LBM CT-FFR had good correlation (r=0.64), small bias (0.009) and good limits of agreement (-0.223 to 0.206). The AUC of LBM CT-FFR (AUC=0.894, 95% confidence interval [CI]: 0.792-0.996) was significantly higher than CTA (AUC=0.685, 95% CI: 0.576-0.794) to detect FFR ≤0.8 (p=0.0021). Per-lesion specificity, sensitivity, and accuracy of LBM CT-FFR were 97.7%, 79.3%, and 90.4%, respectively. LBM CT-FFR has very good diagnostic accuracy to detect lesion-specific ischaemia (FFR ≤0.8) and can be performed in less than one hour.

  9. Xanthogranulomatous cholecystitis: Diagnostic performance of CT to differentiate from gallbladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goshima, Satoshi, E-mail: gossy@par.odn.ne.j [Department of Radiology, University of Pittsburgh Medical Center, Lothrop St., Pittsburgh, PA 15213 (United States); Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194 (Japan); Chang, Samuel; Wang, Jin Hong [Department of Radiology, University of Pittsburgh School of Medicine, 3362 Fifth Ave., Pittsburgh, PA15213 (United States); Kanematsu, Masayuki [Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194 (Japan); Department of Radiology Services, Gifu University School of Medicine, 1-1- Yanagido, Gifu 501-1194 (Japan); Bae, Kyongtae T. [Department of Radiology, University of Pittsburgh School of Medicine, 3362 Fifth Ave., Pittsburgh, PA15213 (United States); Federle, Michael P. [Department of Radiology, University of Pittsburgh Medical Center, Lothrop St., Pittsburgh, PA 15213 (United States); Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5105 (United States)

    2010-06-15

    Purpose: To retrospectively evaluate CT findings of xanthogranulomatous cholecystitis (XGC) and to measure diagnostic performance for distinguishing it from gallbladder (GB) cancer. Methods and materials: Our institutional review board approved this retrospective study. Three blinded radiologists, first independently and then in consensus, retrospectively evaluated postcontrast CT images of 35 patients with histopathologically proved XGC and GB cancer, all of whom subsequently had cholecystectomy. These included 18 patients with XGC (13 male, 5 female; age range, 35-84, mean 63 years) and 17 with GB cancer (6 male, 11 female; age range, 45-95, mean 69). Differences in CT findings between XGC and GB cancer and diagnostic performances for each CT finding were calculated. Sensitivity, specificity, and accuracy were calculated for each radiologist and observer performance was also determined by receiver-operating-characteristic curve analysis. Results: Five CT findings showed significant differences between XGC and GB cancer. Sensitivity, specificity, and accuracy of each finding for the differentiation of XGC were 89%, 65%, 77% with diffuse GB wall thickening, 67%, 82%, 74% with a continuous mucosal line, 61%, 71%, 66% with intra-mural hypo-attenuated nodules, 72%, 77%, 74% with absence of macroscopic hepatic invasion, and 67%, 71%, 69% with absence of intra-hepatic bile duct dilatation, respectively. When at least three of these five CT findings were observed in combination, sensitivity, specificity, and accuracy were 83%, 100% and 91%, respectively. Sensitivities, specificities and Az values for the differentiation of XGC from GB cancer were 83%, 88%, 0.94 for reader 1, 78%, 88%, 0.93 for reader 2, and 78%, 82%, 0.84 for reader 3. Conclusions: The combination of three of the five CT findings that are common with XGC can provide excellent accuracy for the differentiation of XGC and GB cancer.

  10. Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI.

    Science.gov (United States)

    Ko, Sung Min; Song, Meong Gun; Chee, Hyun Kun; Hwang, Hweung Kon; Feuchtner, Gudrun Maria; Min, James K

    2014-12-01

    The purpose of this study was to assess the diagnostic performance of stress perfusion dual-energy CT (DECT) and its incremental value when used with coronary CT angiography (CTA) for identifying hemodynamically significant coronary artery disease. One hundred patients with suspected or known coronary artery disease without chronic myocardial infarction detected with coronary CTA underwent stress perfusion DECT, stress cardiovascular perfusion MRI, and invasive coronary angiography (ICA). Stress perfusion DECT and cardiovascular stress perfusion MR images were used for detecting perfusion defects. Coronary CTA and ICA were evaluated in the detection of ≥50% coronary stenosis. The diagnostic performance of coronary CTA for detecting hemo-dynamically significant stenosis was assessed before and after stress perfusion DECT on a per-vessel basis with ICA and cardiovascular stress perfusion MRI as the reference standard. The performance of stress perfusion DECT compared with cardiovascular stress perfusion MRI on a per-vessel basis in the detection of perfusion defects was sensitivity, 89%; specificity, 74%; positive predictive value, 73%; negative predictive value, 90%. Per segment, these values were sensitivity, 76%; specificity, 80%; positive predictive value, 63%; and negative predictive value, 88%. Compared with ICA and cardiovascular stress perfusion MRI per vessel territory the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA were 95%, 61%, 61%, and 95%. The values for stress perfusion DECT were 92%, 72%, 68%, and 94%. The values for coronary CTA and stress perfusion DECT were 88%, 79%, 73%, and 91%. The ROC AUC increased from 0.78 to 0.84 (p=0.02) with the use of coronary CTA and stress perfusion DECT compared with coronary CTA alone. Stress perfusion DECT plays a complementary role in enhancing the accuracy of coronary CTA for identifying hemodynamically significant coronary stenosis.

  11. Development of GEM detector for plasma diagnostics application: simulations addressing optimization of its performance

    Science.gov (United States)

    Chernyshova, M.; Malinowski, K.; Kowalska-Strzęciwilk, E.; Czarski, T.; Linczuk, P.; Wojeński, A.; Krawczyk, R. D.

    2017-12-01

    The advanced Soft X-ray (SXR) diagnostics setup devoted to studies of the SXR plasma emissivity is at the moment a highly relevant and important for ITER/DEMO application. Especially focusing on the energy range of tungsten emission lines, as plasma contamination by W and its transport in the plasma must be understood and monitored for W plasma-facing material. The Gas Electron Multiplier, with a spatial and energy-resolved photon detecting chamber, based SXR radiation detection system under development by our group may become such a diagnostic setup considering and solving many physical, technical and technological aspects. This work presents the results of simulations aimed to optimize a design of the detector's internal chamber and its performance. The study of the effect of electrodes alignment allowed choosing the gap distances which maximizes electron transmission and choosing the optimal magnitudes of the applied electric fields. Finally, the optimal readout structure design was identified suitable to collect a total formed charge effectively, basing on the range of the simulated electron cloud at the readout plane which was in the order of ~ 2 mm.

  12. Diagnostic value of performing endocervical curettage at the time of colposcopy procedure; a systematic review

    Directory of Open Access Journals (Sweden)

    Shabnam Imannezhad

    2016-03-01

    Full Text Available Introduction: The importance of high-grade cervical intraepithelial neoplasia (CIN as a precursor to invasive cervical cancer suggests a considerable need for accurate screening of the patients for the risk of these lesions. This systematic review aimed to study the diagnostic significance of endocervical curettage (ECC at the time of colposcopy in the detection of CIN 2, 3, and preinvasive lesions.Methods: PubMed was searched to obtain the relevant articles based on the following search term: (endocervical curettage OR ECC AND colposcopy. The most relevant articles were included after studying the title, abstract, and full text of the obtained articles at initial search. Only English language articles published after 1992 with at least 500 patients were included in this study.Result: Among 300 articles identified by the first search, only seven articles were in line with the purpose of this systematic review. Majority of the included studies were retrospective observational studies.Conclusion: Performing ECC has higher sensitivity in women older than 40 years and those with unsatisfactory colposcopy results. However exact diagnostic usefulness of ECC at the time of colposcopy needs to be investigated in further studies.

  13. Diagnostic Performance of Narrow Band Imaging for Nasopharyngeal Cancer: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Sun, Changling; Zhang, Yayun; Han, Xue; Du, Xiaodong

    2018-03-01

    Objective The purposes of this study were to verify the effectiveness of the narrow band imaging (NBI) system in diagnosing nasopharyngeal cancer (NPC) as compared with white light endoscopy. Data Sources PubMed, Cochrane Library, EMBASE, CNKI, and Wan Fang databases. Review Methods Data analyses were performed with Meta-Disc. The updated Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality and potential bias. Publication bias was assessed with a Deeks asymmetry test. The registry number of the protocol published on PROSPERO is CRD42015026244. Results This meta-analysis included 10 studies of 1337 lesions. For NBI diagnosis of NPC, the pooled values were as follows: sensitivity, 0.83 (95% CI, 0.80-0.86); specificity, 0.91 (95% CI, 0.89-0.93); positive likelihood ratio, 8.82 (95% CI, 5.12-15.21); negative likelihood ratio, 0.18 (95% CI, 0.12-0.27); and diagnostic odds ratio, 65.73 (95% CI, 36.74-117.60). The area under the curve was 0.9549. For white light endoscopy in diagnosing NPC, the pooled values were as follows: sensitivity, 0.79 (95% CI, 0.75-0.83); specificity, 0.87 (95% CI, 0.84-0.90); positive likelihood ratio, 5.02 (95% CI, 1.99-12.65); negative likelihood ratio, 0.34 (95% CI, 0.24-0.49); and diagnostic odds ratio, 16.89 (95% CI, 5.98-47.66). The area under the curve was 0.8627. The evaluation of heterogeneity, calculated per the diagnostic odds ratio, gave an I 2 of 0.326. No marked publication bias ( P = .68) existed in this meta-analysis. Conclusion The sensitivity and specificity of NBI for the diagnosis of NPC are similar to those of white light endoscopy, and the potential value of NBI for the diagnosis of NPC needs to be validated further.

  14. Posterior Radioscaphoid Angle as a Predictor of Wrist Degenerative Joint Disease in Patients With Scapholunate Ligament Tears.

    Science.gov (United States)

    Gondim Teixeira, Pedro Augusto; De Verbizier, Jacques; Aptel, Sabine; Wack, Maxime; Dap, François; Dautel, Gilles; Blum, Alain

    2016-01-01

    The purpose of this study is to determine whether the posterior radioscaphoid angle, a marker of posterior displacement of the scaphoid, is associated with degenerative joint disease in patients with scapholunate ligament tears. Images from 150 patients with wrist pain who underwent CT arthrography and radiography were retrospectively evaluated. Patients with and without scapholunate ligament ruptures were divided into two groups according to CT arthrography findings. The presence of degenerative changes (scapholunate advanced collapse [SLAC] wrist) was evaluated and graded on conventional radiographs. Images were evaluated by two readers independently, and an adjudicator analyzed the discordant cases. Posterior radioscaphoid angle values were correlated with CT arthrography and radiographic findings. The association between posterior radioscaphoid angle and degenerative joint disease was evaluated. Scapholunate and radiolunate angles were considered in the analysis. The posterior radioscaphoid angle was measurable in all patients, with substantial interobserver agreement (intraclass correlation coefficient, 0.75). The posterior radioscaphoid angle performed better than did the scapholunate and radiolunate angles in the differentiation of patients with and without SLAC wrist (p degenerative wrist disease, with potential prognostic implications in patients with wrist trauma and scapholunate ligament ruptures.

  15. Diagnostic performance of PET/MR in the evaluation of active inflammation in Crohn disease.

    Science.gov (United States)

    Catalano, Onofrio Antonio; Wu, Vincent; Mahmood, Umar; Signore, Alberto; Vangel, Mark; Soricelli, Andrea; Salvatore, Marco; Gervais, Debra; Rosen, Bruce R

    2018-01-01

    This study investigates the performance of PET/MR versus each sub-modality alone in the assessment of active inflammation in patients with Crohn disease, when compared to surgery as standard of reference. Sensitivity for detecting active inflammation was 91.5% for PET, 80% for MR, and 88% for PET/MR. Specificity for active inflammation was 74% for PET, 87% for MR, and 93% for PET/MR. Diagnostic accuracy was 84% for PET, 83% for MR, and 91% for PET/MR. In conclusion, PET/MR is significantly more accurate than either sub-modality alone and more specific than PET alone in the detection of active inflammation in patients with Crohn disease.

  16. A Diagnostic Comparison of Turkish and Korean Students’ Mathematics Performances on the TIMSS 2011 Assessment

    Directory of Open Access Journals (Sweden)

    Sedat Şen

    2015-11-01

    Full Text Available The purpose of the present study was to analyze an international large-scale data set using a cognitive assessment approach. Although some researchers question the usefulness of international large-scale assessments (e.g., TIMSS, participating countries have continued to use the results from these large-scale assessments to improve their curricula and teaching methods. Despite the common reporting practice—single-score—in these large scale assessments gives useful insights about students’ overall performances, they still lack diagnostic information. Cognitive diagnosis models (CDMs were developed to provide more feedback on students’ cognitive strengths and weaknesses. This study retrofitted the TIMSS 2011 eighth grade mathematics assessment by applying a specific CDM called the DINA (the deterministic, inputs, noisy, “and” gate model to data from South Korea and Turkey. Results of the DINA model were used to make a detailed comparison between students of these two countries.

  17. Reproducibility and diagnostic performance of shear wave elastography in evaluating breast solid mass.

    Science.gov (United States)

    Hong, Sun; Woo, Ok Hee; Shin, Hye Seon; Hwang, Soon-Young; Cho, Kyu Ran; Seo, Bo Kyoung

    Shear wave elastography (SWE) was performed independently by two radiologists in 264 solid breast masses. The images were reviewed for color overlay pattern (COP) classification by the two radiologists, double blinded to any information. The interobserver agreement of the COP was almost perfect (κ=0.908) and high in E max (ICC=0.89). The AUC value of the COP (0.954) was significantly higher than that of E max (0.915) (p=0.002) but not significantly different from that of E max combined with COP (0.957) (p=0.098). The SWE color overlay pattern and E max of breast masses were highly reproducible. The COP had better diagnostic ability than E max , suggesting that COP may be a more reliable parameter for solid breast mass evaluation. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. An Evaluation of the Performance Diagnostic Checklist-Human Services to Assess an Employee Performance Problem in a Center-Based Autism Treatment Facility

    Science.gov (United States)

    Ditzian, Kyle; Wilder, David A.; King, Allison; Tanz, Jeanine

    2015-01-01

    The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to assess the environmental variables that contribute to poor employee performance in human services settings. We administered the PDC-HS to 3 supervisors to assess the variables that contributed to poor performance by 4 staff members when securing…

  19. The Interobserver Variability and Diagnostic Performance of 3-Dimensional Breast Ultrasound

    International Nuclear Information System (INIS)

    Lyou, Chae Yeon; Kim, Sun Mi; Jang, Mi Jung; Kim, Sung Won; Kang, Eun Young; Park, So Yeon; Moon, Woo Kyung

    2011-01-01

    We wanted to evaluate the interobserver variability and diagnostic performance of 3-dimensional (3D) breast ultrasound (US) as compared with that of 2- dimensional (2D) US. We included 150 patients who received US-guided core biopsy and 3D US between June 2009 and April 2010. Three breast imaging radiologists analyzed the 2D and 3D US images using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The intra-observer agreement and inter-observer agreement were calculated. The sensitivity and specificity of 2D and 3D US were evaluated. The intra-observer agreement between 2D and 3D US was mostly slight or fair agreement. However, in terms of the final category, there was substantial agreement for all three radiologists. The inter-observer agreement of 3D US was similar to that of 2D US (moderate agreement for shape, orientation, circumscribed margin and boundary: fair agreement for indistinct margin, angular margin, microlobulated margin, echo pattern and final category). The sensitivity of 3D US for breast cancer was higher than that of 2D US for two radiologists (2D vs. 3D for reader 2: 55.8% vs. 61.5%, 2D vs. 3D for reader 3: 59.6% vs. 63.5%), and the specificity of 3D US was lower than that of 2D US for all the readers (2D vs. 3D for reader 1: 90.8% vs. 86.7%, 2D vs. 3D for reader 2: 90.8% vs. 87.8%, 2D vs. 3D for reader 3: 94.9% vs. 90.8%), but the difference was not significant (p ≥ 0.05). The interobserver variability and diagnostic performance of 3D breast US were similar to those of 2D US

  20. Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department.

    Science.gov (United States)

    Chen, Shan-Ming; Chang, Hung-Ming; Hung, Tung-Wei; Chao, Yu-Hua; Tsai, Jeng-Dau; Lue, Ko-Huang; Sheu, Ji-Nan

    2013-05-01

    Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED). Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN. The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to (99m)Tc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2%, specificity 89.8%). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI. PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.

  1. SU-F-E-01: Pitfalls: Reliability and Performance of Diagnostic X-Sources

    Energy Technology Data Exchange (ETDEWEB)

    Behling, R [Philips Medical Systems DMC GmbHHamburg (United States)

    2016-06-15

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. The author is employee of Royal Philips.

  2. Clinical performance of dual-source computerized tomography (DSCT) in primary diagnostics of coronary heart diseases

    International Nuclear Information System (INIS)

    Brunner, H.; Froehner, S.; Wagner, M.; Schmitt, R.; Brunn, J.; Gietzen, F.H.; Kerber, S.

    2008-01-01

    Dual-source-CT-technology (DSCT) improves temporal resolution of cardiac computed tomography to 83 ms per heart-phase. In this study, the clinical performance of this new method is evaluated. Materials and Methods: In fifty patients (33 male, 17 female; age 50±13 years) with suspected coronary heart disease, CT angiography (slice thickness 0,75 mm, contrast-agent 60-80 ml iomeprol) was performed with a Somatom Definition scanner. Based on the coronary 15-segment-model of the AHA, scores for image quality and lumen reduction were established to enable the observer, to give recommendations for further therapy. Results: Out of 750 possible AHA-segments, 655 were depicted (87,3%). 591 segments (90,2%) were assessed without any limitation of quality, 49 (7,5%) segments showed moderate, and 15 (2,3%) segments severe limitation in image quality. 508 (77,6%) segments were without pathological findings, 92 (14,0%) segments had minimal atherosclerotic lesions, 42 (6,4%) segments suffered from stenoses with lumen reduction less than 70%, and 13 (2,0%) showed significant stenoses of more than 70%. In 31 patients (62%), coronary heart disease was ruled out by CT angiography without any need for further non-invasive or invasive diagnostics. 8 patients (16%) underwent stress-testing for ischemia. In 11 (22%) patients coronary angiography was recommended, and DSCT findings were confirmed in 10 cases. Only one LCx stenosis was overestimated in DSCT. Conclusion: Contrast-enhanced DSCT is a powerful tool in diagnosis of coronary heart disease. 98% of coronary segments could be assessed in diagnostic quality, and at least 90% of haemodynamically significant coronary stenoses were detected. (orig.)

  3. Diagnostic performance of 3D standing CT imaging for detection of knee osteoarthritis features.

    Science.gov (United States)

    Segal, Neil A; Nevitt, Michael C; Lynch, John A; Niu, Jingbo; Torner, James C; Guermazi, Ali

    2015-07-01

    To determine the diagnostic performance of standing computerized tomography (SCT) of the knee for osteophytes and subchondral cysts compared with fixed-flexion radiography, using MRI as the reference standard. Twenty participants were recruited from the Multicenter Osteoarthritis Study. Participants' knees were imaged with SCT while standing in a knee-positioning frame, and with postero-anterior fixed-flexion radiography and 1T MRI. Medial and lateral marginal osteophytes and subchondral cysts were scored on bilateral radiographs and coronal SCT images using the OARSI grading system and on coronal MRI using Whole Organ MRI Scoring. Imaging modalities were read separately with images in random order. Sensitivity, specificity and accuracy for the detection of lesions were calculated and differences between modalities were tested using McNemar's test. Participants' mean age was 66.8 years, body mass index was 29.6 kg/m(2) and 50% were women. Of the 160 surfaces (medial and lateral femur and tibia for 40 knees), MRI revealed 84 osteophytes and 10 subchondral cysts. In comparison with osteophytes and subchondral cysts detected by MRI, SCT was significantly more sensitive (93 and 100%; p osteophytes) than plain radiographs (sensitivity 60 and 10% and accuracy 79 and 94%, respectively). For osteophytes, differences in sensitivity and accuracy were greatest at the medial femur (p = 0.002). In comparison with MRI, SCT imaging was more sensitive and accurate for detection of osteophytes and subchondral cysts than conventional fixed-flexion radiography. Additional study is warranted to assess diagnostic performance of SCT measures of joint space width, progression of OA features and the patellofemoral joint.

  4. SU-F-E-01: Pitfalls: Reliability and Performance of Diagnostic X-Sources

    International Nuclear Information System (INIS)

    Behling, R

    2016-01-01

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. The author is employee of Royal Philips

  5. TH-F-209-01: Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

    International Nuclear Information System (INIS)

    Behling, R.

    2016-01-01

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. Learning Objectives: Understand the basic requirements on medical diagnostic X-ray sources per modality Learn to select the optimal equipment employing state-of-the-art metric Know causes of failures, depending on the way X-ray sources are operated Understand methods to remediate

  6. TH-F-209-00: Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

    International Nuclear Information System (INIS)

    2016-01-01

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. Learning Objectives: Understand the basic requirements on medical diagnostic X-ray sources per modality Learn to select the optimal equipment employing state-of-the-art metric Know causes of failures, depending on the way X-ray sources are operated Understand methods to remediate

  7. TH-F-209-01: Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

    Energy Technology Data Exchange (ETDEWEB)

    Behling, R. [Philips Medical Systems DMC GmbH (United States)

    2016-06-15

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. Learning Objectives: Understand the basic requirements on medical diagnostic X-ray sources per modality Learn to select the optimal equipment employing state-of-the-art metric Know causes of failures, depending on the way X-ray sources are operated Understand methods to remediate

  8. TH-F-209-00: Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. Learning Objectives: Understand the basic requirements on medical diagnostic X-ray sources per modality Learn to select the optimal equipment employing state-of-the-art metric Know causes of failures, depending on the way X-ray sources are operated Understand methods to remediate

  9. Diagnostic Performance of Magnifying Endoscopy for Helicobacter pylori Infection: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Qingqing Qi

    Full Text Available Diagnosis of Helicobacter pylori (H. pylori infection using magnifying endoscopy offers advantages over conventional invasive and noninvasive tests.This meta-analysis aimed to assess the diagnostic performance of magnifying endoscopy in the prediction of H. pylori infection.A literature search of the PubMed, Medline, EMBASE, Science Direct and the Cochrane Library databases was performed. A random-effects model was used to calculate the diagnostic efficiency of magnifying endoscopy for H. pylori infection. A summary receiver operator characteristic curve was plotted, and the area under the curve (AUC was calculated.A total of 18 studies involving 1897 patients were included. The pooled sensitivity and specificity of magnifying endoscopy to predict H. pylori infection were 0.89 [95% confidence interval (CI 0.87-0.91] and 0.82 (95%CI 0.79-0.85, respectively, with an AUC of 0.9461. When targeting the gastric antrum, the pooled sensitivity and specificity were 0.82 (95%CI 0.78-0.86 and 0.72 (95%CI 0.66-0.78, respectively. When targeting the gastric corpus, the pooled sensitivity and specificity were 0.92 (95%CI 0.90-0.94 and 0.86 (95%CI 0.82-0.88, respectively. The pooled sensitivity and specificity using magnifying white light endoscopy were 0.90 (95%CI 0.87-0.91 and 0.81 (95%CI 0.77-0.84, respectively. The pooled sensitivity and specificity using magnifying chromoendoscopy were 0.87 (95%CI 0.83-0.91 and 0.85 (95%CI 0.80-0.88, respectively. The "pit plus vascular pattern" classification in the gastric corpus observed by magnifying endoscopy was able to accurately predict the status of H. pylori infection, as indicated by a pooled sensitivity and specificity of 0.96 (95%CI 0.94-0.97 and 0.91 (95%CI 0.87-0.93, respectively, with an AUC of 0.9872.Magnifying endoscopy was able to accurately predict the status of H. pylori infection, either in magnifying white light endoscopy or magnifying chromoendoscopy mode. The "pit plus vascular pattern

  10. Evaluation of diagnostic performance of whole-body simultaneous PET/MRI in pediatric lymphoma

    International Nuclear Information System (INIS)

    Ponisio, Maria Rosana; Laforest, Richard; Khanna, Geetika; McConathy, Jonathan

    2016-01-01

    Whole-body 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the standard of care for lymphoma. Simultaneous PET/MRI (magnetic resonance imaging) is a promising new modality that combines the metabolic information of PET with superior soft-tissue resolution and functional imaging capabilities of MRI while decreasing radiation dose. There is limited information on the clinical performance of PET/MRI in the pediatric setting. This study evaluated the feasibility, dosimetry, and qualitative and quantitative diagnostic performance of simultaneous whole-body FDG-PET/MRI in children with lymphoma compared to PET/CT. Children with lymphoma undergoing standard of care FDG-PET/CT were prospectively recruited for PET/MRI performed immediately after the PET/CT. Images were evaluated for quality, lesion detection and anatomical localization of FDG uptake. Maximum and mean standardized uptake values (SUV max/mean ) of normal organs and SUV max of the most FDG-avid lesions were measured for PET/MRI and PET/CT. Estimation of radiation exposure was calculated using specific age-related factors. Nine PET/MRI scans were performed in eight patients (mean age: 15.3 years). The mean time interval between PET/CT and PET/MRI was 51 ± 10 min. Both the PET/CT and PET/MRI exams had good image quality and alignment with complete (9/9) concordance in response assessment. The SUVs from PET/MRI and PET/CT were highly correlated for normal organs (SUV mean r 2 : 0.88, P<0.0001) and very highly for FDG-avid lesions (SUV max r 2 : 0.94, P=0.0002). PET/MRI demonstrated an average percent radiation exposure reduction of 39% ± 13% compared with PET/CT. Simultaneous whole-body PET/MRI is clinically feasible in pediatric lymphoma. PET/MRI performance is comparable to PET/CT for lesion detection and SUV measurements. Replacement of PET/CT with PET/MRI can significantly decrease radiation dose from diagnostic imaging in children. (orig.)

  11. Hyperstaticity for ergonomie design of a wrist exoskeleton.

    Science.gov (United States)

    Esmaeili, Mohammad; Jarrassé, Nathanaël; Dailey, Wayne; Burdet, Etienne; Campolo, Domenico

    2013-06-01

    Increasing the level of transparency in rehabilitation devices has been one of the main goals in robot-aided neurorehabilitation for the past two decades. This issue is particularly important to robotic structures that mimic the human counterpart's morphology and attach directly to the limb. Problems arise for complex joints such as the human wrist, which cannot be accurately matched with a traditional mechanical joint. In such cases, mechanical differences between human and robotic joint cause hyperstaticity (i.e. overconstraint) which, coupled with kinematic misalignments, leads to uncontrolled force/torque at the joint. This paper focuses on the prono-supination (PS) degree of freedom of the forearm. The overall force and torque in the wrist PS rotation is quantified by means of a wrist robot. A practical solution to avoid hyperstaticity and reduce the level of undesired force/torque in the wrist is presented, which is shown to reduce 75% of the force and 68% of the torque.

  12. Golf Injuries to the Hand, Wrist, or Elbow

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Golf Injuries to the Hand, Wrist or Elbow Email ... enjoyment of the game injury free. Types of Golf Injuries Golf injuries can include tendonitis, sprains or ...

  13. Treatment of wrist deformities in children with arthrogryposis multiplex congenita

    Directory of Open Access Journals (Sweden)

    Evgeniya A Kochenova

    2016-03-01

    Conclusions: Patients with segmental lesions of the spinal cord at the С6-С7 and С5-С8 level were associated with restoration of active wrist extension up to the neutral position or more and were expected to achieve significant improvement of hand function. Patients with spinal cord lesions at the C5-Th1 level exhibited significant lesions of the muscles, along with bone deformities. Consequently, surgical treatment could only achieve functional wrist position with minimal improvement of hand function. Using differential approaches in the treatment of wrist contracture that are selected by determining the level of spinal cord lesion will enable physicians to predict the outcome and improve the function and appearance of the wrist.

  14. At Home Photography-Based Method for Measuring Wrist Range of Motion.

    Science.gov (United States)

    Trehan, Samir K; Rancy, Schneider K; Johnsen, Parker H; Hillstrom, Howard J; Lee, Steve K; Wolfe, Scott W

    2017-11-01

    Purpose  To determine the reliability of wrist range of motion (WROM) measurements based on digital photographs taken by patients at home compared with traditional measurements done in the office with a goniometer. Methods  Sixty-nine postoperative patients were enrolled in this study at least 3 months postoperatively. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by one of the two attending surgeons with a 1-degree resolution goniometer at the last postoperative office visit. Patients were provided an illustrated instruction sheet detailing how to take digital photographic images at home in six wrist positions (active and passive flexion/extension, and radial/ulnar deviation). Wrist position was measured from digital images by both the attending surgeons in a randomized, blinded fashion on two separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient to assess agreement between clinical and photography-based goniometry, as well as intra- and interobserver agreement. Results  Out of 69 enrolled patients, 30 (43%) patients sent digital images. Of the 180 digital photographs, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was "almost perfect" for passive wrist flexion/extension and "substantial" for active wrist flexion/extension and radial/ulnar deviation. Inter- and intraobserver agreement for the attending surgeons was "almost perfect" for all measurements. Discussion  This study validates a photography-based goniometry protocol allowing accurate and reliable WROM measurements without direct physician contact. Passive WROM was more accurately measured from photographs than active WROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients or their families take and submit their own

  15. Temporal diagnostic analysis of the SWAT model to detect dominant periods of poor model performance

    Science.gov (United States)

    Guse, Björn; Reusser, Dominik E.; Fohrer, Nicola

    2013-04-01

    Hydrological models generally include thresholds and non-linearities, such as snow-rain-temperature thresholds, non-linear reservoirs, infiltration thresholds and the like. When relating observed variables to modelling results, formal methods often calculate performance metrics over long periods, reporting model performance with only few numbers. Such approaches are not well suited to compare dominating processes between reality and model and to better understand when thresholds and non-linearities are driving model results. We present a combination of two temporally resolved model diagnostic tools to answer when a model is performing (not so) well and what the dominant processes are during these periods. We look at the temporal dynamics of parameter sensitivities and model performance to answer this question. For this, the eco-hydrological SWAT model is applied in the Treene lowland catchment in Northern Germany. As a first step, temporal dynamics of parameter sensitivities are analyzed using the Fourier Amplitude Sensitivity test (FAST). The sensitivities of the eight model parameters investigated show strong temporal variations. High sensitivities were detected for two groundwater (GW_DELAY, ALPHA_BF) and one evaporation parameters (ESCO) most of the time. The periods of high parameter sensitivity can be related to different phases of the hydrograph with dominances of the groundwater parameters in the recession phases and of ESCO in baseflow and resaturation periods. Surface runoff parameters show high parameter sensitivities in phases of a precipitation event in combination with high soil water contents. The dominant parameters give indication for the controlling processes during a given period for the hydrological catchment. The second step included the temporal analysis of model performance. For each time step, model performance was characterized with a "finger print" consisting of a large set of performance measures. These finger prints were clustered into

  16. Arthroscopic Resection of Wrist Ganglion Arising from the Lunotriquetral Joint

    OpenAIRE

    Mak, Michael C. K.; Ho, Pak-cheong; Tse, W. L.; Wong, Clara W. Y.

    2013-01-01

    The dorsal wrist ganglion is the most common wrist mass, and previous studies have shown that it arises from the scapholunate interval in the vast majority of cases. Treatment has traditionally been open excision, and more recently arthroscopic resection has been established as an effective and less invasive treatment method. However, application of this technique to ganglia in atypical locations has not been reported, where open excision is the usual practice. This report describes two cases...

  17. Substantia nigra fractional anisotropy is not a diagnostic biomarker of Parkinson's disease: A diagnostic performance study and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Hirata, Fabiana C.C.; Vieira, Gilson; Lucato, Leandro T.; Leite, Claudia C.; Pastorello, Bruno F.; Otaduy, Maria C.G.; Chaim, Khallil T.; Campanholo, Kenia R. [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Sato, Joao R. [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Universidade Federal do ABC, Center of Mathematics, Computation and Cognition, Santo Andre (Brazil); Bor-Seng-Shu, Edson; Novaes, Natalia P. [Hospital Israelita Albert Einstein, Sao Paulo (Brazil); University of Sao Paulo, Department of Neurology, Sao Paulo (Brazil); Magalhaes Melo, Luciano; Goncalves, Marcia R.; Reis Barbosa, Egberto [University of Sao Paulo, Department of Neurology, Sao Paulo (Brazil); Pereira do Nascimento, Felipe Barjud; Amaro, Edson [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Hospital Israelita Albert Einstein, Sao Paulo (Brazil); Jacobsen Teixeira, Manoel [University of Sao Paulo, Department of Neurosurgery, Sao Paulo (Brazil); Cardoso, Ellison Fernando [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Hospital Israelita Albert Einstein, Sao Paulo (Brazil); Institute of Mathematics and Statistics University of Sao Paulo (IME-USP), Sao Paulo (Brazil)

    2017-06-15

    Our goal was to estimate the diagnostic accuracy of substantia nigra fractional anisotropy (SN-FA) for Parkinson's disease (PD) diagnosis in a sample similar to the clinical setting, including patients with essential tremor (ET) and healthy controls (HC). We also performed a systematic review and meta-analysis to estimate mean change in SN-FA induced by PD and its diagnostic accuracy. Our sample consisted of 135 subjects: 72 PD, 21 ET and 42 HC. To address inter-scanner variability, two 3.0-T MRI scans were performed. MRI results of this sample were pooled into a meta-analysis that included 1,432 subjects (806 PD and 626 HC). A bivariate model was used to evaluate diagnostic accuracy measures. In our sample, we did not observe a significant effect of disease on SN-FA and it was uninformative for diagnosis. The results of the meta-analysis estimated a 0.03 decrease in mean SN-FA in PD relative to HC (CI: 0.01-0.05). However, the discriminatory capability of SN-FA to diagnose PD was low: pooled sensitivity and specificity were 72 % (CI: 68-75) and 63 % (CI: 58-70), respectively. There was high heterogeneity between studies (I{sup 2} = 91.9 %). SN-FA cannot be used as an isolated measure to diagnose PD. (orig.)

  18. Cortical Decoding of Individual Finger and Wrist Kinematics for an Upper-Limb Neuroprosthesis

    Science.gov (United States)

    Aggarwal, Vikram; Tenore, Francesco; Acharya, Soumyadipta; Schieber, Marc H.; Thakor, Nitish V.

    2010-01-01

    Previous research has shown that neuronal activity can be used to continuously decode the kinematics of gross movements involving arm and hand trajectory. However, decoding the kinematics of fine motor movements, such as the manipulation of individual fingers, has not been demonstrated. In this study, single unit activities were recorded from task-related neurons in M1 of two trained rhesus monkey as they performed individuated movements of the fingers and wrist. The primates’ hand was placed in a manipulandum, and strain gauges at the tips of each finger were used to track the digit’s position. Both linear and non-linear filters were designed to simultaneously predict kinematics of each digit and the wrist, and their performance compared using mean squared error and correlation coefficients. All models had high decoding accuracy, but the feedforward ANN (R=0.76–0.86, MSE=0.04–0.05) and Kalman filter (R=0.68–0.86, MSE=0.04–0.07) performed better than a simple linear regression filter (0.58–0.81, 0.05–0.07). These results suggest that individual finger and wrist kinematics can be decoded with high accuracy, and be used to control a multi-fingered prosthetic hand in real-time. PMID:19964645

  19. Diagnostic performance of tumor markers AFP and PIVKA-II in Chinese hepatocellular carcinoma patients.

    Science.gov (United States)

    Huang, Shujing; Jiang, Feifei; Wang, Ying; Yu, Yanhua; Ren, Siqian; Wang, Xiaowei; Yin, Peng; Lou, Jinli

    2017-06-01

    Alpha-fetoprotein is an effective biomarker as an aid in hepatocellular carcinoma detection in many countries. However, alpha-fetoprotein has its limitations, especially in early hepatocellular carcinoma diagnosis. Protein induced by vitamin K absence or antagonist-II is another biomarker that is used for hepatocellular carcinoma detection. The aim of this study is to compare the diagnostic performance of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II alone and in combination to explore improving biomarker performance as an aid in early hepatocellular carcinoma detection. In this study a total of 582 serum samples including 132 hepatocellular carcinoma patients, 250 non-hepatocellular carcinoma patients, and 200 healthy volunteers were collected. Alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II levels were measured by both chemiluminescent enzyme immunoassay on LUMIPULSE platform and by chemiluminescent microparticle immunoassay on ARCHITECT platform. Receiver operation characteristic curve analyses were performed for each biomarker and in combination. The results showed that Alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II in combination have shown higher area under the curve compared to alpha-fetoprotein alone for diagnosis in whole patients (0.906 vs 0.870) in hepatocellular carcinoma early-stage patients (0.809 vs 0.77) and in hepatitis B virus-related hepatocellular carcinoma patients (0.851 vs 0.788) with ARCHITECT platform. Protein induced by vitamin K absence or antagonist-II showed higher area under the curve than alpha-fetoprotein for diagnosis of hepatitis B virus-related hepatocellular carcinoma patients (0.901 vs 0.788).We conclude that Combining alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II may improve the diagnostic value for early detection of hepatocellular carcinoma. Protein induced by vitamin K absence or antagonist-II performs better

  20. (Dry) arthroscopic partial wrist arthrodesis: tips and tricks.

    Science.gov (United States)

    del Piñal, F; Tandioy-Delgado, F

    2014-10-01

    One of the options for performing a partial wrist arthrodesis is the arthroscopic technique. As a first advantage arthroscopy allows us to directly assess the state of the articular surface of the carpal bones and define the best surgical option during the salvage operation. Furthermore, it allows performance of the procedure with minimal ligament damage and minimal interference with the blood supply of the carpals. These will (presumably) entail less capsular scarring and more rapid healing. Lastly, there is cosmetic benefit by reducing the amount of external scarring. The procedure has a steep learning curve even for accomplished arthroscopists but can be performed in a competitive manner to the open procedure if the dry technique is used. The aim of this paper is to present the technical details, tricks and tips to make the procedure accessible to all hand specialists with an arthroscopic interest. As it is paramount that the surgeon is acquainted with the "dry" technique, some technical details about it will also be presented. © Georg Thieme Verlag KG Stuttgart · New York.

  1. A digital database of wrist bone anatomy and carpal kinematics.

    Science.gov (United States)

    Moore, Douglas C; Crisco, Joseph J; Trafton, Theodore G; Leventhal, Evan L

    2007-01-01

    The skeletal wrist consists of eight small, intricately shaped carpal bones. The motion of these bones is complex, occurs in three dimensions, and remains incompletely defined. Our previous efforts have been focused on determining the in vivo three-dimensional (3-D) kinematics of the normal and abnormal carpus. In so doing we have developed an extensive database of carpal bone anatomy and kinematics from a large number of healthy subjects. The purpose of this paper is to describe that database and to make it available to other researchers. CT volume images of both wrists from 30 healthy volunteers (15 males and 15 females) were acquired in multiple wrist positions throughout the normal range of wrist motion. The outer cortical surfaces of the carpal bones, radius and ulna, and proximal metacarpals were segmented and the 3-D motion of each bone was calculated for each wrist position. The database was constructed to include high-resolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone. The database does not include soft tissues of the wrist. While there are numerous digital anatomical databases, this one is unique in that it includes a large number of subjects and it contains in vivo kinematic data as well as the bony anatomy.

  2. Evaluating the Performance Diagnostic Checklist-Human Services to Assess Incorrect Error-Correction Procedures by Preschool Paraprofessionals

    Science.gov (United States)

    Bowe, Melissa; Sellers, Tyra P.

    2018-01-01

    The Performance Diagnostic Checklist-Human Services (PDC-HS) has been used to assess variables contributing to undesirable staff performance. In this study, three preschool teachers completed the PDC-HS to identify the factors contributing to four paraprofessionals' inaccurate implementation of error-correction procedures during discrete trial…

  3. Diagnostic performance of computed tomography coronary angiography (from the Prospective National Multicenter Multivendor EVASCAN Study).

    Science.gov (United States)

    Gueret, Pascal; Deux, Jean-François; Bonello, Laurent; Sarran, Anthony; Tron, Christophe; Christiaens, Luc; Dacher, Jean-Nicolas; Bertrand, David; Leborgne, Laurent; Renard, Cedric; Caussin, Christophe; Cluzel, Philippe; Helft, Gerard; Crochet, Dominique; Vernhet-Kovacsik, Hélène; Chabbert, Valérie; Ferrari, Emile; Gilard, Martine; Willoteaux, Serge; Furber, Alain; Barone-Rochette, Gilles; Jankowski, Adrien; Douek, Philippe; Mousseaux, Elie; Sirol, Marc; Niarra, Ralph; Chatellier, Gilles; Laissy, Jean-Pierre

    2013-02-15

    Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p <0.001), male gender (OR 1.5, p <0.002), diabetes (OR 1.5, p <0.0001), and age (OR 1.2, p <0.0001). In conclusion, in this large multicenter study, CTCA identified significant CAD with high sensitivity. However, in routine clinical practice, each patient should be individually evaluated, and the pretest probability of obstructive CAD should be taken into account when deciding which method, CTCA or CA, to use to diagnose its presence and severity. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Performance and Pain Tolerability of Current Diagnostic Allergy Skin Prick Test Devices.

    Science.gov (United States)

    Tversky, Jody R; Chelladurai, Yohalakshmi; McGready, John; Hamilton, Robert G

    2015-01-01

    Allergen skin prick testing remains an essential tool for diagnosing atopic disease and guiding treatment. Sensitivity needs to be defined for newly introduced devices. Our aim was to compare the performance of 10 current allergy skin prick test devices. Single- and multiheaded skin test devices (n = 10) were applied by a single operator in a prospective randomized manner. Histamine (1 and 6 mg/mL) and control diluent were introduced at 6 randomized locations onto the upper and lower arms of healthy subjects. Wheal and flare reactions were measured independently by 2 masked technicians. Twenty-four subjects provided consent, and 768 skin tests were placed. Mean wheal diameter among devices differed from 3.0 mm (ComforTen; Hollister-Stier, Spokane, Wash) to 6.8 mm (UniTest PC; Lincoln Diagnostics, Decatur, Ill) using 1 mg/mL histamine (P Diagnostics, Decatur, Ill; and Sharp-Test; Panatrex, Placentia, Calif) using 6 mg/mL histamine (P pain score of less than 4 on a 10-point visual analog scale. Pain scores were higher among women, but this did not reach statistical significance. The Multi-Test PC and the UniTest PC had the lowest pain scores compared with the other devices. All 10 skin prick test devices displayed good analytical sensitivity and specificity; however, 3 mm cannot arbitrarily be used as a positive threshold. The use of histamine at 1 mg/mL is unacceptable for certain devices but may be preferable for the most sensitive devices. On average, there was no pain score difference between multiheaded and single-head devices. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  5. Diagnostic performance of line-immunoassay based algorithms for incident HIV-1 infection

    Directory of Open Access Journals (Sweden)

    Schüpbach Jörg

    2012-04-01

    Full Text Available Abstract Background Serologic testing algorithms for recent HIV seroconversion (STARHS provide important information for HIV surveillance. We have previously demonstrated that a patient's antibody reaction pattern in a confirmatory line immunoassay (INNO-LIA™ HIV I/II Score provides information on the duration of infection, which is unaffected by clinical, immunological and viral variables. In this report we have set out to determine the diagnostic performance of Inno-Lia algorithms for identifying incident infections in patients with known duration of infection and evaluated the algorithms in annual cohorts of HIV notifications. Methods Diagnostic sensitivity was determined in 527 treatment-naive patients infected for up to 12 months. Specificity was determined in 740 patients infected for longer than 12 months. Plasma was tested by Inno-Lia and classified as either incident ( Results The 10 best algorithms had a mean raw sensitivity of 59.4% and a mean specificity of 95.1%. Adjustment for overrepresentation of patients in the first quarter year of infection further reduced the sensitivity. In the preferred model, the mean adjusted sensitivity was 37.4%. Application of the 10 best algorithms to four annual cohorts of HIV-1 notifications totalling 2'595 patients yielded a mean IIR of 0.35 in 2005/6 (baseline and of 0.45, 0.42 and 0.35 in 2008, 2009 and 2010, respectively. The increase between baseline and 2008 and the ensuing decreases were highly significant. Other adjustment models yielded different absolute IIR, although the relative changes between the cohorts were identical for all models. Conclusions The method can be used for comparing IIR in annual cohorts of HIV notifications. The use of several different algorithms in combination, each with its own sensitivity and specificity to detect incident infection, is advisable as this reduces the impact of individual imperfections stemming primarily from relatively low sensitivities and

  6. Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification.

    Science.gov (United States)

    Winther, Simon; Nissen, Louise; Schmidt, Samuel Emil; Westra, Jelmer Sybren; Rasmussen, Laust Dupont; Knudsen, Lars Lyhne; Madsen, Lene Helleskov; Kirk Johansen, Jane; Larsen, Bjarke Skogstad; Struijk, Johannes Jan; Frost, Lars; Holm, Niels Ramsing; Christiansen, Evald Høj; Botker, Hans Erik; Bøttcher, Morten

    2017-11-09

    Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography. If significant obstruction was suspected in any coronary segment, patients were referred to invasive angiography and fractional flow reserve (FFR) assessment. Heart sound analysis was performed in all patients. A predefined acoustic CAD-score algorithm was evaluated; subsequently, we developed and validated an updated CAD-score algorithm that included both acoustic features and clinical risk factors. Low risk is indicated by a CAD-score value ≤20. Haemodynamically significant CAD assessed from FFR was present in 145 (10.0%) patients. In the entire cohort, the predefined CAD-score had a sensitivity of 63% and a specificity of 44%. In total, 50% had an updated CAD-score value ≤20. At this cut-off, sensitivity was 81% (95% CI 73% to 87%), specificity 53% (95% CI 50% to 56%), positive predictive value 16% (95% CI 13% to 18%) and negative predictive value 96% (95% CI 95% to 98%) for diagnosing haemodynamically significant CAD. Sound-based detection of CAD enables risk stratification superior to clinical risk scores. With a negative predictive value of 96%, this new acoustic rule-out system could potentially supplement clinical assessment to guide decisions on the need for further diagnostic investigation. ClinicalTrials.gov identifier NCT02264717; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

    Directory of Open Access Journals (Sweden)

    Hye Mi Yoo

    2015-05-01

    Full Text Available BackgroundAn anatomical analysis of the transverse carpal ligament (TCL and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings.MethodsUsing 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months.ResultsIn the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were 35.30±2.59 mm and 9.50±2.13 mm, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm. The 13 surgeries performed in the clinical settings yielded satisfactory results.ConclusionsThis peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

  8. Ultrasound-guided procedures around the wrist and hand: How to do

    International Nuclear Information System (INIS)

    Orlandi, Davide; Corazza, Angelo; Silvestri, Enzo; Serafini, Giovanni; Savarino, Edoardo Vincenzo; Garlaschi, Giacomo; Mauri, Giovanni; Cimmino, Marco Amedeo; Sconfienza, Luca Maria

    2014-01-01

    Ultrasound has emerged as a low-cost, radiation-free and effective imaging technique to detect joint abnormalities and to guide percutaneous procedures. Being superficial, wrist and hand tendons and joints represent a good target to perform such procedures using ultrasound guidance. This kind of approach allows for a clear and real-time visualization of the needles during their whole path. In this setting, the knowledge of technical aspects and tips is essential to act in the most accurate way on target tissues that can be as small as a few millimetres. The aim of this review is to summarize the local treatments of inflammatory and degenerative disease described in literature (such as treatment of De Quervain's tenosynovitis, trigger finger, trapezio-metacarpal joint osteoarthritis, etc.), emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the wrist and hand

  9. Possibilities opened up by MRI in the diagnosis of hand and wrist abnormalities

    International Nuclear Information System (INIS)

    Heuck, A.; Steinbach, L.; Stoller, D.; Genant, H.

    1989-01-01

    MRI studies of 63 patients with various abnormalities of the hand and wrist were analyzed. Studies were performed on scanners with a field strength of 0.35, 0.5, or 1.5 T. Imaging parameters included T1- and T2-weighted sequences in the coronal and transverse planes and contiguous slices 3-5 mm thick. In 37 patients with post-traumatic disorders, MRI revealed carpal avascular necrosis, tendon abnormalities and, in some cases, abnormalities of interosseous ligaments and the triangular fibrocartilage. In 15 patients with such inflammatory diseases as arthritis, tenosynovitis and carpal tunnel syndrome and in 11 patients with tumors, MRI provided clear delineation of osseous and soft tissue abnormalities. The current role of MRI in the diagnosis of hand and wrist abnormalities is discussed on the basis of these results. (orig.) [de

  10. Acute hand and wrist injuries sustained during recreational mountain biking: a prospective study.

    Science.gov (United States)

    Bush, Kevin; Meredith, Steve; Demsey, Daniel

    2013-12-01

    Recreational mountain biking continues to increase in popularity and is a significant source of traumatic injury, including injuries to the hand and wrist. A prospective survey of all hand and wrist injuries sustained while participating in recreational mountain biking presenting to the emergency department at the Municipality of Whistler and the District of Squamish was conducted over a 12-month consecutive period. An analysis of 765 unique emergency department visits with 1,079 distinct injuries was performed. Of these injuries, 511 were sustained to the upper limb. Injury to the metacarpal and metacarpal phalangeal joints was the most common hand injury (52) followed by proximal phalanx and proximal interphalangeal joint (20). Mountain biking is a frequent source of a variety of upper limb trauma, and preventative efforts are necessary to minimize the burden of these injuries.

  11. Ultrasound-guided procedures around the wrist and hand: How to do

    Energy Technology Data Exchange (ETDEWEB)

    Orlandi, Davide; Corazza, Angelo [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Silvestri, Enzo [Diagnostica per Immagini, Ospedale Evangelico Internazionale, Corso Solferino 29A, 16100 Genova (Italy); Serafini, Giovanni [Dipartimento di Diagnostica per Immagini, Ospedale Santa Corona, Via XXV Aprile 38, 17037 Pietra Ligure, Savona (Italy); Savarino, Edoardo Vincenzo [Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Via Giustiniani, Padova (Italy); Garlaschi, Giacomo [Dipartimento di Scienze per la Salute, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Mauri, Giovanni [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Cimmino, Marco Amedeo [Dipartimento di Medicina Interna, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Sconfienza, Luca Maria, E-mail: io@lucasconfienza.it [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 2, San Donato Milanese, Milano (Italy)

    2014-07-15

    Ultrasound has emerged as a low-cost, radiation-free and effective imaging technique to detect joint abnormalities and to guide percutaneous procedures. Being superficial, wrist and hand tendons and joints represent a good target to perform such procedures using ultrasound guidance. This kind of approach allows for a clear and real-time visualization of the needles during their whole path. In this setting, the knowledge of technical aspects and tips is essential to act in the most accurate way on target tissues that can be as small as a few millimetres. The aim of this review is to summarize the local treatments of inflammatory and degenerative disease described in literature (such as treatment of De Quervain's tenosynovitis, trigger finger, trapezio-metacarpal joint osteoarthritis, etc.), emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the wrist and hand.

  12. Possibilities opened up by MRI in the diagnosis of hand and wrist abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Heuck, A; Steinbach, L; Stoller, D; Genant, H; Neumann, C

    1989-02-01

    MRI studies of 63 patients with various abnormalities of the hand and wrist were analyzed. Studies were performed on scanners with a field strength of 0.35, 0.5, or 1.5 T. Imaging parameters included T1- and T2-weighted sequences in the coronal and transverse planes and contiguous slices 3-5 mm thick. In 37 patients with post-traumatic disorders, MRI revealed carpal avascular necrosis, tendon abnormalities and, in some cases, abnormalities of interosseous ligaments and the triangular fibrocartilage. In 15 patients with such inflammatory diseases as arthritis, tenosynovitis and carpal tunnel syndrome and in 11 patients with tumors, MRI provided clear delineation of osseous and soft tissue abnormalities. The current role of MRI in the diagnosis of hand and wrist abnormalities is discussed on the basis of these results.

  13. Diagnostic mirrors for ITER: A material choice and the impact of erosion and deposition on their performance

    International Nuclear Information System (INIS)

    Litnovsky, A.; Wienhold, P.; Philipps, V.; Sergienko, G.; Schmitz, O.; Kirschner, A.; Kreter, A.; Droste, S.; Samm, U.; Mertens, Ph.; Donne, A.H.; Rudakov, D.; Allen, S.; Boivin, R.; McLean, A.; Stangeby, P.; West, W.; Wong, C.; Lipa, M.; Schunke, B.; De Temmerman, G.; Pitts, R.; Costley, A.; Voitsenya, V.; Vukolov, K.; Oelhafen, P.; Rubel, M.; Romanyuk, A.

    2007-01-01

    Metal mirrors will be implemented in about half of the ITER diagnostics. Mirrors in ITER will have to withstand radiation loads, erosion by charge-exchange neutrals, deposition of impurities, particle implantation and neutron irradiation. It is believed that the optical properties of diagnostic mirrors will be primarily influenced by erosion and deposition. A solution is needed for optimal performance of mirrors in ITER throughout the entire lifetime of the machine. A multi-machine research on diagnostic mirrors is currently underway in fusion facilities at several institutions and laboratories worldwide. Among others, dedicated investigations of ITER-candidate mirror materials are ongoing in Tore-Supra, TEXTOR, DIII-D, TCV, T-10 and JET. Laboratory studies are underway at IPP Kharkov (Ukraine), Kurchatov Institute (Russia) and the University of Basel (Switzerland). An overview of current research on diagnostic mirrors along with an outlook on future investigations is the subject of this paper

  14. A portable and independent edge fluctuation diagnostic. Final performance report, March 1992--March 1993

    International Nuclear Information System (INIS)

    Tsui, H.; Wootton, A.

    1994-01-01

    A compact self contained portable probe system has been designed and developed to diagnose the edge plasma of devices of different sizes and configurations. The system measures both the mean and the fluctuation quantities of density, temperature and potential from a standardized Langmuir probe array using a fast reciprocating probe drive. It can also be used for other fluctuation diagnostics, such as magnetic probes. The data acquisition and analysis is performed on a Macintosh IIfx which provides a user-friendly environment. The results obtained by the signal processing routines are stored in a tabloid format to allow comparative studies. The resulting database is a core part of the protable signal analysis system. To date measurements have been performed on the stellarator ATF, the reversed field pinch ZT40(m), and the tokamaks TEXT, Versator, Phaedrus-T and TFTR. The data are presently being analyzed and the results collected into the database for the purpose of edge turbulence and transport studies. Existing published data are also being included. The edge database, an output of this project, will provide readily available information for other experimental groups to compare their results with, and for theoretical groups to validate (or otherwise) the predictions of their models

  15. Can continuous scans in orthogonal planes improve diagnostic performance of shear wave elastography for breast lesions?

    Science.gov (United States)

    Yang, Pan; Peng, Yulan; Zhao, Haina; Luo, Honghao; Jin, Ya; He, Yushuang

    2015-01-01

    Static shear wave elastography (SWE) is used to detect breast lesions, but slice and plane selections result in discrepancies. To evaluate the intraobserver reproducibility of continuous SWE, and whether quantitative elasticities in orthogonal planes perform better in the differential diagnosis of breast lesions. One hundred and twenty-two breast lesions scheduled for ultrasound-guided biopsy were recruited. Continuous SWE scans were conducted in orthogonal planes separately. Quantitative elasticities and histopathology results were collected. Reproducibility in the same plane and diagnostic performance in different planes were evaluated. The maximum and mean elasticities of the hardest portion, and standard deviation of whole lesion, had high inter-class correlation coefficients (0.87 to 0.95) and large areas under receiver operation characteristic curve (0.887 to 0.899). Without loss of accuracy, sensitivities had increased in orthogonal planes compared with single plane (from 73.17% up to 82.93% at most). Mean elasticity of whole lesion and lesion-to-parenchyma ratio were significantly less reproducible and less accurate. Continuous SWE is highly reproducible for the same observer. The maximum and mean elasticities of the hardest portion and standard deviation of whole lesion are most reliable. Furthermore, the sensitivities of the three parameters are improved in orthogonal planes without loss of accuracies.

  16. Transfer from point-of-care Ultrasonography training to diagnostic performance on patients--a randomized controlled trial

    DEFF Research Database (Denmark)

    Todsen, Tobias; Jensen, Morten Lind; Tolsgaard, Martin Grønnebæk

    2016-01-01

    BACKGROUND: Clinicians are increasingly using point-of-care ultrasonography for bedside examinations of patients. However, proper training is needed in this technique, and it is unknown whether the skills learned from focused Ultrasonography courses are being transferred to diagnostic performance...... test and binary logistic regression, respectively. RESULTS: There was a significant difference in the performance score between the intervention group (27.4%) and the control group (18.0%, P = .004) and the diagnostic accuracy between the intervention group (65%) and the control group (39%, P = .014......). CONCLUSIONS: Clinicians could successfully transfer learning from an Ultrasonography course to improve diagnostic performance on patients. However, our results also indicate a need for more training when new technologies such as point-of-care ultrasonography are introduced....

  17. Indirect wrist MR arthrography: the effects of passive motion versus active exercise

    Energy Technology Data Exchange (ETDEWEB)

    Schweitzer, M.E.; Natale, P.; Winalski, C.S.; Culp, R. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States)

    2000-01-01

    Purpose. In the wrist, to determine whether passive motion or active exercise yields a better indirect MR arthrographic effect following intravenous gadolinium administration.Design and patients. Twenty-six consecutive patients were studied by indirect wrist MR arthrography. In half active exercise and in half passive motion was performed. Four regions of interest were studied including the distal radioulnar joint, the radiocarpal joint, the midcarpal joint, and the triangular fibrocartilage. Ranges and means of signal intensity were calculated. Surgical follow-up was performed in 22 patients.Results. The joint fluid intensity was greatest in the distal radioulnar joint. Fluid signal intensity was greater and more consistent in the passive motion group although the results did not achieve statistical significance. Imaging accuracy appeared similar in the two groups and was excellent for the triangular fibrocartilage (100%) and scapholunate ligaments (96%).Conclusion. Active exercise and passive motion yield similar degrees of wrist arthrographic effect, but the effect of passive motion is somewhat more consistent. Preliminary data show good accuracy for internal derangements. (orig.)

  18. How Much Volume of Local Anesthesia and How Long Should You Wait After Injection for an Effective Wrist Median Nerve Block?

    Science.gov (United States)

    Lovely, Lyndsay M; Chishti, Yasmin Z; Woodland, Jennifer L; Lalonde, Donald H

    2018-05-01

    Many surgeons and emergentologists use non-ultrasound-guided wrist nerve blocks. There is little evidence to guide the ideal volume of local anesthesia or how long we should wait after injection before performing pain-free procedures. This pilot study examined time to maximal anesthesia to painful needle stick in 14 volunteer participants receiving bilateral wrist blocks of 6 versus 11 mL of local. One surgeon performed all 14 bilateral wrist median nerve blocks in participants who remained blinded until after bandages were applied to their wrist. No one could see which wrist received the larger 11-mL volume injection versus the 6-mL block. Blinded sensory assessors then measured perceived maximal numbness time and numbness to needle stick pain in the fingertips of the median nerve distribution. Failure to get a complete median nerve block occurred in seven of fourteen 6-mL wrist blocks versus failure in only one of fourteen 11-mL blocks. Perceived maximal numbness occurred at roughly 40 minutes after injection, but actual numbness to painful needle stick took around 100 minutes. Incomplete median nerve numbness occurred with both 6- and 11-mL non-ultrasound-guided blocks at the wrist. In those with complete blocks, it took a surprisingly long time of 100 minutes for maximal anesthesia to occur to painful needle stick stimuli to the fingertips of the median nerve distribution. Non-ultrasound-guided median nerve blocks at the wrist as described in this article lack reliability and take too long to work.

  19. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    International Nuclear Information System (INIS)

    Medina, L.S.; Yaylali, Ilker; Zurakowski, David; Ruiz, Jennifer; Altman, Nolan R.; Grossman, John A.I.

    2006-01-01

    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine

  20. Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage.

    Science.gov (United States)

    Lee, Ryan K L; Griffith, James F; Ng, Alex W H; Nung, Ryan C H; Yeung, David K W

    2016-01-01

    The purpose of this study was to assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments. A prospective study included 40 wrists in 39 patients (25 men, 14 women; mean age, 35 years). MR arthrography was performed with a 3-T MRI system with and without axial traction. Two radiologists independently measured wrist and carpal joint space widths and semiquantitatively graded articular cartilage visibility. Using conventional arthrography as the reference standard and working in consensus, they assessed for the presence of tears of the TFCC, lunotriquetral ligament (LTL), and scapholunate ligament (SLL). Visibility of a tear before traction was compared with visibility after traction. With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p ≤ 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears. Wrist MR arthrography with axial traction significantly improved the visibility of articular cartilage and the detection and visibility of tears of the TFCC and intrinsic ligaments. The results favor more widespread use of traction during MR arthrography of the wrist.

  1. Pediatric echocardiograms performed at primary centers: Diagnostic errors and missing links!

    International Nuclear Information System (INIS)

    Saraf, Rahul P; Suresh, PV; Maheshwari, Sunita; Shah, Sejal S

    2015-01-01

    The present study was undertaken to assess the accuracy of pediatric echocardiograms done at non-tertiary centers and to evaluate the relationship of inaccurate interpretations with age, echocardiogram performer and complexity of congenital heart disease (CHD). The echocardiogram reports of 182 consecutive children with CHD (5 days-16 years) who were evaluated at a non-tertiary center and subsequently referred to our center were reviewed. Age of the child at echocardiogram, echocardiogram performer and complexity of CHD were noted. These reports were compared with echocardiogram done at our center. Discrepancies were noted and categorized. To assess our own error rate, we compared our echocardiogram reports with the findings obtained during surgery (n = 172), CT scan (n = 9) or cardiac catheterization reports (n = 1). Most of the children at the non-tertiary center (92%) underwent echocardiogram by personnel other than a pediatric cardiologist. Overall, diagnostic errors were found in 69/182 (38%) children. Moderate and major discrepancies affecting the final management were found in 42/182 (23%) children. Discrepancies were higher when the echocardiogram was done by personnel other than pediatric cardiologist (P < 0.01) and with moderate and high complexity lesions (P = 0.0001). There was no significant difference in proportion of these discrepancies in children ≤ 1 year vs. >1 year of age. A significant number of pediatric echocardiograms done at non-tertiary centers had discrepancies that affected the management of these children. More discrepancies were seen when the echocardiogram performer was not a pediatric cardiologist and with complex CHD

  2. Machine learning for activity recognition: hip versus wrist data

    International Nuclear Information System (INIS)

    Trost, Stewart G; Zheng, Yonglei; Wong, Weng-Keen

    2014-01-01

    Problem addressed: Wrist-worn accelerometers are associated with greater compliance. However, validated algorithms for predicting activity type from wrist-worn accelerometer data are lacking. This study compared the activity recognition rates of an activity classifier trained on acceleration signal collected on the wrist and hip. Methodology: 52 children and adolescents (mean age 13.7  ±  3.1 year) completed 12 activity trials that were categorized into 7 activity classes: lying down, sitting, standing, walking, running, basketball, and dancing. During each trial, participants wore an ActiGraph GT3X+ tri-axial accelerometer on the right hip and the non-dominant wrist. Features were extracted from 10-s windows and inputted into a regularized logistic regression model using R (Glmnet + L1). Results: Classification accuracy for the hip and wrist was 91.0% ± 3.1% and 88.4% ± 3.0%, respectively. The hip model exhibited excellent classification accuracy for sitting (91.3%), standing (95.8%), walking (95.8%), and running (96.8%); acceptable classification accuracy for lying down (88.3%) and basketball (81.9%); and modest accuracy for dance (64.1%). The wrist model exhibited excellent classification accuracy for sitting (93.0%), standing (91.7%), and walking (95.8%); acceptable classification accuracy for basketball (86.0%); and modest accuracy for running (78.8%), lying down (74.6%) and dance (69.4%). Potential Impact: Both the hip and wrist algorithms achieved acceptable classification accuracy, allowing researchers to use either placement for activity recognition. (paper)

  3. Sensory impairments and wrist fractures: A case-control study

    Directory of Open Access Journals (Sweden)

    Bergthora Baldursdottir

    2017-12-01

    Full Text Available Objectives: To investigate vestibular function, foot sensation, postural control and functional abilities, and to evaluate whether these variables are associated with fall-related wrist fracture. Methods: A case-control study was conducted with 98 subjects, age range 50–75 years, who had sustained a fall-related wrist fracture. Forty-eight sex-, age- and physical activity-matched individuals, with no previous history of wrist fracture, served as controls. Measurements included: head-shake test (HST, tuning fork, biothesiometer, Semmes-Weinstein monofilaments (MF, Sensory Organization Test (SOT, Five-Times-Sit-to-Stand Test (FTSTS, 10-m walk test (10MWT, Activities-specific Balance Confidence (ABC, and the Dizziness Handicap Inventory (DHI scales. Logistic regression models were used to determine associations of variables with a fall-related wrist fracture. Results: Vestibular asymmetry was apparent in 82% of wrist fracture subjects and 63% of controls (p = 0.012. Plantar pressure sensation (p <0.001, SOT composite scores (p < 0.001, 10MWT (p <0.001, FTSTS (p <0.001, ABC (p <0.001 and DHI (p <0.005 were significantly poorer among cases than controls. A positive HST (odds ratio (OR 5.424; p = 0.008 and monofilament sensation (OR 3.886; p = 0.014 showed the strongest associations with having a fall-related wrist fracture. Conclusion: Asymmetrical vestibular function and reduced plantar pressure sensation are associated with fall-related wrist fractures among the ageing population. These factors are potential targets for future interventions.

  4. Education in wrist arthroscopy: past, present and future.

    Science.gov (United States)

    Obdeijn, M C; Bavinck, N; Mathoulin, C; van der Horst, C M A M; Schijven, M P; Tuijthof, G J M

    2015-05-01

    Arthroscopy has assumed an important place in wrist surgery. It requires specific operative skills that are now mainly acquired in the operating room. In other fields of endoscopic surgery, e-learning and virtual reality (VR) have introduced new perspectives in teaching skills. This leads to the following research question: Could the current way of teaching wrist arthroscopy skills be supported using new educational media, such as e-learning and simulator training? The literature was searched for available methods of teaching endoscopic skills. Articles were assessed on the evidence of validity. In addition, a survey was sent to all members of the European Wrist Arthroscopy Society (EWAS) to find out whether hand surgeons express a need to embrace modern educational tools such as e-learning or simulators for training of wrist arthroscopy skills. This study shows that the current way of teaching wrist arthroscopy skills can be supported using new educational media, such as e-learning and simulator training. Literature indicates that e-learning can be a valuable tool for teaching basic knowledge of arthroscopy and supports the hypothesis that the use of virtual reality and simulators in training enhances operative skills in surgical trainees. This survey indicates that 55 out of 65 respondents feel that an e-learning program would be a valuable asset and 62 out of the 65 respondents are positive on the additional value of wrist arthroscopy simulator in training. Study results support the need and relevance to strengthen current training of wrist arthroscopy using e-learning and simulator training. V.

  5. Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dornberger, Jenny E. [Unfallkrankenhaus Berlin, Department of Plastic Surgery and Burn Care, Berlin (Germany); Rademacher, Grit; Mutze, Sven [Unfallkrankenhaus Berlin, Institute of Radiology, Berlin (Germany); Eisenschenk, Andreas [Unfallkrankenhaus Berlin, Department of Hand-, Replantation- and Microsurgery, Berlin (Germany); University Medicine Greifswald, Department of Hand Surgery and Microsurgery, Greifswald (Germany); Stengel, Dirk [Unfallkrankenhaus Berlin, Centre for Clinical Research, Berlin (Germany); Charite Medical University Centre, Julius Wolff Institute, Centre for Musculoskeletal Surgery, Berlin (Germany)

    2015-12-15

    To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist. This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher's projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI). The prevalence of significant acute SL tears (grade ≥ III according to Geissler's classification) was 27/72 (38 %, 95 % CI 26-50 %). The SL distance on Stecher's projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher's projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance. In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care. (orig.)

  6. Optimized diagnostic performance of brain magnetic resonance imaging in children with idiopathic growth hormone deficiency

    International Nuclear Information System (INIS)

    Rac, M.

    2006-01-01

    Purpose: The aim of this study was to search for correlations between anatomic changes in the pituitary gland and hormonal disturbances in children with short stature. Material and methods: Children with short stature were enrolled when criteria of pituitary growth hormone deficiency were partly or completely met. Magnetic resonance imaging was performed in 87 children and particular attention was given to the pituitary gland. Measurements were compared with pituitary dimensions accepted as normal in the literature. Contrast with GdDTPA was used to visualize the pituitary gland and associated structures (stalk, infundibulum). T1-weighted images in the sagittal and coronal planes were obtained. The results were statistically analyzed with non-parametric tests. Conclusions: 1. Magnetic resonance imaging is a very sensitive method for detecting changes in the pituitary gland and may well be recommended as a method of choice even though the percentage of changes detected with it is rather small. 2. The use of contrast agent may be abandoned to limit costs when searching for cause of growth deficit in children with idiopathic growth hormone deficiency, save for the following cases: hypoplasia or aplasia of the pituitary gland, transection of the stalk, empty sella syndrome or tumor in the central nervous system. 3. Pituitary volume and height appear to be of greatest diagnostic significance, while width (which varies little) can serve as an auxiliary parameter. (author)

  7. Diagnostic performance of a commercial immunoblot assay for myositis antibody testing.

    Science.gov (United States)

    Bundell, Chris; Rojana-Udomsart, Arada; Mastaglia, Frank; Hollingsworth, Peter; McLean-Tooke, Andrew

    2016-06-01

    The objective of this study was to establish a population based reference range for a commercial immunoblot assay detecting myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs), and to assess the diagnostic performance of this reference range against the manufacturer's recommended ranges in a myositis patient cohort. A total of 124 patients from a myositis cohort and 197 healthy controls were serologically assessed using a commercial immunoblot containing eleven autoantigens (Jo-1, EJ, OJ, PL7, PL12, Mi-2, SRP, Ku, PMScl75, PMScl100 and Ro52) according to the manufacturer's instructions. Use of the manufacturer's reference ranges resulted in detection of MSAs in 19.4% of myositis patients and 9.1% of controls; MAAs were detected in 41.1% of myositis patients and 14.2% of controls. Reference values derived from the healthy control population resulted in significant differences in cut-off values for some autoantibodies, particularly Ro52 and PMScl75. Use of local reference ranges reduced detection of MSAs to 16.9% of myositis patients and 3% of healthy controls, with MAAs 23.4% of patients and 2% of healthy controls. Application of population based reference ranges resulted in significant differences in detection of MSAs and MAAs compared to the manufacturer's recommended ranges. Cut-off levels should be assessed to ensure suitability for the population tested. Copyright © 2016. Published by Elsevier B.V.

  8. Magnetic resonance imaging in local staging of endometrial carcinoma: diagnostic performance, pitfalls, and literature review.

    Science.gov (United States)

    Zandrino, Franco; La Paglia, Ernesto; Musante, Francesco

    2010-01-01

    To assess the diagnostic accuracy of magnetic resonance imaging in local staging of endometrial carcinoma, and to review the results and pitfalls described in the literature. Thirty women with a histological diagnosis of endometrial carcinoma underwent magnetic resonance imaging. Unenhanced T2-weighted and dynamic contrast-enhanced Ti-weighted sequences were obtained. Hysterectomy and salpingo-oophorectomy was performed in all patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the detection of deep myometrial and cervical infiltration. For deep myometrial infiltration T2-weighted sequences reached a sensitivity of 85%, specificity of 76%, PPV of 73%, NVP of 87%, and accuracy of 80%, while contrast-enhanced scans reached a sensitivity of 90%, specificity of 80%, PPV of 82%, NPV of 89%, and accuracy of 85%. For cervical infiltration T2-weighted sequences reached a sensitivity of 75%, specificity of 88%, PPV of 50%, NPV of 96%, and accuracy of 87%, while contrast-enhanced scans reached a sensitivity of 100%, specificity of 94%, PPV of 75%, NPV of 100%, and accuracy of 95%. Unenhanced and dynamic gadolinium-enhanced magnetic resonance allows accurate assessment of myometrial and cervical infiltration. Information provided by magnetic resonance imaging can define prognosis and management.

  9. Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

    Directory of Open Access Journals (Sweden)

    Yasser E Nassef

    2013-11-01

    Full Text Available The aim of the present study was to identify specific markers that mirror liver fibrosis progression as an alternative to biopsy when biopsy is contraindicated, especially in children. After liver biopsies were performed, serum samples from 30 hepatitis C virus (HCV paediatric patients (8-14 years were analysed and compared with samples from 30 healthy subjects. All subjects were tested for the presence of serum anti-HCV antibodies. Direct biomarkers for liver fibrosis, including transforming growth factor-β1, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1, hyaluronic acid (HA, procollagen type III amino-terminal peptide (PIIINP and osteopontin (OPN, were measured. The indirect biomarkers aspartate and alanine aminotransferases, albumin and bilirubin were also tested. The results revealed a significant increase in the serum marker levels in HCV-infected children compared with the healthy group, whereas albumin levels exhibited a significant decrease. Significantly higher levels of PIIINP, TIMP-1, OPN and HA were detected in HCV-infected children with moderate to severe fibrosis compared with children with mild fibrosis (p < 0.05. The diagnostic accuracy of these direct biomarkers, represented by sensitivity, specificity and positive predictive value, emphasises the utility of PIIINP, TIMP-1, OPN and HA as indicators of liver fibrosis among HCV-infected children.

  10. Magnetic resonance arthrography in chronic wrist pain. Artografia con Risonanza Magnetica (arto-RM) nelle malattie dolorose croniche del polso

    Energy Technology Data Exchange (ETDEWEB)

    Valeri, G.; Ferrara, C. (Ancona Univ. (Italy). Cattedra di Radiologia); Carloni, S. (Ancona Univ. (Italy). Cattedra di Ortopedia) (and others)

    The purpose of this paper is to investigate the clinical role of Magnetic Resonance Arthrography (MRA) of the wrist in subjects with chronic pain. Thirty-five patients complaining of wrist pain for more than 6 months were submitted to MRI an MRA. All patients received and intra-articular injection of 2-10 mL of a 10 mmol saline solution of Gd-DPTA. The overall diagnostic accuracy rates of MRI and MRA were 40% and 81% respectively, with sensitivity and specificity of 63% and 39% (MRI) and of 82% and 79% (MRA). The conclusion is that compared with MRI, MRA can be considered a useful tool for the visualization of interosseus carpal ligaments and of the triangular fibrocartilage complex. MRA also helps detect injuries in these structures.

  11. Comparison of 3MP medical-grade to 1MP office grade LCD monitors in mammographic diagnostic and perceptual performance

    International Nuclear Information System (INIS)

    Ong, Aaron; Tan, Shu.; Gledhill, Samuel; Hennessy, Oliver; Lui, Belinda; Lee, Alan; Lemish, Wayne; Styles, Colin; Pun, Emma; Padmanabhan, Meenakshi; Pitman, Alexander G.; Tauro, Paul; Waugh, Paul

    2011-01-01

    Full text: Picture archiving and communication systems images designed to be viewed on high-resolution medical-grade monitors are routinely viewed on office-grade monitors on the wards or at home. This study aimed to determine whether a statistically significant difference in diagnostic (cancer detection) and perceptual (microcalcification detection) performance exists between 3MP grade and 1MP office-grade monitors. 3MP Dome medical-grade liquid crystal display (LCD) monitors (Planar, Beaverton, OR, USA) were compared to 1MP Dell office-grade LCD monitors (Dell Inc, Round Rock, TX, USA). Eight radiologists (reader experi ence 8-30 years) read the same set of 100 mammograms (23/100 with proven cancers and 52/100 with microcalcifications) presented in random order on three occasions separated by two time intervals of 12 weeks. Reads 1 and 3 utilised 3MP monitors and formed the baseline read. Read 2 utilised 1MP monitors and constituted the experimental read. Reading conditions were standardised. Readers were aware of which monitors they were using. Mul tivariate logistic regression analysis (to account for reader variability and monitor impact) was performed to assess for statistical significance. At a = 5%, confidence intervals analysis comparing the measured parameters between 1MP to 3MP monitors demonstrated no statistically significant difference in diagnostic and perceptual performance for the reader group. In cancer detection (the diagnostic task), reader accuracy remained high irrespective of monitor type. Regression analysis comparing performance with 1MP against 3MP monitors found P values of 0.693 and 0.324 for diagnostic and perceptual performance, respectively. There were no statistically and clinically significant differences between 3MP and 1MP monitors in mammographic diagnostic and perceptual performance. Comparable performance may be due to compensatory behav iour by readers.

  12. An Integrated Architecture for On-Board Aircraft Engine Performance Trend Monitoring and Gas Path Fault Diagnostics

    Science.gov (United States)

    Simon, Donald L.

    2010-01-01

    Aircraft engine performance trend monitoring and gas path fault diagnostics are closely related technologies that assist operators in managing the health of their gas turbine engine assets. Trend monitoring is the process of monitoring the gradual performance change that an aircraft engine will naturally incur over time due to turbomachinery deterioration, while gas path diagnostics is the process of detecting and isolating the occurrence of any faults impacting engine flow-path performance. Today, performance trend monitoring and gas path fault diagnostic functions are performed by a combination of on-board and off-board strategies. On-board engine control computers contain logic that monitors for anomalous engine operation in real-time. Off-board ground stations are used to conduct fleet-wide engine trend monitoring and fault diagnostics based on data collected from each engine each flight. Continuing advances in avionics are enabling the migration of portions of the ground-based functionality on-board, giving rise to more sophisticated on-board engine health management capabilities. This paper reviews the conventional engine performance trend monitoring and gas path fault diagnostic architecture commonly applied today, and presents a proposed enhanced on-board architecture for future applications. The enhanced architecture gains real-time access to an expanded quantity of engine parameters, and provides advanced on-board model-based estimation capabilities. The benefits of the enhanced architecture include the real-time continuous monitoring of engine health, the early diagnosis of fault conditions, and the estimation of unmeasured engine performance parameters. A future vision to advance the enhanced architecture is also presented and discussed

  13. [Relieving pre-exam anxiety syndrome with wrist-ankle acupuncture: a randomized controlled trial].

    Science.gov (United States)

    Shu, Shi; Li, Tong-ming; Fang, Fan-fu; He, Hou-luo; Zhou, Qing-hui; Gu, Wei; Zhou, Shuang

    2011-06-01

    Pre-exam anxiety syndrome is a common condition occurring in pre-exam students and directly affects their examination performance and physical state. Wrist-ankle acupuncture has significant therapeutic effects in treating mental disorders and may also relieve the symptoms of pre-exam anxiety syndrome. To assess the therapeutic effect of wrist-ankle acupuncture on pre-exam anxiety syndrome. A total of 60 students who met the inclusion criteria of pre-exam anxiety syndrome were enrolled from a university in Shanghai and they were randomly divided into treatment group and control group. There were 30 cases in each group, and no case failed to follow-up. In the treatment group, wrist-ankle acupuncture was adopted to point upper 1 bilaterally (impression between flexor carpi ulnaris tendon and ulnar margin), and there was no requirement for Deqi (arrival of qi). In the control group, sham acupuncture was adopted. The treatment was applied 3 times totally in both groups one week before the exam, once every other day, each time with the needles retained for 30 min. The therapeutic effects were compared between two groups. Before and after 3 treatments, Sarason Test Anxiety Scale (TAS) and Expectation and Treatment Credibility Scale (ETCS) were measured and evaluated. The therapeutic effect experienced by the treatment group was better than that of the control group (PETCS before treatment between the two groups. The scores of TAS after treatment in two groups were higher than those before treatment (PETCS than those in the control group (P<0.05, P<0.01). No adverse reaction was reported. Wrist-ankle acupuncture can relieve the symptoms of pre-exam anxiety syndrome significantly, and this therapy is highly safe.

  14. Direct digital radiography versus storage phosphor radiography in the detection of wrist fractures

    Energy Technology Data Exchange (ETDEWEB)

    Peer, Siegfried; Neitzel, Ulrich; Giacomuzzi, Salvatore M.; Pechlaner, Sigurd; KUenzel, Karl Heinz; Peer, Regina; Gassner, Eva; Steingruber, Iris; Gaber, O.; Jaschke, Werner

    2002-04-01

    AIM: To define the value of digital radiography with a clinical flat panel detector system for evaluation of wrist fractures in comparison with state of the art storage phosphor radiography. MATERIAL AND METHODS: Hard copy images of 26 fractured wrist specimens were acquired with the same exposure dose on a state of the art storage phosphor radiography system and a clinical flat panel detector. Image features like cortical bone surface, trabecular bone, soft tissues and fracture delineation were independently analysed by 4 observers using a standardised protocol. Image quality ratings were evaluated with an analysis of variance (ANOVA). RESULTS: Flat panel detector radiographs were rated superior with respect to cortical and trabecular bone representation as well as fracture evaluation, while storage phosphor radiographs produced better soft tissue detail. CONCLUSION: In some of the observed image quality aspects, the performance of caesium iodide/amorphous silicon flat panel detector exceeds state of the art storage phosphor radiography. This makes it well suited for skeletal imaging particularly in trauma as seen in the detection of wrist fractures. Peer, S. et al. (2002)

  15. Anatomical Basis and Clinical Application of Synovial Flaps in the Wrist and Distal Forearm.

    Science.gov (United States)

    Colen, David L; Yeh, Jiun-Ting; Colen, Lawrence B

    2017-05-01

    Neuropathic symptoms after median nerve repair at the wrist or secondary to refractory carpal tunnel syndrome may become debilitating. These symptoms develop because of perineural adhesions, intraneural fibrosis, and fixation of the nerve to the transverse carpal ligament after surgery, and often require neurolysis. Interposition of vascularized soft tissue over the median nerve at the time of neurolysis prevents recurrence of such adhesions. The synovial flap, fashioned from the synovial lining of the flexor tendon sheath, is an ideal tissue for this purpose. Previous authors have described the surgical technique of the synovial flap, but the anatomical basis and design of the flap have not been previously discussed. Twenty fresh cadaver upper extremities were injected with Microfil to analyze the arterial anatomy, flap dimensions, and arc of rotation of the flexor tendon synovium mobilized as a flap suitable for coverage of the median nerve at the wrist. The authors determined that both radial and ulnar-based flaps are clinically useful for providing coverage in the wrist and distal forearm. This flap was used in 18 patients with complicated median nerve lesions in this region. All patients had an uncomplicated postoperative course. Of 13 patients treated for posttraumatic median nerve neuromas, all but two had significant resolution of symptoms. When used as a vascularized flap, the flexor tendon synovium provides adequate protection of the median nerve. Flap dimensions and vascularity of this tissue make it an ideal local flap option when performing reoperative surgery on the median nerve.

  16. Direct digital radiography versus storage phosphor radiography in the detection of wrist fractures

    International Nuclear Information System (INIS)

    Peer, Siegfried; Neitzel, Ulrich; Giacomuzzi, Salvatore M.; Pechlaner, Sigurd; KUenzel, Karl Heinz; Peer, Regina; Gassner, Eva; Steingruber, Iris; Gaber, O.; Jaschke, Werner

    2002-01-01

    AIM: To define the value of digital radiography with a clinical flat panel detector system for evaluation of wrist fractures in comparison with state of the art storage phosphor radiography. MATERIAL AND METHODS: Hard copy images of 26 fractured wrist specimens were acquired with the same exposure dose on a state of the art storage phosphor radiography system and a clinical flat panel detector. Image features like cortical bone surface, trabecular bone, soft tissues and fracture delineation were independently analysed by 4 observers using a standardised protocol. Image quality ratings were evaluated with an analysis of variance (ANOVA). RESULTS: Flat panel detector radiographs were rated superior with respect to cortical and trabecular bone representation as well as fracture evaluation, while storage phosphor radiographs produced better soft tissue detail. CONCLUSION: In some of the observed image quality aspects, the performance of caesium iodide/amorphous silicon flat panel detector exceeds state of the art storage phosphor radiography. This makes it well suited for skeletal imaging particularly in trauma as seen in the detection of wrist fractures. Peer, S. et al. (2002)

  17. Comparison of diagnostic performance for perinatal and paediatric post-mortem imaging: CT versus MRI

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Jacques, Thomas S.; Sebire, Neil J.; Guy, Anna; Chong, W.K.; Gunny, Roxanna; Saunders, Dawn; Olsen, Oystein E.; Thayyil, Sudhin; Wade, Angie; Jones, Rod; Norman, Wendy; Taylor, Andrew M.; Scott, Rosemary; Robertson, Nicola J.; Owens, Catherine M.; Offiah, Amaka C.; Chitty, Lyn S.

    2016-01-01

    To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children. We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems. Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %). Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children. (orig.)

  18. CT imaging of congenital lung lesions: effect of iterative reconstruction on diagnostic performance and radiation dose

    International Nuclear Information System (INIS)

    Haggerty, Jay E.; Smith, Ethan A.; Dillman, Jonathan R.; Kunisaki, Shaun M.

    2015-01-01

    Different iterative reconstruction techniques are available for use in pediatric computed tomography (CT), but these techniques have not been systematically evaluated in infants. To determine the effect of iterative reconstruction on diagnostic performance, image quality and radiation dose in infants undergoing CT evaluation for congenital lung lesions. A retrospective review of contrast-enhanced chest CT in infants (<1 year) with congenital lung lesions was performed. CT examinations were reviewed to document the type of lung lesion, vascular anatomy, image noise measurements and image reconstruction method. CTDI vol was used to calculate size-specific dose estimates (SSDE). CT findings were correlated with intraoperative and histopathological findings. Analysis of variance and the Student's t-test were used to compare image noise measurements and radiation dose estimates between groups. Fifteen CT examinations used filtered back projection (FBP; mean age: 84 days), 15 used adaptive statistical iterative reconstruction (ASiR; mean age: 93 days), and 11 used model-based iterative reconstruction (MBIR; mean age: 98 days). Compared to operative findings, 13/15 (87%), 14/15 (93%) and 11/11 (100%) lesions were correctly characterized using FBP, ASiR and MBIR, respectively. Arterial anatomy was correctly identified in 12/15 (80%) using FBP, 13/15 (87%) using ASiR and 11/11 (100%) using MBIR. Image noise was less for MBIR vs. ASiR (P < 0.0001). Mean SSDE was different among groups (P = 0.003; FBP = 7.35 mGy, ASiR = 1.89 mGy, MBIR = 1.49 mGy). Congenital lung lesions can be adequately characterized in infants using iterative CT reconstruction techniques while maintaining image quality and lowering radiation dose. (orig.)

  19. High-performance pickups for beam diagnostics. Design, analysis, characterization and implementation

    International Nuclear Information System (INIS)

    Angelovski, Aleksandar

    2015-01-01

    This work introduces the design, analysis, characterization and implementation of high-performance pickups for two beam diagnostic instruments, a Bunch Arrival-time Monitor (BAM) and an Energy Beam Position Monitor (EBPM) at the European XFEL. As a part of the BAM the cone-shaped pickups are proposed along with the corresponding RF-frontend. The designed pickups deliver a beam induced signal with a slope steepness of around 400 mV/ps and a bandwidth of 40 GHz. These signal characteristics are well inside the design requirements, i.e., a slope steepness of 300 mV/ps and more than ten times better compared to the signal from the state-of-the-art pickups. The pickups are installed and commissioned at three accelerator facilities, FLASH at DESY, the quasi-CW SRF accelerator ELBE at the Helmholtz-Zentrum Dresden-Rossendorf and the SwissFEL injector test facility at Paul Scherrer Institute. The obtained measurement results from the installed pickups are in good agreement with the simulations. A comparison between the signal measurements with the cone-shaped pickup and the state-of-the-art is performed at ELBE showing an improvement by a factor of ten. The potential of the pickups for sub-10 fs arrival-time measurements for bunch charges of 20 pC is demonstrated at ELBE and at SwissFEL injector test facility. The introduced coneshaped pickups are the first commercially available pickups with a bandwidth of up to 40 GHz. For the EBPM, a modular pickup structure with two types of planar pickups, microstrip transmission line and grounded coplanar waveguide with perpendicular connectors is investigated. The transition region between the connector and the line is optimized for two substrate materials, alumina and glass with a reflection coefficient better than -20 dB up to 6 GHz.

  20. Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation

    International Nuclear Information System (INIS)

    Sizemore, Alecia W.; Rabbani, Kaneez Z.; Ladd, Alan; Applegate, Kimberly E.

    2008-01-01

    Malrotation is a congenital disorder of abnormal intestinal rotation and fixation that predisposes infants to potentially life-threatening midgut volvulus. Upper gastrointestinal tract (UGI) examination is sometimes equivocal and can lead to inaccurate diagnosis. To determine the diagnostic performance of UGI examinations in children who subsequently underwent a Ladd procedure for suspected malrotation or volvulus. We reviewed all children up to 21 years old who had undergone both a UGI examination and a Ladd procedure for possible malrotation across 9 years. Children were excluded if they had not undergone either a UGI examination or a Ladd procedure and if congenital abdominal wall defects were present. Of 229 patients identified, 166 (59% male, median age 67 days) were included. Excluded were 47 without a UGI series, 12 with omphalocele or gastroschisis, 1 without verifiable operative data, 1 who had not undergone a Ladd procedure, and 2 older than 21 years. Of the 166 patients, 40% were neonates and 73% were <12 months old, and 31% presented with bilious vomiting and 15% with abdominal distention. Of 163 patients with surgically verified malrotation, 156 had a positive UGI examination, a sensitivity of 96%. There were two patients with a false-positive UGI examination and seven with false-negative examination. Jejunal position was normal in six of the seven with a false-negative examination and abnormal in the two with a false-positive examination. Of 38 patients with surgically verified volvulus, 30 showed volvulus on the UGI series. Five required bowel resection and three died. Jejunal position can lead to inaccurate UGI series interpretation. Meticulous technique and periodic assessment of performance will help more accurately diagnose difficult or equivocal cases. (orig.)

  1. Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation

    Energy Technology Data Exchange (ETDEWEB)

    Sizemore, Alecia W [Indiana University School of Medicine, Department of Radiology, Indianapolis, IN (United States); University of Virginia School of Medicine, Department of Radiology, Charlottesville, VA (United States); Rabbani, Kaneez Z [Indiana University School of Medicine, Department of Medicine, Indianapolis, IN (United States); Ladd, Alan [Indiana University School of Medicine, Division of Pediatric Surgery, Riley Hospital, Indianapolis, IN (United States); Applegate, Kimberly E [Indiana University School of Medicine, Section of Pediatric Radiology, Department of Radiology, Indianapolis, IN (United States); Riley Hospital for Children, Department of Radiology, Indianapolis, IN (United States)

    2008-05-15

    Malrotation is a congenital disorder of abnormal intestinal rotation and fixation that predisposes infants to potentially life-threatening midgut volvulus. Upper gastrointestinal tract (UGI) examination is sometimes equivocal and can lead to inaccurate diagnosis. To determine the diagnostic performance of UGI examinations in children who subsequently underwent a Ladd procedure for suspected malrotation or volvulus. We reviewed all children up to 21 years old who had undergone both a UGI examination and a Ladd procedure for possible malrotation across 9 years. Children were excluded if they had not undergone either a UGI examination or a Ladd procedure and if congenital abdominal wall defects were present. Of 229 patients identified, 166 (59% male, median age 67 days) were included. Excluded were 47 without a UGI series, 12 with omphalocele or gastroschisis, 1 without verifiable operative data, 1 who had not undergone a Ladd procedure, and 2 older than 21 years. Of the 166 patients, 40% were neonates and 73% were <12 months old, and 31% presented with bilious vomiting and 15% with abdominal distention. Of 163 patients with surgically verified malrotation, 156 had a positive UGI examination, a sensitivity of 96%. There were two patients with a false-positive UGI examination and seven with false-negative examination. Jejunal position was normal in six of the seven with a false-negative examination and abnormal in the two with a false-positive examination. Of 38 patients with surgically verified volvulus, 30 showed volvulus on the UGI series. Five required bowel resection and three died. Jejunal position can lead to inaccurate UGI series interpretation. Meticulous technique and periodic assessment of performance will help more accurately diagnose difficult or equivocal cases. (orig.)

  2. CT imaging of congenital lung lesions: effect of iterative reconstruction on diagnostic performance and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Haggerty, Jay E.; Smith, Ethan A.; Dillman, Jonathan R. [University of Michigan Health System, Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Kunisaki, Shaun M. [University of Michigan Health System, Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2015-07-15

    Different iterative reconstruction techniques are available for use in pediatric computed tomography (CT), but these techniques have not been systematically evaluated in infants. To determine the effect of iterative reconstruction on diagnostic performance, image quality and radiation dose in infants undergoing CT evaluation for congenital lung lesions. A retrospective review of contrast-enhanced chest CT in infants (<1 year) with congenital lung lesions was performed. CT examinations were reviewed to document the type of lung lesion, vascular anatomy, image noise measurements and image reconstruction method. CTDI{sub vol} was used to calculate size-specific dose estimates (SSDE). CT findings were correlated with intraoperative and histopathological findings. Analysis of variance and the Student's t-test were used to compare image noise measurements and radiation dose estimates between groups. Fifteen CT examinations used filtered back projection (FBP; mean age: 84 days), 15 used adaptive statistical iterative reconstruction (ASiR; mean age: 93 days), and 11 used model-based iterative reconstruction (MBIR; mean age: 98 days). Compared to operative findings, 13/15 (87%), 14/15 (93%) and 11/11 (100%) lesions were correctly characterized using FBP, ASiR and MBIR, respectively. Arterial anatomy was correctly identified in 12/15 (80%) using FBP, 13/15 (87%) using ASiR and 11/11 (100%) using MBIR. Image noise was less for MBIR vs. ASiR (P < 0.0001). Mean SSDE was different among groups (P = 0.003; FBP = 7.35 mGy, ASiR = 1.89 mGy, MBIR = 1.49 mGy). Congenital lung lesions can be adequately characterized in infants using iterative CT reconstruction techniques while maintaining image quality and lowering radiation dose. (orig.)

  3. Postoperative imaging of orthopaedic hardware in the hand and wrist: is there an added value for tomosynthesis?

    Science.gov (United States)

    De Silvestro, A; Martini, K; Becker, A S; Kim-Nguyen, T D L; Guggenberger, R; Calcagni, M; Frauenfelder, T

    2018-02-01

    To prospectively investigate digital tomosynthesis (DTS) as an alternative to digital radiography (DR) for postoperative imaging of orthopaedic hardware after trauma or arthrodesis in the hand and wrist. Thirty-six consecutive patients (12 female, median age 36 years, range 19-86 years) were included in this institutional review board approved clinical trial. Imaging was performed with DTS in dorso-palmar projection and DR was performed in dorso-palmar, lateral, and oblique views. Images were evaluated by two independent radiologists for qualitative and diagnosis-related imaging parameters using a four-point Likert scale (1=excellent, 4not diagnostic) and nominal scale. Interobserver agreement between the two readers was assessed with Cohen's kappa (k). Differences between DTS and CR were tested with Wilcoxon's signed-rank test. A p-value <0.05 was considered statistically significant. Regarding image quality, interobserver agreement was higher for DTS compared to DR, especially for fracture-related parameters (delineation osteosynthesis material [OSM]: K DTS 0.96 versus K DR 0.45; delineation fracture margins: K DTS 0.78 versus K DR 0.35). Delineation of fracture margins and delineation of adjacent joint spaces scored significant better for DTS compared to DR (delineation fracture margins: DTS1.54, DR2.28, p0.001; delineation adjacent joint spaces: DTS1.31, DR2.24, p0.001). Regarding diagnosis-related findings, interobserver agreement was almost equal. DTS showed a significant higher sharpness of fracture margins (DTS1.94, DR2.33, p0.04). Mean dose area product (DAP) for DTS was significant higher compared to DR (mean DR0.219 Gy·cm 2 , mean DTS0.903 Gy·cm 2 , p0.001). Fracture healing is more visible and interobserver agreement is higher for DTS compared to DR in the postoperative assessment of orthopaedic hardware in the hand and wrist. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  4. Performance of Different Diagnostic Criteria for Familial Mediterranean Fever in Children with Periodic Fevers : Results from a Multicenter International Registry

    NARCIS (Netherlands)

    Demirkaya, Erkan; Saglam, Celal; Turker, Turker; Koné-Paut, Isabelle; Woo, Pat; Doglio, Matteo; Amaryan, Gayane; Frenkel, Joost; Uziel, Yosef; Insalaco, Antonella; Cantarini, Luca; Hofer, Michael; Boiu, Sorina; Duzova, Ali; Modesto, Consuelo; Bryant, Annette; Rigante, Donato; Papadopoulou-Alataki, Efimia; Guillaume-Czitrom, Severine; Kuemmerle-Deschner, Jasmine; Neven, Bénédicte; Lachmann, Helen; Martini, Alberto; Ruperto, Nicolino; Gattorno, Marco; Ozen, Seza

    2015-01-01

    OBJECTIVE: Our aims were to validate the pediatric diagnostic criteria in a large international registry and to compare them with the performance of previous criteria for the diagnosis of familial Mediterranean fever (FMF). METHODS: Pediatric patients with FMF from the Eurofever registry were used

  5. Alzheimer's Disease Diagnostic Performance of a Multi-Atlas Hippocampal Segmentation Method using the Harmonized Hippocampal Protocol

    DEFF Research Database (Denmark)

    Anker, Cecilie Benedicte; Sørensen, Lauge; Pai, Akshay

    PURPOSE Hippocampal volumetry is the most widely used structural MRI biomarker of Alzheimer’s disease (AD), and state-of-the-art, automatic hippocampal segmentation can be obtained using longitudinal FreeSurfer. In this study, we compare the diagnostic AD performance of a single time point, multi...

  6. Intermonitor reliability of the GT3X+ accelerometer at hip, wrist and ankle sites during activities of daily living

    International Nuclear Information System (INIS)

    Ozemek, Cemal; Wilkerson, Brittany S; Kaminsky, Leonard A; Kirschner, Monica M; Byun, Wonwoo

    2014-01-01

    The triaxial GT3X+ accelerometer can measure activity counts in the vertical, horizontal right to left, horizontal front to back planes, and can generate a summative score of the three axes represented by vector magnitude (VM). Information on the reliability of the GT3X+ at the hip, wrist and ankle sites, over all axes and VM during activities of daily living (ADL) is lacking in the literature. Forty healthy adults (14 men and 26 women) were randomly assigned to perform 10 of 20 ADL (consisting of sedentary, housework, yard work, locomotive and recreational activities) while wearing two monitors on the hip, wrist and ankle. Subjects performed each ADL over 7 min and the mean activity counts during the last 4 min were used for analyses. Average intraclass correlations between monitors were high for the three sites for each axis and VM (hip: 0.943, 0.857, 0.864 and 0.966, respectively; wrist: 0.994, 0.963, 0.961 and 0.989, respectively; ankle: 0.977, 0.979, 0.927 and 0.986, respectively). These data suggest that GT3X+ accelerometers measurements made from the hip, wrist and ankle sites are reliable during ADL across all axes and VM. (paper)

  7. Multiparametric MRI of the prostate: diagnostic performance and interreader agreement of two scoring systems.

    Science.gov (United States)

    Lin, Wei-Ching; Muglia, Valdair F; Silva, Gyl E B; Chodraui Filho, Salomão; Reis, Rodolfo B; Westphalen, Antonio C

    2016-06-01

    To compare the diagnostic accuracies and interreader agreements of the Prostate Imaging Reporting and Data System (PI-RADS) v. 2 and University of California San Francisco (UCSF) multiparametric prostate MRI scale for diagnosing clinically significant prostate cancer. This institutional review board-approved retrospective study included 49 males who had 1.5 T endorectal MRI and prostatectomy. Two radiologists scored suspicious lesions on MRI using PI-RADS v. 2 and the UCSF scale. Percent agreement, 2 × 2 tables and the area under the receiver operating characteristic curves (Az) were used to assess and compare the individual and overall scores of these scales. Interreader agreements were estimated with kappa statistics. Reader 1 (R1) detected 78 lesions, and Reader 2 (R2) detected 80 lesions. Both identified 52 of 65 significant cancers. The Az for PI-RADS v. 2 and UCSF scale for R1 were 0.68 and 0.69 [T2 weighted imaging (T2WI)], 0.75 and 0.68 [diffusion-weighted imaging (DWI)] and 0.64 and 0.72 (overall score), respectively, and were 0.72 and 0.75 (T2WI), 0.73 and 0.67 (DWI) and 0.66 and 0.75 (overall score) for R2. The dynamic contrast-enhanced percent agreements between scales were 100% (R1) and 95% (R2). PI-RADS v. 2 DWI of R1 performed better than UCSF DWI (Az = 0.75 vs Az = 0.68; p = 0.05); no other differences were found. The interreader agreements were higher for PI-RADS v. 2 (T2WI: 0.56 vs 0.42; DWI: 0.60 vs 0.46; overall: 0.61 vs 0.42). The UCSF approach to derive the overall PI-RADS v. 2 scores increased the Az for the identification of significant cancer (R1 to 0.76, p < 0.05; R2 to 0.71, p = 0.35). Although PI-RADS v. 2 DWI score may have a higher discriminatory performance than the UCSF scale counterpart to diagnose clinically significant cancer, the utilization of the UCSF scale weighing system for the integration of PI-RADS v. 2 individual parameter scores improved the accuracy its overall score. PI-RADS v. 2 is

  8. Performance assessment and adoption processes of an information monitoring and diagnostic system prototype; FINAL

    International Nuclear Information System (INIS)

    Piette, Mary Ann

    1999-01-01

    This report addresses the problem that buildings do not perform as well as anticipated during design. We partnered with an innovative building operator to evaluate a prototype Information Monitoring and Diagnostic System (IMDS). The IMDS consists of high-quality measurements archived each minute, a data visualization tool, and a web-based capability. The operators recommend similar technology be adopted in other buildings. The IMDS has been used to identify and correct a series of control problems. It has also allowed the operators to make more effective use of the building control system, freeing up time to take care of other tenant needs. They believe they have significantly improved building comfort, potentially improving tenant health, and productivity. The reduction in hours to operate the building are worth about$20,000 per year, which could pay for the IMDS in about five years. A control system retrofit based on findings from the IMDS is expected to reduce energy use by 20 percent over the next year, worth over$30,000 per year. The main conclusion of the model-based chiller fault detection work is that steady-state models can be used as reference models to monitor chiller operation and detect faults. The ability of the IMDS to measure cooling load and chiller power to one-percent accuracy with a one-minute sampling interval permits detection of additional faults. Evolutionary programming techniques were also evaluated, showing promise in the detection of patterns in building data. We also evaluated two technology adoption processes, radical and routine. In routine adoption, managers enhance features of existing products that are already well understood. In radical adoption, innovative building managers introduce novel technology into their organizations without using the rigorous payback criteria used in routine innovations

  9. Diagnostic performance of radiographers as compared to radiologists in magnetic resonance colonography

    International Nuclear Information System (INIS)

    Zijta, F.M.; Florie, J.; Jensch, S.; Bipat, S.; Nievelstein, R.A.J.; Poulus, M.; Thomassen-de Graaf, M.A.; Montauban van Swijndregt, A.D.; Stoker, J.

    2010-01-01

    Purpose: To evaluate the diagnostic performance of radiographers compared to radiologists in the detection of colorectal lesions in MR colonography. Material and methods: 159 patients at increased risk of colorectal cancer were included. Four different experienced observers, one MR radiologist, one radiologist in training and two radiographers evaluated all MR colonography examinations. The protocol included T1-weighted and T2-weighted sequences in prone and supine position. Colonoscopy was used as reference standard. Mean sensitivity rates with 95% confidence intervals (CIs) were determined on a per-patient and per-polyp basis, segmented by size (≥6 mm and ≥10 mm). Specificity was calculated on a per-patient basis. The McNemar and chi-square (χ 2 ) test was used to determine significant differences. Results: At colonoscopy 74 patients (47%) had normal findings; 23 patients had 40 polyps with a size ≥6 mm. In 10 patients at least 1 polyp ≥10 mm was found (20 polyps in total). Similar sensitivities for patients with lesions ≥10 mm were found for radiologists and radiographers (65% (95%CI: 44-86%) vs. 50% (95%CI: 28-72%)) (p = n.s.). For lesions ≥10 mm combined per-patient specificity for radiologists and radiographers was 96% (95%CI: 94-98%) and 73% (95%CI: 68-79%) (p < 0.0001). Combined per-patient sensitivity for lesions ≥6 mm differed significantly between both groups of observers (57% (95%CI: 42-71%) vs. 33% (95%CI: 19-46%)) (p = 0.03). Conclusion: Radiographers have comparable sensitivity but lower specificity relative to radiologists in the detection of colorectal lesions ≥10 mm at MR colonography. Adequate training in evaluating MR colonography is necessary, especially for readers with no prior experience with colonography.

  10. Performance assessment and adoption processes of an information monitoring and diagnostic system prototype

    Energy Technology Data Exchange (ETDEWEB)

    Piette, Mary Ann

    1999-10-01

    This report addresses the problem that buildings do not perform as well as anticipated during design. We partnered with an innovative building operator to evaluate a prototype Information Monitoring and Diagnostic System (IMDS). The IMDS consists of high-quality measurements archived each minute, a data visualization tool, and a web-based capability. The operators recommend similar technology be adopted in other buildings. The IMDS has been used to identify and correct a series of control problems. It has also allowed the operators to make more effective use of the building control system, freeing up time to take care of other tenant needs. They believe they have significantly improved building comfort, potentially improving tenant health, and productivity. The reduction in hours to operate the building are worth about $20,000 per year, which could pay for the IMDS in about five years. A control system retrofit based on findings from the IMDS is expected to reduce energy use by 20 percent over the next year, worth over $30,000 per year. The main conclusion of the model-based chiller fault detection work is that steady-state models can be used as reference models to monitor chiller operation and detect faults. The ability of the IMDS to measure cooling load and chiller power to one-percent accuracy with a one-minute sampling interval permits detection of additional faults. Evolutionary programming techniques were also evaluated, showing promise in the detection of patterns in building data. We also evaluated two technology adoption processes, radical and routine. In routine adoption, managers enhance features of existing products that are already well understood. In radical adoption, innovative building managers introduce novel technology into their organizations without using the rigorous payback criteria used in routine innovations.

  11. Diagnostic performance of bone metabolic indexes for the detection of stroke

    Directory of Open Access Journals (Sweden)

    Li-Ming Tan

    2017-01-01

    Full Text Available Objectives: To explore the diagnostic performance of 25-hydroxyvitamin D (25(OHD, parathyroid hormone (PTH, bone alkaline phosphatase (BALP, and osteocalcin (OC in predicting stroke. Methods: This retrospective survey was conducted in The Second Affiliated Hospital to Nanchang University, Nanchang, Jiangxi Province, China. involved 121 cerebral infarction patients and 103 cerebral hemorrhage patients as the experimental groups, 100 volunteers as the healthy control group and 80 brain trauma patients as the disease control group. The 25(OHD, PTH, BALP, and OC levels of all participants were measured by electrochemiluminescence immunoassay. Results: The serum concentration of 25(OHD in stroke patients was appreciably lower than that of the control groups (p<0.05, and subsequently, the deficiency level of 25(OHD in the stroke population was considerably higher than that of the control groups (p<0.05. The serum concentrations of PTH and OC in stroke patients exceeded those found in the control groups (p<0.05, and the abnormal level in the stroke patients was also higher than that of the control. Compared with the control group, BALP concentrations in cerebral infarction patients were increased significantly. Additionally, abnormal levels of BALP in stroke patients were found to be higher than those in the control groups. However, concentrations and abnormal levels of BALP in cerebral hemorrhage patients were not found to be significantly different than those found in cerebral infarction and the control groups, There were no substantial differences between the 2 control groups. Conclusion: Lack of 25(OHD and excessive PTH, BALP, and OC could indicate a high risk of stroke.

  12. Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy.

    Science.gov (United States)

    Duran, Ibrahim; Schulze, Josefa; Martakis, KyriakoS; Stark, Christina; Schoenau, Eckhard

    2018-03-07

    To assess the diagnostic performance of body mass index (BMI) cut-off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP). The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation programme. Excess body fat was defined as a body fat percentage above the 85th centile assessed by dual-energy X-ray absorptiometry. In total, 329 children (181 males, 148 females) with CP were eligible for analysis. The mean age was 12 years 4 months (standard deviation 2y 9mo). The BMI cut-off values for 'overweight' according to the WHO, WOF, and DAG showed the following sensitivities and specificities for the prediction of excess body fat in our population: WHO: sensitivity 0.768 (95% confidence interval [CI] 0.636-0.870), specificity 0.894 (95% CI 0.851-0.928); WOF: sensitivity 0.696 (95% CI 0.559-0.812), specificity 0.934 (95% CI 0.898-0.960); DAG: sensitivity 0.411 (95% CI 0.281-0.550), specificity 0.993 (95% CI 0.974-0.999). Body mass index showed high specificity, but low sensitivity in children with CP. Thus, 'normal-weight obese' children with CP were overlooked, when assessing excess body fat only using BMI. Excess body fat in children with cerebral palsy (CP) is less common than previously reported. Body mass index (BMI) had high specificity but low sensitivity in detecting excess body fat in children with CP. BMI evaluation criteria of the German Society for Adiposity could be improved in children with CP. © 2018 Mac Keith Press.

  13. Diagnostic Performance of a Rapid Magnetic Resonance Imaging Method of Measuring Hepatic Steatosis

    Science.gov (United States)

    House, Michael J.; Gan, Eng K.; Adams, Leon A.; Ayonrinde, Oyekoya T.; Bangma, Sander J.; Bhathal, Prithi S.; Olynyk, John K.; St. Pierre, Tim G.

    2013-01-01

    Objectives Hepatic steatosis is associated with an increased risk of developing serious liver disease and other clinical sequelae of the metabolic syndrome. However, visual estimates of steatosis from histological sections of biopsy samples are subjective and reliant on an invasive procedure with associated risks. The aim of this study was to test the ability of a rapid, routinely available, magnetic resonance imaging (MRI) method to diagnose clinically relevant grades of hepatic steatosis in a cohort of patients with diverse liver diseases. Materials and Methods Fifty-nine patients with a range of liver diseases underwent liver biopsy and MRI. Hepatic steatosis was quantified firstly using an opposed-phase, in-phase gradient echo, single breath-hold MRI methodology and secondly, using liver biopsy with visual estimation by a histopathologist and by computer-assisted morphometric image analysis. The area under the receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of the MRI method against the biopsy observations. Results The MRI approach had high sensitivity and specificity at all hepatic steatosis thresholds. Areas under ROC curves were 0.962, 0.993, and 0.972 at thresholds of 5%, 33%, and 66% liver fat, respectively. MRI measurements were strongly associated with visual (r2 = 0.83) and computer-assisted morphometric (r2 = 0.84) estimates of hepatic steatosis from histological specimens. Conclusions This MRI approach, using a conventional, rapid, gradient echo method, has high sensitivity and specificity for diagnosing liver fat at all grades of steatosis in a cohort with a range of liver diseases. PMID:23555650

  14. Accurate Point-of-Care Detection of Ruptured Fetal Membranes: Improved Diagnostic Performance Characteristics with a Monoclonal/Polyclonal Immunoassay

    Directory of Open Access Journals (Sweden)

    Linda C. Rogers

    2016-01-01

    Full Text Available Objective Accurate and timely diagnosis of rupture of membranes (ROM is imperative to allow for gestational age-specific interventions. This study compared the diagnostic performance characteristics between two methods used for the detection of ROM as measured in the same patient. Methods Vaginal secretions were evaluated using the conventional fern test as well as a point-of-care monoclonal/polyclonal immunoassay test (ROM Plus® in 75 pregnant patients who presented to labor and delivery with complaints of leaking amniotic fluid. Both tests were compared to analytical confirmation of ROM using three external laboratory tests. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV, and accuracy. Results Diagnostic performance characteristics uniformly favored ROM detection using the immunoassay test compared to the fern test: sensitivity (100% vs. 77.8%, specificity (94.8% vs. 79.3%, PPV (75% vs. 36.8%, NPV (100% vs. 95.8%, and accuracy (95.5% vs. 79.1%. Conclusions The point-of-care immunoassay test provides improved diagnostic accuracy for the detection of ROM compared to fern testing. It has the potential of improving patient management decisions, thereby minimizing serious complications and perinatal morbidity.

  15. Clinical value of MRI on wrists with arthritis

    International Nuclear Information System (INIS)

    Ma Qiang; Ma Daqing; He Wen; Le Erhu; Ma Xinfa; Wang Jun; Zuo Zhaoyong

    2006-01-01

    Objective: To study the appearances of various kinds of arthritis on MRI, and to assess and evaluate the role of MRI on diagnosing various kinds of arthritis. Methods: One hundred and fifty-one patients with medical history of wrist pain entered the study. T 1 -weighted spin echo, STIR (short time inversion recovery) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were examined in the coronal planes. MRl, plain wrist radiographs, clinical data including swollen joint and patient global assessment (AIMS), and laboratory, examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score (HAQ). According to 1987 American Rheumatism Association (ARA) revised criteria, in 151 patients, 80 patients were diagnosed as rheumatoid arthritis, 29 patients as undifferentiated spondyloarthropathy, 20 patients as seronegative spondyloarthropathy, and 22 as other kinds of connective tissue diseases. Results: All 80 patients diagnosed with rheumatoid arthritis had bilateral pannus. Among 29 patients diagnosed with undifferentiated spondyloanthropathy, 3 cases had bilateral pannus, 24 had lateral pannus. Among 20 patients diagnosed with seronegative spondyloanthropathy, 4 cases had bilateral pannus, 15 had lateral pannus. Among 22 patients diagnosed with other kinds of connective tissue disease, 21 had lateral pannus. Bilateral pannus on bilateral wrists occured in 87 patients. There were not significant difference in the unilateral pannus among patients with various arthritis (χ 2 =6.157; P>0.05). But there were significant difference in the bilateral pannus among patients with various arthritis (χ 2 =126.882, P 2 =94.192, P 2 =70.354, P 2 =96.174, P<0.001). Conclusion: MRI can show the pathologic changes of wrists with various kinds of arthritis. MRI plays an important role in the differential diagnosis of various kinds of arthritis

  16. Preclinical study of diagnostic performances of contrast-enhanced spectral mammography versus MRI for breast diseases in China.

    Science.gov (United States)

    Wang, Qingguo; Li, Kangan; Wang, Lihui; Zhang, Jianbing; Zhou, Zhiguo; Feng, Yan

    2016-01-01

    To evaluate diagnostic performances of CESM for breast diseases with comparison to breast MRI in China. Sixty-eight patients with 77 breast lesions underwent MR and CESM. Two radiologists interpreted either MRI or CESM images, separately and independently. BI-RADS 1-3 and BI-RADS 4-5 were classified into the suspicious benign and suspicious malignant groups. Diagnostic accuracy parameters were calculated. Receiver operating characteristic (ROC) curves were constructed for the two modalities. The agreement and correlation between maximum lesion diameter based on CESM and MRI, or CESM and pathology were analyzed. Diagnostic accuracy parameters for CESM were sensitivity 95.8 %, specificity 65.5 %, PPV 82.1 %, NPV 90.5 % and accuracy 84.4 %. The diagnostic accuracy parameters for breast MRI were sensitivity 93.8 %, specificity 82.8 %, PPV 88.2 %, NPV 92.3 %and accuracy 89.6 %. Area under the curve (AUC) of ROC was 0.96 for breast MRI and 0.88 for CESM. The Bland-Altman plots showed a mean difference of 0.7 mm with 95 % limits of agreement of 11.4 mm in tumor diameter measured using CESM and breast MRI. The differences of size measurement between CESM and breast MRI were significant, whereas no difference was observed between CESM and pathology as well as between breast MRI and pathology. The better correlation with pathological results was found in CESM than breast MRI. Our study demonstrates that CESM possesses better diagnostic performances than breast MRI in terms of diagnostic sensitivity and lesion size assessment. And CESM is a good alternative method of screening breast cancer in high-risk people.

  17. The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents.

    Science.gov (United States)

    Heemskerk, Laura; Norman, Geoff; Chou, Sophia; Mintz, Marcy; Mandin, Henry; McLaughlin, Kevin

    2008-11-01

    Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

  18. Imaging of radial wrist pain. I. Imaging modalities and anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ryan Ka Lok; Griffith, James F.; Ng, Alex Wing Hung [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, Shatin (China); Wong, Clara Wing Yee [The Chinese University of Hong Kong, Department of Orthopedics and Traumatology, Shatin (China)

    2014-06-15

    Radial wrist pain is a common clinical complaint. The relatively complex anatomy in this region, combined with the small size of the anatomical structures and occasionally subtle imaging findings, can pose problems when trying to localize the exact cause of pain. To fully comprehend the underlying pathology, one needs a good understanding of both radial-sided wrist anatomy and the relative merits of the different imaging techniques used to assess these structures. In part I of this review, these aspects will be discussed. (orig.)

  19. Arthrography in lesions of triangular fibrocartilage of the wrist

    International Nuclear Information System (INIS)

    Rau, W.S.; Seifert, J.

    1982-01-01

    Arthography of the wrist is a safe method to demonstrate lesions of the triangular fibrocartilage. Indications are posttraumatic pain and restriction of movement of the wrist. Lesions of the triangular fibrocartilage are caused by a distal fracture of the radius with shortening, sudden drop on the overextended hand and work with rock drills. The extent of injury is quite different: small fissures and splits, detachment of the discus from the lower end of the ulna, fragmentation and destruction of the fibrocartilage. Problems of therapy, however, are greater than problems of diagnosis: actually there is no generally adopted surgical method for the treatment of discus lections. (orig./MG)

  20. Arthrography in lesions of triangular fibrocartilage of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Rau, W.S.; Seifert, J.

    1982-05-01

    Arthography of the wrist is a safe method to demonstrate lesions of the triangular fibrocartilage. Indications are posttraumatic pain and restriction of movement of the wrist. Lesions of the triangular fibrocartilage are caused by a distal fracture of the radius with shortening, sudden drop on the overextended hand and work with rock drills. The extent of injury is quite different: small fissures and splits, detachment of the discus from the lower end of the ulna, fragmentation and destruction of the fibrocartilage. Problems of therapy, however, are greater than problems of diagnosis: actually there is no generally adopted surgical method for the treatment of discus lesions.

  1. Hand and Wrist Injuries in Boxing and the Martial Arts.

    Science.gov (United States)

    Drury, Benjamin Todd; Lehman, Thomas P; Rayan, Ghazi

    2017-02-01

    Hand and wrist injuries in martial arts are typically a reflection of the combat nature of this discipline. In striking sports, the axial load mechanism of injury is common and causes fractures and dislocations; in grappling sports, sprain injuries and degenerative changes predominate. There is clear evidence to support that hand protection reduces the risk of hand injury. Traditional training in martial arts on proper technique and target selection in striking sports reduces the risk of hand injury, and is an important component of hand and wrist injury prevention. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Radiographic findings in wrists and hands of patients with leprosy

    International Nuclear Information System (INIS)

    Carreto, A.; Montero, F.; Garcia Frasquet, A.; Carpintero, P.

    1998-01-01

    Leprosy, like other neuropathic disorders, can involve the skeleton, affecting both bone and joints, especially those segments that have to withstand weight. To asses the osteoarticular involvement of the wrist and hand in 58 patients with leprosy. The radiographic images of wrist and hand of 58 patients with Hansen's disease were reviewed. The entire spectrum of specific and nonspecific bone lesions described in the literature is presented. Despite the fact that the upper limbs do not have to withstand the weight that the feet and ankles do, radiographic images show that gripping and other common motions can also produce lesions compatible with those of neuropathic arthropathy. (Author) 20 refs

  3. MRI of the wrist: Comparison of high resolution pulse sequences and different fat-suppression techniques; Magnetresonanztomographie des Handgelenks - Vergleich hochaufloesender Pulssequenzen und unterschiedlicher Fettsignalunterdrueckungen an Leichenpraeparaten

    Energy Technology Data Exchange (ETDEWEB)

    Staebler, A.; Spieker, A.; Bonel, H.; Glaser, C.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik; Schrank, C.; Putz, R. [Muenchen Univ. (Germany). Anatomische Anstalt; Petsch, R. [Siemens AG, Erlangen (Germany). Unternehmensbereich Medizinische Technik

    2000-02-01

    Purpose: To evaluate high resolution sequences with and without fat-suppression techniques for MR imaging of the wrist. Results: The highest homogeneity and the least artifacts were achieved by the T{sub 1}-w SE sequence. For the STIR and PD-FS TSE sequence high rankings were found for the detection of free water. The PD FS sequence had high ranking also for visualization of the SL ligament and the triangular fibrocartilage. The best sequence for the assessment of hyaline cartilage was the FLASH-FS sequence. For detailed analysis of bony structures the CISS sequence performed best. Conclusion: The isolated use of a PD-FS-TSE sequence enables for evaluation of all clinically relevant structures at the wrist. Dedicated questions for hyaline cartilage are answered best by the use of a FLASH 3D-FS sequence. Selective water excitation reduces acquisition time to 60%, nevertheless FS sequences are still diagnostically superior to WE sequences. (orig./AJ) [German] Ziel: Beurteilung der Wertigkeit hochaufloesender MRT-Sequenzen ohne und mit Fettsignalunterdrueckung (FS) und selektiver Wasseranregung (WE) fuer Untersuchungen des Handgelenkes. Ergebnisse: SE-T{sub 1} zeigte die hoechste Signalhomogenitaet bei geringsten Artefakten. Die STIR und PD FS-Sequenz stellten Signal von freiem Wasser am besten dar. Die beste Knorpeldarstellung erreicht die FLASH 3D-FS-Sequenz. Die Kortikalis und die Spongiosa konnten am besten mit der CISS-Sequenz beurteilt werden. Die FS-Sequenzen waren den WE-Sequenzen diagnostisch ueberlegen. Schlussfolgerungen: Mit der PD FS TSE-Sequenz mit verlaengerter Echozeit ist eine gute Beurteilung aller klinisch wichtigen Strukturen moeglich. Die beste Darstellung des hyalinen Knorpels wird mit der FLASH-3D-FS-, des Knochens mit der CISS-Sequenz erreicht. Die selektive Wasseranregung bei FLASH- und DESS-Sequenzen reduziert die Aufnahmezeit, ohne die diagnostische Aussagekraft der FS-Sequenzen zu erreichen. (orig./AJ)

  4. Age-Related Decline of Wrist Position Sense and its Relationship to Specific Physical Training

    Directory of Open Access Journals (Sweden)

    Ann Van de Winckel

    2017-11-01

    Full Text Available Perception of limb and body positions is known as proprioception. Sensory feedback, especially from proprioceptive receptors, is essential for motor control. Aging is associated with a decline in position sense at proximal joints, but there is inconclusive evidence of distal joints being equally affected by aging. In addition, there is initial evidence that physical activity attenuates age-related decline in proprioception. Our objectives were, first, to establish wrist proprioceptive acuity in a large group of seniors and compare their perception to young adults, and second, to determine if specific types of training or regular physical activity are associated with preserved wrist proprioception. We recruited community-dwelling seniors (n = 107, mean age, 70 ± 5 years, range, 65–84 years without cognitive decline (Mini Mental State Examination-brief version ≥13/16 and young adult students (n = 51, mean age, 20 ± 1 years, range, 19–26 years. Participants performed contralateral and ipsilateral wrist position sense matching tasks with a bimanual wrist manipulandum to a 15° flexion reference position. Systematic error or proprioceptive bias was computed as the mean difference between matched and reference position. The respective standard deviation over five trials constituted a measure of random error or proprioceptive precision. Current levels of physical activity and previous sport, musical, or dance training were obtained through a questionnaire. We employed longitudinal mixed effects linear models to calculate the effects of trial number, sex, type of matching task and age on wrist proprioceptive bias and precision. The main results were that relative proprioceptive bias was greater in older when compared to young adults (mean difference: 36% ipsilateral, 88% contralateral, p < 0.01. Proprioceptive precision for contralateral but not for ipsilateral matching was smaller in older than in young adults (mean difference: 38

  5. Frequency of abnormal hand and wrist radiographs at time of diagnosis of polyarticular juvenile rheumatoid arthritis.

    Science.gov (United States)

    Mason, Tom; Reed, Ann M; Nelson, Audrey M; Thomas, Kristen B; Patton, Alice; Hoffman, Alan D; Achenbach, Sara; O'Fallon, William M

    2002-10-01

    To determine the frequency of radiographic abnormalities in hand/wrist radiographs of children with newly diagnosed polyarticular juvenile rheumatoid arthritis (polyJRA) because radiographs of small joints are an important tool in assessing outcomes in RA and there are clinical similarities between RA and polyJRA. A medical record review was performed to identify cases of polyJRA seen at Mayo Clinic from January 1, 1994, to December 31, 2001. Hand/wrist radiographs, obtained at the time of diagnosis, were reviewed by 3 radiologists with attention to periarticular osteopenia, joint space narrowing (JSN), or erosion. At least 2 radiologists had to independently identify abnormal findings on the same radiograph. The relative carpal length (RCL), judged by Poznanski's method, was also determined. From the review of 159 medical records, 60 cases of newly diagnosed polyJRA were identified. Twenty-five of these had hand/wrist radiographs at diagnosis; 18 sets were available for this study. Of those, 2/3 were female, 6% (1/18) had subcutaneous nodules, 7% (1/14) had elevated levels of serum rheumatoid factor, and 44% (7/16) had elevated serum levels of antinuclear antibodies. Median age at diagnosis was 10.2 years, median duration of hand/wrist symptoms at diagnosis was 10 months, and median number of joints with either swelling, pain on range of motion (ROM), or limited ROM was 14.5. Sixty-one percent of radiographs taken at the time of diagnosis of polyJRA were abnormal. While 44% had periarticular osteopenia, 28% had either erosions or JSN. Six (33%) had RCL > 2 SD below the mean for age. Five (83%) of those with RCL, > 2 SD below the mean for age, had periarticular osteopenia, JSN, or erosion. We conclude the frequency of abnormal hand/wrist radiographs is very high very early in the course of polyJRA. More studies are needed to determine to what extent these radiographic abnormalities correlate with clinical outcomes.

  6. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

    International Nuclear Information System (INIS)

    Yamada, Yoshitake; Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Kuribayashi, Sachio; Abe, Takayuki; Ogawa, Kenji

    2013-01-01

    To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA -950 ) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P -950 . The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA -950 . (orig.)

  7. Hand and wrist involvement in systemic sclerosis: US features.

    Science.gov (United States)

    Freire, Véronique; Bazeli, Ramin; Elhai, Muriel; Campagna, Raphaël; Pessis, Éric; Avouac, Jérôme; Allanore, Yannick; Drapé, Jean-Luc; Guérini, Henri

    2013-12-01

    To characterize ultrasonographic (US) features in the hand of patients with systemic sclerosis (SSc) and to evaluate the sensitivity of US in the detection of calcinosis and acroosteolysis. The local ethics committee approved this study, and oral informed consent was obtained. A total of 44 consecutive patients with SSc (34 women; mean age, 56.1 years ± 12.1 [standard deviation]; 10 men; mean age, 45.0 years ± 14.0) and 30 healthy control subjects (20 women; mean age, 46.3 years ± 12.1; 10 men; mean age, 39.6 years ± 10.8) were included between October 2010 and December 2011. Bilateral US, including Doppler assessment of the wrists, hands, and fingers, was performed, and presence of synovitis, tenosynovitis with or without a layered appearance, calcifications, acroosteolysis, and distal vascularization was recorded. Radiography of both hands was performed to assess for acroosteolysis and calcinosis. Frequency of US features, sensitivity of US for calcinosis and acroosteolysis, and respective confidence intervals were calculated. Synovitis was found in 17 patients (39%). Tenosynovitis was found in 12 patients (27%), and it had a layered pattern in 15 (41%) of 37 cases. Calcinosis was found in 17 patients (39%) with US, with a sensitivity of 89%. Acroosteolysis was found in nine (20%) patients with US and in 10 (23%) patients with radiography, with 90% sensitivity for US. Distal vascularization was detected in 26 patients (59%) and 30 control subjects (100%) and was in contact with the acroosteolysis bed in seven (78%) of nine patients with SSc. US can be used to assess features of SSc, including synovitis, tenosynovitis, calcinosis, acroosteolysis, and distal vascularization and is sensitive for calcinosis and acroosteolysis detection. A layered pattern (similar to the appearance of an artichoke heart) of tenosynovitis was seen commonly. Online supplemental material is available for this article. © RSNA, 2013.

  8. 78 FR 68905 - Agency Information Collection (Wrist Conditions Disability Benefits Questionnaire) Under OMB Review

    Science.gov (United States)

    2013-11-15

    ... Number: 2900-NEW (Wrist Conditions Disability Benefits Questionnaire). Type of Review: New data... Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits Administration...- NEW (Wrist Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER...

  9. Validation of the IOF quality of life questionnaire for patients with wrist fracture

    NARCIS (Netherlands)

    Lips, P.T.A.M.; Jameson, K.; Bianchi, M.L.; Goemaere, S.; Boonen, S.; Reeve, J.; Stepan, J.; Johnell, O.; van Schoor, N.M.; Dennison, E.; Kanis, J.A.; Cooper, C.

    2010-01-01

    Introduction: Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a

  10. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad.

    LENUS (Irish Health Repository)

    Mc Laughlin, Patrick

    2012-04-01

    Tablet devices have recently been used in radiological image interpretation because they have a display resolution comparable to desktop LCD monitors. We identified a need to examine tablet display performance prior to their use in preliminary interpretation of radiological images. We compared the spatial and contrast resolution of a commercially available tablet display with a diagnostic grade 2 megapixel monochrome LCD using a contrast detail phantom. We also recorded reporting discrepancies, using the ACR RADPEER system, between preliminary interpretation of 100 emergency CT brain examinations on the tablet display and formal review on a diagnostic LCD. The iPad display performed inferiorly to the diagnostic monochrome display without the ability to zoom. When the software zoom function was enabled on the tablet device, comparable contrast detail phantom scores of 163 vs 165 points were achieved. No reporting discrepancies were encountered during the interpretation of 43 normal examinations and five cases of acute intracranial hemorrhage. There were seven RADPEER2 (understandable) misses when using the iPad display and 12 with the diagnostic LCD. Use of software zoom in the tablet device improved its contrast detail phantom score. The tablet allowed satisfactory identification of acute CT brain findings, but additional research will be required to examine the cause of "understandable" reporting discrepancies that occur when using tablet devices.

  11. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39{+-}15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI{sup eventscan)}. Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI{sup eventscand}id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  12. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    International Nuclear Information System (INIS)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo

    2011-01-01

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39±15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI eventscan) . Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI eventscand id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  13. Impairment of gradual muscle adjustment during wrist circumduction in Parkinson's disease.

    Directory of Open Access Journals (Sweden)

    Carolien M Toxopeus

    Full Text Available Purposeful movements are attained by gradually adjusted activity of opposite muscles, or synergists. This requires a motor system that adequately modulates initiation and inhibition of movement and selectively activates the appropriate muscles. In patients with Parkinson's disease (PD initiation and inhibition of movements are impaired which may manifest itself in e.g. difficulty to start and stop walking. At single-joint level, impaired movement initiation is further accompanied by insufficient inhibition of antagonist muscle activity. As the motor symptoms in PD primarily result from cerebral dysfunction, quantitative investigation of gradually adjusted muscle activity during execution of purposeful movement is a first step to gain more insight in the link between impaired modulation of initiation and inhibition at the levels of (i cerebrally coded task performance and (ii final execution by the musculoskeletal system. To that end, the present study investigated changes in gradual adjustment of muscle synergists using a manipulandum that enabled standardized smooth movement by continuous wrist circumduction. Differences between PD patients (N = 15, off-medication and healthy subjects (N = 16 concerning the relation between muscle activity and movement performance in these groups were assessed using kinematic and electromyographic (EMG recordings. The variability in the extent to which a particular muscle was active during wrist circumduction--defined as muscle activity differentiation--was quantified by EMG. We demonstrated that more differentiated muscle activity indeed correlated positively with improved movement performance, i.e. higher movement speed and increased smoothness of movement. Additionally, patients employed a less differentiated muscle activity pattern than healthy subjects. These specific changes during wrist circumduction imply that patients have a decreased ability to gradually adjust muscles causing a decline in

  14. On performance of cylindrical dipole antenna in diagnostics of wave phenomena in space plasma

    Science.gov (United States)

    Kiraga, A.

    Tubular and wire antennas have been employed since an advent of in situ measurements in space. It is generally accepted that they are well suited to recipe electromagnetic radiation from remote sources as well as divers local plasma emissions. Quasi thermal noise spectroscopy provides an example of well documented, both experimentally and theoretically, technique to study solar wind plasma. In many data sets of wave spectra, recorded with use of tubular or wire antennas at all altitudes inside a plasma sphere, there is pronounced, permanent, variable frequency spectral structure, routinely assigned to upper hybrid band (UHR) emissions. On the other hand, spectral structure, which could be assigned to upper hybrid band, is less pronounced and infrequent, in sets of wave spectra recorded in polar region with the use of spherical double probes. These apparently inconsistent observations have not drawn much attention of wave community. Assignment to UHR emission have been bolstered by theoretical plausibility, permanency in data sets, frequency verification with independent techniques and conviction that measurements were performed with good voltmeter with well known properties. It has been recognized that stray capacitance acts as a voltage divider and underestimates real voltage imposed on antenna. But in sufficiently dense and cold main plasma component, even short antenna is inductive in some frequency band below upper hybrid frequency. Stray capacitance and antenna inductance result in circuit resonance, which is very pronounced, if antenna resistance is low and input resistance is high. In such circumstances, a good voltmeter concept is very misleading. In this report we show that good voltmeter concept is not sufficient for interpretation of passive mode spectra recorded with tubular antenna on IK -19, APEX and CORONAS satellites. With orbit inclination of ~80deg and altitude range of 500-3000km, very divers plasmas were encountered, but distinct plasma emission

  15. Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology.

    Science.gov (United States)

    Sciacchitano, Salvatore; Lavra, Luca; Ulivieri, Alessandra; Magi, Fiorenza; De Francesco, Gian Paolo; Bellotti, Carlo; Salehi, Leila B; Trovato, Maria; Drago, Carlo; Bartolazzi, Armando

    2017-07-25

    Since it is impossible to recognize malignancy at fine needle aspiration (FNA) cytology in indeterminate thyroid nodules, surgery is recommended for all of them. However, cancer rate at final histology is blood assay.We performed systematic reviews and meta-analyses to compare their features, feasibility, diagnostic performance and cost. GEC, GEC+BRAF, M/F panel+miRNA GEC and M/F panel by NGS were the best in ruling-out malignancy (sensitivity = 90%, 89%, 89% and 90% respectively). BRAF and M/F panel alone and by NGS were the best in ruling-in malignancy (specificity = 100%, 93% and 93%). The M/F by NGS showed the highest accuracy (92%) and BRAF the highest diagnostic odds ratio (DOR) (247). GAL-3-ICC performed well as rule-out (sensitivity = 83%) and rule-in test (specificity = 85%), with good accuracy (84%) and high DOR (27) and is one of the cheapest (113 USD) and easiest one to be performed in different clinical settings.In conclusion, the more accurate molecular-based test-methods are still expensive and restricted to few, highly specialized and centralized laboratories. GAL-3-ICC, although limited by some false negatives, represents the most suitable screening test-method to be applied on a large-scale basis in the diagnostic algorithm of indeterminate thyroid lesions.

  16. Appraising and applying evidence about a diagnostic test during a performance-based assessment

    Directory of Open Access Journals (Sweden)

    Franklin Ellen

    2004-10-01

    Full Text Available Abstract Background The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and apply research about a diagnostic test within a clinical context and to compare our students with peers trained at other institutions. Methods 4th year medical students who previously had demonstrated competency at probability revision and just starting first-year Internal Medicine residents were used for this research. Following an encounter with a simulated patient, subjects critically appraised a paper about an applicable diagnostic test and revised the patient's pretest probability given the test result. Results The medical students and residents demonstrated similar skills at critical appraisal, correctly answering 4.7 and 4.9, respectively, of 6 questions (p = 0.67. Only one out of 28 (3% medical students and none of the 15 residents were able to correctly complete the probability revision task (p = 1.00. Conclusions This study found that most students completing medical school are able to appraise an article about a diagnostic test but few are able to apply the information from the article to a patient. These findings raise questions about the clinical usefulness of the EBM skills possessed by graduating medical students within the area of diagnostic testing.

  17. Performance study of the primary standard ionization chamber for deployment of the diagnostic radiology qualities

    International Nuclear Information System (INIS)

    Cardoso, Ricardo de Souza; Bossio, Francisco; Quaresma, Daniel da Silva; Peixoto, Jose Guilherme Pereira

    2013-01-01

    Activities radiotherapy, diagnostic radiology and radiation protection, require knowledge of physical and dosimetric parameters, to be applied safely. Aiming to meet demand in Brazil, the National Laboratory of Metrology of Ionising Radiation - LNMRI - is deploying the primary standard for the calibration of secondary standard chambers, used in quality control in hospitals, clinics and industries. (author)

  18. 78 FR 18988 - Establishing the Performance Characteristics of In Vitro Diagnostic Devices for the Detection of...

    Science.gov (United States)

    2013-03-28

    ... either electronic or written comments on this guidance at any time. General comments on Agency guidance... INFORMATION section for information on electronic access to the guidance. Submit electronic comments on the... diagnostic devices for the detection of antibodies to B. burgdorferi in human serum, plasma, and blood. These...

  19. Diagnostic performance of I-123-labeled serum amyloid P component scintigraphy in patients with amyloidosis

    NARCIS (Netherlands)

    Hazenberg, BPC; van Rijswijk, MH; Piers, DA; Lub-de Hooge, MN; Vellenga, E; Haagsma, EB; Hawkins, PN; Jager, PL

    Purpose: To assess the diagnostic accuracy and additional information provided by I-123-labeled serum amyloid P component ( SAP) scintigraphy in patients with systemic and localized amyloidosis. Subjects and Methods: I-123-labeled human SAP was injected intravenously into 20 controls and 189

  20. Agreement and Diagnostic Performance of FITNESSGRAM®, International Obesity Task Force, and Hungarian National BMI Standards

    Science.gov (United States)

    Laurson, Kelly R.; Welk, Gregory J.; Marton, Orsolya; Kaj, Mónika; Csányi, Tamás

    2015-01-01

    Purpose: This study examined agreement between all 3 standards (as well as relative diagnostic associations with metabolic syndrome) using a representative sample of youth from the Hungarian National Youth Fitness Study. Method: Body mass index (BMI) was assessed in a field sample of 2,352 adolescents (ages 10-18.5 years) and metabolic syndrome…

  1. Svelte Integrated Delivery System Performance Examined Through Diagnostic Catheter Delivery : The SPEED Registry

    NARCIS (Netherlands)

    Khattab, Ahmed A.; Nijhoff, Freek; Schofer, Joachim; Berland, Jacques; Meier, Bernhard; Nietlispach, Fabian; Agostoni, Pierfrancesco; Brucks, Steffen; Stella, Pieter

    2015-01-01

    Aims: The multi-center SPEED registry evaluated the procedural success and in-hospital clinical outcomes of direct stenting with the Svelte 'all-in-one' coronary stent Integrated Delivery System (IDS) through diagnostic catheters to identify the clinical indications for which this approach is

  2. Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents

    Directory of Open Access Journals (Sweden)

    Raphael Gonçalves de Oliveira

    2017-09-01

    Conclusions: Overweight and obesity using BMI showed a moderate association with MetS, regardless of the diagnostic criteria used. However, the IOTF criterion showed better predictive capacity for the presence of MetS than the WHO and the Conde and Monteiro criteria.

  3. Diagnostic model for assessing traceability system performance in fish processing plants

    NARCIS (Netherlands)

    Mgonja, J.T.; Luning, P.A.; Vorst, van der J.G.A.J.

    2013-01-01

    This paper introduces a diagnostic tool that can be used by fish processing companies to evaluate their own traceability systems in a systematic manner. The paper begins with discussions on the rationale of traceability systems in food manufacturing companies, followed by a detailed analysis of the

  4. Meta-Analysis: Association Between Wrist Posture and Carpal Tunnel Syndrome Among Workers

    Directory of Open Access Journals (Sweden)

    Doohee You

    2014-03-01

    Conclusion: We found evidence that prolonged exposure to non-neutral wrist postures is associated with a twofold increased risk for CTS compared with low hours of exposure to non-neutral wrist postures. Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

  5. Synovial Chondrosarcoma in the Hand and Wrist: A Case Report

    International Nuclear Information System (INIS)

    An, Yeong Yi; Kim, Jee Young; Kang, Seok Jin; Kang, Yong Koo; Baik, Jun Hyun

    2010-01-01

    Synovial chondrosarcoma is extremely rare and arises de novo or from malignant transformation of synovial chondromatosis. It commonly involves large joints, such as the knee or hip. Here, we present an unusual case of synovial chondrosarcoma from synovial chondromatosis in the hand and wrist, clearly demonstrating the characteristic findings on plain radiograph and MR imaging

  6. Synovial Chondrosarcoma in the Hand and Wrist: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    An, Yeong Yi; Kim, Jee Young; Kang, Seok Jin; Kang, Yong Koo; Baik, Jun Hyun [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2010-01-15

    Synovial chondrosarcoma is extremely rare and arises de novo or from malignant transformation of synovial chondromatosis. It commonly involves large joints, such as the knee or hip. Here, we present an unusual case of synovial chondrosarcoma from synovial chondromatosis in the hand and wrist, clearly demonstrating the characteristic findings on plain radiograph and MR imaging.

  7. Stiffness of the ligaments of the human wrist joint

    NARCIS (Netherlands)

    Savelberg, H.H.C.M.; Kooloos, J.G.M.; Huiskes, H.W.J.; Kauer, J.M.G.

    1992-01-01

    The stiffnesses of the superficial ligaments of 14 human cadaver wrist joints have been determined. In these experiments the tested, fresh-frozen carpal joints are divided into a number of bone-ligament-bone complexes, which are loaded in a tensile testing machine at a rate of 66% of the ligaments'

  8. Education in wrist arthroscopy: past, present and future

    NARCIS (Netherlands)

    Obdeijn, M. C.; Bavinck, N.; Mathoulin, C.; van der Horst, C. M. A. M.; Schijven, M. P.; Tuijthof, G. J. M.

    2015-01-01

    Arthroscopy has assumed an important place in wrist surgery. It requires specific operative skills that are now mainly acquired in the operating room. In other fields of endoscopic surgery, e-learning and virtual reality (VR) have introduced new perspectives in teaching skills. This leads to the

  9. Performance of a real-time PCR assay in routine bovine mastitis diagnostics compared with in-depth conventional culture.

    Science.gov (United States)

    Hiitiö, Heidi; Riva, Rauna; Autio, Tiina; Pohjanvirta, Tarja; Holopainen, Jani; Pyörälä, Satu; Pelkonen, Sinikka

    2015-05-01

    Reliable identification of the aetiological agent is crucial in mastitis diagnostics. Real-time PCR is a fast, automated tool for detecting the most common udder pathogens directly from milk. In this study aseptically taken quarter milk samples were analysed with a real-time PCR assay (Thermo Scientific PathoProof Mastitis Complete-12 Kit, Thermo Fisher Scientific Ltd.) and by semi-quantitative, in-depth bacteriological culture (BC). The aim of the study was to evaluate the diagnostic performance of the real-time PCR assay in routine use. A total of 294 quarter milk samples from routine mastitis cases were cultured in the national reference laboratory of Finland and examined with real-time PCR. With BC, 251 out of 294 (85.7%) of the milk samples had at least one colony on the plate and 38 samples were considered contaminated. In the PCR mastitis assay, DNA of target species was amplified in 244 samples out of 294 (83.0%). The most common bacterial species detected in the samples, irrespective of the diagnostic method, was the coagulase negative staphylococci (CNS) group (later referred as Staphylococcus spp.) followed by Staphylococcus aureus. Sensitivity (Se) and specificity (Sp) for the PCR assay to provide a positive Staph. aureus result was 97.0 and 95.8% compared with BC. For Staphylococcus spp., the corresponding figures were 86.7 and 75.4%. Our results imply that PCR performed well as a diagnostic tool to detect Staph. aureus but may be too nonspecific for Staphylococcus spp. in routine use with the current cut-off Ct value (37.0). Using PCR as the only microbiological method for mastitis diagnostics, clinical relevance of the results should be carefully considered before further decisions, for instance antimicrobial treatment, especially when minor pathogens with low amount of DNA have been detected. Introducing the concept of contaminated samples should also be considered.

  10. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography

    DEFF Research Database (Denmark)

    Vavere, Andrea L; Simon, Gregory G; George, Richard T

    2013-01-01

    Multidetector coronary computed tomography angiography (CTA) is a promising modality for widespread clinical application because of its noninvasive nature and high diagnostic accuracy as found in previous studies using 64 to 320 simultaneous detector rows. It is, however, limited in its ability...... to detect myocardial ischemia. In this article, we describe the design of the CORE320 study ("Combined coronary atherosclerosis and myocardial perfusion evaluation using 320 detector row computed tomography"). This prospective, multicenter, multinational study is unique in that it is designed to assess...... the diagnostic performance of combined 320-row CTA and myocardial CT perfusion imaging (CTP) in comparison with the combination of invasive coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). The trial is being performed at 16 medical centers located in 8...

  11. Orthogonal views improves localisation in bone scans of wrist

    International Nuclear Information System (INIS)

    Roth, A.L.

    1997-01-01

    Full text: Of all nuclear medicine studies, bone scans are the most fundamental. However, straightforward these may seem, there are always mechanisms that can be implemented which assist in a more precise diagnosis, particularly in areas with an intricate bone structure. An 18-year-old right-handed student presented to her doctor with a one month history of pain over the right distal radio-ulna joint area. Clinically, she had prominence of the right ulna, which suggested that there may have been a previous injury to the wrist. Also, pronation/supination were painful where there was swelling of the extensor carpi ulnaris tendon, as well as some discomfort with clicking in ulna deviation/rotation. The X-rays demonstrated some premature radial epiphysial closure. A bone scan was requested to attempt to localise the main inflammatory focus. The dynamic study was performed in the planar projection with an immediate blood pool for 300k being taken. These demonstrated a vascular blush medially. A medial blood pool image was acquired and it localised the abnormal vascularity as being dorsal. A separate focal area of less intense blood pooling was also noted in the line of the distal ulna. Delayed images showed increased uptake localised to the ulna styloid. Anatomically, the superficial vascular blush correlated with tenosynovitis. Hence, the orthogonal initial and delayed images were definitive in the diagnoses of tenosynovitis of the extensor carpi ulnaris tendon. This clearly complements the information provided by the palmar view. However, it is important to remember that an increased radiation dose to the technologist is incurred as a result of the extra orthogonal view, hence attention to technique is imperative

  12. Orthogonal views improves localisation in bone scans of wrist

    Energy Technology Data Exchange (ETDEWEB)

    Roth, A.L.

    1997-09-01

    Full text: Of all nuclear medicine studies, bone scans are the most fundamental. However, straightforward these may seem, there are always mechanisms that can be implemented which assist in a more precise diagnosis, particularly in areas with an intricate bone structure. An 18-year-old right-handed student presented to her doctor with a one month history of pain over the right distal radio-ulna joint area. Clinically, she had prominence of the right ulna, which suggested that there may have been a previous injury to the wrist. Also, pronation/supination were painful where there was swelling of the extensor carpi ulnaris tendon, as well as some discomfort with clicking in ulna deviation/rotation. The X-rays demonstrated some premature radial epiphysial closure. A bone scan was requested to attempt to localise the main inflammatory focus. The dynamic study was performed in the planar projection with an immediate blood pool for 300k being taken. These demonstrated a vascular blush medially. A medial blood pool image was acquired and it localised the abnormal vascularity as being dorsal. A separate focal area of less intense blood pooling was also noted in the line of the distal ulna. Delayed images showed increased uptake localised to the ulna styloid. Anatomically, the superficial vascular blush correlated with tenosynovitis. Hence, the orthogonal initial and delayed images were definitive in the diagnoses of tenosynovitis of the extensor carpi ulnaris tendon. This clearly complements the information provided by the palmar view. However, it is important to remember that an increased radiation dose to the technologist is incurred as a result of the extra orthogonal view, hence attention to technique is imperative.

  13. High-resolution magnetic resonance imaging of the wrist: Normal anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Baker, L.L.; Hajek, P.C.; Bjoerkengren, A.; Sartoris, D.J.; Resnick, D.; Galbraith, R.; Gelberman, R.H.

    1987-02-01

    Magnetic resonance imaging (MRI) provided adequate depiction of carpal soft tissue structures in normal volunteers, as well as accurate anatomic correlation with cadaveric specimens. Using a high field strength system and surface coil techniques, the intricate anatomy of the wrist was best defined on long TR short TE images. However, from a practical view, T1 weighted images (TR 600 ms, TE 25 ms) were most useful because of short imaging times, satisfactory image quality, and the absence of motion artifacts. The coronal plane provided the clearest definition of important structures. Potential diagnostic limitations exist due to the inability of MRI to clearly delineate articular cartilage, joint capsules, and small interosseous ligaments. The presence of intra-articular fluid in both living subjects and cadaveric specimens, however, allowed for fine depiction of these structures on T2 weighted images.

  14. Molecular diagnosis of bacterial vaginosis: Does adjustment for total bacterial load or human cellular content improve diagnostic performance?

    Science.gov (United States)

    Plummer, E L; Garland, S M; Bradshaw, C S; Law, M G; Vodstrcil, L A; Hocking, J S; Fairley, C K; Tabrizi, S N

    2017-02-01

    We investigated the utility of quantitative PCR assays for diagnosis of bacterial vaginosis and found that while the best model utilized bacterial copy number adjusted for total bacterial load (sensitivity=98%, specificity=93%, AUC=0.95[95%CI=0.93,0.97]), adjusting for total bacterial or human cell load did not consistently increase the diagnostic performance of the assays. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve.

    Science.gov (United States)

    Papafaklis, Michail I; Muramatsu, Takashi; Ishibashi, Yuki; Bourantas, Christos V; Fotiadis, Dimitrios I; Brilakis, Emmanouil S; Garcia-Garcia, Héctor M; Escaned, Javier; Serruys, Patrick W; Michalis, Lampros K

    2018-03-01

    Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (pvirtual resting Pd/Pa and FFR (r=0.69, pVirtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  16. Prevalence and diagnostic performance of computed tomography angiography spot sign for intracerebral hematoma expansion depend on scan timing

    Energy Technology Data Exchange (ETDEWEB)

    Tsukabe, Akio; Watanabe, Yoshiyuki; Tanaka, Hisashi; Kunitomi, Yuki; Nishizawa, Mitsuo; Arisawa, Atsuko; Tomiyama, Noriyuki [Osaka University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Suita, Osaka (Japan); Yoshiya, Kazuhisa; Shimazu, Takeshi [Osaka University Graduate School of Medicine, Department of Traumatology and Acute Critical Medicine, Suita, Osaka (Japan)

    2014-12-15

    The computed tomography angiography (CTA) spot sign correlates with intracerebral hemorrhage (ICH) expansion; however, various diagnostic performances for hematoma expansion, especially in sensitivity, have been reported. We aimed to assess the impact of scan timing of CTA on the diagnostic performance of the CTA spot sign for ICH expansion in two different arterial phases within patients. Eighty-three consecutive patients with primary ICH who received two sequential CTAs were recruited. Two neuroradiologists reviewed CTAs for CTA spot signs, while one reviewed initial and follow-up non-contrast CT for measuring ICH volume. The time interval between two phases was then calculated, and the diagnostic performance of CTA spot sign in each phase was evaluated. CTA spot signs were observed in 20/83 (24.1 %) patients in the early phase and 44/83 (53.0 %) patients in the late phase. The mean time interval between the two phases was 12.7 s. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for hematoma progression of CTA spot sign were 48.1, 87.5, 65.0, 77.8, and 74.7 %, respectively, in early phase and 92.6, 66.1, 56.8, 94.9, and 74.7 %, respectively, in late phase. The CTA spot sign was significantly associated with ICH expansion in early (P < 0.001) and late (P < 0.00001) phases (Pearson's chi-square test). A mere 10-s difference in scan timing could make a difference on prevalence and diagnostic performance of the CTA spot sign, suggesting a need for the standardization of the CTA protocol to generalize the approach for effective clinical application. (orig.)

  17. Performance of the Quidel Sofia Rapid Influenza Diagnostic Test During the 2012-2013 and 2013-2014 Influenza Seasons

    Science.gov (United States)

    2016-03-23

    Performance of the Quidel Sofia rapid influenza diagnostic test during the 2012–2013 and 2013–2014 influenza seasons Peter E. Kammerer, Jennifer M... Influenza A+B Fluorescent Immunoassay was used to test nasal swab specimens from patients with influenza -like illness at US–Mexico border-area clinics in...the 2012–2013 and 2013–2014 influenza seasons. Compared with real-time reverse transcription polymerase chain reaction, the overall sensitivities and

  18. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis.

    Science.gov (United States)

    Kim, Mi Sung; Kwon, Heon-Ju; Kang, Kyung A; Do, In-Gu; Park, Hee-Jin; Kim, Eun Young; Hong, Hyun Pyo; Choi, Yoon Jung; Kim, Young Hwan

    2018-02-01

    To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis. 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed. There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001). Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.

  19. Characteristics of Handwriting of People With Cerebellar Ataxia: Three-Dimensional Movement Analysis of the Pen Tip, Finger, and Wrist.

    Science.gov (United States)

    Fujisawa, Yuhki; Okajima, Yasutomo

    2015-11-01

    There are several functional tests for evaluating manual performance; however, quantitative manual tests for ataxia, especially those for evaluating handwriting, are limited. This study aimed to investigate the characteristics of cerebellar ataxia by analyzing handwriting, with a special emphasis on correlation between the movement of the pen tip and the movement of the finger or wrist. This was an observational study. Eleven people who were right-handed and had cerebellar ataxia and 17 people to serve as controls were recruited. The Scale for the Assessment and Rating of Ataxia was used to grade the severity of ataxia. Handwriting movements of both hands were analyzed. The time required for writing a character, the variability of individual handwriting, and the correlation between the movement of the pen tip and the movement of the finger or wrist were evaluated for participants with ataxia and control participants. The writing time was longer and the velocity profile and shape of the track of movement of the pen tip were more variable in participants with ataxia than in control participants. For participants with ataxia, the direction of movement of the pen tip deviated more from that of the finger or wrist, and the shape of the track of movement of the pen tip differed more from that of the finger or wrist. The severity of upper extremity ataxia measured with the Scale for the Assessment and Rating of Ataxia was mostly correlated with the variability parameters. Furthermore, it was correlated with the directional deviation of the trajectory of movement of the pen tip from that of the finger and with increased dissimilarity of the shapes of the tracks. The results may have been influenced by the scale and parameters used to measure movement. Ataxic handwriting with increased movement noise is characterized by irregular pen tip movements unconstrained by the finger or wrist. The severity of ataxia is correlated with these unconstrained movements. © 2015 American

  20. Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT

    Energy Technology Data Exchange (ETDEWEB)

    Yunaga, Hiroto; Ohta, Yasutoshi; Kitao, Shinichiro; Ogawa, Toshihide [Tottori University, Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Yonago City, Tottori (Japan); Kaetsu, Yasuhiro [Kakogawa Higashi Hospital, Department of Cardiology, Kakogawa (Japan); Watanabe, Tomomi; Furuse, Yoshiyuki; Yamamoto, Kazuhiro [Tottori University, Division of Cardiology, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Yonago (Japan)

    2017-07-15

    Multi-detector-row computed tomography angiography (MDCTA) plays an important role in the assessment of patients with suspected coronary artery disease. However, MDCTA tends to overestimate stenosis in calcified coronary artery lesions. The aim of our study was to evaluate the diagnostic performance of calcification-suppressed material density (MD) images produced by using a single-detector single-source dual-energy computed tomography (ssDECT). We enrolled 67 patients with suspected or known coronary artery disease who underwent ssDECT with rapid kilovolt-switching (80 and 140 kVp). Coronary artery stenosis was evaluated on the basis of MD images and virtual monochromatic (VM) images. The diagnostic performance of the two methods for detecting coronary artery disease was compared with that of invasive coronary angiography as a reference standard. We evaluated 239 calcified segments. In all the segments, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting significant stenosis were respectively 88%, 88%, 75%, 95% and 88% for the MD images, 91%, 71%, 56%, 95% and 77% for the VM images. PPV was significantly higher on the MD images than on the VM images (P < 0.0001). Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions. (orig.)

  1. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study

    Science.gov (United States)

    Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W.; Arokoski, Jari P.; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T.; Tervonen, Osmo; Koski, Juhani M.; Saarakkala, Simo

    2016-01-01

    Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level. PMID:26926836

  2. Diagnostic performance of qualitative shear-wave elastography according to different color map opacities for breast masses.

    Science.gov (United States)

    Kim, Hana; Youk, Ji Hyun; Gweon, Hye Mi; Kim, Jeong-Ah; Son, Eun Ju

    2013-08-01

    To compare the diagnostic performance of qualitative shear-wave elastography (SWE) according to three different color map opacities for breast masses 101 patients aged 21-77 years with 113 breast masses underwent B-mode US and SWE under three different color map opacities (50%, 19% and 100%) before biopsy or surgery. Following SWE features were reviewed: visual pattern classification (pattern 1-4), color homogeneity (Ehomo) and six-point color score of maximum elasticity (Ecol). Combined with B-mode US and SWE, the likelihood of malignancy (LOM) was also scored. The area under the curve (AUC) was obtained by ROC curve analysis to assess the diagnostic performance under each color opacity. A visual color pattern, Ehomo, Ecol and LOM scoring were significantly different between benign and malignant lesions under all color opacities (Pbreast lesion under all color opacities. The difference in color map opacity did not significantly influence diagnostic performance of SWE. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy.

    Science.gov (United States)

    Zhan, Hui-Li; Li, Wen-Ting; Bai, Rong-Jie; Wang, Nai-Li; Qian, Zhan-Hua; Ye, Wei; Yin, Yu-Ming

    2017-04-05

    The injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese. Fourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists. Triangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr. High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

  4. Building Performance Optimization while Empowering Occupants Toward Environmentally Sustainable Behavior through Continuous Monitoring and Diagnostics

    Science.gov (United States)

    2016-12-01

    Federal Energy Management Program FM Facility Manager GHG Green House Gases HASP Health and Safety Plan HVAC Heating Ventilation and... workplace energy efficiency enhancement by the DOD personnel. 2.1.2 ID-F Intelligent Dashboards for Facility Managers Creation of the Base Building...demonstration project. The first technology, ‘ID-F,’ targets building facility managers and allows real time diagnostics for BAS systems with features

  5. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad.

    Science.gov (United States)

    Loosemore, Michael; Lightfoot, Joseph; Gatt, Ian; Hayton, Mike; Beardsley, Chris

    2017-03-01

    Background: The purpose of this investigation was to explore prospectively the nature and duration of hand and wrist injuries in training and competition in the Great Britain (GB) amateur boxing squad between 2005 and 2012. Methods: Longitudinal prospective injury surveillance of the GB boxing squad was performed from 2005 to 2012. The location, region affected, description, and the duration of each injury were recorded by the team doctor and team physiotherapist. We recorded whether the injury occurred during competition or training and also whether it was a new or a recurrent injury. The injury rate during competition was calculated as the number of injuries per 1000 hours. Results: Finger carpometacarpal instability and finger metacarpophalangeal joint extensor hood and capsule sprain also known as "boxer's knuckle" injuries were significantly more common than other injury diagnoses. The number of injuries during training or competition was similar, which is remarkable given the far greater number of training hours than competition hours performed. Injury rate for hand and wrist injuries in competition was 347 injuries per 1000 hours, while the estimated injury rate in training was <0.5 injuries per 1000 hours. Conclusion: Carpometacarpal instability and boxer's knuckle were more common than any other kind of hand and wrist injury in this cohort of elite amateur boxers. The rate of hand and wrist injuries was higher in competition than in training. Our study highlights the importance of hand and wrist injury prevention in the competition environment.

  6. The development, evaluation and performance of molecular diagnostics for detection of Mycobacterium tuberculosis.

    Science.gov (United States)

    Bates, Matthew; Zumla, Alimuddin

    2016-01-01

    The unique pathogenesis of tuberculosis (TB) poses several barriers to the development of accurate diagnostics: a) the establishment of life-long latency by Mycobacterium tuberculosis (M.tb) after primary infection confounds the development of classical antibody or antigen based assays; b) our poor understanding of the molecular pathways that influence progression from latent to active disease; c) the intracellular nature of M.tb infection in tissues means that M.tb and/or its components, are not readily detectable in peripheral specimens; and d) the variable presence of M.tb bacilli in specimens from patients with extrapulmonary TB or children. The literature on the current portfolio of molecular diagnostics tests for TB is reviewed here and the developmental pipeline is summarized. Also reviewed are data from recently published operational research on the GeneXpert MTB/RIF assay and discussed are the lessons that can be taken forward for the design of studies to evaluate the impact of TB diagnostics.

  7. Diagnostic Performance of Bronchoalveolar Lavage Fluid CD4/CD8 Ratio for Sarcoidosis: A Meta-analysis.

    Science.gov (United States)

    Shen, Yongchun; Pang, Caishuang; Wu, Yanqiu; Li, Diandian; Wan, Chun; Liao, Zenglin; Yang, Ting; Chen, Lei; Wen, Fuqiang

    2016-06-01

    The usefulness of bronchoalveolar lavage fluid (BALF) CD4/CD8 ratio for diagnosing sarcoidosis has been reported in many studies with variable results. Therefore, we performed a meta-analysis to estimate the overall diagnostic accuracy of BALF CD4/CD8 ratio based on the bulk of published evidence. Studies published prior to June 2015 and indexed in PubMed, OVID, Web of Science, Scopus and other databases were evaluated for inclusion. Data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were pooled from included studies. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. Deeks's funnel plot was used to detect publication bias. Sixteen publications with 1885 subjects met our inclusion criteria and were included in this meta-analysis. Summary estimates of the diagnostic performance of the BALF CD4/CD8 ratio were as follows: sensitivity, 0.70 (95%CI 0.64-0.75); specificity, 0.83 (95%CI 0.78-0.86); PLR, 4.04 (95%CI 3.13-5.20); NLR, 0.36 (95%CI 0.30-0.44); and DOR, 11.17 (95%CI 7.31-17.07). The area under the SROC curve was 0.84 (95%CI 0.81-0.87). There was no evidence of publication bias. Measuring the BALF CD4/CD8 ratio may assist in the diagnosis of sarcoidosis when interpreted in parallel with other diagnostic factors. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Utility of DWI with quantitative ADC values in ovarian tumors: a meta-analysis of diagnostic test performance.

    Science.gov (United States)

    Pi, Shan; Cao, Rong; Qiang, Jin Wei; Guo, Yan Hui

    2018-01-01

    Background Diffusion-weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) values are widely used in the differential diagnosis of ovarian tumors. Purpose To assess the diagnostic performance of quantitative ADC values in ovarian tumors. Material and Methods PubMed, Embase, the Cochrane Library, and local databases were searched for studies assessing ovarian tumors using quantitative ADC values. We quantitatively analyzed the diagnostic performances for two clinical problems: benign vs. malignant tumors and borderline vs. malignant tumors. We evaluated diagnostic performances by the pooled sensitivity and specificity values and by summary receiver operating characteristic (SROC) curves. Subgroup analyses were used to analyze study heterogeneity. Results From the 742 studies identified in the search results, 16 studies met our inclusion criteria. A total of ten studies evaluated malignant vs. benign ovarian tumors and six studies assessed malignant vs. borderline ovarian tumors. Regarding the diagnostic accuracy of quantitative ADC values for distinguishing between malignant and benign ovarian tumors, the pooled sensitivity and specificity values were 0.91 and 0.91, respectively. The area under the SROC curve (AUC) was 0.96. For differentiating borderline from malignant tumors, the pooled sensitivity and specificity values were 0.89 and 0.79, and the AUC was 0.91. The methodological quality of the included studies was moderate. Conclusion Quantitative ADC values could serve as useful preoperative markers for predicting the nature of ovarian tumors. Nevertheless, prospective trials focused on standardized imaging parameters are needed to evaluate the clinical value of quantitative ADC values in ovarian tumors.

  9. Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

    Science.gov (United States)

    Rowe, Christopher; Vittinghoff, Eric; Santos, Glenn-Milo; Behar, Emily; Turner, Caitlin; Coffin, Phillip O

    2017-04-01

    Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM) codes in identifying opioid overdose events in the emergency department (ED) by examining multiple performance measures, including sensitivity and specificity. Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9-CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9-CM code by the documenting physician. Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9-CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [CI] = 13.6% to 37.8%) and

  10. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm

    Energy Technology Data Exchange (ETDEWEB)

    Bao, Hongjing; Wang, Shanshan; Wang, Guangbin; Hasan, Mansoor-ul; Yao, Bin; Wu, Chao; Wu, Lebin [Shandong University, Department of MR, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, Shandong (China); Yang, Li [Fudan University, Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Shanghai (China); Zhang, Xu [Shandong Chest Hospital, Department of Radiology, Jinan, Shandong (China); Chen, Weibo; Chan, Queenie [Philips Healthcare, Shanghai (China); Chhabra, Avneesh [UT Southwestern Medical Center, Dallas, TX (United States)

    2017-06-15

    To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 ± 0.62 and 3.10 ± 0.83, inter-observer performance was excellent (k = 0.842). DW-MRN is feasible for improved visualisation of extremity nerves and their lesions in the wrist and palm with adequate image quality, thereby providing a supplementary method to conventional MR imaging. (orig.)

  11. Indirect MR arthrography of the wrist in the diagnosis of TFCC-lesions

    International Nuclear Information System (INIS)

    Herold, T.; Lenhart, M.; Held, P.; Feuerbach, S.; Link, J.; Babel, M.; Ruf, S.

    2001-01-01

    Purpose: The objective of this prospective study was to assess the value of the indirect MR arthrography (MR-AR) of the wrist in the detection of lesions of the TFCC. Material and methods: Indirect MR-AR was performed in 45 patients (23 f/22 m) with unclear ulnar wrist pain. After i.v. injection of 0.1 mmol/kg Gd-DTPA and after a motion-phase of the wrist (15 minutes) MRI was performed in a coronal plane. We used a STIR-, a fatsaturated (fs) T1-SE and a 3D-DESS sequence. The images were evaluated by two radiologists using a consensus score. The lesions were assigned to the system of Palmer and correlated with arthroscopy. Results: Indirect MR-AR showed in 35 of 45 patients a lesion of the TFCC, but arthroscopy only revealed a defect in 32 cases. This means three false positive but no false negative assessments by MRI. Using this MRI protocol sensitivity and specificity in the detection of TFCC lesions were calculated as 100% and 77%. The accuracy was 93%. Small degenerative changes of the fibres were most common (Palmer type IIA). In trauma patients the ligaments usually showed tears near the insertion at the ulna (Palmer type IB). The sensitivity and specificity was 88% and 95% for evaluation of the scapho-lunate (SL) ligament, the accuracy was 93%. Arthroscopy and MRI did not diagnose any rupture of the lunate-triquetral (LT) ligament. Conclusion: Indirect MR-AR is a non-invasive method with a high sensitivity in the evaluation of the TFCC and associated injuries. Therefore, it is an excellent screening procedure to assess the indication for therapeutic arthroscopy. (orig.) [de

  12. Diffusion-weighted MR neurography of median and ulnar nerves in the wrist and palm

    International Nuclear Information System (INIS)

    Bao, Hongjing; Wang, Shanshan; Wang, Guangbin; Hasan, Mansoor-ul; Yao, Bin; Wu, Chao; Wu, Lebin; Yang, Li; Zhang, Xu; Chen, Weibo; Chan, Queenie; Chhabra, Avneesh

    2017-01-01

    To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P < 0.05). In patients, the mean image quality scores for the two observers were 3.24 ± 0.62 and 3.10 ± 0.83, inter-observer performance was excellent (k = 0.842). DW-MRN is feasible for improved visualisation of extremity nerves and their lesions in the wrist and palm with adequate image quality, thereby providing a supplementary method to conventional MR imaging. (orig.)

  13. Trigger wrist and carpal tunnel syndrome caused by hand intramuscular intrasynovial angiofibrolipoma: A rare case report

    Directory of Open Access Journals (Sweden)

    Turan C Dulgeroglu

    2016-08-01

    Full Text Available Trigger wrist is a clinical entity characterized by triggering or the crackling of the wrist. Here, a case is reported of intrasynovial angiofibrolipoma that caused trigger wrist and carpal tunnel syndrome. This is the only case report where trigger wrist and carpal tunnel syndrome caused by the intrasynovial angiofibrolipoma were developed simultaneously. it is believed that that adhesive tenosynovitis developing in the tendons may have contributed to the triggering and carpal tunnel syndrome in the wrist as a result of inflammation occuring as a consequence of intrasynovial angiofibrolipoma. [Hand Microsurg 2016; 5(2.000: 107-109

  14. [Treatment of triangular fibrocartilage complex tear under wrist arthroscopy].

    Science.gov (United States)

    Mi, Kun; Liu, Wu; Liu, Pengfei; Feng, Zhibin; Li, Yuwen; Hui, Guisheng

    2011-01-01

    To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC). Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12 cases, and by falling in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main clinical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and lifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 +/- 5.18) degrees at volar flexion, (41.22 +/- 3.83) degrees at dorsal extension, (17.82 +/- 2.48) degrees at radial deviation, (21.35 +/- 4.61) degrees at ulnar deviation, (69.85 +/- 8.36) degrees at pronation, and (70.13 +/- 6.34) degrees at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridement on triangular fibrocartilage disc, ulnolunate ligament, and ulnotriguetrum ligament; and 1 case of ID with trimming plastic operation. All incisions healed by first intention, and no complications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal life and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 +/- 6.21) degrees at volar flexion, (45.37 +/- 4.65) degrees at dorsal extension, (18.95 +/- 3.56) degrees at radial deviation, (26.28 +/- 5.09) degrees at ulnar deviation, (78.87 +/- 7.69) degrees at pronation, and (76.46 +/- 8

  15. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Jong, Marcus C. de; Genders, Tessa S.S.; Geuns, Robert-Jan van; Moelker, Adriaan; Hunink, M.G.M.

    2012-01-01

    To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26-4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28-3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29-3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52). Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance. (orig.)

  16. Meta-analysis: association between wrist posture and carpal tunnel syndrome among workers.

    Science.gov (United States)

    You, Doohee; Smith, Allan H; Rempel, David

    2014-03-01

    Carpal tunnel syndrome (CTS) is a common work-related peripheral neuropathy. In addition to grip force and repetitive hand exertions, wrist posture (hyperextension and hyperflexion) may be a risk factor for CTS among workers. However, findings of studies evaluating the relationship between wrist posture and CTS are inconsistent. The purpose of this paper was to conduct a meta-analysis of existing studies to evaluate the evidence of the relationship between wrist posture at work and risk of CTS. PubMed and Google Scholar were searched to identify relevant studies published between 1980 and 2012. The following search terms were used: "work related", "carpal tunnel syndrome", "wrist posture", and "epidemiology". The studies defined wrist posture as the deviation of the wrist in extension or flexion from a neutral wrist posture. Relative risk (RR) of individual studies for postural risk was pooled to evaluate the overall risk of wrist posture on CTS. Nine studies met the inclusion criteria. All were cross-sectional or case-control designs and relied on self-report or observer's estimates for wrist posture assessment. The pooled RR of work-related CTS increased with increasing hours of exposure to wrist deviation or extension/flexion [RR = 2.01; 95% confidence interval (CI): 1.646-2.43; p Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

  17. CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing.

    Science.gov (United States)

    Tian, Panwen; Wang, Ye; Li, Lei; Zhou, Yongzhao; Luo, Wenxin; Li, Weimin

    2017-02-01

    Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions. This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed. The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.

  18. Effect of breast cancer phenotype on diagnostic performance of MRI in the prediction to response to neoadjuvant treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bufi, Enida, E-mail: reagandus@alice.it [Department of Bioimaging and Radiological Sciences, Catholic University, Rome (Italy); Belli, Paolo; Di Matteo, Marialuisa [Department of Bioimaging and Radiological Sciences, Catholic University, Rome (Italy); Terribile, Daniela; Franceschini, Gianluca [Department of Surgery, Breast Unit, Catholic University, Rome (Italy); Nardone, Luigia [Department of Radiotherapy, Catholic University, Rome (Italy); Petrone, Gianluigi [Department of Pathology, Catholic University, Rome (Italy); Bonomo, Lorenzo [Department of Bioimaging and Radiological Sciences, Catholic University, Rome (Italy)

    2014-09-15

    Aim: The estimation of response to neoadjuvant chemotherapy (NAC) is useful in the surgical decision in breast cancer. We addressed the diagnostic reliability of conventional MRI, of diffusion weighted imaging (DWI) and of a merged criterion coupling morphological MRI and DWI. Diagnostic performance was analysed separately in different tumor subtypes, including HER2+ (human epidermal growth factor receptor 2)/HR+ (hormone receptor) (hybrid phenotype). Materials and methods: Two-hundred and twenty-five patients underwent MRI before and after NAC. The response to treatment was defined according to the RECIST classification and the evaluation of DWI with apparent diffusion coefficient (ADC). The complete pathological response – pCR was assessed (Mandard classification). Results: Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), HER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of cases. Average ADC was statistically higher after NAC (p < 0.001) among patients showing pCR vs. those who had not pCR. The RECIST classification showed adequate performance in predicting the pCR in Triple Negative (area under the receiver operating characteristic curve, ROC AUC = 0.9) and in the HER2+ subgroup (AUC = 0.826). Lower performance was found in the Luminal and Hybrid subgroups (AUC 0.693 and 0.611, respectively), where the ADC criterion yielded an improved performance (AUC = 0.787 and 0.722). The coupling of morphological and DWI criteria yielded maximally improved performance in the Luminal and Hybrid subgroups (AUC = 0.797 and 0.761). Conclusion: The diagnostic reliability of MRI in predicting the pCR to NAC depends on the tumor phenotype, particularly in the Luminal and Hybrid subgroups. In these cases, the coupling of morphological MRI evaluation and DWI assessment may facilitate the diagnosis.

  19. Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses?

    Science.gov (United States)

    Lee, Eun Jung; Jung, Hae Kyoung; Ko, Kyung Hee; Lee, Jong Tae; Yoon, Jung Hyun

    2013-07-01

    To evaluate which shear wave elastography (SWE) parameter proves most accurate in the differential diagnosis of solid breast masses. One hundred and fifty-six breast lesions in 139 consecutive women (mean age: 43.54 ± 9.94 years, range 21-88 years), who had been scheduled for ultrasound-guided breast biopsy, were included. Conventional ultrasound and SWE were performed in all women before biopsy procedures. Ultrasound BI-RADS final assessment and SWE parameters were recorded. Diagnostic performance of each SWE parameter was calculated and compared with those obtained when applying cut-off values of previously published data. Performance of conventional ultrasound and ultrasound combined with each parameter was also compared. Of the 156 breast masses, 120 (76.9 %) were benign and 36 (23.1 %) malignant. Maximum stiffness (Emax) with a cut-off of 82.3 kPa had the highest area under the receiver operating characteristics curve (Az) value compared with other SWE parameters, 0.860 (sensitivity 88.9 %, specificity 77.5 %, accuracy 80.1 %). Az values of conventional ultrasound combined with each SWE parameter showed lower (but not significantly) values than with conventional ultrasound alone. Maximum stiffness (82.3 kPa) provided the best diagnostic performance. However the overall diagnostic performance of ultrasound plus SWE was not significantly better than that of conventional ultrasound alone. • SWE offers new information over and above conventional breast ultrasound • Various SWE parameters were explored regarding distinction between benign and malignant lesions • An elasticity of 82.3 kPa appears optimal in differentiating solid breast masses • However, ultrasound plus SWE was not significantly better than conventional ultrasound alone.

  20. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    Science.gov (United States)

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.

  1. Dose and diagnostic performance comparison between phase-contrast mammography with synchrotron radiation and digital mammography: a clinical study report.

    Science.gov (United States)

    Fedon, Christian; Rigon, Luigi; Arfelli, Fulvia; Dreossi, Diego; Quai, Elisa; Tonutti, Maura; Tromba, Giuliana; Cova, Maria Assunta; Longo, Renata

    2018-01-01

    Two dosimetric quantities [mean glandular dose (MGD) and entrance surface air kerma (ESAK)] and the diagnostic performance of phase-contrast mammography with synchrotron radiation (MSR) are compared to conventional digital mammography (DM). Seventy-one patients (age range, 41 to 82 years) underwent MSR after a DM examination if questionable or suspicious breast abnormalities were not clarified by ultrasonography. The MGD and the ESAK delivered in both examinations were evaluated and compared. Two on-site radiologists rated the images in consensus according to the Breast Imaging Reporting and Data System assessment categories, which were then correlated with the final diagnoses by means of statistical generalized linear models (GLMs). Receiver operating characteristic curves were also used to assess the diagnostic performance by comparing the area under the curve (AUC). An important MGD and ESAK reduction was observed in MSR due to the monoenergetic beam. In particular, an average 43% reduction was observed for the MGD and a reduction of more than 50% for the ESAK. GLM showed higher diagnostic accuracy, especially in terms of specificity, for MSR, confirmed by AUC analysis ([Formula: see text]). The study design implied that the population was characterized by a high prevalence of disease and that the radiologists, who read the DM images before referring the patient to MSR, could have been influenced in their assessments. Within these limitations, the use of synchrotron radiation with the phase-contrast technique applied to mammography showed an important dose reduction and a higher diagnostic accuracy compared with DM. These results could further encourage research on the translation of x-ray phase-contrast imaging into the clinics.

  2. [Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

    Science.gov (United States)

    Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

    2018-04-01

    Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

  3. Diagnostic Performance and Confidence of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Cystic and Cysticlike Liver Lesions.

    Science.gov (United States)

    Corvino, Antonio; Catalano, Orlando; Corvino, Fabio; Sandomenico, Fabio; Petrillo, Antonella

    2017-09-01

    The aims of this study were to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the characterization of atypical cystic and cysticlike focal liver lesions in comparison with conventional US and to determine whether the use of CEUS can reduce the need for further diagnostic workup. In a 3-year period 48 patients with 50 atypical cystic and cysticlike lesions found at conventional US underwent CEUS. Diagnostic confirmation was obtained in cytohistopathologic examinations, with other imaging modalities, and in follow-up. Overall, there were 24 cystic lesions and 26 cysticlike solid lesions, specifically 32 benign and 18 malignant lesions. The conventional US and CEUS images and cine loops were reviewed by two blinded readers independently. Sensitivity, specificity, area under the ROC curve (A z ), and interobserver agreement were calculated. Diagnostic performance improved after review of CEUS examinations by both readers (conventional US A z = 0.781 vs 0.972; CEUS A z = 0.734 vs 0.957). Interreader agreement increased, although slightly (conventional US weighted κ = 0.894; CEUS weighted κ = 0.953). In terms of differential diagnosis, the occurrence of correctly characterized lesions increased after CEUS for both readers (reader 1, 62% to 98%; reader 2, 56% to 96%). The development of low-acoustic-power CEUS has made it possible to identify several imaging features of cystic and cysticlike focal liver lesions that, in association with history and clinical findings, may help to correctly characterize them. Our data indicate the usefulness of CEUS in the evaluation of patients with these lesions.

  4. Performance and analysis of the TVTS diagnostic system on HT-7 tokamak

    International Nuclear Information System (INIS)

    Han Xiaofeng; Shao Chunqiang; Xi Xiaoqi; Zhao Junyu; Qing Zang; Yang Jianhua; Dai Xingxing

    2013-01-01

    A high spatial resolution imaging Thomson scattering diagnostic system was developed in ASIPP. After about one month trial running on the superconducting HT-7 tokamak, the system was proved to be capable of measuring plasma electron temperature. The system setup and data calibration are described in this paper and then the instrument function is studied in detail, as well as the measurement capability, an electron temperature of 50 eV to 2 keV and density beyond 1x10"1"9 m"-"3. Finally, the data processing method and experimental results are presented. (author)

  5. Median nerve neuropathy in the forearm due to recurrence of anterior wrist ganglion that originates from the scaphotrapezial joint: Case Report

    Directory of Open Access Journals (Sweden)

    Okada Kiyoshi

    2012-01-01

    Full Text Available Abstract Background Median nerve neuropathy caused by compression from a tumor in the forearm is rare. Cases with anterior wrist ganglion have high recurrence rates despite surgical treatment. Here, we report the recurrence of an anterior wrist ganglion that originated from the Scaphotrapezial joint due to incomplete resection and that caused median nerve neuropathy in the distal forearm. Case presentation A 47-year-old right-handed housewife noted the appearance of soft swelling on the volar aspect of her left distal forearm, and local resection surgery was performed twice at another hospital. One year after the last surgery, the swelling reappeared and was associated with numbness and pain in the radial volar aspect of the hand. Magnetic resonance imaging revealed that the multicystic lesion originated from the Scaphotrapezial joint and had expanded beyond the wrist. Exploration of the left median nerve showed that it was compressed by a large ovoid cystic lesion at the distal forearm near the proximal end of the carpal tunnel. We resected the cystic lesion to the Scaphotrapezial joint. Her symptoms disappeared 1 week after surgery, and complications or recurrent symptoms were absent 13 months after surgery. Conclusions A typical median nerve compression was caused by incomplete resection of an anterior wrist ganglion, which may have induced widening of the cyst. Cases with anterior wrist ganglion have high recurrence rates and require extra attention in their treatment.

  6. The effect of wheelchair propulsion style on changes in time spent in extreme wrist orientations after a bout of fatiguing propulsion.

    Science.gov (United States)

    Zukowski, Lisa A; Hass, Chris J; Shechtman, Orit; Christou, Evangelos A; Tillman, Mark D

    2017-10-01

    This study compared how wheelchair propulsion styles affect changes in percentage of time spent in extreme wrist orientations, which have been associated with median nerve injury, after a fatiguing bout of propulsion. Twenty novice, non-disabled adult males learned arcing (ARC) and semicircular (SEMI) propulsion styles and utilised each to perform a wheelchair fatigue protocol. ARC and SEMI did not significantly differ in terms of changes after the fatigue protocol in percentage of time spent in extreme flexion/extension or radial/ulnar deviation at the push phase beginning or end. A pattern was observed, although not significant, of greater increases in percentage of time spent in extreme wrist extension and ulnar deviation during the push phase beginning and ulnar deviation during the push phase end while utilising SEMI relative to ARC. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles. Practitioner Summary: How wheelchair propulsion styles change with fatigue in terms of extreme wrist orientations was examined. This study evinces that individual differences are greater than observed changes in extreme wrist orientations for both propulsion styles and point towards the need for future research on individual differences utilising propulsion styles.

  7. Spontaneous Extensor Tendon Rupture in the Rheumatoid Wrist: Risk Factors and Preventive Role of Extended Tenosynovectomy.

    Science.gov (United States)

    Hsueh, Jung-Hua; Liu, Wen-Chung; Yang, Kuo-Chung; Hsu, Kuei-Chang; Lin, Cheng-Ta; Chen, Lee-Wei

    2016-03-01

    Spontaneous extensor tendon rupture is often seen in rheumatoid arthritis (RA) patients, but the risk factors are not clearly defined. We therefore collected the data of RA patients with previous extensor tendon rupture and those with tenosynovitis and analyzed the relationship between extended tenosynovectomy and spontaneous extensor tendon rupture. We retrospectively reviewed 17 spontaneous extensor tendon rupture episodes in 15 RA patients and 14 tenosynovitis episodes that required tenosynovectomy in 12 RA patients from 1997 to 2013. Correlations between the incidence of tendon rupture, X-ray findings, and clinical findings in the affected wrists before tendon rupture were analyzed statistically using the test for proportion. The following parameters were significantly correlated with spontaneous extensor tendon rupture: disease duration longer than 8 years, persistent tenosynovitis longer than 1 year duration, and Larsen grade greater than 4 (P = 0.02, 0.03, and 0.01, respectively). Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray contributed to a higher spontaneous extensor tendon rupture rate among RA patients (P = 0.01, 0.05, and 0.03, respectively). Extended tenosynovectomy was performed on 14 wrists in 12 RA patients with persistent tenosynovitis longer than 6 months, and Larsen grade did not deteriorate in this group compared with those who did not undergo the surgery. No spontaneous extensor tendon rupture occurred following the surgery. Risk factors of spontaneous extensor tendon rupture included disease duration longer than 8 years, persistent tenosynovitis longer than 1 year, and wrist Larsen grade greater than 4. Dislocation of the distal end of the ulna, carpal collapse, and the scallop sign on X-ray indicated a higher probability of extensor tendon rupture. Rheumatologists should consult with hand surgeons promptly to preserve hand function before tendon rupture. Prophylactic extended tenosynovectomy

  8. Diagnostic Performance of CT Colonography for the Detection of Colorectal Polyps

    International Nuclear Information System (INIS)

    Yun, Ji Young; Ro, Hee Jeong; Choi, Jung Bin; Chung, Ji Eun; Kim, Yong Jin; Suh, Won Hyuck; Lee, Jong Kyun; Park, Jong Beom

    2007-01-01

    To investigate the diagnostic value of CT colonography for the detection of colorectal polyps. From December 2004 to December 2005, 399 patients underwent CT colonography and follow-up conventional colonoscopy. We excluded cases of advanced colorectal cancer. We retrospectively analyzed the CT colonography findings and follow-up conventional colonoscopy findings of 113 patients who had polyps more than 6 mm in diameter. Radiologists using 3D and 2D computer generated displays interpreted the CT colonography images. The colonoscopists were aware of the CT colonography findings before the procedure. CT colonography detected 132 polyps in 107 of the 113 patients and conventional colonoscopy detected 114 colorectal polyps more than 6 mm in diameter in 87 of the 113 patients. The sensitivity of CT colonography analyzed per polyp was 91% (41/45) for polyps more than 10 mm in diameter and 89% (101/114) for polyps more than 6 mm in diameter. Thirteen polyps were missed by CT colonography and were detected on follow-up conventional colonoscopy. CT colonography is a sensitive diagnostic tool for the detection of colorectal polyps and adequate bowel preparation, optimal bowel distention and clinical experience are needed to reduce the rate of missing appropriate lesions

  9. Diagnostic performance of 320-detector CT coronary angiography in patients with atrial fibrillation: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Lei; Yang, Lin; Fan, Zhanming; Yu, Wei; Lv, Biao; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China)

    2011-05-15

    To evaluate the feasibility, diagnostic accuracy, and radiation dose of CT coronary angiography (CTCA) in patients with atrial fibrillation (AF) using 320-detector CT. Thirty-seven patients with persistent AF and suspected coronary artery disease (CAD) were enrolled. All patients underwent both 320-detector CTCA and conventional coronary angiography (CCA). CT image quality and the presence of significant ({>=}50%) stenosis were evaluated by two radiologists blinded to the results of CCA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using CCA as the reference standard. Differences in detection of coronary artery stenosis between 320-detector CTCA and CCA were evaluated with McNemar's test. Patient radiation dose was calculated by multiplying dose length product by conversion coefficient of 0.017. In total 474 evaluated coronary segments, 459 (96.8%) segments were diagnostically evaluable. On per-segment analysis, sensitivity, specificity, PPV and NPV were 90.0% (18 of 20), 99.3% (436 of 439), 85.7% (18 of 21) and 99.5% (436 of 438). No significant difference was found between 320-detector CTCA and CCA on the detection of significant stenosis (P = 1.000). Effective doses of 320-detector CTCA was 13.0 {+-} 4.7 mSv. 320-detector CTCA is feasible and accurate in excluding CAD in patients with AF. (orig.)

  10. Myeloma-Derived Light Chain Paired with a Diagnostic Monoclonal Antibody Hinders Immunoassay Performance.

    Science.gov (United States)

    Tu, Bailin; Tieman, Bryan; Moore, Jeffrey; Pan, You; Muerhoff, A Scott

    2017-06-01

    Monoclonal antibodies are widely used as the capture and detection reagents in diagnostic immunoassays. In the past, myeloma fusion partners expressing endogenous heavy and/or light chains were often used to generate hybridoma cell lines. As a result, mixed populations of antibodies were produced that can cause inaccurate test results, poor antibody stability, and significant lot-to-lot variability. We describe one such scenario where the P3U1 (P3X63Ag8U.1) myeloma fusion partner was used in the generation of a hybridoma producing protein induced vitamin K absence/antagonist-II (PIVKA II) antibody. The hybridoma produces three subpopulations of immunoglobulin as determined by ion exchange (IEx) chromatography that exhibit varying degrees of immunoreactivity (0%, 50%, or 100%) to the target antigen as determined by Surface Plasmon Resonance. To produce an antibody with the highest possible sensitivity and specificity, the antigen-specific heavy and light chain variable domains (VH and VL) were cloned from the hybridoma and tethered to murine IgG1 and kappa scaffolds. The resulting recombinant antibody was expressed in Chinese hamster ovary cells and is compatible for use in a diagnostic immunoassay.

  11. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference.

    Science.gov (United States)

    Yamada, Yoshitake; Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Abe, Takayuki; Kuribayashi, Sachio; Ogawa, Kenji

    2013-08-01

    To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA-950) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA-950. The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA-950. • Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography. • Interobserver agreement for tomosynthesis was significantly higher than that for radiography. • Sensitivity increased with increasing LAA -950 in both tomosynthesis and radiography. • Tomosynthesis imparts a similar radiation dose to two projection chest radiography. • Radiation dose and cost of tomosynthesis are lower than those of MDCT.

  12. Collaboration between radiological technologists (radiographers) and junior doctors during image interpretation improves the accuracy of diagnostic decisions

    International Nuclear Information System (INIS)

    Kelly, B.S.; Rainford, L.A.; Gray, J.; McEntee, M.F.

    2012-01-01

    Rationale and Objectives: In Emergency Departments (ED) junior doctors regularly make diagnostic decisions based on radiographic images. This study investigates whether collaboration between junior doctors and radiographers impacts on diagnostic accuracy. Materials and Methods: Research was carried out in the ED of a university teaching hospital and included 10 pairs of participants. Radiographers and junior doctors were shown 42 wrist radiographs and 40 CT Brains and were asked for their level of confidence of the presence or absence of distal radius fractures or fresh intracranial bleeds respectively using ViewDEX software, first working alone and then in pairs. Receiver Operating Characteristic was used to analyze performance. Results were compared using one-way analysis of variance. Results: The results showed statistically significant improvements in the Area Under the Curve (AUC) of the junior doctors when working with the radiographers for both sets of images (wrist and CT) treated as random readers and cases (p ≤ 0.008 and p ≤ 0.0026 respectively). While the radiographers’ results saw no significant changes, their mean Az values did show an increasing trend when working in collaboration. Conclusion: Improvement in performance of junior doctors following collaboration strongly suggests changes in the potential to improve accuracy of patient diagnosis and therefore patient care. Further training for junior doctors in the interpretation of diagnostic images should also be considered. Decision making of junior doctors was positively impacted on after introducing the opinion of a radiographer. Collaboration exceeds the sum of the parts; the two professions are better together.

  13. Clinical and Demographic Stratification of Test Performance: A Pooled Analysis of Five Laboratory Diagnostic Methods for American Cutaneous Leishmaniasis

    Science.gov (United States)

    Boggild, Andrea K.; Ramos, Ana P.; Espinosa, Diego; Valencia, Braulio M.; Veland, Nicolas; Miranda-Verastegui, Cesar; Arevalo, Jorge; Low, Donald E.; Llanos-Cuentas, Alejandro

    2010-01-01

    We evaluated performance characteristics of five diagnostic methods for cutaneous leishmaniasis. Patients who came to the Leishmania Clinic of Hospital Nacional Cayetano Heredia in Lima, Peru, were enrolled in the study. Lesion smears, culture, microculture, polymerase chain reaction (PCR), and leishmanin skin test (LST) were performed. A total of 145 patients with 202 lesions were enrolled: 114 patients with 161 lesions fulfilled criteria for cutaneous leishmaniasis. Sensitivity and specificity were 57.8% (95% confidence interval [CI] = 50.2–65.4%) and 100.0% for culture, 78.3% (95% CI = 71.9–84.7%) and 100.0% for microculture, 71.4% (95% CI = 64.4–78.4%) and 100.0% for smears, 78.2% (95% CI = 70.6–85.8%) and 77.4% (95% CI = 62.7–92.1%) for LST, and 96.9% (95% CI = 94.2–99.6%) and 65.9% (95% CI = 51.4–80.4%) for PCR. PCR was more sensitive than the other assays (P < 0.001). Sensitivities of culture, smears, and LST varied by lesion duration and appearance. PCR offers performance advantages over other assays, irrespective of patient age, sex, lesion duration, or appearance. That clinical factors influence performance of non-molecular assays offers clinicians a patient-focused approach to diagnostic test selection. PMID:20682880

  14. High-resolution MR imaging of wrist cartilage

    International Nuclear Information System (INIS)

    Rominger, M.B.; Bernreuter, W.K.; Listinsky, J.J.; Lee, D.H.; Kenney, P.J.; Colgin, S.L.

    1991-01-01

    This paper reports that cartilage is an important prognostic factor in arthritis. MR imaging can demonstrate both articular cartilage and subchondral bone. Our purpose was to compare various sequences, for wrist cartilage imaging and determine how extensive damage must be before it is detectable with MR imaging. Six cadaver wrists were imaged before and after arthroscopic cartilage injury (coronal and axial T1- and T2-weighted SE sequences, 3-mm sections; SPGR 45 degrees flip angle volume images with fat saturation. 1.2-mm sections; plus T1-weighted coronal images with fat saturation after injury; General Electric Signa, 1.5 T, with transmit-receive extremity coil). Twenty-two defects were created arthroscopically. Five normal volunteers were imaged for comparison. The greatest contrast among bone, cartilage, and synovial fluid was achieved with T1-weighted fat-suppressed SE image and SPGR. Gradient-recalled volume sequences generated very thin sections but were susceptible to artifact

  15. Pose Tracking Algorithm of an Endoscopic Surgery Robot Wrist

    International Nuclear Information System (INIS)

    Wang, L; Yin, H L; Meng, Q

    2006-01-01

    In recent two decades, more and more research on the endoscopic surgery has been carried out [2]. Most of the work focuses on the development of the robot in the field of robotics and the navigation of the surgery tools based on computer graphics. But the tracking and locating of the EndoWrist is also a very important aspect. This paper deals with the the tracking algorithm of the EndoWrist's pose (position and orientation). The linear tracking of the position is handled by the Kalman Filter. The quaternion-based nonlinear orientation tracking is implemented with the Extended Kalman Filter. The most innovative point of this paper is the parameterization of the motion model of the Extended Kalman Filter

  16. Pose Tracking Algorithm of an Endoscopic Surgery Robot Wrist

    Energy Technology Data Exchange (ETDEWEB)

    Wang, L [Chinese-German Institute of Automatic Control Engineering, Tongji University (China); Yin, H L [Chinese-German Institute of Automatic Control Engineering, Tongji University (China); Meng, Q [Shanghai University of Electric Power (China)

    2006-10-15

    In recent two decades, more and more research on the endoscopic surgery has been carried out [2]. Most of the work focuses on the development of the robot in the field of robotics and the navigation of the surgery tools based on computer graphics. But the tracking and locating of the EndoWrist is also a very important aspect. This paper deals with the the tracking algorithm of the EndoWrist's pose (position and orientation). The linear tracking of the position is handled by the Kalman Filter. The quaternion-based nonlinear orientation tracking is implemented with the Extended Kalman Filter. The most innovative point of this paper is the parameterization of the motion model of the Extended Kalman Filter.

  17. The Clinical Utility and Diagnostic Performance of MRI for Identification of Early and Advanced Knee Osteoarthritis: A Systematic Review

    Science.gov (United States)

    Quatman, Carmen E.; Hettrich, Carolyn M.; Schmitt, Laura C.; Spindler, Kurt P.

    2013-01-01

    Background Current diagnostic strategies for detection of structural articular cartilage abnormalities, the earliest structural signs of osteoarthritis, often do not capture the condition until it is too far advanced for the most potential benefit of non-invasive interventions. Purpose Systematically review the literature relative to the following questions: (1) Is MRI a valid, sensitive, specific, accurate and reliable instrument to identify knee articular cartilage abnormalities compared to arthroscopy? (2) Is MRI a sensitive tool that can be utilized to identify early cartilage degeneration? Study Design Systematic Review Methods A systematic search was performed in November 2010 using PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), and SCOPUS (from 1996) databases. Results Fourteen level I and 13 level II studies were identified that met inclusion criteria and provided information related to diagnostic performance of MRI compared to arthroscopic evaluation. The diagnostic performance of MRI demonstrated a large range of sensitivities, specificities, and accuracies. The sensitivity for identifying articular cartilage abnormalities in the knee joint was reported between 26–96%. Specificity and accuracy was reported between 50–100% and 49–94%, respectively. The sensitivity, specificity, and accuracy for identifying early osteoarthritis were reported between 0–86%, 48–95%, and 5–94%, respectively. As a result of inconsistencies between imaging techniques and methodological shortcomings of many of the studies, a meta-analysis was not performed and it was difficult to fully synthesize the information to state firm conclusions about the diagnostic performance of MRI. Conclusions There is evidence in some MRI protocols that MRI is a relatively valid, sensitive, specific, accurate, and reliable clinical tool for identifying articular cartilage degeneration. Due to heterogeneity of MRI sequences it is not possible to make definitive

  18. Evaluation of the diagnostic performance and operational characteristics of four rapid immunochromatographic syphilis tests in Burkina Faso.

    Science.gov (United States)

    Bocoum, Fadima Yaya; Ouédraogo, Henri; Tarnagda, Grissoum; Kiba, Alice; Tiendrebeogo, Simon; Bationo, Fabrice; Liestman, Benjamin; Diagbouga, Serge; Zarowsky, Christina; Traoré, Ramata Ouédraogo; Kouanda, Séni

    2015-06-01

    Little information is available on the rapid diagnostic testing for syphilis in Burkina Faso. The objectives of the study were (i) to assess the sensitivity and specificity of four on site rapid tests in comparison with Treponema pallidum haemagglutination assay (TPHA) as a gold standard and (ii) to evaluate the operational characteristics of those tests among health workers in a maternity unit. Four rapid syphilis tests commercially available in Burkina Faso were evaluated using archived serum samples and Treponema pallidum hemagglutination assay (TPHA) as the gold standard. Blood samples were collected between November 2011 and June 2012 from blood donors at the Regional Blood Transfusion Center of Ouagadougou. The sensitivity and specificity of the tests were calculated. Evaluation of operational characteristics such as clarity of pamphlet, complexity of technique, duration, was conducted in a first-level healthcare center with health workers in maternity unit. Alere DetermineTM Syphilis was the most sensitive of the four rapid syphilis tests evaluated. It was followed by SD Bioline Syphilis 3.0, Cypress Diagnostics Syphilis Quick test and Accu-Tell ® Rapid Anti-TP, which was the least sensitive. The four tests demonstrated a good diagnostic specificity for syphilis (95-98%), and healthcare workers found them easy to use. The study allowed confirming the good performance of three of four rapid syphilis tests in Burkina Faso. More research will be conducted to assess the feasibility of introducing selected rapid tests for syphilis in antenatal care services.

  19. Diagnostic performance of a novel cadmium-zinc-telluride gamma camera system assessed using fractional flow reserve.

    Science.gov (United States)

    Tanaka, Hirokazu; Chikamori, Taishiro; Tanaka, Nobuhiro; Hida, Satoshi; Igarashi, Yuko; Yamashita, Jun; Ogawa, Masashi; Shiba, Chie; Usui, Yasuhiro; Yamashina, Akira

    2014-01-01

    Although the novel cadmium-zinc-telluride (CZT) camera system provides excellent image quality, its diagnostic value using thallium-201 as assessed on coronary angiography (CAG) and fractional flow reserve (FFR) has not been validated. METHODS AND RESULTS: To evaluate the diagnostic accuracy of the CZT ultrafast camera system (Discovery NM 530c), 95 patients underwent stress thallium-201 single-photon emission computed tomography (SPECT) and then CAG within 3 months. Image acquisition was performed in the supine and prone positions after stress for 5 and 3 min, respectively, and in the supine position at rest for 10 min. Significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or a lesion with <90% and ≥50% stenosis and FFR ≤0.75. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 90%, 64%, and 78% for left anterior descending coronary artery stenosis, 78%, 84%, and 81% for left circumflex stenosis, and 83%, 47%, and 60% for right coronary artery (RCA) stenosis. The combination of prone and supine imaging had a higher specificity for RCA disease than supine imaging alone (65% vs. 47%), with an improvement in accuracy from 60% to 72%. Using thallium-201 with short acquisition time, combined with prone imaging, CZT SPECT had a high diagnostic yield in detecting significant coronary stenosis as assessed using FFR.

  20. Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative?

    Science.gov (United States)

    Kabakaş, Fatih; Uğurlar, Meriç; Turan, Derya Bayirli; Yeşiloğlu, Nebil; Mersa, Berkan; Özçelik, İsmail Bülent

    2016-08-01

    The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery.

  1. Analytical and diagnostic performance of a qPCR assay for Ichthyophonus spp. compared to the tissue culture 'gold standard'.

    Science.gov (United States)

    Lowe, Vanessa C; Hershberger, Paul K; Friedman, Carolyn S

    2018-06-04

    Parasites of the genus Ichthyophonus infect many fish species and have a non-uniform distribution within host tissues. Due in part to this uneven distribution, the comparative sensitivity and accuracy of using molecular-based detection methods versus culture to estimate parasite prevalence is under debate. We evaluated the analytical and diagnostic performance of an existing qPCR assay in comparison to the 'gold standard' culture method using Pacific herring Clupea pallasii with known exposure history. We determined that the assay is suitable for use in this host, and diagnostic specificity was consistently high (>98%) in both heart and liver tissues. Diagnostic sensitivity could not be fully assessed due to low infection rates, but our results suggest that qPCR is not as sensitive as culture under all circumstances. Diagnostic sensitivity of qPCR relative to culture is likely affected by the amount of sample processed. The prevalence values estimated by the 2 methods were not significantly different when sample amounts were equal (heart tissue), but when the assayed sample amounts were unequal (liver tissue), the culture method detected a significantly higher prevalence of the parasite than qPCR. Further, culture of liver also detected significantly more Ichthyophonus infections than culture of heart, suggesting that the density and distribution of parasites in tissues also plays a role in assay sensitivity. This sensitivity issue would be most problematic for fish with light infections. Although qPCR does not detect the presence of a live organism, DNA-based pathogen detection methods provide the opportunity for alternate testing strategies when culture is not possible.

  2. Dynamic Causal Modeling of the Cortical Responses to Wrist Perturbations

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    Yuan Yang

    2017-09-01

    Full Text Available Mechanical perturbations applied to the wrist joint typically evoke a stereotypical sequence of cortical and muscle responses. The early cortical responses (<100 ms are thought be involved in the “rapid” transcortical reaction to the perturbation while the late cortical responses (>100 ms are related to the “slow” transcortical reaction. Although previous studies indicated that both responses involve the primary motor cortex, it remains unclear if both responses are engaged by the same effective connectivity in the cortical network. To answer this question, we investigated the effective connectivity cortical network after a “ramp-and-hold” mechanical perturbation, in both the early (<100 ms and late (>100 ms periods, using dynamic causal modeling. Ramp-and-hold perturbations were applied to the wrist joint while the subject maintained an isometric wrist flexion. Cortical activity was recorded using a 128-channel electroencephalogram (EEG. We investigated how the perturbation modulated the effective connectivity for the early and late periods. Bayesian model comparisons suggested that different effective connectivity networks are engaged in these two periods. For the early period, we found that only a few cortico-cortical connections were modulated, while more complicated connectivity was identified in the cortical network during the late period with multiple modulated cortico-cortical connections. The limited early cortical network likely allows for a rapid muscle response without involving high-level cognitive processes, while the complexity of the late network may facilitate coordinated responses.

  3. Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study.

    Science.gov (United States)

    Fleischmann, Robert; Tränkner, Steffi; Bathe-Peters, Rouven; Rönnefarth, Maria; Schmidt, Sein; Schreiber, Stephan J; Brandt, Stephan A

    2018-03-01

    The lack of objective disease markers is a major cause of misdiagnosis and nonstandardized approaches in delirium. Recent studies conducted in well-selected patients and confined study environments suggest that quantitative electroencephalography (qEEG) can provide such markers. We hypothesize that qEEG helps remedy diagnostic uncertainty not only in well-defined study cohorts but also in a heterogeneous hospital population. In this retrospective case-control study, EEG power spectra of delirious patients and age-/gender-matched controls (n = 31 and n = 345, respectively) were fitted in a linear model to test their performance as binary classifiers. We subsequently evaluated the diagnostic performance of the best classifiers in control samples with normal EEGs (n = 534) and real-world samples including pathologic findings (n = 4294). Test reliability was estimated through split-half analyses. We found that the combination of spectral power at F3-P4 at 2 Hz (area under the curve [AUC] = .994) and C3-O1 at 19 Hz (AUC = .993) provided a sensitivity of 100% and a specificity of 99% to identify delirious patients among normal controls. These classifiers also yielded a false positive rate as low as 5% and increased the pretest probability of being delirious by 57% in an unselected real-world sample. Split-half reliabilities were .98 and .99, respectively. This retrospective study yielded preliminary evidence that qEEG provides excellent diagnostic performance to identify delirious patients even outside confined study environments. It furthermore revealed reduced beta power as a novel specific finding in delirium and that a normal EEG excludes delirium. Prospective studies including parameters of pretest probability and delirium severity are required to elaborate on these promising findings.

  4. Diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears at 3.0 T.

    Science.gov (United States)

    Lee, Ji Hyun; Yoon, Young Cheol; Jee, Sukkyung

    2015-06-01

    Indirect magnetic resonance (MR) arthrography is a non-invasive method for shoulder imaging. However, there are no studies that have examined the diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears in a large patient population. To assess the diagnostic performance of indirect fast spin-echo (FSE) MR arthrography for the diagnosis of rotator cuff tears at 3.0 T. A total of 149 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery were enrolled in this retrospective study. Two musculoskeletal radiologists evaluated images from each patient for the presence of supraspinatus-infraspinatus (SSP-ISP) or subscapularis (SSC) tendon tears. Using the arthroscopic findings as the reference standard, the overall diagnostic performance and detection rates for SSP-ISP and SSC tendon tears were calculated. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSP-ISP tendon tears were 94% and 95%, 89% and 85%, and 93% and 93%, respectively. The sensitivity of imaging for detection of SSP-ISP tendon tears by readers I and II were 100% and 100% for full-thickness tears and 84% and 86% for partial-thickness tears, respectively. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSC tendon tears were 80% and 76%, 89% and 93%, and 85% and 85%, respectively. Indirect MR arthrography is useful for the detection of SSP-ISP and SSC tendon tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT.

    Science.gov (United States)

    Yunaga, Hiroto; Ohta, Yasutoshi; Kaetsu, Yasuhiro; Kitao, Shinichiro; Watanabe, Tomomi; Furuse, Yoshiyuki; Yamamoto, Kazuhiro; Ogawa, Toshihide

    2017-07-01

    Multi-detector-row computed tomography angiography (MDCTA) plays an important role in the assessment of patients with suspected coronary artery disease. However, MDCTA tends to overestimate stenosis in calcified coronary artery lesions. The aim of our study was to evaluate the diagnostic performance of calcification-suppressed material density (MD) images produced by using a single-detector single-source dual-energy computed tomography (ssDECT). We enrolled 67 patients with suspected or known coronary artery disease who underwent ssDECT with rapid kilovolt-switching (80 and 140 kVp). Coronary artery stenosis was evaluated on the basis of MD images and virtual monochromatic (VM) images. The diagnostic performance of the two methods for detecting coronary artery disease was compared with that of invasive coronary angiography as a reference standard. We evaluated 239 calcified segments. In all the segments, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting significant stenosis were respectively 88%, 88%, 75%, 95% and 88% for the MD images, 91%, 71%, 56%, 95% and 77% for the VM images. PPV was significantly higher on the MD images than on the VM images (P < 0.0001). Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions. • Computed tomography angiography tends to overestimate stenosis in calcified coronary artery. • Dual-energy CT enables us to suppress calcification of coronary artery lesions. • Calcification-suppressed material density imaging reduces false-positive diagnosis of calcified lesion.

  6. Diagnostic performance of qualitative shear-wave elastography according to different color map opacities for breast masses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hana; Youk, Ji Hyun, E-mail: jhyouk@yuhs.ac; Gweon, Hye Mi; Kim, Jeong-Ah; Son, Eun Ju

    2013-08-15

    Purpose: To compare the diagnostic performance of qualitative shear-wave elastography (SWE) according to three different color map opacities for breast masses Materials and methods: 101 patients aged 21–77 years with 113 breast masses underwent B-mode US and SWE under three different color map opacities (50%, 19% and 100%) before biopsy or surgery. Following SWE features were reviewed: visual pattern classification (pattern 1–4), color homogeneity (E{sub homo}) and six-point color score of maximum elasticity (E{sub col}). Combined with B-mode US and SWE, the likelihood of malignancy (LOM) was also scored. The area under the curve (AUC) was obtained by ROC curve analysis to assess the diagnostic performance under each color opacity. Results: A visual color pattern, E{sub homo}, E{sub col} and LOM scoring were significantly different between benign and malignant lesions under all color opacities (P < 0.001). For 50% opacity, AUCs of visual color pattern, E{sub col}, E{sub homo} and LOM scoring were 0.902, 0.951, 0.835 and 0.975. But, for each SWE feature, there was no significant difference in the AUC among three different color opacities. For all color opacities, visual color pattern and E{sub col} showed significantly higher AUC than E{sub homo}. In addition, a combined set of B-mode US and SWE showed significantly higher AUC than SWE alone for color patterns, E{sub homo}, but no significant difference was found in E{sub col}. Conclusion: Qualitative SWE was useful to differentiate benign from malignant breast lesion under all color opacities. The difference in color map opacity did not significantly influence diagnostic performance of SWE.

  7. Diagnostic performance of qualitative shear-wave elastography according to different color map opacities for breast masses

    International Nuclear Information System (INIS)

    Kim, Hana; Youk, Ji Hyun; Gweon, Hye Mi; Kim, Jeong-Ah; Son, Eun Ju

    2013-01-01

    Purpose: To compare the diagnostic performance of qualitative shear-wave elastography (SWE) according to three different color map opacities for breast masses Materials and methods: 101 patients aged 21–77 years with 113 breast masses underwent B-mode US and SWE under three different color map opacities (50%, 19% and 100%) before biopsy or surgery. Following SWE features were reviewed: visual pattern classification (pattern 1–4), color homogeneity (E homo ) and six-point color score of maximum elasticity (E col ). Combined with B-mode US and SWE, the likelihood of malignancy (LOM) was also scored. The area under the curve (AUC) was obtained by ROC curve analysis to assess the diagnostic performance under each color opacity. Results: A visual color pattern, E homo , E col and LOM scoring were significantly different between benign and malignant lesions under all color opacities (P < 0.001). For 50% opacity, AUCs of visual color pattern, E col , E homo and LOM scoring were 0.902, 0.951, 0.835 and 0.975. But, for each SWE feature, there was no significant difference in the AUC among three different color opacities. For all color opacities, visual color pattern and E col showed significantly higher AUC than E homo . In addition, a combined set of B-mode US and SWE showed significantly higher AUC than SWE alone for color patterns, E homo , but no significant difference was found in E col . Conclusion: Qualitative SWE was useful to differentiate benign from malignant breast lesion under all color opacities. The difference in color map opacity did not significantly influence diagnostic performance of SWE

  8. 4-corner arthrodesis and proximal row carpectomy: a biomechanical comparison of wrist motion and tendon forces.

    Science.gov (United States)

    Debottis, Daniel P; Werner, Frederick W; Sutton, Levi G; Harley, Brian J

    2013-05-01

    Controversy exists as to whether a proximal row carpectomy (PRC) is a better procedure than scaphoid excision with 4-corner arthrodesis for preserving motion in the painful posttraumatic arthritic wrist. The purpose of this study was to determine how the kinematics and tendon forces of the wrist are altered after PRC and 4-corner arthrodesis. We tested 6 fresh cadaver forearms for the extremes of wrist motion and then used a wrist simulator to move them through 4 cyclic dynamic wrist motions, during which time we continuously recorded the tendon forces. We repeated the extremes of wrist motion measurements and the dynamic motions after scaphoid excision with 4-corner arthrodesis, and then again after PRC. We analyzed extremes of wrist motion and the peak tendon forces required for each dynamic motion using a repeated measures analysis of variance. Wrist extremes of motion significantly decreased after both the PRC and 4-corner arthrodesis compared with the intact wrist. Wrist flexion decreased on average 13° after 4-corner arthrodesis and 12° after PRC. Extension decreased 20° after 4-corner arthrodesis and 12° after PRC. Four-corner arthrodesis significantly decreased wrist ulnar deviation from the intact wrist. Four-corner arthrodesis allowed more radial deviation but less ulnar deviation than the PRC. The average peak tendon force was significantly greater after 4-corner arthrodesis than after PRC for the extensor carpi ulnaris during wrist flexion-extension, circumduction, and dart throw motions. The peak forces were significantly greater after 4-corner arthrodesis than in the intact wrist for the extensor carpi ulnaris during the dart throw motion and for the flexor carpi ulnaris during the circumduction motion. The peak extensor carpi radialis brevis force after PRC was significantly less than in the intact wrist. The measured wrist extremes of motion decreased after both 4-corner arthrodesis and PRC. Larger peak tendon forces were required to achieve

  9. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Yoshitake [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan); Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Kuribayashi, Sachio [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Abe, Takayuki [Keio University School of Medicine, Center for Clinical Research, Tokyo (Japan); Ogawa, Kenji [Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan)

    2013-08-15

    To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA{sub -950}) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA{sub -950}. The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA{sub -950}. (orig.)

  10. C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

    Energy Technology Data Exchange (ETDEWEB)

    Guggenberger, Roman; Ulbrich, Erika J.; Kaelin, Pascal; Pfammatter, Thomas; Alkadhi, Hatem; Andreisek, Gustav [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zuerich (Switzerland); Dietrich, Tobias J. [Balgrist University Hospital, Department of Radiology, Zurich (Switzerland); Scholz, Rosemarie; Koehler, Christoph; Elsaesser, Thilo [Siemens Healthcare GmbH, Business Area Advanced Therapies, Forchheim (Germany); Le Corroller, Thomas [Aix-Marseille Universite, CNRS, ISM UMR 7287, Marseille (France); Radiology Department, APHM, Marseille (France)

    2017-02-15

    To investigate radiation dose and diagnostic performance of C-arm flat-panel CT (FPCT) versus standard multi-detector CT (MDCT) shoulder arthrography using MRI-arthrography as reference standard. Radiation dose of two different FPCT acquisitions (5 and 20 s) and standard MDCT of the shoulder were assessed using phantoms and thermoluminescence dosimetry. FPCT arthrographies were performed in 34 patients (mean age 44 ± 15 years). Different joint structures were quantitatively and qualitatively assessed by two independent radiologists. Inter-reader agreement and diagnostic performance were calculated. Effective radiation dose was markedly lower in FPCT 5 s (0.6 mSv) compared to MDCT (1.7 mSv) and FPCT 20 s (3.4 mSv). Contrast-to-noise ratios (CNRs) were significantly (p < 0.05) higher in FPCT 20-s versus 5-s protocols. Inter-reader agreements of qualitative ratings ranged between κ = 0.47-1.0. Sensitivities for cartilage and rotator cuff pathologies were low for FPCT 5-s (40 % and 20 %) and moderate for FPCT 20-s protocols (75 % and 73 %). FPCT showed high sensitivity (81-86 % and 89-99 %) for bone and acromioclavicular-joint pathologies. Using a 5-s protocol FPCT shoulder arthrography provides lower radiation dose compared to MDCT but poor sensitivity for cartilage and rotator cuff pathologies. FPCT 20-s protocol is moderately sensitive for cartilage and rotator cuff tendon pathology with markedly higher radiation dose compared to MDCT. (orig.)

  11. Diagnostic Performance of Computed Tomography Colonography and Colonoscopy: A Prospective and Validated Analysis of 231 Paired Examinations

    International Nuclear Information System (INIS)

    Arnesen, R.B.; Benzon, E. von; Adamsen, S.; Svendsen, L.B.; Raaschou, H.O.; Hart Hansen, O.

    2007-01-01

    Background: Detection of colorectal tumors with computed tomography colonography (CTC) is an alternative to conventional colonoscopy (CC), and clarification of the diagnostic performance is essential for cost-effective use of both technologies. Purpose: To evaluate the diagnostic performance of CTC compared with CC. Material and Methods: 231 consecutive CTCs were performed prior to same-day scheduled CC. The radiologist and endoscopists were blinded to each other's findings. Patients underwent a polyethylene glycol bowel preparation, and were scanned in prone and supine positions using a single-detector helical CT scanner and commercially available software for image analysis. Findings were validated (matched) in an unblinded comparison with video-recordings of the CCs and re-CCs in cases of doubt. Results: For patients with polyps 5 mm and 10 mm, the sensitivity was 69% (95% CI 58-80%) and 81% (68-94%), and the specificity was 91% (84-98%) and 98% (93-100%), respectively. For detection of polyps 5 mm and 10 mm, the sensitivity was 66% (57-75%) and 77% (65-89%). A flat, elevated low-grade carcinoma was missed by CTC. One cancer relapse was missed by CC, and a cecal cancer was missed by an incomplete CC and follow-up double-contrast barium enema. Conclusion: CC was superior to CTC and should remain first choice for the diagnosis of colorectal polyps. However, for diagnosis of lesions 10 mm, CTC and CC should be considered as complementary methods

  12. C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

    International Nuclear Information System (INIS)

    Guggenberger, Roman; Ulbrich, Erika J.; Kaelin, Pascal; Pfammatter, Thomas; Alkadhi, Hatem; Andreisek, Gustav; Dietrich, Tobias J.; Scholz, Rosemarie; Koehler, Christoph; Elsaesser, Thilo; Le Corroller, Thomas

    2017-01-01

    To investigate radiation dose and diagnostic performance of C-arm flat-panel CT (FPCT) versus standard multi-detector CT (MDCT) shoulder arthrography using MRI-arthrography as reference standard. Radiation dose of two different FPCT acquisitions (5 and 20 s) and standard MDCT of the shoulder were assessed using phantoms and thermoluminescence dosimetry. FPCT arthrographies were performed in 34 patients (mean age 44 ± 15 years). Different joint structures were quantitatively and qualitatively assessed by two independent radiologists. Inter-reader agreement and diagnostic performance were calculated. Effective radiation dose was markedly lower in FPCT 5 s (0.6 mSv) compared to MDCT (1.7 mSv) and FPCT 20 s (3.4 mSv). Contrast-to-noise ratios (CNRs) were significantly (p < 0.05) higher in FPCT 20-s versus 5-s protocols. Inter-reader agreements of qualitative ratings ranged between κ = 0.47-1.0. Sensitivities for cartilage and rotator cuff pathologies were low for FPCT 5-s (40 % and 20 %) and moderate for FPCT 20-s protocols (75 % and 73 %). FPCT showed high sensitivity (81-86 % and 89-99 %) for bone and acromioclavicular-joint pathologies. Using a 5-s protocol FPCT shoulder arthrography provides lower radiation dose compared to MDCT but poor sensitivity for cartilage and rotator cuff pathologies. FPCT 20-s protocol is moderately sensitive for cartilage and rotator cuff tendon pathology with markedly higher radiation dose compared to MDCT. (orig.)

  13. T1 mapping cardiovascular magnetic resonance imaging to detect myocarditis—Impact of slice orientation on the diagnostic performance

    Energy Technology Data Exchange (ETDEWEB)

    Bohnen, Sebastian, E-mail: s.bohnen@uke.de [University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg (Germany); Radunski, Ulf K., E-mail: u.radunski@uke.de [University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg (Germany); Lund, Gunnar K., E-mail: glund@uke.de [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Tahir, Enver, E-mail: e.tahir@uke.de [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Avanesov, Maxim, E-mail: m.avanesov@uke.de [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Stehning, Christian, E-mail: christian.stehning@philips.com [Philips Research, Hamburg (Germany); Schnackenburg, Bernhard, E-mail: bernhard.schnackenburg@philips.com [Philips Healthcare Germany, Hamburg (Germany); Adam, Gerhard, E-mail: g.adam@uke.de [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Blankenberg, Stefan, E-mail: s.blankenberg@uke.de [University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg (Germany); Muellerleile, Kai, E-mail: kamuellerleile@uke.de [University Medical Center Hamburg-Eppendorf, University Heart Center, General and Interventional Cardiology, Hamburg (Germany)

    2017-01-15

    Background: T1 mapping is a promising diagnostic tool to improve the diagnostic accuracy of cardiovascular magnetic resonance (CMR) in patients with suspected myocarditis. However, there are currently no data on the potential influence of slice orientation on the diagnostic performance of CMR. Thus, we compared the diagnostic performance of global myocardial T1 and extracellular volume (ECV) values to differentiate patients with myocarditis from healthy individuals between different slice orientations. Methods: This study included 48 patients with clinically defined myocarditis and 13 healthy controls who underwent CMR at 1.5 T. A modified Look-Locker inversion-recovery (MOLLI) sequence was used for T1 mapping before and 15 min after administration of 0.075 mmol/kg Gadolinium-BOPTA. T1 mapping was performed on three short and on three long axes slices, respectively. Native T1, post-contrast T1 and extracellular volume (ECV) −BOPTA maps were calculated using a dedicated plug-in written for the OsiriX software and compared between the mean value of three short-axes slices (3SAX), the central short-axis (1SAX), the mean value of three long-axes slices (3LAX), the four-chamber view (4CH), the three-chamber view (3CH) and the two-chamber view (2CH). Results: There were significantly lower native T1 values on 3LAX (1081 ms (1037–1131 ms)) compared to 3SAX (1107 ms (1069–1143 ms), p = 0.0022) in patients with myocarditis, but not in controls (1026 ms (1009–1059 ms) vs. 1039 ms (1023–1055 ms), p = 0.2719). The areas under the curve (AUC) to discriminate between myocarditis and healthy controls by native myocardial T1 were 0.85 (p < 0.0001) on 3SAX, 0.85 (p < 0.0001) on 1SAX, 0.76 (p = 0.0002) on 3LAX, 0.70 (p = 0.0075) on 4CH, 0.72 (p = 0.0020) on 3CH and 0.75 (p = 0.0003) on 2CH. The AUCs for ECV-BOPTA were 0.83 (p < 0.0001) on 3 SAX, 0.82 (p < 0.0001) on 1SAX, 0.77 (p = 0.0005) on 3LAX, 0.71 (p = 0.0079) on 4CH, 0.69 (p = 0.0371) on 3CH and 0.75 (p = 0.0006) on

  14. T1 mapping cardiovascular magnetic resonance imaging to detect myocarditis—Impact of slice orientation on the diagnostic performance

    International Nuclear Information System (INIS)

    Bohnen, Sebastian; Radunski, Ulf K.; Lund, Gunnar K.; Tahir, Enver; Avanesov, Maxim; Stehning, Christian; Schnackenburg, Bernhard; Adam, Gerhard; Blankenberg, Stefan; Muellerleile, Kai

    2017-01-01

    Background: T1 mapping is a promising diagnostic tool to improve the diagnostic accuracy of cardiovascular magnetic resonance (CMR) in patients with suspected myocarditis. However, there are currently no data on the potential influence of slice orientation on the diagnostic performance of CMR. Thus, we compared the diagnostic performance of global myocardial T1 and extracellular volume (ECV) values to differentiate patients with myocarditis from healthy individuals between different slice orientations. Methods: This study included 48 patients with clinically defined myocarditis and 13 healthy controls who underwent CMR at 1.5 T. A modified Look-Locker inversion-recovery (MOLLI) sequence was used for T1 mapping before and 15 min after administration of 0.075 mmol/kg Gadolinium-BOPTA. T1 mapping was performed on three short and on three long axes slices, respectively. Native T1, post-contrast T1 and extracellular volume (ECV) −BOPTA maps were calculated using a dedicated plug-in written for the OsiriX software and compared between the mean value of three short-axes slices (3SAX), the central short-axis (1SAX), the mean value of three long-axes slices (3LAX), the four-chamber view (4CH), the three-chamber view (3CH) and the two-chamber view (2CH). Results: There were significantly lower native T1 values on 3LAX (1081 ms (1037–1131 ms)) compared to 3SAX (1107 ms (1069–1143 ms), p = 0.0022) in patients with myocarditis, but not in controls (1026 ms (1009–1059 ms) vs. 1039 ms (1023–1055 ms), p = 0.2719). The areas under the curve (AUC) to discriminate between myocarditis and healthy controls by native myocardial T1 were 0.85 (p < 0.0001) on 3SAX, 0.85 (p < 0.0001) on 1SAX, 0.76 (p = 0.0002) on 3LAX, 0.70 (p = 0.0075) on 4CH, 0.72 (p = 0.0020) on 3CH and 0.75 (p = 0.0003) on 2CH. The AUCs for ECV-BOPTA were 0.83 (p < 0.0001) on 3 SAX, 0.82 (p < 0.0001) on 1SAX, 0.77 (p = 0.0005) on 3LAX, 0.71 (p = 0.0079) on 4CH, 0.69 (p = 0.0371) on 3CH and 0.75 (p = 0.0006) on

  15. Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography

    DEFF Research Database (Denmark)

    Døhn, Uffe Møller; Ejbjerg, Bo J; Hasselquist, Maria

    2008-01-01

    , specificity and accuracy (concordance) of MRI for detecting erosions were 61%, 93% and 77%, respectively, while the respective values were 24%, 99% and 63% for radiography. The intramodality agreements when measuring erosion volumes were high for both CT and MRI (Spearman correlation coefficients 0.92 and 0...... sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones, while radiography showed very low sensitivity. The tested volumetric method was highly reproducible and correlated to scores of erosions....... measuring volumes of erosions on CT and MRI is reproducible and correlated to semiquantitative assessments (scores) of erosions on CT, MRI and radiography. METHODS: Seventeen patients with rheumatoid arthritis and four healthy control individuals underwent CT, MRI and radiography of one wrist, performed...

  16. The Takei Handheld Dynamometer: An Effective Clinical Outcome Measure Tool for Hand and Wrist Function in Boxing.

    Science.gov (United States)

    Gatt, Ian; Smith-Moore, Sophie; Steggles, Charlie; Loosemore, Mike

    2018-05-01

    The aim of this article was to explore retrospectively the Takei dynamometer as a valid and reliable outcome measure tool for hand and wrist pathology in the Great Britain amateur boxing squad between 2010 and 2014. Longitudinal retrospective injury surveillance of the Great Britain boxing squad was performed from 2010 to 2014. The location, region affected, description, and duration of each injury were recorded by the team doctor and team physiotherapists. For each significant injury, we recorded hand grip scores using the Takei handheld dynamometer and compared the scores with baseline measures. At the hand, fractures and dislocations were highly detected with an average difference of 40.2% ( P 20% should be highly considered for significant pathology. The Takei dynamometer is a valid and reliable outcome measure tool for hand and wrist pathologies in boxing. Our study highlights the importance of appropriate clinical tools to guide injury management in this sport.

  17. Clinical Evaluation of Iliopsoas Strain with Findings from Diagnostic Musculoskeletal Ultrasound in Agility Performance Canines – 73 Cases

    Directory of Open Access Journals (Sweden)

    Robert Cullen

    2017-06-01

    Full Text Available Objective: Iliopsoas injury and strain is a commonly diagnosed disease process, especially amongst working and sporting canines. There has been very little published literature regarding iliopsoas injuries and there is no information regarding the ultrasound evaluation of abnormal iliopsoas muscles. This manuscript is intended to describe the ultrasound findings in 73 canine agility athletes who had physical examination findings consistent with iliopsoas discomfort. The population was chosen given the high incidence of these animals for the development of iliopsoas injury; likely due to repetitive stress.Methods: Medical records of 73 agility performance canines that underwent musculoskeletal ultrasound evaluation of bilateral iliopsoas muscle groups were retrospectively reviewed. Data included signalment, previous radiographic findings, and ultrasound findings. A 3-tier grading scheme for acute strains was used while the practitioner also evaluated for evidence of chronic injury and bursitis.Results: The majority of pathologies were localised to the tendon of insertion, with the majority being low grade I-II strains (80.8%. Tendon fibre disruption (71.2% and indistinct hypoechoic lesions (91.8% were the most common of acute changes noted. Hyperechoic chronic changes were noted in 84.9 percent of cases. Acute and chronic changes were commonly seen together (62.8%.Conclusion: Diagnostic musculoskeletal ultrasound was used to identify lesions of the iliopsoas tendon consistent with acute and chronic injury, as well as identifying the region of pathology. The majority of agility performance dogs had low grade acute strains based on the tiered system, with mixed acute and chronic lesions being noted frequently.Application: Diagnostic musculoskeletal ultrasound provides a non-invasive diagnostic modality for patients suspected of having an iliopsoas strain.

  18. Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

    International Nuclear Information System (INIS)

    Chang, Weiling; Peduto, Anthony J.; Aguiar, Rodrigo O.C.; Trudell, Debra J.; Resnick, Donald L.

    2007-01-01

    To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

  19. Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Weiling [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Sharp-Grossmont Hospital, Department of Radiology, La Mesa, CA (United States); Peduto, Anthony J. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Westmead Hospital and Western Clinical School of Sydney University, Department of Radiology, Sydney (Australia); Aguiar, Rodrigo O.C. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Universidade Federal do Rio de Janeiro, Rio de Janerio (Brazil); Trudell, Debra J.; Resnick, Donald L. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States)

    2007-07-15

    To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

  20. The Green Propellant Infusion Mission Thruster Performance Testing for Plume Diagnostics

    Science.gov (United States)

    Deans, Matthew C.; Reed, Brian D.; Arrington, Lynn A.; Williams, George J.; Kojima, Jun J.; Kinzbach, McKenzie I.; McLean, Christopher H.

    2014-01-01

    The Green Propellant Infusion Mission (GPIM) is sponsored by NASA's Space Technology Mission Directorate (STMD) Technology Demonstration Mission (TDM) office. The goal of GPIM is to advance the technology readiness level of a green propulsion system, specifically, one using the monopropellant, AF-M315E, by demonstrating ground handling, spacecraft processing, and on-orbit operations. One of the risks identified for GPIM is potential contamination of sensitive spacecraft surfaces from the effluents in the plumes of AF-M315E thrusters. NASA Glenn Research Center (GRC) is conducting activities to characterize the effects of AF-M315E plume impingement and deposition. GRC has established individual plume models of the 22-N and 1-N thrusters that will be used on the GPIM spacecraft. The model simulations will be correlated with plume measurement data from Laboratory and Engineering Model 22-N, AF-M315E thrusters. The thrusters are currently being tested in a small rocket, altitude facility at NASA GRC. A suite of diagnostics, including Raman spectroscopy, Rayleigh spectroscopy, and Schlieren imaging are being used to acquire plume measurements of AF-M315E thrusters. Plume data will include temperature, velocity, relative density, and species concentration. The plume measurement data will be compared to the corresponding simulations of the plume model. The GRC effort will establish a data set of AF-M315E plume measurements and a plume model that can be used for future AF-M315E applications.

  1. Analysis of mental disorders in tinnitus patients performed with Composite International Diagnostic Interview.

    Science.gov (United States)

    Zirke, N; Seydel, C; Arsoy, D; Klapp, B F; Haupt, H; Szczepek, A J; Olze, H; Goebel, G; Mazurek, B

    2013-10-01

    Known association between tinnitus and psychological distress prompted us to examine patients with chronic tinnitus by using the Composite International Diagnostic Interview (CIDI), which is a standardized and reliable method used for the diagnosis of mental disorders. One hundred patients with chronic tinnitus admitted to the Tinnitus Center, Charité-Universitätsmedizin Berlin, were included in this study. Data were collected between February 2008 and February 2009. Besides CIDI, the Tinnitus Questionnaire according to Goebel and Hiller, the Hospital Anxiety Depression Scale, and the General Anxiety Disorder-7 were used. Using CIDI, we have identified one or more mental disorders in 46 tinnitus patients. In that group, we found persistent affective disorders (37 %), anxiety disorders (32 %), and somatoform disorders (27 %). Those patients who had affective or anxiety disorders were more distressed by tinnitus and were more anxious and more depressed than tinnitus patients without mental disorders. Psychological impairment positively correlated with tinnitus distress: Patients with decompensated tinnitus had significantly more affective and anxiety disorders than patients with compensated tinnitus. In the present study, we have detected a high rate (almost half of the cases) of psychological disorders occurring in patients with chronic tinnitus. The patients diagnosed with psychological disorders were predominantly affected by affective and anxiety disorders. Psychological disorders were associated with severity of tinnitus distress. Our findings imply a need for routine comprehensive screening of mental disorders in patients with chronic tinnitus.

  2. Success, Failure and Emotions: Examining the Relationship between Performance Feedback and Emotions in Diagnostic Reasoning

    Science.gov (United States)

    Jarrell, Amanda; Harley, Jason M.; Lajoie, Susanne; Naismith, Laura

    2017-01-01

    Students experience a variety of emotions following achievement outcomes which stand to influence how they learn and perform in academic settings. However, little is known about the link between student outcome emotions and dimensions of performance feedback in computer-based learning environments (CBLEs). Understanding the dynamics of this…

  3. Performance of thyroid scintigraphy in the thyrotoxicosis etiological diagnosis: about 210 cases; Performance de la scintigraphie thyroidienne dans le diagnostic etiologique des thyrotoxicoses: a propos de 210 cas

    Energy Technology Data Exchange (ETDEWEB)

    Chatti, K.; Nouira, M.; Guezguez, M.; Sfar, R.; Essabbah, H. [CHU Sahloul, Service de medecine nucleaire, Sousse (Tunisia); Zantour, B. [CHU Mahdia, service d' endocrinologie (Tunisia)

    2010-07-01

    Purpose: The thyrotoxicosis is a syndrome linked to thyroid hormones excess grouping any causes leading to a overload in circulating hormones, including these ones linked to an inflammatory process (thyroiditis) or an exogenous contribution. The etiologic diagnosis is based on complementary examinations. The objective of our work is to elucidate the performance of scintigraphy in the etiologic diagnosis and the therapy approach of thyrotoxicosis through the experience of our service. Conclusions: Scintigraphy has a place in the etiologic diagnosis of thyrotoxicosis. it brings functional and morphological information and allows to guide the diagnostic and therapeutic approach. (N.C.)

  4. Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects

    Energy Technology Data Exchange (ETDEWEB)

    Carotti, M. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Salaffi, F., E-mail: fsalaff@tin.it [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Morbiducci, J. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Ciapetti, A., E-mail: ciapetti.a@libero.it [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Bartolucci, L. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Gasparini, S. [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Ferraccioli, G. [Division of Rheumatology, Catholic University of the Sacred Heart, Rome (Italy); Giuseppetti, G.M. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Grassi, W. [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy)

    2012-08-15

    Objectives: To evaluate the presence of blood flow by colour Doppler ultrasonography (CDUS) in the wrist and finger joints of rheumatoid arthritis (RA) patients and healthy subjects and to define a cut-off value of CDUS resistive index (RI). Methods: Forty-three patients with RA and 43 healthy controls were examined by CDUS. The wrists, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were evaluated in each patient and he