CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

The blast pelvis

Decreasing the human cost of war is a vital role within the Ministry of Defence, and the Defence Medical Services. With the considerable improvements in care, from point of wounding to rehabilitation, it is possible that we have reached the ceiling of optimal management with available, deployed resources. Injury prevention or mitigation may therefore have a more important role than ever in improving survival rates. The current character of conflict, and certainly the recent conflicts in Iraq and Afghanistan have seen the Improvised Explosive Device used to devastating effect to personnel. These devices cause multisystem injuries, and have a high fatality. The lower extremity was most often affected in these recent conflicts, and many fatalities occurred. A greater understanding of lower extremity trauma biomechanics is likely to be key to preventing future fatalities due to injuries in this body region. This thesis focusses on lower extremity blast injury, performs a review of current understanding, and undertakes a casualty data analysis to further understand injury patterns and the cause of fatal wounding. This analysis finds that haemorrhage secondary to pelvic fracture is the key factor in fatal lower extremity injuries, and therefore an area of considerable research interest. Pelvic injury patterns were therefore analysed using measurement techniques to qualify injury patterns and understand the link between injury patterns and the presence of vascular injury. Subsequent physical and computational testing provided a platform to apply different loading conditions to the pelvis to replicate a blast injury, and understand the behaviour of the bony structures under high rate axial loading. This thesis concludes that the anterior pelvic ring at the pubic symphysis is key to pelvic integrity at high rates of loading. Disruption of the anterior pelvis can lead to subsequent posterior ligamentous rupture which, due to the proximity to major vessels, can lead to major haemorrhage and death. Preventing lateral disruption may be the key to maintaining pelvic integrity at these high loading rates, and preventing vascular compromise and fatality from lower extremity blast injuries.Open Acces

Short and Long Term Immobilization on the Lumbar Spinal Joints: An Experimental Study Using Large Animal Model

Low back pain (LBP) is a common, widespread social and economic problem. Degenerative disc disease has been considered as a main risk factor for the LBP. In order to develop safe, effective and cost-efficient treatments, it is important to explore the pathomechanisms of this disease. In vivo animal models have an irreplaceable role in detecting long-term reactions to environmental factors, biology or biomechanical risk factors, and preclinical evaluation of therapeutics. Large animal models, due to their similarity in cellular populations, anatomy and biomechanics, are more closely comparable to the human intervertebral disc than smaller animal models. The major goal of current thesis was characterizing the effect of short and long term immobilization on the magnetic resonance imaging, radiological, histological and biomechanical characteristics of the in vivo ovine lumbar spine joints. To achieve this target, four experimental projects were performed. In the first experimental portion, a three-dimension motion capture system was set up and validated. A reliable method of the spinal kinematic analysis was established. The second experimental portion evaluated the biomechanical aspect of a synthetic biomimetic spine model with a validated spinal biomechanical test system combined with the motion capture system set up in the first study. This established the whole system applicability to the specific goal of examining spinal biomechanics. The third experimental chapter is an in vitro ovine biomechanical study. The purpose of this study was to characterize the effect of loading and soaking conditions on the spinal segment biomechanical property. Results indicated the biomechanics of spinal samples with hydration and dehydration discs differ considerably. Thus, the suitable pretest conditions need to be considered during in vitro spinal biomechanical test. The fourth experimental portion was the in vivo ovine model study. The aim of this chapter was evaluate the effect of the short and long term immobilization on the ovine lumbar spinal joints. The posterior pedicle screw instrumentation was applied on skeletally mature sheep lumbar spine. The immobilized level and adjacent levels spinal joints were evaluated at 0, 6 and 26 weeks. Results demonstrated the both short and long term immobilization can induce spinal joint degeneration on sheep model. This work presents a novel degenerative disc model without the need for annulus violation or chemical treatmen

Evaluation of functional activity compensation strategies, level of physical activity, quality of life and management of physiotherapy for non-operative children with Legg-Calve-Perthes Disease

Abstract Background Legg-Calve-Perthes (Perthes) disease is defined as poor blood circulation in the hip joint and is associated with pain, limited range of motion, muscle weakness and joint instability. Physiotherapy is a key management approach to improve hip mobility and muscle strength to enhance daily functional activities. Walking was the only task that has been considered in the Perthes literature, while limited information is available regarding how children with Perthes could perform daily functional activities such as balance and squat activities. These activities have been recommended in the physiotherapy programme for non-operative children with Perthes to enhance their independence. Therefore, there is a need to investigate how non-operative children with Perthes perform during these activities to identify the abnormal movement pattern to help in setting an optimal rehabilitation goal. In addition, there is a need to understand the difficulties that may face patients with Perthes in the course of their lives. It is recommended that investigating physical activity level, quality of life, and how they manage the physiotherapy treatment is essential to understand Perthes disease's effect on children with Perthes and their families. Therefore, this thesis aims to provide essential knowledge to understand the effects of the disease better through: - evaluating how non-operative children with Perthes compensate in their movement during three functional activities (walking, single leg balance and squat), - evaluating physical activity levels and quality of life, and evaluating how they manage physiotherapy treatment. Methods This thesis was divided into two studies: study one aims to systematically review Perthes gait literature's quality and identify movement-compensation strategies during walking in non-operative children with Perthes. The quality of Perthes gait literature has been investigated by two independent reviewers using the adapted Downs and Black checklist. Study two aims to evaluate how non-operative children with Perthes perform during three functional activities (walking, single-leg balance and squat) by using the movement analysis toolkit, to evaluate the physical activity level and quality of life, and to evaluate how non-operative children with Perthes and their families manage the physiotherapy treatment by completing the questionnaires. Before investigating the abnormal movement pattern during three functional activities for children with Perthes, it is important to establish the reliability of the researcher on placing markers and the reliability of children walking to identify the source of error associated with biomechanical data. This reliability study has been investigated as part of the methods for study 2. Results The systematic review study identified eight articles that met all the inclusion criteria. The analysis of the overall agreement between two independent raters performing the adapted Downs and Black checklist on literature revealed an ‘almost perfect’ agreement as presented a Kappa value of 0.906 (95% CI: 0.84–1). The quality of Perthes gait literature displayed variations in data quality, with scores ranging from 12 to 17 out of 20 due to limitations on reporting, internal validity, external validity, and power information. The second study showed a statistically significant difference in the Perthes group compared to control in three functional activities (P<0.05). The hip joint was the most affected joint during functional activities as it showed lower minimum hip flexion and decreased hip rotation by approximately 7° on the affected Perthes leg compared to the control group. The kinetic data demonstrated that the peak of hip abductor moment was significantly higher in the Perthes group than the control group in three functional activities. In addition, children with Perthes iii demonstrated no statically significant difference in the level of physical activity compared to the control group (p>0.05), while they showed a statically significant difference (p<0.05) in quality of life as presented four scores lower than the control group. A questionnaire on managing physiotherapy treatment revealed that both non-operative children with Perthes and their parents reported greatly concerning pain. Conclusion The finding of movement-compensation strategy during functional activities and poor quality of life among non-operative children with Perthes may be due to pain, hip abductor muscle weakness, abnormal femoral head shape and lack of participation in the activities. Therefore, more research is needed to investigate the role of physiotherapy, pain management, and finding safe and enjoyable activities such as swimming and cycling to reduce the consequences of Perthes disease and help clinical providers set an optimal rehabilitation goal

Bodies of Seeing: A video ethnography of academic x-ray image interpretation training and professional vision in undergraduate radiology and radiography education

This thesis reports on a UK-based video ethnography of academic x-ray image interpretation training across two undergraduate courses in radiology and radiography. By studying the teaching and learning practices of the classroom, I initially explore the professional vision of x-ray image interpretation and how its relation to normal radiographic anatomy founds the practice of being ‘critical’. This criticality accomplishes a faculty of perceptual norms that is coded and organised and also, therefore, of a specific radiological vision. Professionals’ commitment to the cognitivist rhetoric of ‘looking at’/‘pattern recognition’ builds this critical perception, a perception that deepens in organisation when professionals endorse a ‘systematic approach’ that mediates matter-of-fact thoroughness and offers a helpful critical commentary towards the image. In what follows, I explore how x-ray image interpretation is constituted in case presentations. During training, x-ray images are treated with suspicion and as misleading and are aligned with a commitment to discursive contexts of ‘missed abnormality’, ‘interpretive risk’, and ‘technical error’. The image is subsequently constructed as ambiguous and that what is shown cannot be taken at face value. This interconnects with reenacting ideals around ‘seeing clearly’ that are explained through the teaching practices and material world of the academic setting and how, if misinterpretation is established, the ambiguity of the image is reduced by embodied gestures and technoscientific knowledge. By making this correction, the ambiguous image is reenacted and the misinterpretation of image content is explained. To conclude, I highlight how the professional vision of academic x-ray image interpretation prepares students for the workplace, shapes the classificatory interpretation of ab(normal) anatomy, manages ambiguity through embodied expectations and bodily norms, and cultivates body-machine relations