Is the use of the cervical vertebrae maturation method justified to determine skeletal age? A comparison of radiation dose of two strategies for skeletal age estimation

The aim of this study was to assess effective doses of a lateral cephalogram radiograph with and without thyroid shield and compare the differences with the radiation dose of a hand-wrist radiograph. Thermoluminescent dosimeters were placed at 19 different sites in the head and neck of a tissue-equivalent human skull (RANDO phantom). Analogue lateral cephalograms with and without thyroid shield (67kV, 250 mA, 10 mAs) and hand-wrist radiographs (40kV, 250 mA, 10 mAs) were obtained. The effective doses were calculated using the 2007 International Commission on Radiological Protection recommendations. The effective dose for conventional lateral cephalogram without a thyroid shield was 5.03 microsieverts (µSv). By applying a thyroid shield to the RANDO phantom, a remarkable dose reduction of 1.73 µSv could be achieved. The effective dose of a conventional hand-wrist radiograph was calculated to be 0.16 µSv. Adding the effective dose of the hand-wrist radiograph to the effective dose of the lateral cephalogram with thyroid shield resulted in a cumulative effective dose of 3.46 µSv. Without thyroid shield, the effective dose of a lateral cephalogram was approximately 1.5-fold increased than the cumulative effective dose of a hand-wrist radiograph and a lateral cephalogram with thyroid shield. Thyroid is an organ that is very sensitive to radiation exposure. Its shielding will significantly reduce the effective dose. An additional hand-wrist radiograph, involving no vulnerable tissues, however, causes very little radiation risk. In accordance with the ALARA (As Low As Reasonably Achievable) principle, if an evaluation of skeletal age is indicated, an additional hand-wrist radiograph seems much more justifiable than removing the thyroid shiel

Pharyngeal airway dimensions: a cephalometric, growth-study-based analysis of physiological variations in children aged 6-17

SummaryOBJECTIVE: The aim was to assess pharyngeal airway dimensions and physiological changes based on lateral cephalometric radiographs from healthy untreated children aged 6-17 years. MATERIALS/METHODS: The sample consisted of 880 lateral cephalograms (412 females and 468 males) of the Zurich Craniofacial Growth Study. Statistical analyses on cephalometric measurements of airway dimensions (distances ‘p': shortest distance between soft palate and posterior pharyngeal wall and ‘t': shortest distance between tongue and posterior pharyngeal wall) and craniofacial parameters were performed. To disclose differences between different age groups, a Kruskal-Wallis test was applied. The influence of gender on ‘p' and ‘t' was analysed by a Mann-Whitney U-test for each age group separately. The Spearman correlation was computed in order to investigate associations between craniofacial parameters. Variables associated with ‘p' and ‘t' were chosen for multiple regression model investigation. RESULTS: The results demonstrated high interindividual variations. A slight influence of age on ‘p' (P = 0.034) could be attested (+1.03mm) but not on ‘t' (P = 0.208). With the exception of the 9-year age group, no significant differences between the genders were found. Correlation analysis revealed several statistically significant correlations between ‘t' or ‘p' and antero-posterior cephalometric variables. All correlation coefficients were, however, very low and the adjusted coefficient of determination also revealed the regression model to be very weak. CONCLUSIONS: The high interindividual variations of ‘p' and ‘t' render the use of reference values problematic. Contrary to other craniofacial structures, neither age-related changes nor sexual dimorphism were found for ‘p' and ‘t'. Any associations to antero-posterior cephalometric characteristics seem lo

The inclination of mandibular incisors revisited

Objective: To reassess the inclination of lower incisors and evaluate possible associations with gender, age, symphyseal parameters, and skeletal pattern. Materials and Methods: Twelve hundred and seventy-two (605 females, 667 males) cephalograms of untreated subjects of a craniofacial growth study (age: 8-16 years) were evaluated. Correlations between the angulation of the lower incisors and age, symphyseal distances (height, width, and depth), symphyseal ratios (height-width, height-depth), and skeletal angles (divergence of the jaws and gonial angle) were investigated for all ages separately and for both sexes independently. Results: The inclination of lower incisors increased over age (8 years: girls  =  93.9° [95% CI, 92.3°-95.7°], boys  =  93.3° [95% CI, 91.8°-94.9°]; 16 years: girls  =  96.1° [95% CI, 94.1°-98.2°], boys  =  97.1° [95% CI, 95.6°-98.6°]). Inclination of lower incisors correlated with the divergence of the jaws for all ages significantly or highly significantly, except for boys and girls 9 years of age and girls 11 and 12 years of age, for which only a tendency was observed. Similarly, a strong correlation to gonial angle could be observed. No correlation could be found between the inclination of lower incisors and any symphyseal parameters (absolute measurements and ratios), except for symphyseal depth. Conclusion: Lower incisor inclination is linked to the subject's sex, age, and skeletal pattern. It is not associated with symphyseal dimensions, except symphyseal depth. Factors related to natural inclination of lower incisors should be respected when establishing a treatment plan

MRI of the temporo-mandibular joint: which sequence is best suited to assess the cortical bone of the mandibular condyle? A cadaveric study using micro-CT as the standard of reference

Objective: To determine the best suited sagittal MRI sequence out of a standard temporo-mandibular joint (TMJ) imaging protocol for the assessment of the cortical bone of the mandibular condyles of cadaveric specimens using micro-CT as the standard of reference. Methods: Sixteen TMJs in 8 human cadaveric heads (mean age, 81years) were examined by MRI. Upon all sagittal sequences, two observers measured the cortical bone thickness (CBT) of the anterior, superior and posterior portions of the mandibular condyles (i.e. objective analysis), and assessed for the presence of cortical bone thinning, erosions or surface irregularities as well as subcortical bone cysts and anterior osteophytes (i.e. subjective analysis). Micro-CT of the condyles was performed to serve as the standard of reference for statistical analysis. Results: Inter-observer agreements for objective (r = 0.83-0.99, P < 0.01) and subjective (κ = 0.67-0.88) analyses were very good. Mean CBT measurements were most accurate, and cortical bone thinning, erosions, surface irregularities and subcortical bone cysts were best depicted on the 3D fast spoiled gradient echo recalled sequence (3D FSPGR). Conclusion: The most reliable MRI sequence to assess the cortical bone of the mandibular condyles on sagittal imaging planes is the 3D FSPGR sequence. Key Points : • MRI may be used to assess the cortical bone of the TMJ. • Depiction of cortical bone is best on 3D FSPGR sequences. • MRI can assess treatment response in patients with TMJ abnormalitie

The impact of ACLS training in theoretical knowledge

Background and aim: Italy has a public health system where also young physicians hold various jobs, including Emergency Services. Advanced Cardiovascular Life Support (ACLS) course is developed for the management of cardiovascular emergencies. This study evaluates the preparation of Italian physicians on ACLS and their perceived need to be trained on it. Methods: surveys had been administered to 4698 Medical Doctors. They consisted of questions on sociodemographic characteristics, knowledge of ACLS protocol, and willingness to attend an ACLS course. Results: Online survey reached 4698 physicians, 137 of them had been excluded for invalid answering. People who had attended an ACLS course scored significantly higher on the test (M=5.68 SD=1.89) than those who had not (M=4.71 SD=1.91). Experienced physicians scored significantly higher (M=5.25 SD=1.96) than recently licensed ones (M=4.84 SD=1.94). Multiple regression was used to predict the ACLS test score. Conclusions: ACLS training has a stronger effect on Cardiovascular Emergency management knowledge (d=-.510) than general working experience (d=-.212). The median score in ACLS knowledge is low (5/10), despite its importance. Multiple linear regression reveals that ACLS has the greatest impact on the score. A small portion of doctors have attended an ACLS course (22%), but the majority of them would participate (89%)

SIMED-New Doc course, a matter of reflection

Background and aim: Obtaining a degree in medicine in Italy qualifies for the medical profession; this fact has entailed a newly qualified doctor's remarkable involvement on the medical activities of the National Health Service, especially during the Covid-19 pandemic. It is important to understand the knowledge of the newly qualified doctors and to create specific courses oriented to them. The aim of the study is to evaluate the impact of a peer learning course for the students who attend the last year of medicine school, with the purpose of defining the formal requests to integrate on the course. Methods: A pre and post qualitative research has been carried out on SIMED-NEWDOC course. The course consisted on peer teaching lectures, as lecturers were resident doctors part of SIMED board. At the end of the course it has been submitted a survey to the participants, and data has been analyzed. Results: The students enrolled were 139, the average of the participants was 27% of the registered. A qualitative evaluation questionnaire was submitted, the responses were 32 (86%). Average age was 25. Participants attending the last year of medicine school were 30 (95%). 40% of them declared to have attended at least 5 lessons. Among the course participants, 96% judged the course as very useful. Conclusions: All questionnaire results are useful to reflect on future projects. It is necessary to implement further educational projects to better understand the phenomenon, considering the positive impact that participants declared

TRACKING OF THE HAND “PRESSURE POINT” ON THE GRIP OF A RECURVE BOW: A WEARABLE SOLUTION

The purpose of this study was to design and prototype a non-invasive wearable solution suitable for measuring speeds, accelerations and orientation of the hand-grip as well as the pressures between the hand and the grip of a recurve bow. Therefore, a device has been created that properly blends two technologies: an Inertial Measurement Unit (IMU) and a Force-Sensitive-Resistor (FSR) membrane. A preliminary evaluation of the device performance was conducted in collaboration with the Olympic athlete Mauro Nespoli. The obtained results demonstrate the potential of the proposed system, as well as highlight a number of interesting information from a biomechanical point of view, closely related to the shooting technique

Heavy-ion test report of LTC1668 DAC - LiteBIRD-NOTE-84

This document presents the results of a heavy-ion test program carried out on the Linear Technology LT1668 16-bit 50 Msps DAC (LTC1668IG) to identify single-event effects. In particular, it was studied the detection of single-event latch-up (SEL), single-event upsets (SEU), and single-event transients (SET) due to heavy-ions radiation. The tests were performed at the heavy-ion facility Tandem-ALPI at INFN Legnaro National Laboratory (Italy) in February 2021 and June 2022 for a total irradiation time of ~51 hours