The influence of short range forces on melting along grain boundaries

We investigate a model which couples diffusional melting and nanoscale structural forces via a combined nano-mesoscale description. Specifically, we obtain analytic and numerical solutions for melting processes at grain boundaries influenced by structural disjoining forces in the experimentally relevant regime of small deviations from the melting temperature. Though spatially limited to the close vicinity of the tip of the propagating melt finger, the influence of the disjoining forces is remarkable and leads to a strong modification of the penetration velocity. The problem is represented in terms of a sharp interface model to capture the wide range of relevant length scales, predicting the growth velocity and the length scale describing the pattern, depending on temperature, grain boundary energy, strength and length scale of the exponential decay of the disjoining potential. Close to equilibrium the short-range effects near the triple junctions can be expressed through a contact angle renormalisation in a mesoscale formulation. For higher driving forces strong deviations are found, leading to a significantly higher melting velocity than predicted from a purely mesoscopic description.Comment: 10 page

Scoliosis imaging : an analysis of radiation risk in the CT scan projection radiograph and a comparison with projection radiography and EOS

Introduction: Scoliosis is defined as a deformity of the spine with lateral curvature in the coronal plane. It requires regular X-ray imaging to monitor the progress of the disorder, therefore scoliotic patients are frequently exposed to radiation. It is important to lower the risk from these exposures for young patients. The aim of this work is to compare organ dose (OD) values resulting from Scan Projection Radiograph (SPR) mode in CT against projection radiography and EOS® imaging system when assessing scoliosis. Methods: A dosimetry phantom was used to represent a 10-year old child. Thermoluminescent dosimetry detectors were used for measuring OD. The phantom was imaged with CT in SPR mode using 27 imaging parameters; projection radiography and EOS machines using local scoliosis imaging procedures. Imaging was performed in anteroposterior, posteroanterior and lateral projections. Results: 17 protocols delivered significantly lower radiation dose than projection radiography (p <0.05). OD values from the CT SPR imaging protocols and projection radiography were statistically significant higher than the results from EOS. No statistically significant differences in OD were observed between 10 imaging protocols and those from projection radiography and EOS imaging protocols (p >0.05). Conclusion: EOS has the lowest dose. Where this technology is not available we suggest there is a potential for OD reduction in scoliosis imaging using CT SPR compared to projection radiography. Further work is required to investigate image quality in relation to the measurement of Cobb angle with CT SPR

Development and validation of a bespoke phantom to test accuracy of Cobb angle measurements

Introduction: Adolescent idiopathic scoliosis (AIS) is a spinal deformity that causes the spine to bend laterally. Patients with AIS undergo frequent X-ray examinations to monitor the progression of the disorder by through the measurement of the Cobb angle. Frequent exposure of adolescents poses the risk of radiation-induced cancer. The aim of this research was to design and build a bespoke phantom representing a 10-year-old child with AIS to allow optimisation of imaging protocols for AIS assessment through the accuracy of Cobb angle measurements. Method: Poly-methyl methacrylate (PMMA) and plaster of Paris (PoP) were used to represent human soft tissue and bone tissue, respectively, to construct a phantom exhibiting a 15olateral curve of the spine. The phantom was validated by comparing the Hounsfield unit (HU)of its vertebrae with that of human and sheep. Additionally, comparisons of signal-to-noise ratio (SNR) to those from a commercially available phantom. An assessment of the accuracy of the radiographic assessment of the Cobb angle measurement was performed. Results: The HU of the PoP vertebrae was 628 (SD= 56), human vertebrae was 598 (SD= 79) and sheep vertebra was 605 (SD= 83). The SNR values of the two phantoms correlated strongly (r = 0.93 (p = 0.00)). The measured scoliosis angle was 14 degrees. Conclusion:The phantom has physical characteristics (in terms of spinal deformity) and radiological characteristics (in terms of HU and SNR values) of the spine of a 10-year-old child with AIS. This phantom has utility for the optimisation of x-ray imaging techniques in 10 year old children. Implications for practice: A phantom to investigate new x-ray imaging techniques and technology in the assessment of scoliosis and to optimise currently used protocols

The accuracy of Cobb angle measurement on CT scan projection radiograph images

Introduction: Adolescent idiopathic scoliosis (AIS) is a spinal deformity that can affect young children. It requires frequent exposure to X-rays to monitor the deformity, which can lead to the development of radiation-induced cancer later in life. The aim of this study is to test the accuracy of using scan projection radiography (SPR) in computed tomography (CT) scans for AIS assessment. This scanning mode delivers low radiation compared with conventional radiography. Method: A bespoke phantom with a 14°scoliotic spine was scanned in CT SPR mode using 18 imaging acquisitions. These images were visually evaluated against set criteria to determine their suitability for Cobb angle measurements Those deemed of insufficient quality were excluded from the study (n=8, excluded). Cobb angle measurements were then performed on the remaining images (n=10, included) by 13 observers. Results: On average, the difference between the measured Cobb angle andthe known angle was –2.75°(SD 1.46°). The agreement between the observers was good (p = 0.861, 95% CI 0.70-0.95)and comparable to similar studies on other imaging modalities which are used for Cobb angle estimation. Conclusion: CT SPR images can be usedfor AIS assessment with the 5°margin of error that is clinically acceptable. Implications for practice: The outcome is promising for patients and health providers because it provides an opportunity to reduce patient dose, achieve clinically acceptable Cobb angle measurements whilst using existing (CT) technology that is available in most hospital

STEPFORWARD study: a randomised controlled feasibility trial of a self-aligning prosthetic ankle-foot for older patients with vascular-related amputations

Objectives To determine the feasibility of conducting a full-scale randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard prosthetic ankle-foot. Design Multicentre parallel group feasibility RCT. Setting Five prosthetics centres in England recruiting from July 2018 to August 2019. Participants Adults aged ≥50 years with a vascular-related or non-traumatic transtibial amputation for 1 year or longer, categorised as having 'limited community mobility' and using a non-self-aligning ankle-foot. Intervention Participants were randomised into one of two groups for 12 weeks: self-aligning prosthetic ankle-foot or existing non-self-aligning prosthetic ankle-foot. Outcomes Feasibility measures: recruitment, consent and retention rates; and completeness of questionnaire and clinical assessment datasets across multiple time points. Feasibility of collecting daily activity data with wearable technology and health resource use data with a bespoke questionnaire. Results Fifty-five participants were randomised (61% of the target 90 participants): n=27 self-aligning ankle-foot group, n=28 non-self-aligning ankle-foot group. Fifty-one participants were included in the final analysis (71% of the target number of participants). The consent rate and retention at final follow-up were 86% and 93%, respectively. The average recruitment rate was 1.25 participants/site/month (95% CI 0.39 to 2.1). Completeness of questionnaires ranged from 89%–94%, and clinical assessments were 92%–95%, including the activity monitor data. The average completion rates for the EQ-5D-5L and bespoke resource use questionnaire were 93% and 63%, respectively. Conclusions This feasibility trial recruited and retained participants who were categorised as having 'limited community mobility' following a transtibial amputation. The high retention rate of 93% indicated the trial was acceptable to participants and feasible to deliver as a full-scale RCT. The findings support a future, fully powered evaluation of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard non-self-aligning version with some adjustments to the trial design and delivery

Self-aligning prosthetic device for older patients with vascular-related amputations: protocol for a randomised feasibility study (the STEPFORWARD study)

Introduction: The majority of older patients with a transtibial amputation are prescribed a standard (more rigid, not self-aligning) prosthesis. These are mostly suitable for level walking, and cannot adjust to different sloped surfaces. This makes walking more difficult and less energy efficient, possibly leading to longer term disuse. A Cochrane Review concluded that there was insufficient evidence to recommend any individual type of prosthetic ankle-foot mechanism. This trial will establish the feasibility of conducting a large-scale trial to assess the effectiveness and cost-effectiveness of a self-aligning prosthesis for older patients with vascular-related amputations and other health issues compared with a standard prosthesis. Methods and analysis: This feasibility trial is a pragmatic, parallel group, randomised controlled trial (RCT) comparing standard treatment with a more rigid prosthesis versus a self-aligning prosthesis. The target sample size is 90 patients, who are aged 50 years and over, and have a transtibial amputation, where amputation aetiology is mostly vascular-related or non-traumatic. Feasibility will be measured by consent and retention rates, a plausible future sample size over a 24-month recruitment period and completeness of outcome measures. Qualitative interviews will be carried out with trial participants to explore issues around study processes and acceptability of the intervention. Focus groups with staff at prosthetics centres will explore barriers to successful delivery of the trial. Findings from the qualitative work will be integrated with the feasibility trial outcomes in order to inform the design of a full-scale RCT. Ethics and dissemination: Ethical approval was granted by Yorkshire and the Humber—Leeds West Research Ethics Committee on 4 May 2018. The findings will be disseminated via peer-reviewed research publications, articles in relevant newsletters, presentations at relevant conferences and the patient advisory group