Harris lines of the tibia across centuries: a comparison of two populations, medieval and contemporary in Central Europe

Objective: To determine the incidence of Harris lines in two medieval populations which inhabited the Canton of Berne, in Central Switzerland, and to compare the results with those of a contemporary population living in the same geographical area. A simplified method is described for measuring the age of the individual at the time of formation of Harris lines, with possible future applications. Design and patients: Radiographs of 112 well-preserved tibiae of skeletons of two medieval populations from the eighth to fifteenth centuries were reviewed for the incidence of Harris lines. The results were compared with those of 138 current patients living in the same geographic location in Central Switzerland. Age and gender of the medieval individual were determined using known anthropological methods. Age of bone at the time of formation of Harris lines was estimated according to the method of Maat. Results: Harris lines were found in 88 of 112 (80%) of the examined medieval skeletons and in 28 of 138 (20%) of the living individuals. Higher incidences of Harris lines were found at the age of 2years and at ages between 8 and 12years in both populations. No gender difference was found regarding the incidence of Harris lines. In both populations the occurrence of Harris lines was associated with certain diseases such as degenerative bone disease, trauma, osteoporosis, rheumatoid arthritis, peripheral vascular diseases, rickets and bony deformities. Conclusion: A high incidence of Harris lines was found in the medieval population, perhaps reflecting difficult living and hygienic conditions, but also the poor care and neglect of the children population. Measuring the age of the individual at the time of formation of Harris lines is simple and may have future clinical applications in the paediatric population for medico-legal purposes. The application of Harris lines as a marker in follow-up of osteoporosis may need further evaluatio

Diagnostic and interventional radiology: a strategy to introduce reference dose level taking into account the national practice

The purpose of this study is to present a strategy to define the reference dose levels for fluoroscopic, dose-intensive examinations. This work is a part of the project of the Federal Office of Public Health of Switzerland to translate the guidelines of the International Commission on Radiological Protection and the European Union into action. The study will also be used to set reference dose levels on the basis of a national survey. All the fluoroscopic units, involved in the survey, were equipped with a KAP (kerma-area product) meter. All KAP meters were first calibrated to ensure the comparability of the dose measurements. The doses and the dose rates together with subjective image quality measurements were acquired in all the centres. Eight types of examination were chosen by a panel of radiologists, and each of the five centres involved agreed to monitor 20 patients per examination type. A wide variation in the dose and the image quality in fixed geometry was observed. For example, the skin dose rate for abdominal examinations varied in the range of 12-42 mGy min−1 for comparable image quality. Average KAP values of 67, 178, 106, 102, 473, 205, 307 and 316 Gy cm2 were recorded for barium meal, abdominal angiography, cerebral angiography, barium enema, hepatic embolisation, biliary drainage, cerebral embolisation and femoral stenting, respectively. The values obtained in this limited study are generally higher than the ones available in the literature and strategies to optimise these studies have to be discussed. A strict control concerning the denomination of the examination type involved in such a study is mandatory to obtain reliable data. This can only be done through a close collaboration between physicians, radiographers and medical physicist

Strategien zur Reduktion der CT-Strahlendosis

Zusammenfassung: Die rasante technische Weiterentwicklung der CT hat in den letzten Jahren zu einer deutlichen Zunahme der diagnostischen Möglichkeiten geführt, mit dem Resultat, dass die CT-Untersuchungszahlen weltweit angestiegen sind. Dies hat ebenfalls Auswirkung auf die Strahlenexposition der Bevölkerung. Bis heute sind zahlreiche Publikationen erschienen, die gezeigt haben, dass eine Dosisreduktion erreicht werden kann, ohne dadurch die Bildqualität und Sensitivität der CT zu beeinträchtigen. Die Mehrzahl der Strategien zur Dosisoptimierung sind einfach anzuwenden und unabhängig von der Detektorkonfiguration des CT-Scanners. Im vorliegenden Übersichtsartikel werden die wichtigsten Methoden vorgestellt: indikationsabhängige Methoden (z.B. rechtfertigende Indikation, Reduktion der Röhrenspannung für die CT-Angiographie, Wahl von Kollimation und Pitchfaktor, Minimierung der Untersuchungsphasen, Senkung der Röhrenspannung und des -stroms für die Nativphase), herstellerabhängige Methoden (z.B. automatische Röhrenstrommodulation, adaptive Filter zur Reduktion des Bildrauschens, iterative Bildrekonstruktion) und allgemeine Methoden (z.B. Patientenzentrierung im Isozentrum der CT-Gantry, Reduktion der Scanlänge, Anwendung von Röntgenschutzmitteln, Reduktion der Röhrenspannung und/oder des -stroms für den CT-Planungsscan

How to set up and apply reference levels in fluoroscopy at a national level

A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110Gy cm2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literatur

Protective Embolization of the Gastroduodenal Artery with a One-HydroCoil Technique in Radioembolization Procedures

Purpose: Protective occlusion of the gastroduodenal artery (GDA) is required to avoid severe adverse effects and complications in radioembolization procedures. Because of the expandable features of HydroCoils, our goal was to occlude the GDA with only one HydroCoil to provide particle reflux protection. Methods: Twenty-three subjects with unresectable liver tumors, who were scheduled for protective occlusion of the GDA before radioembolization therapy, were included. The primary end point was to achieve a proximal occlusion of the GDA with only one detachable HydroCoil. Evaluated parameters were duration of deployment, and early (during the intervention) and late (7-21days) occlusion rates of GDA. Secondary end points included complete duration of the intervention, amount of contrast medium used, fluoroscopy rates, and adverse effects. Results: In all cases, the GDA was successfully occluded with only one HydroCoil. The selected diameter/length range was 4/10mm in 2 patients, 4/15mm in 6 patients, and 4/20mm in 15 patients. HydroCoils were implanted, on average, 3.75mm from the origin of the GDA (range 1.5-6.8mm), with an average deployment time of 2:47 (median 2:42, range 2:30-3:07) min. In 21 (91%) of 23 patients, a complete occlusion of the GDA was achieved during the first 30min after the coil implantation; however, in all patients, a late occlusion of the GDA was present after 6 to 29days. No clinical or technical complications were reported. Conclusion: We demonstrated that occlusion of the GDA with a single HydroCoil is a safe procedure and successfully prevents extrahepatic embolization before radioembolizatio

Postmortem imaging of blood and its characteristics using MSCT and MRI

The rapid development of computed tomography (CT) and magnetic resonance imaging (MRI) led to the introduction and establishment in postmortem investigations. The objectives of this preliminary study were to describe the imaging appearances of the early postmortem changes of blood after cessation of the circulation, such as sedimentation, postmortem clotting, and internal livores, and to give a few first suggestions on how to differentiate them from other forensic findings. In the Virtopsy project, 95 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy and therefore 44 cases have been investigated in this study. Postmortem alterations as well as the forensic relevant findings of the blood, such as internal or subcutaneous bleedings, are presented on the basis of their imaging appearances in multislice CT and MR

Degeneration of the cervical disc: histology compared with radiography and magnetic resonance imaging

Decisions about the treatment of neck pain are largely made on the basis of information gained from plain X-rays and magnetic resonance imaging (MRI), which are used routinely as part of preliminary investigation. We performed a descriptive cadaveric study to compare histology with radiography and MRI. We correlated plain radiography, disc height [Farfan index (FI)] and MRI findings with histology to assess the ability of radiology to detect significant pathologic lesions. The study included 52 motion segments from nine subjects over the age of 50, who underwent routine hospital autopsy. Disc degeneration was assessed by histology, radiography, disc height (FI: anterior disc height plus posterior disc height divided by anterioposterior diameter) and MRI using established grading systems. Most of the discs were classified radiologically as grade 1 (19/52), grade 2 (13/52), grade 3 (9/52) or grade 4 (3/52). Eight of the discs were graded as normal. The distribution of MRI grades was grade 0 (9/36), grade 1 (9/36), grade 2 (7/36), grade 3 (8/36) and grade 4 (3/36). Half of the discs (26/52) showed advanced (grade 4) degeneration histologically. FI correlated with histological grade (P=0.013), MRI grade (P=0.02) and radiological grade (P<0.001) of degeneration. Radiological and histological grade of degeneration showed a weak correlation (r=0.3, P=0.033). MRI correlated with overall histological grade (r=0.41, P=0.015, n=34). Histological features (e.g., tears, rim lesions, prolapse of nucleus material) were poorly recognised by MRI, which had a sensitivity for disc material prolapse and annulus tears of less than 40%. Our study showed that discs from patients over 50years are histologically severely degenerated; however, these changes may not be detected by conventional radiography and MR

SEVERE OSTEOPOROSIS DUE TO SYSTEMIC MAST CELL DISEASE: SUCCESSFUL TREATMENT WITH INTERFERON ALPHA-2B

We describe a 33-yr-old man suffering from severe vertebral osteoporosis and urticaria pigmentosa due to systemic mast cell disease (SMCD). Because i.v. clodronate therapy could not prevent further vertebral fractures, an additional treatment with interferon alpha-2b was initiated. During 24 months of treatment, our patient had no further pain episodes, no new vertebral fractures were discovered, trabecular bone mineral density (BMD) increased significantly and urticarial symptoms improved. Nevertheless, the extent of skin lesions remained unchanged. On histological examination, a remarkable decrease of mast cells was observed in the bone marrow, but not in the skin. Five months after discontinuation of interferon alpha-2b, trabecular BMD decreased and urticarial symptoms deteriorated. These findings illustrate a beneficial effect of interferon alpha-2b on SMCD-induced osteoporosis as well as urticarial symptoms, and raise the question whether this treatment may have a diverse impact on mast cell populations in different tissue

Cohort-based T-SSIM Visual Computing for Radiation Therapy Prediction and Exploration

We describe a visual computing approach to radiation therapy (RT) planning, based on spatial similarity within a patient cohort. In radiotherapy for head and neck cancer treatment, dosage to organs at risk surrounding a tumor is a large cause of treatment toxicity. Along with the availability of patient repositories, this situation has lead to clinician interest in understanding and predicting RT outcomes based on previously treated similar patients. To enable this type of analysis, we introduce a novel topology-based spatial similarity measure, T-SSIM, and a predictive algorithm based on this similarity measure. We couple the algorithm with a visual steering interface that intertwines visual encodings for the spatial data and statistical results, including a novel parallel-marker encoding that is spatially aware. We report quantitative results on a cohort of 165 patients, as well as a qualitative evaluation with domain experts in radiation oncology, data management, biostatistics, and medical imaging, who are collaborating remotely.Comment: IEEE VIS (SciVis) 201