AJR. American journal of roentgenology
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AJR Am J Roentgenol · Jul 2011
Clinical TrialRadiographic and CT evaluation of recombinant human bone morphogenetic protein-2-assisted spinal interbody fusion.
Bone morphogenetic proteins BMPs, when used in spinal fusion, hasten healing and initiate distinct imaging features. We undertook a study to record and analyze the radiographic and CT changes after the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal fusion surgery. ⋯ Features observed on imaging that we attributed to the use of rhBMP-2 included an enhanced fusion rate and an increased incidence of prevertebral soft-tissue swelling in patients who underwent cervical fusion. Endplate resorption was observed in 100% of patients who underwent cervical fusion and in 82% of the lumbar levels. Subsidence of the cage resulting in narrowing of the disk space was seen in more than 50% of cases. Cage migration and heterotopic bone formation in the spinal canal and neural foramen occurred maximally in the lumbar spine of patients in whom a polyetheretherketone cage was placed using a transforaminal approach.
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AJR Am J Roentgenol · Jul 2011
The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change?
The objective of our study was to evaluate the prevalence and site of fractures detected on skeletal surveys performed for suspected child abuse at a tertiary children's hospital and to determine whether any survey images may be eliminated without affecting clinical care or the ability to make a diagnosis. ⋯ In skeletal surveys performed for suspected child abuse, fractures limited to sites other than the long bones, ribs, skull, and clavicles are rare. The additional radiation exposure and cost of obtaining radiographs of the spine, pelvis, hands, and feet may outweigh their potential benefit. Given the rarity of fractures of the spine, pelvis, hands, and feet, consideration may be given to eliminating those views from routine skeletal surveys performed to evaluate for suspected child abuse.
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AJR Am J Roentgenol · Jul 2011
Are chest radiographs routinely indicated after chest tube removal following cardiac surgery?
The purpose of this prospective study was to determine the incidence and clinical significance of pneumothoraces detected on routine radiography after chest tube removal following cardiac surgery and correlate those findings with an immediate postprocedure assessment of the likelihood of new pneumothorax. ⋯ Chest radiography performed after chest tube removal following cardiac surgery is necessary only if the patient has respiratory or hemodynamic changes or if there are problems with the technical aspect of chest tube removal. Following this guideline in our patient population could have eliminated 86.3% of radiographs without missing any clinically significant pneumothoraces.
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In this review, we attempt to address many of the issues that are related to ensuring patient benefit in body CT, balancing the use of ionizing radiation and iodinated contrast media. We attempt to not only summarize the literature but also make recommendations relevant to CT protocols, including the technical parameters of both the scanner and the associated contrast media. ⋯ Although CT is a powerful tool that has transformed the practice of medicine, the benefits are accompanied by important risks. Radiologists must understand these risks and the strategies available to minimize them as well as the risks associated with contrast medium delivery in abdominal CT.