Imaging of knee injuries with special focus on tibial plateau fractures

Acute knee injury is a common event throughout life, and it is usually the result of a traffic accident, simple fall, or twisting injury. Over 90% of patients with acute knee injury undergo radiography. An overlooked fracture or delayed diagnosis can lead to poor patient outcome. The major aim of this thesis was retrospectively to study imaging of knee injury with a special focus on tibial plateau fractures in patients referred to a level-one trauma center. Multi-detector computed tomography (MDCT) findings of acute knee trauma were studied and compared to radiography, as well as whether non-contrast MDCT can detect cruciate ligaments with reasonable accuracy. The prevalence, type, and location of meniscal injuries in magnetic resonance imaging (MRI) were evaluated, particularly in order to assess the prevalence of unstable meniscal tears in acute knee trauma with tibial plateau fractures. The possibility to analyze with conventional MRI the signal appearance of menisci repaired with bioabsorbable arrows was also studied. The postoperative use of MDCT was studied in surgically treated tibial plateau fractures: to establish the frequency and indications of MDCT and to assess the common findings and their clinical impact in a level-one trauma hospital. This thesis focused on MDCT and MRI of knee injuries, and radiographs were analyzed when applica-ble. Radiography constitutes the basis for imaging acute knee injury, but MDCT can yield information beyond the capabilities of radiography. Especially in severely injured patients , sufficient radiographs are often difficult to obtain, and in those patients, radiography is unreliable to rule out fractures. MDCT detected intact cruciate ligaments with good specificity, accuracy, and negative predictive value, but the assessment of torn ligaments was unreliable. A total of 36% (14/39) patients with tibial plateau fracture had an unstable meniscal tear in MRI. When a meniscal tear is properly detected preoperatively, treatment can be combined with primary fracture fixation, thus avoiding another operation. The number of meniscal contusions was high. Awareness of the imaging features of this meniscal abnormality can help radiologists increase specificity by avoiding false-positive findings in meniscal tears. Postoperative menisci treated with bioabsorbable arrows showed no difference, among different signal intensities in MRI, among menisci between patients with operated or intact ACL. The highest incidence of menisci with an increased signal intensity extending to the meniscal surface was in patients whose surgery was within the previous 18 months. The results may indicate that a rather long time is necessary for menisci to heal completely after arrow repair. Whether the menisci with an increased signal intensity extending to the meniscal surface represent improper healing or re-tear, or whether this is just the earlier healing feature in the natural process remains unclear, and further prospective studies are needed to clarify this. Postoperative use of MDCT in tibial plateau fractures was rather infrequent even in this large trauma center, but when performed, it revealed clinically significant information, thus benefitting patients in regard to treatment.

X-ray scattering and diffraction enhanced imaging studies of in vitro breast tissues

This thesis is a study of the x-ray scattering properties of tissues and tumours of the breast. Clinical radiography is based on the absorption of the x-rays when passing right through the human body and gives information about the densities of the tissues. Besides being absorbed, x-rays may change their direction within the tissues due to elastic scattering or even to refraction. The phenomenon of scattering is a nuisance to radiography in general, and to mammography in particular, because it reduces the quality of the images. However, scattered x-rays bear very useful information about the structure of the tissues at the supra-molecular level. Some pathologies, like breast cancer, produce alterations to the structures of the tissues, being especially evident in collagen-rich tissues. On the other hand, the change of direction due to refraction of the x-rays on the tissue boundaries can be mapped. The diffraction enhanced imaging (DEI) technique uses a perfect crystal to convert the angular deviations of the x-rays into intensity variations, which can be recorded as images. This technique is of especial interest in the cases were the densities of the tissues are very similar (like in mammography) and the absorption images do not offer enough contrast. This thesis explores the structural differences existing in healthy and pathological collagen in breast tissue samples by the small-angle x-ray scattering (SAXS) technique and compares these differences with the morphological information found in the DEI images and the histo-pathology of the same samples. Several breast tissue samples were studied by SAXS technique in the European Synchrotron Radiation Facility (ESRF) in Grenoble, France. Scattering patterns of the different tissues of the breast were acquired and compared with the histology of the samples. The scattering signals from adipose tissue (fat), connective tissue (collagen) and necrotic tissue were identified. Moreover, a clear distinction could be done between the scattering signals from healthy collagen and from collagen from an invasive tumour. Scattering from collagen is very characteristic. It includes several scattering peaks and scattering features that carry information about the size and the spacing of the collagen fibrils in the tissues. It was found that the collagen fibrils in invaded tumours were thinner and had a d-spacing length 0,7% longer that fibrils from healthy tumours. The scattering signals from the breast tissues were compared with the histology by building colour-coded maps across the samples. They were also imaged with the DEI technique. There was a total agreement between the scattering maps, the morphological features seen in the images and the information of the histo- pathological examination. The thesis demonstrates that the x-ray scattering signal can be used to characterize tissues and that it carries important information about the pathological state of the breast tissues, thus showing the potential of the SAXS technique as a possible diagnostic tool for breast cancer.

Scattering and Refraction as Contrast Mechanisms in X-Ray Imaging

Differentiation of various types of soft tissues is of high importance in medical imaging, because changes in soft tissue structure are often associated with pathologies, such as cancer. However, the densities of different soft tissues may be very similar, making it difficult to distinguish them in absorption images. This is especially true when the consideration of patient dose limits the available signal-to-noise ratio. Refraction is more sensitive than absorption to changes in the density, and small angle x-ray scattering on the other hand contains information about the macromolecular structure of the tissues. Both of these can be used as potential sources of contrast when soft tissues are imaged, but little is known about the visibility of the signals in realistic imaging situations. In this work the visibility of small-angle scattering and refraction in the context of medical imaging has been studied using computational methods. The work focuses on the study of analyzer based imaging, where the information about the sample is recorded in the rocking curve of the analyzer crystal. Computational phantoms based on simple geometrical shapes with differing material properties are used. The objects have realistic dimensions and attenuation properties that could be encountered in real imaging situations. The scattering properties mimic various features of measured small-angle scattering curves. Ray-tracing methods are used to calculate the refraction and attenuation of the beam, and a scattering halo is accumulated, including the effect of multiple scattering. The changes in the shape of the rocking curve are analyzed with different methods, including diffraction enhanced imaging (DEI), extended DEI (E-DEI) and multiple image radiography (MIR). A wide angle DEI, called W-DEI, is introduced and its performance is compared with that of the established methods. The results indicate that the differences in scattered intensities from healthy and malignant breast tissues are distinguishable to some extent with reasonable dose. Especially the fraction of total scattering has large enough differences that it can serve as a useful source of contrast. The peaks related to the macromolecular structure come to angles that are rather large, and have intensities that are only a small fraction of the total scattered intensity. It is found that such peaks seem to have only limited usefulness in medical imaging. It is also found that W-DEI performs rather well when most of the intensity remains in the direct beam, indicating that dark field imaging methods may produce the best results when scattering is weak. Altogether, it is found that the analysis of scattered intensity is a viable option even in medical imaging where the patient dose is the limiting factor.

Cold model study of local liquid holdup in the dropping zone using x-ray

It is important to know and to quantify the liquid holdups both dynamic and static at local levels as it will lead to understand various blast furnace phenomena properly such as slag/metal.gas.solid reactions, gas flow behaviour and interfacial area between the gas/solid/liquid. In the present study, considering the importance of local liquid holdup and non-availability of holdup data in these systems, an attempt has been made to quantify the local holdups in the dropping and around raceway zones in a cold model study using a non-wetting packing for liquid. In order to quantify the liquid holdups at microscopic level, a previously developed technique, X-ray radiography, has been used. It is observed that the liquid flows in preferred paths or channels which carry droplets/rivulets. It has been found that local holdup in some regions of the packed bed is much higher than average at a particular flow rate and this can have important consequences for the correct modelling of such systems.

Non-Destructive Evaluation of Defects and Damage in Composite Materials and Structures

The mechanical behaviour of composite materials differs from that of conventional structural materials owing to their heterogeneous and anisotropic nature. Different types of defects and anomalies get induced in these materials during the fabrication process. Further, during their service life, the components made of composite materials develop different types of damage. The performance and life of such components is governed by the combined effect of all these defects and damage. While porosity, voids, inclusions etc., are some defects those can get induced during the fabrication of composites, matrix cracks, interface debonds, delaminations and fiber breakage are major types of service induced damage which are of concern. During the service life of components made of composites, one type of damage can grow and initiate another type of damage. For example, matrix cracks can gradually grow to the interface and initiate debonds. Interface debonds in a particular plane can lead to delaminations. Consequently, the combined effect of different types of distributed damage causes the failure of the component. A set of non-destructive evaluation (NDE) methods is well established for testing conventional metallic materials. Some of them can also be utilized for composite materials as they are, and in some cases with a little different approach or modification. Ultrasonics, Radiography, Thermography, Fiber Optics, Acoustic Emision Techniques etc., to name a few. Detection, evaluation and characterization of different types of defects and damage encountered in composite materials and structures using different NDE tools is discussed briefly in this paper.

X 射线转换屏用Tb3+激活磷酸盐发光玻璃

Phosphate glasses 60P2O5-15CS2O- 15Al2O3-10BaO were made by high temperature melt-annealing method. The absorption spectra, excitation spectra and emission spectra of Gd³⁺-Tb³⁺ and Ce3+-Gd³⁺-Tb³⁺ co-doped phosphate glass 60P2O5-15CS2O- 15Al2O3-10BaO were studied. The experimental results indicate that, the doping of Ce3+ and Gd³⁺ in Tb³⁺ phosphate glass has a good effect on the 545 nm emission of Tb³⁺ at UV excitation. The Ce3+-Gd³⁺-Tb³⁺ co-doped phosphate glass have a good x-ray luminescence at the radiation of x-ray with energy in 50-120 kev, and a high space resolution. The Ce3+-Gd³⁺-Tb³⁺ co-doped phosphate luminescence glass is a promising material for using in the digital radiography system in medical devices.

Efeitos do tratamento periodontal não cirúrgico sobre a densidade e altura óssea alveolar

O objetivo deste trabalho foi avaliar o efeito do tratamento periodontal não cirúrgico (TPNC), na densidade e na altura óssea alveolar, em pacientes com periodontite, utilizando radiografias digitais diretas. Cento e um sítios, em dezenove pacientes (idade média 36 7.3 anos) foram acompanhados no dia 0, e 90 e 180 dias após TPNC. Os índices clínicos de profundidade de bolsa a sondagem (PBS), nível de inserção clínica, sangramento à sondagem e índice de placa foram registrados e radiografias digitais foram feitas. A densidade foi analisada através de regiões ósseas de interesse colocadas sobre a crista óssea alveolar (ROI I) e sobre o osso medular (ROI II). A altura óssea alveolar foi medida através da distância da crista óssea alveolar até a junção cemento esmalte. Os sítios profundos (PBS ≥ 5mm) apresentaram uma melhora clínica significante (p <0.01), acompanhada de um aumento na densidade da ROI I (p <0.01). A ROI II mostrou um aumento na densidade dos sítios com PBS ≤ 3mm em pacientes com periodontite agressiva (p <0.05). No entanto, houve diminuição nos sítios com PBS ≥ 5mm nesses mesmos pacientes (p <0.03). A altura óssea alveolar não sofreu alteração após TPNC. Após o tratamento periodontal não cirúrgico, observou-se que as radiografias obtidas através da técnica digital direta parecem mostrar um aumento na densidade da crista óssea, nos sítios profundos dos pacientes com periodontite. No entanto, a redução da profundidade de bolsa e do ganho no nível de inserção clínica não foi acompanhada por alterações significantes na altura óssea alveolar nestes sítios.

Caracterização de um sistema digital de aquisição de imagens radiográficas utilizando nêutrons térmicos e raios gama para a inspeção de componentes mecânicos.

Ensaio não destrutivo é uma ferramenta essencial quando um equipamento, dispositivo ou componente não pode ser submetido a procedimentos destrutivos ou invasivos devido a razões de segurança, alto custo ou outras restrições físicas ou logísticas. Dentro deste quadro radiografias por transmissão com raios gama e nêutrons térmicos são técnicas singulares para inspecionar um objeto e desvendar sua estrutura interna devido à capacidade de atravessar uma vasta gama de materiais utilizados na indústria. Grosso modo, raios gama são mais atenuados por materiais pesados enquanto nêutrons térmicos são mais atenuados por materiais mais leves, tornando-as ferramentas complementares. Este trabalho apresenta os resultados obtidos na inspeção de vários componentes mecânicos, através da radiografia por transmissão com nêutrons térmicos e raios gama. O fluxo de nêutrons térmicos de 4,46x105 n.cm-2.s-1 disponível no canal principal do reator de pesquisa Argonauta do Instituto de Engenharia Nuclear foi usado como fonte para as imagens radiográficas com nêutrons. Raios dekeV emitidos pelo 198Au, também produzido no reator, foram usados como fonte de radiação para radiografias . Imaging Plates, especificamente produzidos para operar com nêutrons térmicos ou com raios X, foram empregados como detectores e dispositivos de armazenamento e captação de imagens para cada uma dessas radiações. Esses dispositivos exibem varias vantagens quando comparados ao filme radiográfico convencional. Com efeito, além de maior sensibilidade e serem reutilizáveis não são necessários câmaras escuras e processamento químico para a revelação. Em vez disso, ele é lido por um feixe de laser que libera elétrons armadilhados na rede cristalina durante a exposição à radiação, fornecendo uma imagem final digital. O desempenho de ambos os sistemas de aquisição de imagens, assim constituído, foi avaliado com respeito à sensibilidade, resolução espacial, linearidade e range dinâmico, incluído uma comparação com sistemas radiográficos com nêutrons empregando filmes e folhas de gadolínio como conversor de nêutrons em partículas carregadas. Além desta caracterização, diversos equipamentos e componentes foram radiografados com ambos os sistemas visando-se avaliar suas capacidades de desvendar a estrutura interna desses objetos e detectar estruturas e estados anormais. Dentro desta abordagem, uma neutrongrafia detectou a presença de material cerâmico remanescente empregado como molde no processo de fabricação nos canais de refrigeração de uma aleta do estator de uma turbina tipo turbo-fan, que deveria estar livre desse material. O reostato danificado de um sensor de pressão automotivo, foi identificado por neutrongrafia, embora nesse caso a radiografia também conseguiu realizar essa tarefa com melhor resolução, corroborando assim as curvas de resolução espacial obtidas na caracterização dos dois sistemas. A homogeneidade da distribuição do material encapsulado em uma gaxeta explosiva de chumbo utilizada na indústria aeroespacial foi igualmente verificada por neutrongrafia porque esse metal é relativamente transparente para nêutrons, mas suficientemente opaco para o explosivo rico em hidrogênio. Diversos outros instrumentos e componentes tais como variômetro, altímetro, bússola aeronáutica, injetor automotivo de combustível, foto-camera, disco rígido de computador, motor de passo, conectores eletrônicos e projéteis foram radiografados com ambos os sistemas visando avaliar suas habilidades em desvendar diferentes peculiaridades em função do agente interrogador.

Avaliação longitudinal da densidade radiográfica da crista óssea alveolar em pacientes com periodontite crônica e em pacientes saudáveis

A periodontite é um grupo dentro das doenças periodontais onde o tecido de suporte é acometido como resultado de um desequilíbrio entre uma agressão bacteriana e a resposta imunológica do hospedeiro. O exame radiográfico é um método não invasivo que quando usado de forma adequada pode prover imagens que demonstram perdas ósseas iniciais. A avaliação da densidade óssea já foi previamente descrita. Este estudo teve como objetivo avaliar as alterações de densidade óssea da crista alveolar no período de 4 meses, tanto em pacientes com periodontite crônica antes e depois da terapia básica, quanto em pacientes periodontalmente saudáveis. Os pacientes dos dois grupos foram submetidos a exame periodontal com Florida Probe. Foram realizadas 6 radiografias por paciente em cada momento da avaliação, à partir dessas imagens realizamos a avaliação da densidade óssea da crista alveolar através de áreas de interesse (ROI), utilizando o Kodak Dental Imaging Software 6.7. As comparações entre as medidas radiográficas do baseline e as da reavaliação, não apresentaram diferenças significantes para ROI 1, ROI 2, JCE-CO nos dois grupos. Sendo assim, observamos que o grupo de pacientes com periodontite crônica não apresentou diferença significante para densidade óssea da crista alveolar 4 meses após o tratamento, mesmo apresentando melhora dos parâmetros clínicos periodontais. O grupo de pacientes periodontalmente saudáveis também não apresentou alterações de densidade no mesmo período de tempo.

Characterisation of impact response of metallic foam/ceramic laminates

The impact response of laminated composites consisting of alternate layers of AI ahoy foam and Al2O3 was studied experimentally in low and intermediate velocity regimes. Low velocity impacts (1.2-2.8 m s(-1)) were conducted using an instrumented falling weight apparatus and were compared with static indentation tests (0.2 x 10(-4) m s(-1)). Intermediate velocity impacts were carried out by means of both Hopkinson bar (60 m s(-1)) and gas gun (200 m s(-1)) tests, Post-impact damage was assessed using X-ray radiography and microscopy, It was found that there is good correlation between low velocity impact and quasi-static responses. In both cases, penetration of the layered targets resulted in the formation of a distinctive plug. Increasing impact velocity (intermediate velocity range) snitched the penetration mode from plugging to fragmentation, giving rise to an increase in the absorbed energy. In this range, impacts led to localisation of damage in the region under the projectile, Furthermore, a comparison has been made between the penetration response of foam laminates and dense metal laminates of equivalent areal density. Preliminary results suggest that the dense metal laminates are superseded by the foam laminates on an energy absorption basis.

Effect of salinity on food consumption and growth of juvenile Nile tilapia (Oreochromi niloticus L.)

The effect of salinity (0, lO and 20%o, water temperature 28 ± l oC) on food consumption and growth of juvenile Nile tilapia, Oreochromis niloticus L. (9.94 ± 0.15 g) were investigated by feeding group of 20 fish at 2% body weight day. Individual food consumption was measured using X-radiography. There were no significant differences in growth or white muscle protein concentrations among groups. During feed deprivation, weight loss was similar for fish held at O%o and 10 %o salinity, but after 7 days over 50% of the fish maintained at 20%o salinity developed lesions covering 5-25% of the body. No significant relationships were observed between individual specific growth rates and food consumption rates within the groups. The fish in all salinity groups showed a negative correlation between specific growth rate and food conversion ratio. The coefficient of variation for wet weight specific food consumption and the mean share of meal for each fish were used as a measure of social hierarchy strength. A negative correlation was observed between coefficient of variation in food consumption and mean share of meal. The social hierarchy structure was similar in all salinities; 25% of the fish were dominant (18.29% above an equal share of meal) and 30% were subordinate (16.19% below an equal share of meal) and the remainder 45% fish fed theoretical share of meal (MSM, 5.26%).

Effect of salinity and food ration level on the growth of Nile tilapia (Oreochromis niloticus L.)

The effect of salinity (0, 10 & 20‰, water temperature 28 ± 1°C) and food ration (3 and 4.5% bw/day) on food consumption and growth of Nile tilapia, Oreochromis niloticus (10.77 ± 0.21g) were investigated. Individual food consumption was measured using X-radiography technique. Salinities (0, 10 & 20‰) did not have significant effect on the growth rate of groups of Nile tilapia fed at different ration levels (3 & 4.5% bw/day). This study showed that the growth of all-male fish was significantly better than all-female fish for all three salinities and two rations. Salinities from 0 to 20‰ had no effect on growth performance of males or female fish. In the present study, it was evident that fish fed at 3% bw/day ration ate all the food offered and fish fed at 4.5% bw/day did not consumed all amounts. Also, growth performance did not significantly differ among fish fed at 3% bw/day ration level and reared at different salinities. Fish reared under higher salinities (20‰) and fed at higher ration (4.5% bw/day) level had skin lesions and injuries on their body. It was assumed that fish fed at higher ration under higher salinities (20‰) and maintained higher osmoregulatory costs together with osmotic stress may have a negative influence on the appetite of fish. Another possibility that may have affected the appetite could be the unionized ammonia levels that were high. The high-unionized ammonia levels combined with the osmotic stress may have been the cause, or have aided, development of skin lesions and injuries on the fish at higher salinities.

The Compact Pulsed Hadron Source: A Design Perspective

During the past. decades, large-scale national neutron sources have been developed in Asia, Europe, and North America. Complementing such efforts, compact hadron beam complexes and neutron sources intended to serve primarily universities and industrial institutes have been proposed, and some have recently been established. Responding to the demand in China for pulsed neutron/proton-beam platforms that are dedicated to fundamental and applied research for users in multiple disciplines from materials characterization to hadron therapy and radiography to accelerator-driven sub-critical reactor systems (ADS) for nuclear waste transmutation, we have initiated the construction of a compact, yet expandable, accelerator complex-the Compact Pulsed Hadron Source (CPHS). It consists of an accelerator front-end (a high-intensity ion source, a 3-MeV radio-frequency quadrupole linac (RFQ), and a 13-MeV drift-tube linac (DTL)), a neutron target station (a beryllium target with solid methane and room-temperature water moderators/reflector), and experimental stations for neutron imaging/radiography, small-angle scattering, and proton irradiation. In the future, the CPHS may also serve as an injector to a ring for proton therapy and radiography or as the front end to an ADS test facility. In this paper, we describe the design of the CPHS technical systems and its intended operation.

Estudo do comportamento no âmbito da radioprotecção de uma população trabalhadora na área da medicina dentária

Monografia apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Medicina Dentária

Vascular calcification and mineral bone disorder in chronic kidney disease

Chronic Kidney Disease (CKD), osteoporosis and mild hyponatremia are all prevalent chronic conditions that may coexist and are often under-recognized. Mineral-Bone Disorder begins early in the natural history of CKD and results in complex abnormalities of bone which ultimately confers a well-established increased risk of fragility fractures in End Stage Kidney Disease. Hyponatremia is a novel, usually renal mediated metabolic perturbation, that most commonly occurs independently of the stage of renal dysfunction but which may also predispose to increased fracture risk. The extent -if any- to which either early stages of renal dysfunction or the presence of hyponatremia contribute to fracture occurrence in the general population, independently of osteoporosis, is unclear. Renal transplantation is the treatment of choice for ESKD and although it restores endogenous renal function it typically fails to normalize either the long term cardiovascular or fracture risk. One potential mechanism contributing to these elevated long-term risks and to diminished Health Related Quality of Life is persistent, post-transplant hyperparathyroidism. In this study we retrospectively examine the association of renal function and serum sodium with Bone Mineral Density and fracture occurrence in a retrospective cohort of 1930 female members of the general population who underwent routine DXA scan. We then prospectively recruited a cohort of 90 renal transplant recipients in order to examine the association of post transplant parathyroid hormone (PTH) level with measures of CKD Mineral Bone Disorder, including, DXA Bone Mineral Density, Vascular Calcification (assessed using both abdominal radiography and CT techniques, as well as indirectly by carotid-femoral Pulse Wave Velocity) and Quality of Life (using the Short Form-12 and a PTH specific symptom score). In the retrospective DXA cohort, moderate CKD (eGFR 30-59ml/min/1.73m2) and hyponatremia (<135mmol/L) were associated with fracture occurrence, independently of BMD, with an adjusted Odds Ratio (95% Confidence Interval), of 1.37 (1.0, 1.89) and 2.25 (1.24, 4.09) respectively. In the renal transplant study, PTH was independently associated with the presence of osteoporosis, adjusted Odds Ratio (95% Confidence Interval), 1.15 (per 10ng/ml increment), (1.04, 1.26). The presence of osteoporosis but not PTH was independently associated with measures of vascular calcification, adjusted ß (95% Confidence Interval), 12.45, (1.16, 23.75). Of the eight quality-of-life domains examined, post-transplant PTH (per 10ng/ml increment), was only significantly and independently associated with reduced Physical Functioning, (95% Confidence Interval), 1.12 (1.01, 1.23). CKD and hyponatremia are both common health problems that may contribute to fracture occurrence in the general population, a major on-going public health concern. PTH and decreased Bone Mineral Density may signal sub-optimal long-term outcomes post renal transplantation, influencing bone and vascular health and to a limited extent long term Health Related Quality of Life