PURPOSE: To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproducibility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The utilization of this system is evaluated through phantom and patient case studies. MATERIALS AND METHODS: We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, portal and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. RESULTS: The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT. The results show that the localization errors are 0.8+/-0.2 mm (AP) and 1.0+/-0.3 mm (Lateral) in the cases relating to the brain and 1.1+/-0.5 mm (AP) and 1.0+/-0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software. CONCLUSION: A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproducibility of the patients' setup in 3DCRT and IMRT. With adjustment of the completed GUI-based algorithm, and a good quality DRR image, our software may be used for clinical applications.
Brain ; Humans ; Pelvis ; Radiography ; Radiotherapy ; Radiotherapy, Conformal

OBJECTIVETo investigate the image quality, radiation dose and diagnostic value of the low-tube-voltage high-pitch dual-source computed tomography (DSCT) with sinogram affirmed iterative reconstruction (SAFIRE) for non-enhanced abdominal and pelvic scans.

METHODSThis institutional review board-approved prospective study included 64 patients who gave written informed consent for additional abdominal and pelvic scan with DSCT in the period from November to December 2012. The patients underwent standard non-enhanced CT scans (protocol 1) [tube voltage of 120 kVp/pitch of 0.9/filtered back-projection (FBP) reconstruction] followed by high-pitch non-enhanced CT scans (protocol 2) (100 kVp/3.0/SAFIRE). The total scan time, mean CT number, signal-to-noise ratio (SNR), image quality, lesion detectability and radiation dose were compared between the two protocols.

RESULTSThe total scan time of protocol 2 was significantly shorter than that of protocol 1 (1.4±0.1 seconds vs. 7.6±0.6 seconds, P<0.001). There was no significant difference between protocol 1 and protocol 2 in mean CT number of all organs (liver, 55.4±6.3 HU vs. 56.1±6.8 HU, P=0.214; pancreas, 43.6±5.9 HU vs. 43.7±5.8 HU, P=0.785; spleen, 47.9±3.9 HU vs. 49.4±4.3 HU, P=0.128; kidney, 32.2±2.3 HU vs. 33.1±2.3 HU, P=0.367; abdominal aorta, 44.8±5.6 HU vs. 45.0±5.5 HU, P=0.499; psoas muscle, 50.7±4.1 HU vs. 50.3±4.5 HU, P=0.279). SNR on images of protocol 2 was higher than that of protocol 1 (liver, 5.0±1.2 vs. 4.5±1.1, P<0.001; pancreas, 4.0±1.0 vs. 3.6±0.8, P<0.001; spleen, 4.7±1.0 vs. 4.1±0.9, P<0.001; kidney, 3.1±0.6 vs. 2.8±0.6, P<0.001; abdominal aorta, 4.1±1.0 vs. 3.8±1.0, P<0.001; psoas muscle, 4.5±1.1 vs. 4.3±1.2, P=0.012). The overall image noise of protocol 2 was lower than that of protocol 1 (9.8±3.1 HU vs. 11.1±3.0 HU, P<0.001). Image quality of protocol 2 was good but lower than that of protocol 1 (4.1±0.7 vs. 4.6±0.5, P<0.001). Protocol 2 perceived 229 of 234 lesions (97.9%) that were detected in protocol 1 in the abdomen and pelvis. Radiation dose of protocol 2 was lower than that of protocol 1 (4.4±0.4 mSv vs. 7.3±2.4 mSv, P<0.001) and the mean dose reduction was 41.4%.

CONCLUSIONThe high-pitch DSCT with SAFIRE can shorten scan time and reduce radiation dose while preserving image quality in non-enhanced abdominal and pelvic scans.

PURPOSE: This study analysed the incidence and the degree of an acetabular retroversion in a dysplastic hip. MATERIALS AND METHODS: 28 cases of dysplastic hips, in whom the CE angle was <20 degrees, and 20 cases of control group with a normal CE angle were enrolled in this study. Four cuts among the CT images (most superior cut of the femoral head, middle cut of the proximal half, middle portion, and middle cut of the distal half of the femoral head) were used to measure the acetabular anteversion. RESULTS: In the control group, anteversion of four cuts (form the cranial to caudal) were observed with an average of 4.1, 10.3, 16.5, 19.7degrees, and there was one case with a retroversion. In the dysplastic hips, the average anteversion angles were 4.4, 11.0, 17.9, 20.8degrees, and 9 cases with retroversion were discovered. In all cases showing retroversion, an overlapping of the acetabular anterior and posterior wall (cross-over sign) was observed on the simple pelvis AP radiography. CONCLUSION: There was a 32% incidence of acetabular retroversion, which was much higher than the control group (p<0.05). Therefore, in order to prevent an over-correction of the retroversion, which may cause impingement, the presence and the amount of retroversion must be recognized using CT before performing a periacetabular osteotomy.
Acetabulum* ; Head ; Hip* ; Incidence* ; Osteotomy ; Pelvis ; Radiography

Pelvic lipomatosis is a rare condition characteristized by the deposition of an excessive amount of benign adipose tissue in the bony pelvis. Tile proliferating adipose tissue may compress the pelvic viscera in varying degrees, including the pelvic portion of the ureters. Occasionally, marked bilateral ureteral obstruction may lead to the development of uremia. Computed tomography is emerging as useful diagnostic adjuvants in the confirmation of pelvic lipomatosis. A case of pelvic lipomatosis studied by CT and conventional radiography is presented.
Adipose Tissue ; Lipomatosis* ; Pelvis ; Radiography ; Uremia ; Ureter ; Ureteral Obstruction ; Viscera

Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its treatment algorithm, and corresponding cases involving unstable pelvic ring injury.
Classification ; Clinical Protocols ; Congenital Abnormalities ; Humans ; Orthopedics ; Pelvic Bones ; Pelvis ; Physical Examination ; Radiography ; Review Literature as Topic

To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department,.a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is deceased at 20, 40, 80, 160cm away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Patient Care ; Pelvis ; Radiation, Ionizing ; Radiography, Thoracic ; Spine

BACKGROUND: Sacral slanting is a frequent unique phenomenon in patients with adolescent idiopathic scoliosis (AIS) and may be important for selecting the distal fusion level. However, the reason of the phenomenon remains unknown. The purpose of this study was to determine the association between sacral slanting and adjacent structures in patients with AIS. METHODS: A total of 303 AIS patients who underwent both whole spine standing anteroposterior (AP) and whole leg standing AP radiography were included. The degree of sacral slanting, pelvic obliquity, lumbar curve angles (L1-L4), and L4 tilt were assessed on whole spine standing AP radiographs. Whole leg standing AP radiographs were used to assess the degree of leg length discrepancy (LLD). Demographic data and radiological parameters were analyzed descriptively. Pearson correlation analysis and partial correlation analysis of the parameters were performed. A p-value of less than 0.05 was considered statistically significant. RESULTS: The proportion of patients with ≥ 5° of sacral slanting among those with < 3° of pelvic obliquity was 8.9% (27/303). Thirty-two patients (10.6%, 32/303) showed more than 10 mm of LLD. Sacral slanting was positively correlated with pelvic obliquity and lumbar curve (r = 0.445 and r = 0.325, respectively). Pelvic obliquity was also correlated with LLD and L4 tilt (r = 0.123 and r = 0.311, respectively). However, partial correlation analysis showed that LLD was not directly correlated with sacral slanting (r = −0.034). CONCLUSIONS: Sacral slanting can be thought to be a compensatory mechanism for large lumbar curves, which is accompanied by pelvic obliquity. In contrast, a congenitally slanted upper sacrum may contribute to scoliosis in some cases. LLD was not directly correlated with sacral slanting.
Adolescent* ; Humans ; Leg ; Leg Length Inequality ; Pelvis ; Radiography ; Sacrum ; Scoliosis* ; Spine

Sarcoma of the kidney is a rare condition. Leiomyosarcoma is the most common of the kidney sarcomas. Renal leiomyosarcoma usually originates from the smooth muscle layers of the kidney, for example, the renal capsule and renal vessels. Renal pelvis neoplasms, however, are primarily transitional cell carcinomas, and renal pelvis leiomyosarcomas are extremely uncommon. Renal pelvis leiomyosarcoma has never been reported in Korea. Moreover, no more than 10 cases have been reported internationally. However, none of these were associated with kidney abnormalities. Here we describe a case of leiomyosarcoma that originated from the blind end of a bifid renal pelvis.
Female ; Humans ; Kidney Neoplasms/*pathology ; Kidney Pelvis/*pathology/radiography ; Leiomyosarcoma/*pathology ; Tomography, X-Ray Computed

The Caudal regression syndrome is characterized by sacrococcygeal or lumbosacrococcygeal agenesis, of variable extent, most often accompanied by multiple musculoskeletal abnormalities of the pelvis and legs. It is rare fetal complication of diabetic pregnancy. Although the exact teratogenic mechanism is not known, hyperglycemia appears to play a crucial role as a teratogen. Strict control of diabetes preconceptually and in early pregnancy is presumed to reduce the risk of occurrence. We report a case of caudal regression syndrome detected by pelvic radiography and MRI in the newborn of the diabetic mother.
Humans ; Hyperglycemia ; Infant, Newborn* ; Leg ; Magnetic Resonance Imaging ; Mothers* ; Musculoskeletal Abnormalities ; Pelvis ; Pregnancy ; Radiography

PURPOSE: This study examined the minimum seven years clinical and radiological results of revision total hip arthroplasty using an allogenic impaction bone graft and a cemented cup in an acetabular bone deficiency. MATERIALS AND METHODS: Fifty two revision total hip arthroplasty procedures performed on forty nine patients between March 1992 and June 1998 and followed for more than minimum seven years were examined. The clinical and radiological results were evaluated by Harris hip score and roentgenography including anterior-posterior view of pelvis and lateral view of operated hip. RESULTS: The mean Harris hip score was 47 points preoperatively, 81 points at three years after revision, and 84 points at seven years. The radiological evaluation revealed osseous union that trabeculated between grafted bone and host bone within four months in 47 hips, a complete grafted bone-cement radiolucent line of two millimeters or more in at least one zone in 5 hips at two years and in 7 hips at the seven year follow-up. CONCLUSION: We recommend the technique using an allogenic impaction bone graft and cemented cup to reconstruct an acetabular cavitary defect in revision total hip arthroplasty.
Acetabulum* ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip ; Humans ; Pelvis ; Radiography ; Transplants*