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Altrincham, United Kingdom

Kotnis N.A.,McMaster University | Chiavaras M.M.,McMaster University | Harish S.,McMaster University | Harish S.,Diagnostic Healthcare
Skeletal Radiology | Year: 2012

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis. © 2011 ISS. Source

Friedewald S.M.,Caldwell Breast Center | Rafferty E.A.,Massachusetts General Hospital | Rose S.L.,Comprehensive Breast Center | Durand M.A.,Yale University | And 9 more authors.
JAMA - Journal of the American Medical Association | Year: 2014

IMPORTANCE: Mammography plays a key role in early breast cancer detection. Single-institution studies have shown that adding tomosynthesis to mammography increases cancer detection and reduces false-positive results. OBJECTIVE: To determine if mammography combined with tomosynthesis is associated with better performance of breast screening programs in the United States. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of screening performance metrics from 13 academic and nonacademic breast centers using mixed models adjusting for site as a random effect. EXPOSURES: Period 1: digital mammography screening examinations 1 year before tomosynthesis implementation (start dates ranged from March 2010 to October 2011 through the date of tomosynthesis implementation); period 2: digital mammography plus tomosynthesis examinations from initiation of tomosynthesis screening (March 2011 to October 2012) through December 31, 2012. MAIN OUTCOMES AND MEASURES: Recall rate for additional imaging, cancer detection rate, and positive predictive values for recall and for biopsy. RESULTS: A total of 454 850 examinations (n=281 187 digital mammography; n=173 663 digital mammography + tomosynthesis) were evaluated. With digital mammography, 29 726 patients were recalled and 5056 biopsies resulted in cancer diagnosis in 1207 patients (n=815 invasive; n=392 in situ). With digital mammography + tomosynthesis, 15 541 patients were recalled and 3285 biopsies resulted in cancer diagnosis in 950 patients (n=707 invasive; n=243 in situ). Model-adjusted rates per 1000 screens were as follows: for recall rate, 107 (95% CI, 89-124) with digital mammography vs 91 (95% CI, 73-108) with digital mammography + tomosynthesis; difference, -16 (95% CI, -18 to -14; P < .001); for biopsies, 18.1 (95% CI, 15.4-20.8) with digital mammography vs 19.3 (95% CI, 16.6-22.1) with digital mammography + tomosynthesis; difference, 1.3 (95% CI, 0.4-2.1; P = .004); for cancer detection, 4.2 (95% CI, 3.8-4.7) with digital mammography vs 5.4 (95% CI, 4.9-6.0) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001); and for invasive cancer detection, 2.9 (95% CI, 2.5-3.2) with digital mammography vs 4.1 (95% CI, 3.7-4.5) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001). The in situ cancer detection rate was 1.4 (95% CI, 1.2-1.6) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3% to 6.4% (difference, 2.1%; 95% CI, 1.7%-2.5%; P < .001) and for biopsy from 24.2% to 29.2% (difference, 5.0%; 95% CI, 3.0%-7.0%; P < .001). CONCLUSIONS AND RELEVANCE: Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes. Copyright 2014 American Medical Association. All rights reserved. Source

Hill K.,West Park Healthcare Center | Dolmage T.E.,Diagnostic Healthcare | Woon L.,West Park Healthcare Center | Goldstein R.,West Park Healthcare Center | Brooks D.,University of Toronto
Thorax | Year: 2010

Rationale The SenseWear armband (SAB) is designed to measure energy expenditure (EE). In people with chronic obstructive pulmonary disease (COPD), EE estimated using the SAB (EESAB) is a popular outcome measure. However, a detailed analysis of the measurement properties of the SAB in COPD is lacking. Objective To examine the sensitivity of EESAB, agreement between EESAB and EE measured via indirect calorimetry (EE IC), and its repeatability in COPD. Methods 26 people with COPD (forced expiratory volume in 1 s (FEV1)=496±8% predicted; 15 males) spent 6 min in five standardised tasks that comprised supine, sitting, standing and two walking speeds. A subgroup (n=12) walked using a rollator. Throughout each task, measurements of EESAB and EEIC were collected. The protocol was repeated on a second day. Results EESAB increased between standing and slow walking (2.4, metabolic equivalents (METs) 95% CI 2.2 to 2.7) as well as slow and fast walking (0.5 METs, 95% CI 0.3 to 0.7). Considering all tasks together, the difference between EESAB and EEIC was -0.2 METs (p=0.21) with a limit of agreement of 1.3 METs. The difference between days in EESAB was 0.0 METs with a coefficient of repeatability of 0.4 METs. Rollator use increased the variability in EE SAB, compromising its repeatability and agreement with EE IC. Conclusions EESAB was sensitive to small but important changes. There was fair agreement between EESAB and EEIC, and measurements of EESAB were repeatable. These observations suggest that the SAB is useful for the evaluation of EE in patients with COPD who walk without a rollator. Source

Chatha D.S.,Diagnostic Healthcare | Schweitzer M.E.,University of Ottawa
Bulletin of the NYU Hospital for Joint Diseases | Year: 2011

Purpose. It is somewhat surprising that radiographic criteria for lumbar stenosis have been transposed from radiography and CT to MR without scientific validation. As these radiographic criteria were developed via population studies with criteria defined by two standard deviations from the mean, we sought to perform the same methodology via MR. Methods. The study was approved by the institutional review board; the requirement for informed consent was waived. One-hundred patients referred for possible metastatic disease, aged 4 to 94 were studied. Measurements were obtained on a midline sagittal T2-weighted (6000/120) image at each disc level, as well as at the mid-vertebral level. The distributive mean, and standard deviations were calculated and -2 SD was used as a "cutoff" for spinal stenosis. To assess for interobserver variation, 20% of the measurements were repeated by a second observer. To assess for intraobserver variation, another 20% of the measurements were repeated a second time at a minimum of a two month interval. Results. The spinal canal was narrowest at L5-S1 (mean: 1.16 cm), and widest at L1-L2 (mean: 1.56 cm). Overall the narrowest measurements were at the intervertebral disc space and were narrower at the lower disc spaces. In our population, the lowest cutoff limit (two standard deviations below the mean) had a range between 0.38 cm at the L3-L4 disc space and 0.9 cm at the L1 vertebral level. Notably at the L3 level the size range was from 0.77 to 1.75 Conclusion. Traditional measurements of canal diameters may be too large when applied to soft tissue analysis on MR. We suggest using a cutoff of smaller than 0.90 cm for developmental stenosis. Source

Diagnostic Healthcare | Date: 2013-04-23

A sample analyzer has an illuminator for illuminating an assay sample to cause luminescence, and a support for a sample vessel containing the assay sample. The support is adapted to position the assay sample proximate the illuminator. A detector is positioned along an optical axis extending from the illuminator, through the positioned assay sample, to the detector, so as to detect the luminescence from the assay sample. A reflector is removably disposed between the illuminator and the assay sample so as to reflect a portion of the luminescence back through the positioned assay sample toward the detector.

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