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Diagnosis of Thoracic Spine Fractures Essay (Article Review)

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Updated: Jun 4th, 2022

Introduction: The Significance of the Article

Diagnosing fractures on a thoracic spine is extremely hard; given the fact that a patient’s life often depends on the results clarity and correctness, it is crucial to figure out which method is the best. Moreover, the issue of radiation and the associated health problems should be raised. Hence, it can be concluded that the given article is of high significance.

Objectives: What Had to be Done

The key purpose of the research was to figure out which of the specified methods for diagnosing fractures on a thoracic spine is more accurate and less harmful for the patient, the MDCT, or biplane radiography.

Concepts and Their Definition: The Key Issues

Karul et al. introduce several basic concepts required to handle the issue professionally. Among them, MDCT, biplane radiography and sagittal reformation must be mentioned. Though Karul et al. do not provide the definitions for the terms, they offer an extensive description of the first two.

Central Argument: MDCT vs. the Biplane Radiography

As one might have guessed, the key argument of the paper revolves around the necessity to conduct both the biplane radiography and the MDCT tests in diagnosing the patients in case of fractures in thoracic spine. Because of the associated difficulties, it is considered preferable to use both methods; however, due to high radiation level, the outcomes can be deplorable. Therefore, the key argument is that the MDCT is the most efficient method.

Methodology: The Power of Flat Detector Direct Digital System

To the researchers’ credit, one must admit that the methodology is almost impeccable. Applying several (seven, to be exact, i.e., experimental group analysis, biplane radiography analysis, comparison of the two methods, dose calculation, image analysis and statistical analysis) methods at the same time, Karul et al. have managed to provide objective results.

The Provided Evidence: Experimental Group Results

According to Karul et al., out of 107 patients, 65 (60.7%) have been diagnosed with thoracic vertebral fractures. In its turn, the biplane radiography proved efficient only in 32 cases out of 107. The authors also offer extensive statistical data concerning the efficiency of the two diagnostic methods.

Generally speaking, the provided evidence seems adequate and all-embracing. However, it would also be desirable that the authors should also provide the patients’ body mass indices, since the latter, according to Karul et al., seem to have had a tangible influence on the outcome of the research: “The wide variation in DLP (1.9–97.8 on biplane radiography/80.2–871 on MDCT) was primarily due to the varying body mass index of the patients” (Karul et al., 2013, 3–4).

Value Positions and Their Clarity: Concerning the Veracity

It is especially important that the research also offers numerical value positions to prove the point. While there is no major statistical data, which would have been desirable for the paper comparing two diagnostic methods, it is still important that

Literature: Defining the Place in the Medical Hall of Fame

Karul et al. are not the only ones to handle the issue of MDCT vs. biplane radiography. The researches concerning the reasonability of the radiation of spine have been conducted by Berry et al. (2005), Brown, Antveil, Sise & Sack (2005), and Yoshikara, Van der Heiden & Stahel (2011).

The specifics of the MDCT method, as well as it efficiency, have been researched by Kazawa (2012) DeFilippo et al. (2010), Ilika & Ozyurek (2011), Kim et al. (2012) and Collins et al. (2012). While Kazawa (2012) focused on the efficiency of combined MRI and MDCT methods, DeFilippo et al. (2010) explored the specifics of the MDCT diagnosis in case of a wrist trauma. In his turn, Ilica & Ozyurek (2011) peovided an account of the situation in which MDCT proves efficient. Finally, Kim et al. (2012) offers the results of MDCT efficiency when the sterna fracture is diagnosed, and Collins et al. (2012) help define the advantages of MDCT in case of a bone fracture in general.

It is also necessary to mention that the biplane radiography and its effects have also been widely discussed over the past few years. Among the most notable researches, the ones conducted by Vecht, Perera, Athanasiou & Vecht (2010), Myers et al. (2011), Lee et al. (2011), Torry et al. (2011) and Ehsan, Majdi-nasab, Dobbins & McAdams (2012) should be mentioned.

Finally, such papers as Anthes, Muangman, Bulger & Stern (2012), Sloane, Chan & Vilke (2008), Gross (2010), Lu, Li, Huang & Kao (2010), Akhaddar, El-asri & Boucetta (2011) and Bernstein (2010), which help define the complexity of a thoracic spine fracture, are essential for the evaluation.

Contribution: The Point Has Been Proven

There is no point in denying that the choice between the two techniques instead of using both diagnosing methods and, thus, threatening the lives of patients, has been brewing for quite long. Therefore, the key contribution of Karul et al. is that the choice can finally be made.

The Author’s Style: Delicate Persuasion

Written in a purely academic style, the article, however, does not claim its results the ultimate solution. Stressing that biplane radiography does not have the advantages of the MDCT, Karul et al. still leave some room for further discoveries.

Bumping into the Limitations: Where Scientists Fear to Tread

Like any other research, however, the given article also has its limitations. To start with, the authors of the research have adopted a retrospective analysis. In addition, it is necessary to take individual specifics of each patient to come to an unambiguous conclusion, which is, again, impossible.

Conclusion: When Everything Is Said and Done

Despite the above-mentioned limitations and a few flaws, one must admit that Karul et al. (2013) have conducted an impressive research that will help reduce the negative effect of radiation and diminish the radiation dose received by the patients who undergo diagnostic tests.

Reference List

Akhaddar, A., El-asri, A. & Boucetta, M. (2011). Multiple isolated thoracic spinous process fractures (Clay-Shoveler’s fracture). The Spine Journal, 11(6), 458–459.

Anthes, T., Muangman, N., Bulger, E. & Stern, E. J. (2012). Knee kinematic profiles during drop landings: A biplane fluoroscopy study upper thoracic spine fracture dislocation in a motorcyclist. Current Problems in Diagnostic Radiology, 41(4), 128–129.

Bernstein, M. (2010). Easily missed thoracolumbar spine fractures. European Journal of Radiology, 74(1), 6–15.

Berry et al. (2005). Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. The Journal of Trauma: Injury, Infection and Critical Care, 59(6), 1410–1413.

Brown, C., Antveil, J. L., Sise, M. J. & Sack, D. I. (2005). Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: Its time has come.. The Journal of Trauma: Injury, Infection and Critical Care, 58(5), 890–896.

Collins, J. M. et al. (2012). Multidetector Ct of temporal bone fractures. Seminars in Ultrasound, CT and MRI, 33(5), 418–431.

DeFilippo, M. et al. (2010). MDT arthography of the wrist: Diagnosis accuracy and indications. European Journal of Radiology, 74(1), 221–225.

Ehsan, S., Majdi-nasab, N., Dobbins, I. & McAdams, H. (2012). Biplane correlation imaging: A feasibility study based on phantom and human data. Journal of Digital Imaging, 25(1), 137–147.

Gross, E. A. (2010). Computed tomographic screening for thoracic and lumbar fractures: is spine reformatting necessary? The American Journal of Emergency Medicine, 28(1), 73–75.

Ilika, A. & Ozyurek, S. (2011). Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations. Japanese Journal of Radiology, 29(2), 98–103.

Karul, M., et al. (2013). Fractures of the thoracic spine in patients with minor trauma: Comparison of diagnostic accuracy and dose of biplane radiography and MDCT. European Journal of Radiology xxx, xxx–xxx.

Kazawa, N. (2012). T2WI MRI and MRI-MDCT correlations of the osteoporotic vertebral compressive fractures. European Journal of Radiology, 81(7), 1630–1636.

Kim, E. Y. et al. (2012). Sternal fracture in the emergency department: Diagnostic value of multidetector CT with sagittal and coronal reconstruction images. European Journal of Radiology, 81(5), 708–711.

Lee, M. W. et al. (2011). Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience. The British Journal of Radiology, 84(1004), 691–697.

Lu, M.-S., Li, Y.-Y., Huang, Y.-K. & Kao, C.-L. (2010). Thoracic spine fracture: An unusual case of bilateral massive hemothorax. The Journal of Trauma: Injury, Infection and Critical Care, 68(6), 1511.

Myers, C. A. et al. (2011). In vivo tibiofemoral kinematics during 4 functional tasks of increasing demand using biplane fluoroscopy. The American Journal of Sports Medicine. 40(1), 170–178.

Sloane, C. M., Chan, T. C. & Vilke, G. M. (2008). Thoracic spine compression fracture after TASER activation. The Journal of elementary Medicine, 34(3), 283–285.

Torry, M. R. et al. (2011). Knee kinematic profiles during drop landings: A biplane fluoroscopy study. Medicine & Science in Sports & Science, 43(3), 533–541.

Vecht, J., Perera, R., Athanasiou, T. & Vecht, J. (2010). Biplane angiography in left ventricular outflow obstruction. The Annals of Thoracic Surgery, 90(3), e44.

Yoshikara, H., Van der Heiden, T. & Stahel, P. F. (2011). A missed injury leading to delayed diagnosis and postoperative infection of an unstable thoracic spine fracture – case report of a potentially preventable complication. Patient Safety in Surgery, 5(1), 25.

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