The exposure of radiation is lower using a selenium x-ray detector compared to conventional film-screen technique in chest radiography. The digital selenium system performs well in a clinical setting, providing visualisation of pathological findings as good as a standard screen-film system.

Vertebral kyphoplasty is a procedure used for the treatment of compression fractures. While early randomized-controlled trials were equivocal regarding its benefits, more recent RCTs have shown favorable results for kyphoplasty with regard to pain relief, functional recovery, and health-care related quality of life compared to control patients. Risks of kyphoplasty include but are not limited to cement extrusion, infection, hematoma, and vertebral body fracture of adjacent levels. We describe a case of a 66-year-old male attorney who underwent eleven kyphoplasties in an approximately one-year period, the majority of which were for fractures of vertebrae adjacent to those previously treated with kyphoplasty. Information on treatment was gathered from the patient's hospital chart and outpatient office notes. Following the last of the eleven kyphoplasties (two at T8, one each at all vertebrae from T9 to L5), the patient was able to function without pain and return to work. His physiologic thoracic kyphosis of 40 degrees prior to the first procedure was maintained, as were his lung and abdominal volumes. We conclude that kyphoplasty is an appropriate procedure for the treatment of vertebral compression fractures and can be used repeatedly to address fractures of levels adjacent to a previous kyphoplasty.

Background: Orthopaedic surgeons rely on radiographs to assist in the evaluation and treatment of patients. The technological advances of smartphones have allowed data to be transferred quickly and viewed from remote locations. The diagnostic accuracy of viewing radiographs on smartphones remains unproven. As such, this study aimed to evaluate the ability of smartphones to allow surgeons to correctly diagnose and interpret radiographs of ankle fractures on one of the most popular smartphones, an Apple iPhone 4S (Apple Inc, Cupertino, CA, USA). Methods: Using the smartphone, individual pictures were taken of anteroposterior, mortise, and lateral radiographs of 20 ankle fractures. These images were then evaluated through 10 questions that included acceptable quality, presence and displacement of fibula, medial malleolus, and posterior malleolar fractures, ankle subluxation, syndesmotic disruption, Lauge-Hansen classification, and the need for open reduction and internal fixation. Results were compared to the same radiographs viewed on a picture archiving and communication system (PACS) workstation. Results: Ten orthopaedic surgery residents and five orthopaedic surgery attendings evaluated the radiographs and answered a total of 6000 questions. When comparing the responses between those images viewed on the smartphone versus those viewed on the PACS workstation, 826 differences were found. After analysis of both interobserver and intraobserver reliability, a significant difference was found between viewing modalities, with the smartphone found to be not as reliable as the PACS workstation. However, when looking at the single question of whether or not the fracture would require operative fixation, no significant difference was found between the use of a smartphone or PACS workstation. Conclusions: The smartphone images demonstrated a reliable prediction of the proper treatment for the 20 ankle fractures despite noted differences between the two viewing modalities.

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