Staying abreast of imaging - Current status of breast cancer detection in high density breast.

OBJECTIVES: The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions. KEY FINDINGS: Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available. CONCLUSION: Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma. IMPLICATIONS FOR PRACTICE: It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.

Knowledge of nosocomial infection control practices among radiographers in Jordan.

INTRODUCTION: Nosocomial infections add health-related and financial burdens on health systems. This study aims to evaluate the radiographers' knowledge of nosocomial infection control practices in Jordan. METHODS: A cross-sectional questionnaire-based assessment was conducted. The main domains of the knowledge based test were the nature of nosocomial infections, standard precautions, and infection control practices specific to the radiology department. Comparison of knowledge among radiographers was assessed using the Student t-test and ANOVA. Multiple linear regression was used to find predictors of the knowledge score. RESULTS: The final analysis included 100 radiographers from educational, private, and public hospitals. Mean knowledge score was 66.2% (SD: 20.3%, range: 25.0-100%). Questions with the lowest correctly scored were about the main source of infections (17%), recapping used needles (27%), gloves use (27%), the necessity of using overshoes (26%) and a cap (26%) when there is a risk of biological fluid splashes, the necessity of using sterile gloves (7%) and protective masks (5%) during all invasive procedures, the manoeuvrability around a sterile field (54%), and the safety of passing the imaging plate to the scrub nurse in order to place it under the radiographer's direction (37%). Predictors of knowledge score were the academic degree and training status (R2 = 0.21, P < 0.001). CONCLUSION: Knowledge of infection control practices among Jordanian radiographers was moderate. Future training should focus on handling used needles, the use of protective barriers, and the manoeuvrability around sterile fields. Improved academic curriculum and on-site training could enhance knowledge in infection control practices.

In the digital era, architectural distortion remains a challenging radiological task.

AIM: To compare readers' performance in detecting architectural distortion (AD) compared with other breast cancer types using digital mammography. MATERIALS AND METHODS: Forty-one experienced breast screen readers (20 US and 21 Australian) were asked to read a single test set of 30 digitally acquired mammographic cases. Twenty cases had abnormal findings (10 with AD, 10 non-AD) and 10 cases were normal. Each reader was asked to locate and rate any abnormalities. Lesion and case-based performance was assessed. For each collection of readers (US; Australian; combined), jackknife free-response receiver operating characteristic (JAFROC), figure of merit (FOM), and inferred receiver operating characteristic (ROC), area under curve (Az) were calculated using JAFROC v.4.1 software. Readers' sensitivity, location sensitivity, JAFROC, FOM, ROC, Az scores were compared between cases groups using Wilcoxon's signed ranked test statistics. RESULTS: For lesion-based analysis, significantly lower location sensitivity (p=0.001) was shown on AD cases compared with non-AD cases for all reader collections. The case-based analysis demonstrated significantly lower ROC Az values (p=0.02) for the first collection of readers, and lower sensitivity for the second collection of readers (p=0.04) and all-readers collection (p=0.008), for AD compared with non-AD cases. CONCLUSIONS: The current work demonstrates that AD remains a challenging task for readers, even in the digital era.

Dental and oral hygiene status in Jordanian children with cleft lip and palate: a comparison between unilateral and bilateral clefts.

OBJECTIVES: The purpose of this study was to assess and compare the dental health and oral hygiene status of subjects with unilateral and bilateral cleft lip and palate (BCLP). METHODS: Oral and dental examinations were carried out in 98 children with cleft lip and palate and 98 unaffected subjects matching in gender and age, using the standard dental indices dmft and DMFT. Plaque and gingival indices were scored using the plaque and gingival indices of Silness and Löe. RESULTS: The prevalence of dental caries was significantly higher in children with cleft lip and palate than their control in both permanent and deciduous teeth. Patients with BCLP experienced more dental caries than unilateral cleft lip and palate (UCLP) patients in both dentitions. Similarly, plaque accumulation and gingivitis were significantly higher in the cleft lip and palate patients compared with their controls. Only plaque accumulation was significantly higher in the BCLP patients than in the UCLP patients. CONCLUSION: Bilateral cleft lip and palate patients appear to be at a higher risk of caries experience and poorer in oral hygiene than those with UCLP patients. These findings not only provide a baseline for oral health parameters in patients with cleft lip and palate but also emphasize the need for intensive preventive measures of oral disease to optimize clinical outcome.

Dental development in children with cleft lip and palate: a comparison between unilateral and bilateral clefts.

AIM: The aims of this study were to assess and compare the dental development in patients with unilateral (UCLP) and bilateral (BCLP) cleft lip and palate. STUDY DESIGN: Dental developmental delay was compared between 40 UCLP patients (20 boys and 20 girls, average age 9.6 +/- 2.7 years) and 40 BCLP patients matched by sex and age (to the nearest 6 months). For the purpose of comparison, a total of 80 panoramic radiographs of unaffected group matching in age and sex were selected randomly. METHODS: Using panoramic radiographs, the seven left mandibular permanent teeth, second molar to central incisor, were rated on eight stage scales using the methods described by Demirjian et al. [1973]. The stage of each tooth was converted to the corresponding numeric value, and then all values were added to obtain a dental maturity score, which corresponded to a dental age. STATISTICS: The differences in developmental delay between the two cleft groups were determined using independent t-test. RESULTS: There was statistically significant difference (P<0.0001) between chronologic and dental age in cleft patients. The mean dental development delay in UCLP was 0.34 years and for BCLP was 0.61 years. BCLP patients were found to have a greater delay than UCLP patients (P<0.05). Girls showed an advanced dental development in both types of clefts. Comparison between the two cleft groups showed only significant difference in the amount of delay in female subjects. CONCLUSION: Dental development in UCLP and BCLP patients was significantly delayed compared to non cleft reference. Dental development in boys was significantly behind that of girls. A significant difference in the amount of delay between both cleft types was found only in female subjects.

Morbidity of iliac crest donor site following open bone harvesting in cleft lip and palate patients.

The aim of this prospective study was to assess donor site morbidity associated with open iliac crest bone harvesting to graft secondary alveolar clefts. At a university teaching hospital, 64 Jordanian patients underwent secondary alveolar bone grafting with iliac crest bone harvest. The same standardized surgical technique was used over a 6-year period by a single maxillofacial surgeon. The duration of time until postoperative ambulation and length of hospitalization were recorded. A graded visual analog scale of 1-10 was used to score the patient's postoperative pain, and perception of surgical scar and procedure. More than 76% of the patients found that postoperative pain at the hip donor site was as or less than they had expected, and the median value for the worst pain was 4. About 42% of the patients found the hip donor site to be more painful than the mouth. About 91% of the patients reported walking within the first 24h postoperatively and 89% of the patients were able to walk with normal gait within 2 weeks of surgery. The procedure was considered to result in an esthetically acceptable donor site scar, which was rated highly by patients. Harvesting bone from the iliac crest is well tolerated by patients and has low morbidity.

Long-term clinical and radiological outcomes of surgical management of central giant cell granuloma of the maxilla.

The aim of this study was to report the results of long-term clinical and radiological follow up of the surgical management of central giant cell granuloma of the maxilla. A retrospective analysis was conducted on 12 patients--5 male and 7 female whose ages ranged from 9 to 41 years, with central giant cell granuloma of the maxilla treated between 1991 and 2000. The anterior maxilla was involved in five cases, seven cases were in the posterior region, and none crossed the midline. Four patients were asymptomatic and eight patients presented with pain, mobility of teeth, and rapidly enlarging facial swelling. Radiographically, all lesions were radiolucent; 58.3% were unilocular, and the borders were well-defined in 33.3%. Roots were commonly displaced by the lesion, but no root resorption was observed. Cortical perforation was seen clinically and on CT scan in four patients. All cases were treated with thorough curettage until healthy bone was encountered. In cases with cortical perforation the affected buccal and/or palatal mucosa was excised. When the maxillary sinus was affected or the lesion was bulging into the nose, the nasal mucosa was also removed. All patients were reviewed annually for a follow-up period of 2-9 years; the condition recurred in two patients. It is concluded that thorough curettage is a satisfactory method for the treatment of non-aggressive and aggressive central giant cell granuloma of the maxilla, with a low recurrence rate and favorable postoperative outcome.

Papillon-Lefèvre syndrome: a review of the literature and report of 4 cases.

This report describes 4 cases of Papillon-Lefèvre syndrome (PLS) affecting 2 Jordanian families with a total of 8 children. In family A, 3 girls out of 6 siblings were affected; and in family B, the eldest of 2 brothers. The patients were between 4 1/2 and 12 years old, and their parents, who are first cousins, were not affected. Diagnosis was determined by history, and clinical, laboratory, and radiographic examinations. All present cases exhibited the typical clinical features of PLS: hyperkeratosis of the palms and soles and the presence of advanced destructive periodontitis resulting in early loss of both the primary and permanent dentitions. In Case 4, cutaneous lesions were noticed at age 6 months and the child was edentulous by the age of 12 years. In all cases, there was a relationship between increased severity of skin lesions and seasonal variations and intensified periodontal destruction. There was an early eruption of the permanent teeth. The teeth were caries-free with no sign of root resorption. Dentists play a significant role in the diagnosis and management of PLS patients.

Impaction status of third molars in Jordanian students.

The status of third molars was studied radiographically in 108 male and 124 female Jordanian students (mean age, 20.4 years). The results showed that 9.1% of third molars were congenitally missing. Approximately 73% of the subjects had all four third molars, 12% had three third molars and 11% had two third molars. Only 1.7% had agenesis of all third molars. Third molar agenesis showed predilection for the maxilla over the mandible. There was no significant sexual dimorphism in the agenesis of third molars. Impaction of third molars was found in one third of the subjects with predilection (5.2%) to the maxilla. The proportion of impaction in males was 17.4% and in females 16.2%. Angular position of mandibular third molars revealed that half of the teeth were mesially tilted (average angle 20 degrees +/- 13 [SD] and 41% were in vertical position. A highly significant correlation (r = 0.79, p < 0.001) in the inclination angles was observed between the right and left side of the mandible. The level of eruption of third molars showed 58% of the teeth were fully erupted to occlusal plane, whereas 26% were embedded below the cervical line of adjacent second molar (level C). Males showed a significantly higher frequency (p < 0.001) of level C eruption than females. Results indicated that 11.6% of the subjects or 8.4% of the third molars had incomplete root formation, of which two thirds to one thirds root completion was at a ratio of 4.3:1. The clinical significance of these results is discussed.