Radiography

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The role of ultrasound in the diagnosis and management of scoliosis
(W.B. Saunders Company, 1996) Kirby, Alanah; Paterson, Audrey; Price, Richard
The Nottingham system of back shape and body appraisal for idiopathic scoliosis
(1996) Burwell, R. G.; Webb, J. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.
Torsion in lower limb bones of healthy subjects
(IOS Press, 1997) Kirby, Alanah; Aujla, R. K.; Burwell, R. G.; Cole, A. A.; Moulton, A.; Diab, K. M.; Sevastik, J. A.
Flashlight Online is part of the American Association forHigher Education, Teaching Learning and Technology Group's(TLTG) Flashlight Program (http://www.tltgroup.org/programs/flashlight.html). The core of Flashlight Online is theCurrent Student Inventory (CSI); a bank of approximately 500ready-made questions that can be used to create an onlinesurvey. The questions are designed to help institutions obtainrelevant information about common issues relating to learningtechnologies and their use. Academics, staff developers andlearning technologists can select questions, creating surveyswhich can be edited using Dreamweaver. Surveys can includethe author's own questions as well as ones taken from thequestion bank. In addition, it is possible to change the font sizeand colour and tailor the background of the survey form.
Preliminary study of a new real-time ultrasound method for measuring rib rotation and spinal rotation in scoliosis.
(IOS Press, 1997) Kirby, Alanah; Aujla, R. K.; Burwell, R. G.; Cole, A. A.; Moulton, A.; Polak, F. J.; Webb, J. K.; Diab, K. M.; Sevastik, J. A.
Torsion in the lower limb bones of patients with adolescent idiopathic scoliosis (AIS) treated surgically.
(IOS Press, 1997) Burwell, R. G.; Kirby, Alanah; Cole, A. A.; Moulton, A.; Pratt, R. K.; Webb, J. K.; Diab, K. M.; Sevastik, J. A.
Anthropometry and allometry in girls with right thoracic adolescent idiopathic scoliosis (AIS).
(ISO Press, 1997) Cole, A. A.; Burwell, R. G.; Kirby, Alanah; Polak, F. J.; Webb, J. K.; Diab, K. M.; Sevastik, J. A.
The effect of the Universal Spine System (USS) on segmental vertebral derotation in adolescent idiopathic scoliosis (AIS) assessed by CT scans.
(IOS Press, 1997) Cole, A. A.; Webb, J. K.; Burwell, R. G.; Kirby, Alanah; Preston, B. J.; Hoare, M. A.; Diab, K. M.; Sevastik, J. A.
Torsion in the lower limb bones of children screened for adolescent idiopathic scoliosis (AIS).
(IOS Press, 1997) Burwell, R. G.; Kirby, Alanah; Cole, A. A.; Webb, J. K.; Moulton, A.; Cavdar, S.; Diab, K. M.; Sevastik, J. A.
Torsion in lower limb bones of patients with patellofemoral pain syndrome
(IOS Press, 1997) Moulton, A.; Burwell, R. G.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Szypryt, E. P.; Diab, K. M.; Sevastik, J. A.
Evaluation of vertebral rotation by ultrasound for the early detection of adolescent idiopathic scoliosis (AIS).
(IOS Press, 1998) Burwell, R. G.; Kirby, Alanah; Aujla, R. K.; Kirk, E. L.; Pratt, R. K.; Bailey, M. A.; Webb, J. K.; Stokes, I. A. F.
Segmental rotation of vertebrae and ribs in scoliosis evaluated by a new real-time ultrasound method.
(1999) Kirby, Alanah; Burwell, R. G.; Cole, A. A.; Pratt, R. K.; Webb, J. K.; Moulton, A.
The importance of human resources management (HRM) to the success or failure of health systemperformance has, until recently, been generally overlooked. In recent years it has been increasinglyrecognised that getting HR policy and management right has to be at the core of any sustainablesolution to health system performance. In comparison to the evidence base on health care reformrelatedissues of health system finance and appropriate purchaser/provider incentive structures,there is very limited information on the HRM dimension or its impact.Despite the limited, but growing, evidence base on the impact of HRM on organisationalperformance in other sectors, there have been relatively few attempts to assess the implications ofthis evidence for the health sector. This paper examines this broader evidence base on HRM inother sectors and examines some of the underlying issues related to good HRM in the healthsector.The paper considers how human resource management (HRM) has been defined and evaluated inother sectors. Essentially there are two sub-themes: how have HRM interventions been defined?and how have the effects of these interventions been measured in order to identify whichinterventions are most effective? In other words, what is good HRM?The paper argues that it is not only the organisational context that differentiates the health sectorfrom many other sectors, in terms of HRM. Many of the measures of organisational performanceare also unique. Performance in the health sector can be fully assessed only by means of indicatorsthat are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff peroccupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated)or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgerycomplications).The paper also stresses the need for a fit between the HRM approach and the organisationalcharacteristics, context and priorities, and for recognition that so-called bundles of linked andcoordinated HRM interventions will be more likely to achieve sustained improvements inorganisational performance than single or uncoordinated interventions.
Evaluation of a new real-time ultrasound method for measuring segmental rotation of vertebrae and ribs in scoliosis.
(IOS Press, 1999) Kirby, Alanah; Burwell, R. G.; Cole, A. A.; Pratt, R. K.; Webb, J. K.; Moulton, A.; Stokes, I. A. F.
Back shape assessment in each of three positions in preoperative patients with adolescent idiopathic scoliosis: evaluation of a 10-level Scoliometer method interpolated to 18-levels.
(IOS Press, 2002) Burwell, R. G.; Aujla, R. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Webb, J. K.; Moulton, A.
A Scoliometer was used by one observer (RKP) to assess the reproducibility of angle of trunk inclinations (ATIs) in 13 preoperative patients with AIS (thoracic 7, thoracolumbar 6, mean Cobb angle 50 degrees, right 9, age 15.4 years, girls 10). Three positions were used namely standing forward-bending, (FB) sitting FB and prone. Readings of ATI on the back were obtained at each of 10 levels (T1-S1). The subject was repositioned after walking around the room and a second set of readings obtained (repeats). All readings were converted by a computer program to 18 levels and plotted. The readings from 18 levels were analysed by level, as well as summated and averaged both without and with correction for the side of the curve. Conclusions. Back surface asymmetry measured with a Scoliometer in these preoperative patients with AIS is less in the prone position than in each of the forward bending positions. The standing FB position has the best reproducibility which supports the practice of using this position to measure Scoliometer ATIs in preoperative patients with AIS.
Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method.
(IOS, 2002) Burwell, R. G.; Aujla, R. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Webb, J. K.; Grivas, T. B.
This paper evaluates a new real-time ultrasound method to assess the difference between axial spinal (laminal) rotation and rib rotation at the apex of the scoliosis curve. An Aloka SSD 500 portable ultrasound machine with a veterinary long (172mm) 3.5 MHz linear array transducer was used to assess the reproducibility of the method in 13 preoperative patients with AIS. With the subject in a prone position and her head supported, readings of laminal and rib rotation were made directly on the back at 18 and 12 levels respectively The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). All the readings were made by one observer (ASK). After plotting on graphs three levels of maximal difference between spine rotation and rib rotation about the apex were chosen visually by one observer (RGB) for which the mean apical spine-minus-rib rotation difference (SRRD) was calculated for each repeat. Findings for apical SRRDs. The mean apical SRRDs for the two repeats are 7.1 degrees and 6.9 degrees (range 2-18 degrees) with coefficients of variation of 49% and 62% respectively. Reproducibility. Graphic representation of spinal and rib rotation by 12 levels shows a fairly good agreement between repeats for most subjects. Spinal rotation is always greater than rib rotation. A paired t-test for the mean apical SRRD of the repeats shows no significant difference. Linear regression analysis of the mean apical SRRD repeats correlate significantly (r=0.70, P=0.008) with a residual mean square of 6.9 degrees (rms = 2.6 degrees). The technical error of the measurement (TEM) is 2.3 degrees and coefficient of reliability (R) 0.66. Conclusions. Real-time ultrasound can assess the difference between spinal and rib rotation about the apex of the scoliosis curve without the altered position detectably affecting the findings. The error (2-3 degrees) is high relative the mean apical SRRD (6-7 degrees). The apical SRRD findings have relevance to the pathogenesis of AIS.
Preliminary study of a new real-time ultrasound method for measuring spinal and rib rotation in preoperative patients with adolescent idiopathic scoliosis.
(IOS Press, 2002) Burwell, R. G.; Aujla, R. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Webb, J. K.; Moulton, A.; Grivas, T. B.
A portable ultrasound machine with a linear array transducer was used by one observer (ASK) to evaluate the reproducibility for each of spinal (laminal) rotation and rib rotation in 13 preoperative patients with AIS (thoracic 7, thoracolumbar 6, mean Cobb angle 50 degrees, right 9, left 4, age 15.4 years, girls 10). With the subject in a prone position and her head supported, readings of spinal (laminal) and rib rotations were made directly on the back at 18 and 12 levels respectively. The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). Conclusious. Repositioning the patient significantly alters some single level readings of lam inal rotation and rib rotation. Although the mean average spinal rotation and rib rotation each have acceptable reproducibility, repositioning the patient significantly alters the findings. In the appraisal of surgery by ultrasound the positional change reported here for (I) single level laminal rotation and rib rotation, and (2) mean average rotation imposes caution on the interpretation of the findings. The method enables the axial spine-nh rotation differences to be evaluated which is the subject of a separate paper.
Anterior universal spine system for adolescent idiopathic scoliosis: a follow-up study using scoliometer, real-time ultrasound and radiographs.
(IOS, 2002) Burwell, R. G.; Aujla, R. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Webb, J. K.; Moulton, A.; Grivas, T. B.
Nine patients with AIS treated surgically with anterior USS instrumentation were examined by several methods pre-operatively and at each of 8 weeks, 1 year and 2 years after surgery (mean age 14.6 years, girls 7, boys 2, thoracolumbar 7, lumbar 1, thoracic 1, left 7, right 2). The methods used were (1) Scoliometer to measure angle of trunk inclinations (ATIs) in the standing forward bending position at each of 10 levels and converted to 18 levels by a computer program, (2) real-time ultrasound in the prone position of laminal rotations at each of 1 8 levels from TI-SI, and (3) anteroposterior radiographs in the standing erect position measured for each of Cobb angle, segmental vertebral rotation (Perdriolle) and segmental vertebral translation from the Ti-Si line (horizontal translation of each vertebral centroid from the T1-S1 line). The findings were plotted graphically and segmentally for each of Scoliometer ATJs, ultrasound laminal rotations, and radiographic vertebral rotations and translations. Findings. Graphical representation of the data shows that the improvement brought about by surgery is most clearly and consistently evident for segmental vertebral translation. The statistical analysis shows that the radiological parameters (Cobb angle, apical vertebral rotation and apical vertebral translation) and ultrasound spinal (laminal) rotation do not change detectably in follow-up. The Scoliometer ATI findings show an increase from 4 degrees (at 8 weeks) to 7 degrees (at 2 years) which is statistically significant. The evidence from this small sample of patients is consistent with the view that the compared with posterior USS, anterior USS surgery for AIS results in (1) similar initial rib hump correction, and (2) less rib hump reassertion during follow-up. More data are needed to evaluate these views.
Ultrasound Measurement of Femoral Anteversion and Tibial Torsion
(Scottish Executive, 2002) Kirby, Alanah; Rowe, P. J.
This project aimed to establish a method of measuring femoral anteversion and tibial torsion using real time ultrasound images and a new system of electronic inclinometry. The inclinometry system was carefully calibrated and proved accurate to within 1 degree and precise to with 0.2 of a degree. Individual inclinometers were attached firmly to both a 5MHz and a 7.5MHz linear array ultrasonic transducer using a specially produced clamp which gripped the front and rear of the probe head. Two low profile flexible switches linked by wire to a data collection computer were used to start and stop recording of the output of the inclinometers at 50Hz
The early detection of adolescent idiopathic scoliosis in three positions using the scoliometer and real time ultrasound: should the prone position also be used?
(ISO Press, 2002) Burwell, R. G.; Aujla, R. K.; Kirby, Alanah; Moulton, A.; Webb, J. K.; Peuchot, Bernard; Tanguy, Alain
The standing forward bending position is in general use for the early detection of adolescent idiopathic scoliosis. It also reveals humps caused by leg-length inequality and for this reason some workers have advocated using the sitting forward bending position. Most recently the prone position has been evaluated and even recommended. The introduction of B-mode and subsequently real-time ultrasound to measure rib rotation and spinal rotation has involved using the prone position. The numerical description of back humps in scientific studies requires measurements at several levels on the back from T1-S1. This paper utilizes 30 subjects referred by school screening for scoliosis from whom 10-level Scoliometer Angle of Trunk Inclinations (ATIs) were obtained twice in each of three positions--standing forward bending, sitting forward bending and prone. The ATIs were converted to 18 levels and (1) analysed for reproducibility, (2) compared in the three positions, and (3) compared with real-time ultrasound data of rib rotation obtained in the prone position. Several statistical methods are used. The reproducibility is best in the sitting and prone positions. While the prone position produces lower ATI readings, R squared values are significantly higher and Residual Mean Square (RMS) values significantly lower than those for each of the standing and sitting forward bending positions. Though the prone position has clear advantages, it is not advocated in clinical practice for various reasons. More research is needed. The evidence supports the view that the sitting forward bending position has advantages for the early detection of adolescent idiopathic scoliosis.
Scoliometer-derived correction factor to correct for anterior ribcage asymmetry in the transverse plane (TP) in preoperative AIS when measuring rib rotation in the prone position by ultrasound.
(International Research Society of Spinal Deformities, 2004) Burwell, R. G.; Aujla, R. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Webb, J. K.; Moulton, A.; Sawatzky, B. J.
Relation of rib deformity to vertebral in the transverse plane at the curve apex in preoperative adolescent idiopathic scoliosis (AIS): an ultrasound, radiographical and surface study of pathomechanisms.
(International Research Society of Spinal Deformities, 2004) Burwell, R. G.; Aujla, R. K.; Cole, A. A.; Kirby, Alanah; Pratt, R. K.; Webb, J. K.; Moulton, A.; Sawatzky, B. J.