This thesis describes the development and applications of a new, high-speed, non-invasive, radiographic method by which the orientational and configurational characteristics of an internal human organ can be determined. The application of the method requires the organ to possess a radiologically recognizable contour seen simultaneously by two X-ray sources. / The method does not rely on the existence of anatomical landmarks or implanted artifacts, neither is any prior information about the general orientation of the contour necessary, nor does the operator need to have stereoscopic acuity. / In the presentation, first the developed algorithm is analyzed then the method is described in terms of general requirements and execution. Subsequent chapters deal with the sensitivity and accuracy considerations and the potential of the technique is demonstrated in a series of simulation experiments showing that the accuracy of the method is basically limited only by the digital process employed. / The practical feasibility of the method is demonstrated in a series of in-vivo experiments involving vertebrae of scoliotic and non-scoliotic subjects. The results of these experiments show that, in the case of vertebral bodies, such characteristics as inclination, torsion, wedge angle and true shape can be routinely determined with an accuracy of about 2 degrees angular and 0.2 cm linear.

No description available.

Thesis (M.Tech.: Chiropractic)-Durban University of Technology, 2008 / To evaluate the lumbar lordosis, lumbosacral angle, lumbosacral disc angle, lumbosacral lordosis angle, intervertebral disc angles and heights, interpedicular distances, sagittal canal diameters and the lumbar gravity line (selected radiographic parameters) in young to middle aged Indian females in Durban. To determine any association between the selected radiographic parameters and the age of the subjects, weight, height and body mass index of the subjects, occupation, smoking, previous pregnancy and leg length inequality (selected anthropometric and demographic factors). Methods: Sixty healthy, asymptomatic, young to middle aged, Indian females were recruited for this study. All subjects underwent a case history, a physical examination and radiographic evaluation (AP and lateral views) of the lumbar spine. SPSS version 15.0 (SPSS Inc., Chicago, Ill, USA) was used to analyze the data. Results: The mean (± SD) of the lumbar lordosis, lumbosacral angle, lumbosacral disc angle and lumbosacral lordosis angle was 49º (± 6º), 39º (± 8º), 12º (± 5º) and 143.2º (± 5º) respectively. For the lumbar intervertebral disc angles at L1-L2, L2-L3, L3-L4, L4-L5 and L5- S1 levels, the mean (± SD) was 6º (± 2º), 8º (± 2º), 10º (± 3º), 12º (± 4º) and 12º (± 5º) respectively. The anterior and posterior intervertebral disc heights at the respective vertebral levels were: L1-L2: anterior: 8 mm (± 2), posterior 5 mm (± 2); L2-L3: anterior: 10 mm (± 2), posterior 5 mm (± 2); L3-L4: anterior: 12 mm (± 2), posterior 5 mm (± 2); L4-L5: anterior: 14 mm (± 3), posterior 5 mm (± 2) and L5-S1: anterior: 13 mm (± 4), posterior 6 mm (± 2). The mean (± SD) of the interpedicular distance at the L1, L2, L3, L4 and L5 vertebral levels was 23 mm (± 2), 24 mm (± 2), 25 mm (± 2), 27 mm (± 2) and 31 mm (± 3) respectively. For the sagittal canal diameter at the L1, L2, L3, L4 and L5 vertebral levels, the mean (± SD) was 20 mm (± 5), 21 mm (± 3), 21 mm (± 3), 21 mm (± 3) and 19 mm (± 3) respectively. The lumbar gravity line intersected the sacrum in 67.3% of the subjects. In 29.1% of the subjects, the lumbar gravity line passed anterior to the sacrum while in 3.6% of the subjects, it passed posterior to the sacrum. iv A significant association was found between lumbar lordosis and the height of the subjects in this study (p = 0.004). A decrease in the intervertebral disc height at L5-S1 was associated with smoking (p = 0.005). A decrease in the intervertebral disc height at L4-L5 was associated with previous pregnancy (p = 0.016). Body mass index of 26–30 kg.m-2 was significantly associated with an increase in the intervertebral disc angles at L3-L4 (p = 0.028) and L4-L5 (p = 0.031). A decrease in the L5-S1 intervertebral disc angle was also significantly associated with smoking (p = 0.023). There was a significant association between previous pregnancy and an increase in the intervertebral disc angle at L3-L4 (p = 0.016). A significant association was found between the age of the subjects and the L5-S1 intervertebral disc angle (p = 0.007). Specifically it was the 23–27 year group and 33–37 year group who were significantly different from each other (p = 0.033). Conclusion: Similarities and differences were found in the mean values of the radiographic parameters measured in this study and those reported in the literature. A number of the selected anthropometric and demographic factors were associated with some of the lumbar radiographic parameters. Further studies are required to establish the clinical significance of these findings.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Aim: To determine the intra- and inter-examiner reliability of the radiographic assessment of the cervical lordosis of asymptomatic adult males. Participants: Eighty lateral plain film radiographs of the cervical spine of asymptomatic males aged 18-45 years (taken in a previous study) were utilised for this study. However, due to the obstruction of the C7 vertebral body by the trapezius muscle, the examiners were unable to assess the CL on all 80 plain film radiographs. Three examiners took part in the study viz. Examiner One who was a qualified chiropractor with three years of clinical experience, Examiner Two who was a qualified chiropractor with six years of clinical experience and Examiner Three who was a chiropractic master’s student. Methodology: The initial set of assessments of the CL using the C1-C7 and C2-C7 modified Cobb methods was completed by Examiner One and captured on an Excel spread sheet for Round One. The procedure was then repeated for Examiners Two and Three. The process was repeated for the second set of assessments (Round Two). Each examiner was given a maximum of two weeks to complete their assessments for each round. The data was statistically analysed using SPSS 22.0 and Stata 13. Descriptive data was presented in tables as mean and standard deviation at a 95% confidence interval while intra- and inter-examiner reliability was determined using the Kappa coefficient. Results: The mean (± SD) CL values obtained by each examiner using the C1-C7 modified Cobb method for Round One was: Examiner One: 45.6˚ (± 10.4˚) (n = 70), Examiner Two: 44.0˚ (± 11.0˚) (n = 75) and Examiner Three: 43.8˚ (± 12.0˚) (n = 72). The mean (± SD) CL values obtained by each examiner using the C1-C7 modified Cobb method for Round Two was: Examiner One: 46.7˚ (± 10.7˚) (n = 72), Examiner Two: 43.3˚ (± 11.1˚) (n = 74) and Examiner Three: 43.8˚ (± 11.5˚) (n = 72). The mean (± SD) CL values obtained by each examiner using the C2-C7 modified Cobb method for Round One was: Examiner One: 15.9˚ (± 9.2˚) (n = 72), Examiner Two: 22.6˚ (± 9.7˚) (n = 75) and Examiner Three: 17.2˚ (± 9.7˚) (n = 72). The mean (± SD) CL values obtained by each examiner using the C2-C7 modified Cobb method for Round Two was: Examiner One: 16.3˚ (± 9.4˚) (n = 72), Examiner Two: 20.5˚ (± 9.0˚) (n = 74) and Examiner Three: 16.9˚ (± 9.2˚) (n = 72). The intra-examiner reliability obtained by each examiner using the C1-C7 modified Cobb method for Round One and Round Two was: Examiner One: K = 0.16, Examiner Two: K = 0.11 and Examiner Three: K = 0.16. The intra-examiner reliability obtained by each examiner using the C2-C7 modified Cobb method for Round One and Round Two was: Examiner One: K = 0.21, Examiner Two: K = 0.04, Examiner Three: K = 0.22. The inter-examiner reliability obtained by each examiner using the C1-C7 modified Cobb method for Round One and Round Two respectively was: Examiner One vs Examiner Two: K = 0.03; K = 0.09, Examiner One vs Examiner Three: K = 0.19; K = 0.15, Examiner Two vs Examiner Three: K = 0.03; K = 0.08. The inter-examiner reliability obtained by each examiner using the C2-C7 modified Cobb method for Round One and Round Two respectively was: Examiner One vs Examiner Two: K = 0.00; K = 0.01, Examiner One vs Examiner Three: K = 0.19; K = 0.11, Examiner Two vs Examiner Three: K = 0.02; K = 0.05. There was a significant difference in the intra-examiner findings for both the modified Cobb methods (p < 0.05). Using the C1-C7 modified Cobb method, there was a significant difference in the inter-examiner reliability findings between all three examiners for both rounds (p < 0.05). There was no significant difference in the inter-examiner findings of the CL using the C2-C7 modified method between Examiner One versus Examiner Two for Round One (p = 0.33) and Round Two (p = 0.23) but there was a significant difference in the findings between Examiner One versus Examiner Three (p < 0.05) and between Examiner Two versus Examiner Three (p < 0.05) for Round Two only. Conclusion: The results of this study are in agreement with those of a previous study which reported that the C1-C7 modified Cobb method over-valued the magnitude of the curve while the C2-C7 modified Cobb method under-valued the curve. A significant difference in the intra-examiner findings suggests that recall bias did not significantly affect the assessments while inter-examiner findings suggest that experience and skill of the examiners as well as assessments that require drawing of lines and measuring of angles might lead to differences in the results obtained. Further studies which would utilise a large number of digitised radiographic images from both asymptomatic and symptomatic individuals are required to confirm the findings of this study. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background Literature has shown that clinical and radiological diagnoses do not always correlate in patients with neck pain (Ferrari and Russel, 2003; Peterson and Hsu, 2004). It is not known if this applies to the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) and if the radiological diagnosis leads to a change in the patient’s initial management plan. The impact of cervical spine plain film radiographs will therefore be investigated in the diagnosis and management of patients that presented with neck pain to the CDC at the DUT. It is also not known whether the reason for referral for cervical spine plain film radiographs is always indicated as per the indications in the clinic handbook and radiological referral guidelines. Objectives Objectives were: (1) To determine the suspected pre-radiographic clinical diagnosis and management of the selected clinical records prior to referral for cervical spine plain film radiography; (2) To record the reasoning to send for cervical spine plain film radiographic imaging and to establish whether these are in line with proposed guidelines for referral as found in the literature; (3) To determine the relationship between the suspected pre-radiographic clinical and the radiological diagnoses of patients with neck pain; (4) To determine the number of incidental findings in the selected patients’ plain film radiographs; (5) To determine any change in the pre-radiographic clinical diagnoses and management following radiological reporting of the selected patient’s plain film radiographs. Method This was a quantitative, retrospective, clinical study. The archives at the CDC at the DUT were searched for cervical spine plain film radiographs between 1 January 1997 to 31 December 2013 and these were matched with the corresponding clinical records. After applying the inclusion and exclusion criteria, 73 records were included in the study. The patient’s personal information was coded to ensure confidentiality (Appendix A) and specific clinical and radiological information was recorded (Appendix B). Statistical analysis included the use of frequency counts, percentages, mean, standard deviation and range for the descriptive objectives. Results A total of 73 clinical files and corresponding plain film radiographs were assessed. The mean age of the patients was 44 years. The gender distribution was 64.4% (n=47) females and 35.6% (n=26) males. The most frequent primary radiological diagnosis was loss of lordosis at 41.1% (n=30) followed by cervical spondylosis at 35.6% (n=26) and old cervical spinal trauma at 12.3% (n=9). Sixty four percent (n=47) of patients in this study were sent for cervical spine plain film radiographs after their initial clinical consultation. Reasons that are not considered relevant indications for plain film radiographic referral were present in 46.2% (n=34) of cases; these described non-specific mechanical disorders. The most common reason for plain film radiographic referral was due to positive orthopaedic tests 57.5% (n=42). A total of 27.4% (n=20) of clinical files reviewed had a change in their initial clinical diagnosis and 72.6% (n=53) of these patients had no change in diagnosis. All of the post-radiographic clinical diagnoses were non-specific mechanical conditions. Numerous treatment modalities were utilized by the students with the most common pre-radiographic treatment being soft tissue therapy at 63.0% (n=46). A total of 75% (n=55) of patients had a change of treatment after plain film radiographs were performed and spinal manipulative therapy (SMT) was the main treatment added in 41% of cases. Conclusion Cervical spine plain film radiographs have little impact on the diagnosis of patients with non-specific mechanical neck pain without red flags. It was however found that plain film radiographs had an impact on the management in the majority of cases, especially with an increase in SMT use after plain film radiographs. / M

Thesis (M.Tech.: Chiropractic)-Durban University of Technology, 2008 / To evaluate the lumbar lordosis, lumbosacral angle, lumbosacral disc angle, lumbosacral lordosis angle, intervertebral disc angles and heights, interpedicular distances, sagittal canal diameters and the lumbar gravity line (selected radiographic parameters) in young to middle aged Indian females in Durban. To determine any association between the selected radiographic parameters and the age of the subjects, weight, height and body mass index of the subjects, occupation, smoking, previous pregnancy and leg length inequality (selected anthropometric and demographic factors). Methods: Sixty healthy, asymptomatic, young to middle aged, Indian females were recruited for this study. All subjects underwent a case history, a physical examination and radiographic evaluation (AP and lateral views) of the lumbar spine. SPSS version 15.0 (SPSS Inc., Chicago, Ill, USA) was used to analyze the data. Results: The mean (± SD) of the lumbar lordosis, lumbosacral angle, lumbosacral disc angle and lumbosacral lordosis angle was 49º (± 6º), 39º (± 8º), 12º (± 5º) and 143.2º (± 5º) respectively. For the lumbar intervertebral disc angles at L1-L2, L2-L3, L3-L4, L4-L5 and L5- S1 levels, the mean (± SD) was 6º (± 2º), 8º (± 2º), 10º (± 3º), 12º (± 4º) and 12º (± 5º) respectively. The anterior and posterior intervertebral disc heights at the respective vertebral levels were: L1-L2: anterior: 8 mm (± 2), posterior 5 mm (± 2); L2-L3: anterior: 10 mm (± 2), posterior 5 mm (± 2); L3-L4: anterior: 12 mm (± 2), posterior 5 mm (± 2); L4-L5: anterior: 14 mm (± 3), posterior 5 mm (± 2) and L5-S1: anterior: 13 mm (± 4), posterior 6 mm (± 2). The mean (± SD) of the interpedicular distance at the L1, L2, L3, L4 and L5 vertebral levels was 23 mm (± 2), 24 mm (± 2), 25 mm (± 2), 27 mm (± 2) and 31 mm (± 3) respectively. For the sagittal canal diameter at the L1, L2, L3, L4 and L5 vertebral levels, the mean (± SD) was 20 mm (± 5), 21 mm (± 3), 21 mm (± 3), 21 mm (± 3) and 19 mm (± 3) respectively. The lumbar gravity line intersected the sacrum in 67.3% of the subjects. In 29.1% of the subjects, the lumbar gravity line passed anterior to the sacrum while in 3.6% of the subjects, it passed posterior to the sacrum. iv A significant association was found between lumbar lordosis and the height of the subjects in this study (p = 0.004). A decrease in the intervertebral disc height at L5-S1 was associated with smoking (p = 0.005). A decrease in the intervertebral disc height at L4-L5 was associated with previous pregnancy (p = 0.016). Body mass index of 26–30 kg.m-2 was significantly associated with an increase in the intervertebral disc angles at L3-L4 (p = 0.028) and L4-L5 (p = 0.031). A decrease in the L5-S1 intervertebral disc angle was also significantly associated with smoking (p = 0.023). There was a significant association between previous pregnancy and an increase in the intervertebral disc angle at L3-L4 (p = 0.016). A significant association was found between the age of the subjects and the L5-S1 intervertebral disc angle (p = 0.007). Specifically it was the 23–27 year group and 33–37 year group who were significantly different from each other (p = 0.033). Conclusion: Similarities and differences were found in the mean values of the radiographic parameters measured in this study and those reported in the literature. A number of the selected anthropometric and demographic factors were associated with some of the lumbar radiographic parameters. Further studies are required to establish the clinical significance of these findings.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2017. / Radiographs are the most commonly used modalities for the purpose of diagnosing skeletal disorders. Radiographs are important for chiropractors to exclude any contra-indications prior to spinal manipulative therapy. If contra-indications are found treatment is modified to what best suits each patient. There is a gap in the literature regarding chiropractors reading the same set of radiographs and agreeing on findings. Objectives The study investigated inter- and intra-examiner reliability of lumbar spine radiograph analysis by chiropractors and its impact on clinical management. Methods Inter- and intra-examiner examination of radiographs occurred in two rounds separated by two weeks. Six chiropractors read the same 30 radiographs and clinical history was only available in the second round. Results Inter-observer agreement for categorisation for Round One was 96.78% and Round Two 89.49%. Inter-observer agreement in management was 96.45% in round one and 96.00% in Round two. Agreement between chiropractors had no statistically significant difference. Identification average improved from 0.09 to 0.89 kappa. Overall specificity was relatively high and sensitivity was relatively low. Conclusion Reliability/Agreement between chiropractors was strong in both rounds. Categorising of the diagnosis improved from poor to substantial from Round One to Round Two. Case history improved the accuracy of interpreting the radiographs although this change was not statistically significant. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Aim: The aim of this study was to evaluate the normal selected radiographic parameters (thoracic kyphosis (TK), anterior vertebral body height (AVBH), posterior vertebral body height (PVBH), intervertebral disc height (IVDH) and interpedicular distance (IPD)) in young to middle-aged males across the four racial groups in Durban. Participants: Eighty young to middle-aged apparently healthy males between the ages of 18-45 years from the White, Black, Indian and Coloured racial groups in Durban. Methodology: After written informed consent was acquired, all participants underwent a case history, physical examination and thoracic orthopaedic examination. An AP and lateral radiograph of the thoracic spine was then obtained. The TK, AVBH, PVBH, IVDH and IPD were assessed using methods described previously. The IBM SPSS version 20 was utilized for the data analysis. Mean, standard deviation (SD) and range are reported for the TK, AVBH, PVBH and IPD for each of the four racial groups. For the IVDH, however, the median for the respective vertebral levels is given. ANOVA testing with Bonferroni post-hoc tests were used to determine overall inter-group variations and compare each group to the other. Pearson’s correlation test was used to determine the relationship between the thoracic kyphosis and the other radiographic parameters that were assessed. Results : The mean, SD, minimum and maximum values of the thoracic kyphosis by racial group There was no significant difference in the TK among the four race groups. Significant differences (p < 0.05) were observed in the AVBH, PVBH, IVDH and IPD between the White, Black, Indian and Coloured males at various thoracic levels. Conclusion: The trends of the various radiographic parameters observed in this study support the argument that these parameters should be based on sex, age and geographic race. These values would be useful for South African spinal health care practitioners in the diagnosis and management of spinal disorders.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Thoracic spine pain (TSP) is a very common condition and can be just as disabling as cervical and lumbar pain. The causes of thoracic spine pain are numerous, ranging from less serious non-specific mechanical causes to serious specific underlying pathology. Chiropractors used to request routine radiographs as part of their diagnostic work-up, however limited correlation currently exists between radiographical findings and clinical symptoms in non-specific mechanical thoracic spine pain. The overutilization of plain film radiographs worldwide emphasises the need to investigate which clinical conditions in patients with TSP are sent for radiographs and if they were ethically indicated. Literature is currently limited on the role of thoracic spine x-rays and their influence on the management of patients with TSP. Objectives: The objectives of this retrospective study were: 1) to record the consultation at which thoracic spine radiographs were requested by the student or clinician and the reasons therefore, 2) to determine the number of incidental radiographic findings in the selected patients‟ radiographs, 3) to determine the suspected clinical diagnosis and management of the selected patients prior to referral for thoracic spine radiographs, 4) to determine any change in the clinical diagnoses and management following radiographic reporting of the selected patient‟s radiographs, 5) to determine the correlation between the suspected clinical diagnosis and the radiographic diagnosis of patients with thoracic spine pain. Method: The archives of the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) were searched for all available thoracic spine radiographs and corresponding patient files of patients who presented to the clinic with thoracic spine pain from 1 January 1997 to 31 December 2014. The ABCS (Alignment, Bone, Cartilage, Soft tissue) System was utilised to record data of the radiographs without any knowledge of the patient‟s main compliant. The corresponding patient files were then evaluated with selected clinical variables being recorded. Statistical analysis and interpretation included frequency counts, percentages, mean, standard deviation and ranges for the descriptive objectives. The radiographic and clinical diagnoses were then compared in a two-by-two table to determine any possible relationships in diagnoses of patients with thoracic spine pain. Results: Thirty clinical files and their corresponding thoracic spine radiographs were analysed in this study. The mean age of the patients was 43.6 (± 19.1) years with a gender distribution of 40% males and 60% females. Statistical testing using paired t-tests in order to assess the correlation between the clinical and radiological diagnoses was not possible, as the categories were too different. The most frequent primary radiological diagnosis was both old trauma and scoliosis at 33.3%, followed by thoracic spondylosis at 20%. The majority of thoracic spine radiographs were requested at the initial consultation. The most common reasons for radiographic referral were severe, progressive TSP at 58.6%, trauma at 48.3% and persistent, localised TSP for more than four weeks at 37.9%. The diagnosis remained unchanged in 70% of the patients following radiographic examination. However, in 30% of the cases the clinical diagnosis was changed following radiographic examination. Most patients were diagnosed with non-specific mechanical causes of thoracic spine pain. A wide variety of treatment modalities were utilised before and after radiographic examination, including soft tissue therapy, electro modalities, spinal manipulative therapy and dry needling. A total of 66.6% of the patients in the study had changes made to their management protocol following radiographic evaluation. There was a greater use of spinal manipulative therapy, following radiographic evaluation at 56.7% versus only 26.7% of cases prior to radiographic imaging. Conclusion: Thoracic spine radiographs have little impact on the diagnosis and management of patients with thoracic spine pain as the majority of clinical diagnoses were non- specific mechanical causes of thoracic spine pain. Thoracic spine radiographs were influential in the diagnosis and management of 30% of the cases. Thoracic spine radiographs may therefore be over-utilised at the DUT CDC. However, the use of spinal manipulative therapy more than doubled following radiographic evaluation of the thoracic spine in patients with thoracic spine pain. / M