The Role Of Digital Radiography In Musculoskeletal

Imaging: A Review Article

Ms. Gauri Awathale1, Mr. Suhas Tivaskar2, Mr. Anurag Luharia3, Dr. Rajasbala Dhande4, Aniket Pathade5

1] UG Student, [Link]. MRIT (Medical Radiology and Imaging Technology), Department of Radiology, School of Allied Health Science,
Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
2] Assistant Professor, MRIT (Medical Radiology and Imaging Technology), Department of Radiology, School of Allied Health Sciences,
Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
3] Assistant Professor, MRIT (Medical Radiology and Imaging Technology), Department of Radiology, School of Allied Health Sciences,
Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
4] HOD & Professor, Department of Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences,
Wardha, Maharashtra, India.

Corresponding author's name and address: Mr. Suhas Pruthviraj Tivaskar Assistant Professor, MRIT (Medical Radiology and Imaging
Technology), Department of Radiology, School of Allied Health Sciences, Datta Meghe Institute of Medical Sciences, Wardha,
Maharashtra, India
DOI: 10.47750/pnr.2022.13.S08.09

Background: Digital radiography is a type of imaging that employs an x-ray-sensitive cassette to display information digitally so
doctors may see it as they examine a patient. Without an image receptor, the data is transmitted instantaneously to a computer. As a
result of DR, both the amount of radiation and the total price decreased. Portable digital radiography is very helpful for examining the
musculoskeletal system of trauma victims. These qualities are especially useful in musculoskeletal applications. This can reduce the
radiation dose and the number of exposures in clinical settings. We evaluated digital radiography's potential in diagnosing
musculoskeletal problems by comparing its image quality to that of traditional film and film screens to determine whether or not it is
an improvement over the latter. Frequency-modified digital imaging outperformed film at differentiating soft-tissue structures and
identifying regions with significant attenuation differences. The traditional film-screen technology was great at portraying minute
anatomical details and pinpointing the area around prostheses. This was due to the unsettling halo effect surrounding the prosthesis in
digital photographs, as opposed to the excellent spatial resolution of the conventional film approach. The unsharp masking operator
responsible for the halo effect was not adjusted for any individual tests in this set. It is possible to use the digital system to cut the
radiation dose (exposure) by half without compromising data. In our facility, musculoskeletal imaging is performed using digital
radiography (DR) rather than screen-film (S.F.). Due to our ongoing process of improving image quality, our DR images are now
favoured over Screen Film images, and we have explained our current optimal settings for the Fuji 9000. (Fuji Medical Systems,
Tokyo, Japan). Advantages of DR include higher contrast resolution, variable picture contrast, image reprocessing, and simple image-
to-image management and communication system transfers (IMAC).

Keywords: Digital Radiography, Resolution, musculoskeletal, Image Optimal Image, Spatial Resolution,

INTRODUCTION
Digital radiography (DR) for the musculoskeletal system is widely employed in the medical diagnostic imaging system
(MDIS) program and elsewhere. It is often considered an adequate reserve for screen-film (S.F.) radiography [1]. Images
similar to those seen on a cinema screen have been created in previous research by adjusting parameters in the image
processing software. [2-3] The first digital radiography systems we evaluated confirmed our suspicions that the
manufacturer's recommended image processing settings did not always yield a suitable image for interpretation. Better
abnormality visibility is one reason digital radiography of the musculoskeletal system is preferred over conventional
radiography.
A resolution was comparable to our previous screen-film technology, benefits in offering a range of contrast levels, and
the ability to reprocess images using the same source material. In the hospital and the emergency room, we have switched
to digital radiography from traditional radiography. Within a year, we want to have changed from screen-film radiography
to digital radiography in our outpatient section. We consider the image quality of DR to be superior to the exposure

48 Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 8 ¦ 2022

quantity used in our 100-speed system. However, achieving higher-intension images on screen-film systems with higher
exposures is still possible. [1] The quality of an image can be altered by several variables, such as the method of image
acquisition, the type of display device used, and the type of display mode used. Evaluation and improvement of image
quality can occur at either the purchase or presentation end of this imaging continuum, thanks to the modular nature of
digital systems. How we evaluate images' quality varies from task to task [4-5]. While digital radiography has several
applications in imaging (including the chest, musculoskeletal system, and genitourinary system), there is a universal
threshold for acceptable image quality. This work and its companion paper on image accession are based on research in
scholarly medical journals. In this case, the study focuses on the process of picture clarification and the presentation of
digital radiography images. The introductory section of the complementary work on picture accession provides a standard
definition of digital radiography. Briefly, in this guide, the phrase "digital radiography" encompasses both traditional
digital radiography and its predecessor, computed radiography. Cassette radiography and less frequent use of digital
radiography fall under the scope of this recommendation. [6]

ASSURING THE QUALITY IMAGE

The replacement of screen film with DR is insufficient to provide high-quality images with a DR system. Since there are
substantial distinctions between the two systems, technology specialists must be trained to work with both. To achieve
high-quality images, selecting the smallest imaging plate feasibly is essential and using high-resolution imaging plates
appropriately. Proper collimation and exposure time are needed. Modifications must be made to the data used in image
processing to obtain the most information. In prior sections [1-7], we laid out the steps we take to get optimal performance.
At first, receive paired images from both the S.F. and DR cameras. The DR images are set up to generate numerous
images from each data set by carefully adjusting the limit parameters. Keeping detailed records of preferences and facts
was preferable to methods that hid information. This procedure is repeated until satisfactory results are achieved for all
body parts in the images.

RESOLUTION
High-resolution imaging plates for all limbs (hands, arms, elbows, wrists, ankles, and feet) are required for adequate
resolution. Around 4.5lp/mm high-contrast resolution is provided by the imaging plates with high resolution. [1]

BENEFITS OF DR FOR THE SKELETAL AND MUSCULAR SYSTEM

High resolution, a flexible range of contrast & brightness, the ability to reprocess images to obtain additional information,
and using DR as an entry point into image management and communication system [IMAC] are what we have found to
be the most significant benefits of digital radiography of the musculoskeletal system. [1]

USE OF DR WITH IMAGE REPROCESSING TO PROVIDE A MORE OPTIMAL IMAGE

Initial image processing is subpar due to a mismatch between the patient's size and form and the quality preset in the
algorithm. In such a circumstance, refining the digital data can often eliminate the need for further radiographs.

ADJUSTING THE RANGE OF CONTRAST

Raising or lowering the contrast ratio can improve the legibility of structures. Because of the varying densities in the final
image, specific radiographic images, such as those of the hip, the base of the skull, zygomatic arch, and nasal bone, are
impossible to obtain. After adjusting the contrast range or receiving two separate imaging-processing settings, better
detail can be seen in buildings. In a correct lateral view of the hip, this intertrochanteric fracture has healed better than is
typical. This is due to the more excellent latitude value producing a picture with less contrast.

REPROCESSING OF IMAGES TO OBTAIN ADDITIONAL INFORMATION

Occasionally, a radiography image may reveal the presence of a secondary pathology. The additional information in these
circumstances may allow for a more precise diagnosis with the help of further image processing. The displaced sixth
cervical vertebra on the seventh cervical vertebra is seen in this retouched picture. After the image was reprocessed, it
was clear that a little plug of methacrylate had been used to fill a gap throughout the screw, but when the screw was
removed, the methacrylate came out with it, indicating that the hole had been filled. [1]

DIGITAL RADIOGRAPHY OF MUSCULOSKELETAL USING STIMULABLE PHOSPHOR

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 8 ¦ 2022 49

When used in skeletal radiology, digital radiography can offer several advantages over older film-screen methods,
including better image preservation, transmission, processing, and display [8-9]. Exciting developments in
musculoskeletal imaging include image processing and the manipulation of picture contrast and density, which may lead
to more accurate information about soft tissues than is now possible with radiography alone. Insufficient spatial resolution
[10, 11] may be a drawback of digital musculoskeletal radiography. However, there is a lack of clinical expertise in digital
musculoskeletal radiography. Here, we provide our experience with a preliminary implementation of digital radiography
in the clinical practice of musculoskeletal radiology.
The focus of the present investigation was to evaluate the perfection with which anatomic structures could be illustrated
with the two imaging systems at varying radiation and to compare the model with which important features of common
musculoskeletal wounds could be displayed and assessed with the two imaging systems.

PERFORMANCE OF KNEE IMAGE DIGITAL ANALYSIS OF RADIOGRAPH OF PATIENT WITH

END-STAGE KNEE
Radiographs taken when the patient is bearing weight anterior-posteriorly or posteroanterior (PA) are typically used to
evaluate these features in osteoarthritic knees [12]. Although imaging modalities like M.R.I. are growing, radiography
remains the oldest approach for diagnosing and monitoring knee Osteo Arthritis. Patients with mild knee Osteo Arthritis,
as shown by their average Kallgren & Lawrence (K&L) grade of 1.3, were initially used to demonstrate the usefulness
and validity of the limitations of the Knee Image Digital Analysis (KIDA), and measurements were performed to
differentiate these patients from healthy controls.

A standardised, semi-flexed P.A. radiograph was done below full weight-bearing according to the ‘Buckland’–Wright
technique [13-14]. An aluminium step wedge was put next to the knee, against the detector. Within the exposure,
aluminium evaluates bone density and finds the pixel size after correcting for possible magnification. Before therapy
(baseline), throughout treatment, and at 1- and two years post-treatment, radiographs were taken.

SPATIAL RESOLUTION REQUIREMENTS FOR DETECTION OF SUBPERIOSTEAL

RESORPTION
Better-resolution skeletal radiography, like the septal lines in chest imaging, is used by several facilities to detect
subperiosteal resorption in the phalanges [15, 16]. Subperiosteal resorption has been widely recognised as a practical test
for digital radiology systems due to its reputation as one of the most resolution-intensive skeletal imaging scenarios.
To better understand the progression of secondary hyperparathyroidism in patients with chronic renal failure, we have
digitised direct magnification hand radiographs. An analogous collection of standard radiographs was also digitised. The
digitised photos were computer-processed to create images with varied spatial resolutions. Processes were applied to each
digitised image to keep the contrast range uniform. The diagnostic requirements were established by comparing the
average of the processed images with the standard of the original films using Receiver Operating Characteristic (ROC)
analysis. [17]

SPECIFIC MUSCULOSKELETAL APPLICATION

The level of detail obtained by portable film-screen radiography is typically lower than that obtained from exams
employing more complex scatter suppression techniques and takes numerous, repeated exposures to achieve acceptable
quality. While fewer re-exposures are required thanks to DR's robust linear response, detail is better-seen thanks to digital
processing's ability to enhance edges. Portable musculoskeletal tests are one of the most prevalent applications of DR
technology, where it is essential in imaging patients with severe trauma. The patient's spine, chest, pelvis, and extremities
are imaged using mobile computed radiography. Our hospital employs DR for 18% of its total workload, making it the
standard for portable ED exams. Like the skeletal radiologist, we have found that doctors prefer DR images over
traditional radiographs. [18]

TECHNICAL CONSIDERATIONS
The storage phosphor in DR systems takes the film’s place on a standard TV set (photostimulable phosphor). Traditional
radiographic imaging equipment and techniques are employed, and the phosphor imaging plate is housed in a film
cassette. Fine-grained (5-10 um) barium fluorohalide crystals doped with divalent europium form the phosphor layer on
the bendable image plate. This is mixed with a binder and spread across a thin layer of protective film. Similar to screens,
the image plates necessitate delicate handling. Dust buildup is a typical cause of artefacts; hence it is advised that plates

50 Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 8 ¦ 2022

be cleaned once a week. To begin with, the imaging plate is exposed to incoming radiation, which excites electrons to
higher energy levels (conduction band) (X-rays). [18]

RADIATION DOSE REDUCTION

For most musculoskeletal assessments, DR can reduce radiation dose (less exposure and fewer repeat examinations)
without seemingly sacrificing diagnostic accuracy. From what we've seen and heard from others, it seems that a 25-50%
reduction in exposure is conceivable compared to the conventional film-screen method [19,20]. We conducted a direct
qualitative comparison (Murphey MD et al., ARRS meeting, May 1991) of DR and traditional radiography in several
standards and pathological musculoskeletal examinations at varied percentage exposures, which differ from conventional
procedures by reducing milliampere seconds. Lower exposure levels led to a decline in the percentage of superior
phosphor plate images (43% at 100% exposure and 26% at 75% exposure) and an improvement in the rate of conventional
radiographs graded as equivalent or better than their corresponding phosphor plate image (3% at 100% exposure and 4%
at 75% exposure). Despite this, 93% of DR pictures were rated as better than or on par with their traditional radiograph
counterparts when using a 50% exposure approach. Images captured by phosphor plates get increasingly grainy when the
exposure time is shortened (owing to quantum mottle). The result of which is a reduction in spatial precision. The
increased X-ray attenuation during central musculoskeletal tests (spine, pelvis, hips) makes this noise even louder. Our
evaluation of observer performance uncovered a striking contrast between the diagnostic validity of DR pictures at 50%
exposure and that of conventional radiography in these settings (Murphey MD et al., ARRS meeting, May 1991).
Exposures similar to traditional radiography allow more precise imaging of these core regions and patients with
substantial body habitus. Contrarily, at least half the standard exposure time can be eliminated from the procedure for
radiography of the periphery without compromising image quality. There is no well-defined standard for determining the
most significant radiation dose reduction attainable without compromising diagnostic validity DR for individual tests.
There will be a tradeoff between increased noise and the necessary spatial resolution. Therefore, these thresholds will
vary depending on the type of deformity and the anatomical position of the radiograph. [21-30]

DISCUSSION
Only significant bones and joints, including the spine, were analysed in this study. Conventional methods, digital
radiography of the hands and feet, and more expert film-screen and exposure circumstances, including the mammographic
technique and magnification, should all be compared and contrasted. As a result, the current study did not focus on these
anatomical regions. In musculoskeletal radiology, the contrast and density manipulation benefits for improving data on
soft tissues, and the low spatial resolution drawbacks, are the most important differences between the digital system and
conventional radiography.
As evidenced by the findings given. Radiographic investigation of Osteo Arthritis (OA) features is aided by Knee Image
Digital Analysis (KIDA), even in individuals with advanced OA. It is important to note that rapid reanalysis of photos
increases repeatability (decreases SDDs and decreases systematic bias between measurements). This highlights the
significance of conducting time- and sequence-randomized analyses within a limited window to answer a focused
research issue. One observer is preferable to several observers when analysing photos since there is more of a chance for
error when more people are involved in the process. In this case, the digital radiography was properly configured and
applied. Therefore, the resulting images were of high quality. High image quality stability and sufficient resolution are
provided. In musculoskeletal radiography, it is possible to reduce exposure by 25–50%. In addition to the other images
produced for each trial, a musculoskeletal radiologist also retrospectively analysed the decline images and the repetition
photos in their timed sequence for the musculoskeletal. [31-37]

CONCLUSION
These benefits, especially the enhanced dynamic range and image processing capabilities, are particularly useful in
musculoskeletal radiography applications. We've made an effort to detail and exhibit both the benefits (lower radiation
exposure, fewer repeat exams, more thorough examination of the spine, soft tissue, and portable studies) and drawbacks
(high cost, limited throughput, lower spatial resolution, higher noise, and a shift in image size and format) of DR in
musculoskeletal imaging.

REFERENCES

1. Freedman M, Steller D. Digital radiography of the musculoskeletal system: The optimal image. Journal of digital imaging. 1995 Feb;8(1):37-42.

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 8 ¦ 2022 51

 2. Wilson AJ, Mann FA, Murphy Jr WA, Monsees BS, Linn MR. Photostimulable phosphor digital radiography of the extremities: diagnostic accuracy
compared with conventional radiography. AJR. American journal of roentgenology. 1991 Sep;157(3):533-8.
3. Kreipke DL, Silver DI, Tarver RD, Braunstein EM. Readability of cervical spine imaging: Digital versus film/screen radiograph Computerisedized
medical imaging and graphics. 1990 Mar 1;14(2):119-25.
4. International Commission on Radiation Units and Measurements. ICRU report 54, medical imaging the assessment of image quality. Bethesda,
Md: International Commission on Radiation Units and Measurements; 1996.
5. Beutel J, Kundel HL, Kim Y, Van Metter RL, Horii SC. Handbook of medical imaging. Spie Press; 2000.
6. Krupinski EA, Williams MB, Andriole K, Strauss KJ, Applegate K, Wyatt M, Bjork S, Seibert JA. Digital radiography image quality: image
processing and display. Journal of the American College of Radiology. 2007 Jun 1;4(6):389-400.
7. Nelson MC, Freedman MT, Einar VP, Lo SC, Smith DV, Leckie RG, Mun SK. Image processing of storage phosphor musculoskeletal radiographs:
a comparison of the AGFA and Fuji bone algorithms. InMedical Imaging 1994: Image Processing 1994 May 11 (Vol. 2167, pp. 854-867). SPIE.
8. Merritt CR. Computed radiography: a new approach to plain film imaging. Diagnostic Imaging. 1985 Jan; 1:58-65.
9. Sonoda M, Takano M, Miyahara J, Kato H. Computed radiograutilisingzing scanning laser stimulated luminescence. Radiology. 1983
Sep;148(3):833-8.
10. Chan HP, Vyborny CJ, MacMahon H, Metz CE, Sickles EA. Digital mammography. ROC studies the effects of pixel size and unsharp-mask
filtering, detecting subtle microcalcifications. Investigative radiology. 1987 Jul 1;22(7):581-9.
11. Nakano Y, Hiraoka T, Togashi K, Nishimura K, Itoh K, Fujisawa I, Sagoh T, Minami S, Itoh H, Torizuka K. Direct radiographic magnification
with computed radiography. American Journal of Roentgenology. 1987 Mar 1;148(3):569-73.
12. Vignon E, Piperno M, Le Graverand MP, Mazzuca SA, Brandt KD, Mathieu P, Favret H, Vignon M, Merle‐Vincent F, Conrozier T. Measurement
of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon
schuss views. Arthritis & Rheumatism. 2003 Feb;48(2):378-84.
13. Buckland-Wright JC, Ward RJ, Peterfy C, Mojcik CF, Leff RL. Reproducibility of the semiflexed (metatarsophalangeal) radiographic knee position
and automated measurements of medial tibiofemoral joint space width in a multicenter clinical trial of knee osteoarthritis. The Journal of
Rheumatology. 2004 Aug 1;31(8):1588-97.
14. Buckland-Wright JC, Wolfe F, Ward RJ, Flowers N, Hayne C. Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a
comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views. The Journal of Rheumatology.
1999 Dec 1;26(12):2664-74.
15. Uchida K, Watanabe H, Aoki T, Nakamura K, Nakata H. Clinical evaluation of irreversible data compression for computed radiography of the
hand. Journal of digital imaging. 1998 Aug;11(3):121-5.
16. VÖLK M, Strotzer M, Gmeinwieser J, Alexander J, FRÜND R, Seitz J, Manke C, Spahn M, Feuerbach S. Flat-panel X-ray detector using
amorphous silicon technology: reduced radiation dose for the detection of foreign bodies. Investigative radiology. 1997 Jul 1;32(7):373-7.
17. Murphey MD. Digital skeletal radiography: spatial resolution requirements for detection of subperiosteal resorption. American Journal of
Roentgenology. 1989 Mar 1;152(3):541-6.
18. Milos MJ, Aberle DR, Baraff LJ, Gold RH, Scanlan RL, Bassett LW. Initial clinical experience with computed radiography imaging in an
emergency department. Applied Radiology. 1989 Jan 1;18(1):32-7.
19. Prokop M, Galanski M, Oestmann JW, Von Falkenhausen U, Rosenthal H, Reimer P, Nischelsky J, Reichelt S. Storage phosphor versus screen-
film radiography: effect of varying exposure parameters and unsharp mask filtering on the detectability of cortical bone defects. Radiology. 1990
Oct;177(1):109-13.
20. Pettersson H, Aspelin P, Boijsen E, Herrlin K, Egund N. Digital radiography of the spine, large bones, and joints using stimulable phosphor: early
clinical experience. Acta Radiologica. 1988 May;29(3):267-71.
21. Murphey MD, Quale JL, Martin NL, Bramble JM, Cook LT, Dwyer 3rd SJ. Computed radiography in musculoskeletal imaging: state of the art.
AJR. American journal of roentgenology. 1992 Jan;158(1):19-27.
22. Mettler Jr FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008
Jul;248(1):254-63.
23. Bali, Thool, Lokhande Shalini, A. Lalawmpuii, Ambule Kalyani, Shendre Vaishnavi, and Warghane Roshani. “Case Report on Primary Infertility
with Hypothyroidism and Diabetes Mellitus.” Journal of Pharmaceutical Research International, December 15, 2021, 263–66.
[Link]
24. Bandela, Vinod, Ram Basany, Anil Kumar Nagarajappa, Sakeenabi Basha, Saraswathi Kanaparthi, Kiran Kumar Ganji, Santosh Patil, Ravi Kumar
Gudipaneni, Ghazi Sghaireen Mohammed, and Mohammad Khursheed Alam. “Evaluation of Stress Distribution and Force in External Hexagonal
Implant: A 3-D Finite Element Analysis.” International Journal of Environmental Research and Public Health 18, no. 19 (September 29, 2021):
10266. [Link]
25. Bankar, Nandkishor, Gangaram L. Bhadarge, Neha Bhatt, and Rakesh Kumar Jha. “Study of Haematological and Biochemical Parameters of
COVID-19 Patients in ICU and in Ward.” Journal of Pharmaceutical Research International, December 15, 2021, 442–48.
[Link]
26. Bankar, Nandkishor, Dhruba Hari Chandi, Praful Patil, and Gaurav Mahajan. “Comparative Antibiogram of Escherichia Coli Isolated from the
Urinary Tract Infection in Patients from Tertiary Care Hospital.” Journal of Pharmaceutical Research International, July 7, 2021, 123–28.
[Link]
27. Bansal, Riya, G. D. Vishnu Vardhan, and Ashish Bele. “Impact of Pre-Operative Coping Strategies and Exercises on Post-Operative Recovery
and Quality of Life of Patients with Cancer Having Depression.” Journal of Pharmaceutical Research International, October 2, 2021, 402–11.
[Link]
28. Bansod, Shashank, and Bhushan Madke. “Non-Immunological Contact Urticaria (NICU) Due to Ethanol Containing Hand Sanitiser: A Case
Report.” JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021. [Link]
29. Bante, Vaishnavi, Vaishali Rahate, Rahul Dixit, Rakesh Kumar Jha, and Roshan Kumar Jha. “Self-Medication Practices: A Threatening
Challenge.” Journal of Pharmaceutical Research International, July 21, 2021, 21–25. [Link]
30. Bauer, Michael, Tasha Glenn, Eric D. Achtyes, Martin Alda, Esen Agaoglu, Kürşat Altınbaş, Ole A. Andreassen, et al. “Variations in Seasonal
Solar Insolation Are Associated with a History of Suicide Attempts in Bipolar I Disorder.” International Journal of Bipolar Disorders 9, no. 1
(December 2021): 26. [Link]

52 Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 8 ¦ 2022

31. Bawane, Shiva, Manjusha Mahakalkar, and Ruchira Ankar. “A Case Report on Severe Acute Respiratory Infection.” Journal of Pharmaceutical
Research International, December 14, 2021, 206–10. [Link]
32. Bawankar, Payal, and Savita Pohekar. “To Assess Effectiveness of Informational Booklet on Knowledge Regarding Bardet- Biedl Syndrome
among Nursing Students.” Journal of Pharmaceutical Research International, October 30, 2021, 861–65.
[Link]
33. Bawiskar, Dushyant. “A Case Report on Physiotherapy Rehabilitation of Patient with Lacunar Infarct.” Bioscience Biotechnology Research
Communications 14, no. 6 (June 15, 2021): 01–04. [Link]
34. Bawiskar, Dushyant, and Pratik Phansopkar. “Efficacy of Agility Training in a Police Cadet: A Case Study.” Journal of Pharmaceutical Research
International, July 24, 2021, 281–87. [Link]
35. Bawiskar, Nipun, Aamil Rasheed, Jahnabi Bhagawati, and Sourya Acharya. “Transient Myocardial Ischemia in a Case Post Intra-Muscular
Adrenaline.” Journal of Pharmaceutical Research International, December 17, 2021, 36–40. [Link]
36. Bawiskar, Nipun, Dhruv Talwar, Sourya Acharya, and Sunil Kumar. “Hematological Manifestations of COVID-19 and Their Prognostic
Significance in an Intensive Care Unit: A Cross-Sectional Study.” Cureus, November 25, 2021. [Link]
37. Beedkar, Aishwarya Uday. “A Review of Impact of COVID-19 Pandemic on Medical and Healthcare Fraternity.” Bioscience Biotechnology
Research Communications 14, no. 6 (June 15, 2021): 247–52. [Link]

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 8 ¦ 2022 53