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Acker SN, Weaver K. Limiting radiation exposure when evaluating injured children. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:312-313. [PMID: 38609284 DOI: 10.1016/s2352-4642(24)00085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Shannon N Acker
- University of Colorado School of Medicine, Aurora, CO 80045, USA.
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Suda AJ, Pepke J, Obertacke U, Stadthalter H. No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02511-0. [PMID: 38635088 DOI: 10.1007/s00068-024-02511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Whole-body computer tomographic examinations (WBCT) are essential in diagnosing the severely injured. The structured clinical evaluation in the emergency trauma room, according to ATLS® and guidelines, helps to indicate the correct radiological imaging to avoid overtriage and undertriage. This retrospective, single-center study aimed to evaluate the value of WBCT in patients with an inconspicuous primary survey and whether there is any evidence for this investigation in this group of patients. METHODS This retrospective, single-center study was conducted with patients admitted to a maximum-care hospital and supraregional trauma center in Germany and part of the TraumaNetwork DGU® in southwest Germany between January 2012 and November 2017. Hospital files were used for evaluation, and WBCT was carried out using a 32-row MSCT device from Siemens Healthineers, Volume Zoom, Erlangen, Germany. For evaluation, non-parametric procedures such as the chi-square test, U test, Fisher test, and Wilcoxon rank sum test were used to test for significance (p < 0.05). RESULTS From 3976 patients treated with WBCT, 120 patients (3.02%) showed an inconspicuous primary survey. This examination did not reveal any trauma sequelae in any of this group. Additionally, 198 patients (4.98%) showed minor clinical symptoms in the primary survey, but no morphological trauma sequence could be diagnosed in WBCT diagnostics. Three hundred forty-two patients were not admitted as inpatients after WBCT and discharged to further outpatient treatment because there were no objectifiable reasons for inpatient treatment. Four hundred fifteen patients did not receive WBCT for, e.g., isolated extremity trauma, child, pregnancy, or death. CONCLUSION Not one of the clinically asymptomatic patients had an imageable injury after WBCT diagnostics in this study. WBCT should only be performed in severely injured patients after clinical assessment regardless of "trauma mechanism." According to guidelines and ATLS®, the clinical examination seems to be a safe and reliable method for reasonable and responsible decision-making regarding the realization of WBCT with all well-known risk factors.
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Affiliation(s)
- Arnold J Suda
- AUVA Trauma Center Salzburg, Department for Orthopaedics and Trauma Surgery, Dr-Franz-Rehrl-Platz 5, 5010, Salzburg, Austria.
- University Medical Centre Mannheim, Medical Faculty Mannheim of Heidelberg University, Centre for Orthopaedics and Trauma Surgery, Theodor-Kutzer-Ufer 1-3, 67168, Mannheim, Germany.
| | - Julia Pepke
- University Medical Centre Mannheim, Medical Faculty Mannheim of Heidelberg University, Centre for Orthopaedics and Trauma Surgery, Theodor-Kutzer-Ufer 1-3, 67168, Mannheim, Germany
| | - Udo Obertacke
- University Medical Centre Mannheim, Medical Faculty Mannheim of Heidelberg University, Centre for Orthopaedics and Trauma Surgery, Theodor-Kutzer-Ufer 1-3, 67168, Mannheim, Germany
| | - Holger Stadthalter
- AUVA Trauma Center Salzburg, Department for Orthopaedics and Trauma Surgery, Dr-Franz-Rehrl-Platz 5, 5010, Salzburg, Austria
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3
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Caruso D, De Santis D, Del Gaudio A, Guido G, Zerunian M, Polici M, Valanzuolo D, Pugliese D, Persechino R, Cremona A, Barbato L, Caloisi A, Iannicelli E, Laghi A. Low-dose liver CT: image quality and diagnostic accuracy of deep learning image reconstruction algorithm. Eur Radiol 2024; 34:2384-2393. [PMID: 37688618 PMCID: PMC10957592 DOI: 10.1007/s00330-023-10171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES To perform a comprehensive within-subject image quality analysis of abdominal CT examinations reconstructed with DLIR and to evaluate diagnostic accuracy compared to the routinely applied adaptive statistical iterative reconstruction (ASiR-V) algorithm. MATERIALS AND METHODS Oncologic patients were prospectively enrolled and underwent contrast-enhanced CT. Images were reconstructed with DLIR with three intensity levels of reconstruction (high, medium, and low) and ASiR-V at strength levels from 10 to 100% with a 10% interval. Three radiologists characterized the lesions and two readers assessed diagnostic accuracy and calculated signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), figure of merit (FOM), and subjective image quality, the latter with a 5-point Likert scale. RESULTS Fifty patients (mean age: 70 ± 10 years, 23 men) were enrolled and 130 liver lesions (105 benign lesions, 25 metastases) were identified. DLIR_H achieved the highest SNR and CNR, comparable to ASiR-V 100% (p ≥ .051). DLIR_M returned the highest subjective image quality (score: 5; IQR: 4-5; p ≤ .001) and significant median increase (29%) in FOM (p < .001). Differences in detection were identified only for lesions ≤ 0.5 cm: 32/33 lesions were detected with DLIR_M and 26 lesions were detected with ASiR-V 50% (p = .031). Lesion accuracy of was 93.8% (95% CI: 88.1, 97.3; 122 of 130 lesions) for DLIR and 87.7% (95% CI: 80.8, 92.8; 114 of 130 lesions) for ASiR-V 50%. CONCLUSIONS DLIR yields superior image quality and provides higher diagnostic accuracy compared to ASiR-V in the assessment of hypovascular liver lesions, in particular for lesions ≤ 0.5 cm. CLINICAL RELEVANCE STATEMENT Deep learning image reconstruction algorithm demonstrates higher diagnostic accuracy compared to iterative reconstruction in the identification of hypovascular liver lesions, especially for lesions ≤ 0.5 cm. KEY POINTS • Iterative reconstruction algorithm impacts image texture, with negative effects on diagnostic capabilities. • Medium-strength deep learning image reconstruction algorithm outperforms iterative reconstruction in the diagnostic accuracy of ≤ 0.5 cm hypovascular liver lesions (93.9% vs 78.8%), also granting higher objective and subjective image quality. • Deep learning image reconstruction algorithm can be safely implemented in routine abdominal CT protocols in place of iterative reconstruction.
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Affiliation(s)
- Damiano Caruso
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Domenico De Santis
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Antonella Del Gaudio
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Gisella Guido
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Marta Zerunian
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Michela Polici
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Daniela Valanzuolo
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Dominga Pugliese
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Raffaello Persechino
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Antonio Cremona
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Luca Barbato
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Andrea Caloisi
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Elsa Iannicelli
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Andrea Laghi
- Department of Medical-Surgical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy.
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Chung R, Dane B, Yeh BM, Morgan DE, Sahani DV, Kambadakone A. Dual-Energy Computed Tomography: Technological Considerations. Radiol Clin North Am 2023; 61:945-961. [PMID: 37758362 DOI: 10.1016/j.rcl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Compared to conventional single-energy CT (SECT), dual-energy CT (DECT) provides additional information to better characterize imaged tissues. Approaches to DECT acquisition vary by vendor and include source-based and detector-based systems, each with its own advantages and disadvantages. Despite the different approaches to DECT acquisition, the most utilized DECT images include routine SECT equivalent, virtual monoenergetic, material density (eg, iodine map), and virtual non-contrast images. These images are generated either through reconstructions in the projection or image domains. Designing and implementing an optimal DECT workflow into routine clinical practice depends on radiologist and technologist input with special considerations including appropriate patient and protocol selection and workflow automation. In addition to better tissue characterization, DECT provides numerous advantages over SECT such as the characterization of incidental findings and dose reduction in radiation and iodinated contrast.
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Affiliation(s)
- Ryan Chung
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
| | - Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016, USA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, 505 Parnassus Avenue, M391, Box 0628, San Francisco, CA 94143-0628, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street, South JTN 456, Birmingham, AL 35249-6830, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, RR220, Seattle, WA 98112, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
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Long M, Albeshan S, Alashban Y, England A, Moore N, Young R, Bezzina P, McEntee MF. The effect of contact radiation shielding on breast dose during CT abdomen-pelvis: a phantom study. RADIATION PROTECTION DOSIMETRY 2023; 199:2104-2111. [PMID: 37551012 DOI: 10.1093/rpd/ncad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Abstract
This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen-pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92-1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53-1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91-1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92-1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen-pelvis.
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Affiliation(s)
- Maria Long
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Salman Albeshan
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, PO Box 145111, Riyadh 4545, Saudi Arabia
| | - Yazeed Alashban
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, PO Box 145111, Riyadh 4545, Saudi Arabia
| | - Andrew England
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Niamh Moore
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Rena Young
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Paul Bezzina
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida MSD 2080, Malta
| | - Mark F McEntee
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
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Radiya K, Joakimsen HL, Mikalsen KØ, Aahlin EK, Lindsetmo RO, Mortensen KE. Performance and clinical applicability of machine learning in liver computed tomography imaging: a systematic review. Eur Radiol 2023; 33:6689-6717. [PMID: 37171491 PMCID: PMC10511359 DOI: 10.1007/s00330-023-09609-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Machine learning (ML) for medical imaging is emerging for several organs and image modalities. Our objectives were to provide clinicians with an overview of this field by answering the following questions: (1) How is ML applied in liver computed tomography (CT) imaging? (2) How well do ML systems perform in liver CT imaging? (3) What are the clinical applications of ML in liver CT imaging? METHODS A systematic review was carried out according to the guidelines from the PRISMA-P statement. The search string focused on studies containing content relating to artificial intelligence, liver, and computed tomography. RESULTS One hundred ninety-one studies were included in the study. ML was applied to CT liver imaging by image analysis without clinicians' intervention in majority of studies while in newer studies the fusion of ML method with clinical intervention have been identified. Several were documented to perform very accurately on reliable but small data. Most models identified were deep learning-based, mainly using convolutional neural networks. Potentially many clinical applications of ML to CT liver imaging have been identified through our review including liver and its lesion segmentation and classification, segmentation of vascular structure inside the liver, fibrosis and cirrhosis staging, metastasis prediction, and evaluation of chemotherapy. CONCLUSION Several studies attempted to provide transparent result of the model. To make the model convenient for a clinical application, prospective clinical validation studies are in urgent call. Computer scientists and engineers should seek to cooperate with health professionals to ensure this. KEY POINTS • ML shows great potential for CT liver image tasks such as pixel-wise segmentation and classification of liver and liver lesions, fibrosis staging, metastasis prediction, and retrieval of relevant liver lesions from similar cases of other patients. • Despite presenting the result is not standardized, many studies have attempted to provide transparent results to interpret the machine learning method performance in the literature. • Prospective studies are in urgent call for clinical validation of ML method, preferably carried out by cooperation between clinicians and computer scientists.
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Affiliation(s)
- Keyur Radiya
- Department of Gastroenterological Surgery at University Hospital of North Norway (UNN), Tromso, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway.
| | - Henrik Lykke Joakimsen
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Centre for Clinical Artificial Intelligence (SPKI), University Hospital of North Norway, Tromso, Norway
| | - Karl Øyvind Mikalsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Centre for Clinical Artificial Intelligence (SPKI), University Hospital of North Norway, Tromso, Norway
- UiT Machine Learning Group, Department of Physics and Technology, UiT the Arctic University of Norway, Tromso, Norway
| | - Eirik Kjus Aahlin
- Department of Gastroenterological Surgery at University Hospital of North Norway (UNN), Tromso, Norway
| | - Rolv-Ole Lindsetmo
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Head Clinic of Surgery, Oncology and Women Health, University Hospital of North Norway, Tromso, Norway
| | - Kim Erlend Mortensen
- Department of Gastroenterological Surgery at University Hospital of North Norway (UNN), Tromso, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
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Ryan ME, Jaju A. Revolutionizing pediatric neuroimaging: the era of CT, MRI, and beyond. Childs Nerv Syst 2023; 39:2583-2592. [PMID: 37380927 DOI: 10.1007/s00381-023-06041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To review the evolution of cross-sectional imaging in pediatric neuroradiology from early developments to current advancements and future directions. METHODS Information was obtained through a PubMed literature search as well as referenced online resources and personal experience from radiologists currently practicing pediatric neuroimaging and those who experienced the era of nascent cross-sectional imaging. RESULTS The advent of computed tomography (CT) and magnetic resonance imaging (MRI) in the 1970s and 1980s brought about a revolutionary shift in the field of medical imaging, neurosurgical and neurological diagnosis. These cross-sectional imaging techniques ushered in a new era by enabling the visualization of soft tissue structures within the brain and spine. Advancements in these imaging modalities have continued at a remarkable pace, now providing not only high high-resolution and 3-dimensional anatomical imaging, but also functional assessment. With each stride forward, CT and MRI have provided clinicians with invaluable insights, improving the accuracy and precision of diagnoses, facilitating the identification of optimal surgical targets, and guiding the selection of appropriate treatment strategies. CONCLUSION This article traces the origins and early developments of CT and MRI, chronicling their journey from pioneering technologies to their current indispensable status in clinical applications and exciting possibilities that lie ahead in the realm of medical imaging and neurologic diagnosis.
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Affiliation(s)
- Maura E Ryan
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Chicago, IL, USA.
- Northwestern University Feinberg School of Medicine, 420 East Superior St, Chicago, IL, USA.
| | - Alok Jaju
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, 420 East Superior St, Chicago, IL, USA
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Initial experience on abdominal photon-counting computed tomography in clinical routine: general image quality and dose exposure. Eur Radiol 2023; 33:2461-2468. [PMID: 36477938 PMCID: PMC10017564 DOI: 10.1007/s00330-022-09278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Photon-counting computed tomography has lately found its way into clinical routine. The new technique could offer substantial improvements regarding general image quality, image noise, and radiation dose reduction. This study evaluated the first abdominal examinations in clinical routine and compared the results to conventional computed tomography. METHODS In this single-center retrospective study, 66 patients underwent photon-counting and conventional abdominal CT. Four radiologists assessed general image quality, image noise, and image artifacts. Signal-to-noise ratio and dose properties of both techniques within the clinical application were compared. An ex vivo phantom study revealed the radiobiological impact by means of DNA double-strand break foci in peripheral blood cells by enumerating γ-H2AX+53BP1 foci. RESULTS General image quality in accordance with the Likert scale was found superior for photon-counting CT (4.74 ± 0.46 vs. 4.25 ± 0.54; p < 0.001). Signal-to-noise ratio (p < 0.001) and also dose exposure were higher for photon-counting CT (DLP: 419.2 ± 162.2 vs. 372.3 ± 236.6 mGy*cm; p = 0.0435). CT exposure resulted in significantly increased DNA damage in comparison to sham control (p < 0.001). Investigation of the average foci per cell and radiation-induced foci numbers revealed significantly elevated numbers (p = 0.004 and p < 0.0001, respectively) after photon-counting CT. CONCLUSION Photon-counting CT in abdominal examinations showed superior results regarding general image quality and signal-to-noise ratio in clinical routine. However, this seems to be traded for a significantly higher dose exposure and corresponding double-strand break frequency. Optimization of standard protocols in further clinical applications is required to find a compromise regarding picture quality and dose exposure. KEY POINTS • Photon-counting computed tomography promises to enhance the diagnostic potential of medical imaging in clinical routine. • Retrospective single-center study showed superior general image quality accompanied by higher dose exposure in initial abdominal PCCT protocols compared to state-of-the-art conventional CT. • A simultaneous ex vivo phantom study revealed correspondingly increased frequencies of DNA double-strand breaks after PCCT.
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Linet MS, Applegate KE, McCollough CH, Bailey JE, Bright C, Bushberg JT, Chanock SJ, Coleman J, Dalal NH, Dauer LT, Davis PB, Eagar RY, Frija G, Held KD, Kachnic LA, Kiess AP, Klein LW, Kosti O, Miller CW, Miller-Thomas MM, Straus C, Vapiwala N, Wieder JS, Yoo DC, Brink JA, Dalrymple JL. A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools. J Am Coll Radiol 2023; 20:251-264. [PMID: 36130692 PMCID: PMC10578400 DOI: 10.1016/j.jacr.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 12/27/2022]
Abstract
US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.
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Affiliation(s)
- Martha S Linet
- Chief and Senior Investigator, Radiation Epidemiology Branch (retired) and currently NIH Scientist Emerita, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Kimberly E Applegate
- Division Chief and Professor of Pediatric Radiology (retired), University of Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, and currently Chair of Committee 3 of the International Commission on Radiological Protection, Ottawa, Canada
| | - Cynthia H McCollough
- Brooks-Hollern Professor of Medical Physics and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Janet E Bailey
- Professor of Radiology and Associate Chair for Education in Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Cedric Bright
- Associate Dean for Admissions and Clinical Professor, Department of Internal Medicine, East Carolina's Brody School of Medicine, Greenville, North Carolina
| | - Jerrold T Bushberg
- Clinical Professor of Radiology and Radiation Oncology, University of California Davis School of Medicine, Sacramento, California, and Vice President, National Council of Radiation Protection and Measurements, Bethesda, Maryland
| | - Stephen J Chanock
- Director and Chief of the Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jenna Coleman
- Executive Director of the Medical Educational Council of Pensacola, Pensacola, Florida
| | - Nicole H Dalal
- Resident, Department of Internal Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Lawrence T Dauer
- Attending Physicist, Departments of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela B Davis
- Dean School of Medicine (emerita) and Arline H. and Curtis F. Garvin Research Professor, Center for Community Health Integration, and Professor of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert Y Eagar
- Diagnostic Radiology Resident, Department of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Guy Frija
- Professor of Radiology (Emeritus), Université de Paris, Paris, France
| | - Kathryn D Held
- President of the National Council on Radiation Protection and Measurements, Bethesda, Maryland, and Associate Radiation Biologist, Department of Radiation Oncology, Massachusetts General Hospital and Associate Professor of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Lisa A Kachnic
- Chair, Department of Radiation Oncology, Columbia University Medical Center and the Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Ana P Kiess
- Assistant Professor of Radiation Oncology and Molecular Radiation Sciences and Director of the Residency Program, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lloyd W Klein
- Clinical Professor of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Ourania Kosti
- Senior Program Officer at the Nuclear and Radiation Studies Board of the National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Charles W Miller
- Chief (retired) Radiation Studies Branch, Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, Atlanta, Georgia, and currently a Consultant in Nuclear and Radiological Environmental Health, Atlanta, Georgia
| | - Michelle M Miller-Thomas
- Associate Professor of Radiology and Director of Medical Student Education at Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Christopher Straus
- Associate Professor of Radiology and Director of Medical Student Education, University of Chicago School of Medicine, Chicago, Illinois
| | - Neha Vapiwala
- Professor and Vice Chair of Education, Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica S Wieder
- Director of the Center for Radiation Information and Outreach, US Environmental Protection Agency, Washington, DC
| | - Don C Yoo
- Director of Nuclear Medicine, Miriam Hospital and Professor of Diagnostic Imaging and Clinical Educator, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - James A Brink
- Chair, Department of Radiology, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John L Dalrymple
- Professor of Obstetrics, Gynecology and Reproductive Biology and Associate Dean for Medical Education Quality Improvement, Harvard Medical School, Boston, Massachusetts, and Associate Chair and Vice Chair for Faculty Development and Faculty Affairs and Gynecologic Oncology Fellowship Program Director, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Identification of Bone Mineral Density Deficit Using L1 Trabecular Attenuation by Opportunistic Multidetector CT Scan in Adult Patients. Tomography 2023; 9:150-161. [PMID: 36649000 PMCID: PMC9844499 DOI: 10.3390/tomography9010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/30/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Multidetector computer tomography (CT) has been used to diagnose pathologies such as osteoporosis via opportunistic screening, where the assessment of the bone structure and the measurement of bone mineral density (BMD) are of great relevance. PURPOSE To construct reference BMD values based on the measurement of the attenuation of the L1 vertebral body by multidetector CT scan (in the soft tissue and bone windows) in adult patients and to establish normative ranges by sex and age of BMD values. MATERIALS AND METHODS A retrospective cross-sectional study of 5080 patients who underwent multidetector CT scan between January and December 2021. Adult patients (≥18 years) with non-contrast multidetector CT scan of the abdomen or thorax-abdomen at a voltage 120 kV. The attenuation of the L1 vertebral body in Hounsfield units (HU) in both windows were compared using the Mann-Whitney U-test with α = 0.05. Additionally, the quartiles of the BMD were constructed (in both windows) grouped by sex and age. RESULTS Only 454 (51.30 ± 15.89 years, 243 women) patients met the inclusion criteria. There is no difference in BMD values between windows (soft tissue: 163.90 ± 57.13, bone: 161.86 ± 55.80, p = 0.625), mean L1 attenuation decreased linearly with age at a rate of 2 HU per year, and the presence of BMD deficit among patients was high; 152 of 454 (33.48%) patients presented BMD values suggestive of osteoporosis, and of these, approximately half 70 of 454 (15.42%) corresponded to patients with BMD values suggestive of a high risk of osteoporotic fracture. CONCLUSIONS From clinical practice, the bone mineral density (BMD) of a patient in either window below the first quartile for age- and sex-matched peers suggests a deficit in BMD that cannot be ignored and requires clinical management that enables identification of the etiology, its evolution, and the consequences of this alteration.
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Patra A, Saha A, Bhattacharya K. Efficient Storage and Encryption of 32-Slice CT Scan Images Using Phase Grating. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2023; 48:1757-1770. [PMID: 35765311 PMCID: PMC9226269 DOI: 10.1007/s13369-022-06986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
Medical images are treated as sensitive as it carries patients' confidential information and hence must be protected from unauthorized access. So, a strong encryption mechanism is a primary criterion to transmit these images over the internet to protect them from intruders. In many existing algorithms, noise affection in the extracted images is high, hence not suitable for medical data encryption. Here, we present a new method using phase grating to multiplex as well as encrypting 32 cross-sectional CT scan images (slices) in a single canvas for optimization of storage space and improvement of security. The entire process is divided into a few steps. Before transmission, the main canvas is encrypted with the help of a random phase matrix. The main canvas is further encrypted by the transposition method to enhance security. After decryption, inverse Fourier transform is applied at the proper location of the decrypted canvas to extract the images from the spectra. Quality is measured with peak-signal-to-noise ratio and correlation coefficient methods. Here, it is greater than 38 and the correlation coefficient is close to 1 for all images, thereby indicating of good quality of extracted images. The effect of three common cyber-attacks (viz. known-plaintext attack, chosen-plaintext attack, and chosen-ciphertext attack) is also presented here. The correlation coefficient during cyber-attacks is found to be close to zero, which implies the robustness of the algorithm against cyber-attacks. Finally, a comparison with existing techniques shows the effectiveness of the proposed method.
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Affiliation(s)
- Anirban Patra
- Department of ECE, JIS College of Engineering, Kalyani, India
- Department of Applied Optics and Photonics, University of Calcutta, Kolkata, India
| | - Arijit Saha
- Department of ECE, B P Poddar Institute of Management and Technology, Kolkata, India
| | - Kallol Bhattacharya
- Department of Applied Optics and Photonics, University of Calcutta, Kolkata, India
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Orlando A, Coresh J, Carrick MM, Quan G, Berg GM, Dhakal L, Hamilton D, Madayag R, Lascano CHP, Bar-Or D. Significant National Declines in Neurosurgical Intervention for Mild Traumatic Brain Injury with Intracranial Hemorrhage: A 13-Year Review of the National Trauma Data Bank. Neurotrauma Rep 2023; 4:137-148. [PMID: 36941880 PMCID: PMC10024583 DOI: 10.1089/neur.2022.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
There have been large changes over the past several decades to patient demographics in those presenting with mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH; complicated mTBI) with the potential to affect the use of neurosurgical interventions. The objective of this study was to characterize long-term trends of neurosurgical interventions in patients with complicated mTBI using 13 years of the National Trauma Data Bank (NTDB). This was a retrospective cohort study of adult (≥18 years) trauma patients included in the NTDB from 2007 to 2019 who had an emergency department Glasgow Coma Scale score 13-15, an intracranial hemorrhage (ICH), and no skull fracture. Neurosurgical intervention time trends were quantified for each ICH type using mixed-effects logistic regression with random slopes and intercepts for hospitals, as well as covariates for time and 14 demographic, injury, and hospital characteristics. In total, 666,842 ICH patients across 1060 hospitals were included. The four most common hemorrhages were isolated subdural hemorrhage (36%), isolated subarachnoid hemorrhage (24%), multiple hemorrhage types (24%), and isolated unspecified hemorrhages (9%). Overall, 49,220 (7%) patients received a neurosurgical intervention. After adjustment, the odds of neurosurgical intervention significantly decreased every 10 years by the following odds ratios (odds ratio [95% confidence interval]): 0.85 [0.78, 0.93] for isolated subdural, 0.63 [0.51, 0.77] for isolated subarachnoid, 0.50 [0.41, 0.62] for isolated unspecified, and 0.79 [0.73, 0.86] for multiple hemorrhages. There were no significant temporal trends in neurosurgical intervention odds for isolated epidural hemorrhages (0.87 [0.68, 1.12]) or isolated contusions/lacerations (1.03 [0.75, 1.41]). In the setting of complicated mTBI, the four most common ICH types were associated with significant declines in the odds of neurosurgical intervention over the past decade. It remains unclear whether changing hemorrhage characteristics or practice patterns drove these trends.
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Affiliation(s)
- Alessandro Orlando
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Address correspondence to: Alessandro Orlando, PhD, MPH, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 501 E. Hampden Avenue, Englewood, CO 80443, USA;
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Glenda Quan
- Swedish Medical Center, Englewood, Colorado, USA
| | | | | | | | | | | | - David Bar-Or
- Medical City Plano, Plano, Texas, USA
- Swedish Medical Center, Englewood, Colorado, USA
- Wesley Medical Center, Wichita, Kansas, USA
- Penrose Hospital, Colorado Springs, Colorado, USA
- St. Anthony Hospital, Lakewood, Colorado, USA
- South Texas Health System McAllen, McAllen, Texas, USA
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13
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Ackermans LLGC, Volmer L, Timmermans QMMA, Brecheisen R, Damink SMWO, Dekker A, Loeffen D, Poeze M, Blokhuis TJ, Wee L, Ten Bosch JA. Clinical evaluation of automated segmentation for body composition analysis on abdominal L3 CT slices in polytrauma patients. Injury 2022; 53 Suppl 3:S30-S41. [PMID: 35680433 DOI: 10.1016/j.injury.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sarcopenia is a muscle disease that involves loss of muscle strength and physical function and is associated with adverse health effects. Even though sarcopenia has attracted increasing attention in the literature, many research findings have not yet been translated into clinical practice. In this article, we aim to validate a deep learning neural network for automated segmentation of L3 CT slices and aim to explore the potential for clinical utilization of such a tool for clinical practice. MATERIALS AND METHODS A deep learning neural network was trained on a multi-centre collection of 3413 abdominal cancer surgery subjects to automatically segment muscle, subcutaneous and visceral adipose tissue at the L3 lumbar vertebral level. 536 Polytrauma subjects were used as an independent test set to show generalizability. The Dice Similarity Coefficient was calculated to validate the geometric similarity. Quantitative agreement was quantified using Bland-Altman's Limits of Agreement interval and Lin's Concordance Correlation Coefficient. To determine the potential clinical usability, randomly selected segmentation images were presented to a panel of experienced clinicians to rate on a Likert scale. RESULTS Deep learning results gave excellent agreement versus a human expert operator for all of the body composition indices, with Concordance Correlation Coefficient for skeletal muscle index of 0.92, Skeletal muscle radiation attenuation 0.94, Visceral Adipose Tissue index 0.99 and Subcutaneous Adipose Tissue Index 0.99. Triple-blinded visual assessment of segmentation by clinicians correlated only to the Dice coefficient, but had no association to quantitative body composition metrics which were accurate irrespective of clinicians' visual rating. CONCLUSION A deep learning method for automatic segmentation of truncal muscle, visceral and subcutaneous adipose tissue on individual L3 CT slices has been independently validated against expert human-generated results for an enlarged polytrauma registry dataset. Time efficiency, consistency and high accuracy relative to human experts suggest that quantitative body composition analysis with deep learning should is a promising tool for clinical application in a hospital setting.
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Affiliation(s)
- Leanne L G C Ackermans
- Department of Traumatology, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands; Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands.
| | - Leroy Volmer
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Quince M M A Timmermans
- Department of Traumatology, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands
| | - Ralph Brecheisen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands
| | - Steven M W Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen Aachen 52074, Germany
| | - Andre Dekker
- Clinical Data Science, Faculty of Health Medicine and Lifesciences, Maastricht University, Paul Henri Spaaklaan 1, Maastricht 6229 GT, the Netherlands
| | - Daan Loeffen
- Department of Radiology, Maastricht University Medical Centre+, 6229 HX Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Traumatology, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands
| | - Taco J Blokhuis
- Department of Traumatology, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands; Clinical Data Science, Faculty of Health Medicine and Lifesciences, Maastricht University, Paul Henri Spaaklaan 1, Maastricht 6229 GT, the Netherlands
| | - Jan A Ten Bosch
- Department of Traumatology, Maastricht University Medical Centre+, Maastricht 6229 HX, the Netherlands
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McGraw C, Mains CW, Taylor J, D'Huyvetter C, Salottolo K, Bar-Or D. Predictors of transfer from a remote trauma facility to an urban level I trauma center for blunt splenic injuries: a retrospective observational multicenter study. Patient Saf Surg 2022; 16:30. [PMID: 36085048 PMCID: PMC9463793 DOI: 10.1186/s13037-022-00339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background The decision-making for admission versus emergent transfer of patients with blunt splenic injuries presenting to remote trauma centers with limited resources remains a challenge. Although splenectomy is standard for hemodynamically unstable patients, the specific criterion for non-operative management continues to be debated. Often, lower-level trauma centers do not have interventional radiology capabilities for splenic artery embolization, leading to transfer to a higher level of a care. Thus, the aim of this study was to identify specific characteristics of patients with blunt splenic injuries used for admittance or transfer at a remote trauma center. Methods A retrospective observational study was performed to examine the management of splenic injuries at a mountainous and remote Level III trauma center. Trauma patients ≥ 18 years who had a blunt splenic injury and initially received care at a Level III trauma center prior to admittance or transfer were included. Data were collected over 4.5 years (January 1, 2016 – June 1, 2020). Patients who were transferred out in > 24 h were excluded. Patient demographics, injury severity, spleen radiology findings, and clinical characteristics were compared by decision to admit or transfer to a higher level of care ≤ 24 h of injury. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Multivariable logistic models were used to identify predictors of transfer. Results Of the 73 patients included with a blunt splenic injury, 48% were admitted and 52% were transferred to a Level I facility. Most patients were male (n = 58), were a median age of 26 (21–42) years old, most (n = 62) had no comorbidities, and 47 had been injured from a ski/snowboarding accident. Compared to admitted patients, transferred patients were significantly more likely to be female (13/38 vs. 3/36, p = 0.007), to have an abbreviated injury scale score ≥ 3 of the chest (31/38 vs. 7/35, p = 0.002), have a higher injury severity score (16 (16–22) vs. 13 (9–16), p = 0.008), and a splenic injury grade ≥ 3 (32/38 vs. 12/35, p < 0.001). After adjustment, splenic injury grade ≥ 3 was the only predictor of transfer (OR: 12.1, 95% CI: 3.9–37.3, p < 0.001). Of the 32 transfers with grades 3–5, 16 were observed, and 16 had an intervention. Compared to patients who were observed after transfer, significantly more who received an intervention had a blush on CT (1/16 vs. 7/16, p = 0.02) and a higher median spleen grade of 4 (3–5) vs. 3 (3–3.5), p = 0.01). Conclusions Our data suggest that most patients transferred from a remote facility had a splenic injury grade ≥ 3, with concomitant injuries but were hemodynamically stable and were successfully managed non-operatively. Stratifying by spleen grade may assist remote trauma centers with refining transfer criteria for solid organ injuries. Supplementary Information The online version contains supplementary material available at 10.1186/s13037-022-00339-4.
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Affiliation(s)
| | - Charles W Mains
- Trauma Services Department, Centura Health Trauma System, Centennial, CO, USA
| | - Jodie Taylor
- Trauma Services Department, St. Anthony Summit Hospital, Frisco, CO, USA
| | - Cecile D'Huyvetter
- Trauma Services Department, Centura Health Trauma System, Centennial, CO, USA
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15
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Akila AS, Anitha J, Arun SA. Two-stage lung nodule detection framework using enhanced UNet and convolutional LSTM networks in CT images. Comput Biol Med 2022; 149:106059. [DOI: 10.1016/j.compbiomed.2022.106059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/09/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022]
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16
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Toia GV, Mileto A, Wang CL, Sahani DV. Quantitative dual-energy CT techniques in the abdomen. Abdom Radiol (NY) 2022; 47:3003-3018. [PMID: 34468796 DOI: 10.1007/s00261-021-03266-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Advances in dual-energy CT (DECT) technology and spectral techniques are catalyzing the widespread implementation of this technology across multiple radiology subspecialties. The inclusion of energy- and material-specific datasets has ushered overall improvements in CT image contrast and noise as well as artifacts reduction, leading to considerable progress in radiologists' ability to detect and characterize pathologies in the abdomen. The scope of this article is to provide an overview of various quantitative clinical DECT applications in the abdomen and pelvis. Several of the reviewed applications have not reached mainstream clinical use and are considered investigational. Nonetheless awareness of such applications is critical to having a fully comprehensive knowledge base to DECT and fostering future clinical implementation.
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Affiliation(s)
- Giuseppe V Toia
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Mailbox 3252, Madison, WI, 53792, USA.
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Carolyn L Wang
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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17
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Su L, Dalby KS, Luehmann H, Elkassih SA, Cho S, He X, Detering L, Lin YN, Kang N, Moore DA, Laforest R, Sun G, Liu Y, Wooley KL. Ultrasmall, elementary and highly translational nanoparticle X-ray contrast media from amphiphilic iodinated statistical copolymers. Acta Pharm Sin B 2022; 13:1660-1670. [PMID: 37139426 PMCID: PMC10149980 DOI: 10.1016/j.apsb.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 11/01/2022] Open
Abstract
To expand the single-dose duration over which noninvasive clinical and preclinical cancer imaging can be conducted with high sensitivity, and well-defined spatial and temporal resolutions, a facile strategy to prepare ultrasmall nanoparticulate X-ray contrast media (nano-XRCM) as dual-modality imaging agents for positron emission tomography (PET) and computed tomography (CT) has been established. Synthesized from controlled copolymerization of triiodobenzoyl ethyl acrylate and oligo(ethylene oxide) acrylate monomers, the amphiphilic statistical iodocopolymers (ICPs) could directly dissolve in water to afford thermodynamically stable solutions with high aqueous iodine concentrations (>140 mg iodine/mL water) and comparable viscosities to conventional small molecule XRCM. The formation of ultrasmall iodinated nanoparticles with hydrodynamic diameters of ca. 10 nm in water was confirmed by dynamic and static light scattering techniques. In a breast cancer mouse model, in vivo biodistribution studies revealed that the 64Cu-chelator-functionalized iodinated nano-XRCM exhibited extended blood residency and higher tumor accumulation compared to typical small molecule imaging agents. PET/CT imaging of tumor over 3 days showed good correlation between PET and CT signals, while CT imaging allowed continuous observation of tumor retention even after 10 days post-injection, enabling longitudinal monitoring of tumor retention for imaging or potentially therapeutic effect after a single administration of nano-XRCM.
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18
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Rehani MM, Applegate K, Bodzay T, Heon Kim C, Miller DL, Ali Nassiri M, Chul Paeng J, Srimahachota S, Srinivasa S, Takenaka M, Terez S, Vassileva J, Zhuo W. Accounting for radiation exposure from previous CT exams while deciding on the next exam: What do referring clinicians think? Eur J Radiol 2022; 155:110468. [PMID: 35973303 DOI: 10.1016/j.ejrad.2022.110468] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/11/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To obtain clinicians' views of the need to account for radiation exposure from previous CT scans and the advisability of a regulatory mechanism to control the number of CT scans for an individual patient. METHODS A convenience survey was conducted by emailing a link to a three-question electronic survey to clinicians in many countries, mostly through radiology and radiation protection contacts. RESULTS 505 responses were received from 24 countries. 293 respondents (58%) understand that current regulations do not limit the number of CT scans that can be prescribed for a single patient in a year. When asked whether there should be a regulation to limit the number of CT scans that can be prescribed for a single patient in one year, only a small fraction (143, 28%) answered 'No', 182 (36%) answered 'Maybe' and 166 (33%) answered 'Yes'. Most respondents (337; 67%) think that radiation risk should form part of the consideration when deciding whether to request a CT exam. A minority (138; 27%) think the decision should be based only on the medical indication for the CT exam. Comparison among the 4 countries (South Korea, Hungary, USA and Canada) with the largest number of respondents indicated wide variations in responses. CONCLUSIONS A majority of the surveyed clinicians consider radiation risk, in addition to clinical factors, when prescribing CT exams. Most respondents are in favor of, or would consider, regulation to control the number of CT scans that could be performed on a patient annually.
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Affiliation(s)
- Madan M Rehani
- Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Tamás Bodzay
- Traumatology, Dr. Manninger Jenő Trauma Center, Budapest, Hungary
| | - Chi Heon Kim
- Neurosurgery, Seoul National University College of Medicine, South Korea
| | - Donald L Miller
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, USA
| | | | - Jin Chul Paeng
- Nuclear Medicine, Seoul National University College of Medicine, South Korea
| | - Suphot Srimahachota
- Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | | | - Mamoru Takenaka
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Sera Terez
- Radiology Clinic and Nuclear Medicine, University of Szeged, Hungary
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Weihai Zhuo
- Medical Physics, Institute of Radiation Medicine, Fudan University, China
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Laohawetwanit T, Wanpiyarat N, Lerttanatum N. Useful histopathologic features for diagnosing focal liver lesions with spindle cell morphology: A clinicopathologic study. Ann Diagn Pathol 2022; 59:151975. [DOI: 10.1016/j.anndiagpath.2022.151975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/18/2022] [Accepted: 05/05/2022] [Indexed: 11/01/2022]
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Jiang S, Song CY, Feng MX, Lu YQ. Adult patients with allied disorders of Hirschsprung’s disease in emergency department: An 11-year retrospective study. World J Gastrointest Surg 2022; 14:656-669. [PMID: 36158276 PMCID: PMC9353751 DOI: 10.4240/wjgs.v14.i7.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the past years, only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease (ADHD), most of which were individual case reports or lacked detailed clinical information. Although many studies have reported patients presenting to the emergency department (ED) with recurrent abdominal symptoms for a number of disorders, there are few data involving ADHD. However, owing to a lack of awareness of the disease, misdiagnoses and mistreatments are common. Severe complications such as perforation, bleeding, malabsorption, and even death in ADHD had been reported by many studies.
AIM To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.
METHODS We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital. Their basic information, clinical manifestations, and imaging findings were analyzed. Blood indices were compared between the ADHD and irritable bowel syndrome (IBS) groups.
RESULTS Adult patients with ADHD had a mean age of 48.8 ± 14.3 years, and 77.4% had been treated before admission. The transverse colon was the most common dilated part (73.6%), and constipation (67.9%) was the most common symptom. ADHD patients can present with uncommon symptoms and false-negative imaging findings. Logistic regression analysis indicated that body mass index (BMI) [odds ratio (OR) = 0.786, P = 0.013], cholinesterase (per 1000 units; OR = 0.693, P = 0.008), and blood chlorine (OR = 0.816, P = 0.022) were determined to be independent related factors between the ADHD and IBS groups. The area under the receiver operating characteristics curve of these three indices combined was 0.812 (P < 0.001).
CONCLUSION Emergency physicians should be vigilant regarding patients with chronic constipation, abdominal pain, or abdominal distension, and consider the possibility of ADHD despite its rarity. Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD. BMI, cholinesterase, and blood chlorine have good discriminative abilities between ADHD and IBS. The nutritional status of adult patients with ADHD is worthy of further attention. Surgical treatment for adult patients with ADHD is important and inevitable.
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Affiliation(s)
- Shuai Jiang
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
| | - Cong-Ying Song
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
| | - Meng-Xiao Feng
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, Zhejiang Province, China
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McBain KA, Habib R, Laggis G, Quaiattini A, M Ventura N, Noel GPJC. Scoping review: The use of augmented reality in clinical anatomical education and its assessment tools. ANATOMICAL SCIENCES EDUCATION 2022; 15:765-796. [PMID: 34800073 DOI: 10.1002/ase.2155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this review was to identify the different augmented reality (AR) modalities used to teach anatomy to students, health professional trainees, and surgeons, and to examine the assessment tools used to evaluate the performance of various AR modalities. A scoping review of four databases was performed using variations of: (1) AR, (2) medical or anatomical teaching/education/training, and (3) anatomy or radiology or cadaver. Scientific articles were identified and screened for the inclusion and exclusion criteria as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses with extension for scoping reviews guidelines. Virtual reality was an exclusion criterion. From this scoping review, data were extracted from a total of 54 articles and the following four AR modalities were identified: head-mounted display, projection, instrument and screen, and mobile device. The usability, feasibility, and acceptability of these AR modalities were evaluated using a variety of quantitative and qualitative assessment tools. Within more recent years of AR integration into anatomy education, the assessment of visuospatial ability, cognitive load, time on task, and increasing academic achievement outcomes are variables of interest, which continue to warrant more exploration. Sufficiently powered studies using validated assessment tools must be conducted to better understand the role of AR in anatomical education.
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Affiliation(s)
- Kimberly A McBain
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Rami Habib
- School of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - George Laggis
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Quaiattini
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Nicole M Ventura
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Geoffroy P J C Noel
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
- Division of Anatomy, Department of Surgery, University of California San Diego, San Diego, California, USA
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22
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[3D whole body scans in dermatology-a new era in clinical practice and research?]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:575-579. [PMID: 35258658 DOI: 10.1007/s00105-022-04966-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/13/2022]
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23
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Inkinen SI, Mäkelä T, Kaasalainen T, Peltonen J, Kangasniemi M, Kortesniemi M. Automatic head computed tomography image noise quantification with deep learning. Phys Med 2022; 99:102-112. [PMID: 35671678 DOI: 10.1016/j.ejmp.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/02/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Computed tomography (CT) image noise is usually determined by standard deviation (SD) of pixel values from uniform image regions. This study investigates how deep learning (DL) could be applied in head CT image noise estimation. METHODS Two approaches were investigated for noise image estimation of a single acquisition image: direct noise image estimation using supervised DnCNN convolutional neural network (CNN) architecture, and subtraction of a denoised image estimated with denoising UNet-CNN experimented with supervised and unsupervised noise2noise training approaches. Noise was assessed with local SD maps using 3D- and 2D-CNN architectures. Anthropomorphic phantom CT image dataset (N = 9 scans, 3 repetitions) was used for DL-model comparisons. Mean square error (MSE) and mean absolute percentage errors (MAPE) of SD values were determined using the SD values of subtraction images as ground truth. Open-source clinical head CT low-dose dataset (Ntrain = 37, Ntest = 10 subjects) were used to demonstrate DL applicability in noise estimation from manually labeled uniform regions and in automated noise and contrast assessment. RESULTS The direct SD estimation using 3D-CNN was the most accurate assessment method when comparing in phantom dataset (MAPE = 15.5%, MSE = 6.3HU). Unsupervised noise2noise approach provided only slightly inferior results (MAPE = 20.2%, MSE = 13.7HU). 2DCNN and unsupervised UNet models provided the smallest MSE on clinical labeled uniform regions. CONCLUSIONS DL-based clinical image assessment is feasible and provides acceptable accuracy as compared to true image noise. Noise2noise approach may be feasible in clinical use where no ground truth data is available. Noise estimation combined with tissue segmentation may enable more comprehensive image quality characterization.
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Affiliation(s)
- Satu I Inkinen
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
| | - Teemu Mäkelä
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland; Department of Physics, University of Helsinki, P.O. Box 64, FI-00014 Helsinki, Finland
| | - Touko Kaasalainen
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Juha Peltonen
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Marko Kangasniemi
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Mika Kortesniemi
- HUS Diagnostic Center, Radiology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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24
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Song Y, Ren S, Lu Y, Fu X, Wong KKL. Deep learning-based automatic segmentation of images in cardiac radiography: A promising challenge. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 220:106821. [PMID: 35487181 DOI: 10.1016/j.cmpb.2022.106821] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Due to the advancement of medical imaging and computer technology, machine intelligence to analyze clinical image data increases the probability of disease prevention and successful treatment. When diagnosing and detecting heart disease, medical imaging can provide high-resolution scans of every organ or tissue in the heart. The diagnostic results obtained by the imaging method are less susceptible to human interference. They can process numerous patient information, assist doctors in early detection of heart disease, intervene and treat patients, and improve the understanding of heart disease symptoms and clinical diagnosis of great significance. In a computer-aided diagnosis system, accurate segmentation of cardiac scan images is the basis and premise of subsequent thoracic function analysis and 3D image reconstruction. EXISTING TECHNIQUES This paper systematically reviews automatic methods and some difficulties for cardiac segmentation in radiographic images. Combined with recent advanced deep learning techniques, the feasibility of using deep learning network models for image segmentation is discussed, and the commonly used deep learning frameworks are compared. DEVELOPED INSIGHTS There are many standard methods for medical image segmentation, such as traditional methods based on regions and edges and methods based on deep learning. Because of characteristics of non-uniform grayscale, individual differences, artifacts and noise of medical images, the above image segmentation methods have certain limitations. It is tough to obtain the needed results sensitivity and accuracy when performing heart segmentation. The deep learning model proposed has achieved good results in image segmentation. Accurate segmentation improves the accuracy of disease diagnosis and reduces subsequent irrelevant computations. SUMMARY There are two requirements for accurate segmentation of radiological images. One is to use image segmentation to improve the development of computer-aided diagnosis. The other is to achieve complete segmentation of the heart. When there are lesions or deformities in the heart, there will be some abnormalities in the radiographic images, and the segmentation algorithm needs to segment the heart altogether. The quantity of processing inside a certain range will no longer be a restriction for real-time detection with the advancement of deep learning and the enhancement of hardware device performance.
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Affiliation(s)
- Yucheng Song
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Shengbing Ren
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Yu Lu
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen, China.
| | - Xianghua Fu
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen, China
| | - Kelvin K L Wong
- School of Computer Science and Engineering, Central South University, Changsha, China.
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25
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Scharf J, Chouchane M, Finegan DP, Lu B, Redquest C, Kim MC, Yao W, Franco AA, Gostovic D, Liu Z, Riccio M, Zelenka F, Doux JM, Meng YS. Bridging nano- and microscale X-ray tomography for battery research by leveraging artificial intelligence. NATURE NANOTECHNOLOGY 2022; 17:446-459. [PMID: 35414116 DOI: 10.1038/s41565-022-01081-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
X-ray computed tomography (CT) is a non-destructive imaging technique in which contrast originates from the materials' absorption coefficient. The recent development of laboratory nanoscale CT (nano-CT) systems has pushed the spatial resolution for battery material imaging to voxel sizes of 50 nm, a limit previously achievable only with synchrotron facilities. Given the non-destructive nature of CT, in situ and operando studies have emerged as powerful methods to quantify morphological parameters, such as tortuosity factor, porosity, surface area and volume expansion, during battery operation or cycling. Combined with artificial intelligence and machine learning analysis techniques, nano-CT has enabled the development of predictive models to analyse the impact of the electrode microstructure on cell performances or the influence of material heterogeneities on electrochemical responses. In this Review, we discuss the role of X-ray CT and nano-CT experimentation in the battery field, discuss the incorporation of artificial intelligence and machine learning analyses and provide a perspective on how the combination of multiscale CT imaging techniques can expand the development of predictive multiscale battery behavioural models.
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Affiliation(s)
- Jonathan Scharf
- Department of Nano-Engineering, University of California San Diego, La Jolla, CA, USA.
| | - Mehdi Chouchane
- Laboratoire de Réactivité et Chimie des Solides (LRCS), Université de Picardie Jules Verne, UMR CNRS 7314, Hub de l'Energie, Amiens, France
- Réseau sur le Stockage Electrochimique de l'Energie (RS2E), FR CNRS 3459, Hub de l'Energie, Amiens, France
| | | | - Bingyu Lu
- Department of Nano-Engineering, University of California San Diego, La Jolla, CA, USA
| | - Christopher Redquest
- Department of Chemical Engineering, University of California San Diego, La Jolla, CA, USA
| | - Min-Cheol Kim
- Department of Nano-Engineering, University of California San Diego, La Jolla, CA, USA
| | - Weiliang Yao
- Department of Materials Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Alejandro A Franco
- Laboratoire de Réactivité et Chimie des Solides (LRCS), Université de Picardie Jules Verne, UMR CNRS 7314, Hub de l'Energie, Amiens, France
- Réseau sur le Stockage Electrochimique de l'Energie (RS2E), FR CNRS 3459, Hub de l'Energie, Amiens, France
- Alistore-ERI European Research Institute, FR CNRS 3104, Hub de l'Energie, Amiens, France
- Institut Universitaire de France, Paris, France
| | | | - Zhao Liu
- Thermo Fisher Scientific, Waltham, MA, USA
| | | | | | - Jean-Marie Doux
- Department of Nano-Engineering, University of California San Diego, La Jolla, CA, USA.
| | - Ying Shirley Meng
- Department of Nano-Engineering, University of California San Diego, La Jolla, CA, USA.
- Sustainable Power and Energy Center (SPEC), University of California San Diego, La Jolla, CA, USA.
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26
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Charting the potential of brain computed tomography deep learning systems. J Clin Neurosci 2022; 99:217-223. [DOI: 10.1016/j.jocn.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/17/2022] [Accepted: 03/08/2022] [Indexed: 12/22/2022]
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Cone-Beam Computed Tomography: A New Tool on the Horizon for Forensic Dentistry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095352. [PMID: 35564747 PMCID: PMC9104190 DOI: 10.3390/ijerph19095352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
Abstract
Teeth and bones of calvarium are important structures from a forensic point of view, as they are extremely resilient to destruction or decomposition, even under temperature variations. Radiology is inevitably an important tool in forensic investigations. Maxillofacial radiology provides a considerable amount of information for the identification of remains and evidence in case of legal matters. The advent of cone-beam computed tomography (CBCT) in the arena of maxillofacial 3D imaging has contributed immensely to forensic science such as the age estimation through teeth, analysis of bite marks, determination of race and sex, etc. The advantages of accuracy in imaging the anatomy, digitized technology favoring easier comparison of records and storage of records for a longer period, cost reduction, dose reduction, and easier portability have made it an unavoidable adjunct in forensic investigations. The aim of this paper is to review and highlight the importance of CBCT in successful forensic identification and analysis. This review is written to address the various aspects of CBCT as a recently developed technology that may be very useful in some forensic contexts, based on searches for current studies in the literature using PubMed, Scopus, Web of Science, and Google Scholar databases, to identify studies published since inception to December 2021, with no language restriction. In conclusion, CBCT is an accessible 3D imaging technology with many applications, one of them being in forensic sciences.
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Braun S, Indra L, Lösch S, Milella M. Perimortem Skeletal Sharp Force Trauma: Detection Reliability on CT Data, Demographics and Anatomical Patterns from a Forensic Dataset. BIOLOGY 2022; 11:biology11050666. [PMID: 35625394 PMCID: PMC9138488 DOI: 10.3390/biology11050666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Simple Summary The increased use of computed tomography images in forensic anthropology is easily explained with a variety of benefits: among other reasons they are digitally stored, they can easily be shared and they are non-invasive. However, it is not clear how suitable these images are for forensic anthropologists to detect sharp force trauma. Therefore, we analyzed computed tomography images, by observing digital images of 41 forensic cases in different viewing modalities. In addition, we looked for anatomical injury patterns in the soft- and hard-tissues and any significant correlations between the manner of death (suicide or homicide) with different parameters. Our findings indicated a superiority of viewing the images in 2D, but not all bone lesions were detected. The manner of death was significantly correlated to some of the parameters, which could be extrapolated to future forensic anthropological cases. We promote the inclusion of imaging training into the anthropological curricula. Abstract The increasing importance of trauma analysis by means of postmortem computed tomography (PMCT) is insufficiently reflected in forensic curricula, nor are best practice manuals available. We attempt to detect sharp force bone lesions on PMCT of closed forensic cases with the aims of assessing errors and pointing out patterns in anatomical location and manner of death (MOD). We investigated 41 closed sharp force fatality cases, with available PMCT and forensic reports. Two observers with different radiological training assessed the lesions on PMCT scans (2D and 3D) for comparison with the reports. Between 3% (suicides) and 15.3% (homicides) of sharp force injuries caused visible bone lesions. While our observations were repeatable, each forensic investigation left a similar number of bone lesions undetected. Injury patterns differed between MOD, with thoracic bone lesions being most frequent overall. Soft tissue injury location varied between the MOD. Associations between MOD and age as well as number of injuries were significant. The detection of bone lesions on PMCT for untrained forensic specialists is challenging, curricula and pertinent manuals are desirable. With the low frequency of bone lesions compared to soft tissue injuries, we should be aware when analyzing decomposed bodies.
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Muff JL, Heye T, Thieringer FM, Brantner P. Clinical acceptance of advanced visualization methods: a comparison study of 3D-print, virtual reality glasses, and 3D-display. 3D Print Med 2022; 8:5. [PMID: 35094166 PMCID: PMC8801110 DOI: 10.1186/s41205-022-00133-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/17/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To compare different methods of three-dimensional representations, namely 3D-Print, Virtual Reality (VR)-Glasses and 3D-Display regarding the understanding of the pathology, accuracy of details, quality of the anatomical representation and technical operability and assessment of possible change in treatment in different disciplines and levels of professional experience. METHODS Interviews were conducted with twenty physicians from the disciplines of cardiology, oral and maxillofacial surgery, orthopedic surgery, and radiology between 2018 and 2020 at the University Hospital of Basel. They were all presented with three different three-dimensional clinical cases derived from CT data from their area of expertise, one case for each method. During this, the physicians were asked for their feedback written down on a pencil and paper questionnaire. RESULTS Concerning the understanding of the pathology and quality of the anatomical representation, VR-Glasses were rated best in three out of four disciplines and two out of three levels of professional experience. Regarding the accuracy of details, 3D-Display was rated best in three out of four disciplines and all levels of professional experience. As to operability, 3D-Display was consistently rated best in all levels of professional experience and all disciplines. Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants. Physicians with a professional experience of more than ten years reported no change in treatment using any method. CONCLUSIONS 3D-Print, VR-Glasses, and 3D-Displays are very well accepted, and a relevant percentage of participants with less than ten years of professional work experience could imagine a possible change in treatment using any of these three-dimensional methods. Our findings challenge scientists, technicians, and physicians to further develop these methods to improve the three-dimensional understanding of pathologies and to add value to the education of young and inexperienced physicians.
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Affiliation(s)
- Julian Louis Muff
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
| | - Tobias Heye
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Florian Markus Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery and 3D Print Lab, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Philipp Brantner
- Department of Radiology, Gesundheitszentrum Fricktal, Rheinfelden, Switzerland
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30
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Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients. Updates Surg 2022; 74:343-353. [PMID: 35001252 DOI: 10.1007/s13304-021-01199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
High energy blunt trauma patients with normal vital signs are usually investigated with a Contrast Enhanced Computed Tomography (CECT) for torso injuries. CECT involves high levels of radiations, often showing no injuries in patients over-triaged to the trauma center. The aim of our study was to suggest an alternative diagnostic protocol based on Emergency Room (ER) tests (physical exam, blood tests, extended FAST, Chest and Pelvis X-ray) to avoid CECT in selected patients. A prospective cohort study was conducted from September 2018 to September 2019. Five hundred patients fulfilled the inclusion criteria. Patients received torso-CECT scan only if they had at least one positive ER test. The validity of the single component of the protocol and the global validity of the ER tests to detect torso injuries was assessed through sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, positive (+ LR) and negative (- LR) likelihood ratio. Multivariate analysis was performed to identify independent predictors of torso injuries. One hundred and seventy patients received a torso-CECT scan because of positive ER tests. ER tests showed a global sensitivity for torso injuries of 86.96% (95% CI 80.17-92.08) specificity of 83.98%(95% CI 79.79-87.60), PPV of 67.42% (95% CI 61.83-72.54), NPV of 94.41% (95% CI 91.63-96.30) + LR of 5.43 (95% CI 4.25-6.93), - LR of 0.16 (95% CI 0.10-0.24). ER tests in an experienced center seem to be able to identify more severe blunt trauma patients needing CECT. Further studies are advisable to confirm these results.
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31
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Lala B, Shah J, Salvador TM, Ricci JA. Expanding the Utilization of Low-Dose Computed Tomography in Plastic and Reconstructive Surgery Based on Validated Practices Among Surgical Specialties. Ann Plast Surg 2021; 87:e163-e170. [PMID: 33833174 DOI: 10.1097/sap.0000000000002815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION As computed tomography (CT) usage increases, so have concerns over radiation-induced malignancy. To mitigate these risks, low-dose CT (LDCT) has emerged as a versatile alternative by other specialties, although its use in plastic surgery remains sparse. This study aimed to investigate validated uses of LDCT across surgical specialties and extrapolate these insights to expand its application for plastic surgeons. METHODS A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using search terms "low dose CT" OR "low dose computed tomography" AND "surgery," where the name of each surgical specialty was substituted for word "surgery" and each specialty term was searched separately in combination with the 2 CT terms. Data on radiation dose, outcomes, and level of evidence were collected. Validated surgical applications were correlated with similar procedures and diagnostic tests performed routinely by plastic surgeons to extrapolate potential applications for plastic surgeons. RESULTS A total of 3505 articles were identified across surgical specialties, with 27 ultimately included. Depending on the application, use of LDCT led to a 25% to 97% reduction in radiation dose and all studies reported noninferior image quality and diagnostic capability compared with standard-dose CT. Potential identified uses included the following: evaluation of soft tissue infections, preoperative and postoperative management of facial and hand fractures, flap design, 3D modeling, and surgical planning. DISCUSSION Low-dose CT is a valid imaging alternative to standard-dose CT. Expanded utilization in plastic surgery should be considered to minimize the iatrogenic effects of radiation and to promote patient safety without compromising outcomes.
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Affiliation(s)
- Brittany Lala
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY
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32
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Sharaf BA, Morris JM, Kuruoglu D. EPPOCRATIS: A Point-of-Care Utilization of Virtual Surgical Planning and Three-Dimensional Printing for the Management of Acute Craniomaxillofacial Trauma. J Clin Med 2021; 10:5640. [PMID: 34884342 PMCID: PMC8658368 DOI: 10.3390/jcm10235640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/28/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
While virtual surgical planning (VSP) and three-dimensional planning (3DP) have become important tools in acute craniomaxillofacial surgery, the incorporation of point of care VSP and 3DP is crucial to allow for acute facial trauma care. In this article, we review our approach to acute craniomaxillofacial trauma management, EPPOCRATIS, and discuss current challenges and future directions in acute facial trauma management.
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Affiliation(s)
- Basel A. Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55902, USA;
| | - Jonathan M. Morris
- Anatomic Modeling Lab, Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA;
- Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | - Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55902, USA;
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Ghosh SK. The evolution of epistemological methodologies in anatomy: From antiquity to modern times. Anat Rec (Hoboken) 2021; 305:803-817. [PMID: 34558798 DOI: 10.1002/ar.24781] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 12/31/2022]
Abstract
Present day scenario regarding epistemological methods in anatomy is in sharp contrast to the situation during ancient period. This study aimed to explore the evolution of epistemological methodologies in anatomy across centuries. In ancient times Egyptian embalmers acquired anatomical knowledge from handling human bodies and likewise anatomical studies in India involved human dissection. Ancient Greeks used theological principles-based methods, animal dissection and human dissection in practice of anatomy. Human dissection was also practiced in ancient China for gaining anatomical knowledge. Prohibition of human dissection led to use of animal dissection in ancient Rome and the trend continued in Europe through Middle Ages. Epistemological methods used by Muslim scholars during Middle Ages are not clearly chronicled. Human dissection returned as primary epistemological method in Renaissance Europe and empirical methods were reinstated after ancient period in human dissection during 16th century. The situation further improved with introduction of pragmatic experiment based approach during 17th century and autopsy-based methods during 18th century. Advances in anatomical knowledge continued with advent of microscope-based methods and emergence of anatomical sections in practice of human dissection in 19th century. Introduction of human observational studies, medical imaging, and molecular methods presented more options in terms of epistemological methods for investigating the human body during 20th century. Onset of 21st century has witnessed dominance of technology-based methods in anatomy. Limited emphasis on ethics in epistemological methodologies since antiquity is a dark aspect of otherwise an eventful evolutionary journey but recent developments are in positive direction.
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Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, India
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Ganguly PS, Pelt DM, Gürsoy D, de Carlo F, Batenburg KJ. Improving reproducibility in synchrotron tomography using implementation-adapted filters. JOURNAL OF SYNCHROTRON RADIATION 2021; 28:1583-1597. [PMID: 34475305 PMCID: PMC8415339 DOI: 10.1107/s1600577521007153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
For reconstructing large tomographic datasets fast, filtered backprojection-type or Fourier-based algorithms are still the method of choice, as they have been for decades. These robust and computationally efficient algorithms have been integrated in a broad range of software packages. The continuous mathematical formulas used for image reconstruction in such algorithms are unambiguous. However, variations in discretization and interpolation result in quantitative differences between reconstructed images, and corresponding segmentations, obtained from different software. This hinders reproducibility of experimental results, making it difficult to ensure that results and conclusions from experiments can be reproduced at different facilities or using different software. In this paper, a way to reduce such differences by optimizing the filter used in analytical algorithms is proposed. These filters can be computed using a wrapper routine around a black-box implementation of a reconstruction algorithm, and lead to quantitatively similar reconstructions. Use cases for this approach are demonstrated by computing implementation-adapted filters for several open-source implementations and applying them to simulated phantoms and real-world data acquired at the synchrotron. Our contribution to a reproducible reconstruction step forms a building block towards a fully reproducible synchrotron tomography data processing pipeline.
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Affiliation(s)
- Poulami Somanya Ganguly
- Computational Imaging, Centrum Wiskunde and Informatica, Amsterdam, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Daniël M. Pelt
- Computational Imaging, Centrum Wiskunde and Informatica, Amsterdam, The Netherlands
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
| | - Doga Gürsoy
- X-ray Science Division, Argonne National Laboratory, Argonne,IL, USA
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, USA
| | | | - K. Joost Batenburg
- Computational Imaging, Centrum Wiskunde and Informatica, Amsterdam, The Netherlands
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, The Netherlands
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35
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Implementation of a computed tomography dose management program across a multinational healthcare organization. Eur Radiol 2021; 31:9188-9197. [PMID: 34003348 DOI: 10.1007/s00330-021-07986-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/18/2021] [Accepted: 04/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Radiation dose index monitoring (RDIM) systems may help identify CT dose reduction opportunities, but variability and complexity of imaging procedures make consistent dose optimization and standardization a challenge. This study aimed to investigate the feasibility to standardize and optimize CT protocols through the implementation of a Dose Excellence Program within a European healthcare network. METHODS The Dose Excellence Program consisted of a multidisciplinary team that developed standardized organizational adult CT protocols and thresholds for relevant radiation dose indices (RDIs). Baseline data were collected retrospectively from the RDIM (Phase I, 2015). Organization's protocols were implemented and monitored from the RDIM for deviations (Phase II, 2016). Following standardization, radiation dose optimization was initiated (Phase III, 2017). Data from the three most used protocols were retrospectively extracted and grouped by country for all phases. The mean number of series (RS) and RDIs were compared between phases and with organizational reference levels. A Mann-Whitney test was conducted; p < .05 was considered as significant. RESULTS Data from 9588, 12638, and 6093 examinations were analyzed from General Chest, General Head, and Thorax/Abdomen/Pelvis (TAP) multiphase respectively. Overall, after Phase III, mean RS and CTDIvol p75 were below the organizational reference levels in all countries for the three protocols. The CTDIvol decreased by 45% in Switzerland (p < .00001), 32% in Turkey (p < .00001), and 28% in Switzerland (p = .0027) for General Chest, General Head, and TAP multiphase respectively. CONCLUSIONS The implementation of a Dose Excellence Program within a large-scale healthcare organization allowed unifying protocols and optimizing radiation dose across countries. KEY POINTS • Engaging a multidisciplinary team can enhance the use of an RDIM system for CT dose management in a multinational healthcare environment. • Deep dive of baseline data and standardization of CT practices by defining organizational clinical indication CT protocols with RPIDs is an essential step before optimization of radiation dose. • Following the implementation of the program, the mean RS and CTDIvol were below or equal to the organizational reference levels in all countries.
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Shi Z, Li H, Cao Q, Wang Z, Cheng M. A material decomposition method for dual-energy CT via dual interactive Wasserstein generative adversarial networks. Med Phys 2021; 48:2891-2905. [PMID: 33704786 DOI: 10.1002/mp.14828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Dual-energy computed tomography (DECT) is highly promising for material characterization and identification, whereas reconstructed material-specific images are affected by magnified noise and beam-hardening artifacts. Although various DECT material decomposition methods have been proposed to solve this problem, the quality of the decomposed images is still unsatisfactory, particularly in the image edges. In this study, a data-driven approach using dual interactive Wasserstein generative adversarial networks (DIWGAN) is developed to improve DECT decomposition accuracy and perform edge-preserving images. METHODS In proposed DIWGAN, two interactive generators are used to synthesize decomposed images of two basis materials by modeling the spatial and spectral correlations from input DECT reconstructed images, and the corresponding discriminators are employed to distinguish the difference between the generated images and labels. The DECT images reconstructed from high- and low-energy bins are sent to two generators separately, and each generator synthesizes one material-specific image, thereby ensuring the specificity of the network modeling. In addition, the information from different energy bins is exploited through the feature sharing of two generators. During decomposition model training, a hybrid loss function including L1 loss, edge loss, and adversarial loss is incorporated to preserve the texture and edges in the generated images. Additionally, a selector is employed to define the generator that should be trained in each iteration, which can ensure the modeling ability of two different generators and improve the material decomposition accuracy. The performance of the proposed method is evaluated using digital phantom, XCAT phantom, and real data from a mouse. RESULTS On the digital phantom, the regions of bone and soft tissue are strictly and accurately separated using the trained decomposition model. The material densities in different bone and soft-tissue regions are near the ground truth, and the error of material densities is lower than 3 mg/ml. The results from XCAT phantom show that the material-specific images generated by directed matrix inversion and iterative decomposition methods have severe noise and artifacts. Regarding to the learning-based methods, the decomposed images of fully convolutional network (FCN) and butterfly network (Butterfly-Net) still contain varying degrees of artifacts, while proposed DIWGAN can yield high quality images. Compared to Butterfly-Net, the root-mean-square error (RMSE) of soft-tissue images generated by the DIWGAN decreased by 0.01 g/ml, whereas the peak-signal-to-noise ratio (PSNR) and structural similarity (SSIM) of the soft-tissue images reached 31.43 dB and 0.9987, respectively. The mass densities of the decomposed materials are nearest to the ground truth when using the DIWGAN method. The noise standard deviation of the decomposition images reduced by 69%, 60%, 33%, and 21% compared with direct matrix inversion, iterative decomposition, FCN, and Butterfly-Net, respectively. Furthermore, the performance of the mouse data indicates the potential of the proposed material decomposition method in real scanned data. CONCLUSIONS A DECT material decomposition method based on deep learning is proposed, and the relationship between reconstructed and material-specific images is mapped by training the DIWGAN model. Results from both the simulation phantoms and real data demonstrate the advantages of this method in suppressing noise and beam-hardening artifacts.
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Affiliation(s)
- Zaifeng Shi
- School of Microelectronics, Tianjin University, Tianjin, 300072, China.,Tianjin Key Laboratory of Imaging and Sensing Microelectronic Technology, Tianjin, 300072, China
| | - Huilong Li
- School of Microelectronics, Tianjin University, Tianjin, 300072, China
| | - Qingjie Cao
- School of Mathematical Sciences, Tianjin Normal University, Tianjin, 300072, China
| | - Zhongqi Wang
- School of Microelectronics, Tianjin University, Tianjin, 300072, China
| | - Ming Cheng
- School of Microelectronics, Tianjin University, Tianjin, 300072, China
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Guerraty M, Bhargava A, Senarathna J, Mendelson AA, Pathak AP. Advances in translational imaging of the microcirculation. Microcirculation 2021; 28:e12683. [PMID: 33524206 PMCID: PMC8647298 DOI: 10.1111/micc.12683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
The past few decades have seen an explosion in the development and use of methods for imaging the human microcirculation during health and disease. The confluence of innovative imaging technologies, affordable computing power, and economies of scale have ushered in a new era of "translational" imaging that permit us to peer into blood vessels of various organs in the human body. These imaging techniques include near-infrared spectroscopy (NIRS), positron emission tomography (PET), and magnetic resonance imaging (MRI) that are sensitive to microvascular-derived signals, as well as computed tomography (CT), optical imaging, and ultrasound (US) imaging that are capable of directly acquiring images at, or close to microvascular spatial resolution. Collectively, these imaging modalities enable us to characterize the morphological and functional changes in a tissue's microcirculation that are known to accompany the initiation and progression of numerous pathologies. Although there have been significant advances for imaging the microcirculation in preclinical models, this review focuses on developments in the assessment of the microcirculation in patients with optical imaging, NIRS, PET, US, MRI, and CT, to name a few. The goal of this review is to serve as a springboard for exploring the burgeoning role of translational imaging technologies for interrogating the structural and functional status of the microcirculation in humans, and highlight the breadth of current clinical applications. Making the human microcirculation "visible" in vivo to clinicians and researchers alike will facilitate bench-to-bedside discoveries and enhance the diagnosis and management of disease.
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Affiliation(s)
- Marie Guerraty
- Division of Cardiovascular Medicine, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
USA
| | - Akanksha Bhargava
- Russell H. Morgan Department of Radiology and Radiological
Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janaka Senarathna
- Russell H. Morgan Department of Radiology and Radiological
Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asher A. Mendelson
- Department of Medicine, Section of Critical Care, Rady
Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arvind P. Pathak
- Russell H. Morgan Department of Radiology and Radiological
Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, The Johns Hopkins
University School of Medicine, Baltimore, MD, USA
- Department of Electrical Engineering, Johns Hopkins
University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns
Hopkins University School of Medicine, Baltimore, MD, USA
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Frush DP, Sorantin E. Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community. Pediatr Radiol 2021; 51:532-543. [PMID: 33743037 DOI: 10.1007/s00247-020-04924-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 01/15/2023]
Abstract
Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.
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Affiliation(s)
- Donald P Frush
- Pediatric Radiology, Duke University Medical Center, Room #2568, 40 Duke Medicine Circle, Red Zone, Duke South Box 3808, Durham, NC, 27710, USA.
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
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Mahaffey AL. Prominence of Analytical Chemistry in Modern-Day Healthcare: Current Medical Discoveries, Student Perspectives, and Systems Thinking. Anal Chem 2021; 93:4775-4781. [PMID: 33689291 DOI: 10.1021/acs.analchem.1c00041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the course of two years (2018 and 2020), anatomists and medical professionals became wonderstruck by two significant organ discoveries. The findings were previously undetected by conventional standards of medicine. Two different research groups and specialties, nonetheless, relied on applications founded on the principles of analytical chemistry education and techniques. In this article, I penned a discussion on both medical discoveries birthed through analytical processes. Secondarily, an examination of student perspectives on the versatility of analytical chemistry in healthcare and a review of the seemingly minimal representation (toward awareness) of analytical chemistry in health sciences programs are presented: Should there be a higher representation of analytical chemistry topics in undergraduate and graduate health profession programs? If so, what would be the plan of action? Increased notability of analytical chemistry in health sciences textbooks? Or the inception of a nontechnical novel analytical chemistry course for health sciences majors? Here, I attempt to answer these questions and present a plausible solution with the goal of acknowledging the prominence of analytical chemistry in medicine today.
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Affiliation(s)
- Angela L Mahaffey
- Marcella Niehoff School of Nursing, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, Illinois 60660, United States
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40
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Bailleul AM, Lu J, Li Z. DiceCT applied to fossilized hard tissues: A preliminary case study using a miocene bird. JOURNAL OF EXPERIMENTAL ZOOLOGY PART B-MOLECULAR AND DEVELOPMENTAL EVOLUTION 2021; 336:364-375. [PMID: 33666331 DOI: 10.1002/jez.b.23037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/02/2021] [Accepted: 02/14/2021] [Indexed: 11/12/2022]
Abstract
Iodine-based contrasting agents for computed tomography (CT) have been used for decades in medicine. Agents like Lugol's iodine enhance the contrasts between soft tissues and mineralized (skeletal) tissues. Because a recent study on extant avian heads showed that iodine-ethanol (I2 E) is a better contrast enhancer overall than the standard Lugol's iodine, here, we tested if I2 E could also enhance the CT contrasts of two fossilized skeletal tissues: bone and calcified cartilage. For this, we used a partial ankle joint from an extinct pheasant from the Late Miocene of Northwest China (Linxia Basin). The pre-staining CT scans showed no microstructural details of the sample. After being immersed into a solution of 1% I2 E for 8 days and scanned a second time, the contrasts were drastically enhanced between the mineralized tissues (bony trabeculae and calcified cartilage) and the sediments and minerals inside vascular spaces. After three other staining-scanning cycles in 2%, 3%, and 6% I2 E solutions, the best contrasts were obtained after immersion in 6% I2 E for 7 days. Energy Dispersive Spectroscopy showed that iodine was preferentially absorbed by the mineralized tissues and the minerals in the vascular spaces, but not by the sediments. This method not only effectively increased the contrasts of two different fossilized skeletal tissues, it was also non-destructive and reversible because part of the fossil was successfully de-stained after a few days in pure ethanol. These preliminary results indicate that iodine-ethanol has the potential to be used widely in vertebrate paleontology to improve CT imaging of fossilized tissues.
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Affiliation(s)
- Alida M Bailleul
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Beijing, China.,CAS Center for Excellence in Life and Paleoenvironment, Beijing, China
| | - Jing Lu
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Beijing, China.,CAS Center for Excellence in Life and Paleoenvironment, Beijing, China
| | - Zhiheng Li
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Beijing, China.,CAS Center for Excellence in Life and Paleoenvironment, Beijing, China
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Warner E, Wang N, Lee J, Rao A. Meaningful incorporation of artificial intelligence for personalized patient management during cancer: Quantitative imaging, risk assessment, and therapeutic outcomes. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van der Merwe CM, Mahomed N. An audit of radiation doses received by paediatric patients undergoing computed tomography investigations at academic hospitals in South Africa. SA J Radiol 2020; 24:1823. [PMID: 33240540 PMCID: PMC7669994 DOI: 10.4102/sajr.v24i1.1823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Diagnostic reference levels (DRLs) are a crucial element of auditing radiation doses in paediatric computed tomography (CT). Currently, there are no national paediatric CT DRLs in South Africa. Objectives The aim of this article was to establish local paediatric DRLs for CT examinations at two academic hospitals and to compare paediatric CT radiation output levels with established DRLs in the developed and developing world. Method Computed Tomography Dose Indexvolume (CTDIvol) and dose length product (DLP) values were collected from CT examinations performed at two university hospitals for patients aged 0–15 years, during 01 November 2016–30 April 2017. The 75th percentile of the data distribution was calculated for each CT examination type and age group, further categorised into routine working hours and after-hours for both hospitals and statistically compared. Results Of the 1031 CT examinations performed, CT brain examination was the most common (755/1031; 72.23%). DLP values were increased in the after-hours categories compared to regular working hours at both hospitals. The largest increase was in the 0–1 year age group (150.56%). With the exception of CT Chest and CT abdomen in the 0–1 year age group, the CTDIvol and DLP values compared favourably to international standards. Conclusion Most of the calculated DRLs are acceptable and internationally comparable. This likely indicates effective reduction techniques and protocols. Computed tomography body examination protocols for 0–1 year patients should be reviewed. Strategies should be implemented to limit higher doses in after-hours examinations.
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Affiliation(s)
- Cornelis M van der Merwe
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nasreen Mahomed
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Booij R, Budde RPJ, Dijkshoorn ML, van Straten M. Technological developments of X-ray computed tomography over half a century: User's influence on protocol optimization. Eur J Radiol 2020; 131:109261. [PMID: 32937253 DOI: 10.1016/j.ejrad.2020.109261] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
Since the introduction of Computed Tomography (CT), technological improvements have been impressive. At the same time, the number of adjustable acquisition and reconstruction parameters has increased substantially. Overall, these developments led to improved image quality at a reduced radiation dose. However, many parameters are interrelated and part of automated algorithms. This makes it more complicated to adjust them individually and more difficult to comprehend their influence on CT protocol adjustments. Moreover, the user's influence in adapting protocol parameters is sometimes limited by the manufacturer's policy or the user's knowledge. As a consequence, optimization can be a challenge. A literature search in Embase, Medline, Cochrane, and Web of Science was performed. The literature was reviewed with the objective to collect information regarding technological developments in CT over the past five decades and the role of the associated acquisition and reconstruction parameters in the optimization process.
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Affiliation(s)
- Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
| | - Marcel L Dijkshoorn
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
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Mao JZ, Agyei JO, Khan A, Hess RM, Jowdy PK, Mullin JP, Pollina J. Technologic Evolution of Navigation and Robotics in Spine Surgery: A Historical Perspective. World Neurosurg 2020; 145:159-167. [PMID: 32916361 DOI: 10.1016/j.wneu.2020.08.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
Spine surgery is continuously evolving. The synergy between medical imaging and advances in computation has allowed for stereotactic neuronavigation and its integration with robotic technology to assist in spine surgery. The discovery of x-rays in 1895, the development of image intensifiers in 1940, and then advancements in computational science and integration have allowed for the development of computed tomography. In combination with the advancements of stereotaxy in the late 1980s, and manipulation of volumetric and special data for 3-dimensional reconstruction in 1998, computed tomography has revolutionized neuronavigational systems. Integrating all these technologies, robotics in spine surgery was introduced in 2004. Since then, it has become a safe modality that can reproducibly place accurate pedicle screws. Robotics may have the added benefits of improving the surgical workflow and optimizing surgeon ergonomics. Growing at a rapid rate, the second-generation spinal robotics have overcome preliminary limitations and errors. However, comparatively, robotics in spine surgery remains in its infancy. By leveraging technologic advancements in medical imaging, computation, and stereotactic navigation, robotics in spine surgery will continue to mature and expand in utility.
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Affiliation(s)
- Jennifer Z Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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Talwar AA, Heiman AJ, Kotamarti VS, Bommareddy K, Harris ES, Sandberg ML, Patel A, Ricci JA. High-Resolution Maxillofacial Computed Tomography Is Superior to Head Computed Tomography in Determining the Operative Management of Facial Fractures. J Surg Res 2020; 256:381-389. [PMID: 32745748 DOI: 10.1016/j.jss.2020.06.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Computed tomography of the head (CTH) and maxillofacial bones (CTMF) can be performed concurrently, but CTMF is frequently ordered separately, after facial fractures identified on CTH scans. This study aims to evaluate whether obtaining additional CTMF after CTH changes operative management of patients with facial trauma. MATERIALS AND METHODS A retrospective chart review was performed of all patients with facial trauma who presented to our level 1 trauma center between January 2009 and May 2019. CTH and CTMF were reviewed for each patient. Fracture numbers and patterns were compared to determine if CTMF provided additional information that necessitated change in management, based on predetermined criteria. RESULTS A total of 1215 patients were assessed for facial trauma. Of them, 899 patients underwent both CTH and CTMF scans. CTH identified 22.7% less fractures than CTMF (P < 0.001); specifically, more orbital, nasal, naso-orbito-ethmoid, zygoma, midface, and mandible fractures (P < 0.001). Of all patients 9.2% (n = 83) of patients with nonoperative fractures on CTH were reclassified as operative on CTMF; 0.6% (n = 5) with operative patterns on CTH were reclassified as nonoperative on CTMF, and 18.1% (n = 163) experienced a changed in their operative plan though operative fractures were seen on both imaging modalities. Additional findings seen on CTMF delegated change in the operative plan in 27.9% (n = 251) of cases. CONCLUSIONS CTMF scans are necessary to determine operative intervention. As CTH and CTMF are constructed from the data, physicians should consider ordering both scans simultaneously for all patients with facial trauma to limit radiation exposure, control costs, and avoid delays in care.
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Affiliation(s)
- Ankoor A Talwar
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | - Adee J Heiman
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | | | - Kanthi Bommareddy
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | - Erin S Harris
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | | | - Ashit Patel
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Bronx, New York.
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Cörek E, Rodgers G, Siegrist S, Einfalt T, Detampel P, Schlepütz CM, Sieber S, Fluder P, Schulz G, Unterweger H, Alexiou C, Müller B, Puchkov M, Huwyler J. Shedding Light on Metal-Based Nanoparticles in Zebrafish by Computed Tomography with Micrometer Resolution. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e2000746. [PMID: 32567135 DOI: 10.1002/smll.202000746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/26/2020] [Indexed: 06/11/2023]
Abstract
Metal-based nanoparticles are clinically used for diagnostic and therapeutic applications. After parenteral administration, they will distribute throughout different organs. Quantification of their distribution within tissues in the 3D space, however, remains a challenge owing to the small particle diameter. In this study, synchrotron radiation-based hard X-ray tomography (SRμCT) in absorption and phase contrast modes is evaluated for the localization of superparamagnetic iron oxide nanoparticles (SPIONs) in soft tissues based on their electron density and X-ray attenuation. Biodistribution of SPIONs is studied using zebrafish embryos as a vertebrate screening model. This label-free approach gives rise to an isotropic, 3D, direct space visualization of the entire 2.5 mm-long animal with a spatial resolution of around 2 µm. High resolution image stacks are available on a dedicated internet page (http://zebrafish.pharma-te.ch). X-ray tomography is combined with physico-chemical characterization and cellular uptake studies to confirm the safety and effectiveness of protective SPION coatings. It is demonstrated that SRμCT provides unprecedented insights into the zebrafish embryo anatomy and tissue distribution of label-free metal oxide nanoparticles.
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Affiliation(s)
- Emre Cörek
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Griffin Rodgers
- Biomaterials Science Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Stefan Siegrist
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Tomaz Einfalt
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Pascal Detampel
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Christian M Schlepütz
- Swiss Light Source, Paul Scherrer Institute, Forschungsstrasse 111, Villigen, 5232, Switzerland
| | - Sandro Sieber
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Pascal Fluder
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Georg Schulz
- Biomaterials Science Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Harald Unterweger
- Department of Otorhinolaryngology, Head and Neck Surgery, Section for Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius Stiftung Professorship, Erlangen University of Erlangen, Waldstraße 1, Erlangen, 91054, Germany
| | - Christoph Alexiou
- Department of Otorhinolaryngology, Head and Neck Surgery, Section for Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius Stiftung Professorship, Erlangen University of Erlangen, Waldstraße 1, Erlangen, 91054, Germany
| | - Bert Müller
- Biomaterials Science Center, Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Maxim Puchkov
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
| | - Jörg Huwyler
- Department of Pharmaceutical Technology, University of Basel, Klingelbergstrasse. 50, Basel, 4056, Switzerland
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Abstract
Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI studies are useful for evaluating deep space or bony infections and preoperative surgical planning.
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Traumatic cardiac dislocation-A case report and review of the literature including a new classification system. J Trauma Acute Care Surg 2020; 87:944-953. [PMID: 31453985 DOI: 10.1097/ta.0000000000002445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Birk G, Kästle M, Tilp C, Stierstorfer B, Klee S. Automatization and improvement of μCT analysis for murine lung disease models using a deep learning approach. Respir Res 2020; 21:124. [PMID: 32448249 PMCID: PMC7245846 DOI: 10.1186/s12931-020-01370-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background One of the main diagnostic tools for lung diseases in humans is computed tomography (CT). A miniaturized version, micro-CT (μCT) is utilized to examine small rodents including mice. However, fully automated threshold-based segmentation and subsequent quantification of severely damaged lungs requires visual inspection and manual correction. Methods Here we demonstrate the use of densitometry on regions of interest (ROI) in automatically detected portions of the lung, thus avoiding the need for lung segmentation. Utilizing deep learning approaches, the middle part of the lung is found in a μCT-stack and a ROI is placed in the left and the right lobe. Results The intensity values within the ROIs of the μCT images were collected and subsequently used for the calculation of different lung-related parameters, such as mean lung attenuation (MLA), mode, full width at half maximum (FWHM), and skewness. For validation, the densitometric approach was correlated with histological readouts (Ashcroft Score, Mean Linear Intercept). Conclusion We here show an automated tool that allows rapid and in-depth analysis of μCT scans of different murine models of lung disease.
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Affiliation(s)
- Gerald Birk
- Department of Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany.
| | - Marc Kästle
- Department of Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Cornelia Tilp
- Department of Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Birgit Stierstorfer
- Department of Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Stephan Klee
- Department of Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
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Fontes CAP, Dos Santos AASMD, de Oliveira SA, Aidê MA. Influenza A virus H1N1 associated pneumonia - acute and late aspects evaluated with high resolution tomography in hospitalized patients. Multidiscip Respir Med 2020; 15:692. [PMID: 33117533 PMCID: PMC7542991 DOI: 10.4081/mrm.2020.692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Influenza A (H1N1) virus often compromises the respiratory tract, leading to pneumonia, which is the principal cause of death in these patients. The purpose of this study was to review the acute and late phase pulmonary findings in influenza A(H1N1) associated pneumonia using high resolution computed tomography (HRCT), and to determine the importance of performing end expiration series. Methods Between July and August 2009, 140 patients presented with influenza A (H1N1) confirmed by real-timepolymerase chain reaction. Out of these, 27 patients underwent HRCT in the acute and late phases of pneumonia, allowing for a comparative study. Late phase exams were performed due to clinical worsening and up to 120 days later in patients with persistent complaints of dyspnea. Results Ground glass opacities, consolidations, and the combination of both were associated with the acute phase, whereas persistence or worsening of the lesions, lesion improvement, and air trapping in the end expiration series (as seen using HRCT, n=6) were observed in the late phase. Conclusions In the HRCT end expiration series, air trapping was found in the late phase of H1N1 associated pneumonia. Generally, these exams are not evaluated in research articles, and air trapping has not previously been studied using the end expiration series. Our study brings more scientific knowledge about aspects of pulmonary involvement by influenza A (H1N1), through evaluation with end expiration series, which makes the CT exam dynamic, translating the respiratory movement, and showing bronchial alteration.
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Affiliation(s)
| | - Alair Augusto Sarmet Moreira Damas Dos Santos
- Radiology Service, Department of Radiology, Faculty of Medicine, Antônio Pedro University Hospital, Federal Fluminense University, Niterói.,Imaging Center of the Complex Hospital of Niterói (CHN), Niterói
| | - Solange Artimos de Oliveira
- Department of Clinical Medicine, Faculty of Medicine, Antônio Pedro University Hospital, Federal Fluminense University, Niterói, Brazil
| | - Miquel Abdon Aidê
- Department of Clinical Medicine, Faculty of Medicine, Antônio Pedro University Hospital, Federal Fluminense University, Niterói, Brazil
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