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Liang P, Chen J, Yao L, Yu Y, Liang K, Chang Q. DAWTran: dynamic adaptive windowing transformer network for pneumothorax segmentation with implicit feature alignment. Phys Med Biol 2023; 68:175020. [PMID: 37541224 DOI: 10.1088/1361-6560/aced79] [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: 05/04/2023] [Accepted: 08/04/2023] [Indexed: 08/06/2023]
Abstract
Objective. This study aims to address the significant challenges posed by pneumothorax segmentation in computed tomography images due to the resemblance between pneumothorax regions and gas-containing structures such as the trachea and bronchus.Approach. We introduce a novel dynamic adaptive windowing transformer (DAWTran) network incorporating implicit feature alignment for precise pneumothorax segmentation. The DAWTran network consists of an encoder module, which employs a DAWTran, and a decoder module. We have proposed a unique dynamic adaptive windowing strategy that enables multi-head self-attention to effectively capture multi-scale information. The decoder module incorporates an implicit feature alignment function to minimize information deviation. Moreover, we utilize a hybrid loss function to address the imbalance between positive and negative samples.Main results. Our experimental results demonstrate that the DAWTran network significantly improves the segmentation performance. Specifically, it achieves a higher dice similarity coefficient (DSC) of 91.35% (a larger DSC value implies better performance), showing an increase of 2.21% compared to the TransUNet method. Meanwhile, it significantly reduces the Hausdorff distance (HD) to 8.06 mm (a smaller HD value implies better performance), reflecting a reduction of 29.92% in comparison to the TransUNet method. Incorporating the dynamic adaptive windowing (DAW) mechanism has proven to enhance DAWTran's performance, leading to a 4.53% increase in DSC and a 15.85% reduction in HD as compared to SwinUnet. The application of the implicit feature alignment (IFA) further improves the segmentation accuracy, increasing the DSC by an additional 0.11% and reducing the HD by another 10.01% compared to the model only employing DAW.Significance. These results highlight the potential of the DAWTran network for accurate pneumothorax segmentation in clinical applications, suggesting that it could be an invaluable tool in improving the precision and effectiveness of diagnosis and treatment in related healthcare scenarios. The improved segmentation performance with the inclusion of DAW and IFA validates the effectiveness of our proposed model and its components.
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Affiliation(s)
- Pengchen Liang
- The Department of School of Microelectronics, Shanghai University, Shanghai, 201800, People's Republic of China
| | - Jianguo Chen
- The School of Software Engineering, Sun Yat-sen University, Zhuhai, Guangdong Province, 519000, People's Republic of China
| | - Lei Yao
- The Department of School of Microelectronics, Shanghai University, Shanghai, 201800, People's Republic of China
| | - Yanfang Yu
- The Department of Pulmonary and Critical Care Medicine, Jiading Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, 201800, People's Republic of China
| | - Kaiyi Liang
- The Department of Radiology Jiading District Central Hospital Affiliated with the Shanghai University of Medicine and Health Sciences, Shanghai, 201800, People's Republic of China
| | - Qing Chang
- The Department Shanghai Key Laboratory of Gastric Neoplasms, Department of Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201800, People's Republic of China
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de Moya M, Brasel KJ, Brown CVR, Hartwell JL, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Sperry J, Weinberg JA, Martin MJ. Evaluation and management of traumatic pneumothorax: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg 2022; 92:103-107. [PMID: 34538823 DOI: 10.1097/ta.0000000000003411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This is a recommended algorithm of the Western Trauma Association for the management of a traumatic pneumothorax. The current algorithm and recommendations are based on available published prospective cohort, observational, and retrospective studies and the expert opinion of the Western Trauma Association members. The algorithm and accompanying text represents a safe and reasonable approach to this common problem. We recognize that there may be variability in decision making, local resources, institutional consensus, and patient-specific factors that may require deviation from the algorithm presented. This annotated algorithm is meant to serve as a basis from which protocols at individual institutions can be developed or serve as a quick bedside reference for clinicians. LEVEL OF EVIDENCE Consensus algorithm from the Western Trauma Association, Level V.
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Affiliation(s)
- Marc de Moya
- From the Department of Surgery, Medical College of Wisconsin (M.dM.), Milwaukee, WI; Oregon Heatlh Science University (K.J.B.), Portland, OR; Department of Surgery, Dell Medical School (C.V.R.B.), University of Texas at Austin, Austin, TX; Department of Surgery, Indiana University School of Medicine (J.L.H.), Indianapolis, IN; Department of Surgery, University of Southern California (K.I.), Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center (E.J.L.), Los Angeles, CA; Department of Surgery, Ernest E Moore Shock Trauma center (E.E.M.), Denver, CO; Department of Surgery, Scripps Mercy Hospital (K.A.P., M.J.M.), San Diego, CA; Department of Surgery, Inova Trauma Center (A.G.R.), Falls Church, VA; Department of Surgery, Children's Hospital (N.G.R.), Cincinnati, OH; Department of Surgery, University of Pittsburgh (J.S.), Pittsburgh, PA; Department of Surgery, St. Joseph's Hospital and Medical Center (J.A.W.), Phoenix, AZ
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Deep learning detection and quantification of pneumothorax in heterogeneous routine chest computed tomography. Eur Radiol Exp 2020; 4:26. [PMID: 32303861 PMCID: PMC7165213 DOI: 10.1186/s41747-020-00152-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Automatically detecting and quantifying pneumothorax on chest computed tomography (CT) may impact clinical decision-making. Machine learning methods published so far struggle with the heterogeneity of technical parameters and the presence of additional pathologies, highlighting the importance of stable algorithms. METHODS A deep residual UNet was developed and evaluated for automated, volume-level pneumothorax grading (i.e., labelling a volume whether a pneumothorax was present or not), and pixel-level classification (i.e., segmentation and quantification of pneumothorax), on a retrospective series of routine chest CT data. Ground truth annotations were provided by radiologists. The fully automated pixel-level pneumothorax segmentation method was trained using 43 chest CT scans and evaluated on 9 chest CT scans with pixel-level annotation basis and 567 chest CT scans on a volume-level basis. RESULTS This method achieved a receiver operating characteristic area under the curve (AUC) of 0.98, an average precision of 0.97, and a Dice similarity coefficient (DSC) of 0.94. This segmentation performance resulted to be similar to the inter-rater segmentation accuracy of two radiologists, who achieved a DSC of 0.92. The comparison of manual and automated pneumothorax quantification yielded a Pearson correlation coefficient of 0.996. The volume-level pneumothorax grading accuracy was evaluated on 567 chest CT scans and yielded an AUC of 0.98 and an average precision of 0.95. CONCLUSIONS We proposed a deep learning method for the detection and quantification of pneumothorax in heterogeneous routine clinical data that may facilitate the automated triage of urgent examinations and enable treatment decision support.
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Bou Zein Eddine S, de Moya MA. Reply to letter: Observing pneumothoraces: The 35 millimeter rule is safe for both blunt and penetrating chest trauma. J Trauma Acute Care Surg 2020; 87:738-739. [PMID: 31135766 DOI: 10.1097/ta.0000000000002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Savo Bou Zein Eddine
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Medical, College of Wisconsin, Milwaukee, WI Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Medical, College of Wisconsin, Milwaukee, WI
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Li X, Thrall JH, Digumarthy SR, Kalra MK, Pandharipande PV, Zhang B, Nitiwarangkul C, Singh R, Khera RD, Li Q. Deep learning-enabled system for rapid pneumothorax screening on chest CT. Eur J Radiol 2019; 120:108692. [DOI: 10.1016/j.ejrad.2019.108692] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022]
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Wibmer AG, Hricak H, Ulaner GA, Weber W. Trends in oncologic hybrid imaging. Eur J Hybrid Imaging 2018; 2:1. [PMID: 29782605 PMCID: PMC5954767 DOI: 10.1186/s41824-017-0019-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
Hybrid imaging plays a central role in the diagnosis and management of a wide range of malignancies at all stages. In this article, we review the most pertinent historical developments, emerging clinical applications of novel radiotracers and imaging technologies, and potential implications for training and practice. This includes an overview of novel tracers for prostate, breast, and neuroendocrine tumors, assessment of tumor heterogeneity, the concept of image-guided ‘biologically relevant dosing’, and theranostic applications. Recent technological advancements, including time-of-flight PET, PET/MRI, and ‘one-minute whole-body PET’, are also covered. Finally, we discuss how these rapidly evolving applications might affect current training curricula and how imaging-derived big data could be harnessed to the benefit of our patients.
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Affiliation(s)
- Andreas G Wibmer
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.,2Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Hedvig Hricak
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Gary A Ulaner
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.,2Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Wolfgang Weber
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.,2Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Jeong J, Ko J, Lim H, Kweon OK, Kim WH. Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy. Vet Surg 2016; 45:O102-O110. [PMID: 27731512 PMCID: PMC5129584 DOI: 10.1111/vsu.12571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/09/2016] [Indexed: 11/27/2022]
Abstract
Objective To develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the retroperitoneal space as an initial step for clinical application of retroperitoneal laparoscopy in dogs. Study Design Cadaveric and experimental study. Animals Cadaveric (n=8) and healthy (n=6) adult dogs. Methods The retroperitoneal access technique was developed in 3 cadavers based on the human technique and transperitoneal observation. Its application and working space establishment with carbon dioxide (CO2) insufflation alone was evaluated in 5 cadavers by observing with a transperitoneal telescope and in 6 live dogs by repeated computed tomography (CT) scans at pressure of 0, 5, 10, and 15 mmHg. Recordings of retroperitoneoscopy as well as working space volume and linear dimensions measured on CT images were analyzed. Results Retroperitoneal access and working space establishment with CO2 insufflation alone were successfully performed in all 6 live dogs. The only complication observed was in 1 dog that developed subclinical pneumomediastinum. As pressure increased, working space was established from the ipsilateral to the contralateral side, and peritoneal tearing eventually developed. Working space volume increased significantly from 5 mmHg and linear dimensions increased significantly from 0 to 10 mmHg. With pneumo‐retroperitoneum above 5 mmHg, retroperitoneal organs, including kidneys and adrenal glands, were easily visualized. Conclusion The retroperitoneal access technique and working space establishment with CO2 insufflation starting with 5 mmHg and increasing to 10 mmHg provided adequate working space and visualization of retroperitoneal organs, which may allow direct access for retroperitoneal laparoscopy in dogs.
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Affiliation(s)
- Junemoe Jeong
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Jonghyeok Ko
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Hyunjoo Lim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Wan Hee Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
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Zefov VN, Almatrooshi MA. Chest X-ray findings in late-onset congenital diaphragmatic hernia, a rare emergency easily misdiagnosed as hydropneumothorax: a case report. J Med Case Rep 2015; 9:291. [PMID: 26695937 PMCID: PMC4688985 DOI: 10.1186/s13256-015-0755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/02/2015] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Late-onset congenital diaphragmatic hernia is a rare anomaly with misleading symptoms and signs. CASE PRESENTATION We describe the case of a 7-year-old Middle Eastern girl who presented with acute nonspecific abdominal symptoms and respiratory distress of 2 days' duration after sustaining a blunt trauma on her left chest wall on a background of chronic ill-defined left chest pain of 2 weeks' duration. Her initial chest radiograph showed an air-fluid level, which was thought to be a hydropneumothorax, so a chest tube was inserted and was shown to be positioned between the chest wall and the air collection; therefore, a nasogastric tube was inserted and it was positioned in the left chest cavity so the diagnosis of late-onset congenital diaphragmatic hernia was made. On retrospective analysis of the first abdominal X-ray, it showed a subtle lucent area that was triangular in shape and continued with the chest cavity, which indicates a sign of diaphragmatic hernia. In addition, the next unusual point was the nonvisualization of the diaphragm, which should be reported in any abdominal X-ray. An exploratory laparotomy was performed on our patient using a left-sided subcostal incision; the operative findings revealed a very small posterior rim of the diaphragm and a hypoplastic left lung. Her stomach, spleen, and left colon with the omentum were in the left side of her chest. She made an uneventful recovery postoperatively and was discharged after 1 week. CONCLUSIONS Gastric and intestinal gas shadow distribution provides an important marker in the diagnosis of late-onset congenital diaphragmatic hernia and should be sought for in every case of suspected congenital diaphragmatic hernia in addition to noting the position of the nasogastric tube in the chest cavity.
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Affiliation(s)
- Vassil Nikolov Zefov
- Radiology Department, Dubai Health Authority, Latifa Hospital, Oud Metha Road, Dubai, United Arab Emirates.
| | - Maryam Anas Almatrooshi
- Radiology Department, Dubai Health Authority, Latifa Hospital, Oud Metha Road, Dubai, United Arab Emirates.
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Optimizing working space in laparoscopy: CT measurement of the influence of small body size in a porcine model. J Pediatr Surg 2015; 50:465-71. [PMID: 25746709 DOI: 10.1016/j.jpedsurg.2014.05.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/02/2014] [Accepted: 05/25/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION In our continuing research into the determinants of laparoscopic working space, the influence of small body size was investigated. METHODS In eight 6-kg pigs, the effects of intraabdominal CO2 pneumoperitoneum pressure (IAP), prestretching of the abdominal wall, and neuromuscular blockade (NMB) on laparoscopic working space volume and distances were studied. Computed tomography was used to measure working space during two stepwise abdominal insufflation-runs up to an IAP of 15mm Hg. Results were compared with data from earlier experiments in 20-kg pigs. RESULTS Cardiorespiratory parameters were stable up to an IAP of 8-10mm Hg. In 6-kg pigs working-space dimensions were five times smaller than in 20-kg pigs. Working-space volume, anteroposterior (AP) diameter and symphysis-diaphragm distance increased linearly up to an IAP of 8mm Hg. Above 8mm Hg, compliance decreased. Eighty percent of the total volume (618ml) and of AP diameter (3cm) at 15mm Hg had been achieved at an IAP of 10mm Hg. Prestretching by a first insufflation resulted in a statistically significant increase in working space volume and in AP diameter during the second insufflation. This effect was significantly larger than in 20-kg pigs. Neuromuscular blockade did not have a significant effect on working-space. CONCLUSIONS Working space in growing individuals is very limited. Eighty percent of the working space created by an IAP of 15mm Hg was already achieved at 10mm Hg, while cardiorespiratory side effects at an IAP of 8-10mm Hg seem acceptable. Prestretching of the abdominal wall significantly increased working space, even more so than in 20-kg pigs. As in 20-kg pigs, NMB had no significant effect on laparoscopic working space. Prestretching of the abdominal wall is a promising cheap, safe and easy strategy to increase laparoscopic working space, lessening the need for prolonged high-pressure pneumoperitoneum.
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Vlot J, Specht PA, Wijnen RMH, van Rosmalen J, Mik EG, Bax KMA. Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model. Surg Endosc 2014; 29:2210-6. [PMID: 25361652 DOI: 10.1007/s00464-014-3927-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/27/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this paper was to determine the effect of neuromuscular blockade (NMB) on working space in a porcine laparoscopy model. BACKGROUND Conflicting results on the effect of NMB on laparoscopic working space are found in literature. Almost all studies are limited by absence of objective assessment of working space or use surrogate outcomes. METHODS In a standardized porcine laparoscopy model, laparoscopic working-space dimensions with and without NMB were investigated in 16 animals using computed tomography at intra-abdominal pressures of 0, 5, 10, and 15 mmHg during multiple runs of abdominal insufflation. RESULTS No statistically significant effect of NMB on abdominal dimensions and laparoscopic working-space volume was found during CO2 pneumoperitoneum. In contrast, the effect of pre-stretching of the abdominal wall by a previous abdominal insufflation was found to be significant. CONCLUSIONS This experimental study confirms the results from several clinical studies that NMB does not influence laparoscopic working space. Studies dealing with working space during laparoscopy should take note of pre-stretching bias.
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Affiliation(s)
- John Vlot
- Department of Pediatric Surgery, Erasmus MC: University Medical Center, P.O Box 2060, 3000 CB, Rotterdam, The Netherlands,
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Affiliation(s)
- Mark Harrison
- Consultant in Emergency Medicine in the Emergency Department, Wansbeck General Hospital, Northumbria Healthcare NHS Trust, Ashington
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Abstract
PURPOSE OF REVIEW Pneumothorax, a potentially life-threatening condition, is present in about one-third of chest trauma patients. Traditionally, pneumothorax has been diagnosed and managed by use of chest radiography, which has been found inaccurate and inconsistent. With the ubiquitous application of multidetector computed tomography (MDCT) in emergency care, MDCT quantification of pneumothoraces becomes an emerging technique for accurate determination of the size of pneumothoraces. The use of MDCT quantification provides a promising means to improve pneumothorax management. RECENT FINDINGS Recent studies have demonstrated that MDCT is the gold standard for detecting pneumothorax and MDCT provides an effective imaging modality for the accurate measurement of the volume of pneumothoraces. The use of MDCT volumetric quantification of pneumothoraces has been evidenced in the improvement of performance in pneumothorax management for clinically stable chest trauma patients. SUMMARY The MDCT volumetric quantification of pneumothoraces is a new concept in the care of chest trauma patients and has the potential to improve pneumothorax management. Further clinical studies are needed to establish a MDCT-based clinical guideline for pneumothorax management.
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Oveland NP, Lossius HM, Wemmelund K, Stokkeland PJ, Knudsen L, Sloth E. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with CT scanning. Chest 2013. [PMID: 23188058 DOI: 10.1378/chest.12-1445] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although thoracic ultrasonography accurately determines the size and extent of occult pneumothoraces (PTXs) in spontaneously breathing patients, there is uncertainty about patients receiving positive pressure ventilation. We compared the lung point (ie, the area where the collapsed lung still adheres to the inside of the chest wall) using the two modalities ultrasonography and CT scanning to determine whether ultrasonography can be used reliably to assess PTX progression in a positive-pressure-ventilated porcine model. METHODS Air was introduced in incremental steps into fi ve hemithoraces in three intubated porcine models. The lung point was identified on ultrasound imaging and referenced against the lateral limit of the intrapleural air space identified on the CT scans. The distance from the sternum to the lung point (S-LP) was measured on the CT scans and correlated to the insufflated air volume. RESULTS The mean total difference between the 131 ultrasound and CT scan lung points was 6.8 mm (SD, 7.1 mm; range, 0.0-29.3 mm). A mixed-model regression analysis showed a linear relationship between the S-LP distances and the PTX volume ( P , .001). CONCLUSIONS In an experimental porcine model, we found a linear relation between the PTX size and the lateral position of the lung point. The accuracy of thoracic ultrasonography for identifying the lung point (and, thus, the PTX extent) was comparable to that of CT imaging. These clinically relevant results suggest that ultrasonography may be safe and accurate in monitoring PTX progression during positive pressure ventilation.
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Affiliation(s)
- Nils Petter Oveland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Droebak, Norway; Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
| | - Hans Morten Lossius
- Department of Research and Development, Norwegian Air Ambulance Foundation, Droebak, Norway; Department of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Kristian Wemmelund
- Faculty of Health Sciences, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lars Knudsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Sloth
- Faculty of Health Sciences, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Yao J, Bliton J, Summers RM. Automatic segmentation and measurement of pleural effusions on CT. IEEE Trans Biomed Eng 2013; 60:1834-40. [PMID: 23372069 DOI: 10.1109/tbme.2013.2243446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Pleural effusion is an important biomarker for the diagnosis of many diseases. We develop an automated method to evaluate pleural effusion on CT scans, the measurement of which is prohibitively time consuming when performed manually. The method is based on parietal and visceral pleura extraction, active contour models, region growing, Bezier surface fitting, and deformable surface modeling. Twelve CT scans with three manual segmentations were used to validate the automatic segmentation method. The method was then applied on 91 additional scans for visual assessment. The segmentation method yielded a correlation coefficient of 0.97 and a Dice coefficient of 0.72±0.13 when compared to a professional manual segmentation. The visual assessment estimated 83% cases with negligible or small segmentation errors, 14% with medium errors, and 3% with large errors.
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Affiliation(s)
- Jianhua Yao
- National Institutes of Health, Bethesda, MD 20892, USA.
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Vlot J, Slieker JC, Wijnen R, Lange JF, Bax KNMA. Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model. Surg Endosc 2013; 27:1980-5. [PMID: 23319284 DOI: 10.1007/s00464-012-2697-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/25/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adequate working space is a prerequisite for safe and efficient minimal access surgery. No objective data exist in literature about the effect of mechanical bowel preparation (MBP) on working space in laparoscopic surgery. We objectively measured this effect with computed tomography in a porcine laparoscopy model. METHODS Using standardized anesthesia, twelve 20-kg pigs without MBP and eight 20-kg pigs with MBP were studied with computed tomography at intra-abdominal pressure (IAP) levels of 0, 5, 10, and 15 mmHg. Volumes and dimensions of the pneumoperitoneum were measured on reconstructed CT images and compared between the pigs with and those without MBP. RESULTS A reproducible and statistically significant increase of approximately 500 ml in pneumoperitoneum volume was found in the MBP group at all levels of IAP. This represents a 43 % relative increase at a pneumoperitoneum pressure of 5 mmHg, 21 % at IAP 10 mmHg, and 18 % at IAP 15 mmHg. Peak inspiratory pressure was lower at IAP 0 and 5 mmHg in the MBP group. Anteroposterior diameter in the group with MBP was lower at 0 mmHg, but abdominal dimensions were similar in both groups at all other IAPs. This shows that the gain in working space is due to a diminished volume of the intra-abdominal content and not to compression or displacement of the bowel. CONCLUSIONS MBP increases working space by reducing bowel content. Especially at low intra-abdominal working pressures, the increase in working space associated with MBP could represent an important benefit in challenging laparoscopic surgery.
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Affiliation(s)
- John Vlot
- Department of Pediatric Surgery, Erasmus MC: University Medical Center Rotterdam, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
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Vlot J, Wijnen R, Stolker RJ, Bax K. Optimizing working space in porcine laparoscopy: CT measurement of the effects of intra-abdominal pressure. Surg Endosc 2012; 27:1668-73. [PMID: 23239305 DOI: 10.1007/s00464-012-2654-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several factors may affect volume and dimensions of the working space in laparoscopic surgery. The precise impact of these factors has not been well studied. In a porcine model, we used computed tomographic (CT) scanning for measuring working space volume and distances. In a first series of experiments, we studied the relationship between intra-abdominal pressure (IAP) and working space. METHODS Eleven 20 kg pigs were studied under standardized anesthesia and volume-controlled ventilation. Cardiorespiratory parameters were monitored continuously, and blood gas samples were taken at different IAP levels. Respiratory rate was increased when ETCO₂ exceeded 7 kPa. Breath-hold CT scans were made at IAP levels of 0, 5, 10, and 15 mmHg. Insufflator volumes were compared to CT-measured volumes. Maximum dimensions of pneumoperitoneum were measured on reconstructed CT images. RESULTS Respiratory rate had to be increased in three animals. Mild hypercapnia and acidosis occurred at 15 mmHg IAP. Peak inspiratory pressure rose significantly at 10 and 15 mmHg. CT-measured volume increased relatively by 93 % from 5 to 10 mmHg IAP and by 19 % from 10 to 15 mmHg IAP. Comparing CT volumes to insufflator volumes gave a bias of 76 mL. The limits of agreement were -0.31 to +0.47, a range of 790 mL. The internal anteroposterior diameter increased by 18 % by increasing IAP from 5 to 10 mmHg and by 5 % by increasing IAP from 10 to 15 mmHg. At 15 mmHg, the total relative increase of the pubis-diaphragm distance was only 6 %. Abdominal width did not increase. CONCLUSIONS CT allows for precise calculation of the actual CO₂ pneumoperitoneum volume, whereas the volume of CO₂ released by the insufflator does not. Increasing IAP up to 10 mmHg achieved most gain in volume and in internal anteroposterior diameter. At an IAP of 10 mmHg, higher peak inspiratory pressure was significantly elevated.
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Affiliation(s)
- John Vlot
- Department of Pediatric Surgery, Erasmus University Medical Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
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Automated quantification of pneumothorax in CT. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:736320. [PMID: 23082091 PMCID: PMC3469107 DOI: 10.1155/2012/736320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 09/09/2012] [Indexed: 12/01/2022]
Abstract
An automated, computer-aided diagnosis (CAD) algorithm for the quantification of pneumothoraces from Multidetector Computed Tomography (MDCT) images has been developed. Algorithm performance was evaluated through comparison to manual segmentation by expert radiologists. A combination of two-dimensional and three-dimensional processing techniques was incorporated to reduce required processing time by two-thirds (as compared to similar techniques). Volumetric measurements on relative pneumothorax size were obtained and the overall performance of the automated method shows an average error of just below 1%.
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Mennicke M, Gulati K, Oliva I, Goldflam K, Skali H, Ledbetter S, Platz E. Anatomical distribution of traumatic pneumothoraces on chest computed tomography: implications for ultrasound screening in the ED. Am J Emerg Med 2012; 30:1025-31. [DOI: 10.1016/j.ajem.2011.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 06/10/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022] Open
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Cai W, Lee JG, Fikry K, Yoshida H, Novelline R, de Moya M. MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax. Comput Med Imaging Graph 2012; 36:375-86. [PMID: 22560899 DOI: 10.1016/j.compmedimag.2012.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 03/08/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Abstract
It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate volume of pneumothoraces in the improvement of the performance in decision-making regarding CTD in the management of traumatic pneumothoraces. For this purpose, an occurrence frequency map was calculated for quantitative analysis of the importance of each clinical parameter in the decision-making regarding CTD by a computer simulation of decision-making using a genetic algorithm (GA) and a support vector machine (SVM). A total of 14 clinical parameters, including volume of pneumothorax calculated by our CAV scheme, was collected as parameters available for decision-making. The results showed that volume was the dominant parameter in decision-making regarding CTD, with an occurrence frequency value of 1.00. The results also indicated that the inclusion of volume provided the best performance that was statistically significant compared to the other tests in which volume was excluded from the clinical parameters. This study provides the scientific evidence for the application of CAV scheme in MDCT volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax.
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Affiliation(s)
- Wenli Cai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Micropower impulse radar: a novel technology for rapid, real-time detection of pneumothorax. Emerg Med Int 2011; 2011:279508. [PMID: 22046538 PMCID: PMC3200219 DOI: 10.1155/2011/279508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/27/2011] [Indexed: 11/17/2022] Open
Abstract
Pneumothorax detection in emergency situations must be rapid and at the point of care. Current standards for detection of a pneumothorax are supine chest X-rays, ultrasound, and CT scans. Unfortunately these tools and the personnel necessary for their facile utilization may not be readily available in acute circumstances, particularly those which occur in the pre-hospital setting. The decision to treat therefore, is often made without adequate information. In this report, we describe a novel hand-held device that utilizes Micropower Impulse Radar to reliably detect the presence of a pneumothorax. The technology employs ultra wide band pulses over a frequency range of 500 MHz to 6 GHz and a proprietary algorithm analyzes return echoes to determine if a pneumothorax is present with no user interpretation required. The device has been evaluated in both trauma and surgical environments with sensitivity of 93% and specificity of 85%. It is has the CE Mark and is available for sale in Europe. Post market studies are planned starting in May of 2011. Clinical studies to support the FDA submission will be completed in the first quarter of 2012.
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Cai W, Lee EY, Vij A, Mahmood SA, Yoshida H. MDCT for computerized volumetry of pneumothoraces in pediatric patients. Acad Radiol 2011; 18:315-23. [PMID: 21216160 DOI: 10.1016/j.acra.2010.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/20/2010] [Accepted: 11/01/2010] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Our purpose in this study was to develop an automated computer-aided volumetry (CAV) scheme for quantifying pneumothorax in multidetector computed tomography (MDCT) images for pediatric patients and to investigate the imaging parameters that may affect its accuracy. MATERIALS AND METHODS Fifty-eight consecutive pediatric patients (mean age 12 ± 6 years) with pneumothorax who underwent MDCT for evaluation were collected retrospectively for this study. All cases were imaged by a 16- or 64-MDCT scanner with weight-based kilovoltage, low-dose tube current, 1.0-1.5 pitch, 0.6-5.0 mm slice thickness, and a B70f (sharp) or B31f (soft) reconstruction kernel. Sixty-three pneumothoraces ≥1 mL were visually identified in the left (n = 30) and right (n = 33) lungs. Each identified pneumothorax was contoured manually on an Amira workstation V4.1.1 (Mercury Computer Systems, Chelmsford, MA) by two radiologists in consensus. The computerized volumes of the pneumothoraces were determined by application of our CAV scheme. The accuracy of our automated CAV scheme was evaluated by comparison between computerized volumetry and manual volumetry, for the total volume of pneumothoraces in the left and right lungs. RESULTS The mean difference between the computerized volumetry and the manual volumetry for all 63 pneumothoraces ≥1 mL was 8.2%. For pneumothoraces ≥10 mL, ≥50 mL, and ≥200 mL, the mean differences were 7.7% (n = 57), 7.3% (n = 33), and 6.4% (n = 13), respectively. The correlation coefficient was 0.99 between the computerized volume and the manual volume of pneumothoraces. Bland-Altman analysis showed that computerized volumetry has a mean difference of -5.1% compared to manual volumetry. For all pneumothoraces ≥10 mL, the mean differences for slice thickness ≤1.25 mm, = 1.5 mm, and = 5.0 mm were 6.1% (n = 28), 3.5% (n = 10), and 12.2% (n = 19), respectively. For the two reconstruction kernels, B70f and B31f, the mean differences were 6.3% (n = 42, B70f) and 11.7% (n = 15, B31f), respectively. CONCLUSION Our automated CAV scheme provides an accurate measurement of pneumothorax volume in MDCT images of pediatric patients. For accurate volumetric quantification of pneumothorax in children in MDCT images by use of the automated CAV scheme, we recommended reconstruction parameters based on a slice thickness ≤1.5 mm and the reconstruction kernel B70f.
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Rezai P, Tochetto S, Galizia M, Yaghmai V. Perinephric hematoma: semi-automated quantification of volume on MDCT: a feasibility study. ACTA ACUST UNITED AC 2010; 36:222-7. [DOI: 10.1007/s00261-010-9634-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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