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Muhanna N, Douglas CM, Daly MJ, Chan HHL, Weersink R, Townson J, Monteiro E, Yu E, Weimer E, Kucharczyk W, Jaffray DA, Irish JC, de Almeida JR. Evaluating an Image-Guided Operating Room with Cone Beam CT for Skull Base Surgery. J Neurol Surg B Skull Base 2020; 82:e306-e314. [PMID: 34306954 DOI: 10.1055/s-0040-1701211] [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: 05/21/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022] Open
Abstract
Importance Skull base surgery requires precise preoperative assessment and intraoperative management of the patient. Surgical navigation is routinely used for complex skull base cases; however, the image guidance is commonly based on preoperative scans alone. Objective The primary objective of this study was to assess the image quality of intraoperative cone-beam computed tomography (CBCT) within anatomical landmarks used in sinus and skull base surgery. The secondary objective was to assess the registration error of a surgical navigation system based on intraoperative CBCT. Design Present study is a retrospective case series of image quality after intraoperative cone beam CT. Setting The study was conducted at Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto. Participants A total of 46 intraoperative scans (34 patients, 21 skull base, 13 head and neck) were studied. Main Outcome and Measures Thirty anatomical landmarks (vascular, soft tissue, and bony) within the sinuses and anterior skull base were evaluated for general image quality characteristics: (1) bony detail visualization; (2) soft-tissue visualization; (3) vascular visualization; and (4) freedom from artifacts (e.g., metal). Levels of intravenous (IV) contrast enhancement were quantified in Hounsfield's units (HU). Standard paired-point registration between imaging and tracker coordinates was performed using 6 to 8 skin fiducial markers and the corresponding fiducial registration error (FRE) was measured. Results Median score for bony detail on CBCT was 5, remaining at 5 after administration of IV contrast. Median soft-tissue score was 2 for both pre- and postcontrast. Median vascular score was 1 precontrast and 3 postcontrast. Median score for artifacts on CBCT were 2 for both pre-and postcontrast, and metal objects were noted to be the most significant source of artifact. Intraoperative CBCT allowed preresection images and immediate postresection images to be available to the skull base surgeon. There was a significant improvement in mean (standard deviation [SD]) CT intensity in the left carotid artery postcontrast 334 HU (67 HU) ( p < 10 -10 ). The mean FRE was 1.8 mm (0.45 mm). Conclusion Intraoperative CBCT in complex skull base procedures provides high-resolution bony detail allowing immediate assessment of complex resections. The use of IV contrast with CBCT improves the visualization of vasculature. Image-guidance based on CBCT yields registration errors consistent with standard techniques.
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Affiliation(s)
- Nidal Muhanna
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center-Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Catriona M Douglas
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jason Townson
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Eugene Yu
- Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Emilie Weimer
- Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - David A Jaffray
- Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Bayrak S, Kursun Cakmak ES, Kamalak H. Contrast-to-noise ratios of different dental restorative materials: an in-vitro cone beam computed tomography study. Eur Oral Res 2020; 54:36-41. [PMID: 32518909 PMCID: PMC7252535 DOI: 10.26650/eor.20200079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In radiological views, strong beam hardening and streaking artifacts occur due to high-density structures and polyenergetic X-ray beams, and these lead to misdiagnosis. This study was performed in vitro to compare the contrast-to-noise ratio (CNR) of commonly used dental restorative materials by using Cone Beam Computed Tomography (CBCT) images with and without artifact reduction (AR) mode. Materials and methods A total of 108 molar teeth were restored with nine different groups of restorative materials, with each group containing 12 teeth. Teeth were placed in a dry human mandible and scanned, one by one, via Planmeca 3D ProMax (Planmeca, Helsinki, Finland) with and without AR mode. Images were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD) to calculate the CNR. Results CNR was calculated to be the highest in compomer (Glassiosite) images without AR mode (mean: 3.36) and with AR mode (mean: 3.61). CNR was calculated to be the lowest in amalgam (Tytin) images without AR mode (mean: 0.21) and with AR mode (mean: 0.23). A significant difference was found between materials in terms of CNR measurements (p ≤ 0.05). CNR measurements were increased after the AR mode application (p ≤ 0.05). Conclusion AR mode was effective in reducing artifacts arising from dental materials on CBCT images, so it is necessary to use AR mode for correct diagnoses.
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Affiliation(s)
- Seval Bayrak
- Abant İzzet Baysal University, Dentistry Faculty,Dentomaxillofacial Radiology Department, Bolu,Turkey
| | | | - Hakan Kamalak
- Kahramanmaras Sütcü İmam University, Dentistry Faculty, Department of Restorative Dentistry, Kahramanmaras,Turkey
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Zoller G, Hahn H, Di Girolamo N. Technological Advances in Diagnostic Imaging in Exotic Pet Medicine. Vet Clin North Am Exot Anim Pract 2019; 22:397-417. [PMID: 31395322 DOI: 10.1016/j.cvex.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diagnostic imaging relies on interpretation of interactions between the body tissue and various energies, such as x-rays, ultrasound, and magnetic or nuclear energies, to differentiate normal from abnormal tissues. Major technological improvements regarding emission and detection of the energetic waves, as well as reconstruction and interpretation of the images, have occurred. These advances made possible visualization of smaller structures, quantitative evaluation of functional processes, and development of unique imaging-guided procedures. This article reviews the technological advances that allowed development of cone beam computed tomography, dual-energy x-ray absorptiometry, and contrast-enhanced ultrasonography, which all could have applications in exotic pet medicine.
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Affiliation(s)
- Graham Zoller
- Exotic Pet Department, Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
| | - Harriet Hahn
- Diagnostic Imaging Department, Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France
| | - Nicola Di Girolamo
- Tai Wai Small Animal and Exotic Hospital, 69-75 Chik Shun Street, Tai Wai, Sha Tin, New Territories, Hong Kong
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Kursun-Cakmak EŞ, Demirturk Kocasarac H, Bayrak S, Ustaoğlu G, Noujeim M. Estimation of contrast-to-noise ratio in CT and CBCT images with varying scan settings in presence of different implant materials. Dentomaxillofac Radiol 2019; 48:20190139. [PMID: 31386553 DOI: 10.1259/dmfr.20190139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the contrast-to-noise ratio (CNR) of four different types of dental implant materials in CT and cone beam CT (CBCT) images with varying scan settings. METHODS Four different types of implants: zirconium (Zr), titanium (Ti) Grade 4 and 5 and titanium-zirconium (Ti-ZrO2) alloy were placed in a 3% gelatin phantom in a cylindrical plastic container and scanned with two different CT machines (GE Medical systems and Toshiba Medical Systems) and one CBCT machine (I-CAT, Imaging Sciences International) with different voxel sizes of 0.2, 0.25, 0.3 and 0.4 mm. Images were analyzed using ImageJ software with the purpose of estimating the CNR. RESULTS The CNR obtained from images acquired with CT was lower than the CBCT with all voxel sizes tested. 0.3 and 0.4 mm voxel sizes exhibited the highest CNR (p < 0.05) that gives the best image quality. Among the implant materials tested, titanium Grade 5 has the highest levels of CNR while Zirconium has the lowest (p < 0.05). CONCLUSIONS The optimum protocol for radiographic follow-up in areas near implants on the I-CAT is low-resolution settings (0.3 and 0.4 mm voxel sizes) which gave the highest CNR thus image quality. In presence of Zr implants, an alternative imaging modality (i.e., MRI) may be considered to avoid low-quality images.
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Affiliation(s)
| | | | - Seval Bayrak
- Department of Oral and Maxillofacial Radiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Gülbahar Ustaoğlu
- Department of Periodontology, Abant Izzet Baysal University, Bolu, Turkey
| | - Marcel Noujeim
- Department of Comprehensive Dentistry, UT Health San Antonio, Texas, USA
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Döring S, Arzi B, Barich CR, Hatcher DC, Kass PH, Verstraete FJM. Evaluation of the diagnostic yield of dental radiography and cone-beam computed tomography for the identification of anatomic landmarks in small to medium-sized brachycephalic dogs. Am J Vet Res 2018; 79:54-61. [PMID: 29287153 DOI: 10.2460/ajvr.79.1.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield of dental radiography (Rad method) and 3 cone-beam CT (CBCT) methods for the identification of predefined anatomic landmarks in brachycephalic dogs. ANIMALS 19 client-owned brachycephalic dogs admitted for evaluation and treatment of dental disease. PROCEDURES 26 predefined anatomic landmarks were evaluated separately by use of the RAD method and 3 CBCT software modules (serial CBCT slices and custom cross sections, tridimensional rendering, and reconstructed panoramic views). A semiquantitative scoring system was used, and mean scores were calculated for each anatomic landmark and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant, the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the 6 possible pairs of diagnostic methods. RESULTS Differences of diagnostic yield among the Rad and 3 CBCT methods were significant for 19 of 26 anatomic landmarks. For these landmarks, Rad scores were significantly higher than scores for reconstructed panoramic views for 4 of 19 anatomic landmarks, but Rad scores were significantly lower than scores for reconstructed panoramic views for 8 anatomic landmarks, tridimensional rendering for 18 anatomic landmarks, and serial CBCT slices and custom cross sections for all 19 anatomic landmarks. CONCLUSIONS AND CLINICAL RELEVANCE CBCT methods were better suited than dental radiography for the identification of anatomic landmarks in brachycephalic dogs. Results of this study can serve as a basis for CBCT evaluation of dental disorders in brachycephalic dogs.
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Riggs GG, Cissell DD, Arzi B, Hatcher DC, Kass PH, Zhen A, Verstraete FJM. Clinical Application of Cone Beam Computed Tomography of the Rabbit Head: Part 2-Dental Disease. Front Vet Sci 2017; 4:5. [PMID: 28194401 PMCID: PMC5277021 DOI: 10.3389/fvets.2017.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/12/2017] [Indexed: 11/13/2022] Open
Abstract
Domestic rabbits are increasing in popularity as household pets; therefore, veterinarians need to be familiar with the most common diseases afflicting rabbits including dental disease. Current diagnostic approaches include gross oral examination, endoscopic oral examination, skull radiography, and computed tomography (CT). Cone beam computed tomography (CBCT), a new oral and maxillofacial imaging modality that has the capability to produce high-resolution images, has not yet been described for use in evaluating dental disease in rabbits. A total of 15 client-owned rabbits had CBCT, oral examination, dental charting, and dental treatment performed under general anesthesia. Images were evaluated using transverse and custom multiplanar (MPR), 3D, and panoramic reconstructed images. The CBCT findings were grouped into abnormalities that could be detected on conscious oral examination vs. abnormalities that could not be detected by conscious oral examination. Potential associations between the two categories were examined by pairwise Fisher’s exact test with statistical significance determined by P < 0.05. The most common findings identified on CBCT images were periodontal ligament space widening (14/15), premolar and molar malocclusion (13/15), apical elongation (13/15), coronal elongation (12/15), inflammatory tooth resorption (12/15), periapical lucency (11/15), moth-eaten pattern of osteolysis of the alveolar bone (9/15), ventral mandibular border contour changes (9/15), and missing teeth (8/15). Of the CBCT abnormalities likely to be observed on oral examination, coronal elongation (detectable on oral examination) was significantly associated with apical elongation (P = 0.029). There were no other significant associations between CBCT findings that are also clinically detectable and CBCT findings that are not be detectable on oral examination. This suggests that pathology often exists that is not apparent upon oral examination. This study establishes the common CBCT findings associated with dental disease in rabbits and demonstrates the feasibility of this technology to diagnose and plan treatment in dental disorders in this species.
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Affiliation(s)
- G G Riggs
- Dentistry and Oral Surgery Service, William Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California , Davis, CA , USA
| | - Derek D Cissell
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California , Davis, CA , USA
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California , Davis, CA , USA
| | - David C Hatcher
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA; Diagnostic Digital Imaging Center, Sacramento, CA, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California , Davis, CA , USA
| | - Amy Zhen
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California , Davis, CA , USA
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California , Davis, CA , USA
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