3D Planning Research Articles

Impact of different respiratory gating methods on target delineation and a radiotherapy plan for solitary pulmonary tumors.

Respiratory movement has an important impact on the radiotherapy for lung tumor. Respiratory gating technology is helpful to improve the accuracy of target delineation. This study investigated the value of prospective and retrospective respiratory gating simulations in target delineation and radiotherapy plan design for solitary pulmonary tumors (SPTs) in radiotherapy. The enrolled patients underwent CT simulation with three-dimensional (3D) CT non gating, prospective respiratory gating, and retrospective respiratory gating simulation. The target volumes were delineated on three sets of CT images, and radiotherapy plans were prepared accordingly. Tumor displacements and movement information obtained using the two respiratory gating approaches, as well as the target volumes and dosimetry parameters in the radiotherapy plan were compared. No significant difference was observed in tumor displacement measured using the two gating methods (p > 0.05). However, the internal gross tumor volumes (IGTVs), internal target volumes (ITVs), and planning target volumes (PTVs) based on the retrospective respiratory gating simulation were larger than those obtained using prospective gating (group A: pIGTV = 0.041, pITV = 0.003, pPTV = 0.008; group B: pIGTV = 0.025, pITV = 0.039, pPTV = 0.004). The two-gating PTVs were both smaller than those delineated on 3D non gating images (p < 0.001). V5Gy, V10Gy, V20Gy, V30Gy, and mean lung dose in the two gated radiotherapy plans were lower than those in the 3D non gating plan (p < 0.001); however, no significant difference was observed between the two gating plans (p > 0.05). The application of respiratory gating could reduce the target volume and the radiation dose that the normal lung tissue received. Compared to prospective respiratory gating, the retrospective gating provides more information about tumor movement in PTV.

A pilot study on preferences from surgeons to deal with an innovative customized and connected knee prosthesis – A discret choice experiment

BackgroundTo address the increasing global demand for Total Knee Arthroplasty and reduce the need for revisions, several technologies combining 3D planning and artificial intelligence have emerged. These innovations aim to enhance customization, improve component positioning accuracy and precision. The integration of these advancements paves the way for the development of personalized and connected knee implant. Questions/purposesThese groundbreaking advancements may necessitate changes in surgical practices. Hence, it is important to comprehend surgeons' intentions in integrating these technologies into their routine procedures. Our study aims to assess how surgeons' preferences will affect the acceptability of using this new implant and associated technologies within the entire care chain. MethodsWe employed a Discrete Choice Experiment, a predictive technique mirroring real-world healthcare decisions, to assess surgeons' trade-off evaluations and preferences. ResultsA total of 90 experienced surgeons, performing a significant number of procedures annually (mostly over 51) answered. Analysis indicates an affinity for technology but limited interest in integrating digital advancements like preoperative software and robotics. However, they are receptive to practice improvements and considering the adoption of future sensors. ConclusionsIn conclusion, surgeons prefer customized prostheses via augmented reality, accepting extra cost. Embedded sensor technology is deemed premature by them.

Our experience in 3D-modelling in pilon (distal tibial plafond) fractures

BACKGROUND: Internal fixation of pilon fractures remains challenging despite the development of new technologies in medical imaging and implant design and various scientific investigations on this problem. A key point in therapeutic strategy is preoperative planning. Since the beginning of the twenty-first century, the procedure has changed dramatically from plain radiograph drawing to 3D models and internal fixation simulation in vitro. AIM: This study aimed to evaluate 3D modeling in pilon fracture osteosynthesis preoperative planning. MATERIALS AND METHODS: The study used open, prospective, randomized, and comparative analysis. We analyzed the data of 60 patients with pilon fractures who had undergone surgical treatment for pilon fractures between July 1, 2020, and December 12, 2021, in Moscow City Hospital No. 17. In 30 patients, 3D models were used in preoperative planning, and in another 30 patients, the traditional planning method was performed. The operation time, intraoperation, X-ray dosage, blood loss, fracture reduction quality, and long-term results were analyzed. Additionally, the surgeon’s comfort in applying the 3D model and ease of doctor–patient communication were assessed using questionnaires. RESULTS: Results showed that 3D modeling in pilon fracture osteosynthesis preoperative planning has advantages over traditional preoperative planning. CONCLUSION: Therefore, 3D planning is a promising novel method for distal tibial fracture internal fixation preoperative planning, which provides significant higher degree of fracture anatomy comprehension and facilitates reduction maneuvers and implant positioning.

Harnessing the power of artificial intelligence: A new door for quick surgery in Pakistan.

Artificial intelligence (AI) has the potential to transform surgery in Pakistan, improving results, reducing complications, and increasing patient safety. Deep learning, a branch of machine learning, can assist surgeons in making wise judgments. Pubmed and Research Gate discuss the promise of AI in surgery. Incorporating AI in healthcare systems can expedite diagnosis and management while avoiding injudicious resource allocation. AI-based techniques in cardiology, nephrology, and neurology enable high-accuracy detection of cardiovascular disease risks, kidney disease treatment, and epileptic episode identification. Neurological devices like bispectral index monitor (BIS) and Near-infrared spectroscopy (NIRS) utilize advanced technology for reliable monitoring and objective diagnosis of neurological issues (Ahmed, 2022). AI uses electronic data and neural network methods to evaluate operating room logistics, time management, and anesthesiologist activities using electronic data and neural network methods (Khan F. H., 2019). AI algorithms are effectively detect minute differences for accurate diagnosis, with studies showing high specificity, sensitivity, and inter-operator repeatability. AI can be used to train and assess neurosurgical residents and early mid-career surgeons, improving diagnosis and 3D simulation labs (Shlobin, 2022). Surgeons play a crucial role in adopting AI-based technologies for surgical care by partnering with data scientists to capture novel clinical data and generate meaningful interpretations. They should demand transparency and interpretability in algorithms to hold AI accountable for its predictions and recommendations.AI advancements in plastic surgery practice, research, and education offer opportunities for improvement. Combining AI-enabled decision-making tools with predictive analytics and human intuition, surgeons can make real-time decisions based on 3D planning, anatomical localization, and navigation (Rasteau, 2022). While current AI tools cannot perform complex surgical procedures, advancements may enable them to perform more complex tasks in the future. Pakistan is a significant market for AI-based solutions, utilizing technology in various industries to address challenges and boost demand. The country has enhanced its self-security systems, including AI-powered missiles, cyber security, and effective cameras (Khan, 2022). AI allows tasks to be completed more precisely and efficiently, with machine learning and deep learning being advanced subtypes. In developing countries like Pakistan, AI tools are needed for patient-centred diagnosis and treatment assistance, especially in emergency surgery such as cardiac illnesses or life threatening bleeding caused road traffic accident. Hence insuring patient receive care timely. An appropriate budget should be allocated for AI technologies in the health sector.

From two-dimensional to three-dimensional marine spatial planning methodology: A case study of Qidong

The oceans are three-dimensional (3D) spaces, resource redistribution has long tended to involve two-dimensional (2D) planning, which has obscured the resource attributes and ecological features of the ocean's different layers, and is prone to cause erroneous sea-use conflicts. This study established a new 3D marine spatial planning (MSP) method consisting of ecological protection zoning (EPZ) and intensive sea-use zoning (ISZ) programs involving marine 3D spatial laying: EPZ was determined using a Marxan model. Based on spatial idleness and environmental friendliness principles, and appropriate newly added sea-use activities were designed to form synergistic sea-use combinations to establish an ISZ program. A case study of Qidong was conducted to test the applicability of the 3D planning program and compare the differences in the zoning results according to the two scenarios of ecological protection and exploitation. Results indicated that EPZ of mid-bottom waterbodies accounted for the highest proportion (47.62%). The best solutions and planning units selected frequency grading could be achieved separately for two scenarios of EPZ. For ISZ, the zoning for both scenarios achieves a synergistic effect between the newly added sea-use activities in the transportation zone; through the northward shift of sea-use in the southern fairway of Qidong, this sea-use activity converted the initially antagonistic attributes with the ecological protection zone to a synergistic purpose. Differences in the results of the intensive sea use zoning between the two scenarios were manifested in the EPZ and surrounding sea use activities, focusing on fishing and ecological control zones and the arrangement of wind power. The 3D MSP methods can address the conflict between some sea-use activities in 2D planning and the conflict between stakeholders competing for the sea-use right, and it also provides a solution for the coastal government to redistribute the marine resources and coordinate the sea-use elements. The relevant practice can provide theoretical and technical support for ecological protection, intensive and economical utilization of marine spatial resources, and national spatial planning framework improvement.

3D pre-operative planning and patient-specific guides for re-directional peri-acetabular osteotomy in children and adolescents

Surgical procedures to correct hip dysplasia associated with subluxation or dislocation of the femoral head are complex. The 3D geometric abnormalities of the acetabulum and proximal femur vary across patients. We, therefore, suggest a patient-specific surgical treatment involving computer-assisted 3D planning of the peri-acetabular osteotomies, taking into account the femoral head position; 3D printing of patient-specific guides for the cuts, repositioning, and fixation; and intra-operative application of the simulated displacements with their fixation. Level of evidenceIV.

Deep-learning based 3D reconstruction of lower limb bones from biplanar radiographs for preoperative osteotomy planning

PurposeThree-dimensional (3D) preoperative planning has become the gold standard for orthopedic surgeries, primarily relying on CT-reconstructed 3D models. However, in contrast to standing radiographs, a CT scan is not part of the standard protocol but is usually acquired for preoperative planning purposes only. Additionally, it is costly, exposes the patients to high doses of radiation and is acquired in a non-weight-bearing position.MethodsIn this study, we develop a deep-learning based pipeline to facilitate 3D preoperative planning for high tibial osteotomies, based on 3D models reconstructed from low-dose biplanar standing EOS radiographs. Using digitally reconstructed radiographs, we train networks to localize the clinically required landmarks, separate the two legs in the sagittal radiograph and finally reconstruct the 3D bone model. Finally, we evaluate the accuracy of the reconstructed 3D models for the particular application case of preoperative planning, with the aim of eliminating the need for a CT scan in specific cases, such as high tibial osteotomies.ResultsThe mean Dice coefficients for the tibial reconstructions were 0.92 and 0.89 for the right and left tibia, respectively. The reconstructed models were successfully used for clinical-grade preoperative planning in a real patient series of 52 cases. The mean differences to ground truth values for mechanical axis and tibial slope were 0.52° and 4.33°, respectively.ConclusionsWe contribute a novel framework for the 2D–3D reconstruction of bone models from biplanar standing EOS radiographs and successfully use them in automated clinical-grade preoperative planning of high tibial osteotomies. However, achieving precise reconstruction and automated measurement of tibial slope remains a significant challenge.

Is there a role for acromioplasty and tuberoplasty in reverse shoulder arthroplasty to improve impingement-free range of motion?

Hypothesis and BackgroundLateralizing the center of rotation in reverse shoulder arthroplasty (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture. MethodsEighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications. ResultsAfter virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (P < .001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed. ConclusionIn a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture.

Comparison of As-Built Surveys Using Handheld Laser Scanner and Conventional Method

With the advent of laser scanners in general, handheld laser scanners have become a tool used by surveyors to capture point clouds. The handheld laser scanner is useful for tight and confined spaces where a terrestrial laser scanner or a human cannot enter. Many surveyors still rely on the conventional method, which involves using a distometer and measuring tape for their strata as-built surveys. This is due to the simplicity and cost-effectiveness of the equipment. However, the conventional method is highly susceptible to human errors, unlike the laser scanner, which captures all features in point clouds without human intervention. In this research, data collected from both handheld laser scanners and conventional methods are compared. The handheld laser scanner captured a total of three levels. After collecting data at the site, the GeoSLAM Hub software processed the point clouds. This software helps convert the 3D point clouds into a 2D plan, with dimensions listed for the subsequent comparison process. The comparison focuses on the X and Y dimensions of the unit, with a tolerance of ±0.1m as per the circular KPUP-1-2015-JILID-I-v2016 provided by JUPEM. Following the comparison, the Root Mean Square Error (RMSE) is determined, with the lowest and highest values being 0.018m and 0.024m, respectively. In conclusion, the results show a minimum difference of 0.001m and a maximum difference of 0.049m, which falls within the provided tolerance. The handheld laser scanner offers visual aids to surveyors, enabling them to identify discrepancies' locations quickly. However, its drawback lies in the equipment's cost. Ultimately, the strata as-built plan is prepared for the three surveyed levels.

基于EMSDBO算法农业植保无人机三维航迹多目标优化研究

Both cruising ability and safety should be considered in the 3D inspection path planning of agricultural unmanned aerial vehicles (UAVs). Specific to a complex working environment, the 3D inspection environment of agricultural UAVs was simulated through terrain modeling and threat modeling. First, the dynamic constraints of flight approaching rate and response time were added to the threat cost, and the 3D mission space model and flight path cost function were constructed considering the influence of UAVs’ turning performance. Second, the offset estimation strategy, variable spiral search strategy, quasi-reverse learning strategy and dimension-by-dimension mutation strategy were introduced into the dung beetle optimizer (DBO) algorithm to improve the global optimization ability and convergence rate of the algorithm. By establishing a three-dimensional trajectory planning model for unmanned aerial vehicles, the trajectory planning is transformed into a multi-objective function optimization problem, and an improved algorithm is used to solve the three-dimensional trajectory planning of unmanned aerial vehicles. The fitness is evaluated by considering the objective function of trajectory cost, terrain cost, and danger level, and the trajectory planning is iteratively optimized. The results indicate that the proposed improved dung beetle algorithm for trajectory planning has lower overall cost and stability in adapting to different complex terrain environments.

The influence of the weight-bearing state on three-dimensional (3D) planning in lower extremity realignment – analysis of novel vs. state-of-the-art planning approaches

BackgroundThe use of 3D planning to guide corrective osteotomies of the lower extremity is increasing in clinical practice. The use of computer-tomography (CT) data acquired in supine position neglects the weight-bearing (WB) state and the gold standard in 3D planning involves the manual adaption of the surgical plan after considering the WB state in long-leg radiographs (LLR). However, this process is subjective and dependent on the surgeons experience. A more standardized and automated method could reduce variability and decrease costs.PurposeThe aim of the study was (1) to compare three different three-dimensional (3D) planning modalities for medial open-wedge high tibial osteotomy (MOWHTO) and (2) to describe the current practice of adapting NWB CT data after considering the WB state in LLR. The purpose of this study is to validate a new, standardized approach to include the WB state into the 3D planning and to compare this method against the current gold standard of 3D planning. Our hypothesis is that the correction is comparable to the gold standard, but shows less variability due compared to the more subjective hybrid approach.MethodsThree surgical planning modalities were retrospectively analyzed in 43 legs scheduled for MOWHTO between 2015 and 2019. The planning modalities included: (1) 3D hybrid (3D non-weight-bearing (NWB) CT models after manual adaption of the opening angle considering the WB state in LLR, (2) 3D NWB (3D NWB CT models) and (3) 3D WB (2D/3D registration of 3D NWB CT models onto LLR to simulate the WB state). The pre- and postoperative hip-knee-ankle angle (HKA) and the planned opening angle (°) were assessed and differences among modalities reported. The relationship between the reported differences and BMI, preoperative HKA (LLR), medial meniscus extrusion, Outerbridge osteoarthritis grade and joint line convergence angle (JLCA) was analyzed.ResultsThe mean (std) planned opening angle of 3D hybrid did not differ between 3D hybrid and 3D WB (0.4 ± 2.1°) (n.s.) but was higher in 3D hybrid compared to 3D NWB (1.1° ± 1.1°) (p = 0.039). 3D WB demonstrated increased preoperative varus deformity compared to 3D NWB: 6.7 ± 3.8° vs. 5.6 ± 2.7° (p = 0.029). Patients with an increased varus deformity in 3D WB compared to 3D NWB (> 2 °) demonstrated more extensive varus alignment in LLR (p = 0.009) and a higher JLCA (p = 0.013).ConclusionSmall intermodal differences between the current practice of the reported 3D hybrid planning modality and a 3D WB approach using a 2D/3D registration algorithm were reported. In contrast, neglecting the WB state underestimates preoperative varus deformity and results in a smaller planned opening angle. This leads to potential under correction in MOWHTO, especially in patients with extensive varus deformities or JLCA.Clinical RelevanceIncorporating the WB state in 3D planning modalities has the potential to increase accuracy and lead to a more consistent and reliable planning in MOWHTO. The inclusion of the WB state in automatized surgical planning algorithms has the potential to reduce costs and time in the future.

The Value of Computed Tomography-Based Planning in Shoulder Arthroplasty Compared to Intra-/Interobserver Reliability of X-ray Planning.

Background: Reversed total shoulder arthroplasty (RTSA) is an established surgery for many pathologies of the shoulder and the demand continues to rise with an aging population. Preoperative planning is mandatory to support the surgeon's understanding of the patient's individual anatomy and, therefore, is crucial for the patient's outcome. Methods: In this observational study, we identified 30 patients who underwent RTSA with two- and three-dimensional preoperative planning. Each patient underwent new two-dimensional planning from a medical student and an orthopedic resident as well as through a mid-volume and high-volume shoulder surgeon, which was repeated after a minimum of 4 weeks. The intra- and interobserver reliability was then analyzed and compared to the 3D planning and the implanted prosthesis. The evaluated parameters were the size of the pegged glenoid baseplate, glenosphere, and humeral short stem. Results: The inter-rater reliability showed higher deviations in all four raters compared to the 3D planning of the base plate, glenosphere, and shaft. The intra-rater reliability showed a better correlation in more experienced raters, especially in the planning of the shaft. Conclusions: Our study shows that 3D planning is more accurate than traditional planning on plain X-rays, despite experienced shoulder surgeons showing better results in 2D planning than inexperienced ones.

Quality Assessment Radiotherapy Planning of Breast Cancer Patients with Built-In Metal Port Implants

Purpose: To evaluate the quality of radiation planning for breast cancer patients with implants with a built-in metal port. Conduct a quantitative analysis of the quality of planning, assess the dose load on critical organs for this category of patients.Material and methods: Homogeneity and conformity indices were calculated, and dose loads in critical organs were assessed for irradiation plans using 3D conformal RT (3D CRT) technology for 23 breast cancer patients with a built-in metal port implants. Calculations were carried out both taking into account (outlining) the metal port and artifacts from it on CT images, and without taking it into account.Results: Based on the results of the analysis of the calculated values of conformity and homogeneity indices, doses in critical organs of irradiation plans for 23 patients with breast cancer, it was shown that the presence of a metal port and artifacts from it affects the nature of the dose distribution.Conclusions: When creating a 3D CRT treatment plan, it is necessary to delineate the metal port and artifacts and assign true densities.

3D maxillofacial surgery planning - one decade development of technology.

Nowadays, techniques and the use of patient specific implants seem to be the recent high technology standard in reconstructive surgery. Surgery planning is as old as the surgery procedures themselves. Any good surgeon, before entering the operating theatre, has a plan for how to proceed. It is based on knowledge and experience in combination of evaluation of all case relevant information. In fact, virtual surgery planning and CAD/CAM reflects the technological "state of the art" into the medical daily practice. Recently, 3D printing technologies became easy and accessible for everyone. Virtual 3D images substituted the plaster models, the film profile analysis switched to digital, 3D printed bone models of the case helped to understand the morphology of the deformity and prepare the osteotomies with "hands on the bone". The authors' own 20 years of experience on surgical planning, the development of digital technologies in oral and maxillofacial surgery is traced and comments on case examples are presented.

The Sum of the Leg Length Discrepancy and the Difference in Global Femoral Offset Is Equal to That of the Contralateral Intact Side and Improves Postoperative Outcomes after Total Hip Arthroplasty: A Three-Dimensional Analysis.

Background/Objectives: Global femoral offset (GFO) and leg length discrepancy (LLD) affect outcomes after total hip arthroplasty (THA). Moreover, the sum of the difference in GFO between the THA and non-surgical sides and LLD (SGL) reportedly affects the outcomes in a two-dimensional evaluation. We examined the association of the GFO, LLD, and SGL with the Harris Hip Score (HHS) using a three-dimensional (3D) evaluation. Methods: We retrospectively surveyed 172 patients with hemilateral hip osteoarthritis who underwent THA. The GFO, LLD, and SGL were measured using the 3D pelvis and femur models; these models were adjusted for the pelvis and femur, and the coordinate systems were parallelized. Furthermore, their relationship with the modified HHS (mHHS) 1 year after THA was determined. Results: Significant correlations were found among mHHS, GFO, and SGL in the binomial group, whereas LLD was not significantly correlated. The optimal values of GFO and SGL were 1.01 mm and 0.18 mm/100 cm body height, respectively, which were considered optimal when the SGL values were approximately equal to those of the non-operative side. The optimal ranges for GFO and SGL were -1.65 to 3.67 mm and -4.78 to 5.14 mm/100 cm, respectively. Conclusions: Our findings were obtained after adjusting the pelvis and femur to a unified coordinate system. Therefore, the results of this study can be directly applied to 3D planning.

Anatomical cup implantation assisted with dynamic 3D planning improves functional outcomes in primary total hip arthroplasty: A retrospective study.

Anatomical cup implantation is a promising approach in primary total hip arthroplasty (THA) and improves functional outcomes. We aimed to evaluate the cup position and functional outcomes in primary THA with preoperative dynamic 3D planning. We retrospectively reviewed 54 hips in 48 patients who underwent primary THA with anatomical cup implantation (mean follow-up time: 52months). Cup positions were evaluated based on patient-specific morphology, the acetabular fossa and the combined anteversion test. Functional outcomes were assessed after THA. The paired-sample t-test was performed for surgical and contralateral native hips among 42 patients who underwent unilateral THA. Two hips suffered intraoperative trochanteric fracture, but no hip dislocations occurred. No patients reported groin or thigh pain, and all patients were capable of deep squatting and one-leg standing. The mean Harris hip score, WOMAC score, and physical SF-36 score were 94.46 ± 6.16, 10.41 ± 3.62, and 95.19 ± 8.74, respectively. Except for acetabular offset, THA restored biomechanics to those of contralateral native hip, including cup anteversion, abduction, femoral offset and acetabular height (P> 0.05). This study provided evidence for the application of anatomical cup implantation assisted with dynamic 3D planning in primary THA, which restored morphology and improved functional outcomes.

Effective Differences between 2D and 3D Planned Brachytherapy in Lung Cancer: An Institutional Retrospective Study.

Background and Objectives: Advanced lung cancer is usually manifested by endoluminal tumor propagation, resulting in central airway obstruction. The objective of this study is to compare the high dose rate brachytherapy treatment outcomes in non-small-cell lung cancer (NSCLC) depending on the treatment planning pattern-two-dimension (2D) or three-dimension (3D) treatment planning. Materials and Methods: The study was retrospective and two groups of patients were compared in it (a group of 101 patients who underwent 2D planned high-dose-rate endobronchial brachytherapy (HDR-EBBT) in 2017/18 and a group of 83 patients who underwent 3D planned HDR-EBBT between January 2021 and June 2023). Results: In the group of 3D planned brachytherapy patients, there was a significant improvement in terms of loss of symptoms of bronchial obstruction (p = 0.038), but no improvement in terms of ECOG PS (European Cooperative Oncology Group Performance Status) of the patient (p = 0.847) and loss of lung atelectasis (if there was any at the beginning of the disease) (p = 0.781). Two-year overall survival and time-to-progression periods were similar for both groups of patients (p = 0.110 and 0.154). Fewer treatment complications were observed, and 91.4% were in 3D planned brachytherapy (BT) patients. Conclusions: Three-dimensionally planned HDR-EBBT is a suggestive, effective palliative method for the disobstruction of large airways caused by endobronchial lung tumor growth. Independent or more often combined with other types of specific oncological treatment, it certainly leads to the loss of symptoms caused by bronchial obstruction and the improvement of the quality of life of patients with advanced NSCLC. Complications of the procedure with 3D planning are less compared to 2D planned HDR-EBBT.

Application and evaluation of artificial intelligence 3D preoperative planning software in developmental dysplasia of the hip

BackgroundAccurate preoperative planning is crucial for successful total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The aim of this study was to compare the accuracy of an artificial intelligence-assisted three-dimensional (3D) planning system (AIHIP) with two-dimensional templates in predicting acetabular cup size in THA for DDH.MethodThis study retrospectively analyzed image data from 103 DDH patients who had THA between May 2019 and August 2023. AIHIP was used for 3D planning, and two-dimensional (2D) templates were used by two experienced surgeons. Accuracy was assessed by comparing predicted and actual cup sizes, and potential factors affecting accuracy were analyzed, including gender, side, BMI, and dysplasia classification.ResultsAIHIP had higher accuracy in predicting the acetabular cup size compared to the 2D template. Within ± 0 size, AIHIP’s accuracy was 84.1%, while the 2D template’s was 64.0% (p < 0.05). Within ± 1 size, AIHIP's accuracy was 95.1%, while the 2D template’s was 81.1% (p < 0.05). Accuracy was unaffected by gender, side, or BMI but was by DDH classification. In subgroup analysis, AIHIP's mean absolute error (0.21 ± 0.54) was significantly lower than the 2D template’s (0.62 ± 0.95) for Crowe II and Crowe III (p < 0.05).ConclusionAIHIP is superior to 2D templates in predicting the acetabular cup size accurately for THA in DDH patients. AIHIP may be especially beneficial for Crowe II and III DDH patients, as 2D templates may not accurately predict cup size in these cases.

Pre-selection blade size choice for the microsurgical clipping of cerebral artery aneurysms: A numerical study

BackgroundBrain strokes comprise the third leading cause of death worldwide. Microsurgical clipping is recognized as being one of the most effective approaches to the treatment of brain aneurysms. The incomplete closure of the distal-side aneurysm neck is the most common cause of the persistent filling of the dome. Since the diameter of the neck increases when the neck of the aneurysm is squeezed closed by the blades of the clip, the blades should be correspondingly longer. This study provided an assessment of whether the presurgical selection of clips using a 3D planning system is feasible in terms of selecting the most suitable clip for aneurysm occlusion. MethodsThe computational model was created based on computer tomography data obtained from nine brain aneurysms. The closing of the aneurysm was provided in two steps. The first the length of the blades used for closing corresponded to the length of the aneurysm neck as confirmed by the radiological measurements. The second the length of the blades was adjusted according to stage one, so as to determine the minimum required for the closure of all the gaps in the interior space of the aneurysm neck. ResultsNo differences were detected between the radiological measurement of the aneurysm neck size and the measurements obtained from the reconstructed stereolithographic 3D models. It was observed that the size of the aneurysm neck increased following clipping by 40% to 60% of its original size. The larger the aneurysm neck, the greater the deformation of the aneurysm. ConclusionFirstly, the 3D reconstruction of CT/MRI data did not result in any loss of accuracy and the measurement of the neck of the aneurysm was the same for both of the methods employed. The second, and more important, outcome was that the deformation of the neck of the cerebral aneurysm is at least 1.4x greater than its original size. This information is essential in terms of the pre-selection of the size of the clip.

Real-time Reconstruction of Comminuted Mandibular Fractures Using 3D Printing.

Comminuted fractures of the jaws are complex injuries requiring special attention. In the past, treatment included closed reduction using maxillomandibular fixation. With advancements in technology and fixation systems, open reduction became a prevalent option. These fractures are difficult to reconstruct during the primary treatment phase, thus resulting in higher complication rates. The introduction of three-dimensional (3D) planning and printing brought about superior outcomes, yet these focus on secondary reconstruction due to the need for outsourcing planning and titanium printing. In this report, we describe real-time in-house 3D planning and printing using computer-assisted design software and a 3D-fused deposition printer for virtual reduction of the comminuted fractures and printing of the reconstructed mandible. Following virtual 3D reduction, the newly created mandibles were 3D printed. The model was then used to preband a reconstruction plate, which in turn was used as a template during surgery for reducing the segments. The process of virtual reduction and printing should take a couple of hours at most. The results of five cases showed good alignment and proper function. Three-dimensional technology can be applied in the everyday primary care treatment protocol of comminuted fractures as an in-house tool which greatly improves both functional and aesthetic outcomes.