Adequate Imaging Modality Research Articles

Efficiency of different imaging methods in detecting ocular foreign bodies.

Ocular foreign bodies (OFBs) are a relatively common occurrence in ocular injuries, and a severe risk factor for vision disorders. They are notoriously challenging to identify and localize precisely to allow surgical removal, even with the most recent technological advancements. To compare the efficiency of different imaging methods in detecting and localizing OFBs. We conducted a retrospective analysis of the medical records of patients with OFBs, detected by ultrasound biomicroscopy (UBM) and confirmed during surgery. Patients who presented to our medical center between January 2016 and January 2022 and also underwent computed tomography (CT), X ray, and/or ocular B-scan ultrasonography (B-scans) were selected. This study included 134 patients with a history of ocular trauma and OFBs (mean age: 47.25 years, range: 8-78). The mean time interval from injury to UBM examination was 36.31 months (range: 0.2-120 months). Most OFBs were metallic (51.82%) or plant-based (25.37%); 22.39% of them were located in the sclera, 26.87% in the anterior chamber, and 23.88% in the ciliary body and iris. OFBs ranged in size from 0.10 to 6.67mm (mean: 1.15±1.10mm). B-scans identified OFBs in 37 of the 119 patients examined (31.09%); CT in 52 of 84 patients (61.90%); and radiography in 29 of 50 patients (58.00%). Univariate and multivariate analyses determined that both CT and radiography showed low detection rates for plant-based versus non-plant-based OFBs (CT: p<0.001; radiography: p=0.007), small particles (<1.00mm vs. >1.00mm; CT: p=0.001, radiography: p=0.024), and with eyeball wall locations (vs. intraocular; CT: p<0.001, radiography: p=0.021). Similarly, B-scans were less efficient for plant-based and eyeball wall-located OFBs (both p=0.001), whereas the difference based on dimensions was not significant (p=0.118). CT, radiography, and B-scans showed lower detection rates for plant-based, small, and eyeball wall-located OFBs. Our findings strongly suggest that UBM could be a more adequate imaging modality when such OFBs are suspected.

A Rare Complication of Neglected Workplace Trauma Leading to Fistula Formation

A long-term retained foreign body is rare and could lead to abnormal fistula formation. We present the case of a 25-year-old male with purulent discharge from the dorsal aspect of the left foot caused by a retained foreign body. The retained foreign body, a piece of rubber slipper retained over the past one year due to workplace injury to his left foot resulted in the formation of a fistula, a rare complication. The diagnosis was confirmed intraoperatively. We performed an emergency exploration of the left foot, the adhesions around the fistula were dissected, and we excised the fistula along with the foreign body. No severe complications occurred after surgery. We report this case to highlight that neglected foreign bodies can lead to various complications and healthcare professionals should be able to diagnose them with adequate imaging modalities.

Management of acute mesenteric ischaemia: Results of a worldwide survey

Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide. A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected. We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity. Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes.

Ultrasonographic stabilization of hydronephrosis after pyeloplasty: Key determinant of postoperative follow-up?

Although more than 1500 pediatric pyeloplasties are performed in the United States per year, there is a lack of consensus on the adequate imaging modality and timing of follow-up after surgery. The aim of this study is to evaluate if ultrasonographic stabilization in the grade of hydronephrosis after pyeloplasty is an adequate parameter to define the optimal length of follow-up after surgery and to detect failed procedures. Secondarily, we want to analyze clinical variables that could impact ultrasonographic stabilization. This is a retrospective chart review of patients who underwent pyeloplasty between 2012 and 2020. Patients were included if they were ≤21 years-old at the time of surgery, had pre and postoperative renal-ultrasounds, had ≥3 months of postoperative follow-up, and had met the criteria for ultrasonographic stabilization after surgery. Ultrasonographic stabilization was defined as 2 consecutive ultrasounds after pyeloplasty, a minimum of 1-month apart, with the same degree of hydronephrosis according to the Society for Fetal Urology (SFU) grading system. Data concerning clinical, surgical, and postoperative variables were collected. A total of 143 pyeloplasties met the inclusion criteria. Median age at surgery was 10.5 months with a median post-operative follow-up time of 29 months. Ultrasonographic stabilization was achieved in a mean time of 14.5 months post-operatively. Compared to the preoperative US SFU grade, at ultrasonographic stabilization 127 (88.9%) patients had an improvement of ≥1 grades of hydronephrosis. There were 9 pyeloplasty failures that were diagnosed and surgically corrected in a median of 7.5 months after the initial surgery. No clinical or surgical variables were associated with time to achieve ultrasonographic stabilization. There is great variability in the length of follow-up after pyeloplasty, ranging from 3-months to 7-years. In our cohort, the bast majority of patients had achieved ultrasonographic stabilization and displayed improvement in their initial grade of hydronephrosis by 14.5 months after surgery. Timeframe in which surgical failures were diagnosed and corrected. There were not clinical or surgical variables associated to time to achieve stabilization. Similar results have been reported in the literature; however, most of them have evaluated as their main outcome resolution and not stabilization of hydronephrosis. Ultrasonographic stabilization is a suitable and non-invasive parameter for determining the length of follow-up after unilateral pyeloplasty, as it is an adequate timeframe for identifying failed pyeloplasties, observing improvement or stabilization of hydronephrosis, and performing any additional procedure required after the primary repair.

Posttreatment Imaging of the Shoulder.

The shoulder joint is vulnerable for injuries following trauma and in the context of sporting activities. Degenerative rotator cuff disease is also a common entity. Conservative therapy is often not indicated or does not lead to the desired success, so surgical intervention is necessary. Routine follow-ups, but also persistent complaints, delayed healing, or recurrent trauma, usually need postoperative imaging of the shoulder. The choice of the adequate imaging modality and technique is important to reach the correct diagnosis. Additionally, knowledge of the most common surgical procedures, as well as typical normal findings and expected pathologies on different imaging modalities, is crucial for the radiologist to play a relevant role in the postoperative diagnostic process. This article addresses postoperative imaging after rotator cuff repair, shoulder arthroplasty, and surgery for shoulder stabilization with an emphasis on computed tomography and magnetic resonance imaging.

Measuring peri-implant bone lesions using low-dose cone-beam computed tomography.

High-definition cone-beam computed tomography (HD-CBCT) offers superior image quality at the cost of higher radiation dose compared to low-dose CBCT (LD-CBCT). The aim of this study was to investigate whether peri-implant bone lesions can be accurately quantified using LD-CBCT, even when including the influence of surrounding tissues. Twelve titanium implants restored with all-ceramic crowns were placed in bovine bone, and peri-implant lesions were prepared. Radiographic imaging was performed using IR (intraoral radiography), HD-CBCT and LD-CBCT. To simulate the in-vivo situation, the samples were placed inside a dry human mandible, and a second LD-CBCT imaging was performed (LD-CBCT*). The datasets were presented to four observers in random order. Maximum lesion depth and width were measured in a standardized mesiodistal slice in IR, HD-CBCT, LD-CBCT, and LD-CBCT*. Mean lesion depth and width measurements for each sample in HD-CBCT served as reference. Interrater agreement was slight for depth and excellent for width in HD-CBCT and both LD modes. For all observers, measurement deviations from HD-CBCT were below 0.3 mm in the LD protocols (LD-CBCT depth: 0.22 ± 0.17 mm, width: 0.22 ± 0.13 mm; LD-CBCT* depth: 0.24 ± 0.23 mm, width: 0.25 ± 0.21 mm) and at 0.4 mm in IR. Absolute differences between LD-CBCT and HD-CBCT are small, although surrounding tissues decrease LD-CBCT image quality. Within the limitations of an in-vitro trial, LD-CBCT may become an adequate imaging modality for monitoring peri-implant lesions at a substantially decreased radiation dose.

Pediatric bone marrow alterations

The age-dependent development of the bone marrow follows aconstant pattern and has an impact on the localization and morphology of various bone marrow processes. Physiological, reactive and benign bone marrow alterations must be differentiated from inflammatory or malignant infiltrations. In many cases, aspecific age distribution pattern and typical morphological characteristics in magnetic resonance imaging (MRI) enable adiagnostic classification. The only adequate imaging modality that can provide information about the bone marrow composition is MRI.

Nörofibromatozis Tip 1: Çocuk hastalarda Klinik ve Beyin MRG bulguları

Objective: Neurofibromatosis type 1 is a most common neurocutaneous syndrome characterized by multi-system involvement and an increased incidence of both benign and malignant tumors. Its diagnosis and follow-up is important because of increased cancer susceptibility in children. The aim of this study is to review the cranial MRI findings, neoplastic and non-neoplastic lesions of the brain in neurofibromatosis type I in pediatric patients. Material and Methods: 183 patients which diagnosed with neurofibromatosis type 1 and had at least 1 MRI between July 2010 and March 2019 were evaluated. Twelve patients were siblings. Contrasted cranial MRI obtained from 82 female and 101 male patients, between ages 1-18 years (averageage 10) retrospectively scanned thereafter type and locations of lesions evaluated by a 9 years experienced radiologist. Results: Out of 183 patients; 37 had no hamartomatous cranial lesions, 24 had optic gliomas or optic nerve thickening (9 bilaterally, 10 rightside, 5 leftside), 8 had plexiform neurofibromas (head or neck location), 9 had subcutaneous neurofibromas. Additionally 9 had intracranial arachnoid cysts, 6 low grade glial tumor, 1 medulloblastoma, 1 glioblastoma, 1 nodular heterotopia. Two patients had suspected low grade glial tumor and their size and view are stableat follow-up. The most common localization of hamartomatous lesions are the globus pallidus, dentate nucleus, mesencephalon, thalamus and pons respectively. The least common area is putamen. In addition, 3 patients are followed with Noonan Syndrome. In two of these patients, intracranial arachnoid cysts were observed in addition to hamartomatous lesions. Conclusion: Neurofibromatosis type 1 is one of the tumor predisposition syndrome that leads to an increased incidence of malign and benign tumors, which are major cause of mortality and morbidity. Gliomas are the most common intracranial tumors and the second most common tumor type after neurofibromas. Regular follow up is important for early diagnosis and treatment of malignancy. Brain MRI is adequate and necessary imaging modality for the diagnosis and follow up of brain involment in Neurofibromatosis type 1 patients.

Computed tomography evaluation of early post-operative complications of the Whipple procedure.

PurposePancreaticoduodenectomy (the Whipple procedure) is the only potential curative treatment for periampullary tumours. Although mortality due to the procedure is gradually decreasing, the morbidity rates remain high. This study aimed to evaluate early computed tomography (CT) findings in patients suspected of complications following the Whipple procedure.Material and methodsThe CT images of patients who underwent the conventional Whipple procedure between January 2015 and January 2019 and underwent CT examination for the detection of early postoperative complications were retrospectively evaluated by two radiologists.ResultsThe Whipple operation was performed to 65 patients, and the CT scans of 45 patients (30 males, 15 females) were included in the study. There were no complications in 21 patients. Complications were present in 24 patients (53.33%), of whom 13 had more than one complication. Eight patients had fluid collection in the operation site, two had haematoma, 10 had an abscess, and five had a pancreatic fistula. In addition, a hepatic abscess was detected in one patient, delayed gastric emptying in six patients, anastomotic leakage from the gastrojejunostomy line in two patients, superior mesenteric vein (SMV) thrombosis in two patients, and intraluminal haemorrhage and active extravasation in one patient. Mortality due to complications occurred in one patient in the early postoperative period. Other complications were treated by spontaneous, surgical or percutaneous interventional procedures.ConclusionsDespite the decreasing mortality rates in recent years, the Whipple procedure is risky and has high morbidity even when performed in experienced centres. CT is the adequate imaging modality for the evaluation of this anatomically altered region and detection of complications.

Adherence to Needed Adjuvant Therapy Could Decrease Recurrence Rates for Rural Patients With Early Breast Cancer

PurposeThe purpose of this study was to evaluate the differences in stage upon diagnosis, adherence to adjuvant treatment, and recurrence between rural and urban patients with early breast cancer. MethodsThis retrospective study included 3640 patients with primary breast cancer recruited from 2000 to 2009. Patients who developed recurrence or metastasis were verified by adequate diagnostic imaging modalities and pathology. The χ2 test was used to compare groups with respect to variables (recurrence and clinicopathologic features). A multivariable Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for breast cancer recurrence risk. ResultsCompared with tumors in urban patients, those in rural patients showed higher histologic grade, larger size, more lymphatic metastasis, and higher Ki-67 index; therapy adherence was strongly associated with recurrence in both. Compared with urban patients, the female rural patients had a higher recurrence rate. However, no significant difference in recurrence rates was observed between urban and rural patients following guideline adherence. ConclusionsThe results of our study suggest that the later stage upon diagnosis and nonadherence to treatment contribute toward worse breast cancer outcomes among rural patients with breast cancer. Adherence to needed adjuvant therapy could decrease recurrence rates for rural patients with early breast cancer.

Imaging Modality of Choice for Pre-Operative Cochlear Imaging: HRCT vs. MRI Temporal Bone.

Congenital inner ear malformations occur as a result of the arrest or aberrance of inner ear development due to the heredity, gene mutation or other factors. Ever since the availability of cochlear implants, pre-operative evaluation by imaging of temporal bone has gained much attention. Precise selection of the candidate for cochlear implant dependent on preoperative radiological investigations. Only CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) can provide a better picture of anatomy and pathology. To compare pre-operative imaging findings of both MRI and High Resolution Computed Tomography (HRCT) temporal bone and to find the best modality of choice in patients with bilateral profound Sensorineural Hearing Loss (SNHL). This was a prospective, longitudinal, observational study conducted between June 2010 to November 2012. A total of 144 temporal bones were evaluated in 72 children with bilateral profound SNHL with congenital inner ear malformations. Each temporal bone was considered as a single case (144 cases). All the patients underwent HRCT and high field MRI study. MRI study included T2 W axial 3D FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence. Anatomic abnormalities in each temporal bone were described and noted. For complete and better evaluation of Vestibulo-Cochlear Nerve (VCN) additional 3D oblique parasagittal view was taken perpendicular to the internal auditory canal with a small Field Of View (FOV). HRCT and MRI allowed accurate detection of inner ear malformations in children with bilateral SNHL. Majority of the patients presented with multiple structural abnormalities of inner ear. The common pathologies detected in the study were semicircular canal abnormality (89/144) followed by cochlear abnormalities (39/144). Most common cochlear abnormality was Mondini's deformity (14/144). MRI demonstrated absent of vestibulo-cochlear nerve in 15 cases. Few abnormalities of inner ear are better illustrated on CT, while others are better showed on MRI. Hence, neither HRCT nor MRI of the brain and temporal bones appears to be adequate imaging modality rather they are complementary to each other for pre-operative imaging of cochlear implantation.

Is Computed Tomography an Adequate Imaging Modality for the Evaluation of Juvenile Ossifying Fibroma? A Comparison of 2 Imaging Modalities (Computed Tomography and Magnetic Resonance Imaging)

Given the problems of overuse of medical technology and the current burden of health care cost in the United States, it is important to establish clear imaging guidelines to diagnose conditions such as juvenile ossifying fibroma (JOF). This study compared the efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of JOF and thus could aid establishing such guidelines. Radiologic criteria were established by 2 radiologists to compare the efficacy of CT and MRI in the evaluation of JOF. The following parameters were compared: presence of a well-defined corticated border, presence of a well-delineated internal calcified component, fluid-to-fluid levels, and anatomic extent of the lesion. Six patients diagnosed with JOF of the craniofacial bones from 2002 to 2013 had preoperative CT and MRI studies available for review. After review of CT and MRI images, fluid-to-fluid levels and anatomic extent of the lesions were comparable on CT and MRI. However, the corticated borders and the internal calcified component were better defined on CT images, which also enabled for distinction between the 2 subtypes of JOF. No MRI characteristics were identified that allowed for this distinction. Based on these findings, CT is an adequate and preferable imaging modality in the evaluation of JOF.

Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double-row rotator cuff repair.

Despite proven accuracy of US for the evaluation of rotator cuff integrity, there is no US-based classification for this purpose. This study aimed to assess US for the evaluation of rotator cuff repair integrity in accordance with a well-established MRI classification. The authors retrospectively reviewed 257 patients who underwent arthroscopic double-row suture anchor repair for rotator cuff tears. Post-operative function was rated using the Constant score, the UCLA rating and the SSV, whereas repair integrity was assessed using US as described in the MRI classification of Sugaya et al. A total of 212 patients aged 55.6 ± 9.8 years had complete functional and radiographic assessments at a mean follow-up of 36.8 ± 11.6 months. Using all three ratings, repairs of Type I had highest scores, repairs of Type II had discernibly lower scores, whereas repairs of Types III, IV and V had similar intermediate scores. Comparison of the UCLA scores with those of Sugaya et al. revealed similar scores for repairs of Type I and of Type V. The scores are less comparable for repairs of Types II, III and IV, because US does not allow identification of partial tears if shielded by bony structures and because partial tears correspond to minimal impairment. The study reveals that US is an adequate imaging modality to classify rotator cuff repair integrity, which could reduce economic and practical burdens of CTA, MRI or MRA. The results also confirm that post-operative repair integrity and functional outcome depend on pre-operative tear size and fatty infiltration, which provides clinicians with reasoning for early surgical repair and warning of the risks of strenuous activity for patients with larger tears. Prognostic study, Level IV.

Imaging of the midfacial and orbital trauma.

The severity of midfacial and orbital injuries depends on the one hand on cause, force vector, load point, or area and on the other hand on the bony and soft tissue resistance as well as individual anatomy. These variables result in a variety of possible injuries of the midfacial and orbital complex. The time critical choice of an adequate imaging modality of these injuries is influenced by the possible severity of concomitant injuries. Besides the confirmation of a clinical diagnosis, the need for high-resolution three-dimensional imaging for preoperative planning of facial reconstruction using intraoperative navigation has become more and more important in the past years. To achieve optimal functional and esthetic outcomes, the anatomical complexity of the midface has to be addressed and the adequate imaging modality has to be chosen keeping the upcoming surgical treatment in mind. The current imaging modalities for midfacial and orbital trauma are presented and critically evaluated depending on the indications. Furthermore, new strategies to support surgeons in achieving best possible midfacial reconstructions are discussed. An algorithm to choose the adequate imaging modality in midfacial and orbital traumatology is provided.

AB0947 Are X-Rays the Adequate Imaging Modality for Structural Damage Assessment of the Sacro-Iliac Joints? Comparative Study of 29 Spondyloarthritis Patients with Structural Damage of the Sacroiliac Joints and 48 Controls

BackgroundDiagnosis and/or classification of a patient with axial Spondyloarthritis (SpA) generally relies on the presence of structural damage of the sacroiliac joints (SIJ) assessed by plain X-rays. However, the psychometric...

Clinical, radiologic, and pathologic analysis of penile epithelioid hemangioendothelioma: A diagnostic and management dilemma

Epithelioid hemangioendotheliomas (EHE) are rare soft tissue tumors and only 17 cases involving the penis have been reported in the literature. These tumors are often incorrectly diagnosed as Peyronie's disease or superficial penile thrombosis. We present the case of a 59-year-old male referred to our institution with EHE after being incorrectly diagnosed with Peyronie's disease. A color Doppler ultrasound of the penis showed a highly vascular mass superficial to the tunica albuginea and a subsequent biopsy demonstrated EHE with low-grade features. Complete local excision was performed and given the patient's low-risk pathological features, he has been followed with only close surveillance. Early recognition of epithelioid vascular tumors is important and using adequate imaging modalities is critical to avoid prolonged periods of misdiagnosis.

Bildgebung bei Rückenschmerzen

Next to conventional x-ray examinations, modern imaging modalities as computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in the assessment of back pain. Guidelines and recommendations should be helpful for the - not always simple - indication for imaging for back pain. However, the latter have to be individually adapted regarding clinical symptoms and appearance for every patient. Choosing the adequate imaging modality depends on several criteria, as the suspected- and differential diagnosis, the acuteness, age of patient and the temporal availability of the examination.

Adult Small Bowel Obstruction

Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential complications that are associated with an SBO make it essential for the emergency physician (EP) to make a timely and accurate diagnosis. The primary objective was to perform a systematic review and meta-analysis of the history, physical examination, and imaging modalities associated with the diagnosis of SBO. The secondary objectives were to identify the prevalence of SBO in prospective ED-based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision-making to the diagnosis and management of SBO. MEDLINE, EMBASE, major emergency medicine (EM) textbooks, and the bibliographies of selected articles were scanned for studies that assessed one or more components of the history, physical examination, or diagnostic imaging modalities used for the diagnosis of SBO. The selected articles underwent a quality assessment by two of the authors using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data used to compile sensitivities and specificities were obtained from these studies and a meta-analysis was performed on those that examined the same historical component, physical examination technique, or diagnostic test. Separate information on the prevalence and management of SBO was used in conjunction with the meta-analysis findings of computed tomography (CT) to determine the test and treatment threshold. The prevalence of SBO in the ED was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and/or abdominal distention on examination were the best history and physical examination predictors of SBO. X-ray was determined to be the least useful imaging modality for the diagnosis of SBO, with a pooled positive likelihood ratio (+LR) of 1.64 (95% confidence interval [CI] = 1.07 to 2.52). On the other hand, CT and magnetic resonance imaging (MRI) were both quite accurate in diagnosing SBO with +LRs of 3.6 (5- to 10-mm slices, 95% CI = 2.3 to 5.4) and 6.77 (95% CI = 2.13 to 21.55), respectively. Although limited to only a select number of studies, the use of ultrasound (US) was determined to be superior to all other imaging modalities, with a +LR of 14.1 (95% CI = 3.57 to 55.66) and a negative likelihood ratio (-LR) of 0.13 (95% CI = 0.08 to 0.20) for formal scans and a +LR of 9.55 (95% CI = 2.16 to 42.21) and a -LR of 0.04 (95% CI = 0.01 to 0.13) for beside scans. Using the CT results of the meta-analysis for the 5- to 10-mm slice subgroup as well as information on intravenous (IV) contrast reactions and nasogastric (NG) intubation management, the pretest probability threshold for further testing was determined to be 1.5%, and the pretest probability threshold for beginning treatment was determined to be 20.7%. The potentially useful aspects of the history and physical examination were limited to a history of abdominal surgery, constipation, and the clinical examination findings of abnormal bowel sounds and abdominal distention. CT, MRI, and US are all adequate imaging modalities to make the diagnosis of SBO. Bedside US, which can be performed by EPs, had very good diagnostic accuracy and has the potential to play a larger role in the ED diagnosis of SBO. More ED-focused research into this area will be necessary to bring about this change.

The End of X‐rays for Suspected Small Bowel Obstruction? Using Evidence‐based Diagnostics to Inform Best Practices in Emergency Medicine

The End of X‐rays for Suspected Small Bowel Obstruction? Using Evidence‐based Diagnostics to Inform Best Practices in Emergency Medicine

Three-dimensional histological specimen preparation for accurate imaging and spatial reconstruction of the middle and inner ear

Purpose This paper presents a highly accurate cross-sectional preparation technique. The research aim was to develop an adequate imaging modality for both soft and bony tissue structures featuring high contrast and high resolution. Therefore, the advancement of an already existing microgrinding procedure was pursued. The central objectives were to preserve spatial relations and to ensure the accurate three-dimensional reconstruction of histological sections.Methods Twelve human temporal bone specimens including middle and inner ear structures were utilized. They were embedded in epoxy resin, then dissected by serial grinding and finally digitalized. The actual abrasion of each grinding slice was measured using a tactile length gauge with an accuracy of one micrometre. The cross-sectional images were aligned with the aid of artificial markers and by applying a feature-based, custom-made auto-registration algorithm. To determine the accuracy of the overall reconstruction procedure, a well-known reference object was used for comparison. To ensure the compatibility of the histological data with conventional clinical image data, the image stacks were finally converted into the DICOM standard.Results The image fusion of data from temporal bone specimens’ and from non-destructive flat-panel-based volume computed tomography confirmed the spatial accuracy achieved by the procedure, as did the evaluation using the reference object.Conclusion This systematic and easy-to-follow preparation technique enables the three-dimensional (3D) histological reconstruction of complex soft and bony tissue structures. It facilitates the creation of detailed and spatially correct 3D anatomical models. Such models are of great benefit for image-based segmentation and planning in the field of computer-assisted surgery as well as in finite element analysis. In the context of human inner ear surgery, three-dimensional histology will improve the experimental evaluation and determination of intra-cochlear trauma after the insertion of an electrode array of a cochlear implant system.