Advanced Imaging Research Articles

Abstract ED02-03: Innovative approaches at the diagnosis and treatment of invasive lobular carcinoma

Abstract Invasive Lobular Carcinoma (ILC) represents a unique subtype of breast cancer characterized by distinctive clinical and molecular features. This presentation aims to delve into innovative approaches in the diagnosis and treatment of ILC, focusing on novel techniques in imaging, unique molecular findings, signaling pathway alterations, targetable biomarkers, and microenvironment profiling that can pave the way for the development of novel therapies. Imaging Techniques in ILC: Accurate diagnosis is the foundation for effective treatment. ILC often presents diagnostic challenges due to the fact that lobular cells tends to infiltrate the affected organs in a diffuse manner instead of forming a discrete tumor mass making diagnostic imaging such as screening mammograms and CT scans less precise. This presentation will explore cutting-edge imaging techniques such as contrast-enhanced mammography, novel radioisotopes for positron emission tomography (PET) such as Fluoroestradiol F18 (FES), Fluciclovine and prostate-specific membrane antigen (PSMA) for improved detection and characterization of ILC lesions. Furthermore, we will discuss emerging modalities like radiomics and artificial intelligence, which hold promise in enhancing early diagnosis and risk assessment. Molecular Insights into ILC: ILC is distinguished by its unique molecular profile, notably the loss of E-cadherin expression. We will delve into recent advancements in understanding the molecular landscape of ILC, including genomic alterations, epigenetic changes, and the role of signaling pathways providing insights into potential therapeutic vulnerabilities. Targetable Biomarkers and Pathways: Identification of targetable biomarkers is essential for the development of precision therapies in ILC. This presentation will highlight promising targets, including ERBB2 (HER2), ROS1, TROP2, AKT1 along with other novel biomarkers. Microenvironment Profiling: The tumor microenvironment plays a pivotal role in cancer progression and therapy response. We will discuss recent advancements in characterizing the ILC microenvironment, including the immune cell infiltrate and stromal components. Understanding the dynamic interplay between the tumor and its microenvironment can inform the development of immunotherapies and combination strategies tailored to ILC. In conclusion, this presentation will provide a comprehensive overview of the latest innovations in ILC diagnosis and treatment. Our exploration of advanced imaging techniques, molecular findings, targetable pathways, biomarkers, and microenvironment profiling will shed light on the exciting potential for personalized therapeutic approaches in the management of ILC. By staying at the forefront of these developments, we can pave the way for improved outcomes and enhanced quality of life for patients with ILC. Citation Format: J. Mouabbi. Innovative approaches at the diagnosis and treatment of invasive lobular carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr ED02-03.

Should We Wait for Bone-on-Bone Arthritis? Equivalent Clinical Outcomes in Patients Requiring Advanced Imaging Prior to Primary Total Hip Arthroplasty

IntroductionPlain radiographs remain the standard for diagnosing osteoarthritis (OA). Total hip arthroplasty (THA) is generally offered only for advanced OA by plain radiographs. Advanced imaging is used as an adjunct to assess OA severity in cases of progressive symptoms with less advanced OA by plain radiographs. The objective of this study was to compare outcomes following THA in patients who have advanced OA visualized by plain radiographs to patients who have less severe OA visualized by plain radiographs. MethodsFrom February 2016 to February 2020, 93 patients who had Kellgren-Lawrence (KL) grade 0 to 2 OA and underwent THA were identified. The median age was 65 years, and 55% were women. They were matched 1:3 to patients who underwent THA for KL 4 OA based on age, sex, BMI, and Charlson Comorbidity Index. The primary outcome was achievement of the Hip Injury and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) at 1 year postoperatively. ResultsThere was no difference between the KL 0 to 2 and KL 4 cohorts in the achievement of HOOS JR MCID (86 versus 85.6%, P = 0.922), SCB (81.7 versus 80.2%, P = 0.751), or PASS (89.2 versus 85.6%, P = 0.374). The KL 0 to 2 cohort had a similar improvement in their 2-year HOOS JR (42.5 versus 38.6, P = 0.019). ConclusionIn this series, there was no difference in outcomes following primary THA between patients who have severe OA on plain radiographs (KL 4) compared to those who have less severe OA (KL 0 to 2). In the setting of severe symptoms and the absence of advanced OA on radiographs, advanced imaging can be used to guide treatment and select patients who could benefit from THA.

Use of Computed Tomography for Shoulder Arthroplasty: A Systematic Review

IntroductionThe prevalence of total shoulder arthroplasties is on the rise annually. Improvements in implant quality, construct stability, and surgical techniques have notably enhanced post-operative results, prompting an expansion of indications for shoulder arthroplasty. Despite its high success rate, opportunities for enhancement remain, especially in preoperative planning and intraoperative execution. Advanced imaging technologies offer significant potential in optimizing implant placement, thus improving the longevity of the procedure. To our knowledge, a comprehensive review examining the impact of advanced imaging on shoulder arthroplasty has yet to be conducted. This systematic review aims to investigate the benefits of advanced imaging technologies in this context, focusing on their application in preoperative planning, osteoarthritis assessment, intraoperative adjustments, patient-specific instrumentation, and navigational aids. MethodsThis review utilized a comprehensive search of PubMed to identify relevant studies published from 2000 to 2024, focusing on the application of various imaging techniques in shoulder arthroplasty. The search was conducted by two authors and centered on plain radiography, CT scans, and MRI. The selection criteria included availability of full-text articles, English language, direct comparison of imaging techniques, and a focus on patient outcomes, including discussions on broader applications such as intraoperative navigation and patient-specific instrumentation development. ResultsEnhanced imaging techniques, particularly CT scans and MRIs, have been shown to significantly improve outcomes in shoulder arthroplasty. While plain radiographs remain standard, CT scans provide superior bony detail, crucial for evaluating glenoid wear and determining augmentation needs. Preoperative CT imaging has been demonstrated to enhance implant placement accuracy. Moreover, intraoperative technologies based on CT imaging, such as patient-specific instrumentation and navigation systems, contribute to better surgical results. ConclusionThe benefits of CT imaging in shoulder arthroplasty significantly outweigh the associated costs. Current literature strongly supports the adoption of CT imaging in these procedures, particularly when used alongside modern operative technologies.

Educating the next generation of radiologists: a comparative report of ChatGPT and e-learning resources

Rapid technological advances have transformed medical education, particularly in radiology, which depends on advanced imaging and visual data. Traditional electronic learning (e-learning) platforms have long served as a cornerstone in radiology education, offering rich visual content, interactive sessions, and peer-reviewed materials. They excel in teaching intricate concepts and techniques that necessitate visual aids, such as image interpretation and procedural demonstrations. However, Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI)-powered language model, has made its mark in radiology education. It can generate learning assessments, create lesson plans, act as a round-the-clock virtual tutor, enhance critical thinking, translate materials for broader accessibility, summarize vast amounts of information, and provide real-time feedback for any subject, including radiology. Concerns have arisen regarding ChatGPT's data accuracy, currency, and potential biases, especially in specialized fields such as radiology. However, the quality, accessibility, and currency of e-learning content can also be imperfect. To enhance the educational journey for radiology residents, the integration of ChatGPT with expert-curated e-learning resources is imperative for ensuring accuracy and reliability and addressing ethical concerns. While AI is unlikely to entirely supplant traditional radiology study methods, the synergistic combination of AI with traditional e-learning can create a holistic educational experience.

“Blunt adrenal injury does not affect outcomes in adult patients with isolated abdominal injury – A National Trauma Data Bank review®”

IntroductionTraumatic blunt adrenal injury (BAI) has been an area of debate, with conflicting data on its impact. BAI from blunt abdominal injury is challenging to diagnose early due to retroperitoneal gland location and minimal clinical signs. The incidence of BAI ranges from 0.03 % to 4.95 %, with an increasing trend attributed to advanced CT imaging. Conflicting data exists regarding BAI's implications on patient outcomes, necessitating a comprehensive evaluation. MethodsA retrospective review of the National Trauma Data Bank (NTDB®) for 2017-2021 included a total of 352,654 patients with 337,628 polytrauma patients and 15,026 isolated abdominal trauma patients. Patients were categorized into those with and without adrenal injury. Demographic data and outcomes were compared using statistical tests, focusing on Injury Severity Scores (ISS), mortality, length of stay, and ventilation days. ResultsPolytrauma patients with BAI had increased mortality, longer ICU and hospital stays, and ventilation requirements when compared to polytrauma patients without BAI. However, when evaluating isolated abdominal trauma patients with BAI showed no significant differences when compared to isolated abdominal trauma without BAI in mortality or ICU LOS and a slight decrease in ICU admissions, hospital LOS, and ventilation requirement. DiscussionThe study indicates a significant association between BAI and increased trauma severity among polytrauma patients. Mortality, however, did not exhibit a consistent rise across all patients with adrenal injury, emphasizing that BAI may not independently influence outcomes. These findings align with the notion that adrenal injury is linked to the overall trauma burden rather than being a primary determinant of mortality.

Concurrent inflammation-related brain reorganization in multiple sclerosis and depression

BackgroundNeuroinflammation affects brain tissue integrity in multiple sclerosis (MS) and may have a role in major depressive disorder (MDD). Whether advanced magnetic resonance imaging characteristics of the gray-to-white matter border serve as proxy of neuroinflammatory activity in MDD and MS remain unknown. MethodsWe included 684 participants (132 MDD patients with recurrent depressive episodes (RDE), 70 MDD patients with a single depressive episode (SDE), 222 MS patients without depressive symptoms (nMS), 58 MS patients with depressive symptoms (dMS), and 202 healthy controls (HC)). 3 T-T1w MRI-derived gray-to-white matter contrast (GWc) was used to reconstruct and characterize connectivity alterations of GWc-covariance networks by means of modularity, clustering coefficient, and degree. A cross-validated support vector machine was used to test the ability of GWc to stratify groups according to their depression symptoms, measured with BDI, at the single-subject level in MS and MDD independently. FindingsMS and MDD patients showed increased modularity (ANOVA partial-η2 = 0.3) and clustering (partial-η2 = 0.1) compared to HC. In the subgroups, a linear trend analysis attested a gradient of modularity increases in the form: HC, dMS, nMS, SDE, and RDE (ANOVA partial-η2 = 0.28, p < 0.001) while this trend was less evident for clustering coefficient. Reduced morphological integrity (GWc) was seen in patients with increased depressive symptoms (partial-η2 = 0.42, P < 0.001) and was associated with depression scores across patient groups (r = -0.2, P < 0.001). Depressive symptoms in MS were robustly classified (88 %). ConclusionsSimilar structural network alterations in MDD and MS exist, suggesting possible common inflammatory events like demyelination, neuroinflammation that are caught by GWc analyses. These alterations may vary depending on the severity of symptoms and in the case of MS may elucidate the occurrence of comorbid depression.

Enhancing Therapeutic Efficacy and Safety of Immune Checkpoint Inhibition for Bladder Cancer: A Comparative Analysis of Injectable vs. Intravesical Administration.

Bladder cancer (BC) presents a significant global health burden, characterized by high recurrence rates post-initial treatment. Gender differences in BC prevalence and response to therapy emphasize the importance of personalized treatment strategies. While Bacillus Calmette-Guérin (BCG) remains a cornerstone of BC therapy, resistance poses a challenge, necessitating alternative strategies. Immune checkpoint inhibitors (ICIs) have shown promise, yet systemic toxicity raises concern. Intravesical administration of ICIs offers a potential solution, with recent studies demonstrating the feasibility and efficacy of intravesical pembrolizumab. Although systemic toxicity remains a concern, its localized administration may mitigate adverse events. Additionally, liposomal delivery of ICIs exhibits promises in enhancing drug penetration and reducing toxicity. Novel imaging modalities compatible with Vesical Imaging-Reporting and Data System (VI-RADS) and capable of predicting high-grade bladder cancer can aid the pre-operative shared decision making of patient and surgeon. Future research should focus on refining treatment approaches, optimizing dosing regimens, and leveraging advanced imaging techniques to improve patient outcomes. In conclusion, intravesical immunotherapy presents a promising avenue for BC treatment, offering enhanced therapeutic effectiveness while minimizing systemic toxicity. Continued research efforts are essential to validate these findings and optimize intravesical immunotherapy's role in BC management, ultimately improving patient outcomes.

Exploring the State of Cancer Imaging Research in Africa

IntroductionThe growing cancer burden in Africa demands urgent action. Medical imaging is crucial for cancer diagnosis and management and is an essential enabler of precision medicine. To understand the readiness for quantitative imaging analysis to support cancer management in Africa, we analyzed the utilization patterns of imaging modalities for cancer research across the continent. MethodsWe retrieved articles by systematically searching PubMed, using a combination of search terms {“Neoplasm”}AND {“Radiology” or “Diagnostic imaging” or “Radiography” or “Interventional Radiology” or “Radiotherapy” or “Radiation Oncology”} AND {Africa* or 54 African countries}. Articles describing cancer diagnosis or management in humans with the utilization of imaging were included. Exclusion criteria were: review articles, non-English articles, publications before 2000, non-cancer diagnoses, and studies conducted outside Africa. ResultsThe analysis of diagnostic imaging in Africa revealed a diverse utilization pattern across different cancer types and regions. The literature search identified 107 publications on cancer imaging in Africa. The studies were carried out in 19 African countries on 12 different cancer types with 6 imaging modalities identified. Most cancer imaging research studies utilized multiple imaging modalities. Ultrasound was the most used distinct imaging modality and MRI was the least frequently used. Most research studies originated from Nigeria, South Africa and Egypt. ConclusionWe demonstrate substantial variability in the presence of imaging modalities, widespread utilization of ultrasonography and limited availability of advanced imaging modalities for cancer research.

Posterior Shoulder Instability Part I – Diagnosis, Non-Operative Management, and Labral Repair for Posterior Shoulder Instability – An International Expert Delphi Consensus Statement

The purpose of this study was to establish consensus statements on the diagnosis, non-operative management, and labral repair for posterior shoulder instability. A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating based on their level of expertise in the field. Experts were assigned to one of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80-89% agreement, whereas strong consensus was defined as 90-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. Unanimous agreement was reached on the indications for non-operative management and labral repair which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient's preference to avoid or delay surgery. Additionally, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization. The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for non-operative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in non-operative management, whether a poster-inferior portal is required.

Recommendation of minimal distal tibial length for long axis coordinate system definitions

Accurate anatomical coordinate systems for the foot and ankle are critical for interpreting their complex biomechanics. The tibial superior-inferior axis is crucial for analyzing joint kinematics, influencing bone motion analysis during gait using CT imaging and biplane fluoroscopy. However, the lack of consensus on how to define the tibial axis has led to variability in research, hindering generalizability. Even as advanced imaging techniques evolve, including biplane fluoroscopy and weightbearing CT, there exist limitations to imaging the entire foot together with the full length of the tibia. These limitations highlight the need to refine axis definitions. This study investigated various superior-inferior axes using multiple distal tibia lengths to determine the minimal field of view for representing the full tibia long-axis. Twenty human cadaver tibias were imaged and segmented to generate 3D bone models. Axes were calculated based on coordinate definitions that required user manual input, and a gold standard mean superior-inferior axis was calculated based on the population’s principal component analysis axis. Four manually calculated superior-inferior tibial axes groups were established based on landmarks and geometric fittings. Statistical analysis revealed that geometrically fitting a cylinder 1.5 times the mediolateral tibial width, starting 5 cm above the tibial plafond, yielded the smallest angular deviation from the gold standard. From these findings, we recommend a minimum field of view that includes 1.5 times the mediolateral tibial width, starting 5 cm above the tibial plafond for tibial long-axis definitions. Implementing these findings will help improve foot and ankle research generalizability and impact clinical decisions.

Imaging of Structural Timber Based on In Situ Radar and Ultrasonic Wave Measurements: A Review of the State-of-the-Art.

With the rapidly growing interest in using structural timber, a need exists to inspect and assess these structures using non-destructive testing (NDT). This review article summarizes NDT methods for wood inspection. After an overview of the most important NDT methods currently used, a detailed review of Ground Penetrating Radar (GPR) and Ultrasonic Testing (UST) is presented. These two techniques can be applied in situ and produce useful visual representations for quantitative assessments and damage detection. With its commercial availability and portability, GPR can help rapidly identify critical features such as moisture, voids, and metal connectors in wood structures. UST, which effectively detects deep cracks, delaminations, and variations in ultrasonic wave velocity related to moisture content, complements GPR's capabilities. The non-destructive nature of both techniques preserves the structural integrity of timber, enabling thorough assessments without compromising integrity and durability. Techniques such as the Synthetic Aperture Focusing Technique (SAFT) and Total Focusing Method (TFM) allow for reconstructing images that an inspector can readily interpret for quantitative assessment. The development of new sensors, instruments, and analysis techniques has continued to improve the application of GPR and UST on wood. However, due to the hon-homogeneous anisotropic properties of this complex material, challenges remain to quantify defects and characterize inclusions reliably and accurately. By integrating advanced imaging algorithms that consider the material's complex properties, combining measurements with simulations, and employing machine learning techniques, the implementation and application of GPR and UST imaging and damage detection for wood structures can be further advanced.

Exercise Physiology: A Review of Established Concepts and Current Questions

Exercise physiology is the science that studies the processes of physical activity and their impact on the body. It usually requires a multidisciplinary approach with a team of experts because of the multiple physiological systems involved. At the cellular level, exercise can trigger a cascade of events that involve metabolic pathways, muscle recruitment and conditioning, neuromuscular adaptations, and optimization of energy production. On a systematic level, this has involved the cardiovascular system, the respiratory system, the musculoskeletal system, the peripheral and central nervous systems, and even the endocrine system to improve adaptation to meet the demands of exercise, improving strength and endurance with the goal of maximizing performance. This field, which began largely with a focus on the kinetics of oxygen consumption and the relationship between aerobic and anaerobic metabolism, has expanded with technological advancements such as wearable devices, advanced imaging techniques, and genomics, which has allowed for a greater appreciation of the physiologic responses of exercise at the level of molecular and cellular interactions. Recently, this science has evolved into the study of overall health promotion and disease prevention to meet individual fitness needs and goals. This philosophy, which is captured by the motto “Exercise is Medicine”, has been adopted as a Global Health Initiative by the World Health Organization (WHO). Despite the advancements in technology and impactful, large-scale studies, a variety of questions, such as how physical activity interacts with aging to affect physical and cognitive function, how inactivity influences acute and chronic disease states, and how we maximize human performance in extreme conditions like microgravity environments, remain. The purpose of this review is to present and discuss established concepts, controversial topics, and unanswered questions within exercise physiology that have allowed this field to become a science that embraces the overall well-being of individuals.

Emphysematous Pyelonephritis: A Comprehensive Review

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma, characterized by gas within the kidney tissues, predominantly affecting diabetic individuals. We present a comprehensive review of EPN, encompassing its epidemiology, clinical presentation, diagnosis, and management strategies. Despite its rarity, EPN poses significant clinical challenges due to its potential for rapid progression and life-threatening complications. Prompt diagnosis facilitated by advanced imaging modalities and multidisciplinary management approaches are essential for optimizing patient outcomes. Through this review, we aim to enhance understanding and highlight the importance of early recognition and tailored interventions in the management of EPN

MRI based evaluation of carcinoma gallbladder using apparent diffusion coefficient (ADC) and diffusion weighted imaging (DWI)

Background Carcinoma of the gallbladder is a malignant neoplasm, which is associated with a poor prognosis due to its often-asymptomatic nature and late-stage diagnosis. Non-invasive imaging techniques play a key role in the early detection and characterization of gallbladder carcinoma. This thesis presents a comprehensive analysis of the utility of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in the magnetic resonance imaging (MRI) evaluation of carcinoma of the gallbladder. The primary objective of this research was to investigate the exact diagnostic accuracy and potential clinical applications of DWI and ADC in assessing carcinoma of the gallbladder and related tumour aggressiveness. A systematic review of existing literature was conducted to establish a foundation for this study with efforts to acquire relevant imaging data. The results of this study demonstrate the efficacy of DWI and ADC in the detection of carcinoma of the gallbladder when compared to conventional MRI sequences. These advanced imaging techniques hold promise in increasing the accuracy of diagnosis, ultimately leading to improved patient outcomes and more informed clinical decision making. The potential of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in the evaluation of gallbladder cancer using magnetic resonance imaging (MRI) is thoroughly analysed in this thesis. Methods A descriptive prospective study will be done at Acharya Vinoba Bhave Rural Hospital, Sawangi, involving 20 patients with clinically suspected carcinoma gallbladder, who are referred to the department of Radiodiagnosis. These patients will be subjected to study-purposive sampling. Conclusion After an appropriate statistical analysis, we expect to assess the role of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in the magnetic resonance imaging (MRI) evaluation of carcinoma of the gallbladder. CTRI registration This trial has been submitted to Clinical Trials Registry-India (CTRI) for Review. Registration Number: REF/2023/09/072780 Registration date:01/05/2023 URL of trial: https://www.ctri.nic.in/

Gamma Knife Versus Volumetric Arc Modulated Therapy in a Linear Accelerator in Treatment of Multiple Brain Metastasis: Literature Review

This literature review introduces the treatment results of Gamma Knife radiosurgery (GKRS) and volumetric arc therapy (VMAT) administered by linear accelerators for patients diagnosed with multiple brain metastases. The present study aimed to compare Gamma Knife radiosurgery with Volumetric Arc Modulated Therapy (VMAT) administered using a linear accelerator for brain metastases and their respective safety profiles and therapeutic results. The review assesses research on treatment precision, local control rates, survival outcomes, radiation necrosis incidence, and post-treatment quality of life. It evaluates technical progress, treatment plans, and physiological effects on brain tissue. Both modalities have the potential for managing brain metastases, with GKRS being beneficial for well-defined lesions and VMAT being a flexible and efficient option for larger or irregular-shaped metastases. The study highlights the unique benefits of each therapy for different types of brain metastases. GKRS and VMAT are effective treatments for brain metastases, using concentrated radiation for localised lesions and advanced imaging techniques for intricate or expanded regions. GKRS offers precise interventions with minimal invasiveness, suitable for patients with lower metastatic burdens or suboptimal surgical tolerance. Both therapies show similar effectiveness in local control and survival but may be better suited for specific patient needs and lesion characteristics

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

Significant progress has been made in diagnosing and treating congenital heart defects (CHDs) over the past five decades. Notable advancements include pulse oximetry screening for critical CHDs in newborns and percutaneous, catheter-based procedures, improving outcomes even in developing nations. Recent studies demonstrate favorable outcomes with device closure of acyanotic CHDs, with non-fluoroscopy techniques adopted to minimize radiation risks. Positive results are observed with right ventricular outflow tract (RVOT) stent palliation for late-presenting cyanotic congenital heart diseases such as tetralogy of Fallot (TOF). Novel interventions like reverse Potts shunt anastomosis show promise in managing pediatric pulmonary arterial hypertension (PAH), while prophylactic treatments effectively reduce postoperative arrhythmias. Fontan procedure significantly enhances survival rates for individuals with single functional ventricles, although challenges arise with aging populations. In developed countries, fetal cardiac interventions utilizing advanced imaging techniques allow for early detection and preventive interventions, reducing secondary complications. Keyword: Fetal Intervention, Fontan, Non-Fluoroscopy, Percutaneous, Reverse Potts, Rheumatic Heart Disease, RVOT Stenting.

Role of Positron Emission Tomography/Computed Tomography (PET/CT) in Assessment and Follow-up of Gastrointestinal Tract Malignancies

Positron Emission Tomography/Computed Tomography (PET/CT) is a highly advanced imaging method that has several uses in oncology, such as determining the stage of cancer, evaluating the effectiveness of treatment, reevaluating the stage of cancer, and monitoring for the return of cancer over time. PET advancement has brought out a new capacity in medical diagnosis: being able to non-invasively examine the physiological condition of interior tissues. The integration of PET with simultaneous CT combines two procedures that enable the diagnosis of metabolic or receptor-specific abnormalities together with precise anatomical localization. In comparison to PET alone, the PET/CT combination is more effective in accurately identifying the location of abnormalities and distinguishing between normal and abnormal uptake of FDG along with additional tracers. PET/CT has become an essential component of management guidelines in many diseases such as lung, breast, and lymphoproliferative malignancies. The ability to image metabolic processes like glucose metabolism adds to the information provided by structural imaging, especially in the context of treatment monitoring, where metabolic changes can often precede structural changes.

Feasibility of C2 Lamina Screw Placement in a New Zealand Cohort: Computed Tomography Analysis According to Ethnicity and Gender.

Previous analyses have suggested variations in cervical spine canal morphology according to ethnicity, possibly in part due to variations in the posterior elements. The potential for these variations to affect the placement of instrumentation is uncertain. The aim of this study was to report on the feasibility of C2 lamina screw insertion in a New Zealand cohort including analysis of Māori, the indigenous people of New Zealand. A trauma computed tomography database was accessed to identify suitable images. On axial images, where the isthmus was at its widest, the outer diameter (OD) and inner diameter (ID) of the lamina were measured. Screw length was measured from a proposed entry point to the contralateral junction of the lamina and lateral mass. The spinolaminar angle was measured as the angle subtended by the screw trajectory and midsagittal plane. A 5.5-mm OD was accepted as a threshold for the feasibility of lamina screw placement. One hundred eighty-seven images were assessed: 115 New Zealand European and 72 Māori. The mean age of the cohort was 41.9 years (SD 19.6), and most patients (64%) were men. For the entire cohort, mean OD was 6.6 and 6.8 mm on the right and left, respectively; the mean inner diameter was 3.5 and 3.8 mm; mean screw length was 31.5 and 31.5 mm; and mean spinolaminar angle was 46.0° and 46.1°. C2 lamina screw placement was feasible in a majority of patients. Considering only Māori patients, placement was feasible in 96% of right and 94% of left laminae in men but 72% of right and 72% of left laminae in women. In a majority of patients, C2 lamina screw placement is feasible. However, advanced imaging must be carefully assessed preoperatively because data suggest that Māori women may not necessarily have optimal anatomy.Clinical RelevanceCare needs to be taken when assessing and planning surgery inpatients of different ethnicities because variations may exist in the morphology of the posterior elements of C2, leading to variation in optimal fixation strategy.Level of Evidence3.

Harvesting Efficiency: The Rise of Drone Technology in Modern Agriculture

The articles delves into the transformative impact of drone technology on modern agriculture, specifically focusing on its role in enhancing harvesting efficiency. Drones, equipped with advanced sensors and imaging capabilities, have revolutionized traditional farming practices by offering real-time data collection and analysis. This abstract explores how drones facilitate precision agriculture through the optimization of harvesting processes, including crop monitoring, yield estimation, and targeted harvesting. By leveraging drones, farmers can make informed decisions to improve productivity, minimize waste, and maximize yield. The abstract highlights the integration of drone technology into agricultural operations as a sustainable solution to meet the growing demand for food production while minimizing environmental impact. Moreover, it underscores the need for further research and development to fully harness the potential of drones in modern agriculture and address challenges such as regulatory hurdles and cost-effectiveness.

Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study.

Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. DERR1-10.2196/57329.