Computer-assisted Procedures Research Articles

Automated coordinate system estimation: A preliminary step toward computer-assisted radial head arthroplasty planning.

The success of radial head arthroplasty (RHA) relies on the design of the implant and precision of the surgical technique, with preoperative planning potentially playing a crucial role. The accurate establishment of a patient-specific anatomical coordinate system (ACS) is essential for this planning process. This study tested the hypothesis that an innovative automated method would be an accurate, reliable, and efficient framework to determine the ACS of the proximal radius, which would be a step toward improving the precision of RHA planning. We used advanced computational techniques to analyze 50 forearm CT scans, comparing the accuracy, reproducibility, reliability, and efficiency of the automated method with manually derived ACS using expert observers as benchmarks. The results showed that the automated approach was more accurate in identifying anatomical landmarks, with smaller mean distance discrepancies (0.6 mm) than manual observers (1 mm). Its reproducibility was also superior, with narrower reproducibility limits, particularly for ulnar notch landmarks (0.6 to 0.8 mm compared to manual selection 1.2 to 1.4 mm) (p = .01). In addition, the limits of agreement and the mean absolute rotational and translational differences of the axes were narrower for the automated method, which also reduced the construction time to an average of 46 s compared to 150 s manually (p < .001). These findings suggest that the automated method has the potential to enhance the accuracy and efficiency of preoperative and postoperative computer-assisted procedures for RHA. Further research is needed to fully understand the utility of this automated system for enhancing RHA computer-assisted surgical planning.

Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases

Neuronavigation systems are computer-assisted procedures that use preoperative imaging data to ensure accurate anatomical orientation and safe resection during surgery. Despite their widespread use in neurosurgery, evidence of their effectiveness and reliability remains limited. This study aimed to examine the need for neuronavigation systems in patients with intracranial tumors, their relationship with tumor location and size, and their limitations. A retrospective analysis was conducted on 172 patients with intracranial tumors who underwent surgery using neuronavigation systems at our clinic between January 2021 and October 2023. Patients were classified based on tumor size into two groups: those with tumors &amp;lt;3 cm and those with tumors ≥ 3 cm. Further classification was done according to tumor locations such as supratentorial, infratentorial, and skull base, as well as based on superficial and deep-seated tumor locations. The need for neuronavigation systems was assessed using a scoring scale ranging from 0 to 2 assigned during surgery. Of the patients, 49.4% were male and 50.6% were female, with a mean age of 52.9 ± 16.2 years (range 2–80 years). The mean total score for neuronavigation system use was significantly higher in patients with tumors &amp;lt;3 cm and those with deep-seated tumors (p = 0.003). The need for neuronavigation was less in infratentorial tumors. Identifying anatomical and vascular structures during surgery was the surgical stage with the greatest need for neuronavigation use (n=172, 100%). Multivariate binary logistic regression analysis revealed that tumor size ≥3 cm and superficial location were risk factors determining the need for neuronavigation systems. İdentifying anatomical and vascular structures in supratentorial and deep-seated tumors, and evaluating surgical resection in tumors &amp;lt;3 cm are the areas where the use of neuronavigation systems is necessary.

The development of computational methods for Feynman diagrams

Over the last 70 years, Feynman diagrams have played an essential role in the development of many theoretical predictions derived from the standard model Lagrangian. In fact, today they have become an essential and seemingly irreplaceable tool in quantum field theory calculations. In this article, we propose to explore the development of computational methods for Feynman diagrams with a special focus on their automation, drawing insights from both theoretical physics and the history of science. From the latter perspective, the article particularly investigates the emergence of computer algebraic programs, such as the pioneering SCHOONSCHIP, REDUCE, and ASHMEDAI, designed to handle the intricate calculations associated with Feynman diagrams. This sheds light on the many challenges faced by physicists when working at higher orders in perturbation theory and reveal, as exemplified by the test of the validity of quantum electrodynamics at the turn of the 1960s and 1970s, the indispensable necessity of computer-assisted procedures. In the second part of the article, a comprehensive overview of the current state of the algorithmic evaluation of Feynman diagrams is presented from a theoretical point of view. It emphasizes the key algorithmic concepts employed in modern perturbative quantum field theory computations and discusses the achievements, ongoing challenges, and potential limitations encountered in the application of the Feynman diagrammatic method. Accordingly, we attribute the enduring significance of Feynman diagrams in contemporary physics to two main factors: the highly algorithmic framework developed by physicists to tackle these diagrams and the successful advancement of algebraic programs used to process the involved calculations associated with them.

Trends in navigation-handheld systems

Navigation-assisted surgical procedures in orthopedics and trauma surgery have become increasingly widespread over the last 20years. In addition to applications in spinal surgery, they are primarily available for knee and hip endoprosthetics. On the one hand, computer-assisted procedures have been increasingly expanded with robotic assistance systems in recent years, and on the other hand, so-called handheld navigation systems have been developed, which enable specialized use directly in the operating field at lower acquisition costs. The aim of this overview is to describe current handheld systems and to present the respective technical principles and the available scientific results. Three handheld systems for TKA use, two for THA use and one system to support pedicle screw placement on the spine are presented.

Virtual planning for mandible resection and reconstruction

Abstract In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ablative tumor surgery benefit from a computer-assisted approach. Various CAD/CAM-manufactured tools such as surgical guides (guides for osteotomy, resection and predrilling) support the transition from virtual planning to surgery. Patient-specific implants (PSIs) are of particular value as they facilitate both osteosynthesis and the positioning of bone elements. Computer-based approaches may be associated with higher accuracy, efficiency, and superior patient outcomes. However, certain limitations should be considered, such as additional costs or restricted availability. In the future, automation of the planning process and augmented reality techniques, as well as MRI as a non-ionizing imaging modality, have the potential to further improve the digital workflow.

Trends in usage of navigation and robotic assistance in elective spine surgeries: a study of 105,212 cases from 2007 to 2015.

Identify trends of navigation and robotic-assisted elective spine surgeries. Elective spine surgery patients between 2007 and 2015 in the Nationwide Inpatient Sample (NIS) were isolated by ICD-9 codes for Navigation [Nav] or Robotic [Rob]-Assisted surgery. Basic demographics and surgical variables were identified via chi-squared and t tests. Each system was analyzed from 2007 to 2015 for trends in usage. Included 3,759,751 patients: 100,488 Nav; 4724 Rob. Nav were younger (56.7 vs 62.7years), had lower comorbidity index (1.8 vs 6.2, all p < 0.05), more decompressions (79.5 vs 42.6%) and more fusions (60.3 vs 52.6%) than Rob. From 2007 to 2015, incidence of complication increased for Nav (from 5.8 to 21.7%) and Rob (from 3.3 to 18.4%) as well as 2-3 level fusions (from 50.4 to 52.5%) and (from 1.3 to 3.2%); respectively. Invasiveness increased for both (Rob: from 1.7 to 2.2; Nav: from 3.7 to 4.6). Posterior approaches (from 27.4 to 41.3%), osteotomies (from 4 to 7%), and fusions (from 40.9 to 54.2%) increased in Rob. Anterior approach for Rob decreased from 14.9 to 14.4%. Nav increased posterior (from 51.5% to 63.9%) and anterior approaches (from 16.4 to 19.2%) with an increase in osteotomies (from 2.1 to 2.7%) and decreased decompressions (from 73.6 to 63.2%). From 2007 to 2015, robotic and navigation systems have been performed on increasingly invasive spine procedures. Robotic systems have shifted from anterior to posterior approaches, whereas navigation computer-assisted procedures have decreased in rates of usage for decompression procedures.

Computerized text and voice analysis of patients with chronic schizophrenia in art therapy

This explorative study of patients with chronic schizophrenia aimed to clarify whether group art therapy followed by a therapist-guided picture review could influence patients’ communication behaviour. Data on voice and speech characteristics were obtained via objective technological instruments, and these characteristics were selected as indicators of communication behaviour. Seven patients were recruited to participate in weekly group art therapy over a period of 6 months. Three days after each group meeting, they talked about their last picture during a standardized interview that was digitally recorded. The audio recordings were evaluated using validated computer-assisted procedures, the transcribed texts were evaluated using the German version of the LIWC2015 program, and the voice recordings were evaluated using the audio analysis software VocEmoApI. The dual methodological approach was intended to form an internal control of the study results. An exploratory factor analysis of the complete sets of output parameters was carried out with the expectation of obtaining typical speech and voice characteristics that map barriers to communication in patients with schizophrenia. The parameters of both methods were thus processed into five factors each, i.e., into a quantitative digitized classification of the texts and voices. The factor scores were subjected to a linear regression analysis to capture possible process-related changes. Most patients continued to participate in the study. This resulted in high-quality datasets for statistical analysis. To answer the study question, two results were summarized: First, text analysis factor called Presence proved to be a potential surrogate parameter for positive language development. Second, quantitative changes in vocal emotional factors were detected, demonstrating differentiated activation patterns of emotions. These results can be interpreted as an expression of a cathartic healing process. The methods presented in this study make a potentially significant contribution to quantitative research into the effectiveness and mode of action of art therapy.

Computer-assisted microcatheter shaping for intracranial aneurysm embolization: evaluation of safety and efficacy in a multicenter randomized controlled trial

BackgroundThis study aimed to evaluate the efficacy, stability, and safety of computer-assisted microcatheter shaping (CAMS) in patients with intracranial aneurysms.MethodsA total of 201 patients with intracranial aneurysms receiving endovascular coiling...

Robotics and computer-assisted procedures in cranial neurosurgery

The medical technical innovations over the last decade have made operations in the highly sensitive regions of the brain much safer. Presentation of how far computer assistance and robotics have become incorporated into clinical neurosurgery. Evaluation of the scientific literature and analysis of the certification status of the corresponding medical devices. The rapid development of computer technology and the switch to digital imaging has led to the widespread introduction of neurosurgical planning software and intraoperative neuronavigation. In the field of robotics, the penetration into clinical neurosurgery is currently still largely limited to the automatic setting of trajectories. The digitalization of imaging has fundamentally transformed neurosurgery. In the field of cranial neurosurgery, computer-assisted procedures can now be distinguished from noncomputer-assisted procedures only in ahandful of cases. In the coming years important innovations for the clinical implementation can be expected in the field of robotics.

Computer-assisted procedures in orthopedics and trauma surgery-Where do we stand?

Computer-assisted procedures are becoming increasingly more relevant in orthopedics and trauma surgery. The data situation on these systems has improved in recent years but still has alow level of evidence. In particular, data on short-term or medium-term results on the use of these procedures are currently available. These could show that improved precision and reproducibility of the surgical procedures can be achieved by the use of computer-assisted procedures. Nevertheless, there is still no recommendation in the current guidelines for routine use.

Trends in the Charges and Utilization of Computer-Assisted Navigation in Cervical and Thoracolumbar Spinal Surgery.

Retrospective national database study. This study is conducted to assess the trends in the charges and usage of computer-assisted navigation in cervical and thoracolumbar spinal surgery. This study is the first of its kind to use a nationwide dataset to analyze trends of computer-assisted navigation in spinal surgery over a recent time period in terms of use in the field as well as the cost of the technology. Relevant data from the National Readmission Database in 2015-2018 were analyzed, and the computer-assisted procedures of cervical and thoracolumbar spinal surgery were identified using International Classification of Diseases 9th and 10th revision codes. Patient demographics, surgical data, readmissions, and total charges were examined. Comorbidity burden was calculated using the Charlson and Elixhauser comorbidity index. Complication rates were determined on the basis of diagnosis codes. A total of 48,116 cervical cases and 27,093 thoracolumbar cases were identified using computer-assisted navigation. No major differences in sex, age, or comorbidities over time were found. The utilization of computer-assisted navigation for cervical and thoracolumbar spinal fusion cases increased from 2015 to 2018 and normalized to their respective years' total cases (Pearson correlation coefficient=0.756, p =0.049; Pearson correlation coefficient=0.9895, p =0.010). Total charges for cervical and thoracolumbar cases increased over time (Pearson correlation coefficient=0.758, p =0.242; Pearson correlation coefficient=0.766, p =0.234). The use of computer-assisted navigation in spinal surgery increased significantly from 2015 to 2018. The average cost grossly increased from 2015 to 2018, and it was higher than the average cost of nonnavigated spinal surgery. With the increased utilization and standardization of computer-assisted navigation in spinal surgeries, the cost of care of more patients might potentially increase. As a result, further studies should be conducted to determine whether the use of computer-assisted navigation is efficient in terms of cost and improvement of care.

How the variability between computer-assisted analysis procedures evaluating immune markers can influence patients' outcome prediction.

Differences between computer-assisted image analysis (CAI) algorithms may cause discrepancies in the identification of immunohistochemically stained immune biomarkers in biopsies of breast cancer patients. These discrepancies have implications for their association with disease outcome. This study aims to compare three CAI procedures (A, B and C) to measure positive marker areas in post-neoadjuvant chemotherapy biopsies of patients with triple-negative breast cancer (TNBC) and to explore the differences in their performance in determining the potential association with relapse in these patients. A total of 3304 digital images of biopsy tissue obtained from 118 TNBC patients were stained for seven immune markers using immunohistochemistry (CD4, CD8, FOXP3, CD21, CD1a, CD83, HLA-DR) and were analyzed with procedures A, B and C. The three methods measure the positive pixel markers in the total tissue areas. The extent of agreement between paired CAI procedures, a principal component analysis (PCA) and Cox multivariate analysis was assessed. Comparisons of paired procedures showed close agreement for most of the immune markers at low concentration. The probability of differences between the paired procedures B/C and B/A was generally higher than those observed in C/A. The principal component analysis, largely based on data from CD8, CD1a and HLA-DR, identified two groups of patients with a significantly lower probability of relapse than the others. The multivariate regression models showed similarities in the factors associated with relapse for procedures A and C, as opposed to those obtained with procedure B. General agreement among the results of CAI procedures would not guarantee that the same predictive breast cancer markers were consistently identified. These results highlight the importance of developing additional strategies to improve the sensitivity of CAI procedures.

38. Trends in total charges and utilization of computer-assisted navigation in thoracolumbar spine surgery

<h3>BACKGROUND CONTEXT</h3> Computer-assisted navigation (CAN) was developed to improve visualization inside the human body during surgery. This technology allows surgeons to more readily contextualize anatomical structures during complex procedures. The goal of CAN is to improve the accuracy and reproducibility of surgeries. <h3>PURPOSE</h3> Given the increased adoption of CAN for spine surgery, the objective of this study is to assess the charges, trends and usage of CAN in thoracolumbar spine surgery over time in order to better inform surgeons to changes in practice. <h3>METHODS</h3> The 2012-2016 National Readmission Databases (NRD) were queried for patients with ICD-9 and ICD-10 codes for computer-assisted procedures of the thoracolumbar region. Nonelective cases and patients <18 years of age were excluded. Analysis of patient demographics, surgical data, readmissions, and total charges was performed. Comorbidity burden was calculated using the Charlson and Elixhauser comorbidity index. Complication rates were identified based on diagnosis codes. <h3>RESULTS</h3> Following inclusion and exclusion criteria, 6,598 total patients were included, with 246 in 2012, 134 in 2013, 30 in 2014, 2,169 in 2015, and 4,019 in 2016 (Pearson correlation coefficient = 0.866, p = 0.057). Average total charge to a patient in 2016 was $142,013, which is greater than the 2012-2014 mean total charges of $126,698, $111,738, $115,120, and similar to the 2015 mean total charge of $148,134 (Pearson correlation coefficient = 0.660, p = 0.225). The ratio of patients covered under Medicare to those covered by private insurance increased from 0.822 in 2012 to 1.27 in 2016 (Pearson correlation coefficient 0.687, p = 0.313). <h3>CONCLUSIONS</h3> The use of and charges related to CAN in thoracolumbar surgeries has increased overall from 2012-2016, most notably indicated by the steep upward trend in use of this technology in 2016. This indicates an increasing adoption of a more recent innovation in assistive surgical technology, and an associated cost burden that comes with it. CAN has the potential to improve surgical outcomes, but as utilization grows and CAN becomes the standard in thoracolumbar spine surgeries, the charges for care also increase for more patients. As a result, further studies need to be conducted to determine whether the use of CAN is efficient in terms of cost and improvement of patient care. Limitations of this include the fact that there is no ICD-9 code for the use of CAN in thoracolumbar surgery specifically, so patient population was estimated using ICD-9 codes for CAN general use coupled with ICD-9 codes for thoracolumbar surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Computer-Assisted Orthopedic and Trauma Surgery.

There are many ways in which computer-assisted orthopedic and trauma surgery (CAOS) procedures can help surgeons to plan and execute an intervention. This study is based on data derived from a selective search of the literature in the PubMed database, supported by a Google Scholar search. For most applications the evidence is weak. In no sector did the use of computer-assisted surgery yield any relevant clinical or functional improvement. In trauma surgery, 3D-navigated sacroiliac screw fixation has become clinically established for the treatment of pelvic fractures. One randomized controlled trial showed a reduction in the rate of screw misplacement: 0% with 3D navigation versus 20.4% with the conventional procedure und 16.6% with 2D navigation. Moreover, navigation-assisted pedicle screw stabilization lowers the misplacement rate. In joint replacements, the long-term results showed no difference in respect of clinical/functional scores, the time for which the implant remained in place, or aseptic loosening. Computer-assisted procedures can improve the precision of certain surgical interventions. Particularly in joint replacement and spinal surgery, the research is moving away from navigation in the direction of robotic procedures. Future studies should place greater emphasis on clinical and functional results.

Elderspeak in Acute Hospitals? The Role of Context, Cognitive and Functional Impairment.

Older adults are often exposed to elderspeak, a specialized speech register linked with negative outcomes. However, previous research has mainly been conducted in nursing homes without considering multiple contextual conditions. Based on a novel contextually-driven framework, we examined elderspeak in an acute general versus geriatric German hospital setting. Individual-level information such as cognitive impairment (CI) and audio-recorded data from care interactions between 105 older patients (M = 83.2 years; 49% with severe CI) and 34 registered nurses (M = 38.9 years) were assessed. Psycholinguistic analyses were based on manual coding (κ = .85 to κ = .97) and computer-assisted procedures. First, diminutives (61%), collective pronouns (70%), and tag questions (97%) were detected. Second, patients' functional impairment emerged as an important factor for elderspeak. Our study suggests that functional impairment may be a more salient trigger of stereotype activation than CI and that elderspeak deserves more attention in acute hospital settings.

Some improvements of invertibility verifications for second-order linear elliptic operators

This paper presents some computer-assisted procedures to prove the invertibility of a second-order linear elliptic operator and to compute a bound for the norm of its inverse. These approaches are based on constructive L2-norm estimates of the Laplacian and improve on previous procedures that use projection and a priori error estimations. Several examples which confirm the actual effectiveness of the procedures are reported.

Heterologous Machine Learning for the Identification of Antimicrobial Activity in Human-Targeted Drugs.

The emergence of microbes resistant to common antibiotics represent a current treat to human health. It has been recently recognized that non-antibiotic labeled drugs may promote antibiotic-resistance mechanisms in the human microbiome by presenting a secondary antibiotic activity; hence, the development of computer-assisted procedures to identify antibiotic activity in human-targeted compounds may assist in preventing the emergence of resistant microbes. In this regard, it is worth noting that while most antibiotics used to treat human infectious diseases are non-peptidic compounds, most known antimicrobials nowadays are peptides, therefore all computer-based models aimed to predict antimicrobials either use small datasets of non-peptidic compounds rendering predictions with poor reliability or they predict antimicrobial peptides that are not currently used in humans. Here we report a machine-learning-based approach trained to identify gut antimicrobial compounds; a unique aspect of our model is the use of heterologous training sets, in which peptide and non-peptide antimicrobial compounds were used to increase the size of the training data set. Our results show that combining peptide and non-peptide antimicrobial compounds rendered the best classification of gut antimicrobial compounds. Furthermore, this classification model was tested on the latest human-approved drugs expecting to identify antibiotics with broad-spectrum activity and our results show that the model rendered predictions consistent with current knowledge about broad-spectrum antibiotics. Therefore, heterologous machine learning rendered an efficient computational approach to classify antimicrobial compounds.

Alternatives for the generation of triangle meshes to represent bone fragments

The use of computational techniques to help specialists in the treatment of bone injuries and diseases is widespread. These techniques usually require 3D triangle meshes representing bone fragments as input. On the one hand, bone fragments can be visualised in a more effective way. On the other hand, computer-assisted techniques are provided with models that make the application of geometric algorithms easier. The suitability of the method utilised to generate the triangle mesh will depend on the computational techniques in which it will be used. In this paper, a study is performed in order to test the applicability of some mesh generation methods to model bone fragments: Marching Cubes, Ball-pivoting, Poisson reconstruction and Algebraic Point Set Surface. In a first step, bone fragments were segmented from CT scans, and external contours were extracted from the segmented regions. After that, the vertices of each external contour were grouped in order to form the point cloud used as input by the mesh generation methods. Finally, these methods were tested and their main benefits and shortcomings were exposed. The obtained results manifested the performance of each method depending on the fracture type and the special features of the data obtained from CT stacks. In addition, the suitability of each method to be used in computer-assisted medical procedures was analysed and discussed.

The FUTUR study: Feasibility of computer-assisted aortic and iliac endovascular procedures with a mobile C-arm

The FUTUR study: Feasibility of computer-assisted aortic and iliac endovascular procedures with a mobile C-arm

Advanced computer-assisted procedures in craniomaxillofacial surgery: where we came from and where are we going to?

Advanced computer-assisted procedures in craniomaxillofacial surgery: where we came from and where are we going to?