DICOM Research Articles

Can Viewing Modality Affect Frontal Mandibular Bone Height Measurement? A Comparison Between 3D Digital Imaging and Communications in Medicine Viewer and Printed Portable Document Format Cone Beam Computer Tomography Reports

Objectives: Buccal cortical bone dimensions are crucial in dental radiology, as they impact orthodontic treatment outcomes. Changes in alveolar bone dimensions can result in malocclusion and require interdisciplinary approaches for correction. The accurate quantification of buccal bone dimensions is crucial for appropriate treatment planning and avoiding medico-legal issues. This study aimed to compare buccal bone height measurements between three-dimensional (3D) digital imaging and communications in medicine (DICOM) data and portable document format (PDF) cone beam computer topography reports for mandibular frontal teeth, testing the hypothesis of no difference in values between the two modalities. Methods: Each of the five observers performed a total of 720 height measurements (360 by DICOM and 360 by PDF), yielding a total of 3600 measurements overall. Results: Compared with the DICOM format, using PDF files was associated with a significantly greater rate of inability to carry out the measurements (8.8% vs. 3%, respectively, p < 0.001, chi-square). The average buccal bone height measured in the DICOM was 11.51 mm, which was significantly greater than the 10.35 mm measured in the PDF (p < 0.001). The mean height measured by the DICOM was consistently greater than that measured by the PDF, with highly significant differences in the findings of four of the examiners (p < 0.001). Conclusions: Viewing modality significantly affected the height of the buccal bone in the frontal mandibular area. Compared with the generated PDF reports, the 3D DICOM viewer performed better than the printed PDF and enabled more measurements in the target area.

Application of the full digital workflow in immediate removable partial denture: an innovative case report

Background. The fabrication of immediate removable partial dentures (RPDs) is characterized by the integration of digital technologies that enhance precision and efficiency in prosthodontic care. The application of a full digital workflow in this context is increasingly recognized for its potential to address both functional and esthetic needs of patients. The estimated prevalence of immediate RPDs in clinical practice is rising, yet literature exploring their digital fabrication remains limited. To our knowledge, this case report presents one of the first instances of utilizing a comprehensive digital approach for the creation of immediate RPDs, highlighting its benefits in patient outcomes. Case report. A 62-year-old male patient with maxillary anterior incisors mobility opted for immediate RPD treatment due to functional pain and esthetic concerns. Intraoral scanning was employed for impression taking and occlusion registration, generating Standard Tessellation Language files. Cone beam computed tomography provided Digital Imaging and Communication in Medicine (DICOM) files, enabling precise virtual extraction of the incisors and ridge smoothening using Exocad software. The denture design, teeth mounting, and surgical guide were digitally planned based on digital smile design outcomes. Digital light processing was utilized for prosthesis manufacturing, and assembly followed a detailed protocol outlined in the present paper. Post-extraction, regular follow-up sessions are essential to assess patient satisfaction. Conclusions. The integration of intraoral scanning and Computer-Aided Design and Manufacturing CAD/CAM technology offered a promising solution for the rapid production of immediate RPDs with enhanced accuracy and reproducibility. The successful assembly and long-term durability of 3D printed dentures were achieved through strategic design considerations and meticulous data processing.

Pulp Calcification and External Reabsortion Resulting from Dental Trauma in Childhood, Associated with the Applicability of Guided Endodontic Treatment – Endoguide: Case Report

Introduction: Pulp canal calcification is characterized by the deposition of calcified tissue along the canal walls. As a result, the root canal can become completely obliterated, making endodontic treatment and its chemical- mechanical preparation difficult and contributing to accidents and complications. The objective of this case report is to understand that digital dentistry has added value in several dental situations. Endoguide provides safety, precision, efficiency, minimizes operative time, and reduces the chances of root canal deviation and damage to surrounding tissues. Methodology: The literature review was carried out through a bibliographic survey on guided endodontic treatment in obliterated canals. The clinical case reported here was treated at the dentistry clinic of the Euro-American University Center (UNIEURO). Case report: A 23-year-old female patient with a history of trauma in the anterior region of the maxilla at least 10 years ago reported that there was no intervention at the time of the incident and detailed how the trauma occurred. The patient presented to the UNIEURO dental clinic complaining of darkening of the crown of tooth 21. Radiographically, significant external resorption was observed and the clinical examination showed marked vestibularization. When performing sensitivity tests on tooth 21, negative responses were obtained. The lower teeth were also the focus of observation for analysis of possible impairment during the trauma that occurred. It was observed that all were vital, except for tooth 21, thus confirming the diagnostic hypothesis of Pulp Calcification. The patient was referred to the radiology clinic with a request for an imaging exam: Computed Tomography on a Prexion device; known for allowing a more detailed view of the root canal system and the periapical region. Subsequently, intraoral scanning was performed at the Voxells clinic, where the Stereo lithography (STL) file was acquired and combined with images in the DICOM (Digital Imaging and Communications in Medicine) file. Subsequently, Trion was responsible for developing the 3D model and printing it to guide the endodontic access surgery in the appropriate position and angle. Conclusion: The guided endodontic technique is safe, effective and faster. It increases predictability, minimizes the risk of deviations and perforations, and promotes greater comfort for the patient and dentist. It is important for the professional to be familiar with this cutting- edge technology and its benefits in the dental world.

The Clinical Efficacy and Applications of Portable Imaging Devices in Emergency Medical Settings: A Comprehensive Review

Background: The integration of portable imaging devices in emergency medical settings has gained attention due to their potential to enhance diagnostic efficiency and facilitate timely patient care. Initial advancements in mobile imaging technologies under the Digital Imaging and Communications in Medicine (DICOM) standard date back to 2003, yet their clinical adoption remains limited. Methods: This review synthesizes findings from various studies sourced from prominent medical databases, including PubMed, Wiley Online Library, Web of Science, and Scopus. Key search phrases related to mobile DICOM viewers were employed to gather relevant literature assessing the diagnostic efficacy of mobile devices in interpreting radiological images in emergency scenarios. Results: Several studies highlighted that mobile device, including tablets and smartphones, can effectively display and interpret radiological images, offering diagnostic capabilities comparable to traditional PACS workstations. For instance, mobile applications significantly reduced consultation times and enhanced accessibility to imaging data. However, the European Society of Radiology cautioned against their use for primary interpretations, recommending them instead for supplementary opinions or bedside evaluations. Conclusion: The findings underscore the feasibility of utilizing portable imaging devices in emergency settings to improve access to diagnostic imaging and expedite clinical decision-making. Despite their advantages, ongoing concerns regarding image quality, usability, and the need for robust IT infrastructure must be addressed to facilitate broader adoption in clinical practice.

Accuracy of the Hounsfield Unit Values Measured by Implant Planning Software.

Background: The measurement of Hounsfield units (HU) during implant treatment planning is important. Currently, various manufacturers' implant planning software programs offer HU capabilities; however, their accuracy remains unverified. In this study, we aimed to validate the accuracy of HU values measured by implant planning software programs. Methods: This study used one type of multidetector computed tomography (MDCT), two types of cone-beam computed tomography (CBCT), and four implant planning software packages. Three specimens were prepared for the evaluation of HUs, and the standard values of the HUs were measured. Digital Imaging and Communications in Medicine (DICOM) data obtained from MDCT and CBCT were loaded into four implant planning software packages to measure the HU values. The HU and reference values of the four implant planning software programs obtained from MDCT and CBCT were compared. Additionally, the HU values between each implant planning software program were compared. Results: The HU values of the three specimens, as measured using the four implant planning software programs utilizing MDCT, did not exhibit a significant difference from the standard values. Conversely, those obtained from CBCT were significantly different. The measured HU values after the MDCT imaging of the specimens were not significantly different between the implant planning software programs; however, they differed after CBCT imaging. Conclusions: The results of this study indicate that it is not possible to measure HU values using CBCT with implant planning software programs. However, HU values can be measured by any implant planning software using MDCT.

Sex determination method using the third cervical vertebral body by head and neck CT.

This study aimed to measure the volume of the third cervical vertebra using head and neck multi-detector computed tomography (MDCT) and establish a sex determination model based on sex differences in volume. Head and neck CT images of 85 patients were obtained for dental diagnostic and therapeutic purposes. Digital Imaging and Communications in Medicine (DICOM) data obtained from head and neck CT were constructed using a three-dimensional image analysis software. A region of interest was created that included the entire third cervical vertebra and its volume was measured. Descriptive statistics were calculated for the measurements, and the means, standard deviations, and medians of the measurements were calculated separately for men and women. To create a sex determination model, binomial logistic regression analysis was performed using the training data group, with vertebral volume and sex as the explanatory and objective variables, respectively. The mean score of men was significantly higher than that of women. The sex determination model using the volume of the third cervical vertebral body resulted in an 80% correct sex classification rate. The sex determination model can be used with other regional methods to aid sex determination.

The conversion of electroanatomic maps for compatibility with treatment planning systems in cardiac radioablation target volume definition.

Cardiac radioablation (CRA) is a new and promising treatment modality for patients with ventricular tachycardia refractory to standard-of-care treatment. Electroanatomic maps are used to define radiation target volumes; however, there is currently no native method to import electroanatomic maps into the treatment planning system (TPS). To develop Edico, a semi-automated tool to enable electroanatomic map import into a TPS, by converting electroanatomic maps to a Digital Imaging and COmmunications in Medicine (DICOM) standard. The overall aim is to facilitate target volume delineation and improve workflow efficiency in treating patients. Edico imports voltage and spatial data from electroanatomic maps and sorts these into voxels to be exported in a DICOM format, with each voxel containing the average voltage value of the data that falls within it. Three different rectangular electroanatomic maps were created and processed using Edico to ensure that expected features are maintained through processing. A sensitivity analysis of voxel size was completed using 19 different electroanatomic maps processed at five different sets of voxel dimensions, for a total of 95 resulting voxelized datasets. The coefficient of variation in each populated voxel in the datasets was analyzed to determine which voxel sizes are necessary to ensure that data loss is kept to a minimum throughout processing, despite averaging. Five electroanatomic maps were used to re-contour clinical target volumes and planning target volumes for previously-treated patients with their electroanatomic maps now directly registered to their planning computed tomography (CT) scans. All three rectangular test electroanatomic maps were processed as expected. All tested voxel sizes resulted in low coefficients of variation overall, with the exception of the largest voxel size of 1.8×1.8×8mm. When using Edico, a user should choose voxel dimensions similar to or smaller than those of a planning CT. Of five pairs of clinical and planning target volumes from previously treated patients, adjustments were made to four (80%), retrospectively, using the electroanatomic maps generated using Edico, registered to the patients' planning CTs. Edico provides a reliable solution for electroanatomic map import into a TPS and facilitates clinical and planning target volume identification in CRA.

Using Compressed JPEG and JPEG2000 Medical Images in Deep Learning: A Review

Machine Learning (ML), particularly Deep Learning (DL), has become increasingly integral to medical imaging, significantly enhancing diagnostic processes and treatment planning. By leveraging extensive datasets and advanced algorithms, ML models can analyze medical images with exceptional precision. However, their effectiveness depends on large datasets, which require extended training times for accurate predictions. With the rapid increase in data volume due to advancements in medical imaging technology, managing the data has become increasingly challenging. Consequently, irreversible compression of medical images has become essential for efficiently handling the substantial volume of data. Extensive research has established recommended compression ratios tailored to specific anatomies and imaging modalities, and these guidelines have been widely endorsed by government bodies and professional organizations globally. This work investigates the effects of irreversible compression on DL models by reviewing the relevant literature. It is crucial to understand how DL models respond to image compression degradations, particularly those introduced by JPEG and JPEG2000—both of which are the only permissible irreversible compression techniques in the most commonly used medical image format—the Digital Imaging and Communications in Medicine (DICOM) standard. This study provides insights into how DL models react to such degradations, focusing on the loss of high-frequency content and its implications for diagnostic interpretation. The findings suggest that while existing studies offer valuable insights, future research should systematically explore varying compression levels based on modality and anatomy, and consider developing strategies for integrating compressed images into DL model training for medical image analysis.

Influence of Aortic Deviation on Abdominal Aorta Bifurcation Level Relative to Vertebral Position.

Introduction Research on abdominal aortic deviation (AAD) and its impact on the vertebral level of abdominal aortic bifurcation (AAB) has been limited. We aimed to determine the level of AAB with respect to vertebral levels and assess the proportion of AAD and its impact on AAB. Materials and methods This single-arm, cross-sectional, retrospective study involved contrast-enhanced computed tomography (CECT) scans of the abdomen and pelvis of 208 subjects aged 18 years or older. AAD and AAB in terms of vertebral levels were noted using the digital imaging and communication in medicine (DICOM) viewing software RadiAnt (Medixant, Poznań, Poland). Results The rate of AAD was found to be 44 out of 208 (21.2%), 16 out of 98 (16.3%) in men and 28 out of 110 (25.45%) in women (p=0.10). The AAD rates in the 31-40-, 51-60-, and 71-80-year age groups were 11 out of 37 (29.7%), 17 out of 61 (27.8%), and three out of seven (42.8%) with p=0.03, respectively. AAB was seen in the middle of the L4 vertebrae in 65 cases (31.2%), followed by 49 cases (23.6%) in the L4 lower vertebrae. Twenty-three (20.9%) women had AAB above the L4, compared to 13 (13.2%) men (p=0.34). AAB was located below the L4 vertebral level in eight out of 44 (18.18%)subjects with AAD versus 41 out of 164 (25%) subjects without AAD (p=0.55). Conclusion AAD was observed in approximately one-fifth of the subjects in our study cohort, with a higher proportion among women and in elderly age groups. AAB was most commonly observed in the middle of the L4 vertebrae and AAD did not impact AAB levels.

Security of Magnetic Resonance Medical Images using Region-based Lossless Image Compression in Healthcare Information Systems

Purpose The purpose of region-based medical image compression is to optimize the compression process by focusing on specific regions of interest within medical images. Unlike traditional compression methods that treat the entire image uniformly, region-based compression techniques identify and prioritize certain areas or regions within the image that are deemed more diagnostically significant or relevant. By allocating more resources to compressing these critical regions while reducing compression in less important areas, region-based compression methods aim to achieve higher compression efficiency while preserving diagnostic quality. This approach is particularly valuable in medical imaging, where accurate representation of anatomical structures or pathological findings is paramount for clinical diagnosis and decision-making. Region-based compression can help reduce storage requirements, transmission bandwidth, and processing time without compromising the diagnostic integrity of medical images, thereby facilitating more efficient healthcare delivery and telemedicine applications. Methods In this study, we utilized distortion-limiting compression techniques to optimize the compression process for specific regions within medical images. We employed lossless scalable RBC (Region-Based Compression) using Discrete Wavelet Transform (DWT) for Digital Imaging and Communication in Medicine (DICOM) images. The initial step involved medical image pre-processing, followed by segmentation to separate the image into regions of interest (ROI) and non-ROI. Compression techniques were then applied to reduce network bandwidth and storage requirements. Fractal lossy compression was employed for the non-ROI portion, while context-tree weighting lossless compression was proposed for the ROI portion, effectively compressing the image while rejecting noisy background elements. During decompression, the original medical image can be reconstructed using the reverse process. This approach optimizes storage and transmission efficiency while preserving diagnostic integrity in medical imaging applications. Results The experiment involved testing various medical images, and the proposed method outperformed previous techniques in terms of results. According to the findings, the improvement in Peak Signal-to-Noise Ratio (PSNR) over current techniques reached up to 24.23 dB compared to the Joint Photographic Experts Group (JPEG). Additionally, it achieved up to 12.22 dB improvement compared to other transform approaches. These significant enhancements prompted the development of a web and mobile platform for compressing and sending medical images, particularly microscopic ones, in real time. Conclusion This research focuses on employing wavelet transform techniques to compress the Region of Interest (ROI) within medical images. This ROI-based compression approach is particularly valuable as it retains essential diagnostic information while reducing the overall file size. Such a technique holds significant promise for telemedicine systems, especially in rural regions where network resources may be limited or constrained. By selectively compressing the most diagnostically relevant areas of medical images, this approach ensures that critical information is preserved while optimizing data transmission and storage efficiency. This can ultimately enhance access to medical imaging services and facilitate remote diagnosis and treatment in underserved areas with limited network infrastructure.

Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial

Abstract Background In the Complete Revascularization with Multivessel PCI for Myocardial Infarction (COMPLETE) trial, patients with ST-segment-elevation myocardial infarction (MI) who underwent staged revascularization of non-culprit coronary stenoses experienced fewer major adverse cardiovascular events than those who underwent a culprit-only approach (1). Inclusion was, however, based on angiographic and not physiological criteria. Purpose To analyse, using computational modelling, the physiological significance of non-culprit lesions included in the COMPLETE trial, to compare these against angiographic measures of severity, and investigate interactions between physiology and the benefits of complete revascularization. Methods Angiograms with appropriate digital imaging and communications in medicine (DICOM) data from the COMPLETE trial (n=1327) underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and virtual fractional flow reserve (vFFR) using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators’ visual angiographic analysis, core-laboratory 2D-QCA and 3D-QCA. Results vFFR was computed successfully in 635 patients (710 lesions). The median vFFR was 0.82 (interquartile range 0.73–0.91). 302 patients (48%) had at least one physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. Physiologically significant lesions were angiographically more severe than non-significant lesions according to the operator’s visual angiographic assessment (mean stenosis 80% vs. 75%, P<0.0001), 2D-QCA (69% vs. 59%, p<0.0001), and 3D-QCA (56% vs. 43, P<0.0001). Percentage lesion stenosis was significantly different when measured visually, with 2D-QCA and with 3D-QCA (80% vs 62% vs 49%, P<0.0001). vFFR was weakly correlated with operators’ visual angiographic severity (Figure 1) and 2D-QCA, but more strongly with 3D-QCA (r=-0.21, -0.21, and -0.60, respectively; all p<0.0001). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs 49% vs 59%, respectively). There was no statistically significant interaction between physiological lesion significance and any of the trial coprimary or key secondary clinical outcomes, or on an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interactions P>0.30) (Figure 2). Conclusions In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically-significant lesions, 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis, and the benefits of complete revascularization appeared to be independent of physiological lesion significance. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.Figure 1.Figure 2.

AI-Generated Annotations Dataset for Diverse Cancer Radiology Collections in NCI Image Data Commons

The National Cancer Institute (NCI) Image Data Commons (IDC) offers publicly available cancer radiology collections for cloud computing, crucial for developing advanced imaging tools and algorithms. Despite their potential, these collections are minimally annotated; only 4% of DICOM studies in collections considered in the project had existing segmentation annotations. This project increases the quantity of segmentations in various IDC collections. We produced high-quality, AI-generated imaging annotations dataset of tissues, organs, and/or cancers for 11 distinct IDC image collections. These collections contain images from a variety of modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). The collections cover various body parts, such as the chest, breast, kidneys, prostate, and liver. A portion of the AI annotations were reviewed and corrected by a radiologist to assess the performance of the AI models. Both the AI’s and the radiologist’s annotations were encoded in conformance to the Digital Imaging and Communications in Medicine (DICOM) standard, allowing for seamless integration into the IDC collections as third-party analysis collections. All the models, images and annotations are publicly accessible.

Three-dimensional finite element analysis of stress distribution on different complex macro designs in commercially available implants: An in-vitro study

ObjectiveThis study aimed to investigate the effects of different commercially available complex implant macro designs on stress distributions using Finite element analysis. The experiment is done under varying simulated bone conditions to provide reference for clinical application. Materials and methodsThe study employed the Finite Element Analysis (FEA) method to compare four commercially available complex implant macro designs on a Computer-Aided Design (CAD) model of a maxillary bone segment. The three-dimensional geometrical model of the implants was reconstructed from computed tomography (CT)-slices in Digital Imaging and Communications in Medicine (DICOM) format and contact condition between the implant and the bone was considered as ‘Bonded’, implying perfect osseointegration. All materials used in the models were assumed to be isotropic, homogeneous, and linearly elastic. The Finite element simulations employed load of 400 N under both axial and non-axial conditions Stresses were analysed under different bone conditions. ResultsAverage values of von Mises stresses were used for comparing stress levels between implant designs. There was a definite increase in the equivalent stress values from higher density(D1)to lower density (D4) bone conditions for all implants. The percentage of increase ranged from 23.63 to 49.39 on axial loading and 20.39 to 57.19 when subjected to non-axial loading. The equivalent stress values resulted from non-axial loading were 1.78–2.94 times higher than that of axial loading for all implants under all bone densities. Among the complex designs Equinox Myriad Plus implant exhibited the least stress under axial loading (12.749–19.046 MPa) and (37.462–49.217 MPa) for non-axial loading. The stress on the crestal module was higher (1.49–2.99 times) than the overall stress on the implant regardless of the loading direction or bone conditions. ConclusionsData from the present study shows Equinox Myriad Plus implant generating the least equivalent stress and this can be taken as indicator in the biomechanical performance of the design.

Passive fit and time efficiency for prefabricated versus conventionally constructed cobalt chromium CAD\\CAM 3-unit implant supported frameworks in free end saddle models: a pilot invitro study

BackgroundThe passive fit of 3-unit implant supported prefabricated metal screw-retained prosthesis before implant placement might be difficult. Hence, we aim to evaluate the passive fit and time efficiency of CAD/CAM 3-unit implant supported fixed prostheses that were constructed based on virtual versus those based on actual implant positions in Kennedy Class I models.MethodsA sample of 5 Kennedy class I models with thin wiry ridges were restored by 20 frameworks bilaterally, 10 based on actual (group A) and 10 based on virtual (group V) implant positions. The models were imaged using cone beam computed tomography and scanned using an intraoral scanner. The STL (Standard Tessellation Language files) and the DICOM (Digital Imaging and Communications in Medicine) files were registered on a 3D planning software. A CAD/CAM surgical guide was planned, resin printed and used for installing 6 implants bilaterally. In group V, the framework was designed based on the virtual scan bodies and virtual multi-unit abutments, while in group A intra-oral scanning of the model after attaching the scan bodies was necessary. Frameworks of both groups were milled and tested for passive fit using 8 clinical tests. McNemar and Wilcoxon signed rank tests were used to study the effect of the group on passive fit and time efficiency, respectively. The significance level was set at P ≤ 0.05.ResultsNo statistically significant difference was found between group V and group A frameworks regarding passive fit (p-value = 1, OR = 0.5) and time efficiency (P = 0.179, Effect size = 0.948).ConclusionWithin the limitations of this study, it can be concluded that in free end saddle cases, prefabricated CAD\\CAM 3-unit implant-supported cobalt chromium screw retained prostheses can achieve an adequate passive fit. However, their fit might be negatively affected in thin ridges and they might require some adjustments.

LMCD-OR: a large-scale, multilevel categorized diagnostic dataset for oral radiography

In recent years, digital dentistry has increasingly utilized advanced image analysis techniques, such as image classification and disease diagnosis, to improve clinical outcomes. Despite these advances, the lack of comprehensive benchmark datasets is a significant barrier. To address this gap, our research team develop LMCD-OR, a substantial collection of oral radiograph images designed to support extensive artificial intelligence (AI)-driven diagnostics. LMCD-OR comprises 3,818 digital imaging and communications in medicine (DICOM) oral X-ray images from local medical institutions that are meticulously annotated to provide broad category information for both primary dental outpatient services and detailed secondary disease diagnoses. This dataset is engineered to train and validate multiclassification models to improve the precision and scope of oral disease diagnostics. To ensure robust dataset validation, we employ four cutting-edge visual neural network classification models as benchmarks. These models are tested against rigorous performance metrics, demonstrating the ability of the dataset to support advanced image classification and disease diagnosis tasks. LMCD-OR is publicly available at http://dentaldataset.zeroacademy.net.

Accuracy of pelvic bone segmentation for 3d printing: a study of segmentation accuracy based on anatomic landmarks to evaluate the influence of the observer.

3D printing has a wide range of applications and has brought significant change to many medical fields. However, ensuring quality assurance (QA) is essential for patient safety and requires a QA program that encompasses the entire production process. This process begins with imaging and continues on with segmentation, which is the conversion of Digital Imaging and Communications in Medicine (DICOM) data into virtual 3D-models. Since segmentation is highly influenced by manual intervention the influence of the users background on segmentation accuracy should be thoroughly investigated. Seventeen computed tomography (CT) scans of the pelvis with physiological bony structures were identified, anonymized, exported as DICOM data sets, and pelvic bones were segmented by four observers with different backgrounds. Landmarks were measured on DICOM images and in the segmentations. Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement, and the trueness of the segmentation results was analyzed by comparing the DICOM landmark measurements with the measurements of the segmentation results. The correlation between segmentation trueness and segmentation time was analyzed. The lower limits of the 95% confidence intervals of the ICCs for the seven landmarks analyzed ranged from 0.511 to 0.986. The distance between the iliac crests showed the highest agreement between observers, while the distance between the ischial tuberosities showed the lowest. The distance between the upper edge of the symphysis and the promontory showed the lowest deviation between DICOM measurements and segmentation measurements (mean deviations < 1mm), while the intertuberous distance showed the highest deviation (mean deviations 14.5-18.2mm). Investigators with diverse backgrounds in segmentation and varying experience with slice images achieved pelvic bone segmentations with landmark measurements of mostly high agreement in a setup with high realism. In contrast, high variability was observed in the segmentation of the coccyx. In general, interobserver agreement was high, but due to measurement inaccuracies, landmark-based approaches cannot conclusively show that segmentation accuracy is within a clinically tolerable range of 2mm for the pelvis. If the segmentation is performed by a very inexperienced user, the result should be reviewed critically by the clinician in charge.

Magnetic Resonance Images for the Prediction of Chronological Age Using Maxillary Third Molar Teeth: An Observational Study.

Dental age estimation using third molars is a reliable method for estimating the age of individuals. Recently, magnetic resonance imaging (MRI) of the head and neck has been found to be applicable for age estimation of third molar teeth. In the present study, we aimed to apply the Modified Demirjian method of age estimation to magnetic resonance (MR) image sections for dental age estimation by determining the mineralization patterns of the maxillary third molars. MRI scans of the patients were performed using SIGNA™ 3.0Tesla MRI GE Healthcare (Chicago, USA) with a moving, multifunctional coil. Two expert radiologists with more than three years of experience independently analyzed the image sections using the open-source Digital Imaging and Communications in Medicine (DICOM) viewer software. The age and sex of the patients whose images were included in the study were recorded using a specially designed proforma. The stage of development of the maxillary third molars was determined using the modified Demirjian method. Inter observer agreement was calculated using the intra class correlation coefficient. Simple linear regression analysis was used to predict the actual age at the third molar development stage. There was excellent agreement between observers (ICC =0.99 (95% CI = 0.98-0.99)). There was also a significant association between the maxillary third molar tooth development stage and chronological age of the individual (P=0.001; B=1.54; 95% CI = 0.71-2.37). The findings from the present study establish that the Modified Demirjian method can also be reliably applied for dental age assessment in MR sections.

Rapid patient-specific organ dose estimation in computed tomography scans via integration of radiomics features and neural networks.

Computed tomography (CT) offers detailed cross-sectional images of internal anatomy for disease detection but carries a risk of solid cancer or blood malignancies due to exposure to X-ray radiation. This study aimed to develop a new method to quickly predict patient-specific organ doses from CT examinations by training neural networks (NNs) based on radiomics features. CT Digital Imaging and Communications in Medicine (DICOM) image data were exported to DeepViewer, a clinical autosegmentation software, to segment the regions of interest (ROIs) for patient organs. Radiomics feature extraction was performed based on the selected CT data and ROIs. Reference organ doses were computed using Monte Carlo (MC) simulations. Patient-specific organ doses were predicted by training a NN model based on radiomics features and reference doses. For the dose prediction performance, the relative root mean squared error (RRMSE), mean absolute percentage error (MAPE), and coefficient of determination (R2) were evaluated on the test sets. The robustness of the NN model was evaluated via the random rearrangement of patient samples in the training and test sets. The maximal difference between the reference and predicted doses was less than 1 mGy for all investigated organs. The range of MAPE was 1.68% to 5.2% for head organs, 11.42% to 15.2% for chest organs, and 5.0% to 8.0% for abdominal organs; the maximal R2 values were 0.93, 0.86, and 0.89 for the head, chest, and abdominal organs, respectively. The radiomics feature-based NN model can achieve accurate prediction of patient-specific organ doses at a high speed of less than 1 second using a single central processing unit, which supports its use as a user-friendly online clinical application.

Adaptation of virtual surgical planning to midface reconstruction with intraoperative navigation: “navigation mediated midface reconstruction”

ObjectiveThe production of three dimensional models and materials according to preoperative virtual surgical planning is a time consuming process and causes high costs. We aimed to demonstrate the navigation mediated reconstruction of the patients who underwent the removal of tumoral mass in midfacial region according to their preoperatively prepared surgical plannings. Study DesignPatients who underwent the removal of tumoral mass and reconstruction in their midfacial region were included in the study. Virtual surgical planning was performed by the mirror imaging of unaffected side of maxillofacial bones. New created models were converted to DICOM (Digital Imaging and Communications in Medicine) data to use in the navigation system. Histogram analysis was performed to reveal the compatibility of navigation mediated reconstruction with preoperative virtual surgical planning. ResultsReconstruction of orbital floor was achieved in all of the cases. Histogram comparison of the localizations of orbital floor and maxillary walls was calculated at a confidence level of 95 % (p > 0.95) and mean difference was found 0.85 mm; while standard deviation was 3.55 mm. ConclusionWe found that virtually prepared reconstruction of midfacial area can be succesfully adapted to the surgery with the assistance of intraoperative navigation system.

Web-Based DICOM Viewers: A Survey and a Performance Classification.

The standard for managing image data in healthcare is the DICOM (Digital Imaging and Communications in Medicine) protocol. DICOM web-viewers provide flexible and accessible platforms for their users to view and analyze DICOM images remotely. This article presents a comprehensive evaluation of various web-based DICOM viewers, emphasizing their performance in different rendering scenarios, browsers, and operating systems. The study includes a total of 16 web-based viewers, of which 12 were surveyed, and 7 were compared performance-wise based on the availability of an online demo. The criteria for examination include accessibility features, such as available information or requirements for usage, interface features, such as loading capabilities or cloud storage, two-dimensional (2D) viewing features, such as the ability to perform measurements or alter the viewing window, and three-dimensional (3D) viewing features, such as volume rendering or secondary reconstruction. Only 4 of the viewers allow for the viewing of local DICOM files in 3D (other than MPR(Multiplanar reconstruction)). Premium software offers a large amount of features with overall good performance. One of the free alternatives demonstrated the best efficiency in both 2D and 3D rendering but faces challenges with missing 3D rendering features in its interface, which is still in development. Other free options exhibited slower performance, especially in 2D rendering but have more ready-to-use features on their web app. The evaluation also underscores the importance of browser choice, with some browsers performing much better than the competition, and highlights the significance of hardware when dealing with rendering tasks.