Operator Experience Research Articles

Predicting the future caretakers of traumatic vascular injury management via operative exposure among surgical trainees

BackgroundThe management of vascular trauma requires specialized training and expertise. Although traumatic vascular injury is treated currently by both vascular and trauma surgeons in modern practice, it remains unclear who will inherit the role of managing vascular trauma in the coming decades. In this study, we examined disparities in operative experience in vascular trauma among surgical trainees across different surgical specialties. MethodsAccreditation Council for Graduate Medical Education national operative log reports were collected for graduating vascular surgery residents (VSRs), vascular surgery fellows (VSFs), and general surgery residents (GSRs) from 2012 to 2022. Total operative volume for traumatic vascular injury was examined, as were the five major contributing operative domains (neck, thoracic, abdominal, peripheral, and fasciotomy). ResultsA total of 22,052 GSRs, 334 VSRs, and 1672 VSFs graduated over the 10-year study period. VSR had the highest vascular trauma case volume (24.9 ± 3.9 cases/5 years), followed by VSF (22.1 ± 1.5 cases/2 years) then GSR (2.4 ± 0.3 cases/5 years; P < .001). Thoracic vessel exploration/repair (0.7 cases vs 0.6 cases vs 0.0 cases), abdominal vessel exploration/repair (1.0 cases vs 0.9 cases vs 0.0 cases), neck vessel exploration/repair (4.0 cases vs 3.4 cases vs 0.2 cases), peripheral vessel exploration/repair (12.1 cases vs 9.5 cases vs 1.1 cases), and lower extremity fasciotomy for trauma (7.2 cases vs 7.6 cases vs 1.1 cases) were most frequent among the VSR and VSF groups (P < .001 each). On linear regression analysis, both VSF (+0.5 cases/y; R2 = 0.81; P < .001) and GSR (+0.1 cases/y; R2 = 0.75; P = .001) groups experienced a growth in vascular trauma volume. Contrariwise, vascular trauma volume did not change among graduating VSRs (R2 = 0.13; P = .31). ConclusionsDedicated vascular surgical training provides the highest operative exposure to civilian vascular trauma in the United States.

Safety and efficacy of the Contour Neurovascular System for intracranial aneurysm treatment: a retrospective analysis of 76 patients.

The Contour Neurovascular System (CNS) is a novel intrasaccular flow-disrupting device for the treatment of intracranial aneurysms. This study presents the authors' institutional experience and midterm follow-up results with this device. Seventy-six consecutive patients (mean ± SD age 58.9 ± 12.4 years) were treated with the CNS for 76 aneurysms (63 unruptured, 10 recurrent, and 3 ruptured). Aneurysm characteristics, procedural details, and clinical/angiographic outcomes were retrospectively evaluated. The most common aneurysm locations were the basilar tip in 25 (32.9%) cases and the anterior communicating artery in 22 (28.9%). There were 18 (23.7%) sidewall aneurysms. The mean ± SD aneurysm width was 5.6 ± 2.5 mm, and 68 (89.5%) aneurysms were wide-necked. The CNS was successfully implanted in 68 (89.5%) aneurysms, with 11 cases of additional coiling and 1 case each of additional stent and balloon. There were 3 (3.9%) thromboembolic events, of which 1 (1.3%) was symptomatic (a major ischemic stroke) and resulted in morbidity. There were no hemorrhagic events or deaths. At last available follow-up (mean 12 months), 32/56 (57.1%) aneurysms were completely occluded, 16/56 (28.6%) had neck remnants, and 8/56 (14.3%) had an aneurysm remnant. Three (5.4%) aneurysms were retreated. The use of the CNS was safe and feasible but proper aneurysm selection appears to be required, which may be facilitated with increasing operator experience and further study of this device. Similar to other intrasaccular flow disrupters, midterm complete occlusion rates are moderate but may increase with longer follow-up.

72094 - Ultrasonic scissors reduce postoperative seroma after mastectomy and axillary surgery: a single operator experience

72094 - Ultrasonic scissors reduce postoperative seroma after mastectomy and axillary surgery: a single operator experience

Data based digital twin for operational performance optimization in CFB boilers

The benchmarks of controllable variables for circulating fluidized bed (CFB) boilers with small capacity dependencies on operator experience result in boiler efficiency penalties, increased energy consumption, and performance degradation. This study proposes a digital twin (DT) for a CFB boiler based on data-driven methods to determine the benchmarks of controllable variables by mining historical operating data to save energy, with a coefficient, Cm, proposed for the online evaluation of boiler performance. A hybrid data-driven model integrating kernel density estimation and the K-means++ algorithm was proposed to optimize boiler performance for different coal types, with Cm set as the clustering objective to determine the benchmarks of controllable variables from an operator's perspective. In addition, a classification model adopting an extreme gradient boosting algorithm was presented to identify the coal type online. The proposed DT was applied to an on-duty 150 t/h CFB boiler. The results showed that the proposed DT could identify coal types online with an accuracy of no lower than 94.8 %. Moreover, after the industrial commission of DT, the boiler efficiency increased from 84.41 % to 85.96 % on average, the energy savings reached 151.01 GJ, while steam production increased 59,998 kg over three days, thus highlighting that the proposed benchmarks for controllable variables help enhance the performance of CFB boilers.

Mechanical site preparation in South Africa: comparing the productivity of pitting machine operators under different site conditions

ABSTRACT Pitting is the preparation of a tree planting position. In South Africa, various contractors and grower companies have gradually adopted pitting machines over the past decade, to overcome the challenges of manual pitting, such as low productivity, poor ergonomics, and inconsistent pit quality. Even though most forestry stakeholders understand productivity requirements (e.g. pits/shift) from pitting machines, they are often unaware of productivity differences associated with different operators and work conditions. This study aimed to compare the operational productivity and pit quality achieved by different pitting machine operators under different site conditions. The experiment was conducted in two sub-compartments, with two different post-harvest slash treatments: broadcast burning or mulching (and pre-marking). Then, four operators were tasked to dig pits using the same equipment. Operator productivity was assessed by analyzing time study data, while pit quality was estimated by determining pit depth and diameter. The results indicated that Operator 4 performed significantly better on mulched sites (543 pits/PMH) than on burned sites (430 pits/PMH), while Operator 2 was the least productive with 261 and 253 pits/PMH in mulched and burned sites, respectively. The overall average productivity was 120 pits/PMH higher on mulched sites than on burned sites. Although work quality did not correlate with productivity, there were differences between operators on the mulched site. The proportion of good pits varied, but site preparation technique did not significantly affect pit quality. We conclude that operator experience significantly impacts productivity and that marking the pitting spots is important to ensure that the required number of pits per hectare is achieved.

15 Years Survival of Budd-Chiari Patients in a Single Center Study

Abstract Background Budd–Chiari syndrome (BCS) is a heterogeneous group of clinical conditions ranging from acute liver failure to completely asymptomatic patient. It is caused by hepatic venous outflow obstruction at any level from the small hepatic veins (HVs) to the junction of inferior vena cava (IVC) with the right atrium. Aim of the Work: The idea of this work was to report the result so favast clinical experience over 15 years presented by Tropical medicine department Ain Shams University through analysing the patient and disease characteristics, outcome, complications and innovations in therapeutic intervention. Ultimately this should throw lights on the understanding of the pathophysiology causes and clinical consequences of BCS among Egyptian patients. Patients and Methods 199 Egyptian patients with confirmed diagnoses of primary BCS were evaluated regarding their socio-demographic features, etiology, risk factors for BCS, clinical manifestations, management modalities and outcomes. The studied patients were enrolled from patients presented to Budd chiari study group clinic, Tropical Medicine Department ward, Ain Shams University hospitals, from January 2006 till December 2021. Results The commonest complaints in Budd Chiari patients were abdominal enlargement in 79.9% (159 patients) and abdominal pain in 77.9% (155 patients), Ascites was present in 75.4% (150), Hepatomegaly in 75.4% (150), Splenomegaly 61.8% (123). More than Seventy Seven percent (77.9%) of the enrolled patients were Chronic BCS patients, 12.6% were subacute BCS and 9.5% were acute BCS. In this study the leading cause of Budd-Chiari was FVLM 76 patients (38.2%). Several papers concluded that FVLM is the main or leading etiology to BCS but regarding the other papers that showed different results, these differences might possibly be due to the difference in sample size. In the current study the outcomes varied from one etiological factor to the other as in FVLM 78.7% of the BCS FVLM patients were compensated, 14.7% were decompensated and 6.7% died and these results were highly significant. Conclusion It seems that TIPS creation is an effective treatment for eligible BCS patients and has long-term survival benefit with satisfactory shunt patency and patient survival. The outcome of TIPS has improved over the years due to the increase in the operator experience and the availability of PTFE-covered stents.

Trends in Operative Case Logs of Chief Residents in Surgery by Sex and Race: A 5-year National Study.

To examine case logs reported by general surgery residents and identify potential disparities in operative experience. A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers ( P < 0.001). Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.

Preference signaling in orthopaedic surgery: applicant perspectives and opinions.

Orthopaedic surgery has become increasingly competitive over the years, with the COVID-19 pandemic creating additional challenges for applicants and programs. To promote an equitable match experience, the American Orthopaedic Association (AOA) introduced a formal preference signaling (PS) system into the 2022-2023 application cycle. PS allows applicants to indicate their heightened interest in specific programs, which improves the likelihood of receiving an interview and ultimately matching at their desired residency program. The objective of this anonymous survey is to assess applicants' opinions and perspectives toward PS in orthopaedic surgery prior to the 2022-2023 match results. Additionally, we sought to evaluate the signaling strategies being utilized by applicants. An anonymous 22-question survey was distributed to applicants of an orthopaedic surgery residency program (34.2 % response rate). Responses were collected after the application submission deadline but before the match lists and results were available. This survey included questions germane to demographics, signal utilization, signaling reasons and strategies, and opinions toward PS.Descriptive statistics were calculated utilizing R (version 4.2.1) and RStudio. Most respondents (96.1 %) participated in PS, and 96.7 % utilized all 30 signals. Signaling encouraged 24.2 % ofapplicants to apply to fewer programs. In accordance withguidelines, 83.2 % of respondents signaled each away rotation program; however, only 53 % signaled their home program. Applicants commonly signaled 1-10 "reach" and "safety" programs each. Proximity to Family and Perceived Operative Experience were the most important reasons forsignaling, whereas Program Prestige was the least. A program's social presence and virtual interview option did not influence many applicants' decisions for signaling. Most applicants believe that the COVID-19 pandemic and pass/fail licensure examinations influenced PS adoption. Sixty-seven of 149 respondents (45 %) claimed that applicants and programs benefit equally from PS, while 41 % believe programs benefit more. Nearly half (40.94 %) knew very littleor nothing about PS. During the inaugural introduction of PS in orthopaedic surgery, nearly every applicant utilized all 30 signals, prioritizing factors like family proximity and perceived operative experience over program prestige. Thisshift reflects the importance of geographic location andpresumed training quality. Despite unfamiliarity toward PS, personalized signaling strategies were implemented, accompanied by a slight decrease in application volumes. The30 allotted signals in orthopaedic surgery may serve as aninformal application cap due to the necessity of signaling aprogram for an interview invite. However, improved educational efforts are needed to enhance the understanding and maximize the benefits of PS for both applicants and programs.

Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry.

Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

Homestay Operators' Experiences in Initiating and Developing Homestay Enterprises

Community homestay development is one of the strategies to culture-based accommodation, mostly in the rural and remote settlements in Nepal. Homestay tourism has been in practice for more than two decades, and it is rapidly spreading in many parts of the country. This article attempts to bring the views and experiences of community homestay operators regarding their understanding, awareness, perceived benefits, and homestay initiation and development practices from Mahabharat Hills of Bagmati Province. Ethnographic field observations and 'bhalakusari' (in-depth talk) were the dominant methods applied during the data collection process. The findings suggest that due to multiple types of perceived as well as experienced benefits from community homestay tourism, locals have enthusiastically learned and adopted homestay enterprising, in which local-level institutional facilitation and support activities have become main motivators in the processes. In such areas, gradual increase in external facilitation, exposure and capacity development endeavors, increasing tourist arrivals, and wide ranges of direct and indirect economic, socio-cultural, and environmental benefits are visible. All these factors have encouraged the locals to engage and expand community homestay development initiatives in their areas. Despite multiple positive facets of homestay tourism, there exist some challenges too. The article also suggests some policy and practice-level implications.

A Comparative Study of Novel Fibrosis Index and Other Non-invasive Serum Indices for Predicting Fibrosis in Patients of Chronic Liver Disease.

Introduction Chronic liver diseaseprogression leads to liver fibrosis/cirrhosis. Transient Elastography is used for staging liver fibrosis but ascites, obesity, and operator experience limit its applicability. In this study, we compared various non-invasive serum indices in predicting fibrosis in chronic liver disease patients. Materials and methods A total of 142 cases of confirmed Chronic Liver Disease were included. Quantitative determination of liver stiffness by Transient Elastography and relevant blood investigations was done. We compared the liver stiffness measurement by Transient Elastography and fibrosis indices, i.e., Aspartate Transaminase (AST) to Alanine Transaminase (ALT) Ratio (AAR), AST to Platelet Ratio Index (APRI), Fibrosis Index (FI), Fibrosis-4 (FIB-4) Index, Age-Platelet Index (API), Pohl score, and Fibrosis Cirrhosis Index (FCI) with Novel Fibrosis Index (NFI), to predict liver fibrosis stages. Results The optimum cutoff of NFI for the F4 stage was ≥ 6670 with a sensitivity of 75.8% and specificity of 81.8%, for the F3 stage was ≥ 2112 with a sensitivity of 63.6%and specificity of 72.7%, and for the F2 stage was ≥ 1334 with a sensitivity of 100% and specificity of 56.3%. The NFI had the maximum area under the curve compared to other indices in predicting fibrosis stages. Conclusion The Novel Fibrosis Index was the best in predicting fibrosis stages in Chronic Liver Disease patients, with good performance in predicting the F4 stage.

A Coarse-Fine Collaborative Learning Model for Three Vessel Segmentation in Fetal Cardiac Ultrasound Images.

Congenital heart disease (CHD) is the most frequent birth defect and a leading cause of infant mortality, emphasizing the crucial need for its early diagnosis. Ultrasound is the primary imaging modality for prenatal CHD screening. As a complement to the four-chamber view, the three-vessel view (3VV) plays a vital role in detecting anomalies in the great vessels. However, the interpretation of fetal cardiac ultrasound images is subjective and relies heavily on operator experience, leading to variability in CHD detection rates, particularly in resource-constrained regions. In this study, we propose an automated method for segmenting the pulmonary artery, ascending aorta, and superior vena cava in the 3VV using a novel deep learning network named CoFi-Net. Our network incorporates a coarse-fine collaborative strategy with two parallel branches dedicated to simultaneous global localization and fine segmentation of the vessels. The coarse branch employs a partial decoder to leverage high-level semantic features, enabling global localization of objects and suppression of irrelevant structures. The fine branch utilizes attention-parameterized skip connections to improve feature representations and improve boundary information. The outputs of the two branches are fused to generate accurate vessel segmentations. Extensive experiments conducted on a collected dataset demonstrate the superiority of CoFi-Net compared to state-of-the-art segmentation models for 3VV segmentation, indicating its great potential for enhancing CHD diagnostic efficiency in clinical practice. Furthermore, CoFi-Net outperforms other deep learning models in breast lesion segmentation on a public breast ultrasound dataset, despite not being specifically designed for this task, demonstrating its potential and robustness for various segmentation tasks.

The implementation method of point cloud denoising filter based on KinectV2

Abstract In the process of collecting data from point clouds, some factors, such as precision equipment, operator experience, environmental conditions, as well as characteristic diffraction effects of electromagnetic waves, changes in surface characteristics of test objects, and the impact of integration processes, are involved data and records that may display some point noise in the data point cloud. In addition to noise caused by measurement errors, practical applications can be affected by external interference and obstacles, which causes deviating values in the data point cloud to differ from the measurement entity. A 3D scanner, represented by the depth of the camera, is used to collect data. To eliminate these noises and anomalies, it is necessary to filter the initial points of the cloud. In this article, we suggest using statistical filtering algorithms to perform statistical analysis on each point community, remove points that do not meet predetermined standards, and remove outliers. To verify the effectiveness of the algorithm, it is compared with other filtering algorithms. The experimental results show that the filter algorithm proposed in this thesis has better effects on outlier points and can obtain the general shape properties of the point cloud.

A Surgical Skills Rotation for Mid-Level Residents.

The University of Iowa orthopaedic residency previously designed a month-long surgical skill rotation for postgraduate year (PGY)-1 residents. This successful initiative has become a model of interest for other teaching institutions. In addition to the intern year, an important phase in residency occurs during the transition from PGY2 to PGY3, when residents assume greater responsibility and autonomy in leading surgical procedures. To directly address this transition and assess residents' readiness, our residency program established a week-long PGY2 surgical skills rotation. This rotation serves as a training checkpoint and focuses on both training and evaluation of level-appropriate skills in joint arthroplasty, trauma, arthroscopy, and wire navigation. The primary objective of the PGY2 surgical skills rotation is to enhance orthopaedic residents' operative skills and experience by providing increased exposure and practice of requisite technical skills. Similar to the Orthopedic In-Training Examinations that assess residents' knowledge, this week-long program, aimed at assessing residents' proficiency in fundamental orthopaedic technical skills, occurs before their PGY3 year. Faculty-led training and assessment sessions in each area offer residents many opportunities for dedicated practice and improvement. Transferring these acquired skills from the laboratory to the operating room is essential for a training program. To confirm improvement, the final day of the surgical skills rotation was exclusively dedicated to structured performance evaluations, with a specific emphasis on establishing proficiency benchmarks. We herein describe the University of Iowa's PGY2 surgical skills rotation, providing insights into its development, implementation, and outcomes. By sharing our experience, we offer a framework for other academic departments seeking to optimize surgical skills education and ensure the successful transition of mid-level residents.

Examining the Influence of a General Surgery Resident's Transplant Experience on Their Pursuit of Transplant Surgery Fellowship.

Transplant surgery has historically been a less desirable fellowship among general surgery graduates. Limited work has been done to understand factors associated with residents' interest in transplantation. Using a multi-institutional cohort, we examined how the resident experience on transplant surgery may influence their decision to pursue transplant fellowship. Individual demographics, program characteristics, and transplant-specific case logs were collected for graduates from 2010 to 2020 at 20 general surgery residency programs within the US Resident OPerative Experience (ROPE) Consortium. Residents who pursued transplant surgery fellowship were compared to those who went directly into practice or pursued a non-transplant fellowship. Among 1342 general surgery graduates, 52 (3.9%) pursued abdominal transplant fellowship. These residents completed more transplant (22vs. 9), liver (14vs. 9), pancreas (15vs. 11), and vascular access operations (38vs. 30) compared to residents who did not pursue transplant fellowship (all p<0.05). Multivariable logistic regression found that residents underrepresented in medicine were three times more likely (95% CI 1.54-6.58, p<0.01) and residents at a program co-located with a transplant fellowship six times more likely (95% CI 1.95-18.18, p<0.01) to pursue transplant fellowship. Additionally, a resident's increasing total transplant operative volume was associated with an increased likelihood of pursuing a transplant fellowship (OR = 1.12, 95% CI 1.09-1.14, p<0.01). The findings from this multi-institutional study demonstrate that increased exposure to transplant operations and interaction within a transplant training program is associated with a resident's pursuit oftransplant surgery fellowship. Efforts to increase operative exposure, case participation, and mentorship may optimize the resident experience and promote the transplant surgery pipeline.

Stability of orthodontic anchoring devices: a narrative review

Background and objectives. Temporary anchoring devices (TADs) are essential for controlling unwanted reactive movements in teeth because orthodontic treatments require effective anchorage to control tooth movement. The goal of this systematic review is to collect information on the advantages, disadvantages, and applications of TADs in orthodontic treatment by addressing the variables affecting their stability and efficacy. Materials and methods. Our review is a non-Cochrane review, following the PICO format for selection criteria, analyzed studies published between 2011 and 2021. The review focused on systematic reviews, meta-analyses, RCTs, case control, and cohort studies in English, extracted from PubMed and Google Scholar databases. A total of 123 papers were assessed, with 39 included for review. Results. The review found that TAD stability is highly influenced by micro-implant design, operator experience, placement technique, bone morphology and histology, and patient variables (such as age and sex). Notably, the quality and amount of bone, the length and diameter of the implant, and the surgical method all played a significant role in achieving primary stability. Although loosening and discomfort are possible side effects, TADs have been demonstrated to provide reliable and effective anchoring during orthodontic treatment. Conclusions. Greater treatment efficacy and patient comfort are made possible by the significant advancement in orthodontic anchoring that TADs represent. The performance of TADs is largely dependent on variables like operator experience, micro-screw size, and bone quality. The mandibular site presented a higher risk of loosening, although patient factors such as age and sex did not significantly affect the loosening rate. This review emphasizes how important it is to take these factors into account in order to maximize TAD stability and, consequently, therapeutic results.

Brain Tumor Classification Using DenseNet CNN Model

Abstract: In recent years, Due to its powerful soft tissue comparison and non-invasive nature, magnetic resonance imaging,or MRI, has attracted a lot of attention recently. MRI is a frequently utilized imaging modality for the purpose of locating brain cancers in infants. The MRI generates a huge volume of data. Tumor heterogeneity, isointense and hypointense characteristics limit manual segmentation within a reasonable time frame, which in turn limits the application of trustworthy quantitative metrics in clinical practice. Manual segmentation tasks in clinical practice take a lot of time, and the operator's experience has a big impact on how well they execute. Tumor segmentation methods must be accurate and automated, however due to the extreme spatial and structural variety of brain tumors, this is a challenging task. We have suggested completely automatic brain categorization in our project. Using the DenseNet model, we have presented a fully automatic way to classify brain cancers. Tests conducted on the datasets demonstrate the effectiveness of our suggested approach for identifying baby brain cancers from MRI (MRI).

Longitudinal reduction in fluoroscopy with continued use of 3-dimensional electroanatomic mapping systems in catheter ablation of supraventricular tachycardia – then and now

BackgroundCatheter ablation is a first-line treatment for symptomatic, recurrent supraventricular tachycardia (SVT). This study aims to demonstrate if 3D-electroanatomic mapping (EAM) during SVT ablation reduces fluoroscopy time (FT) and determine if further reductions in FT are observed longitudinally. MethodsAll cases of SVT ablation between May 2011–May 2022 at a single tertiary centre were prospectively recruited. FT between the cohorts with and without EAM were compared. Within the EAM subset, the trend of FT across the years was analysed. ResultsThere were 1758 cases included, 563 without EAM, 1195 with EAM. EAM was associated with a longer procedure time (mean + 8.8 min, p = 0.001), but with mean reductions in FT and dose area product (DAP) by 19.6 min and 18 621 mGy*cm2 respectively (p < 0.001). There was comparable efficacy without any increase in complication rates. Over time (2011–2022), further reduction in FT of 0.9 min year on year was observed (p = 0.001). Between 2011 and 2017, there was a significant reduction in FT of 1.1 min year on year (p = 0.019), which was not observed from 2017 onwards (p = 0.061). The greatest reduction in FT was after the first year of adoption. ConclusionEAM in SVT ablation reduces fluoroscopy use. FT was initially observed to reduce further over time before plateauing, likely due to increased operator experience. While there is increased interest in zero fluoroscopy SVT ablation, complementary use of fluoroscopy may still be necessary in complex cases.

Perspectives on technology: Prostate Imaging-Reporting and Data System (PI-RADS) interobserver variability.

To explore the topic of Prostate Imaging-Reporting and Data System (PI-RADS) interobserver variability, including a discussion of major sources, mitigation approaches, and future directions. A narrative review of PI-RADS interobserver variability. PI-RADS was developed in 2012 to set technical standards for prostate magnetic resonance imaging (MRI), reduce interobserver variability at interpretation, and improve diagnostic accuracy in the MRI-directed diagnostic pathway for detection of clinically significant prostate cancer. While PI-RADS has been validated in selected research cohorts with prostate cancer imaging experts, subsequent prospective studies in routine clinical practice demonstrate wide variability in diagnostic performance. Radiologist and biopsy operator experience are the most important contributing drivers of high-quality care among multiple interrelated factors including variability in MRI hardware and technique, image quality, and population and patient-specific factors such as prostate cancer disease prevalence. Iterative improvements in PI-RADS have helped flatten the curve for novice readers and reduce variability. Innovations in image quality reporting, administrative and organisational workflows, and artificial intelligence hold promise in improving variability even further. Continued research into PI-RADS is needed to facilitate benchmark creation, reader certification, and independent accreditation, which are systems-level interventions needed to uphold and maintain high-quality prostate MRI across entire populations.

Relative energy and perceived impact of vessel-generated waves in fetch-limited environments

Houser C, Carswell A, Chittle B, Johnson G, Caschera A, Smith A. 2024. Relative energy and perceived impact of vessel-generated waves in fetch-limited environments. Lake Reserv Manag. 40:285–302 Vessel-generated waves (or wakes) are perceived as an important stressor in both marine and freshwater systems, and they are an increasingly important focus of coastal management. Recent studies suggest that wakes account for a significant portion of the total wave energy in fetch-limited environments and in turn have the potential to resuspend sediment, erode shorelines, degrade water quality, damage infrastructure, and disrupt aquatic ecosystems, in addition to being considered a safety hazard and a nuisance. To assess the relative contribution of wakes to the total wave energy, monitoring was completed at 32 sites across 7 fetch-limited lakes in Ontario, Canada between 2020 and 2023. The percent wake energy was inversely related to the average fetch length, with deviations to the relationship dependent on whether the site was open, an embayment or along a narrow section of the lake. A survey of property owners and residents suggests that the perceived impact of wakes also varies with the fetch length. Shoreline erosion and degraded water quality were identified as primary impacts of wakes in lakes with the smallest average fetch, but very few respondents provided direct evidence of boat wake impacts. Most respondents described vessel operation, experience of the vessel operator and conflict over different boating uses as the primary issues associated with wakes. While boat wakes may contribute a significant portion of the wave energy in fetch-limited lakes, further research is required to determine when and where they may represent a physical and ecological stressor rather than being just a nuisance.