Postoperative CT Scan Images Research Articles

The Value of Axial Imaging to Check Reduction after Anterior Approach Open Reduction for Developmental Dysplasia of the Hip

Background: There are still many controversies regarding the diagnosis and management of developmental dysplasia of the hip (DDH). Axial imaging is routinely used after closed or open reduction to confirm reduction has occurred. In this study, we aimed to determine the rate of early re-dislocation or failure of reduction after anterior approach open reduction (AOR), to establish whether there is a true need for routinely performing post-operative axial imaging.
 Methods: We retrospectively reviewed radiographs, operation notes and post-operative CT scan images of our AOR cases from September 2018 to June 2020. The CT scan images were reviewed to check the post-operative reduction and congruency. The ‘posterior neckline’ and the ‘modified Shenton line’ were used to assess reduction. The related literature was also reviewed.
 Results: Thirty patients were included. The post-operative CT scans confirmed that all cases had reduced congruent hips. The CT scans did not change future treatment plans for any patient in this cohort and did not predict late re-dislocation.
 Conclusions: The rate of early re-dislocation or failure of reduction after AOR was negligible. Traditional routine axial imaging after this operation is therefore unjustified and has no value in predicting possible late re-dislocations. It also comes at the cost of extra radiation to the child and expense for the health system. We recommend stopping the routine use of post-operative axial imaging and using it selectively for specific indications, including teratologic and neuromuscular hips, bilateral DDH, and after revision surgery, in addition to closed reductions and medial approach open reduction.

Efficacy of navigation system-assisted distraction osteogenesis for hemifacial microsomia based on artificial intelligence for 3 to 18 years old: study protocol for a randomized controlled single-blind trial

BackgroundMandibular distraction osteogenesis (MDO) is a major part of the treatment for hemifacial microsomia patients. Due to the narrow surgical field of the intraoral approach, osteotomy accuracy is highly dependent on the surgeons’ experience. Electromagnetic (EM) tracking systems can achieve satisfying accuracy to provide helpful real-time surgical navigation. Our research team developed an EM navigation system based on artificial intelligence, which has been justified in improving the accuracy of osteotomy in the MDO in animal experiments. This study aims to clarify the effect of the EM navigation system in improving the MDO accuracy for hemifacial microsomia patients.MethodsThis study is designed as a single-centered and randomized controlled trial. Altogether, 22 hemifacial microsomia patients are randomly assigned to the experiment and control groups. All patients receive three-dimensional CT scans and preoperative surgical plans. The EM navigation system will be set up for those in the experiment group, and the control group will undergo traditional surgery. The primary outcome is the surgical precision by comparing the osteotomy position of pre- and postoperative CT scan images through the Geomagic Control software. The secondary outcomes include mandibular symmetry (occlusal plane deviation angle, mandibular ramus height, and body length), pain scale, and complications. Other indications, such as the adverse events of the system and the satisfactory score from patients and their families, will be recorded.DiscussionThis small sample randomized controlled trial intends to explore the application of an EM navigation system in MDO for patients, which has been adopted in other surgeries such as orthognathic procedures. Because of the delicate structures of children and the narrow surgical view, accurate osteotomy and protection of nearby tissue from injury are essential for successful treatment. The EM navigation system based on artificial intelligence adopted in this trial is hypothesized to provide precise real-time navigation for surgeons and optimally improve patient outcomes, including function and aesthetic results. The results of this trial will extend the application of new navigation technology in pediatric plastic surgery.Trial registrationChinese Clinical Trial Registry ChiCTR2200061565. Registered on 29 June 2022.

Evaluation of one-point fixation surgery with computer-aided root mean square deviation in zygomaticomaxillary complex fractures

Aims: Our paper aimed to present the results of the one-point fixation method in zygomaticomaxillary fractures by computer-aided mirror image superimposition with root mean square (RMS) deviation.
 Methods: One-point fixation performed zygomaticomaxillary complex fracture patients (n=18) by one surgeon were included in our study. Virtual 3D data of preoperative and postoperative CT-scan images was obtained by Slicer software. Sagittal plan mirror image superpositioning were used to obtain RMS data by Slicer. Mirror image superimposition of the undamaged side to the broken side in preoperative CT-scan imaging was referred as group B or broken group. Superposition of the repaired side’s postoperative imaging to the preoperative broken side was measured as group R or repair group in order to examine zygomatic bone’s postoperative spatial location. Superpositioned mirror 3D images of the non-traumatic side onto post-fixation 3D in postoperative data was measured as group M or mirror group. RMS deviation values of the groups obtained by Slicer were statistically compared.
 Results: Shapiro-Wilk test of groups were demonstrated normal distribution of the data for each group with no difference (p>0.05). In order to compare between groups, paired t-test covariance analysis were shown statistically similar data distrubition between experimental groups (p>0.05).
 Conclusion: Considering the nature of maxillofacial surgery, which disapproves even millimetric errors, we believe that the mean square root deviation will become standard as it allows three-dimensional evaluation and precise mathematical measurements. Besides, in accordance with the recent literature, this study might pay the way for future studies that would increase the usage of the one-point fixation method conducted on larger case series, as this method prevents lower eyelid complications without a visible scar.

Retrograde Cystonephroscopy for Complex Renal Calculi Using Novel Dual-Action Aspiration, Irrigation Cystoscope: Initial Case Series.

Introduction: Percutaneous nephrolithotomy is the gold standard treatment for kidney stones ≥2 cm; however, it remains an invasive procedure with significant risks especially in individuals with severe medical comorbidities. In contrast, while ureteroscopy is far less morbid, a major impediment to its use for larger calculi is the inability to evacuate the many fragments created during laser lithotripsy. Herein, we describe two patients with large-volume calculi and a third high-risk patient with a smaller stone who were treated with cystonephroscopy using a recently released, 16F flexible cystoscope equipped with dual aspiration and irrigation capabilities. Materials and Methods: Three consecutive female patients underwent retrograde cystonephroscopy from June 2021 to July 2021 with a novel 16F aspiration-enabled flexible cystoscope. Demographic data were collected. Preoperative and postoperative CT scan images were reviewed to determine linear stone dimensions and scalene ellipsoid volume. Results: The three female patients had an average age of 72.3 years and an American Society of Anesthesiologists (ASA) physical status score of 3. The mean preoperative stone volume was 4950 mm3. The average postcystonephroscopy stone volume was 217 mm3, resulting in a total stone clearance rate of 97%. No major complications occurred. The average procedure time was 176 minutes. Conclusions: Among the three high-risk female patients, two with large-volume calculi, retrograde cystonephroscopy with a novel aspiration-enabled cystoscope allowed for the procedure to be effectively completed solely via a retrograde approach.

Relationship of the Location of the Ventricular Catheter Tip and Function of the Ventriculoperitoneal Shunt

Object: The objective of this study was to determine the relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt.
 Methods: This prospective observational study included 140 patients from a single institution who underwent a ventriculoperitoneal shunt procedure in which a new ventricular catheter was placed between September, 2013 and September 2016. Data abstracted for each patient included age, sex, diagnosis, site and side of ventricular catheter placement. Postoperative CT scan images were reviewed for accuracy of ventricular catheter placement. Patients were followed up over 2 ½ to 4 ½ years.63 patients were available for follow up. We lost communication with rest of the patients. The relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt was analyzed in 63 patients.
 Results: There were 140 patients included in the study; accuracy ventricular catheter tip placement were 55 (39.28%) using freehand technique. VP shunt functioned well in 43 (68.25%) of 63 patients. Among the 43 patients with well functioning shunt ,19 were in accurate group ,7 were in suboptimal group and 17 were in inaccurate group.26 patients (41.27%) had good outcome with normal development and normal IQ
 Conclusions: Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus. Above all, a significant proportion of shunt failure was due to obstruction of the ventricular catheter, and accurate placement of the shunt catheter is highly important to reduce the incidence of shunt malfunction.
 Bang. J Neurosurgery 2019; 9(1): 16-21

Accuracy of Ventricular Catheter Tip Placement Using Freehand Placement

Background: Inaccurate placement of VP shunt catheter is related to shunt failure.
 Objective: The objective of this study was to determine the accuracy of ventricular catheter placement during ventriculoperitoneal shunt operations using the freehand technique.
 Methodology: This prospective observational study included all patients from a single institution who underwent a ventriculoperitoneal shunt procedure in which a new ventricular catheter was placed between September 2013 and August 2016 for a period of three (03) years. Data abstracted for each patient included age, sex, diagnosis, site and side of ventricular catheter placement. Postoperative CT scan images were reviewed for accuracy of ventricular catheter placement.
 Results: There were 140 patients included in the study; accuracy ventricular catheter tip placement were 55 (39.28%) using freehand technique.
 Conclusion: Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 59-63

Effect of image fusion technology of radioactive particles implantation before and after the planning target and dosimetry

Objective: To compare the post-implant target volumes and dosimetric evaluation with pre-plan, the gross tumor volume(GTV) by CT image fusion-based and the manual delineation of target volume in CT guided radioactive seeds implantation. Methods: A total of 10 patients treated under CT-guidance (125)I seed implantation during March 2016 to April 2016 were analyzed in Peking University Third Hospital.All patients underwent pre-operative CT simulation, pre-operative planning, implantation seeds, CT scanning after seed implantation and dosimetric evaluation of GTV.In every patient, post-implant target volumes were delineated by both two methods, and were divided into two groups. Group 1: image fusion pre-implantation simulation and post-operative CT image, then the contours of GTV were automatically performed by brachytherapy treatment planning system; Group 2: the contouring of the GTV on post-operative CT image were performed manually by three senior radiation oncologists independently. The average of three data was sets. Statistical analyses were performed using SPSS software, version 3.2.0. The paired t-test was used to compare the target volumes and D(90) parameters in two modality. Results: In Group 1, average volume of GTV in post-operation group was 12-167(73±56) cm(3). D(90) was 101-153 (142±19)Gy. In Group 2, they were 14-186(80±58)cm(3) and 96-146(122±16) Gy respectively. In both target volumes and D(90), there was no statistical difference between pre-operation and post-operation in Group 1.The D(90) was slightly lower than that of pre-plan group, but there was no statistical difference (P=0.142); in Group 2, between pre-operation and post-operation group, there was a significant statistical difference in the GTV (P=0.002). The difference of D(90) was similarly (P<0.01). Conclusion: The method of delineation of post-implant GTV through fusion pre-implantation simulation and post-operative CT scan images, the contours of GTV are automatically performed by brachytherapy treatment planning system appears to have improved more accuracy, reproducibility and convenience than manual delineation of target volume by maximum reduce the interference from artificial factor and metal artifacts. Further work and more cases are required in the future.

Postoperative chemoradiotherapy following pancreaticoduodenectomy

The purpose of this research was to analyze the relationship between dose-volumetric parameters and the development of diabetes mellitus (DM) in patients treated with chemoradiotherapy (CRT) following curative resection for upper gastrointestinal (GI) cancers. Medical records of patients who underwent postoperative CRT following curative resection, either pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for upper GI cancers including pancreas, biliary, ampullary, and duodenal cancers, between January 2006 and December 2008 were retrospectively reviewed. A total of 42patients who were regularly followed for at least 2years were included for analysis. Dose-volumetric parameters such as remnant pancreatic volume, mean dose, maximum dose (Dmax), and percentage of volume receiving specific dose or more were obtained from pre- and postoperative CT scan images and treatment plan. Dmax and V50 (percentage of volume receiving at least 50Gy) were statistically significant factors for the development of DM (p = 0.013, p = 0.031, respectively). The sensitivity and specificity of Dmax was 0.875 and 0.559, with cut-off value of 51.1Gy, respectively. V50 had sensitivity of 0.875 and specificity of 0.618 for cut-off value of 16 %. No patient-related factor other than pretreatment cerebrovascular events was associated with the development of DM. On multivariate analysis, V50 was the only factor with statistical significance (p = 0.028), whereas Dmax showed borderline significance (p = 0.079). V50 was the only independent factor associated with the development of diabetes and may function as guideline to predict the development of DM in patients receiving CRT following curative resection.

P21. Postoperative CT Scan Analysis of Thoracolumbar Reconstructions

BACKGROUND CONTEXT: Corpectomy is utilized in the thoracolumbar spine to decompress the neural elements when the involved vertebra(e) are resected for trauma, infection, or neoplasm. After decompression, reconstruction is performed to provide anterior column support and facilitate fusion. This study analyzed postoperative CT scan images to determine the percentage of vertebral body coverage, the footprint, provided by the stabilization construct.

Sagittal Synostosis

We reviewed our experience with nine consecutive patients with untreated isolated nonsyndromic sagittal synostosis. Using a method of 14 clinically relevant measurements taken from preoperative and postoperative CT scan images of these patients, we documented their presenting skeletal dysmorphology and the results of surgical correction at least 1 year after operation. Significant preoperative findings included an elongated cranial vault length that averaged 103 percent of normal and a narrowed cranial vault width both anteriorly at 92 percent and posteriorly at 86 percent of normal. Results of surgical correction, as documented by CT scan measurements, included normalization of the cranial length to 100 percent and of the anterior width to 101 percent of normal and improvement (but undercorrection) of the posterior width to 94 percent of normal. Quantitative measurement of CT scan images confirmed clinically observed findings in these patients before suture release and reconstruction and proved useful in assessing the surgical results achieved.