Reconstruction Of Chest Research Articles

An innovative reconstruction of an enbloc resected composite giant chest and abdominal wall chondrosarcoma with 3D-composite mesh

BackgroundChest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma.Case PresentationA 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up.ConclusionA 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction.

Spondylodiscitis following ingestion of button battery in an infant-a case-based update.

Button battery ingestion in infants is an increasingly common surgical emergency which can lead to oesophageal perforation, mediastinitis, trachea-oesophageal fistulation, airway compromise and death. One exceedingly rare complication of battery ingestion is discitis and osteomyelitis in the cervical and upper thoracic spine. Diagnosis is normally delayed due to the non-specific presentation, delayed imaging findings and the initial clinical focus on dealing with the immediate, and potentially life-threatening, complications. We describe a case of a 1-year-old girl who presented with haematemesis and an oesophageal injury, secondary to button battery ingestion. Sagittal reconstruction of the CT chest demonstrated a suspicious area of vertebral erosion in the cervicothoracic spine which prompted a further evaluation with MRI demonstrating spondylodiscitis of C7-T2 with vertebral erosion and collapse. The child was successfully treated with long course of antibiotics. We wish to highlight the importance of clinical and radiological spinal assessment in children with button battery ingestion to avoid delayed diagnosis and complications of spinal osteomyelitis.

Surgical management of teratoma located in pretracheal retrocaval space: from pre-operative 3D reconstruction to robotic surgery

: The late 1990s saw the development of robotic surgery with its major application in cardiac surgery; since then, robotic technique revealed its huge potential in narrow spaces, like mediastinum. Robotic system properties consent to work safely in restricted areas, thanks to the tridimensional magnified vision and movement accuracy, without conflicts between the instruments. A case of surgical treatment by the robotic approach of teratoma located in pre-tracheal retrocaval space is reported. In the pre-operative phase, a three-dimensional (3D) reconstruction of chest computed tomography (CT) scan images was obtained, to define the correct location of the tumor and its anatomic relationship with adjacent structures. Therefore, pre-operative 3D reconstruction ensures properly planning the operation, minimizing the risk of intraoperative unexpected complications. The surgical removal of the lesion was performed with a robotic 3-arms approach, without complications and with fast recovery. Over the years, robotic indications have been enlarged also to more complex cases, in parallel with the increase in surgeons’ experience. Consequently, preoperative planning of the surgical procedures appears fundamental to establish operative strategies in detail. In this regard, 3D reconstruction of CT scan images may provide an exhaustive vision of the anatomical details, which is useful to plan the surgical procedure and reduce the risk of intraoperative unexpected complications.

Material Analysis of the Remains of a Wooden Chest from the 4th Century and a Proposal for Its Reconstruction

A stone chest found in 1971 near one of the largest early Christian basilicas in Northern Dalmatia (Croatia) contained brass tiles decorated with various biblical scenes. An archaeological study confirmed the thesis that the fragments of brass tiles are most likely the remains of a wooden chest made in the 4th century AD, and that this is one of the best preserved archaeological finds of its kind in the world as one of the biblical scenes shows Mary, together with a record of her name (Maria). Based on the preserved brass tiles, a reconstruction of the wooden chest was made in 1973 with tiles glued onto a plastic frame. Subsequent studies have shown that such a reconstruction was not adequate, as some of the brass tiles were destroyed (disintegrated), and they were not connected properly into a whole that could represent the original. For the new reconstruction of this archaeological object it was necessary to carry out a material analysis, including the chemical composition of the brass tiles, as well as to find a solvent for the glue which could be used to remove the brass tiles from the plastic framework without any additional destruction. Based on extensive investigations and material analyses including the following techniques (SEM, EDX, FTIR, DSC), the starting points for the restoration process of the wooden chest with brass tiles were set, as well as the proposal for the appearance of the new chest.

Anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on three-dimensional reconstruction of chest CT.

With its growing popularity and potential outcome, preoperative three-dimensional reconstruction of chest computed tomography (CT) has been widely used in video-assisted thoracic surgery (VATS) segmentectomy for treating non-small cell lung cancer (NSCLC). This study aimed to summarize the experience of anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on the three-dimensional reconstruction of chest CT. A total of 103 patients with early-stage NSCLC were chosen to undergo VATS segmentectomy based on preoperative three-dimensional reconstruction of chest CT in our institute from September 2019 to July 2022. Data such as clinical characteristics and variations in blood vessels and bronchi were reviewed in this study. The branches of the left lingular pulmonary artery may mutate into the LS1 + 2 + 3. A1 + 2 has four subtypes. The distribution of variation is relatively balanced, and the most common variation is type I (35/103, 33.9%). Most lingular arteries originate from the oblique cleft side of the lingular bronchus (79/103,76.7%). Most V(1 + 2)c* are small developments (70/103, 68.0%). The venous return of the proper segment mainly depends on V(1 + 2)b + c. The variation in the left upper lobe bronchus is complex. The most common variant is the bifurcation type (type A to G, 92/103, 89.3%) and bifurcation type A (62/103, 60.2%). The posterior apical segment artery of the left upper lobe is not accompanied by its bronchus. The variation types of blood vessels and bronchus in the upper lobe of the left lung are complex. Preoperative CT-based three-dimensional reconstruction of pulmonary arteries, veins, and bronchi is of great significance. It can help understand the variations, accurately locate lesions before the surgery, and effectively plan surgeries.

A fully automated noncontrast CT 3-D reconstruction algorithm enabled accurate anatomical demonstration for lung segmentectomy.

BackgroundThree‐dimensional reconstruction of chest computerized tomography (CT) excels in intuitively demonstrating anatomical patterns for pulmonary segmentectomy. However, current methods are labor‐intensive and rely on contrast CT. We hereby present a novel fully automated reconstruction algorithm based on noncontrast CT and assess its performance both independently and in combination with surgeons.MethodsA retrospective pilot study was performed. Patients between May 2020 to August 2020 who underwent segmentectomy in our single institution were enrolled. Noncontrast CTs were used for reconstruction. In the first part of the study, the accuracy of the demonstration of anatomical variants by either automated or manual reconstruction algorithm were compared to surgical observation, respectively. In the second part of the study, we tested the accuracy of the identification of anatomical variants by four independent attendees who reviewed 3‐D reconstruction in combination with CT scans.ResultsA total of 20 cases were enrolled in this study. All segments were represented in this study with two left S1‐3, two left S4 + 5, one left S6, five left basal segmentectomies, one right S1, three right S2, 1 right S2b + 3a, one right S3, two right S6 and two right basal segmentectomies. The median time consumption for the automated reconstruction was 280 (205–324) s. Accurate vessel and bronchial detection were achieved in 85% by the AI approach and 80% by Mimics, p = 1.00. The accuracy of vessel classification was 80 and 95% by AI and manual approaches, respectively, p = 0.34. In real‐world application, the accuracy of the identification of anatomical variant by thoracic surgeons was 85% by AI+CT, and the median time consumption was 2 (1–3) min.ConclusionsThe AI reconstruction algorithm overcame defects of traditional methods and is valuable in surgical planning for segmentectomy. With the AI reconstruction, surgeons may achieve high identification accuracy of anatomical patterns in a short time frame.

Deep learning-based reconstruction of chest ultra-high-resolution computed tomography and quantitative evaluations of smaller airways.

The full-iterative model reconstruction generates ultra-high-resolution computed tomography (U-HRCT) images comprising a 1024×1024 matrix and 0.25mm thickness while suppressing image noises, allowing evaluating small airways 1-2mm in diameter. However, this technique imposes huge computational burdens and requires a long reconstruction time. This study evaluated whether a recently-established deep learning-based reconstruction, Advanced intelligent Clear-IQ Engine (AiCE), allows quantitative morphological analyses of smaller airways with equal or better quality than the full-iterative model reconstruction while shortening the reconstruction time. In phantom tubes mimicking small airways, the measurement error of 0.5-mm-thickness wall was smaller on the AiCE-based than the full-iterative model-based U-HRCT. Moreover, in five patients with chronic obstructive pulmonary disease, the AiCE-based U-HRCT decreased the reconstruction time approximately by 90% with a modest improvement in image noise, contrast, and sharpness compared to the full-iterative model-based U-HRCT. Therefore, the AiCE-based U-HRCT can be readily used clinically for morphologically evaluating peripheral small airways.

Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect.

Background:Three-dimensional (3D) printing of implantable materials is a recent technological advance that is available for clinical application. The most common medical application of 3D printing in plastic surgery is in the field of craniomaxillofacial surgery. There have been few applications of this technology in other areas.Methods:Here, we discuss a case of a large, symptomatic composite thoracic and abdominal defect resulting from the resection of a chondrosarcoma of the costal marginand sections of the abdominal wall, diaphragm, and sternum. The initial and second attempts at reconstruction failed, resulting in a massive hernia. Given the size of the defect, the contiguity with a large abdominal wall defect, and the high risk of recurrence, a rigid thoracic reconstruction was essential to durably repair the thoracic hernia and serve as a scaffold to which both the diaphragm and the abdominal mesh could be secured. A custom-made plate offered the most durable and anatomically accurate reconstruction in this particular clinical scenario. This technology was used in concert with a single section of coated mesh for reconstruction of the diaphragm, chest wall, and abdominal wall.Results:There were no post-operative complications. The patient has improvement of his symptoms and increased functional capacity. There is no evidence of hernia recurrence 1.5 years after repair.Conclusions:3D printing technology proved to be a useful and effective application for reconstruction of this large thoracic defect involving the costal margin. It is an available technology that should be considered for reconstruction of rigid structures with defect-specific precision.

The Utility of the Omentum Flap for Complex Intrathoracic Problems.

Introduction: Omentum flap is a viable reconstructive option for complex chest wall and mediastinal reconstruction. The impact of vasoconstrictors and the laminar pattern of blood flow associated with left ventricular assist devices (LVADs) on the outcomes of reconstructions has not been thoroughly evaluated. Methods: A retrospective review of all patients who underwent chest wall or mediastinal reconstruction using pedicled omentum flaps between 2003 and 2019. Results: Forty patients (60% males) underwent chest wall or mediastinal reconstruction using a pedicled omentum flap at a mean age of 58 years. The median follow-up was 24.3 months. The most common indication was the reconstruction of anterior chest wall/sternal defects (n = 16), followed by coverage of repaired bronchopleural fistula (n = 6), osteoradionecrosis of the anterolateral chest wall (n = 5), reconstruction of anterior/lateral chest wall following oncologic resections (n = 5), coverage of replaced infected LVAD (n = 4), and coverage of exposed/replaced aortic root vascular grafts (n = 4). Vasoconstrictors were used in 26 patients (65%). Eight flaps had partial necrosis, and none of the flaps had complete necrosis. There was no difference in flap complication rates in patients who received vasoconstrictors during the case compared to those who did not (P = 1.0). Thirteen (33%) flaps were skin grafted at a median of 13 days with 100% skin graft viability. Abdominal incisional hernia developed in 8 patients. In patients with LVADs, the omentum remained viable during the follow-up period. Conclusion: The ability of the omentum to easily reach various regions in the chest and the low failure rate make this flap a reliable reconstructive method.

The image quality of deep-learning image reconstruction of chest CT images on a mediastinal window setting

To assess the image quality of deep-learning image reconstruction (DLIR) of chest computed tomography (CT) images on a mediastinal window setting in comparison to an adaptive statistical iterative reconstruction (ASiR-V). Thirty-six patients were evaluated retrospectively. All patients underwent contrast-enhanced chest CT and thin-section images were reconstructed using filtered back projection (FBP); ASiR-V (60% and 100% blending setting); and DLIR (low, medium, and high settings). Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated objectively. Two independent radiologists evaluated ASiR-V 60% and DLIR subjectively, in comparison with FBP, on a five-point scale in terms of noise, streak artefact, lymph nodes, small vessels, and overall image quality on a mediastinal window setting (width 400 HU, level 60 HU). In addition, image texture of ASiR-Vs (60% and 100%) and DLIR-high was analysed subjectively. Compared with ASiR-V 60%, DLIR-med and DLIR-high showed significantly less noise, higher SNR, and higher CNR (p<0.0001). DLIR-high and ASiR-V 100% were not significantly different regarding noise (p=0.2918) and CNR (p=0.0642). At a higher DLIR setting, noise was lower and SNR and CNR were higher (p<0.0001). DLIR-high showed the best subjective scores for noise, streak artefact, and overall image quality (p<0.0001). Compared with ASiR-V 60%, DLIR-med and DLIR-high scored worse in the assessment of small vessels (p<0.0001). The image texture of DLIR-high was significantly finer than that of ASIR-Vs (p<0.0001). DLIR-high improved the objective parameters and subjective image quality by reducing noise and streak artefacts and providing finer image texture.

Extending the Indication of the Superior Thyroid Artery as a Recipient Vessel for Complex Upper Body Defects.

Reconstruction of complex chest and upper back defects can pose a challenge to microsurgeons, especially when prior surgery, scarring, tumor resection, or radiotherapy, have caused a shortage of recipient vessels. Although already being a standard approach for head and neck reconstructions, we investigated whether the indication of the superior thyroid artery (STA) as a safe and universal recipient vessel could be extended for reconstruction in aforementioned regions. Seventeen patients received free myocutaneous vastus lateralis (MVL) muscle flaps for reconstruction of upper body defects (chest n = 11; upper back n = 6). In all cases, the STA was used for microvascular anastomosis because of a lack of standard recipient vessels. A retrospective chart review was performed and the data was screened for patients' demographics, intraoperative and perioperative details, flap survival, surgical complications, and overall long-term outcomes. Patients had a minimum follow-up of 6 months. Defects resulted from infections after cardiac surgery (n = 10), infections after spinal neurosurgery (n = 2) or tumor resection (n = 5). Average defect size measured 144.6 (range, 40-286 cm2; ±67.9 cm2), with a mean size of the MVL free flaps of 266.8 (range, 160-384 cm2; ±69.5 cm2). The flap success rate was 100%, with minor complications in 4 patients. No major complications were observed in any of the patients. The STA is a viable and safe alternative as a recipient vessel for reconstruction of upper body defects, especially when other vessels in proximity to the defect are deprived.

Image Quality and Lesion Detection on Deep Learning Reconstruction and Iterative Reconstruction of Submillisievert Chest and Abdominal CT.

OBJECTIVE. The objective of this study was to compare image quality and clinically significant lesion detection on deep learning reconstruction (DLR) and iterative reconstruction (IR) images of submillisievert chest and abdominopelvic CT. MATERIALS AND METHODS. Our prospective multiinstitutional study included 59 adult patients (33 women, 26 men; mean age ± SD, 65 ± 12 years old; mean body mass index [weight in kilograms divided by the square of height in meters] = 27 ± 5) who underwent routine chest (n = 22; 16 women, six men) and abdominopelvic (n = 37; 17 women, 20 men) CT on a 640-MDCT scanner (Aquilion ONE, Canon Medical Systems). All patients gave written informed consent for the acquisition of low-dose (LD) CT (LDCT) after a clinically indicated standard-dose (SD) CT (SDCT). The SDCT series (120 kVp, 164-644 mA) were reconstructed with interactive reconstruction (IR) (adaptive iterative dose reduction [AIDR] 3D, Canon Medical Systems), and the LDCT (100 kVp, 120 kVp; 30-50 mA) were reconstructed with filtered back-projection (FBP), IR (AIDR 3D and forward-projected model-based iterative reconstruction solution [FIRST], Canon Medical Systems), and deep learning reconstruction (DLR) (Advanced Intelligent Clear-IQ Engine [AiCE], Canon Medical Systems). Four subspecialty-trained radiologists first read all LD image sets and then compared them side-by-side with SD AIDR 3D images in an independent, randomized, and blinded fashion. Subspecialty radiologists assessed image quality of LDCT images on a 3-point scale (1 = unacceptable, 2 = suboptimal, 3 = optimal). Descriptive statistics were obtained, and the Wilcoxon sign rank test was performed. RESULTS. Mean volume CT dose index and dose-length product for LDCT (2.1 ± 0.8 mGy, 49 ± 13mGy·cm) were lower than those for SDCT (13 ± 4.4 mGy, 567 ± 249 mGy·cm) (p < 0.0001). All 31 clinically significant abdominal lesions were seen on SD AIDR 3D and LD DLR images. Twenty-five, 18, and seven lesions were detected on LD AIDR 3D, LD FIRST, and LD FBP images, respectively. All 39 pulmonary nodules detected on SD AIDR 3D images were also noted on LD DLR images. LD DLR images were deemed acceptable for interpretation in 97% (35/37) of abdominal and 95-100% (21-22/22) of chest LDCT studies (p = 0.2-0.99). The LD FIRST, LD AIDR 3D, and LD FBP images had inferior image quality compared with SD AIDR 3D images (p < 0.0001). CONCLUSION. At submillisievert chest and abdominopelvic CT doses, DLR enables image quality and lesion detection superior to commercial IR and FBP images.

Dose reduction with adaptive statistical iterative reconstruction for paediatric CT: phantom study and clinical experience on chest and abdomen CT

To assess the benefit and limits of iterative reconstruction of paediatric chest and abdominal computed tomography (CT). The study compared adaptive statistical iterative reconstruction (ASIR) with filtered back projection (FBP) on 64-channel MDCT. A phantom study was first performed using variable tube potential, tube current and ASIR settings. The assessed image quality indices were the signal-to-noise ratio (SNR), the noise power spectrum, low contrast detectability (LCD) and spatial resolution. A clinical retrospective study of 26 children (M:F = 14/12, mean age: 4years, range: 1-9years) was secondarily performed allowing comparison of 18 chest and 14 abdominal CT pairs, one with a routine CT dose and FBP reconstruction, and the other with 30% lower dose and 40% ASIR reconstruction. Two radiologists independently compared the images for overall image quality, noise, sharpness and artefacts, and measured image noise. The phantom study demonstrated a significant increase in SNR without impairment of the LCD or spatial resolution, except for tube current values below 30-50mA. On clinical images, no significant difference was observed between FBP and reduced dose ASIR images. Iterative reconstruction allows at least 30% dose reduction in paediatric chest and abdominal CT, without impairment of image quality. • Iterative reconstruction helps lower radiation exposure levels in children undergoing CT. • Adaptive statistical iterative reconstruction (ASIR) significantly increases SNR without impairing spatial resolution. • For abdomen and chest CT, ASIR allows at least a 30% dose reduction.

2D image reconstruction of a human chest by using Calderon's method and the adjacent current pattern

In this paper, Calderon's method is applied to a chest-like sensing region, as monitored by electrical impedance tomography. This method provides a direct algorithm for image reconstruction, where the gray value at any pixel of the reconstructed image is computed using a direct and independent approach. The major calculations of image reconstruction in Calderon's method are implemented for a circular boundary and, as a result, the complicated calculations of the scattering transform, as required by non-circular boundaries, are avoided. A unique conformal transformation is used to map a unit disk onto a sensing region with a non-circular boundary, such as a chest-like region. A new method to calculate the Dirichlet-to-Neumann map is also introduced, which is used to compute the scattering transform. The feasibility of the proposed method has been validated by testing the construction of phantoms with chest-like boundaries. Data collected from the chest of a male subject has been used to visualize lung movement, as monitored by the electrical impedance tomography system.

Radiation Dose Reduction with Hybrid Iterative Reconstruction for Pediatric CT

To assess image quality and radiation dose reduction with hybrid iterative reconstruction of pediatric chest and abdominal computed tomographic (CT) data compared with conventional filtered back projection (FBP). A total of 234 patients (median age, 12 years; age range, 6 weeks to 18 years) underwent chest and abdominal CT in this institutional review board-approved HIPAA-compliant retrospective study. CT was performed with a hybrid adaptive statistical iterative reconstruction (ASIR)-enabled 64-detector row CT scanner. Scanning protocols were adjusted for clinical indication and patient weight to enable acquisition of reduced-dose CT images in all patients, and tube current was further lowered for ASIR protocols. Weight, age, and sex were recorded, and objective noise was measured in the descending thoracic aorta for chest CT and in the liver for abdominal CT. Of the 234 consecutive patients who underwent ASIR-enabled CT (115 chest and 119 abdominal examinations), 70 patients had undergone prior FBP CT. ASIR and FBP CT studies (29 chest and 41 abdominal studies) in these 70 patients were reviewed for image quality, artifacts, and diagnostic confidence by two pediatric radiologists working independently. Data were analyzed with multiple paired t tests. Compared with FBP, ASIR enabled dose reduction of 46.4% (3.7 vs 6.9 mGy) for chest CT and 38.2% (5.0 vs 8.1 mGy) for abdominal CT (P < .0001). Both radiologists deemed image quality of and diagnostic confidence with ASIR and FBP CT images as acceptable, without any artifacts. Despite the lower radiation dose used, ASIR images (chest, 10.7 ± 2.5 [mean ± standard deviation]; abdomen, 11.8 ± 3.4) had substantially less objective noise than did FBP images (chest, 13.3 ± 3.8; abdomen, 13.8 ± 5.2) (P = .001, P =.006, respectively). Use of a hybrid iterative reconstruction technique, such as ASIR, enables substantial radiation dose reduction for pediatric CT when compared with FBP and maintains image quality and diagnostic confidence.

Reconstruction of the Anterior Chest for Radiation Ulcer and Radiation Sarcoma with Contralateral Pedicled Latissimus Dorsi Flap

Reconstruction of the Anterior Chest for Radiation Ulcer and Radiation Sarcoma with Contralateral Pedicled Latissimus Dorsi Flap

Continuous Diaphragm Sign

An 11-year-old female presented to the emergency department with fever of 1 day's duration and sore throat. Her family described a 3-week history of cough with fever, trouble breathing, and wheezing. Her medical history included panhypopituitarism and asthma, and she was receiving steroid replacement therapy. She had recently undergone a dental extraction. Examination showed a temperature of 39.5°C, a 3/6 systolic murmur, bibasilar rales, and palpable cervical subcutaneous emphysema. On chest radiograph, the diaphragm appeared continuous and was not obscured by the inferior heart border (Figure 1). A computed tomography scan demonstrated the same finding (Figure 2). Figure 1 Frontal chest radiograph. The diaphragm is not obscured by the inferior heart border (black arrows). Figure 2 Coronal reconstruction of chest computed tomography scan demonstrates a clear space between the heart and diaphragm (black arrows). The images depict a “continuous diaphragm sign,” an infrequent indicator of pneumomediastinum.1 It is seen on a frontal radiograph when gas in the mediastinum separates the heart and the superior surface of the diaphragm, and it can be seen on either upright or supine views.1,2 A continuous diaphragm may also be seen with pneumopericardium, although it is much less common.3,4 Distinguishing the 2 conditions radiographically can be challenging, but pneumopericardium typically appears as an isolated broad band around the heart rather than the multiple thin lucent streaks extending into neck seen with pneumomediastinum.3 Pneumomediastinum occurs after alveolar rupture as gas travels along the bronchovascular interstitial sheaths into the mediastinum.3,5 Nontraumatic causes include invasive procedures and mechanical ventilation, airway obstruction, barotrauma, and pulmonary or pericardial infections, and it has also been described after dental extractions.3–6 Spontaneous pneumomediastinum is rare and usually benign, and tends to occur in males and younger patients.7,8 Common symptoms of pneumomediastinum are chest pain and dyspnea, and signs are subcutaneous emphysema, wheezing, and Hammon sign.3,7,8 Differential diagnoses include pneumothorax and esophageal rupture, and complications include hypotension from impaired venous return, tension pneumothorax, and cardiac tamponade.3,4,7 Most cases follow a benign course and require no therapy, although in 1 series prophylactic antibiotics were given and all cases resolved without complication.8

Intercostal adipofascial perforator flap for reconstruction of overcorrected gynaecomastia deformity

The intercostal perforator fasciocutaneous flap has previously been described in addressing defects in the breast, trunk and arm 1,2,. We describe the first case of an inter-costal artery perforator adipofascial flap in the reconstruction of the male chest following overcorrection of gynaecomastia.

The novel use of Nuss bars for reconstruction of a massive flail chest

The novel use of Nuss bars for reconstruction of a massive flail chest

Time-of-flight sensor for respiratory motion gating

In this technical note we present a system that uses time-of-flight (ToF) technology to acquire a real-time multidimensional respiratory signal from a 3D surface reconstruction of the patient's chest and abdomen without the use of markers. Using ToF sensors it is feasible to acquire a 3D model in real time with a single sensor. An advantage of ToF sensors is that their high lateral resolution makes it possible to define multiple regions of interest to compute an anatomy-adaptive multidimensional respiratory signal. We evaluated the new approach by comparing a ToF based respiratory signal with the signal acquired by a commercially available external respiratory gating system and achieved an average correlation coefficient of 0.88.