Types Of Clips Research Articles

Quantification of breast biopsy clip marker artifact on routine breast MRI sequences: a phantom study

BackgroundTo investigate the artifact sizes of four common breast clip-markers on a standard breast magnetic resonance imaging (MRI) protocol in an in vitro phantom model.MethodsUsing 1.5-T and 3-T whole-body scanners with an 18-channel breast coil, artifact dimensions of four breast biopsy markers in an agarose-gel phantom were measured by two readers on images obtained with the following sequences: T2-weighted fast spin-echo short inversion time fat-suppressed inversion-recovery with magnitude reconstruction (T2-TIRM); T1-weighted spoiled gradient-echo with fat suppression (T1_FL3D), routinely used for dynamic contrast-enhanced imaging; diffusion-weighted imaging (DWI), including a readout segmented echo-planar imaging (RESOLVE-DWI) and echo-planar imaging sequence (EPI-DWI). After outlining the artifacts by freehand regions of interest, sagittal and lateral diameters in axial images were measured.ResultsInterreader agreement for artifact size quantification was high, depending on the sequence (80.4–94.8%). Overall, the size, shape, and appearance of artifacts depended on clip type and MRI sequence. The artifact size ranged from 5.7 × 8.5 mm2 to 13.4 × 17.7 mm2 at 1.5 T and from 6.6 × 8.2 mm2 to 17.7 × 20.7 mm2 at 3 T. Clip artifacts were largest on EPI-DWI and RESOLVE-DWI (p ≤ 0.016). In three out of four clips, T2-TIRM showed the smallest artifact (p ≤ 0.002), while in one clip the artifact was smallest on T1_FL3D (p = 0.026). With the exception of one clip in the RESOLVE sequence, all clips showed a decrease in the artifact area from DWI to ADC images (p ≤ 0.037).ConclusionBreast clip-marker MRI artifact appearances depend on clip type, field strength, and sequence and may reach a significant size, potentially obscuring smaller lesions and hindering accurate assessment of breast tumors.Relevance statementConsiderable variations in artifact size and characteristics across different breast clips, MRI sequences, and field strengths exist. Awareness of these artifacts and their characteristics is essential to ensure accurate interpretation of scans and appropriate treatment planning.Key PointsAwareness of breast clip artifacts is essential for accurate interpretation of MRI.The appearance of artifacts depends on breast clip type, field strength, and sequence.Clip-related artifacts might hinder the visibility of small lesions.Graphical

Computational simulation model of transcatheter edge-to-edge mitral valve repair: a proof-of-concept study.

As transcatheter mitral valve (MV) interventions are expanding and more device types and sizes become available, a tool supporting operators in pre-procedural planning and the clinical decision-making process is highly desirable. We sought to develop a finite element computational simulation model to predict the results of transcatheter edge-to-edge repair (TEER) interventions. We prospectively enrolled patients with secondary mitral regurgitation (MR) referred for a clinically indicated TEER. The 3D trans-oesophageal echocardiograms performed at the beginning of the procedure were used to perform the simulation. On the 3D dynamic model of the MV that was first obtained, we simulated the clip implantation using the same clip type, size, number, and implantation location that was used during the intervention. The 3D model of the MV obtained after the simulation of the clip implantation was compared with the clinical results obtained at the end of the intervention. We analysed the degree and location of residual MR and the shape and area of the diastolic MV area. We performed computational simulation on five patients. Overall, the simulated models predicted well the degree and location of the residual regurgitant orifice(s) but tended to underestimate the diastolic mitral orifice area. In this proof-of-concept study, we present preliminary results on our algorithm simulating clip implantation in five patients with functional MR. We show promising results regarding the feasibility and accuracy in terms of predicting residual MR and the need to improve the estimation of the diastolic MV area.

Three-dimensional Images Fusion Method Useful for Preoperative Simulation of Clipping Surgery for Cerebral Aneurysms.

This study aimed to introduce a three-dimensional (3D) images fusion method for preoperative simulation of aneurysm clipping. Consecutive unruptured aneurysm cases treated with surgical clipping from March 2021 to October 2023 were included. In all cases, preoperative images of plain computed tomography (CT), CT angiography, magnetic resonance imaging (MRI) 3D fluid-attenuated inversion recovery, 3D heavily T2-weighted images, and 3D rotational angiography were acquired and transported into a commercial software (Ziostation2 Plus, Ziosoft, Inc. Tokyo, Japan). The software provided 3D images of skull, arteries including aneurysms, veins, and brain tissue that were freely rotated, magnified, trimmed, and superimposed. Using the 3D images fusion method, two operators predicted clips to be used in the following surgery. The predicted clips and actually used ones were compared to give agreement scores for the following factors: (1) type of clips (simple or fenestrated), (2) shape of clips (straight, curved, angled, or bayonet), and (3) clipping strategy (single or multiple). The agreement score ranged from 0 to 3 because a score of 1 or 0 was given for agreement or disagreement on each factor. Interoperator reproducibility was also evaluated. During the study period, 44 aneurysms from 37 patients were clipped. All procedures were successfully completed, thanks to the precisely reproduced surgical corridors with the 3D images fusion method. Agreement in clip prediction was good with mean agreement score of 2.4. Interobserver reproducibility was also high with the kappa value of 0.79. The 3D images fusion method was useful for preoperative simulation of aneurysm clipping.

Inside out. Social media videos and destination branding. Neuromarketing using EEG technique

PurposeThis study aims to investigate the effectiveness of two types of social media videos used for destination image development: induced/commercial-oriented content and organic content (where content is made without commercial interest, such as vlogs classified as user-generated content).Design/methodology/approachExperimental research using “Emotive EEG” (electroencephalogram) in a controlled environment was conducted with 30 participants (20 males, 10 females), age range 18 to 26. Emotive EEG recording was performed while the participants watched both types of video clips. Test results for both groups indicate that induced content is preferred over organic content.FindingsThis study opens up future research avenues where neuromarketing’s “Marketer Friendly” EEG equipment can be applied to the customer selection process.Originality/valueMarketing analysts can gauge the interest and response of customers on different types of social media video content for destination marketing based on the findings of this study.

Slang Words Found In Nicky Minaj's Songs

This research aims to identify types of slang words and calculate the types of slang words that often appear in Nicky Minaj's song lyrics. This study used Allan and Burridge's (2006) theory of slang words to analyze the data. This research obtained data from transcripts obtained from the internet. The researcher searched for and collected the three required song lyrics which contained the data the researcher needed. The researcher read the song lyrics intensively, that is, the researcher analyzed the research and focused on the data. Based on the analysis found, researchers found 40 slang words in Nicky Minaj's song lyrics. Researchers found 20 slang words with the clipping type (50%), ten slang words with the fresh and creative type (25%), one slang word with the flippant type (2.5%), three slang words with the imitative type (7.5 %), and six slang words with acronym type (15%). The most dominant type of slang word in Nicky Minaj's song lyrics is clipping.

Research on Emotion Recognition Method of Cerebral Blood Oxygen Signal Based on CNN-Transformer Network.

In recent years, research on emotion recognition has become more and more popular, but there are few studies on emotion recognition based on cerebral blood oxygen signals. Since the electroencephalogram (EEG) is easily disturbed by eye movement and the portability is not high, this study uses a more comfortable and convenient functional near-infrared spectroscopy (fNIRS) system to record brain signals from participants while watching three different types of video clips. During the experiment, the changes in cerebral blood oxygen concentration in the 8 channels of the prefrontal cortex of the brain were collected and analyzed. We processed and divided the collected cerebral blood oxygen data, and used multiple classifiers to realize the identification of the three emotional states of joy, neutrality, and sadness. Since the classification accuracy of the convolutional neural network (CNN) in this research is not significantly superior to that of the XGBoost algorithm, this paper proposes a CNN-Transformer network based on the characteristics of time series data to improve the classification accuracy of ternary emotions. The network first uses convolution operations to extract channel features from multi-channel time series, then the features and the output information of the fully connected layer are input to the Transformer netork structure, and its multi-head attention mechanism is used to focus on different channel domain information, which has better spatiality. The experimental results show that the CNN-Transformer network can achieve 86.7% classification accuracy for ternary emotions, which is about 5% higher than the accuracy of CNN, and this provides some help for other research in the field of emotion recognition based on time series data such as fNIRS.

Evaluating the use of standing seam roof as beam lateral bracing

The standing seam roof (SSR) system is the most commonly used roof system for metal buildings in North America, wherein, SSR panels are attached to Z-shaped or C-shaped purlins with clips, which are in turn connected to rafters (i.e. roof beams). For the design of the rafters against lateral torsional buckling, bottom flange braces in conjunction with the purlin provide torsional bracing. Separately, the purlin provides some amount of lateral bracing to the rafter top flange; although, the degree to which the SSR system can restrain the purlin against lateral movement, and thus laterally brace the rafter, has not previously been studied. The objective of this study is to quantify the in-plane strength and stiffness of the SSR system and identify how this translational resistance can be used to provide lateral bracing to the rafter. A total of 11 standing seam roof specimens were tested to investigate the effects of different standing seam roof configurations: SSR panel type, clip type, thermal insulation, and purlin spacing, on the in-plane stiffness and strength of the SSR system. Results showed that the in-plane load-deformation behavior of SSR systems was governed by clip deformations, and that in-plane strength and stiffness is, therefore, particularly sensitive to SSR panel and clip type. A method for using these experimental results in calculations of rafter bracing is described and can lead to reduced size and frequency of bottom flange braces.

Study on Mechanical Properties and Degradation Behavior of Magnesium Alloy Vascular Clip.

The Mg alloy vascular clip has biodegradability and good biocompatibility, which can improve the convenience and safety of clinical application. However, the Mg alloy vascular clip also has some disadvantages, such as an unreasonable structure design and a degradation rate which is too fast. In this study, the process of clamping blood vessels with a biodegradable Mg alloy (Mg-Zn-Nd-Zr and Mg-Zn-Nd) general V-type vascular clip was simulated by finite element simulation software (Abaqus). A new type of vascular clip, the P-type vascular clip, was analyzed and investigated through simulation. The differences between Mg alloy vascular clips of V-type and P-type were analyzed by finite element simulation. In addition, the effects of Zr element on the mechanical properties and corrosion resistance of P-type vascular clips were also investigated to improve the mechanical stability. The results show that during the V-type vascular clip closure of Mg-Zn-Nd-Zr alloy, this clip has some problems, such as uneven distribution of blood vessel stress, crevices in blood vessels and stress concentration. The improved P-type vascular clip has uniform closure, and there is no gap in the blood vessel, which can effectively avoid stress concentration. The improved P-type vascular clip is well closed and can effectively avoid stress concentration. The corrosion resistance of the Mg-Zn-Nd-Zr alloy P-type clip was better than that of the Mg-Zn-Nd alloy P-type clip (degradation rate of 2.02 mm/y and 2.61 mm/y on the 7th day, respectively). Mg-Zn-Nd-Zr alloy The P-type vascular clip remained closed even on the 7th day, which could meet the requirements of clinical application.

1186 Cholecystectomy Operation Notes - a Review and Core Trainee Survey

Abstract Aim The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies. Method A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%. Results 109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure. Conclusions The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.

131 Cholecystectomy operation notes - a review and core trainee survey

Abstract Aim The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies. Methods A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%. Results 109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure. Conclusion The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.

Production Capacity Variations of Horizontal Wells in Tight Reservoirs Controlled by the Structural Characteristics of Composite Sand Bodies: Fuyu Formation in the Qian’an Area of the Songliao Basin as an Example

In order to improve the combined exploitation efficiency of horizontal and vertical wells, and given the fact that the complex and varied spatial structure of sand bodies in the Fuyu oil layer in the Qian’an area of Songliao Basin leads to significant differences in production characteristics of horizontal wells, the sand body types and internal spatial structure are finely dissected according to the theory of configuration analysis, and the internal spatial structure is divided into three configuration styles: spatial clipping type, overlapping type, and separation type. Then, by comparing the productivity characteristics of horizontal wells with different configurations of sand bodies, combined with the analysis of fluid flow law under horizontal well volume fracturing, a main fracture–fracture network–matrix coupled fluid flow model in a tight reservoir based on composite sand body configuration is established. Combined with the actual volume fracturing the horizontal well area, the productivity curves of each cluster in the horizontal section after numerical simulation of volume fracturing of typical horizontal well groups are extracted, which are divided into four types: high-yield stable type, high-yield two-stage type, high-yield rapid-decline type, and low-yield rapid-decline type, and the coupling relationship between the productivity characteristics of each cluster in the horizontal well volume fracturing and sand body configuration style is established, which provides a theoretical basis for the adjustment of different sand body development methods in subsequent oilfields.

Functional brain network based multi-domain feature fusion of hearing-Impaired EEG emotion identification

In the past, Electroencephalography (EEG)-based emotion identification research mainly focused on healthy, disordered, or depressed subjects. Due to the lack of an emotion acquisition and expression channel, there may be a bias in affective cognition for the hearing impaired. In this work, 15 hearing-impaired subjects were recruited to participate in an emotional movie-induced experiment, while their EEG signals were collected for emotion recognition. Four types of movie clips, which contained happiness, calmness, sadness, and fear, were selected. We fused three kinds of features, differential entropy (DE), power spectral density (PSD), and functional brain network to integrate the frequency domain and the spatial domain information of EEG signals. To find the brain region connections of different emotions, different coupling methods, and binarization methods were explored. Moreover, the combination of different brain network attributes was used to find the representativeness of emotional information in the spatial domain. The experimental results show that the combination of phase-locked value (PLV) & 20% sparsity with four brain network attributes (clustering coefficient (CC), node degree (ND), node betweenness centrality (NBC), and node strength (NS)) achieved a higher accuracy of 94.17% for functional brain network-based emotion recognition. In addition, the method of feature fusion obtained a classification accuracy of 95.91% with an SVM-Linear classifier. Moreover, by constructing functional brain network, the key connectivity paths of different emotions are explored, which may provide insights into understanding the emotional processing of the hearing-impaired.

ASSESSMENT OF THE RELATIONSHIP OF INTERNET ADDICTIVE BEHAVIOR AND CLIP THINKING IN SCHOOLCHILDREN

The purpose of the study. To assess the relationship between Internet addictive behavior and clip thinking in schoolchildren
 Materials and methods. 59 students of both sexes of the 8th grade of secondary school № 84 of Krasnoyarsk took part in the study. A modified test based on the J.S. Bruner questionnaire was used to diagnose the clip type of thinking. The level of Internet addiction was assessed using the CIAS scale.
 Results. A pronounced and stable pattern of Internet addictive behavior on the CIAS scale was detected in 15,2% of the surveyed schoolchildren, among whom there were three times more girls compared to boys. The frequency of gambling addiction was higher in boys than in girls, while the frequency of dependence on social networks was 2 times higher among girls. The clip type of thinking was revealed in a third of the surveyed schoolchildren with the same frequency among both boys and girls. At the same time, persons with a theoretical type of thinking were more common among girls, and with a creative type of thinking – among boys. In Internet-addicted girls and boys, clip-type thinking was detected in half of the subjects in both groups.
 Conclusion. Among the identified students with the clip type of thinking, 50% belonged to people with Internet addictive behavior.

An Eye Tracking Investigation of Young People’s Gaze Behaviour to Gambling and Non-Gambling Moving Adverts

Introduction: Data from several areas of public health (e.g., harmful alcohol and tobacco) are consistent with the assertion that children’s exposure to advertising strategies increases intention to consume such products. Most studies have measured self-rated impact of gambling advertising using questionnaires. Given that gambling advertisements come in different forms such as print media/television advertising and contain variable content, it is difficult to understand using subjective measures which aspects of the gambling advertisements increase craving and desire to trigger a gambling session. In the present study, we applied a novel data-driven methodology that directly tracks eye movements to reveal attentional biases towards gambling adverts and promotions by examining differences in young people’s eye gaze behaviour when watching gambling and non-gambling (control) moving adverts. Method: A total of 98 (16–18 years old) children who self-identify as having a low or high craving to gambling watched gambling and non-gambling (control) television adverts, while their eye movements were recorded. Results: The results show that the data-driven method can isolate video clips that best distinguish people on the low-high craving spectrum, reveal the type of each video clip with the largest group differences, and accurately predict young people’s gambling craving on the basis of eye movement patterns. Conclusion: Our findings demonstrate that young people’s craving for gambling can be predicted based on their eye movements to video clips of gambling advertisements and that certain features of gambling advertisements may be more appealing to some group of viewers, particularly those with high craving for gambling.

The Effect of the Ring Spinning Machine Top Drafting Roller Hardness and the Fiber Blend Ratio on the Quality of Yarn

The ring spinning machine, in which the fibers are converted from the roving form to yarn, applies higher draft than the roving frame and roving frame. The rate and control of this draft has a great importance on yarn quality. During this controlled shooting, the hardness of the upper drafting rollers and the size of the clips placed on the aprons are of great importance. The cot stiffness and the clip type determine the dimensions of the fiber clamping surface between the rollers. The hardness of the upper roller used, the pressure applied to the top rollers, the type of clips that adjust the distance between the top and bottom rollers are the parameters that control the controlled drawing in this context. The aim of this study is to improve the yarn quality by changing the cot stiffness. For this, two different experimental factors were chosen to investigate the effect of cot stiffness and fiber type on yarn quality. The first factor is the upper roller hardness at three different lower levels, 70, 76 and 83 shore. The second factor is the fiber type, and the fiber type has two different sub-levels. In this context, the yarns consisting of different fibers planned to be produced are 20/1 Ne 50/50 cotton/acrylic and 20/1 Ne 100% acrylic yarns. Unevenness, thin/thick place, neps, hairiness and strength tests were carried out on the produced yarns. The results obtained were analyzed statistically and the effect of cot stiffness and fiber type on yarn quality was revealed.

Structural Optimization, Fabrication, and Corrosion Behaviors of Biodegradable Mg-Nd-Zn-Zr Alloy Hemostatic Clip

In this study, the process of ligating blood vessels via biodegradable Mg alloy hemostatic clips with toothless, transverse teeth, and embedded teeth was simulated through finite element analysis (FEA). The results showed that the transverse tooth clip caused the minimum stress (0.81489 MPa) to blood vessels. Furthermore, the effects of clips with transverse teeth of different parameters, including lower tooth length, tooth height, and tooth pitch, on clamped blood vessels were studied. The numerical simulation results showed that the three optimal parameters for clips with transverse teeth were 0.2, 0.1, and 0.1 mm, respectively. Then, the optimally designed clip based on the Mg–Nd–Zn–Zr alloy was manufactured and evaluated using immersion tests. Results from the corrosion behavior study showed that closed clips (0.118 ± 0.041 mg·cm−2·day−1) corroded slightly faster than open clips (0.094 ± 0.041 mg·cm−2·day−1). Moreover, micromorphological observations showed that no cracks appeared on the closed clips, indicating that the Mg alloy had excellent performance and avoided stress corrosion cracking (SCC). Thus, the new type of Mg alloy clip kept good blood vessel closure during FEA and exhibited no corrosion cracking during the degradation process, making it a promising candidate for applications with biodegradable hemostatic clips.

Utility and Feasibility of a Low-Cost System to Simulate Clipping Strategy for Cerebral Aneurysms Using Three-Dimensional Computed Tomography Angiography with Virtual Craniotomy

To assess utility and feasibility of a low-cost system to simulate clipping strategy for cerebral aneurysms using patient-specific surgically oriented three-dimensional (3D) computed tomography angiography with virtual craniotomy. From 2017 to 2021, 53 consecutive patients scheduled for aneurysm clipping underwent preoperative planning using 3D computed tomography angiography with virtual craniotomy. The model was oriented in the surgical position to observe the anatomy through surgical corridors. Clipping was planned considering 3 parameters: shape of the clip, clip type (standard vs. fenestrated), and clipping strategy (simple vs. multiple). We used a scoring system (0-3) to assess the concordance of virtual planning with real surgery by assigning 1 point for each correctly predicted parameter. Qualitative assessment of 3D models was a secondary end point. In 51 patients, 3D images perfectly matched the real anatomy shown in surgical videos. Concordance scores of 0, 1, 2, and 3 occurred with a frequency of 5%, 14%, 38%, and 43%, respectively. Concerning the shape of the clip, clip type, and clipping strategy, the concordance occurred in 73%, 80%, and 59%, respectively. Compared with simple clipping, strategies with multiple clippings were more difficult to predict correctly. Concordance scores of 0, 1, 2, and 3 occurred with a frequency of 5.7%, 5.7%, 31.4%, and 57.1%, respectively, in simple clipping and 4.8%, 28.6%, 47.6%, and 19%, respectively, in multiple clipping. In our experience, use of 3D computed tomography angiography with virtual craniotomy is an easy and useful solution to plan clipping strategy. The surgeon's awareness of the surgical anatomy is improved. Although this method has some technical limitations, it represents a low-cost alternative if complex and expensive simulation systems are not available.

Simulation analysis of the force of wedge-shaped aluminum alloy wire clamp

In this paper, the force simulation analysis of the wedge-shaped aluminum alloy wire clamp is carried out by using SOLIDWORKS Simulation software. Through the finite element modeling of the corresponding type of wedge-shaped clip, and combined with the conditions of the maximum tensile force in service state, the strength check and stiffness check, as well as the maximum stress and maximum displacement calculations are carried out. The simulation analysis result shows that the strength and stiffness of the overall structure of the wedge-shaped aluminum alloy wire clip meet the performance requirements.

Assessment of Heating on Titanium Alloy Cerebral Aneurysm Clips during 7T MRI.

Patients with cerebral aneurysms often undergo MR imaging after microsurgical clipping. Ultra-high-field MR imaging at 7T may provide high diagnostic capability in such clinical situations. However, titanium alloy clips have safety issues such as adverse interactions with static magnetic fields and radiofrequency-induced heating during 7T MR imaging. The purpose of this study was to quantitatively assess temperature increases on various types of titanium alloy aneurysm clips during 7T MR imaging. Five types of titanium alloy aneurysm clips were tested, including combinations of short, long, straight, angled, and fenestrated types. Each clip was set in a phantom filled with gelled saline mixed with polyacrylic acid and underwent 7T MR imaging with 3D T1WI with a spoiled gradient recalled acquisition in the steady-state technique. Temperature was chronologically measured at the tips of the clip blade and head, angled part of the clip, and 5 mm from the tip of the clip head using MR imaging-compatible fiber-optic thermometers. Temperature increases at all locations for right-angled and short straight clips were <1°C. Temperature increases at the angled part for the 45° angled clip and the tip of the clip head for the straight fenestrated clip were >1°C. Temperature increases at all locations for the long straight clip were >2°C. Temperature increases on the right-angled and short straight clips remained below the regulatory limit during 7T MR imaging, but temperature increases on the 45° angled, straight fenestrated, and long straight clips exceeded this limit.

Assessment of low-cost surgical metallic clip placement for tumor localization in BIRDAS VI breast cancer patients undergoing neoadjuvant chemotherapy

BackgroundNeoadjunvant chemotherapy has become a challenging connotation for both surgeons and radiologists due to the high clinical response up to dramatic pathological complete response (pCR) that may hinder proper localization of any residual tumoral tissue. So the radiopaque markers implantation at the tumor bed became a reliable and recommended method for tumor localization before surgical intervention or NAC. Many types of commercial clips and markers are available; however they are relatively of high cost and represent a considerable burden on the governments and the heath institute that made the researchers study cheaper alternatives as standard titanium based cholecystectomy surgical clips for tumor localization.ResultsThe study was conducted on 45 patients where 57 clips were inserted corresponding to number of lesions found in the total number of the patients. The response to Neoadjunvant chemotherapy was recorded and showed that 6 patients (about 13.3%) had complete radiological response after NAC, while 27 patients (60%) had regressive course after the treatment. The low cost surgical clips were evaluated by using sono-mammography and magnetic resonance imaging, and complications that occurred were recorded. Our study showed that in only 2 patients (3.5%) there was difficulty in clip visualization by Ultrasound during post-treatment follow up. In 45 patients, all the inserted clips (100%) were well visualized as small signal void on MRI at both T1WIs and T2WIs sequences, and the primary malignancy was easily visualized on both MRI and sono-mammography not interfering with the image interpretation and judgment. As regards the reported complications, our results revealed that in only 2 patients (3.5%) there was evidence of positive clip migration, while only 2 patients (3.5%) developed hematoma during the procedure as shown by ultrasound, Also 4 patients (7%) complained of pain only shortly after clip insertion. No other significant complications like infection or heat sensation developed either during the procedure or during MRI. The total price of the surgical clips was calculated with average cost of the needle about 10 US$ equivalent to 170 LE Egyptian pounds and the clip about 1.3 US$ or 20 Egyptian pounds, which is considered of lower cost when compared to the commercial breast markers of different companies with an estimated price range for clip = 75–200 US$ (average 90 US$). So insertion of surgical clips saved about 1135 Egyptian pounds equivalent to 73–75 US$ per clip placement.ConclusionWe concluded from our study that the use of breast markers are mandatory before NAC where Surgical clips can safely substitute the commercial tissue markers as tumor localizers as they are effective, safe, well tolerated, easily visualized on imaging and do not interfere with assessment of the treatment response, with no evidence of complications and are of low cost compared with the commercial breast clips.