Evaluation of Maxillary Sinus Septa Using Cone Beam Computed Tomography (CBCT): A Retrospective Study.

BACKGROUND: Maxillary sinus septa, which are bony structures dividing the sinus cavity, can pose challenges during sinus lift or implant surgeries by potentially causing perforation of the Schneiderian membrane. This study aimed to estimate the prevalence, height, location, orientation, and risk of perforation of the maxillary sinus septa using cone beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective, cross-sectional study utilized CBCT (NewTom CBCT machine, of which the scan parameters were 90 KvP, 8 mAs, and 14 s exposure with a field of view (FOV) of 8×8 cm and a 0.2 mm3 voxel size) images of 300 maxillary sinuses from patients aged >18 years, obtained from Swami Devi Dyal Hospital and Dental College in Panchkula, India. Scans were analyzed for the presence, height, location, orientation, and risk of septal perforation. The data were categorized based on age, sex, and dentition status. Statistical analyses were performed to assess the prevalence, configuration, and risk factors. RESULTS: The prevalence of maxillary sinus septa was 21.33%, with the majority showing a single septum (90.63%). Septa were predominantly found in the middle region (48.44%), with bucco-palatal orientation (93.75%) being more common than anteroposterior. The mean septa height was 6.16 mm. The perforation was classified as moderate (48.4%), low (46.8%), or high (4.6%). Class III septa were associated with the highest risk of perforation. CONCLUSION: This study highlights a significant prevalence of maxillary sinus septa with variations in height, orientation, and location. The risk of perforation varies with the septa configuration and orientation. CBCT is essential for identifying these anatomical features to minimize surgical complications and to guide preoperative planning.

Prevalence of Incidental Findings and Assessment of Maxillary Sinus Pathologies and Dental Diseases Using Cone-Beam Computed Tomography (CBCT) in the Tamil Nadu Population: A Retrospective Study.

Background Cone-beam computed tomography (CBCT), a cross-sectional imaging technique, is valuable for clinical diagnosis and creating effective treatment plans. CBCT can precisely examine the connection between the maxillary sinuses and the maxillary root apices. Oral radiologists must be aware of all potential incidental findings and should be diligent in thoroughly identifying and assessing possible underlying diseases. Aim To determine the prevalence of incidental maxillary sinus pathologies and their relationship to dental diseases. Materials and methods In the present retrospective study, CBCT scans from 300 subjects (encompassing 600 right and left maxillary sinuses), aged 18 to 70, were gathered from various CBCT centers to represent the Tamil Nadu population. The CBCT images were analyzed using proprietary software, which provided both a panoramic reconstruction view and multiplanar reformation modules, including axial, sagittal, and coronal slices. The entire sample size was classified as follows: Group 1, age groups of 18 to 25 years; Group 2, age groups of 26 to 35 years; Group 3, age groups of 36 to 45 years; Group 4, age groups of 46 to 55 years; Group 5, age groups of 56 to 65 years; Group 6, age groups of 66 to 70 years. The prevalence of incidental maxillary sinus findings was analyzed, and their relationship with periapical abscess, periapical granuloma, periapical cyst, and breach was assessed. Results There was a prevalence of 52.05% of cases that had incidental maxillary sinus findings. Among them, 53.43% were males and 50.65% were females. Maxillary sinus pathologies were more common in individuals between 46 and 55 years, i.e., Group 4. In 300 datasets, the frequency of incidental maxillary sinus findings on the right is 21.33%, on the left is 24%, in both is 6.67%, and absent in 48% of the cases. Mucosal thickening was observed in 30% of cases with a periapical abscess, 19.52% with a periapical granuloma, 25% with a periapical cyst, and 51.79% with a breach. Polypoidal mucosal thickening was present in 32.50% of cases with a periapical abscess, 13.79% with a periapical granuloma, 50% with a periapical cyst, and 23.21% with a breach. Opacification occurred in 37.50% of cases with a periapical abscess, 20.69% with a periapical granuloma, 25% with a periapical cyst, and 25% with a breach. Conclusion Dental professionals should have a bird's-eye view in treating chronic odontogenic infections close to the maxillary sinus. Early diagnosis and prompt treatment of odontogenic infections help prevent maxillary sinus pathologies.

Cone-Beam Computed Tomography (CBCT)-Based Online Adaptive Radiation Therapy (oART) for a Prostate Cancer Patient With Inflammatory Bowel Disease and Bilateral Total Hip Arthroplasty: A Case Report.

This case report addresses the complex management of a patient with concurrent prostate cancer, inflammatory bowel disease (IBD), and bilateral total hip arthroplasty, and demonstrates the efficacy of cone-beam computed tomography (CBCT)-guided daily online adaptive radiation therapy (oART) and advanced imaging techniques in overcoming significant treatment challenges. A 68-year-old male with a history of ulcerative colitis and bilateral hip prostheses was diagnosed with high-risk prostate cancer. Conventional radiation therapy modalities, including external beam radiation therapy (EBRT), proton therapy, and magnetic resonance imaging (MRI)-based oART, faced limitations because of the patient's comorbidities and metallic implants. Daily oART, using the Ethos platform (Varian Medical Systems, Palo Alto, CA, USA) with HyperSight™ metal artifact reduction (MAR) imaging, was employed to enhance treatment efficacy. The daily oART treatment on the Ethos platform facilitated the successful delivery of a therapeutic dose while sparing healthy tissues, and the treatment was successful without an IBD flare-up. Daily oART also optimized the target dose while best sparing the critical organs based on the patient's daily anatomy. The HyperSight MAR algorithm significantly reduced imaging artifacts caused by the hip prostheses, enabling accurate identification of the prostate, bladder, and surrounding organs. The oART workflow was delivered without technical challenges, with a total session time of 20 to 30 minutes, similar to our typical prostate patients without hip implants. Despite the complex anatomy and comorbid conditions, the treatment plan met all organ-at-risk constraints and delivered the prescribed dose to the target volumes. Ethos oART with HyperSight provided an effective solution for treating a patient with concurrent prostate cancer, IBD, and bilateral hip arthroplasty. The patient's case was successfully treated without complications, despite such challenging clinical and technical scenarios.

Metric learning guided sinogram denoising for cone beam CT enhancement.

BACKGROUND: Cone beam computed tomography (CBCT) is a widely available modality, but its clinical utility has been limited by low detail conspicuity and quantitative accuracy. Convenient post-reconstruction denoising is subject to back projected patterned residual, but joint denoise-reconstruction is typically computationally expensive and complex. PURPOSE: In this study, we develop and evaluate a novel Metric-learning guided wavelet transform reconstruction (MEGATRON) approach to enhance image domain quality with projection-domain processing. METHODS: Projection domain based processing has the benefit of being simple, efficient, and compatible with various reconstruction toolkit and vendor platforms. However, they also typically show inferior performance in the final reconstructed image, because the denoising goals in projection and image domains do not necessarily align. Motivated by these observations, this work aims to translate the demand for quality enhancement from the quantitative image domain to the more easily operable projection domain. Specifically, the proposed paradigm consists of a metric learning module and a denoising network module. Via metric learning, enhancement objectives on the wavelet encoded sinogram domain data are defined to reflect post-reconstruction image discrepancy. The denoising network maps measured cone-beam projection to its enhanced version, driven by the learnt objective. In doing so, the denoiser operates in the convenient sinogram to sinogram fashion but reflects improvement in reconstructed image as the final goal. Implementation-wise, metric learning was formalized as optimizing the weighted fitting of wavelet subbands, and a res-Unet, which is a Unet structure with residual blocks, was used for denoising. To access quantitative reference, cone-beam projections were simulated using the X-ray based Cancer Imaging Simulation Toolkit (XCIST). In both learning modules, a data set of 123 human thoraxes, which was from Open-Source Imaging Consortium (OSIC) Pulmonary Fibrosis Progression challenge, was used. Reconstructed CBCT thoracic images were compared against ground truth FB and performance was assessed in root mean square error (RMSE), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM). RESULTS: MEGATRON achieved RMSE in HU value, PSNR, and SSIM were 30.97 ± 4.25, 37.45 ± 1.78, and 93.23 ± 1.62, respectively. These values are on par with reported results from sophisticated physics-driven CBCT enhancement, demonstrating promise and utility of the proposed MEGATRON method. CONCLUSION: We have demonstrated that incorporating the proposed metric learning into sinogram denoising introduces awareness of reconstruction goal and improves final quantitative performance. The proposed approach is compatible with a wide range of denoiser network structures and reconstruction modules, to suit customized need or further improve performance.

Efficacy of Online Adaptive Radiotherapy Using Surface Guidance in Treatment of Tracheal Adenoid Cystic Carcinoma.

Primary tracheal tumors are rare, with adenoid cystic carcinoma (ACC) of the trachea being the second most common malignancy of the trachea. Radical surgical resection is found to have better survival outcomes in tracheal ACC. However, with higher submucosal spread rates in tracheal ACC and the inability to achieve clear margins, complete resection is not usually achievable. In these cases, the use of a 60-70 Gy radiation dose is deemed to be sufficient for definitive treatment with or without concurrent chemotherapy. We report a case of an unresectable ACC treated with online daily adaptive cone beam computed tomography (CBCT) radiotherapy on Ethos™ (Varian Medical Systems, Palo Alto, CA). She was planned to receive 59.4 Gy in 33 fractions in two phases. For daily treatment delivery, the patient was set up on the couch using the surface-guided radiotherapy (SGRT) system of AlignRT™ (Vision RT Ltd., London, UK) and translated to the treatment isocenter. A CBCT scan was acquired, followed by rigid registration with the planning scan and PET CT. Organs at risk (OAR) and primary targets were auto-generated by the AI in a two-step process, reviewed, and edited by the radiation oncologist. Adapted and scheduled plans were compared regarding planning target volume (PTV) coverage and dose to OAR. Better PTV coverage was seen in 26 of 33 fractions with the adapted plan. On the days with lesser coverage, adapted plans demonstrated improvement in the hotspot reduction and reduction in hard dose constraints of the esophagus and lungs. Hence, adapted plans were selected for all treatment days. Our results highlight the superior target coverage and improved OAR-sparing plans in daily online adaptive radiotherapy (o-ART) compared to image-guided radiotherapy (IGRT) plans. The system's ability to adapt to daily anatomical changes, improved target coverage, and better sparing of OARs make it an encouraging option for malignancies requiring motion management.

The Impact of Minimum Invasive Access Cavity Design on the Quality of Instrumentation of Root Canals of Maxillary Molars Using Cone-Beam Computed Tomography: An in Vitro Study.

Aim Minimally invasive dentistry has been facilitated by advances in instruments and restorative materials. This study aims to compare the change in the shaping ability of the RECIPROC blue rotary system in both traditional and conservative access cavities, using cone beam computed tomography (CBCT). Material and methods Sixty root canals of 20 artificial maxillary molars were assigned into two groups (n=30 root canals) according to the access cavity design used: Group I: traditional access cavity (TAC) and Group II: conservative access cavity (CAC). CBCT scans of samples were made before and after root canal preparation using the RECIPROC blue rotary system. The shaping parameters are evaluated in root canal transportation and the centering ability. Three CBCT sections per tooth were analyzed at 3, 6, and 9 mm from the apex to assess the canal transportation and centering ability at three levels, apical, middle, and coronal thirds. Data were analyzed using the GraphPad Prism (GraphPad Software, San Diego, CA). Results The results of this study showed a significant difference in transportation within the coronal and middle thirds. However, in apical thirds, there were no significant differences. Both groups observed a significant difference in the centering ability in the coronal third. Conclusion Within the limitations of this study, CAC can be recommended with caution as an alternative access to TAC.

Accuracy of deep learning-based upper airway segmentation.

INTRODUCTION: In orthodontic treatments, accurately assessing the upper airway volume and morphology is essential for proper diagnosis and planning. Cone beam computed tomography (CBCT) is used for assessing upper airway volume through manual, semi-automatic, and automatic airway segmentation methods. This study evaluates upper airway segmentation accuracy by comparing the results of an automatic model and a semi-automatic method against the gold standard manual method. MATERIALS AND METHODS: An automatic segmentation model was trained using the MONAI Label framework to segment the upper airway from CBCT images. An open-source program, ITK-SNAP, was used for semi-automatic segmentation. The accuracy of both methods was evaluated against manual segmentations. Evaluation metrics included Dice Similarity Coefficient (DSC), Precision, Recall, 95% Hausdorff Distance (HD), and volumetric differences. RESULTS: The automatic segmentation group averaged a DSC score of 0.915±0.041, while the semi-automatic group scored 0.940±0.021, indicating clinically acceptable accuracy for both methods. Analysis of the 95% HD revealed that semi-automatic segmentation (0.997±0.585) was more accurate and closer to manual segmentation than automatic segmentation (1.447±0.674). Volumetric comparisons revealed no statistically significant differences between automatic and manual segmentation for total, oropharyngeal, and velopharyngeal airway volumes. Similarly, no significant differences were noted between the semi-automatic and manual methods across these regions. CONCLUSION: It has been observed that both automatic and semi-automatic methods, which utilise open-source software, align effectively with manual segmentation. Implementing these methods can aid in decision-making by allowing faster and easier upper airway segmentation with comparable accuracy in orthodontic practice.

Visual Behaviour During the Interpretation of Cone-Beam Computed Tomography Images of Traumatic Dental Injuries: An Eye-Tracking Study.

BACKGROUND: This cross-sectional observational study aimed to investigate the visual attention patterns of postgraduate endodontic residents during the interpretation of cone-beam computed tomography (CBCT) scans for traumatic dental injuries (TDIs) using eye-tracking technology. METHODS: A cohort of 10 residents who were recruited from King Abdulaziz University Dental Hospital (KAUDH) underwent interpretation of seven CBCT images of TDIs. Eye-tracking metrics, including dwell time, entry time, end time, and the number of revisits, were recorded and analyzed using nonparametric statistical tests. RESULTS: Eye-tracking data revealed that patients with lateral luxation and extrusive luxation pathologies had the longest mean dwell times (1.82 seconds and 1.50 seconds, respectively). These findings were statistically significant compared to other pathologies (p<0.001). Conversely, horizontal root fractures and periapical radiolucency were identified more quickly by the participants (mean entry times of 6.60 seconds and 8.84 seconds, respectively). CONCLUSIONS: The findings indicate variability in visual attention metrics depending on the type of TDI, suggesting that certain injuries may require more focused attention for accurate diagnosis. Specifically, lateral and extrusive luxation injuries attracted longer dwell times, possibly due to their unique diagnostic challenges. This research provides a basis for future studies aiming to optimize education and training related to CBCT interpretation of traumatic dental injuries.

Cone-Beam Computed Tomography (CBCT) Study on Gender Difference and Root Canal Morphology in Mandibular Premolars.

Introduction: The study examined mandibular premolars' root and canal distribution across genders and sides. Materials and Methods: Cone-beam computed tomography (CBCT) imaging of mandibular premolars was performed using SINORA ORTHOPHOS XG 3D, with specific parameters set. Results: Cone-beam computed tomography (CBCT) imaging of 100 participants revealed mostly single-rooted premolars, with slight variations, notably among females. Mandibular first premolars predominantly had single canals and roots, with a higher occurrence of two canals in females. Statistical analysis showed no significant gender- or side-based differences in root distribution. The findings underscore gender-specific variations in premolar morphology, highlighting the importance of tailored treatment planning, especially for the left side. Conclusion: While CBCT proves valuable, further research is needed to optimize its utility in endodontic decision-making.

Correlation Between Radiological Changes of the Temporomandibular Joint and Upper Cervical Vertebrae in Degenerative Joint Disease: A Cone-Beam Computed Tomography-Based Analytical Study.

Objectives This study was conducted to assess the radiological changes of the temporomandibular joint (TMJ) and cervical vertebrae individually and their correlation in degenerative joint disease (DJD) using a cone-beam computed tomography (CBCT)-based approach. Methodology The study employed a cross-sectional, analytical retrospective design, analyzing one-year data. CBCT scans of 60 patients (120 TMJs) were assessed for degenerative changes using standardized imaging parameters. Eligibility criteria included full field-of-view CBCT scans, excluding those with craniofacial anomalies or prior orthodontic treatment. Radiological assessments of TMJs and cervical vertebrae were conducted by experienced radiologists using the Anjos Pontual method and novel grading system (TMJ Spine Degenerative Severity Index). Results The study included 60 CBCT scans (120 joints), with 31.7% males and 68.3% females. Participants were predominantly aged 31-60 years (58.3%). DJD findings for the right TMJ showed grade 1 changes in 55.0% and grade 2 in 31.7%, while the left TMJ had 46.7% grade 1 and 35.0% grade 2 changes. A strong positive correlation (0.704) was found between bilateral TMJ and cervical vertebrae changes. Age correlated significantly with TMJ alterations but not with cervical vertebrae changes. Conclusion This study demonstrated that there exists a positive association between the radiological changes of TMJ and cervical vertebrae in DJD with age, which can be detected in mild stage of severity on CBCT and can be of use in clinical correlation and application of optimal interventions ensuring better prognosis.

Three-dimensional assessment of the nasopharyngeal airway in Down syndrome during the mixed dentition period: a case-control study.

OBJECTIVE: In this retrospective case-control study, we aimed to evaluate the nasopharyngeal airway volume of children with Down syndrome (DS) and compare the results with those of control participants well matched for sex and age. MATERIALS AND METHODS: Fifteen children with DS (mean age = 9.43 ± 0.38 years; 8 boys, 7 girls) and 15 control participants (mean age = 9.51 ± 0.40 years; 8 boys, 7 girls) were enrolled. The nasopharyngeal airway volume and the cross-sectional morphology were measured with cone-beam computed tomography taken for orthodontic treatment. All measurements were assessed by analysis of covariance (ANCOVA) using Bonferroni post hoc pairwise comparison tests. Covariates were body height and body weight, and the ANB angle and the mandibular plane angle. Significance was set at P < .0019. RESULTS: Nasal airway, superior airway, and total airway volumes of DS participants were significantly smaller than those of the control participants in ANCOVA results adjusted for ANB angle and mandibular plane angle (P = .000). In ANCOVA results adjusted for body height and body weight, no statistically significant differences in the volume measurements were found. CONCLUSION: The results indicate that the nasopharyngeal airway volume differs between children with and without DS and that the airway volume tends to be smaller in DS children than in children without DS.

Clinical and radiographic assessment of gummy smile patients with altered passive eruption: a cross-sectional study in a Thai population.

OBJECTIVES: The study aimed to evaluate the clinical crown length (CCL) among patients diagnosed with altered passive eruption (APE), the causes of a gummy smile, the prevalence of APE, and the correlation between parameters. MATERIALS AND METHODS: A total of 86 gummy smile patients (516 teeth) underwent clinical examination and assessment using cone-beam computed tomography (CBCT), photography, and intraoral scanning. RESULTS: Significantly shorter CCL and distance between the cementoenamel junction and bone crest (CEJ-BC) were observed among APE-affected teeth (p < 0.05). Among the patients, 56.1% of patients were diagnosed with APE, and most of them were affected by a combination of APE and hypermobile upper lip (HUL). Based on 183 APE-affected teeth, the prevalence of APE types and subtypes was as follows: APE1A (96; 19.3%), APE1B (78; 15.9%), APE2A (8; 1.6%), and APE2B (1; 0.2%). Positive correlations were found between keratinized gingival width (KGW) and bone thickness (BT), while negative correlations were observed between gingival thickness (GT) and BT. CONCLUSION: Shorter CCL and CEJ-BC were the highlighted features of APE. APE affected approximately half of the gummy smile patients, with most of them presenting with a combination of HUL. Almost teeth affected by APE were classified as Type I, with a nearly equal distribution between subtypes A and B. CLINICAL RELEVANCE: The clinical and radiographic features of APE contribute to a better understanding of this condition and facilitate the management of patients affected by APE. Approximately half of gummy smile patients will require multidisciplinary treatment.

Cone beam computed tomography (CBCT) and megavoltage computed tomography (MVCT)-based radiomics in head and neck cancers: a systematic review and radiomics quality score assessment.

Background: Cone beam computed tomography (CBCT) and megavoltage computed tomography (MVCT)-based images demonstrate measurable radiomics features that are potentially prognostic. This study aims to systematically synthesize the current research applying radiomics in head and neck cancers for outcome prediction and to assess the radiomics quality score (RQS) of the studies. Methods: A systematic search was performed to identify available studies on PubMed, Web of Science, and Scopus databases. Studies related to radiomics in oncology/radiotherapy fields and based on predefined Patient, Intervention, Comparator, Outcome, and Study design (PICOS) criteria were included. The methodological quality of the included study was evaluated independently by two reviewers according to the RQS. The Mann-Whitney U test was performed according to subgroups. The P values <0.05 were considered statistically significant. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines were adhered to. Results: From a total of 743 identified studies, six original studies were eligible for inclusion in the systematic review (median =97 patients). The intraclass correlation coefficient (ICC) for inter-reviewer on total RQS was excellent with 0.99 [95% confidence interval (CI) of 0.946< ICC <0.999]. There were no significant differences in the analyses between each RQS domain and subgroup components (P always >0.05). Numerically higher RQS domains score for publication year ≤2022 than 2023 and number of patients > median than ≤ median but not statistically significant. Conclusions: The number of radiomics studies involving CBCT and MVCT is still very limited. Self-reported RQS assessments should be encouraged for all radiomics studies.

Conventional versus cone-beam computed tomography in lung biopsy: diagnostic performance, risks, and the advantages of tract embolization with gelfoam particle suspension.

Background: With the widespread adoption of computed tomography (CT) technology, the number of detected pulmonary nodules has gradually increased. CT-guided percutaneous needle biopsy has become the primary method for qualitative diagnosis of pulmonary nodules. Benefiting from its three-dimensional (3D) reconstruction capability, cone-beam CT (CBCT) technology has also been widely adopted. Nevertheless, pneumothorax remains the most common complication of these diagnostic and therapeutic procedures. This study assessed the diagnostic accuracy of conventional CT (CCT)- and CBCT-guided coaxial core needle biopsy (CCNB) and the effectiveness of gelfoam particle suspension in reducing complications through tract embolization. Methods: A retrospective analysis was conducted on 320 patients who had undergone CCNB for nodules ≤3 cm from January 2020 to June 2022 at Zhongshan People's Hospital, comprising 325 biopsies (145 CCT-guided and 180 CBCT-guided). Gelfoam tract embolization was specifically used in biopsies of patients identified with a high risk of complications. Comparative statistics involved diagnostic outcomes (sensitivity, specificity, accuracy), procedural lengths, complication occurrences, and radiation doses. Results: Diagnostically, both CCT (sensitivity 93.3%, specificity 100%, accuracy 94.1%) and CBCT (sensitivity 92.8%, specificity 100%, accuracy 93.8%) offered a similarly high performance. The CCT technique was preferable in terms of shorter median operational times (19 vs. 24 minutes; P<0.001) and greater radiation exposure (13.9 vs. 10.1 mSv; P<0.001). The complication rates of CBCT and CCT, such as those of pneumothorax (18.9% vs. 20.7%; P=0.69) and hemorrhage (23.9% vs. 18.6%; P=0.25), were comparable. Of note, the comparison of biopsies with and without gelfoam embolization revealed a marked reduction in postoperative pneumothorax incidence (1.24% vs. 7.9%; P=0.004) and the requirement for drainage (0% vs. 4.27%; P=0.02), indicating the effectiveness of this procedure. Conclusions: CCT- and CBCT-guided lung biopsies demonstrate equivalent diagnostic capacities, with CCT providing shorter median operational times. Importantly, gelfoam embolization substantially diminishes the risk of postoperative pneumothorax, underscoring its value in high-risk patients.

The preliminary study of the effects of individual musculoskeletally stable position in the treatment of temporomandibular disorders.

BACKGROUND: Temporomandibular Disorders (TMD) is the dysfunction of group of muscles and bones in the joint area, the main symptoms of TMD are the pain of the chewing muscles and (or) the temporomandibular joints, mandibular movement disorders and joint noise. This study was designed to explore the therapeutic effects following Individual Musculoskeletally Stable (IMS) position stabilization splint therapy for TMD patients using Fricton index, cone beam computed tomography (CBCT) and surface-Electromyogram (sEMG). METHODS: In this study, we enrolled 31 TMD patients (ranging from 18 to 26 years old, including 7 males and 24 females), first Fricton index was used to evaluate the clinical curative effect of TMD with the treatment of IMS stabilization splint; then CBCT was used to observe the TMJ condylar position changes of TMD before and after the treatment of IMS stabilization splint; finally sEMG was used to observe the changes of electromyography of anterior temporalis (AT) and masseter muscles (MM) of TMD before and after the treatment of IMS stabilization splint. RESULTS: The course of treatment was 6-8 months, with an average of 7.6 months. After the IMS stabilization splint treatment, TMD symptoms relieved, especially in pain, mandibular movement disorder, but still slightly inferior in the treatment of joint noise. And there was a statistically significant difference in the anterior and inner joint space, the condyle had the tendency of moving forward and outward. AT presented reduction significantly of EMG value at rest position after treatment. CONCLUSIONS: IMS stabilization splint is a therapeutic reversible treatment for TMD, especially for pain and mandibular movement disorder; it produces effects of forward and outward condylar movement and elimination of the masticatory muscles antagonism.

Treatment Reproducibility in Brain Stereotactic Radiotherapy Using a Shim Mask Versus a Standard Mask.

Introduction This study aimed to evaluate the setup accuracy of the new shim mask with mouth bite compared to the standard full brain mask in stereotactic radiosurgery (SRS) and radiotherapy (SRT) treatments for brain metastases or tumors. Method A combined retrospective and prospective design was employed, involving 40 patients treated at our center. Patients previously treated using standard head masks formed the retrospective cohort, while those treated with the Shim mask and mouth bite formed the prospective cohort. Daily cone-beam computed tomography (CBCT) scans were obtained before each treatment session to ensure patient setup accuracy. Key metrics included absolute shifts in translational and rotational directions, the number of repeat CBCTs, and the time interval between CBCTs. Results The Shim mask significantly reduced the mean setup errors in the lateral translation (p=0.022) from 0.17 cm (SD=0.10) to 0.10 cm (SD=0.10), and in X-axis rotation (p=0.030) from 0.79° (SD=0.43) to 0.47° (SD=0.47). By considering cutoff points of 1 mm in translational and 1° in rotational directions, the Shim mask was significantly more accurate in the lateral direction (p=0.004). Moreover, while 70% of patients in the standard group required repeat CBCT scans, none in the Shim group did, resulting in an average time saving of 10.4 minutes per patient. Conclusion The Shim mask with mouth bite offers enhanced immobilization accuracy in SRT/SRS treatments, leading to time and potential cost savings by reducing the need for repeat CBCT scans. This underscores the importance of adopting innovative immobilization techniques to optimize patient outcomes.

Cone-Beam Computed Tomography (CBCT)-Guided Adaptive Boost Radiotherapy for a Patient With Locally Advanced Cervical Cancer Ineligible for Brachytherapy.

Brachytherapy is a critical component of locally advanced cervical cancer treatment, and patients ineligible for brachytherapy historically have poor outcomes. Delivery of boost with stereotactic body radiation therapy (SBRT) has been studied, though toxicity is a concern. Recent case reports have explored adaptive radiation boost, which can adjust plans for inter-fraction motion using magnetic resonance guidance. Herein, we report the first patient with locally advanced cervical cancer ineligible for brachytherapy who was treated with a cone-beam computed tomography (CBCT)-guided adaptive boost following completion of chemoradiation. A 71-year-old female with locally advanced cervical cancer was treated with chemoradiation and was deemed ineligible for a brachytherapy boost due to tumor size, geometry, and a fistula with a tumor in the bladder. She was prescribed a boost to the primary tumor of 25 Gy in five fractions using CBCT-guided adaptive radiation following the completion of chemoradiation. A simulation was performed using a non-contrast CT fused with a mid-chemoradiation magnetic resonance imaging (MRI) scan to create an initial plan. For each treatment fraction, kilovoltage CBCTs were acquired, contours of organs at risk (OARs) were adjusted to reflect anatomy-of-the-day, and an adapted plan was generated. The initial and adapted plans were compared using dose-volume histogram objectives, and the adapted plan was used if it resolved OAR constraint violations or improved target coverage. The use of the initial treatment plan would have resulted in constraint violations for the rectum, sigmoid, and bladder in all fractions. The adapted plans achieved hard constraints in all fractions for all four critical OARs. The mean total treatment time across all five fractions was 58 minutes. This case demonstrates the feasibility of a CBCT-guided adaptive boost approach and the dosimetric benefits of plan adaptation in this setting. Though larger-scale and longer-term data are needed, CBCT-guided adaptive radiation may present a feasible alternative modality to deliver boost doses for brachytherapy-ineligible patients.

State of the art: peripheral diagnostic bronchoscopy.

Lung cancer is the leading cause of cancer related death worldwide and in the United States according to the World Health Organization and National Cancer Institute. Improvements in the diagnosis and treatment of lung cancer are of the utmost importance. A prompt diagnosis is a crucial factor to improve outcomes in the treatment of lung cancer. Although the implementation of lung cancer screening guidelines and the overall steady growth in the use of computed tomography have improved the likelihood of detecting lung cancer at an earlier stage, the diagnosis of peripheral pulmonary lesions (PPLs) has remained a challenge. The bronchoscopic techniques for PPL sampling have historically offered modest diagnostic yields at best in comparison to computed tomography guided transthoracic needle aspiration (TTNA). Fortunately, recent advances in technology have ushered in a new era of diagnostic peripheral bronchoscopy. In this review, we discuss the introduction of advanced intraprocedural imaging included digital tomosynthesis (DT), augmented fluoroscopy (AF), and cone beam computed tomography. We discuss robotic assisted bronchoscopy with a review of the currently available platforms, and we discuss the implementation of novel biopsy tools. These technologic advances in the bronchoscopic approach to PPLs offer greater diagnostic certainty and pave the way toward peripheral therapeutics in bronchoscopy.

Cone-Beam Computed Tomography-Guided Adaptive Radiotherapy: A Case Report on Dynamic Tumor Response in Lung Adenocarcinoma.

Cone-beam computed tomography (CBCT) is an essential tool in radiotherapy, enhancing patient positioning accuracy and enabling precise treatment delivery by monitoring anatomical changes throughout the treatment process. This case report highlights the significant role of CBCT in managing a patient with lung adenocarcinoma treated with concurrent chemoradiation. The lung mass and lower paratracheal lymph nodes were irradiated with 60 Gy in 30 fractions. During the course of treatment, CBCT allowed us to observe substantial tumor shrinkage, prompting a treatment replanning to ensure optimal targeting of the tumor while minimizing radiation exposure to healthy tissues. This adaptive approach resulted in excellent treatment outcomes with no complications, demonstrating the efficacy of CBCT in modern radiotherapy.

Anatomical Factors of the Anterior and Posterior Maxilla Affecting Immediate Implant Placement Based on Cone Beam Computed Tomography Analysis: A Narrative Review.

BACKGROUND: The aim of this narrative review was to provide insights into the influence of the morphological characteristics of the anatomical structures of the upper jaw based on cone beam computed tomography (CBCT) analysis on the immediate implant placement in this region. MATERIAL AND METHODS: To conduct this research, we used many electronic databases, and the resulting papers were chosen and analyzed. From the clinical point of view, the region of the anterior maxilla is specific and can be difficult for immediate implant placement. FINDINGS: Anatomical structures in the anterior maxilla, such as the nasopalatine canal and accessory canals, may limit and influence the implant therapy outcome. In addition to the aforementioned region, immediate implant placement in the posterior maxilla may be challenging for clinicians, especially in prosthetic-driven immediate implant placement procedures. Data presented within the recently published materials summarize the investigations performed in order to achieve more reliable indicators that may make more accurate decisions for clinicians. CONCLUSION: The possibility for immediate implant placement may be affected by the NPC shape in the anterior maxilla, while the presence of ACs may increase the incidence of immediate implant placement complications. The variations in IRS characteristics may be considered important criteria for choosing the implant properties required for successful immediate implant placement.