Length of synostosis and segmented intracranial volume correlate with age in patients with non-syndromic sagittal synostosis.

PURPOSE: The aim of this study is to compare the length of synostosis and segmented intracranial volume (SIV) with age in children with non-syndromic sagittal synostosis. METHODS: Thirty-three consecutive patients (22 boys) who had been operated by cranial vault remodeling because of sagittal synostosis were compared retrospectively from 3D-CT imaging data sets obtained from volumetric CT. The mean age of the patients at preoperative CT imaging was 0.49 (range 0.13-1.3) years and at 1-year postoperative imaging 1.8 (range 1.3-3) years. The mean interval between preoperative CT imaging and surgery was 0.25 (range 0-0.8) years. Pearson's correlation and Student's t test were used in the statistical analyses. RESULTS: Length of sagittal synostosis correlated positively with age at preoperative CT (r = 0.688, p < 0.01). Children with total synostosis (n = 9) were significantly older (mean age 0.74 vs. 0.4 years, p < 0.01) than those with partial synostosis. Of partial synostoses, 9 were located anteriorly, 3 in the middle, and 12 posteriorly. The mean synostosis ratio (synostosis length/total sagittal suture length × 100) was 83%. Preoperative SIV correlated positively with age at preoperative CT (r = 0.788, p < 0.01), whereas the 1-year postoperative SIV did not correlate with age at operation. The older the child at the time of the operation, the less the percentage SIV increased. CONCLUSIONS: Length of sagittal synostosis and SIV increased with age.

The evolution of 3D imaging in orthopedic trauma care.

Three-dimensional (3D) imaging can enhance trauma care by allowing better evaluation of bony detail and implant position compared to conventional fluoroscopy or x­ray. Intraoperative 3D imaging further improves this evaluation by allowing any necessary revisions to be made in the operating room prior to the patient emerging from anesthesia. This revision, if necessary, better achieves the surgical goals and alleviates the stressful situation of obtaining postoperative 3D imaging, where the benefit of revision must be balanced against the cost and risk of returning to the operating room. Improved image volume, resolution, and software capability have allowed surgeons to obtain high-quality, wide field views of bony anatomy that can include the uninjured side as a comparison. In this paper, the evolution of intraoperative 3D imaging over the past 25 years is discussed.

Recent Advances in X-ray Cone-beam Computed Laminography.

X-ray computed tomography is an established volume imaging technique used routinely in medical diagnosis, industrial non-destructive testing, and a wide range of scientific fields. Traditionally, computed tomography uses scanning geometries with a single axis of rotation together with reconstruction algorithms specifically designed for this setup. Recently there has however been increasing interest in more complex scanning geometries. These include so called X-ray computed laminography systems capable of imaging specimens with large lateral dimensions or large aspect ratios, neither of which are well suited to conventional CT scanning procedures. Developments throughout this field have thus been rapid, including the introduction of novel system trajectories, the application and refinement of various reconstruction methods, and the use of recently developed computational hardware and software techniques to accelerate reconstruction times. Here we examine the advances made in the last several years and consider their impact on the state of the art.

[Development of CBCT technique and its application on dental age assessment].

Teeth are the hardest organs in the human body. They are not easily affected by external physical and chemical factors to degrade or deform. Dental age assessment has been widely used in forensic practice. Dental image is one of the most common methods in the age estimation. The emergence of cone beam computed tomography (CBCT) technology provides a new way to obtain three-dimensional image of teeth. It has many advantages such as low-dose radiation, short-time scanning, high-precision image, and finical convenience. Recent development of CBCT technology and its application on age estimation are reviewed in this paper.

CBCT in orthodontics: the wave of future.

UNLABELLED: Cone beam computed tomography (CBCT) has probably been one of the most revolutionary innovations in the field of dentistry in the past decade and it provides a novel platform for orthodontic diagnosis and treatment planning. Current imaging techniques are essentially two-dimensional (2D) representations of threedimensional (3D) objects and suffer from several limitations. Hence, fulfillment of ideal imaging goals has been limited. Twodimensional radiographs are insufficient, especially in complex cases like impacted teeth, supernumerary teeth and orthognathic surgeries. CBCT images provide far more detailed information than conventional 2D radiographs and are user friendly. Soft tissues, skull, airway and the dentition can be observed and measured on CBCT images in a 1:1 ratio. CLINICAL SIGNIFICANCE: CBCT provides an excellent tool for accurate diagnosis, more predictable treatment planning, more efficient patient management and education, improved treatment outcome and patient satisfaction. This article focuses on various applications of cone beam CT technology in orthodontics.

Cone beam computed tomographic imaging: perspective, challenges, and the impact of near-trend future applications.

Cone beam computed tomography (CBCT) can be considered as a valuable imaging modality for improving diagnosis and treatment planning to achieve true guidance for several craniofacial surgical interventions. A new concept and perspective in medical informatics is the highlight discussion about the new imaging interactive workflow. The aim of this article was to present, in a short literature review, the usefulness of CBCT technology as an important alternative imaging modality, highlighting current practices and near-term future applications in cutting-edge thought-provoking perspectives for craniofacial surgical assessment. This article explains the state of the art of CBCT improvements, medical workstation, and perspectives of the dedicated unique hardware and software, which can be used from the CBCT source. In conclusion, CBCT technology is developing rapidly, and many advances are on the horizon. Further progress in medical workstations, engineering capabilities, and improvement in independent software-some open source-should be attempted with this new imaging method. The perspectives, challenges, and pitfalls in CBCT will be delineated and evaluated along with the technological developments.

Emerging breast imaging modalities.

Current limitations in mammography have impelled the development of alternative imaging modalities for general and/or high-risk screenings, problem-solving, diagnosis, staging, pre-surgical planning, and determination of treatment efficacy. From initial studies, emerging breast modalities may overcome the inherent weaknesses of current imaging procedures. Among the modalities discussed here are digital breast tomosynthesis (DBT), molecular breast imaging, automated breast ultrasound, breast elasticity ultrasound imaging, and cone beam breast CT (CBBCT).

Coronary CT angiography radiation dose trends: A 10-year analysis to develop institutional diagnostic reference levels.

PURPOSE: To develop institutional diagnostic reference levels (IDRL) for coronary CT angiography (CCTA) according to patient size by analyzing radiation dose changes over the past 10 years. MATERIALS AND METHODS: This IRB approved retrospective investigation analyzed radiation dose data from CCTA between 2007 and 2016 at our institution. Annual trends in radiation dose were described for each scanner type and scanning mode. Radiation levels were analyzed for normorhythmic patients, patients with prior coronary artery bypass grafting (CABG), arrhythmia, and according to patient size and tube voltage. Median, and quartile values for volume CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE) were calculated. Wilcoxon rank-sum test and Kruskal Wallis test were performed to assess the significance of quantitative data. RESULTS: 35,375 examinations from 33,317 patients (median age, 58 [50-66] years; male patients, 21,087 [58.7%]) were analyzed. CTDIvol, DLP, and SSDE significantly decreased by 9.0%, 30.8%, and 40.1% (all P < 0.05) for all examinations, respectively. All radiation dose metrics progressively decreased across scanning modes (especially retrospectively ECG-gated spiral and prospectively ECG-triggered high-pitch spiral acquisition mode), but did not significantly change across scanners in the last 6 years. CTDIvol and DLP increased with patient size when water-equivalent diameters were >19 cm for normorhythmic and CABG patients. In arrhythmic patients, CTDIvol increased progressively with water-equivalent diameters across all groups. CONCLUSION: CCTA radiation dose has progressively decreased in the past decade except in patients with prior CABG and arrhythmia. Size-specific IDRLs may optimize radiation utilization in these patients going forward.

Technological Advances in Diagnostic Imaging in Exotic Pet Medicine.

Diagnostic imaging relies on interpretation of interactions between the body tissue and various energies, such as x-rays, ultrasound, and magnetic or nuclear energies, to differentiate normal from abnormal tissues. Major technological improvements regarding emission and detection of the energetic waves, as well as reconstruction and interpretation of the images, have occurred. These advances made possible visualization of smaller structures, quantitative evaluation of functional processes, and development of unique imaging-guided procedures. This article reviews the technological advances that allowed development of cone beam computed tomography, dual-energy x-ray absorptiometry, and contrast-enhanced ultrasonography, which all could have applications in exotic pet medicine.

Radiation Dose Optimization in Pediatric Chest CT: Major Indicators of Dose Exposure in 1695 CT Scans over Seven Years.

PURPOSE: To analyze possible influencing factors on radiation exposure in pediatric chest CT using different approaches for radiation dose optimization and to determine major indicators for dose development. MATERIALS AND METHODS: In this retrospective study at a clinic with maximum care facilities including pediatric radiology, 1695 chest CT examinations in 768 patients (median age: 10 years; range: 2 days to 17.9 years) were analyzed. Volume CT dose indices, effective dose, size-specific dose estimate, automatic dose modulation (AEC), and high-pitch protocols (pitch ≥ 3.0) were evaluated by univariate analysis. The image quality of low-dose examinations was compared to higher dose protocols by non-inferiority testing. RESULTS: Median dose-specific values annually decreased by an average of 12 %. High-pitch mode (n = 414) resulted in lower dose parameters (p < 0.001). In unenhanced CT, AEC delivered higher dose values compared to scans with fixed parameters (p < 0.001). In contrast-enhanced CT, the use of AEC yielded a significantly lower radiation dose only in patients older than 16 years (p = 0.04). In the age group 6 to 15 years, the values were higher (p < 0.001). The diagnostic image quality of low-dose scans was non-inferior to high-dose scans (2.18 vs. 2.14). CONCLUSION: Radiation dose of chest CT was reduced without loss of image quality in the last decade. High-pitch scanning was an independent factor in this context. Dose reduction by AEC was limited and only relevant for patients over 16 years. KEY POINTS: · The radiation dose of pediatric chest CT was reduced in the last decade.. · High-pitch scanning is an independent factor of dose optimization.. · Dose reduction by AEC is limited and only relevant for older children.. CITATION FORMAT: · Esser M, Hess S, Teufel M et al. Radiation Dose Optimization in Pediatric Chest CT: Major Indicators of Dose Exposure in 1695 CT Scans over Seven Years. Fortschr Röntgenstr 2018; 190: 1131 - 1140.

Latest biomaterials and technology in dentistry.

Navigation technology is applied successfully in oral and maxillofacial surgery. Laser beams are used for caries removal. With nanodentistry, it is possible to maintain comprehensive oral health care. Nanorobots induce oral analgesia, desensitize teeth, and manipulate the tissue. They can also be used for preventive, restorative, and curative procedures. Strategies to engineer tissue can be categorized into 3 major classes: conductive, inductive, and cell transplantation approaches. Several populations of cells with stem cell properties have been isolated from different parts of the tooth.

Technological advances in nontraditional orthodontics.

New technological advances have helped the orthodontic profession progress in traditional and surgical methods of treatment. The profession has seen transitions from traditional braces to self-ligating brackets, lingual braces, removable aligners, and more advanced technology, which have helped to address concerns that include but are not limited to better diagnostics, anchorage control, length of treatment, and esthetics. An increase in the number of adult patients seeking orthodontic treatment and the need for a timely efficient care will continue to drive technology and the use of cone beam computed tomography, miniscrews, piezocision, distraction osteogenesis, and bioengineering.

Volumes to learn: advancing therapeutics with innovative computed tomography image data analysis.

Semi-automated methods for calculating tumor volumes from computed tomography images are a new tool for advancing the development of cancer therapeutics. Volumetric measurements, relying on already widely available standard clinical imaging techniques, could shorten the observation intervals needed to identify cohorts of patients sensitive or resistant to treatment.

[The present and future of cardiac CT in research and clinical practice: moderated discussion and scientific debate with representatives from the four main vendors].

Noninvasive imaging of the heart using computed tomography (CT) is an increasingly important diagnostic approach for patients with known or suspected coronary artery disease. Coronary CT angiography has recently received great attention because it provides imaging of the coronary arteries and quantification of the coronary plaque burden with a spatial and temporal resolution not available with any other noninvasive imaging test. In this moderated scientific debate we discuss the advantages and disadvantages of different technical solutions to CT imaging of the fast moving heart including its small and tortuous coronary arteries. Our discussion goes into the details of developments regarding larger Z-axis coverage (320-row volume CT, high pitch spiral acquisition), improved temporal resolution (dual-source CT, adaptive multi-segment reconstruction, and shorter gantry rotation times with air-bearing gantries), improved spatial resolution (high-definition detectors), and improved reconstruction algorithms (iterative reconstruction, cone beam reconstruction). The discussion also touches on the future technological developments that will be necessary to further improve the acceptance and widespread clinical use of cardiac CT, focusing on radiation exposure reduction and independence from heart rate. Finally, the representatives of the four main vendors explain the most important research projects regarding cardiac CT that they plan to pursue in the near future.