Noninvasive CSF shunt patency evaluation by superb microvascular imaging.

Occlusion of a ventriculoperitoneal shunt system is a potentially life-threatening complication in patients suffering from hydrocephalus. However, there is no imaging established as standard approach in this acute setting. In the present study, we evaluate the use of superb microvascular imaging for investigation of the patency of ventriculoperitoneal shunt systems. Simulation of low flow rates of cerebrospinal fluid through a small diameter CSF shunt system was performed in a dedicated phantom in order to proof the principle of superb microvascular imaging (SMI) being feasible for the measurement of slow CSF flow through the dedicated CSF shunt system. SMI is able to detect low flow rates in CSF shunt systems effectively and fast. Visualization of a Duplex ultrasound flow and Doppler wave pattern in the VP shunt system after the reservoir has been pressed confirms patency. SMI is an effective method for evaluating CSF shunt patency and diagnosing shunt obstruction. This bears the potential to facilitate evaluation of clinically symptomatic VP shunt patients in an acute setting. Further evaluation of ultrasound flow patterns is granted.

Asymmetric pedicle subtractionosteotomy (aPSO) guided by a 3D-printed model to correct a combined fixed sagittal and coronal imbalance.

Surgical correction of fixed thoracolumbar deformity is usually achieved by estimating the preoperatively planned correction angles during surgery and is therefore prone to inaccuracy. This is particularly problematic in biplanar deformities. To overcome these difficulties, 3D model for planning, preparation, and simulation of an asymmetric pedicle subtraction osteotomy (aPSO) was printed and used to realign coronal and sagittal balance in case of rigid degenerative kyphoscoliosis. A 59-year-old woman presented with severe back pain and spinal claudication and was diagnosed with a rigid kyphoscoliosis with multilevel spinal stenosis. Spino-pelvic parameters were measured preoperatively (pelvic incidence 47° [PI], lumbar lordosis 18° [LL]; pelvic tilt 42° [PT], T1 pelvic angle 40° [TPA], Cobb angle 33°, sagittal vertical axis 10.5 cm [SVA]). To aid the complex deformity in the sagittal and coronal plane, a 1:1 3D model of the spine was printed according to the preoperative computed tomography (CT). With the use of a rebalancing software, the spine was prepared in vitro as a model for intraoperative realignment and the correction was preoperatively simulated. Surgery was accomplished according to the preoperative software-guided plan. Asymmetric pedicle subtraction osteotomy (aPSO) of L3 identical to the 3D model was performed. Additionally, a Smith-Peterson osteotomy of L4/5 with transforaminal lumbar interbody fusion (TLIF) and laminectomy of L2-S1 with pedicle screw instrumentation TH12-S1 was accomplished. Postoperative radiological parameters revealed good success (LL 40°, SVA 6 cm, PT 19°, TPA 22°, and a Cobb angle of 8°). Improvement of the Oswestry disability index (ODI) of 42 to 18, the visual analog scale (VAS) of 8 to 1, and walking distance 100 to 8000 m compared to preoperatively resulted at 24 months follow-up. The precise coronal and sagittal correction of a rigid degenerative kyphoscoliosis presents a major challenge. Asymmetric PSO is able to realign the thoracolumbar spine in both the coronal and sagittal planes. The creation of an in vitro 3D-printed model of a patient's spinal deformity in combination with a software to calculate the correction angles facilitates preoperative planning and implementation of aPSO.

Custom implant design for large cranial defects.

PURPOSE: The aim of this work was to introduce a computer-aided design (CAD) tool that enables the design of large skull defect (>100 [Formula: see text]) implants. Functional and aesthetically correct custom implants are extremely important for patients with large cranial defects. For these cases, preoperative fabrication of implants is recommended to avoid problems of donor site morbidity, sufficiency of donor material and quality. Finally, crafting the correct shape is a non-trivial task increasingly complicated by defect size. METHODS: We present a CAD tool to design such implants for the neurocranium. A combination of geometric morphometrics and radial basis functions, namely thin-plate splines, allows semiautomatic implant generation. The method uses symmetry and the best fitting shape to estimate missing data directly within the radiologic volume data. In addition, this approach delivers correct implant fitting via a boundary fitting approach. RESULTS: This method generates a smooth implant surface, free of sharp edges that follows the main contours of the boundary, enabling accurate implant placement in the defect site intraoperatively. The present approach is evaluated and compared to existing methods. A mean error of 89.29 % (72.64-100 %) missing landmarks with an error less or equal to 1 mm was obtained. CONCLUSION: In conclusion, the results show that our CAD tool can generate patient-specific implants with high accuracy.

[Dose management in radiology: Review of the technological status]. / Dosismanagement in der Radiologie : Ein Überblick zum Stand der Technik.

BACKGROUND: The Euratom directive 2013/59 ("EU directive for radiation protection") has to be implemented into national law by spring 2018 and requires a complete recording of patient dosages and relevant parameters. Additionally, a medical physics expert has to be consulted for each radiological examination above a defined threshold. OBJECTIVES: A complete recording of the dosage administered from all modalities and optimization of the radiological procedures should result in a reduction of the total dosage. MATERIAL AND METHODS: This can be achieved by automated systems that incorporate not only the detection of the dose parameters but also the evaluation and analysis of these data. When provided with warning levels such a system should be able to inform or warn the operator when dose thresholds have been exceeded or even better inform the operator about possible excess dosages before an examination. Depending on the information provided by the modality, dose management systems can operate at different levels in the picture archiving and communication system (PACS), radiological and hospital information systems (RIS/HIS) or with the header information of a digital imaging and communications in medicine (DICOM) image and evaluate and analyze this data. CONCLUSION: A practicable use of such systems is only possible by close cooperation of medical personnel, medical physicists and information technology (IT) administrators. Various systems are available commercially or free but an individual adaptation of these systems is useful and necessary, depending on the requirements of the radiology practice or hospital.

Does caffeine modulate verbal working memory processes? An fMRI study.

To assess the effect of caffeine on the functional MRI signal during a 2-back verbal working memory task, we examined blood oxygenation level-dependent regional brain activity in 15 healthy right-handed males. The subjects, all moderate caffeine consumers, underwent two scanning sessions on a 1.5-T MR-Scanner separated by a 24- to 48-h interval. Each participant received either placebo or 100 mg caffeine 20 min prior to the performance of the working memory task in blinded crossover fashion. The study was implemented as a blocked-design. Analysis was performed using SPM2. In both conditions, the characteristic working memory network of frontoparietal cortical activation including the precuneus and the anterior cingulate could be shown. In comparison to placebo, caffeine caused an increased response in the bilateral medial frontopolar cortex (BA 10), extending to the right anterior cingulate cortex (BA 32). These results suggest that caffeine modulates neuronal activity as evidenced by fMRI signal changes in a network of brain areas associated with executive and attentional functions during working memory processes.

[Simulation of the heart action: a computer controlled module for the generation of variable flow patterns]. / Herzaktions-Simulation: Ein computergesteuertes Modul zur Erzeugung variabler Strömungsprofile.

AIM: The development of a computer controlled pump for the generation of variable flow patterns with high reproducibility for simulating the haemodynamics in physiological model circuits. MATERIAL AND METHODS: The module is controlled by an arbitrary function generator. The shape of the flow profile is generated on the PC based on mathematical functions or drawn by hand. The amplified signal drives a DC motor which is coupled magnetically to a geared pumphead. The lack of mechanical coupling ensures smooth running and a complete attenuation of motor vibrations as well as a disturbance-free flow profile. The spectra were analyzed by Doppler-sonography with a 5 - 12 MHz linear probe and with pressure sensors. Silicon tubes were used as simulated vessels and a water-glycerine mixture with particles of cellulose as simulated blood. RESULTS: The generated flow patterns (constant flow and multi-phase patterns) correlate highly with the measured pressure- and velocity profiles. CONCLUSION: The variability and high reproducibility of the flow profiles and the realtime control of the signal parameters make the simulation of dynamic processes and haemodynamic long-time studies feasible. The module developed facilitates detailed studies of high reproducibility with physiological and pathological flow models and with simulated blood.