An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction.

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

Patients with trochlear dysplasia have dysplastic medial femoral epiphyseal plates.

PURPOSE: To investigate the growth of the epiphyseal plate in patients with trochlea dysplasia using a 3D computed tomography (CT)-based reconstruction of the bony structure of the distal femur. The epiphysis plate was divided into a medial part and a lateral part to compare their differences in patients with trochlear dysplasia. METHODS: This retrospective study included 50 patients with trochlea dysplasia in the study group and 50 age- and sex-matched patients in the control group. Based on the CT images, MIMICS was used to reconstruct the bony structure of the distal femur. Measurements included the surface area and volume of the growth plate (both medial and lateral), the surface area and capacity of the proximal trochlea, trochlea-physis distance (TPD) (both medial and lateral), and height of the medial and lateral condyle. RESULTS: The surface area of the medial epiphyseal plate (1339.8 ± 202.4 mm2 vs. 1596.6 ± 171.8 mm2), medial TPD (4.9 ± 2.8 mm vs. 10.6 ± 3.0 mm), height of the medial condyle (1.1 ± 2.5 mm vs. 4.9 ± 1.3 mm), and capacity of the proximal trochlear groove (821.7 ± 230.9 mm3 vs. 1520.0 ± 498.0 mm3) was significantly smaller in the study group than in the control group. A significant positive correlation was found among the area of the medial epiphyseal plate, the medial TPD, the height of the medial condyle and the capacity of the proximal trochlear groove (r = 0.502-0.638). CONCLUSION: The medial epiphyseal plate was dysplastic in patients with trochlea dysplasia. There is a significant positive correlation between the surface area of the medial epiphyseal plate, medial TPD, height of the medial condyle and capacity of the proximal trochlear groove, which can be used to evaluate the developmental stage of the trochlea in clinical practice and to guide targeted treatment of trochlear dysplasia. LEVEL OF EVIDENCE: III.

Versatile Undergraduate Neurobiology Course-Based Research Experiences Using Open Access 3D Electron Microscopy Image Volumes.

Course-based undergraduate research experiences (CUREs) using inquiry-based methodology provide a range of positive benefits to undergraduates and instructors. Yet, the required time and cost in designing and running CUREs with detailed data acquisition steps can lead to barriers in CURE implementation. This report describes an alternative approach to CUREs that utilizes free, open access 3D image volumes as data-rich resources for neurobiology CUREs. These open access image volume CUREs (ivCUREs) effectively combine the data acquisition and analysis steps within the course, allowing more time for students to critically evaluate their hypotheses and results, compare data with peers, and reflect on their experiences. Undergraduates in this 10-week ivCURE analyzed >670 excitatory synapses across two brain areas for the presence and origins of spinules within presynaptic boutons, and fully reconstructed 13 of these synapses in 3D. These data highlight the prevalence of these enigmatic synaptic features within excitatory presynaptic boutons, and their potential importance to neuronal function. Moreover, these results underscore key benefits to ivCURE implementation, including the (1) low-cost of experimental design and implementation, (2) ability to utilize the same data-rich image volume across multiple ivCUREs, (3) potential to generate publishable analyses, and (4) flexibility to scale projects and class sizes up at little to no cost. Opportunities for undergraduates to engage in inquiry-based ivCUREs that examine a host of unexplored questions in neurobiology will continue to grow, in parallel with rapid advances in 3D microscopy techniques and the increased availability and diversity of open access image volumes and analytical tools.

Evaluation of a large adrenal carcinoma with 3D reconstruction of computed tomography images: A case report and literature review.

Adrenocortical carcinoma (ACC) is an extremely rare disease caused by a cancerous growth in the adrenal cortex. Although most of adrenal tumors are benign, the functional ACC is malignant resulting in endocrine dysfunction and necessitates surgical removal. Retroperitoneal laparoscope adrenalectomy is often used to perform adrenal gland surgery. Here, we reported a case of huge ACC with the size of 6.8 cm × 5.2 cm. To achieve better surgical outcome, we integrated 3D reconstructed CT images into a dynamic video for preoperative planning and intraoperative guiding to resect the diseased adrenal gland completely without neighbor organ's injury and surgery complications. Moreover, we reviewed associated applications using 3D reconstructed CT imaging in surgery field. Finally, the evaluation and effect of such technology were discussed to reveal that the 3D dynamic video can help surgeon to make better preoperative assessment so as to give patients better therapy.

Advancing Precision Rhinoplasty: Preoperative Digital 3D Surgical Planning.

The aim of the study is to assess the efficacy and advantages of utilizing state-of-the-art three-dimensional (3D) reconstruction technology in preoperative planning for rhinoplasty surgery. It is a study of a single rhinoplasty case that was operated at a tertiary hospital. The patient was assessed through a detailed history, blood investigations, radiological investigations and preoperative 3D (three-dimensional) reconstruction of the face and nose. The study utilized high-resolution CT scans and 3D reconstruction software like 3D (three-dimensional) Slicer and Blender 3D (three-dimensional) to analyze nasal anatomy for preoperative planning in rhinoplasty. External and internal nasal measurements were taken, and axial cross-section analysis was conducted to assess nasal structure deviation. The benefits of 3D (three-dimensional) visualization in surgical planning were evaluated, and surgical management was based on preoperative reconstructions. Comprehensive preoperative evaluations were performed, adhering to ethical guidelines. Preoperative 3D (three-dimensional) reconstruction planning methods facilitated precise surgical planning and execution in rhinoplasty with satisfactory outcomes for both the patient and the surgeon. Incorporating 3D (three-dimensional) reconstruction technology in rhinoplasty preoperative planning enhances surgical precision and patient satisfaction, ensuring optimized surgical outcomes while adhering to ethical standards.

AB089. Improving decision-making in traumatic brain injury patients via 3D volumetric analysis of epidural haematoma.

BACKGROUND: Epidural haematoma (EDH) is a common finding in many traumatic brain injury scenarios, which necessitates surgical evacuation if the volume equals 30 cm3. The Tada formula, despite its convenience, have been observed to inaccurately depict haemorrhage volume, which can lead to inappropriate decision-making. Objective: (I) to determine if there are statistical differences between EDH volumes as calculated using three-dimensional (3D) software versus Tada's formula; and (II) whether this difference leads to differences in treatment options. METHODS: Computed tomography (CT)-scan of 15 traumatic brain injury (TBI) patients with EDH in January-February 2024 were obtained, and the volumetric analysis was performed using the (I) 3D Slicer software; and the (II) Tada formula for each scan. In addition, characteristics such as patient demographics and region were noted. We performed a paired t-test to scrutinise whether there were any differences between the volumes obtained via the two methods. RESULTS: There was a significant difference (P≤0.05) between the EDH volumes as calculated via 3D software and the Tada formula. We also noted that some patients who should have been treated surgically were not operated on, and vice versa. The process of 3D segmentation only takes an average of 8.2 minutes per patient; which is comparable to using the Tada formula. The inaccuracy of the Tada formula could be attributed to the irregular volume of the bleeding foci, contrary to the prototypical biconvex shape. CONCLUSIONS: 3D segmentation should be routinely employed in EDH and other TBI-related haemorrhage cases when available, to aid in decision-making. Extensive development is needed to explore the utility of 3D software in emergency neurosurgery.

Determining Macromolecular Structures Using Cryo-Electron Microscopy.

Structural insights into macromolecular and protein complexes provide key clues about the molecular basis of the function. Cryogenic electron microscopy (cryo-EM) has emerged as a powerful structural biology method for studying protein and macromolecular structures at high resolution in both native and near-native states. Despite the ability to get detailed structural insights into the processes underlying protein function using cryo-EM, there has been hesitancy amongst plant biologists to apply the method for biomolecular interaction studies. This is largely evident from the relatively fewer structural depositions of proteins and protein complexes from plant origin in electron microscopy databank. Even though the progress has been slow, cryo-EM has significantly contributed to our understanding of the molecular biology processes underlying photosynthesis, energy transfer in plants, besides viruses infecting plants. This chapter introduces sample preparation for both negative-staining electron microscopy (NSEM) and cryo-EM for plant proteins and macromolecular complexes and data analysis using single particle analysis for beginners.

Molecular characteristics of multiple primary pulmonary nodules under a three-dimensional reconstruction model and relevant multi-omics analyses: a case report.

Background: In addition to CT images and pathological features, many other molecular characteristics remain unknown about multiple primary lung cancer (MPLC) from intrapulmonary metastatic lung cancer. Case presentation: In this study, we reported a patient with an early-stage MPLC with both adenocarcinoma in situ (AIS) subtype and minimally invasive adenocarcinoma (MIA) subtype. The patient was diagnosed with more than 10 nodules and underwent precise surgery assisted by three-dimensional (3D) reconstruction at the left upper lung lobe. Whole-exome sequencing (WES) and multiple immunohistochemistry (mIHC) were performed to reveal the genomic profiling and tumor microenvironments of multiple nodules in this patient with MPLC. Based on 3D reconstruction location information, we found that the genomic and pathological results of adjacent lymph nodes were quite different. On the other hand, PD-L1 expression and the proportion of infiltrating lymphocytes in tumor microenvironments were all at a low status and did not vary in adjacent lymph nodes. Additionally, maximum diameter and tumor mutational burden levels were found to be significantly associated with CD8+ T cell proportion (p<0.05). Besides, CD163+ macrophages and CD4+ T cell proportion were higher in MIA nodules than in AIS nodules (p<0.05). This patient reached a recurrence-free survival of 39 months. Conclusion: Generally, in addition to CT imaging and pathological results, genomic profiling and tumor microenvironments may facilitate identifying the potential molecular mechanisms and clinical outcomes in patients with early-stage MPLC.

Thermal Ablation of Liver Tumors Guided by Augmented Reality: An Initial Clinical Experience.

Background: Over the last two decades, augmented reality (AR) has been used as a visualization tool in many medical fields in order to increase precision, limit the radiation dose, and decrease the variability among operators. Here, we report the first in vivo study of a novel AR system for the guidance of percutaneous interventional oncology procedures. Methods: Eight patients with 15 liver tumors (0.7−3.0 cm, mean 1.56 + 0.55) underwent percutaneous thermal ablations using AR guidance (i.e., the Endosight system). Prior to the intervention, the patients were evaluated with US and CT. The targeted nodules were segmented and three-dimensionally (3D) reconstructed from CT images, and the probe trajectory to the target was defined. The procedures were guided solely by AR, with the position of the probe tip was subsequently confirmed by conventional imaging. The primary endpoints were the targeting accuracy, the system setup time, and targeting time (i.e., from the target visualization to the correct needle insertion). The technical success was also evaluated and validated by co-registration software. Upon completion, the operators were assessed for cybersickness or other symptoms related to the use of AR. Results: Rapid system setup and procedural targeting times were noted (mean 14.3 min; 12.0−17.2 min; 4.3 min, 3.2−5.7 min, mean, respectively). The high targeting accuracy (3.4 mm; 2.6−4.2 mm, mean) was accompanied by technical success in all 15 lesions (i.e., the complete ablation of the tumor and 13/15 lesions with a >90% 5-mm periablational margin). No intra/periprocedural complications or operator cybersickness were observed. Conclusions: AR guidance is highly accurate, and allows for the confident performance of percutaneous thermal ablations.

A study of three-dimensional reconstruction and printing models in two cases of soft tissue sarcoma of the thigh.

PURPOSE: The aim of our study was to demonstrate the value of three-dimensional (3D) reconstruction and three-dimensional printing (3DP) models in two cases of soft tissue sarcoma (STS) of the thigh. MATERIALS AND METHODS: Two patients with STS were recruited and underwent enhanced CT and MRI scans. Then, the 3D models were reconstructed and printed using the obtained data, and five experts were invited to assess the segmentation quality. In addition, 34 junior, intermediate and senior general surgeons were recruited to demonstrate the value of 3D models in preoperative planning and invited five surgeons to complete the assessment of 3D models-assisted intraoperative navigation. Finally, 32 interns were enrolled to explore the significance of 3D models in medical education. RESULTS: All experts agree with the accuracy of the 3D models. The application of 3D models in preoperative planning improved the understanding of general surgeons (P = 0.000, P = 0.000, P = 0.000). After the planning tools were exchanged between the two groups, senior surgeons in group A showed more significant improvements in performance than junior and intermediate surgeons in group A (P = 0.001, P = 0.006). Surgeons unanimously agree on the value of 3D models in intraoperative navigation. When applied for the education of medical interns, these models could enhance their understanding of pathologic anatomies (P = 0.036). CONCLUSION: In two operations for STS of the thigh with complex adjacencies, our study demonstrates that 3D models are of great value for preoperative planning, intraoperative navigation and medical education. More importantly, these models were more helpful to senior general surgeons.

Through the HoloLens™ looking glass: augmented reality for extremity reconstruction surgery using 3D vascular models with perforating vessels.

Precision and planning are key to reconstructive surgery. Augmented reality (AR) can bring the information within preoperative computed tomography angiography (CTA) imaging to life, allowing the surgeon to 'see through' the patient's skin and appreciate the underlying anatomy without making a single incision. This work has demonstrated that AR can assist the accurate identification, dissection and execution of vascular pedunculated flaps during reconstructive surgery. Separate volumes of osseous, vascular, skin, soft tissue structures and relevant vascular perforators were delineated from preoperative CTA scans to generate three-dimensional images using two complementary segmentation software packages. These were converted to polygonal models and rendered by means of a custom application within the HoloLens™ stereo head-mounted display. Intraoperatively, the models were registered manually to their respective subjects by the operating surgeon using a combination of tracked hand gestures and voice commands; AR was used to aid navigation and accurate dissection. Identification of the subsurface location of vascular perforators through AR overlay was compared to the positions obtained by audible Doppler ultrasound. Through a preliminary HoloLens-assisted case series, the operating surgeon was able to demonstrate precise and efficient localisation of perforating vessels.

Three-dimensional reconstruction of the temporal bone: Comparison of in situ, CT, and CBCT measurements.

OBJECTIVE: To evaluate the accuracy of three-dimensional (3D) Cone Beam Computed Tomography (CBCT) and Computed Tomography (CT) reconstructions of human temporal bones compared with in situ measurements. MATERIAL AND METHODS: Experimental anatomical study of 10 human temporal bones. Wilcoxon's test was used to compare 8 distances on each temporal bone measured in situ and then on 3D CT and CBCT reconstructions. Six landmarks were used: external auditory canal (EAC), tip of the mastoid process, tip of the occiput, zygoma, a point situated 1cm above the tip of the mastoid process (T0) (open technique: lower limit of the mastoidectomy), head of stapes. RESULTS: No significant difference was observed between the 3 measuring techniques for any of the distances studied (P>0.05). DISCUSSION: This study demonstrates the equivalence of CBCT and CT for temporal bone measurements. CONCLUSION: CBCT is a new imaging modality providing 3D reconstructions of the temporal bone that are as reliable as those obtained by CT. As a result of better spatial resolution compared to CT, CBCT is associated with a significantly lower radiation dose. This technique constitutes a morphological progress, as CBCT is comparable to CT, allowing investigation of pathological ears with a lower radiation dose.

Malignant pheochromocytoma in the anterior mediastinum with sternal invasion: a case report.

Pheochromocytomas are catecholamine-producing neuroendocrine tumors that usually occur in the adrenal medulla or sympathetic paraganglia. Anterior mediastinum involvement with pheochromocytoma is rare and may not present with typical symptoms. Its clinical manifestation may be unclear and a high index of suspicion is required for accurate diagnosis. We report a rare case of pheochromocytoma of the anterior mediastinum in a 51-year-old female. A painful hard mass on the sternum was the only clinical manifestation. Imageological examination indicated that there might be a malignant mass on the anterior mediastinum and thoracic wall. The patient accepted surgical curettage and thoracic wall reconstruction. Based on pathological results and WHO definition, the final diagnosis was malignant pheochromocytoma. After six months follow-up, the patient had no recurrence or any symptom. Malignant pheochromocytoma in the anterior mediastinum invading the sternum is rare. A local painful mass may be the only clinical manifestation without special laboratory results. Surgery remains as the first choice for these patients. For this rare case, 3D reconstruction by special software may be a good method to realize individualized treatment. The final decision of the diagnosis should be based on pathological results, past medical history and WHO definition. Long-term follow-up is necessary, while other suspicious lesions should also be given sufficient attention.

Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images: a step by step approach by using Mimics software.

There is a rapidly increasing amount of literature outlining the use of three-dimensional (3D) reconstruction and printing technologies in recent years. However, precise instructive articles which describe step-by-step methods of reconstructing 3D images from computed tomography (CT) or magnetic resonance imaging (MRI) remain limited. To address these issues, this article describes a detailed protocol which will allow the reader to easily perform the 3D reconstruction in their future research, to allow investigation of the appropriate surgical anatomy and allow innovative designs of novel screw fixation techniques or pre-operative surgical planning.

Optimal three-dimensional reconstruction for lung cancer tissues.

The existing three-dimensional (3D) x-ray reconstruction methods for lung cancer tissue reconstruct the investigated objects based on a series of two-dimensional (2D) image sections and a chosen 3D reconstruction algorithm. However, because these procedures apply the same segmentation method for all 2D image sections, they may not achieve the optimal segmentation for each section. As a result, the reconstructed 3D images have limited spatial resolution. Furthermore, the existing 3D reconstruction method is time-consuming and results in a limited time resolution. This research presents an innovation of 3D reconstruction by reformulating two main components of the method. First, a validity index for fuzzy clustering is used to obtain the optimal segmentations of any 2D x-ray image. The process is realized by automatically determining the optimal number of clusters for the image. Second, unlike the existing 3D reconstruction methods, a fast-FCM algorithm is used to speed up the 2D image segmenting process, thereby raising the time resolution of the 3D reconstruction process. With the aid of commonly used VTK software, the proposed method has been used to visualize four classes of typical lung cancer tissues: adenocarcinoma, large cell carcinoma, small cell carcinoma, and squamous cell carcinoma. Experimental results validate the effectiveness and efficiency of the proposed algorithm. Thus, the method contributes a useful tool for x-ray-based 3D image reconstruction.

Efficacy of reciprocating and rotary systems for removing root filling material: a micro-computed tomography study.

This study aimed to use micro-computed tomography (micro-CT) imaging to evaluate the efficacy of the reciprocating and rotary systems for the removal of root filling materials in comparison with hand files. Thirty maxillary incisor teeth were prepared with ProTaper Universal (PTU) system, filled using cold lateral condensation and randomly divided into three groups of ten teeth each. The root fillings were removed with WaveOne Reciprocating and ProTaper Universal Re-treatment (PTU-R) systems and hand files. Micro-CT was used to scan the specimens before and after each treatment step. Percentage of volume of residual root filling was measured. The operating time was recorded. PTU-R instruments yielded better results for removing filling material, even though there was no statistically significant difference between PTU-R and WaveOne groups. Reciprocating and rotary systems showed similar performances in terms of efficacy and operating time for root filling removal.

Reconstruction of coronary vessels from intravascular ultrasound image sequences based on compensation of the in-plane motion.

A three-dimensional vessel model is reconstructed by fusing the cross-sectional information of vascular lumen detected from intravascular ultrasound (IVUS) frames with the spatial geometry of the ultrasonic catheter recovered from a pair of nearly orthogonal X-ray angiograms. This model is closer to the actual morphology than those reconstructed from angiograms or IVUS images alone because of the complementarity between angiography and IVUS in imaging coronary vessels. This study proposes a method to reconstruct the coronary vessels from an electrocardiogram (ECG)-gated IVUS image sequence and simultaneously acquired angiograms. The spatial orientation of each cross-section of the vascular lumen detected from IVUS frames was determined through quantitatively compensating the in-plane rigid motion caused by cardiac cycles. Independent validation of the determination of the IVUS spatial orientation with synthetic data was performed. A limited validity study including the back-projection validation and morphology measures with in vivo image data (five datasets) was performed to evaluate quantitatively the reconstruction accuracy.