Design and Implementation of a Cloud PACS Architecture.

The limitations of the classic PACS (picture archiving and communication system), such as the backward-compatible DICOM network architecture and poor security and maintenance, are well-known. They are challenged by various existing solutions employing cloud-related patterns and services. However, a full-scale cloud-native PACS has not yet been demonstrated. The paper introduces a vendor-neutral cloud PACS architecture. It is divided into two main components: a cloud platform and an access device. The cloud platform is responsible for nearline (long-term) image archive, data flow, and backend management. It operates in multi-tenant mode. The access device is responsible for the local DICOM (Digital Imaging and Communications in Medicine) interface and serves as a gateway to cloud services. The cloud PACS was first implemented in an Amazon Web Services environment. It employs a number of general-purpose services designed or adapted for a cloud environment, including Kafka, OpenSearch, and Memcached. Custom services, such as a central PACS node, queue manager, or flow worker, also developed as cloud microservices, bring DICOM support, external integration, and a management layer. The PACS was verified using image traffic from, among others, computed tomography (CT), magnetic resonance (MR), and computed radiography (CR) modalities. During the test, the system was reliably storing and accessing image data. In following tests, scaling behavior differences between the monolithic Dcm4chee server and the proposed solution are shown. The growing number of parallel connections did not influence the monolithic server's overall throughput, whereas the performance of cloud PACS noticeably increased. In the final test, different retrieval patterns were evaluated to assess performance under different scenarios. The current production environment stores over 450 TB of image data and handles over 4000 DICOM nodes.

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography.

BACKGROUND The aim of the study was to determine the prevalence of petrosquamosal sinus (PSS) and other temporal bone (TB) anatomical variations in various patients using high-resolution computed tomography (CT). MATERIAL AND METHODS We reviewed clinical and consecutively obtained CT data for 276 TBs of 138 patients. The incidence of TB anatomical variations was compared among patients with radiological markers of chronic otitis media (RCOM) and non-RCOM. RESULTS The PSS incidence in our sample was 6.9%, and it was significantly higher in TBs with RCOM (14.6%). Selected anatomical variations of RCOM TBs were observed: lateral sigmoid sinus (14.5%), prominent sigmoid sinus (23.6%), PSS (14.6%), and high jugular bulb (17.3%). Lateral sigmoid sinus and prominent sigmoid sinus (p<0.01), high jugular bulb (p<0.05), and PSS (p<0.01) were observed more often in RCOM than in non-RCOM TBs. CONCLUSIONS The TB vascular and anatomical variations, including PSS, a high jugular bulb, and a laterally and prominent placed sigmoid sinus, were more often observed in TBs with RCOM. Presurgical imaging and CT-based navigation techniques for TB surgery can offer remarkable value for understanding the altered anatomy of this complex structure and can localize rare anatomical variations.

[Dysraphic spinal defekt - from diagnostics to therapy]. / Wady rozszczepowe kregoslupa - od diagnostyki do terapii.

Congenital malformations comprise all cases of abnormal fetal develop. ment. Among the most serious ano malies - those of the central nervous system (CNS) - the most common are disrafic disorders, i.e. malformations of neural tube closure. This study is an approach to the problem of congenital malformation diagnostics, in the context of modern prenatal treatment and prognosis.

Detection of cerebral artery fenestrations by computed tomography angiography.

BACKGROUND AND PURPOSE: Cerebral artery fenestrations (CAF) are rare congenital variations usually diagnosed by digital subtraction angiography (DSA). The aim of this study was to examine the frequency of occurrence of fenestrations in cerebral arteries and their coexistence with cerebral aneurysms in computed tomography angiography (CTA). MATERIAL AND METHODS: All reports of cerebral CTA (1140) performed in one institution from March 2005 to December 2007 were analysed. We found 40 patients with single fenestrations of the intracranial arteries. All 40 examinations were retrospectively reviewed for location of vascular malformations and presence of aneurysms or subarachnoid haemorrhage (SAH). Medical histories of those patients were then analysed for evidence of SAH and referral reasons for CTA. RESULTS: Forty fenestrated arteries were found in CTA: 18 basilar arteries (45%), 16 anterior cerebral arteries (40%), 4 anterior communicating arteries (10%) and one middle cerebral artery (2.5%). Only one vertebral artery fenestration was found due to the technique of the examination. Six patients (15%) with fenestrated arteries had a total of 8 aneurysms, although only one aneurysm was ipsilateral to the fenestration. In 8 cases of SAH, two were with no evidence of vascular malformation. The coexistence of CAF and aneurysms in CTA amounted to 15% (6/40), but the incidence of ipsilateral aneurysm was only 2.5% (1/40) and it affected the anterior cerebral artery. CONCLUSIONS: Basilar artery fenestration is the most frequent observed fenestration in CTA, followed by anterior cerebral artery and anterior communicating artery fenestrations. Coexistence of fenestration and aneurysm is uncommon in CTA examination.

[Imaging and assessment of glomus jugulare in MRI and CT techniques]. / Rola tomografii komputerowej i rezonansu magnetycznego w obrazowaniu i ocenie zaawansowania klinicznego przyzwojaków opuszki zyly szyjnej.

INTRODUCTION: Paragangliomas are rare group of tumors originating from paraganglionic tissue. The most common site of occurrence of the head and neck paragangliomas are: carotid body, jugular foramen (glomus jugulare) and tympanic cavity (glomus tympanicum). Magnetic resonance (MR), computed tomography (CT) and angiography are the modalities of choice in detecting and characterizing paragangliomas. AIM: The aim of this study was to compare different imaging techniques of CT and MR in visualization, detecting and characterizing paragangliomas of the jugular foramen. METHODY: Usefulness of CT and MR techniques was analyzed on the basis of CT and MR examinations performed in the group of three patients with different clinical history. CONCLUSIONS: Multidetector CT scanning is especially useful to show subtle destruction of the temporal bone on early stage of disease. MR is the modality of choice in assessing middle ear, scull base or posterior fossa involvement and monitoring growth of paraganglioma. MR and CT angiography are both useful methods to identify arterial feeders of the paragangliomas, and in some cases due to better availability in clinical practice can be alternative to angiography. Angiography in combination with embolization will mainly be used prior to surgical resection.

Radiomics and artificial intelligence in lung cancer screening.

Lung cancer is responsible for more fatalities than any other cancer worldwide, with 1.76 million associated deaths reported in 2018. The key issue in the fight against this disease is the detection and diagnosis of all pulmonary nodules at an early stage. Artificial intelligence (AI) algorithms play a vital role in the automated detection, segmentation, and computer-aided diagnosis of malignant lesions. Among the existing algorithms, radiomics and deep-learning-based types appear to show the most promise. Radiomics is a growing field related to the extraction of a set of features from an image, which allows for automated classification of medical images into a predefined group. The process comprises a series of consecutive steps including image acquisition and pre-processing, segmentation of the desired region of interest, calculation of defined features, feature engineering, and construction of the classification model. The features calculated in this process are mainly shape features, as well as first- and higher-order texture features. To date, more than 100 features have been defined, although this number varies depending on the application. The greatest challenge in radiomics is building a cross-validated model based on a selected set of calculated features known as the radiomic signature. Numerous radiomic signatures have successfully been developed; however, reproducibility and clinical validity of the results obtained constitutes a considerable challenge of modern radiomics. Deep learning algorithms are another rapidly evolving technique and are recognized as a valuable tool in the field of medical image analysis for the detection, characterization, and assessment of lesions. Such an approach involves the design of artificial neural network architecture while upholding the goal of high classification accuracy. This paper illuminates the evolution and current state of artificial intelligence methods in lung imaging and the detection and diagnosis of pulmonary nodules, with a particular emphasis on radiomics and deep learning methods.

Automated size-specific dose estimates using deep learning image processing.

An automated vendor-independent system for dose monitoring in computed tomography (CT) medical examinations involving ionizing radiation is presented in this paper. The system provides precise size-specific dose estimates (SSDE) following the American Association of Physicists in Medicine regulations. Our dose management can operate on incomplete DICOM header metadata by retrieving necessary information from the dose report image by using optical character recognition. For the determination of the patient's effective diameter and water equivalent diameter, a convolutional neural network is employed for the semantic segmentation of the body area in axial CT slices. Validation experiments for the assessment of the SSDE determination and subsequent stages of our methodology involved a total of 335 CT series (60 352 images) from both public databases and our clinical data. We obtained the mean body area segmentation accuracy of 0.9955 and Jaccard index of 0.9752, yielding a slice-wise mean absolute error of effective diameter below 2 mm and water equivalent diameter at 1 mm, both below 1%. Three modes of the SSDE determination approach were investigated and compared to the results provided by the commercial system GE DoseWatch in three different body region categories: head, chest, and abdomen. Statistical analysis was employed to point out some significant remarks, especially in the head category.

Salter-Harris type II fracture of the femoral bone in a 14-year-old boy - case report.

BACKGROUND: Distal femoral physis fractures with displacement are rare injuries seen in adolescents related with high incidence of complication. They may lead to premature physeal closure consequently, to growth arrest and bone deformity. CASE REPORT: The case of a 14-year-old boy with Salter-Harris type II displaced fracture underwent surgery with open reduction has been described. CT examination with multiplanar reconstruction was used in pre-operative assessment of distal femur growth plate fracture. CONCLUSIONS: Knowledge of classification, prognosis and methods of treatment is necessary in accurate pre- and postoperative assessment of physial fractures in adolescents. CT and multiplanar reconstruction improve the understanding of patterns of injury, relative prevalence and accuracy of pre-operative planning.

[Postoperative vertigo caused by too long stapes prosthesis--radiological diagnostics]. / Pooperacyjne zawroty glowy zwiazane z nadmierna dlugoscia protezki strzemiaczka--diagnostyka radiologiczna.

The aim of the study was to describe the value of High Resolution Computed Tomography (HRCT) with MPR and VR reconstruction of the temporal bone in patients with persistent vertigo after stapedotomy. High Resolution Computed Tomography with MPR and VR reconstruction of the temporal bone in the axial and coronal planes with 0.625 - mm slice thickness were performed in 2 patients with persistent vertigo after stapedotomy. Persistent vertigo were observed in 2 patients suffered from otosclerosis several months after stapedotomy. High Resolution Computed Tomography with MPR and VR reconstruction of the temporal bone showed in both cases too long stapes prosthesis. On the base of HRCT results restapedotomy and length reduction of stapes prosthesis were done. The vertigo was resolved in all the cases with revision surgery. HRCT with MPR and VR reconstruction can diagnosed the possible cause of persistent vertigo in patients after stapedotomy.