Radiomics in Musculoskeletal Tumors.

Sarcomas are heterogeneous rare tumors predominantly affecting the musculoskeletal (MSK) system. Due to significant variations in their natural history and variable response to conventional treatments, the discovery of novel diagnostic and prognostic biomarkers to guide therapeutic decision-making is an active and ongoing field of research. As new cellular, molecular, and metabolic biomarkers continue to be discovered, quantitative radiologic imaging is becoming increasingly important in sarcoma management. Radiomics offers the potential for discovering novel imaging diagnostic and predictive biomarkers using standard-of-care medical imaging. In this review, we detail the core concepts of radiomics and the application of radiomics to date in MSK sarcoma research. Also described are specific challenges related to radiomic studies, as well as viewpoints on clinical adoption and future perspectives in the field.

Similar effect of stem geometry on radiological changes with 2 types of cemented straight stem: The Müller stem and the Virtec stem compared in 711 hips.

BACKGROUND AND PURPOSE: There are 2 basic principles in cemented stem fixation: shape-closed and force-closed. We investigated 2 shape-closed straight stems, the Müller (MSS) and the Virtec (VSS), which differ only in geometrical cross section, to determine whether the difference in stem shape would affect the radiological results or long-term survival. PATIENTS AND METHODS: We included 711 hips (in 646 patients) that were operated on between July 1996 and July 2003. Patients randomly received either an MSS (n = 356) or a VSS (n = 355) and were followed prospectively. Radiographs taken at a follow-up of > 10 years were analyzed for osteolysis. Kaplan-Meier (KM) survival analysis was performed using various endpoints. We also performed Cox regression analysis to identify risk factors for aseptic loosening and osteolysis of the stem. RESULTS: After 10 years, KM survival with "revision of any component for any reason" was 92% (95% CI: 88-95) for the MSS and 95% (CI: 92-97) for the VSS (p = 0.1). With "revision for aseptic loosening of the stem" as the endpoint, KM survival was 96% (CI: 9-98) for the MSS and 98% (CI: 97-100) for the VSS (p = 0.2). Cox regression showed that none of the risk factors analyzed were independent regarding aseptic loosening of the stem or regarding osteolysis. INTERPRETATION: The MSS and the VSS showed excellent survival for aseptic loosening after 10 years. For the 2 different stem designs, we did not find any independent risk factors for aseptic loosening or development of osteolysis.

An image-based method to automatically propagate bony landmarks: application to computational spine biomechanics.

In attempts to elucidate the underlying mechanisms of spinal injuries and spinal deformities, several experimental and numerical studies have been conducted to understand the biomechanical behavior of the spine. However, numerical biomechanical studies suffer from uncertainties associated with hard- and soft-tissue anatomies. Currently, these parameters are identified manually on each mesh model prior to simulations. The determination of soft connective tissues on finite element meshes can be a tedious procedure, which limits the number of models used in the numerical studies to a few instances. In order to address these limitations, an image-based method for automatic morphing of soft connective tissues has been proposed. Results showed that the proposed method is capable to accurately determine the spatial locations of predetermined bony landmarks. The present method can be used to automatically generate patient-specific models, which may be helpful in designing studies involving a large number of instances and to understand the mechanical behavior of biomechanical structures across a given population.

Economic burden of surgical site infections at a European university hospital.

OBJECTIVE: To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital. DESIGN: Matched case-control study nested in a prospective observational cohort study. SETTING: Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year. METHODS: All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care. RESULTS: A total of 6,283 procedures were performed: 187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF-19,638 (95% confidence interval [CI], SwF-8,492-SwF-30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13-20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1-9.6 days). Differences were primarily attributable to organ space SSIs (n = 76). CONCLUSIONS: In a European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers.