Comparison of detection of trauma-related injuries using combined "all-in-one" fused images and conventionally reconstructed images in acute trauma CT.

OBJECTIVES: To compare the accuracy of lesion detection of trauma-related injuries using combined "all-in-one" fused (AIO) and conventionally reconstructed images (CR) in acute trauma CT. METHODS: In this retrospective study, trauma CT of 66 patients (median age 47 years, range 18-96 years; 20 female (30.3%)) were read using AIO and CR. Images were independently reviewed by 4 blinded radiologists (two residents and two consultants) for trauma-related injuries in 22 regions. Sub-analyses were performed to analyze the influence of experience (residents vs. consultants) and body region (chest, abdomen, skeletal structures) on lesion detection. Paired t-test was used to compare the accuracy of lesion detection. The effect size was calculated (Cohen's d). Linear mixed-effects model with patients as the fixed effect and random forest models were used to investigate the effect of experience, reconstruction/image processing, and body region on lesion detection. RESULTS: Reading time of residents was significantly faster using AIO (AIO: 266 ± 72 s, CR: 318 ± 113 s; p < 0.001; d = 0.46) while no significant difference was observed in the accuracy of lesion detection (AIO: 93.5 ± 6.0%, CR: 94.6 ± 6.0% p = 0.092; d = - 0.21). Reading time of consultants showed no significant difference (AIO: 283 ± 82 s, CR: 274 ± 95 s; p = 0.067; d = 0.16). Accuracy was significantly higher using CR; however, the difference and effect size were very small (AIO 95.1 ± 4.9%, CR: 97.3 ± 3.7%, p = 0.002; d = - 0.39). The linear mixed-effects model showed only minor effect of image processing/reconstruction for lesion detection. CONCLUSIONS: Residents at the emergency department might benefit from faster reading time without sacrificing lesion detection rate using AIO for trauma CT. KEY POINTS: • Image fusion techniques decrease the reading time of acute trauma CT without sacrificing diagnostic accuracy.

"All-in-one" window/level whole-body computed tomography scan - A faster way to evaluate trauma cases.

PURPOSE: To investigate the accuracy and total assessment time (TAT) of the "All-in-one" (AIO)-window/level setting for whole-body computed tomography (CT) image compared to multiple tissue-specific window/level settings conventionally used for detection of traumatic injuries. METHOD: Contrast-enhanced chest, abdomen, and pelvic CT scans of 50 patients who presented to our emergency department (ED) for major trauma were retrospectively selected. In a simulation of a "wet read" performed at the CT scanner console, 6 readers with different levels of experience had up to 3 min to describe any traumatic finding identified on the CTs. The readers reviewed each patient in two different sessions separated by a washout period to suppress any recall bias from one session to the next. Each scan was reviewed once using the AIO-window/level setting and another time using the conventional bone, lung, and soft tissue window/level display settings, in a randomized order. The CT reports were used as reference standard. RESULTS: Overall, there was no statistically significant difference in the assessment accuracy of the review based on the AIO or the conventional window/level settings (0.89 ± 0.09 vs 0.90 ± 0.08). Using the AIO-window/level settings, TAT was 14.3 s faster when compared with the conventional window/level settings (2.33 ± 0.63 vs 2.57 ± 0.51 min; p < 0.001). CONCLUSIONS: In a time-delimited image review, similar diagnostic accuracy was reached faster using the AIO vs the conventional window/level settings. When providing a "wet read" at the CT console, the ability to identify traumatic injury using a single AIO-window/level may help expedite patient management.

Cochlear amplification and tuning depend on the cellular arrangement within the organ of Corti.

The field of cochlear mechanics has been undergoing a revolution due to recent findings made possible by advancements in measurement techniques. While it has long been assumed that basilar-membrane (BM) motion is the most important determinant of sound transduction by the inner hair cells (IHCs), it turns out that other parts of the sensory epithelium closer to the IHCs, such as the reticular lamina (RL), move with significantly greater amplitude for weaker sounds. It has not been established how these findings are related to the complex cytoarchitecture of the organ of Corti between the BM and RL, which is composed of a lattice of asymmetric Y-shaped elements, each consisting of a basally slanted outer hair cell (OHC), an apically slanted phalangeal process (PhP), and a supporting Deiters' cell (DC). Here, a computational model of the mouse cochlea supports the hypothesis that the OHC micromotors require this Y-shaped geometry for their contribution to the exquisite sensitivity and frequency selectivity of the mammalian cochlea. By varying only the OHC gain parameter, the model can reproduce measurements of BM and RL gain and tuning for a variety of input sound levels. Malformations such as reversing the orientations of the OHCs and PhPs or removing the PhPs altogether greatly reduce the effectiveness of the OHC motors. These results imply that the DCs and PhPs must be properly accounted for in emerging OHC regeneration therapies.

Real-time microscopic phase-shifting profilometry.

A real-time microscopic profilometry system based on digital fringe projection and parallel programming has been developed and experimentally tested. Structured light patterns are projected onto an object through one pathway of a stereoscopic operation microscope. The patterns are deformed by the shape of the object and are then recorded with a high-speed CCD camera placed in the other pathway of the microscope. As the optical pathways of both arms are separated and reach the same object point at a relative angle, the recorded patterns allow the full-field object height variations to be calculated and the three-dimensional shape to be reconstructed by employing standard triangulation techniques. Applying proper hardware triggering, the projector-camera system is synchronized to capture up to 120 unique deformed line patterns per second. Using standard four-step phase-shifting profilometry techniques and applying graphics processing unit programming for fast phase wrapping, scaling, and visualization, we demonstrate the capability of the proposed system to generate 30 microscopic height maps per second. This allows the qualitative depth perception of the stereomicroscope operator to be enhanced by live quantitative height measurements with depth resolutions in the micrometer range.

3D displacement of the middle ear ossicles in the quasi-static pressure regime using new X-ray stereoscopy technique.

A novel X-ray stereoscopy technique, using greyscale information obtained from moving markers, was used to study the 3D motion in both gerbil and rabbit middle ear ossicles in the quasi-static pressure regime. The motion can be measured without visually exposing the ossicles. The ossicles showed non-linear behaviour as a function of both pressure and frequency. For instance, about 80% of the maximum umbo displacement occurs at a 1 kPa (peak-to-peak) pressure load, while a limited increase of the amplitude is noticed when the pressure goes to 2 kPa. In rabbit the ratio of stapes to umbo motion amplitude was 0.35 for a pressure of 2 kPa (peak-to-peak) at 0.5 Hz. From two stereoscopic projections of the marker paths, 3D motion of the ossicles could be calculated. This motion is demonstrated on high-resolution computer models in order to visualize ossicular chain behaviour.

3D morphometric analysis of the human incudomallear complex using clinical cone-beam CT.

Human middle ears show large morphological variations. This could affect our perception of hearing and explain large variation in experimentally obtained transfer functions. Most morphological studies focus on capturing variation by using landmarks on cadaveric temporal bones. We present statistical shape analysis based on clinical cone beam CT (CBCT) scans of 100 patients. This allowed us to include surface information on the incudomallear (IM) complex (joint, ligaments and tendon not included) of 123 healthy ears with a scanning resolution of 150 µm and without a priori assumptions. Statistical shape modeling yields an average geometry for the IM complex and the variations present in the population with a high precision. Mean values, variation and correlations among anatomical features (length of manubrium, combined length of malleus head and neck, lengths of incus long and short process, enclosing angles, ossicular lever ratio, incudomallear angle, and principal moments of inertia) are reported and compared to results from the literature. Most variation is found in overall size and the angle between incus and malleus. The compact representation provided by statistical shape modeling is demonstrated and its benefits for surface modeling are discussed.

A single-ossicle ear: Acoustic response and mechanical properties measured in duck.

To date, the single-ossicle avian middle ear (ME) is poorly understood, despite its striking resemblance to the design of many currently used ossicular replacement prostheses. This study aims to improve comprehension of this system. The acoustic response and the mechanical properties of the mallard middle ear were studied by means of optical interferometry experiments and finite element (FE) simulations. A finite element model was constructed based on µCT data and validated using the experimental results. Stroboscopic holography was used to measure the full-field displacement of the tympanic membrane (TM) under acoustic stimulation, and the transfer function was obtained with laser Doppler vibrometry. A sensitivity analysis concluded that the most influential parameters for ME mechanics are the elasticity of the TM, the extracolumella (the cartilaginous part of the columella) and the annular ligament of the columellar footplate. Estimates for the Young's modulus of the TM were obtained by iteratively updating the FE model to match experimental data. A considerable inter-individual variability was found for the TM's elasticity. Comparison of the experimental results and the optimized FE model shows that, similar to the human middle ear, damping needs to be present in the TM to describe the specific spatial and frequency dependent vibrations of the TM. In summary, our results indicate which mechanical parameters are essential to the good functioning of the avian ME and provide a first estimation of their values.

Cytoarchitecture of the mouse organ of corti from base to apex, determined using in situ two-photon imaging.

The cells in the organ of Corti are highly organized, with a precise 3D microstructure hypothesized to be important for cochlear function. Here we provide quantitative data on the mouse organ of Corti cytoarchitecture, as determined using a new technique that combines the imaging capabilities of two-photon microscopy with the autofluorescent cell membranes of the genetically modified mTmG mouse. This combination allowed us to perform in situ imaging on freshly excised tissue, thus minimizing any physical distortions to the tissue that extraction from the cochlea and chemical fixation and staining might have caused. 3D image stacks of the organ of Corti were obtained from base to apex in the cochlear duct, from which 3D lengths and relative angles for inner and outer hair cells, Deiters' cells, phalangeal processes, and inner and outer pillars were measured. In addition, intercellular distances, diameters, and stereocilia shapes were obtained. An important feature of this study is the quantitative reporting of the longitudinal tilts of the outer hair cells towards the base of the cochlea, the tilt of phalangeal processes towards the apex, and Deiters' cells that collectively form a Y-shaped building block that is thought to give rise to the lattice-like organization of the organ of Corti. The variations of this Y-shaped element along the cochlear duct and between the rows of outer hair cells are shown with the third row morphologically different from the other rows, and their potential importance for the cochlear amplifier is discussed.

Elasticity modulus of rabbit middle ear ossicles determined by a novel micro-indentation technique.

For the purpose of creating a finite element model of the middle ear, the ossicles can be modelled as rigid bodies or as linear elastic materials. The general elasticity parameters used are usually measured on larger bones like the femur. In order to obtain a highly realistic model, the actual elastic modulus (Young's modulus) of the ossicles themselves is needed. We developed a novel 2-needle indentation method of determining the Young's modulus of small samples based on Sneddon's solution. We introduce the second needle in such a way that small specimens can be clamped between the two needles and a symmetry plane is obtained, so that geometry-dependent sample deformations are avoided. A finite element calculated correction factor is used to compensate for the small thickness of the samples. The system was tested on several materials with known parameters in order to validate the technique, and was then used to determine the elasticity parameters of incus and malleus in rabbit. No significant differences between measurement locations were found, and we found an average Young's modulus of 16+/-3 GPa.

Quantification of tympanic membrane elasticity parameters from in situ point indentation measurements: validation and preliminary study.

Correct quantitative parameters to describe tympanic membrane elasticity are an important input for realistic modeling of middle ear mechanics. In the past, several attempts have been made to determine tympanic membrane elasticity from tensile experiments on cut-out strips. The strains and stresses in such experiments may be far out of the physiologically relevant range and the elasticity parameters are only partially determined. We developed a setup to determine tympanic membrane elasticity in situ, using a combination of point micro-indentation and Moiré profilometry. The measuring method was tested on latex phantom models of the tympanic membrane, and our results show that the correct parameters can be determined. These parameters were calculated by finite element simulation of the indentation experiment and parameter optimization routines. When the apparatus was used for rabbit tympanic membranes, Moiré profilometry showed that there is no measurable displacement of the manubrium during the small indentations. This result greatly simplifies boundary conditions, as we may regard both the annulus and the manubrium as fixed without having to rely on fixation interventions. The technique allows us to determine linear elastic material parameters of a tympanic membrane in situ. In this way our method takes into account the complex geometry of the membrane, and parameters are obtained in a physiologically relevant range of strain.