Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery.

OBJECTIVES: Virtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free-hand surgery (FHS), identify predictors of non-union and evaluate the difference in operative time. METHODS: Post-operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non-union. The rate of union, risk difference and inter-rater reliability were calculated. The difference in operative time was assessed. Predictors of non-union were identified using logistic regression. RESULTS: A total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non-union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non-union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non-union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter-rater agreement was high (k = 0.85; ICC = 0.86). CONCLUSION: VSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non-union.

Measurement of airborne particle concentrations near the Sunset Crater volcano, Arizona.

Direct measurements of airborne particle mass concentrations or mass loads are often used to estimate health effects from the inhalation of resuspended contaminated soil. Airborne particle mass concentrations were measured using a personal sampler under a variety of surface-disturbing activities within different depositional environments at both volcanic and nonvolcanic sites near the Sunset Crater volcano in northern Arizona. Focused field investigations were performed at this analog site to improve the understanding of natural and human-induced processes at Yucca Mountain, Nevada. The level of surface-disturbing activity was found to be the most influential factor affecting the measured airborne particle concentrations, which increased over three orders of magnitude relative to ambient conditions. As the surface-disturbing activity level increased, the particle size distribution and the majority of airborne particle mass shifted from particles with aerodynamic diameters less than 10 mum (0.00039 in) to particles with aerodynamic diameters greater than 10 mum (0.00039 in). Under ambient conditions, above average wind speeds tended to increase airborne particle concentrations. In contrast, stronger winds tended to decrease airborne particle concentrations in the breathing zone during light and heavy surface-disturbing conditions. A slight increase in the average airborne particle concentration during ambient conditions was found above older nonvolcanic deposits, which tended to be finer grained than the Sunset Crater tephra deposits. An increased airborne particle concentration was realized when walking on an extremely fine-grained deposit, but the sensitivity of airborne particle concentrations to the resuspendible fraction of near-surface grain mass was not conclusive in the field setting when human activities disturbed the bulk of near-surface material. Although the limited sample size precluded detailed statistical analysis, the differences in airborne particle concentration over 900-y weathered volcanic and nonvolcanic deposits appeared to be potentially significant only under heavy surface disturbances.

Considerations for applying VARSKIN mod 2 to skin dose calculations averaged over 10 cm2.

VARSKIN Mod 2 is a DOS-based computer program that calculates the dose to skin from beta and gamma contamination either directly on skin or on material in contact with skin. The default area for calculating the dose is 1 cm2. Recently, the U.S. Nuclear Regulatory Commission issued new guidelines for calculating shallow dose equivalent from skin contamination that requires the dose be averaged over 10 cm2. VARSKIN Mod 2 was not filly designed to calculate beta or gamma dose estimates averaged over 10 cm2, even though the program allows the user to calculate doses averaged over 10 cm2. This article explains why VARSKIN Mod 2 overestimates the beta dose when applied to 10 cm2 areas, describes a manual method for correcting the overestimate, and explains how to perform reasonable gamma dose calculations averaged over 10 cm2. The article also describes upgrades underway in Varskin 3.