Pre-surgery planning tool for estimation of resection volume to improve nasal breathing based on lattice Boltzmann fluid flow simulations.

PURPOSE: State-of-the-art medical examination techniques (e.g., rhinomanometry and endoscopy) do not always lead to satisfactory postoperative outcome. A fully automatized optimization tool based on patient computer tomography (CT) data to calculate local pressure gradient regions to reshape pathological nasal cavity geometry is proposed. METHODS: Five anonymous pre- and postoperative CT datasets with nasal septum deviations were used to simulate the airflow through the nasal cavity with lattice Boltzmann (LB) simulations. Pressure gradient regions were detected by a streamline analysis. After shape optimization, the volumetric difference between the two shapes of the nasal cavity yields the estimated resection volume. RESULTS: At LB rhinomanometry boundary conditions (bilateral flow rate of 600 ml/s), the preliminary study shows a critical pressure gradient of -1.1 Pa/mm as optimization criterion. The maximum coronal airflow ΔA  := cross-section ratio [Formula: see text] found close to the nostrils is 1.15. For the patients a pressure drop ratio ΔΠ  := (pre-surgery - virtual surgery)/(pre-surgery - post-surgery) between nostril and nasopharynx of 1.25, 1.72, -1.85, 0.79 and 1.02 is calculated. CONCLUSIONS: LB fluid mechanics optimization of the nasal cavity can yield results similar to surgery for air-flow cross section and pressure drop between nostril and nasopharynx. The optimization is numerically stable in all five cases of the presented study. A limitation of this study is that anatomical constraints (e.g. mucosa) have not been considered.

Nasal cavity airflow: Comparing laser doppler anemometry and computational fluid dynamic simulations.

Objective parameters to assess the physical flow conditions of breathing are scarce and decisions for surgery, e.g. nasal septum correction, mainly rely on subjective surgeon judgment. To define decision supporting parameters, we compare laser Doppler anemometry (LDA) and numerical computational fluid dynamic simulations (CFD) of the airflow velocity vector fields in the nasal cavity, including lattice Boltzmann (LB) and finite volume methods (FVM). The simulations are based on an anonymous patient CT dataset with septal deviation. LDA measurements are preformed using a 3D printed model. Nasal airflow geometry is randomly deformed in order to approximate surgical changes. The root-mean-square velocity error near the nasal valve of laser Doppler anemometry and lattice Boltzmann simulations is 0.071. Changes in geometry similarly affect both measurement and simulation.

Custom implant design for large cranial defects.

PURPOSE: The aim of this work was to introduce a computer-aided design (CAD) tool that enables the design of large skull defect (>100 [Formula: see text]) implants. Functional and aesthetically correct custom implants are extremely important for patients with large cranial defects. For these cases, preoperative fabrication of implants is recommended to avoid problems of donor site morbidity, sufficiency of donor material and quality. Finally, crafting the correct shape is a non-trivial task increasingly complicated by defect size. METHODS: We present a CAD tool to design such implants for the neurocranium. A combination of geometric morphometrics and radial basis functions, namely thin-plate splines, allows semiautomatic implant generation. The method uses symmetry and the best fitting shape to estimate missing data directly within the radiologic volume data. In addition, this approach delivers correct implant fitting via a boundary fitting approach. RESULTS: This method generates a smooth implant surface, free of sharp edges that follows the main contours of the boundary, enabling accurate implant placement in the defect site intraoperatively. The present approach is evaluated and compared to existing methods. A mean error of 89.29 % (72.64-100 %) missing landmarks with an error less or equal to 1 mm was obtained. CONCLUSION: In conclusion, the results show that our CAD tool can generate patient-specific implants with high accuracy.

Post-mortem interval estimation of human skeletal remains by micro-computed tomography, mid-infrared microscopic imaging and energy dispersive X-ray mapping.

In this study different state-of-the-art visualization methods such as micro-computed tomography (micro-CT), mid-infrared (MIR) microscopic imaging and energy dispersive X-ray (EDS) mapping were evaluated to study human skeletal remains for the determination of the post-mortem interval (PMI). PMI specific features were identified and visualized by overlaying molecular imaging data and morphological tissue structures generated by radiological techniques and microscopic images gained from confocal microscopy (Infinite Focus (IFM)). In this way, a more distinct picture concerning processes during the PMI as well as a more realistic approximation of the PMI were achieved. It could be demonstrated that the gained result in combination with multivariate data analysis can be used to predict the Ca/C ratio and bone volume (BV) over total volume (TV) for PMI estimation. Statistical limitation of this study is the small sample size, and future work will be based on more specimens to develop a screening tool for PMI based on the outcome of this multidimensional approach.

Lung assist devices influence cardio-energetic parameters: Numerical simulation study.

We aim at an analysis of the effects mechanical ventilators (MVs) and thoracic artificial lungs (TALs) will have on the cardiovascular system, especially on important quantities, such as left and right ventricular external work (EW), pressure-volume area (PVA) and cardiac mechanical efficiency (CME). Our analyses are based on simulation studies which were carried out by using our CARDIOSIM(©) software simulator. At first, we carried out simulation studies of patients undergoing mechanical ventilation (MV) without a thoracic artificial lung (TAL). Subsequently, we conducted simulation studies of patients who had been provided with a TAL, but did not undergo MV. We aimed at describing the patient's physiological characteristics and their variations with time, such as EW, PVA, CME, cardiac output (CO) and mean pulmonary arterial/venous pressure (PAP/PVP). We were starting with a simulation run under well-defined initial conditions which was followed by simulation runs for a wide range of mean intrathoracic pressure settings. Our simulations of MV without TAL showed that for mean intrathoracic pressure settings from negative (-4 mmHg) to positive (+5 mmHg) values, the left and right ventricular EW and PVA, right ventricular CME and CO decreased, whereas left ventricular CME and the PAP increased. The simulation studies of patients with a TAL, comprised all the usual TAL arrangements, viz. configurations "in series" and in parallel with the natural lung and, moreover, hybrid configurations. The main objective of the simulation studies was, as before, the assessment of the hemodynamic response to the application of a TAL. We could for instance show that, in case of an "in series" configuration, a reduction (an increase) in left (right) ventricular EW and PVA values occurred, whereas the best performance in terms of CO can be achieved in the case of an in parallel configuration.

Morphological and tissue characterization of the medicinal fungus Hericium coralloides by a structural and molecular imaging platform.

In this study the potential of new imaging techniques such as Magnetic Resonance Imaging (MRI), Matrix-Assisted Laser Desorption/Ionization (MALDI) profiling mass spectrometry ("MALDI Profiling") and Fourier Transform Infrared (FTIR) spectroscopic imaging was evaluated to study morphological and molecular patterns of the potential medicinal fungus Hericium coralloides. For interpretation, the MALDI profiling, FTIR imaging and MRI results were correlated with histological information gained from Scanning Electron Microscopy (SEM) and Light Microscopy (LM). Additionally we tested several evaluation processes and optimized the methodology for use of complex FTIR images to monitor molecular patterns. It is demonstrated that the combination of these spectroscopic methods enables to gain a more distinct picture concerning morphology and distribution of active ingredients. We were able to obtain high quality FTIR imaging and MALDI-profiling results and to distinguish different tissue types with their chemical ingredients. Beside this, we have created a 3-D reconstruction of a mature Hericium basidioma, based on the MRI dataset: analyses allowed, for the first time, a realistic approximation of the "evolutionary effectiveness" of this bizarrely formed basidioma type, concerning the investment of sterile tissue and its reproductive output (production of basidiospores).

Contrast-enhanced transrectal color doppler ultrasonography (TRCDUS) for assessment of angiogenesis in prostate cancer.

BACKGROUND: The clinical relevance of tumor angiogenesis has been investigated in several human tumors, including prostate carcinoma (PC). Previously, we found angiogenesis, measured as microvessel density (MVD), to be an independent prognostic factor in PC. Therefore, we evaluated contrast-enhanced Transrectal Color Doppler Ultrasonography (TRCDUS) for assessment of angiogenesis in PC. MATERIALS AND METHODS: We investigated 15 patients with PC before radical prostatectomy (RP) and 3 control patients before radical cystoprostatectomy. TRCDUS was performed using a micro-bubble-based ultrasound enhancer Levovist for identifying hypervascularized areas within the prostate. Computer-assisted quantification of color pixel intensity (PI) was used to evaluate objectively the hypervascularized areas; resistive index (RI) measurements were also obtained in these areas. After histopathological examination of the entire prostate gland for tumor confirmation, immunohistochemical evaluation of MVD using a polyclonal antibody against factor VIII was performed as described by Weidner et al. (N Engl J Med 324: 1-8, 1991). TRCDUS findings were correlated with the immunohistochemical data. RESULTS: All patients showed hypervascularized areas (range: 1-9) on contrast-enhanced TRCDUS. Hypervascularized areas showed a sensitivity of 50.8% and a specificity of 95.2% for detecting PC. Analysis of TRCDUS data and immunohistochemistry revealed a significant correlation between PI and MVD in PC specimens, demonstrating a correlation coefficient of r2 = 0.977 (p<0.001). RI did not correlate with MVD. CONCLUSION: Contrast-enhanced TRCDUS showed a high specificity in identifying PC. PI correlated significantly with MVD. Therefore, quantification of color Doppler signals seems to be helpful for assessment of angiogenesis in PC.

Endocranial capacity of the bodo cranium determined from three-dimensional computed tomography.

The 600,000-year-old cranium from Bodo, Ethiopia, is the oldest and most complete early Middle Pleistocene hominid skull from Africa. "Virtual endocast" models created by three-dimensional computed tomography (CT) techniques indicate an endocranial capacity of about 1,250 cc for this cranium (with a reasonable range between approximately 1,200-1,325 cc, depending on how missing portions of the basicranial region are reconstructed). From these determinations, several important implications emerge concerning current interpretations of "tempo and mode" in early hominid brain evolution: 1) already by the early Middle Pleistocene, at least one African hominid species, Homo heidelbergensis, had reached an endocranial capacity within the normal range of modern humans; 2) in spite of its large endocranial capacity, estimates of Bodo's encephalization quotient fall below those found in a large sample of Homo sapiens (both fossil and recent) and Neandertals; and 3) the greatest burst of brain expansion in the Homo lineage may not have been in the last several hundred thousand years, but rather much earlier in the Lower to early Middle Pleistocene.

Early hominid brain evolution: a new look at old endocasts.

Early hominid brain morphology is reassessed from endocasts of Australopithecus africanus and three species of Paranthropus, and new endocast reconstructions and cranial capacities are reported for four key specimens from the Paranthropus clade. The brain morphology of Australopithecus africanus appears more human like than that of Paranthropus in terms of overall frontal and temporal lobe shape. These new data do not support the proposal that increased encephalization is a shared feature between Paranthropus and early Homo. Our findings are consistent with the hypothesis that Australopithecus africanus could have been ancestral to Homo, and have implications for assessing the tempo and mode of early hominid neurological and cognitive evolution.

Endocranial capacity in Sts 71 (Australopithecus africanus) by three-dimensional computed tomography.

In a recent report on early hominid endocranial capacity, it was predicted that future studies would show that: (1) "several key early hominid endocranial estimates may be inflated"; (2) "current views on the tempo and mode of early hominid brain evolution may need reevaluation"; and (3) endocranial capacity in one of these, Sts 71, was "probably closer to 370 cm(3), very near the mean value for female chimpanzees, and not the currently accepted 428 cm(3)" (Conroy et al., Science, 1998; 280: 1730-1731; Falk, Science 1998; 20:1714). Subsequent studies tend to support the first two predictions, but not the third (Culotta, Science, 1999; 284: 1109; Falk, Am. J. Phys. Anthropol. Suppl., 1999; 28: 126; Falk et al., J. Hum. Evol. [in press]). Here we detail the reasons for thinking the currently accepted endocranial value for Sts 71 is probably correct by providing the first quantitative details of endocranial reconstruction in Sts 71 using three-dimensional computed tomography. Relative brain expansion in the hominid lineage started some half-million years before the earliest appearance of the genus Homo, possibly coincident with enhanced tool-making skills and carnivory.

Virtual reality and anthropology.

Since the discovery of the Tyrolean Iceman in 1991 advanced imaging and post processing techniques were successfully applied in anthropology. Specific techniques include spiral computed tomography and 3-dimensional reconstructions including stereolithographic and fused deposition modeling of volume data sets. The Iceman's skull was the first to be reproduced using stereolithography, before this method was successfully applied in preoperative planning. With the advent of high-end graphics workstations and biomedical image processing software packages, 3-dimensional reconstructions were established as a routine tool for analyzing volume data sets. These techniques opened totally new insights in the field of physical anthropology. Computed tomography became the ideal research tool to access the internal structures of various precious fossils without damaging or even touching them. Many of the most precious specimens from the species Autralopithecus (1.8-3.5 Myears), Homo heidelbergensis (200-600 kyears) or Homo neanderthalensis (40-100 kyears) were scanned during the last 5 years. Often the fossils are filled with a stone matrix or other materials. During the postprocessing routines highly advanced algorithms were used to remove virtually these incrustations. Thus it was possible to visualize the morphological structures that lie beneath the matrix. Some specimen were partially destroyed, so the missing parts were reconstructed on computer screen in order to get estimations of the brain volume and endocranial morphology, both major fields of interest in physical anthropology. Moreover the computerized form of the data allows new descriptions of morphologic structures by the means of 'geometric morphometrics'. Some of the results may change aspects and interpretations in human evolution. The introduction of new imaging and post processing techniques created a new field of research: Virtual Anthropology.

Comparing frontal cranial profiles in archaic and modern homo by morphometric analysis.

Archaic and modern human frontal bones are known to be quite distinct externally, by both conventional visual and metric evaluation. Internally this area of the skull has been considerably less well-studied. Here we present results from a comparison of interior, as well as exterior, frontal bone profiles from CT scans of five mid-Pleistocene and Neanderthal crania and 16 modern humans. Analysis was by a new morphometric method, Procrustes analysis of semi-landmarks, that permits the statistical comparison of curves between landmarks. As expected, we found substantial external differences between archaic and modern samples, differences that are mainly confined to the region around the brow ridge. However, in the inner median-sagittal profile, the shape remained remarkably stable over all 21 specimens. This implies that no significant alteration in this region has taken place over a period of a half-million years or more of evolution, even as considerable external change occurred within the hominid clade spanning several species. This confirms that the forms of the inner and outer aspects of the human frontal bone are determined by entirely independent factors, and further indicates unexpected stability in anterior brain morphology over the period during which modern human cognitive capacities emerged. Anat Rec (New Anat): 257:217-224, 1999.

Re-evaluation of the endocranial volume of the Guattari 1 Neandertal specimen (Monte Circeo).

The endocranial capacity of Guattari 1 originally was estimated by Sergi as approximately 1.550 cm3. Using three different approaches, a physical endocast, a stereolithographic model, and a virtual endocast, we have estimated the endocranial capacity of Guattari 1 as approximately 1.350 cm3. This paper explains our revision of the estimated endocranial volume of Guattari 1, provides a cautionary case concerning other estimates of endocranial volume, and demonstrates and encourages the use of recent advances in imaging, modeling, and analysis of endocranial volume.

Respirator triggering of electron beam computed tomography (EBCT): research on vital capacities.

In this project we evaluate the dynamic changes during expiration at different levels of positive-end-expiratory pressure (PEEP) in ventilated patients. We wanted to discriminate between normal lung function and acute respiratory distress syndrome (ARDS). After approval by the local Ethic Committee we studied two ventilated patients: (one with normal lung function and one with ARDS) We used the 50 ms scan mode of the EBCT. The beam was positioned 1 cm above the diaphragm while the table position remained unchanged. We developed an electronic trigger that utilizes the respirator's synchronizing signal to start the EBCT at the onset of expiration. During controlled mechanical expiration at two levels of PEEP (0 and 15 cm H2O), pulmonary aeration was rated as: well-aerated (-900HU to -500HU), poorly aerated (-500HU to -100HU) and non-aerated (-100HU to +100HU). Pathological and normal lung functions showed different dynamic changes. The different PEEP levels resulted in a significant change of pulmonary aeration in the same patient. Although we studied only two patients, respiratory triggered EBCT may be accurate in discriminating pathological changes due to the abnormal lung function in a mechanically ventilated patient.

New methods and techniques in anthropology.

Since the discovery of the Tyrolean Iceman in 1991, advanced imaging and post-processing techniques have been successfully applied to anthropological research. Among the specific techniques are spiral computed tomography and 3-dimensional reconstructions, which include stereolithographic and fused deposition modeling of volume data sets. The Iceman's skull was the first to be produced using stereolithography; subsequently, it has been successfully applied in preoperative planning. With the advent of high-end performance graphics workstations and biomedical image processing software packages, 3-dimensional reconstructions have become established as routine tools for analyzing volume data sets. These techniques enabled dramatically new insights to be gained in the field of physical anthropology. Computed tomography became the ideal research tool to access the internal structures of various precious fossils without even touching--let alone damaging--them. Among the most precious are specimens from the genus Australopithecus (1.8 Myr-3.5 Myr), as well as representatives of Homo heidelbergensis (200 kyr-600 kyr) and Homo neanderthalensis (40 kyr-100 kyr); such fossils have been CT-scanned during the last five years. The fossils often are filled with a stone matrix or other encrustations. During the post-processing routines, highly advanced algorithms were used to remove these encrustations virtually (the concrete fossils remain untouched). Thus it has been possible to visualize the morphological structures that are hidden by the matrix layer. Some specimens have been partially destroyed, but it has been possible for the missing parts were reconstructed on the computer screen in order to get estimations of brain volume and endocranial morphology, both major fields of interest in physical anthropology. Moreover, the data in computerized form allows new descriptions of morphological structures using geometric morphometrics. Some of the results may change aspects and interpretations in human evolution and approaches to long-standing questions in this field. We subsume the introduction of these new imaging and post-processing techniques into a new field of research: Virtual Anthropology.

Three-dimensional computed tomography of the reconstructed lower urinary tract: technique and findings.

The aim of this pilot study in 54 patients was to improve the visualization of the anatomy and postoperative changes in the pelvic topography after bilateral ureteroileal urethrostomy, using surface rendering of electron beam CT (EBCT) data for the 3D display. Fifty-four patients (39 men and 15 women) were scanned with an EBCT unit between 3 and 110 months after performing orthotopic ureteroileal urethrostomy ("Hemi-Kock") or ureteroileal rectosigmoidostomy. Various parameters and spatial viewing points were used in the 3D reconstruction, which was performed interactively on external workstations with commercially available software. The anti-reflux nipple was visualized as a distinct structure in all patients. In 8 patients with an interval of more than 12 months between surgery and CT, the pouch had developed an ovoid shape almost indistinguishable from the original bladder. The segmented data sets were partly animated to display the anatomy as virtual endoscopy. Three-dimensional depiction and virtual endoscopy of the neobladder using EBCT are a new way of imaging the postoperative anatomy. Its clinical efficacy in the diagnosis of inconclusive postoperative morbidity, especially voiding problems, and planning of necessary therapy have to be the subject of further evaluation.

3-Dimensional computerized tomography and virtual reality endoscopy of the reconstructed lower urinary tract.

PURPOSE: We describe postoperative surgical anatomy after orthotopic reconstruction of the lower urinary tract using 3-dimensional (D) computerized tomography (CT) and virtual reality endoscopy. MATERIALS AND METHODS: Electronic beam CT was performed in 39 men and 15 women a mean of 60 years old with an orthotopic ileal neobladder (50) or ureteroileal rectosigmoidostomy (4), followed by 3-D reconstruction of the pelvic anatomical structures using specialized computer hardware and software. The mean interval between surgery and CT was 15 months (range 3 to 110) and the mean interval between 2 subsequent 3-D CT studies in 22 patients was 6 months (range 3 to 9). RESULTS: CT time with the patient on the table was 45 minutes and computerized 3-D reconstruction time with the patient off the table was 4 to 5 hours. The pouch had a smooth ovoid shape in 66 and 82% of the patients on the first and second 3-D CT studies, respectively. Mean length of the antireflux nipple was 4 cm. (range 2.5 to 8) and mean length of the afferent limb was 6 cm. (range 3 to 15). There were no radiologically significant sex specific differences in the shape or dimensions of the urinary reservoirs, except for a tendency toward more acute angles between the pouch and remnant urethra. No pathological findings were visible on 3-D CT that were not also evident on conventional CT. CONCLUSIONS: Three-D CT may be clinically useful for surgical planning of a lower abdominal reoperation or unexplained findings and symptoms in patients with bladder substitutions. Cost and time expenditures for processing preclude its routine use in all cases. Virtual reality endoscopy may be a valuable tool for teaching and scientific purposes.

Virtual anthropology (VA): methodological aspects of linear and volume measurements--first results.

Virtual Anthropology (VA) is the three-dimensional analysis of anthropological objects within a computer environment. For the investigation of fossil hominid material the VA approach is a very powerful and essential technique to obtain quantitative and qualitative data. The permanent accessibility of the virtual objects and the possibility to study inner structures are striking advantages. The present study is an attempt to evaluate the usefulness and problems of VA and to provide data on accuracy and reproducibility. 10 Homo sapiens skulls were CT-scanned and were measured on the computer and with established methods (calipers and mustard seeds/water displacement). Different co-variables like sex, age, observer, and class and dimension of measurement were included. The results are very promising: The mean of absolute difference for linear measurements is 0.71 mm +/- 0.55 (0.58% +/- 0.49), and 31.59 ccm +/- 13.37 (2.26% +/- 0.86) for volume measurements. Reproducibility is 0.11 mm +/- 0.15 for located landmarks and 0.37 mm +/- 0.41 for relocating landmarks. Age and class of measurement are significant factors.

Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation.

Contradictory results have been obtained in classifying various renal diseases when trying to use the resistive index measured by duplex Doppler technique in renoparenchymal arteries. These measurements may have been influenced by the lack of standardization of the anatomic site at which the renoparenchymal artery is sampled. To elucidate this influence, we measured the resistive index, peak systolic velocity, end diastolic velocity, and pulsatility index in 120 healthy kidneys at three different positions of the renal vasculature. The resistive index at the level of the interlobar-arcuate arteries proved to be the parameter with the most consistent results and should be preferred in clinical applications.