Cranial closing wedge ostectomies for management of canine cranial cruciate ligament insufficiency: Comparison and geometric modelling of errors.

Variants of the cranial closing wedge ostectomy (CCWO) may be used to manage cranial cruciate ligament deficient stifles by reduction of the tibial plateau angle (TPA). Concerns have been raised about predictability of achieving target TPA, limb shortening, axis shift, and distalization of the tibial tuberosity. Landmarks derived from tibial radiographs (n = 50) by 5 observers, along with outlines of the cranial and caudal proximal tibial cortices, were used to simulate six CCWO variants. Tested variants were Slocum-type (n = 2), modified (n = 2), isosceles, and anatomical-mechanical axis (AMA)-based CCWO. Observer specific landmarks were used to model pre- and postoperative errors in TPA measurement. Mean landmarks were used to compare key outcome variables between the variants, as well as modelling errors in positioning the wedge apex. Variants differed markedly in TPA, axis shift, mechanical axis length changes, and tibial tuberosity distalization, with more proximally positioned wedges performing better than distally positioned wedges. Errors in TPA identification appeared partially self-correcting due to altered axis shifts. Craniocaudal shifts in wedge apex position had the most severe effects on outcome variables, especially in shorter tibiae with greater initial TPA values. Recent CCWO variants are likely to achieve a satisfactory postoperative TPA with limited axis shift. The AMA-based CCWO technique appears to influence MA length and tibial tuberosity position the least, and apart from the effect on TPA where no advantage could be discerned, it appeared more robust in the face of wedge apex positioning errors than the other techniques.

Injectable Colloidal Gold for Use in Intrafractional 2D Image-Guided Radiation Therapy.

In the western world, approximately 50% of all cancer patients receive radiotherapy alone or in combination with surgery or chemotherapy. Image-guided radiotherapy (IGRT) has in recent years been introduced to enhance precision of the delivery of radiation dose to tumor tissue. Fiducial markers are often inserted inside the tumor to improve IGRT precision and to enable monitoring of the tumor position during radiation therapy. In the present article, a liquid fiducial tissue marker is presented, which can be injected into tumor tissue using thin and flexible needles. The liquid fiducial has high radio-opacity, which allows for marker-based image guidance in 2D and 3D X-ray imaging during radiation therapy. This is achieved by surface-engineering gold nanoparticles to be highly compatible with a carbohydrate-based gelation matrix. The new fiducial marker is investigated in mice where they are highly biocompatible and stable after implantation. To investigate the clinical potential, a study is conducted in a canine cancer patient with spontaneous developed solid tumor in which the marker is successfully injected and used to align and image-guide radiation treatment of the canine patient. It is concluded that the new fiducial marker has highly interesting properties that warrant investigations in cancer patients.