A framework to improve the alignment of individual cytoarchitectonic maps of the Julich-Brain atlas using cortical folding landmarks.

The segregation of the cortical mantle into cytoarchitectonic areas provides a structural basis for the specialization of different brain regions. In vivo neuroimaging experiments can be linked to this postmortem cytoarchitectonic parcellation via Julich-Brain. This atlas embeds probabilistic maps that account for inter-individual variability in the localization of cytoarchitectonic areas in the reference spaces targeted by spatial normalization. We built a framework to improve the alignment of architectural areas across brains using cortical folding landmarks. This framework, initially designed for in vivo imaging, was adapted to postmortem histological data. We applied this to the first 14 brains used to establish the Julich-Brain atlas to infer a refined atlas with more focal probabilistic maps. The improvement achieved is significant in the primary regions and some of the associative areas. This framework also provides a tool for exploring the relationship between cortical folding patterns and cytoarchitectonic areas in different cortical regions to establish new landmarks in the remainder of the cortex.

Changes in movement patterns in relation to sun conditions and spatial scales in wild western gorillas.

For most primates living in tropical forests, food resources occur in patchworks of different habitats that vary seasonally in quality and quantity. Efficient navigation (i.e., spatial memory-based orientation) towards profitable food patches should enhance their foraging success. The mechanisms underpinning primate navigating ability remain nonetheless mostly unknown. Using GPS long-term tracking (596 days) of one group of wild western lowland gorillas (Gorilla gorilla gorilla), we investigated their ability to navigate at long distances, and tested for how the sun was used to navigate at any scale by improving landmark visibility and/or by acting as a compass. Long episodic movements ending at a distant swamp, a unique place in the home range where gorillas could find mineral-rich aquatic plants, were straighter and faster than their everyday foraging movements relying on spatial memory. This suggests intentional targeting of the swamp based on long-distance navigation skills, which can thus be efficient over a couple of kilometres. Interestingly, for both long-distance movements towards the swamp and everyday foraging movements, gorillas moved straighter under sunlight conditions even under a dense vegetation cover. By contrast, movement straightness was not markedly different when the sun elevation was low (the sun azimuth then being potentially usable as a compass) or high (so providing no directional information) and the sky was clear or overcast. This suggests that gorillas navigate their home range by relying on visual place recognition but do not use the sun azimuth as a compass. Like humans, who rely heavily on vision to navigate, gorillas should benefit from better lighting to help them identify landmarks as they move through shady forests. This study uncovers a neglected aspect of primate navigation. Spatial memory and vision might have played an important role in the evolutionary success of diurnal primate lineages.

Gyral peaks and patterns in human brains.

Cortical folding patterns are related to brain function, cognition, and behavior. Since the relationship has not been fully explained on a coarse scale, many efforts have been devoted to the identification of finer grained cortical landmarks, such as sulcal pits and gyral peaks, which were found to remain invariant across subjects and ages and the invariance may be related to gene mediated proto-map. However, gyral peaks were only investigated on macaque monkey brains, but not on human brains where the investigation is challenged due to high inter-individual variabilities. To this end, in this work, we successfully identified 96 gyral peaks both on the left and right hemispheres of human brains, respectively. These peaks are spatially consistent across individuals. Higher or sharper peaks are more consistent across subjects. Both structural and functional graph metrics of peaks are significantly different from other cortical regions, and more importantly, these nodal graph metrics are anti-correlated with the spatial consistency metrics within peaks. In addition, the distribution of peaks and various cortical anatomical, structural/functional connective features show hemispheric symmetry. These findings provide new clues to understanding the cortical landmarks, as well as their relationship with brain functions, cognition, behavior in both healthy and aberrant brains.

Ctenocephalides orientis and Ctenocephalides felis in Thailand: Head geometry by species, sex and geography.

Fleas in the genus Ctenocephalides serve as biological vectors or intermediate hosts of microorganisms such as bacteria, rickettsia, protozoa and helminths. Ctenocephalides felis has a worldwide distribution, while C. orientis has long been considered as a subspecies of C. felis in Asia. To help the morphological recognition of these two species and further explore their differences, we used the geometric morphometric approach applied to the head. Both sexes were examined. Five anatomical landmarks of the head were used, and to capture the curvature of the front head, 10 semilandmarks were added. There was a consistent difference in species classification accuracy when considering landmarks only versus their combination with semilandmarks, suggesting the importance of the curve of the head as a taxonomic signal. Using or not the labels in the reclassification analyses, the head shape allowed by itself almost perfect recognition of the two species, in both sexes, even after adjustment for prior probabilities. The same approach disclosed a high level of sexual size and shape dimorphism in both species. The contribution of size variation to the discrimination by shape was much more important between sexes (from 27% to 45%) than between species (from 0.7% to 7.1%). Nevertheless, in our data, size never could represent a way to reliably recognise the sex of an individual, even less its species. Geographical variation in head shape could only be explored for the C. orientis sample. No significant correlation of morphometric variation with geography could be detected, which would be consistent with gene flow between Thai provinces. The geometric morphometric approach of the flea head, when it incorporates head curves, is a promising tool for rapid, economical, and accurate species and sex identification. It is, therefore, a useful tool for future epidemiological and demographic studies.

Preoperative anatomical landmarks and longitudinal HeartMate 3 pump position in X-rays: Relevance for adverse events.

BACKGROUND: Left ventricular assist device (LVAD) malposition has been linked to hemocompatibility-related adverse events (HRAEs). This study aimed to identify preoperative anatomical landmarks and postoperative pump position, associated with HRAEs during LVAD support. METHODS: Pre- and postoperative chest X-ray measures (≤14 days pre-implantation, first postoperative standing, 6, 12, 18, and 24 months post-implantation) were analyzed for their association with HRAEs over 24 months in 33 HeartMate 3 (HM3) patients (15.2% female, age 66 (9.5) years). RESULTS: HM3 patients with any HRAE showed significantly lower preoperative distances between left ventricle and thoracic outline (dLVT) (25.3 ± 10.2 mm vs. 40.3 ± 15.5 mm, p = 0.004). A ROC-derived cutoff dLVT ≤ 29.2 mm provided 85.7% sensitivity and 72.2% specificity predicting any HRAE during HM3 support (76.2% (>29.2 mm) vs. 16.7% (≤29.2 mm) freedom from HRAE, p < 0.001) and significant differences in cardiothoracic ratio (0.58 ± 0.04 vs. 0.62 ± 0.04, p = 0.045). Postoperative X-rays indicated lower pump depths in patients with ischemic strokes (9.1 ± 16.2 mm vs. 38.0 ± 18.5 mm, p = 0.007), reduced freedom from any neurological event (pump depth ≤ 28.7 mm: 45.5% vs. 94.1%, p = 0.004), and a significant correlation between pump depth and inflow cannula angle (r = 0.66, p < 0.001). Longitudinal changes were observed in heart-pump width (F(4,60) = 5.61, p < 0.001). CONCLUSION: Preoperative X-ray markers are associated with postoperative HRAE occurrence. Applying this knowledge in clinical practice may enhance risk stratification, guide therapy optimization, and improve HM3 recipient management.

Sex differences in direction giving: Are boys better than girls?

Previous research has extensively documented sex differences favoring boys in various domains of spatial cognition. However, relatively little research has examined sex differences in children's direction giving. The current study aimed to bridge this gap. A total of 143 children aged 3 to 10 years were asked to describe and recall routes from survey perspectives (via maps) and route perspectives (via videos). Significant sex effects (favoring boys) in direction-giving accuracy were found in describing route trials. However, boys and girls did not differ in the frequency of utterances encoding landmarks and direction of turns, suggesting that the quality rather than the quantity of words played a more important role in explaining sex differences. In addition, there was no sex difference in the route recall task. Although accuracy was overall higher in the map condition than in the video condition, it did not moderate sex differences. Overall, our study showed a robust sex difference in direction giving, which has important theoretical implications for understanding the development of human sex differences and critical clinical implications for designing training programs to improve children's spatial cognition.

Accuracy of artificial intelligence-assisted growth prediction in skeletal Class I preadolescent patients using serial lateral cephalograms for a 2-year growth interval.

OBJECTIVE: To investigate the accuracy of artificial intelligence-assisted growth prediction using a convolutional neural network (CNN) algorithm and longitudinal lateral cephalograms (Lat-cephs). MATERIALS AND METHODS: A total of 198 Japanese preadolescent children, who had skeletal Class I malocclusion and whose Lat-cephs were available at age 8 years (T0) and 10 years (T1), were allocated into the training, validation, and test phases (n = 161, n = 17, n = 20). Orthodontists and the CNN model identified 28 hard-tissue landmarks (HTL) and 19 soft-tissue landmarks (STL). The mean prediction error values were defined as 'excellent,' 'very good,' 'good,' 'acceptable,' and 'unsatisfactory' (criteria: 0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm, respectively). The degree of accurate prediction percentage (APP) was defined as 'very high,' 'high,' 'medium,' and 'low' (criteria: 90%, 70%, and 50%, respectively) according to the percentage of subjects that showed the error range within 1.5 mm. RESULTS: All HTLs showed acceptable-to-excellent mean PE values, while the STLs Pog', Gn', and Me' showed unsatisfactory values, and the rest showed good-to-acceptable values. Regarding the degree of APP, HTLs Ba, ramus posterior, Pm, Pog, B-point, Me, and mandibular first molar root apex exhibited low APPs. The STLs labrale superius, lower embrasure, lower lip, point of lower profile, B', Pog,' Gn' and Me' also exhibited low APPs. The remainder of HTLs and STLs showed medium-to-very high APPs. CONCLUSION: Despite the possibility of using the CNN model to predict growth, further studies are needed to improve the prediction accuracy in HTLs and STLs of the chin area.

The COVID-19 pandemic as autobiographical period: evidence from an event dating study.

The COVID-19 Pandemic is undoubtedly one of the most impactful and ubiquitous public events in recent history. In this study, we focused on how it affected the organisation of autobiographical memory by examining how often individuals referred to the COVID-19 Pandemic while estimating the date of their autobiographical memories. To that end, we collected word-cued memories from the recent past, event dating protocols, COVID-relatedness ratings, and the transitional impact scores from first-year undergraduates. We found that participants frequently recalled COVID-related memories, and often used the Pandemic as a temporal landmark for dating both COVID-related and unrelated memories. Importantly, reference to the Pandemic in dating estimates was as frequent as the references to other important life periods (high school, university). Despite affecting the lives of these individuals only moderately in psychological and material terms, these data indicate that the Pandemic has become a prominent landmark in autobiographical memory, shaping the way we remember and situate past experiences.

Comparison of femoral tunnel position and knee function in anterior cruciate ligament reconstruction: a retrospective cohort study using measuring-fluoroscopy method versus bony marker method.

BACKGROUND: Previous studies have shown that surgical technique errors especially the wrong bone tunnel position are the primary reason for the failure of anterior cruciate ligament (ACL) reconstruction. In this study, we aimed to compare the femoral tunnel position and impact on knee function during the ACL reconstruction using measuring combined with fluoroscopy method and bony marker method for femoral tunnel localization. METHODS: A retrospective cohort study of patients undergoing ACL reconstruction using the bony marker method or measuring combined with fluoroscopy for femoral tunnel localization was conducted between January 2015 and January 2020. A second arthroscopic exploration was performed more than 1 year after surgery. Data regarding patient demographics, the femoral tunnel position, results of the Lysholm score, the International Knee Documentation Committee (IKDC) score, KT-1000 side-to-side difference, pivot shift grade, and Lachman grade of the knee were collected. RESULTS: A total of 119 patients were included in the final cohort. Of these, 42 cases were in the traditional method group, and 77 cases were in the measuring method group. The good tunnel position rate was 26.2% in the traditional method group and 81.8% in the measuring method group (p < 0.001). At the final follow-up, the Lysholm and IKDC scores were significantly greater in the measuring method group than the traditional method group (IKDC: 84.9 ± 8.4 vs. 79.6 ± 6.4, p = 0.0005; Lysholm: 88.8 ± 6.4 vs. 81.6 ± 6.4, p < 0.001). Lachman and pivot shift grades were significantly greater in the measuring method group (p = 0.01, p = 0008). The results of KT-1000 side-to-side differences were significantly better in the measuring method group compared with those in the traditional method group (p < 0.001). CONCLUSIONS: The combination of the measuring method and intraoperative fluoroscopy resulted in a concentrated tunnel position on the femoral side, a high rate of functional success, improved knee stability, and a low risk of tunnel deviation. This approach is particularly suitable for surgeons new to ACL reconstructive surgery.

Two methods for geometric morphometric analysis of trichodinids from killifishes.

In this study, we compared the efficacy of geometric morphometric techniques, including outlines and landmark-based approaches, to support the differentiation of Trichodina bellottii from three co-occurring killifish species. Both methods were able to differentiate trichodinids from different host species. However, discriminat analyses and MANOVA results based on landmarks had greater accuracy possibly because these analyses only provide information on certain points defined by the researcher, while the analyses based on outlines take into account points with less taxonomic information.

KISS-Keep It Static SLAMMOT-The Cost of Integrating Moving Object Tracking into an EKF-SLAM Algorithm.

The treatment of moving objects in simultaneous localization and mapping (SLAM) is a key challenge in contemporary robotics. In this paper, we propose an extension of the EKF-SLAM algorithm that incorporates moving objects into the estimation process, which we term KISS. We have extended the robotic vision toolbox to analyze the influence of moving objects in simulations. Two linear and one nonlinear motion models are used to represent the moving objects. The observation model remains the same for all objects. The proposed model is evaluated against an implementation of the state-of-the-art formulation for moving object tracking, DATMO. We investigate increasing numbers of static landmarks and dynamic objects to demonstrate the impact on the algorithm and compare it with cases where a moving object is mistakenly integrated as a static landmark (false negative) and a static landmark as a moving object (false positive). In practice, distances to dynamic objects are important, and we propose the safety-distance-error metric to evaluate the difference between the true and estimated distances to a dynamic object. The results show that false positives have a negligible impact on map distortion and ATE with increasing static landmarks, while false negatives significantly distort maps and degrade performance metrics. Explicitly modeling dynamic objects not only performs comparably in terms of map distortion and ATE but also enables more accurate tracking of dynamic objects with a lower safety-distance-error than DATMO. We recommend that researchers model objects with uncertain motion using a simple constant position model, hence we name our contribution Keep it Static SLAMMOT. We hope this work will provide valuable data points and insights for future research into integrating moving objects into SLAM algorithms.

An Audio-Based SLAM for Indoor Environments: A Robotic Mixed Reality Presentation.

In this paper, we present a novel approach referred to as the audio-based virtual landmark-based HoloSLAM. This innovative method leverages a single sound source and microphone arrays to estimate the voice-printed speaker's direction. The system allows an autonomous robot equipped with a single microphone array to navigate within indoor environments, interact with specific sound sources, and simultaneously determine its own location while mapping the environment. The proposed method does not require multiple audio sources in the environment nor sensor fusion to extract pertinent information and make accurate sound source estimations. Furthermore, the approach incorporates Robotic Mixed Reality using Microsoft HoloLens to superimpose landmarks, effectively mitigating the audio landmark-related issues of conventional audio-based landmark SLAM, particularly in situations where audio landmarks cannot be discerned, are limited in number, or are completely missing. The paper also evaluates an active speaker detection method, demonstrating its ability to achieve high accuracy in scenarios where audio data are the sole input. Real-time experiments validate the effectiveness of this method, emphasizing its precision and comprehensive mapping capabilities. The results of these experiments showcase the accuracy and efficiency of the proposed system, surpassing the constraints associated with traditional audio-based SLAM techniques, ultimately leading to a more detailed and precise mapping of the robot's surroundings.

The accuracy and reliability of different midsagittal planes in the symmetry assessment using cone-beam computed tomography.

Symmetry is an essential component of esthetic assessment. Accurate assessment of facial symmetry is critical to the treatment plan of orthognathic surgery and orthodontic treatment. However, there is no internationally accepted midsagittal plane (MSP) for orthodontists and orthognathic surgeons. The purpose of this study was to explore a clinically friendly MSP, which is more accurate and reliable than what is commonly used in symmetry assessment. Forty patients with symmetric craniofacial structures were analyzed on cone-beam computed tomography (CBCT) scans. The CBCT data were exported to the Simplant Pro software to build four reference planes that were constructed by nasion (N), basion (Ba), sella (S), odontoid (Dent), or incisive foramen (IF). A total of 31 landmarks were located to determine which reference plane is the most optimal MSP by comparing the asymmetry index (AI). The mean value of AI showed a significant difference (p < 0.05) among four reference planes. Also, the mean value of AI for all landmarks showed that Plane 2 (consisting of N, Ba, and IF) and Plane 4 (consisting of N, IF, and Dent) were more accurate and stable. In conclusion, the MSP consisting of N, Dent, and IF shows more accuracy and reliability than the other planes. Further, it is more clinically friendly because of its significant advantage in landmarking.

The Untold Story of Occipital Nerve Stimulation in Patients With Cluster Headache: Surgical Technique in Relation to Clinical Efficacy.

OBJECTIVES: Approximately one in every 1000 adults experiences cluster headache (CH). Although occipital nerve stimulation (ONS) appears encouraging in treatment for most patients with refractory CH, some patients do not reach adequate pain relief with ONS. A reason for failure of ONS might be anatomical variations and different surgical approaches. Therefore, an extensive literature analysis was performed, and cadaveric experimentation was combined with our clinical experience to provide a standardized proposal for ONS and obtain optimal management of patients with refractory CH. MATERIALS AND METHODS: Data from 36 articles published between 1998 and 2023 were analyzed to retrieve information on the anatomical landmarks and surgical technique of ONS. For the cadaveric experimentation (N = 1), two electrodes were inserted from the region over the foramen magnum and projected toward the lower third of the mastoid process. RESULTS: The existence of multiple approaches of ONS has been confirmed by the present analysis. Discrepancies have been found in the anatomical locations and corresponding landmarks of the greater and lesser occipital nerve. The surgical approaches differed in patient positioning, electrode placement, and imaging techniques, with an overall efficacy range of 35.7% to 90%. CONCLUSIONS: Reports on the surgical approach of ONS remain contradictory, hence emphasizing the need for standardization. Only if all implanting physicians perform the ONS surgery using a standardized protocol, can future data be combined and outcomes compared and analyzed.

Specific tibial landmarks to improve to accuracy of the tibial cut during total knee arthroplasty. A case control study.

INTRODUCTION: More personalized alignment techniques in total knee arthroplasty (TKA) have recently been described particularly for the young and active patients. Performing the ideal tibial cut might be challenging with a conventional ancillary. Therefore the aims of this study were: (1) to describe specific tibial landmarks to optimize the tibial cut in TKA; (2) to compare the accuracy of the tibial cut with these landmarks compared to a conventional technique. METHODS: This retrospective case-control study compared primary TKAs performed using a conventional technique with extramedullary guide associated with specific tibial landmarks. For each case, one control patient was matched based on body mass index (BMI), age, preoperative Hip Knee Ankle (HKA) angle, and Medial Proximal Tibial Angle (MPTA). All control patients were operated by the same surgeon and similar conventional technique but without landmarks. The MPTA target was to reproduce preoperative deformity with a 3° of varus limit. 34 TKA were included in each group. There was no preoperative difference between both groups. Mean age was 63 years old ± 8. Mean BMI was 32 kg/m2 ± 5. Mean HKA was 170.6° ± 2.5. Mean MPTA was 85.1° ± 2.3. The radiographic assessment was performed preoperatively and at 2 months: HKA, mechanical Medial Distal Femoral Angle (mMDFA), MPTA, tibial slope, restoration of the joint line-height. RESULTS: The tibial landmarks corresponded to the line of insertion of the deep medial collateral ligament fibers extended to the capsular insertion above the Gerdy tubercle. The postoperative MPTA was significantly more varus (87.2° ± 1.6 in landmark group versus 88.3° ± 2.2; p = 0.027) and closer to preoperative bone deformity in landmark group (p = 0.002) with significantly less outliers than in the conventional group. There was no significant difference between both groups postoperatively for HKA (175.4° ± 2.3 versus 175.9° ± 2.5; p = 0.42); mMDFA (88.9° ± 2.3 versus 88.2° ± 2.1; p = 0.18); tibial slope (82.6° ± 1.9 versus 82.4° ± 2.6; p = 0.67), the restoration of the joint line-height (1.5 mm ± 2 versus 1.8 mm ± 2; p = 0.56). CONCLUSION: Specific tibial landmarks during TKA can be used to increase the accuracy of the tibial cut when using personalized alignment techniques in TKA. LEVEL OF EVIDENCE: IV.

Quantitative analysis of surgical landmarks of the face in fixed cadaveric heads: clinical and anatomical implications.

PURPOSE: This study aimed to examine and analyze the presence of sexual dimorphism and symmetry/asymmetry in fixed cadaveric heads and their contributions to clinical practice. METHODS: Measurements were conducted on 6 cadavers and 24 fixed cadaveric heads (n = 30) using a digital microcaliper to assess cranial dimensions, including surgical landmarks, facial index (FI), orbital index (OI), and the danger triangle of the face, offering crucial references for surgeons during surgical interventions. RESULTS: Analyses were conducted on cadavers consisting of 10 females (33.3%) and 20 males (66.7%). Males demonstrated significantly higher values than females in terms of Zy-Zy (Zy = Zygion), nasal body, and width/length of the columella. Hyperleptoprosop types were the most frequently observed, followed by the leptoprosop type. Females exhibited megaseme characteristics according to OI on both sides. Additionally, the danger triangle of the face was greater in males compared than in females, suggesting a higher risk of infection in this region among males. CONCLUSION: The observed sex differences in facial and nasal dimensions, along with facial indices, are crucial for customizing surgical procedures to individual patients. For example, the greater distance in the danger triangle among males highlights the importance of considering anatomical variations to avoid complications, such as septic cavernous sinus thrombosis. Integrating these measurements into preoperative planning can enhance the precision of facial reconstruction and aesthetic surgeries, thereby improving patient outcomes and safety.

Human and Animal Fascioliasis: Origins and Worldwide Evolving Scenario.

Fascioliasis is a plant- and waterborne zoonotic parasitic disease caused by two trematode species: (i) Fasciola hepatica in Europe, Asia, Africa, the Americas, and Oceania and (ii) F. gigantica, which is restricted to Africa and Asia. Fasciolid liver flukes infect mainly herbivores as ruminants, equids, and camelids but also omnivore mammals as humans and swine and are transmitted by freshwater Lymnaeidae snail vectors. Two phases may be distinguished in fasciolid evolution. The long predomestication period includes the F. gigantica origin in east-southern Africa around the mid-Miocene, the F. hepatica origin in the Near-Middle East of Asia around the latest Miocene to Early Pliocene, and their subsequent local spread. The short postdomestication period includes the worldwide spread by human-guided movements of animals in the last 12,000 years and the more recent transoceanic anthropogenic introductions of F. hepatica into the Americas and Oceania and of F. gigantica into several large islands of the Pacific with ships transporting livestock in the last 500 years. The routes and chronology of the spreading waves followed by both fasciolids into the five continents are redefined on the basis of recently generated knowledge of human-guided movements of domesticated hosts. No local, zonal, or regional situation showing disagreement with historical records was found, although in a few world zones the available knowledge is still insufficient. The anthropogenically accelerated evolution of fasciolids allows us to call them "peridomestic endoparasites." The multidisciplinary implications for crucial aspects of the disease should therefore lead the present baseline update to be taken into account in future research studies.

[Ultrasound of nerves of the lower extremities]. / Nervensonographie der unteren Extremitäten.

The ability to visualize the nerves of the lower extremities differs from that of the upper extremities in sonography because the soft tissue cover is significantly larger in some cases. Landmarks are also defined for the lower extremities, which enable precise visualization of the nerves. Nerves and muscles are to be understood as a functional unit. In addition to the clarification of nerve compression syndromes, polyneuropathies and nerve tumors, sonography is also used to visualize muscle atrophy.

The Role of Pre-Contrast Sequences of an MRI-Guided Breast Biopsy in Localizing a Target.

Objective: This retrospective study aims to assess the role of pre-contrast sequences of an MRI-guided breast biopsy (MRIB) exam in confident and accurate lesion site localization based on tissue landmarks. Methods: The charts of all consecutives MRIB that were performed between January 2018 and December 2020 were reviewed. The images of the eligible exams were analyzed by 3 breast radiologists. Each radiologist independently attempted to identify lesion site on pre-contrast MRIB sequences, while blinded to the post-contrast MRIB images. Confidence levels (I-confident, II-not confident, and III-unknown) were assigned by each reviewer. A fourth radiologist assessed the accuracy (≤5 mm-accurate, >5 mm-inaccurate) in lesion site localization using the actual biopsied lesion site and the post-contrast MRIB images as reference. Descriptive statistics were used to calculate the percentage of confidence and accuracy categories for each reviewer, with Chi-square tests applied to analyze relationships between categorical variables. Results: There were 174 female patients with 181 lesions eligible for the trial. When the lesion site is confidently identified on the pre-contrast MRIB images (level 1 confidence), mean grade 1 accuracy was 93.8% (P < .001). Accuracy decreased with Level II and III confidence (55.3% and 34.2% respectively). Up to 61.4% improved accuracy was demonstrated when combining the performance of 2 reviewers. No correlation was found between breast density, lesion morphology, or biopsy positioning with confidence level or accuracy grade. Conclusion: Careful review of the pre-contrast MRIB images and familiarization with the surrounding tissue landmarks are important steps in confidently and accurately detecting lesion site.

Can artificial intelligence-driven cephalometric analysis replace manual tracing? A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to investigate the accuracy and efficiency of artificial intelligence (AI)-driven automated landmark detection for cephalometric analysis on two-dimensional (2D) lateral cephalograms and three-dimensional (3D) cone-beam computed tomographic (CBCT) images. SEARCH METHODS: An electronic search was conducted in the following databases: PubMed, Web of Science, Embase, and grey literature with search timeline extending up to January 2024. SELECTION CRITERIA: Studies that employed AI for 2D or 3D cephalometric landmark detection were included. DATA COLLECTION AND ANALYSIS: The selection of studies, data extraction, and quality assessment of the included studies were performed independently by two reviewers. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A meta-analysis was conducted to evaluate the accuracy of the 2D landmarks identification based on both mean radial error and standard error. RESULTS: Following the removal of duplicates, title and abstract screening, and full-text reading, 34 publications were selected. Amongst these, 27 studies evaluated the accuracy of AI-driven automated landmarking on 2D lateral cephalograms, while 7 studies involved 3D-CBCT images. A meta-analysis, based on the success detection rate of landmark placement on 2D images, revealed that the error was below the clinically acceptable threshold of 2 mm (1.39 mm; 95% confidence interval: 0.85-1.92 mm). For 3D images, meta-analysis could not be conducted due to significant heterogeneity amongst the study designs. However, qualitative synthesis indicated that the mean error of landmark detection on 3D images ranged from 1.0 to 5.8 mm. Both automated 2D and 3D landmarking proved to be time-efficient, taking less than 1 min. Most studies exhibited a high risk of bias in data selection (n = 27) and reference standard (n = 29). CONCLUSION: The performance of AI-driven cephalometric landmark detection on both 2D cephalograms and 3D-CBCT images showed potential in terms of accuracy and time efficiency. However, the generalizability and robustness of these AI systems could benefit from further improvement. REGISTRATION: PROSPERO: CRD42022328800.