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Haptic rendering of isosurfaces directly from medical images.

Virtual environments for surgical training, planning and rehearsal have the potential to significantly enhance patient treatment and diagnosis. Haptic feedback devices provide forces to the physician through a manipulator, simulating palpation, scalpel cuts, or retraction of tissue. While haptics have been studied in other fields, medical applications of haptics remain in their infancy. We propose a method of haptically rendering isosurfaces (representing hard structures) directly from anatomical datasets rather than through traditional intermediate graphical representations such as polygons. Our algorithm determines an implicit surface representation of a volumetric isosurface on the fly, and renders the structure using standard haptic algorithms to calculate the forces felt by the user. This approach has the advantage of providing easy access to the rich volume dataset containing the actual anatomy. By relating Hounsfield units to density, haptic rendering has the ability to provide different resistances based on the tissue type being rendered. We developed and tested our algorithm using a quadric implicit surface, a common primitive in computer graphics, and have applied it to a variety of anatomical image datasets. Our paper describes the algorithm in sufficient detail to facilitate reproduction by others.

Algorithms↗

Computer-generated slide graphics: an exciting advancement or a problem?

Computer-generated slide graphics have significantly altered the face of audiovisual presentations. However, it remains to be determined if dramatic effects enhance presentation clarity and increase information retrieval. This study compared color combination and print type graphics. Ninety medical students were shown a 29-minute, 45-slide presentation addressing aspects of plastic surgery. Each slide represented one of 15 color combinations and one of 3 fonts. The students studied each slide for 10 seconds and then in 25 seconds recorded all information they could recall. Statistical analysis (using ANOVA) revealed a significant difference in information retrieval among slides and a significant interaction between color and font. The "best" was orange block print on a raspberry background. The "worst" was yellow cursive print on a black background. This study demonstrated that (1) color influences information gleaned from a slide presentation and (2) font type simplicity may result in improved retention.

Audiovisual Aids↗

Quantitative three-dimensional assessment of face-lift with an optical facial surface scanner.

Three-dimensional computed tomographic scan images of facial deformities provide information that has been useful in planning and evaluating therapy. However, the benefits of computed tomographic imaging in cosmetic plastic surgery are often insufficient to justify exposing the patient to radiation. This report describes application of an optical, noncontact, three-dimensional surface digitizer with subsecond scanning time for 360-degree examination of the human head. The resultant three-dimensional surface data are suitable for computer graphics display and manipulation, and for noncontact skin surface measurement. The scanner provides accurate and complete coverage of complex facial surfaces. This system was applied to digitization of the human head in the planning and evaluation of facial plastic surgery. The results indicate that the resulting image is accurate enough to detect subtle dimensional changes resulting from surgery, including postoperative edema and surface changes due to face-lift. This type of scanning can assist in a number of tasks performed by plastic surgeons, including collecting anthropomorphic measurements, preoperative and postoperative assessment, volume monitoring, customizing of implants, and interactive planning.

Algorithms↗

Virtual reality: preparation and execution of sinus surgery.

Endonasal sinus surgery requires a great deal of training before it can be performed adequately. Due to the complex and variable anatomy and the proximity of important structures, severe complications are possible, even for experienced surgeons. The nasal endoscopy simulator (NES) is an interactive training system for nasal endoscopy and endonasal sinus surgery that combines computer graphics and virtual reality (VR) techniques. This system consists of a graphics workstation, a tracking system for measuring the position of the endoscope and surgical instruments in space, a head model, image data sets of the nasal cavity and paranasal sinus area, and complementary software. The current NES is a visual and auditory VR system that provides both educational and planning options for sinus surgery. The usual resistance when touching relevant anatomical structures is not provided by this release. Therefore, a "force feedback system" is implemented that allows for such a response. VR simulation will become an important part of surgical education and planning for individual sinus surgery procedures. The ongoing development of the NES will lead to an improved educational environment for residents in training and practitioners.

Computer Graphics↗

Three-dimensional analysis of the intrinsic cardiac ganglia in a young dog.

The intrinsic ganglia of the heart of a young dog were studied by computer graphic reconstruction to determine the accurate location. The heart was embedded in celloidin, and transverse sections were cut. Using every third 60 microns section, a series of 49 sections was mapped. Three-dimensional (3D) images were constructed by a personal computer. Numerous intrinsic ganglia, most of which were located in the epicardiun, were observed. The intrinsic ganglia were found in the base of the aorta and pulmonary vessels and from the base of the superior vena cava to the right atrium, i.e., the sinoatrial nodal region. Using the 3D reconstruction technique, the locations of the intrinsic ganglia could be accurately identified. Furthermore, it was demonstrated that these ganglia formed several groups which formed a continuity. This study suggested that it was necessary to consider the existence of the numerous intrinsic ganglia, when we studied the cardiac innervation.

Animals↗

Characterization of the glycosylation status of proteins.

Proteins are posttranslationally modified by a number of mechanisms, by far the most significant of which in terms of the molecular mass and functional diversity is glycosylation. The oligosaccharide chains added shortly after biosynthesis at the ribosome, and further modified while the protein is translocated through the intracellular membranes, have multiple affects on transport, localization, stability, plasma membrane expression activity, and antigenicity. Characterization of the glycosylation patterns at each site around the protein is essential for detailed understanding of structure/function relationships and the design of potential therapeutic agents. This can be achieved by a series of chromatographic and physicochemical procedures including HPLC, GC, MS, NMR, and computer graphics molecular modeling, which culminate in information on monosaccharide sequence and linkage, glycoprotein conformation, and oligosaccharide-to-protein interactions.

Carbohydrate Conformation↗

DNurbs: DNA modeled with NURBS.

DNurbs (dee-in-urbs) are a small number of bicubic patches wrapping each base pair in complementary DNA. NURBS, the nonuniform rational B-spline surfaces now popular in computer graphics, are employed for the patches. Control points for the surface patches are generated from the molecular surface based on canonical base pairs.

Base Sequence↗

Synthetic amphiphilic peptide models for protein ion channels.

Ion channel proteins are important for the conduction of ions across biological membranes. Recent analyses of their sequences have suggested that they are composed of bundles of alpha-helices that associate to form ion-conducting channels. To gain insight into the mechanisms by which alpha-helices can aggregate and conduct ions, three model peptides containing only leucine and serine residues were synthesized and characterized. A 21-residue peptide, H2N-(Leu-Ser-Ser-Leu-Leu-Ser-Leu)3-CONH2, which was designed to be a membrane-spanning amphiphilic alpha-helix, formed well-defined ion channels with ion permeability and lifetime characteristics resembling the acetylcholine receptor. In contrast, a 14-residue version of this peptide, which was too short to span the phospolipid bilayer as an alpha-helix, failed to form discrete, stable channels. A third peptide, H2N-(Leu-Ser-Leu-Leu-Leu-Ser-Leu)3-CONH2, in which one serine per heptad repeat was replaced by leucine, produced proton-selective channels. Computer graphics and energy minimization were used to create molecular models that were consistent with the observed properties of the channels.

Computer Graphics↗

Human basal ganglia volume asymmetries on magnetic resonance images.

The brains of 19 healthy adults, ages 18-49, were imaged on a GE Signa 1.5 T MR scanner. Basal ganglia were circumscribed on sequential axial proton density-weighted images (TR 1700, TE 20) and submitted for 3-dimensional reconstruction and volumetric analysis at a computer graphics workstation. The 15 right-handed patients (12 men, 3 women) had significantly larger left total basal ganglia volumes, which included larger globus pallidus and lenticular nuclei on the left, but larger caudate nuclei on the right. In contrast, basal ganglia asymmetries were not seen in four left-handers. No sex differences were detected. The basal ganglia appear to belong to an increasing number of CNS structures that display anatomical hemispheric lateralization.

Adult↗

Landmark identification in computerized posteroanterior cephalometrics.

A lack of cognition regarding the reliability of landmark identification in posteroanterior cephalometrics keeps the extracted data questionable. The present study was designed to analyze this problem for the purpose of providing certain insights. An interactive computer graphic package was developed. This package was called EA-PAX (Error Analysis of Postero-Anterior cephalometric X-ray films). A random sample of 40 clear posteroanterior cephalometric head plates was studied. The reliability of landmark identification was established. The skeletal landmarks seemed more reliable than the dental landmarks. The variation in the direction and magnitude of the error was determined for each landmark. Most landmarks had their own characteristic noncircular envelope of error. It is not the philosophy of the present authors to tell the orthodontists what to use. Rather, the philosophy is to be aware of the amount and direction of variation for a particular landmark. Taking this into consideration will enable the orthodontists to look on their cephalometric numbers with a mental awareness of the possible variations. Several clinical and research studies are suggested in the article.

Adolescent↗

Mapping the human brain: past, present, and future.

The ability to map functional activity in the living human brain has rekindled interest in the organization of human neural circuitry specifically and in animal neural circuitry generally. Faced with incredible complexity, researchers are turning to the power of computer graphics for two- and three-dimensional interactive mapping, to the mathematical modeling of dynamics in proposed circuits, and to databases with powerful discovery engines.

Animals↗

New nomenclature and computerized programme of graphics for the description and recording of aortocoronary bypasses.

In the process of drawing up a computerized operation reporting system, a nomenclature for the precise description of recently fitted or existing aortocoronary bypasses has been developed. This is based on a sequence of letters showing in one line which type of bypass has been fitted, the graft material used, the central anastomosis (source) as well as the peripheral anastomoses on the coronary arteries (objective). For this purpose, abbreviations of the customary terms in use in cardiac surgery have been used. A computer graphics programme has been created in parallel, enabling all bypasses (existing and/or new) to be sketched into the diagram of a heart with the aid of a mouse. The bypass nomenclature is automatically generated from the diagram, which can also be printed out as a sketch of the operation. The complete diagram of the heart plus data input forms enable the operation report to be compiled automatically. The nomenclature and the graphics programme are easily learnt, simplify work, can readily be incorporated into a computerized hospital organization and enhance documentation quality.

Abbreviations as Topic↗

A new method for analysing the geometry and timecourse of epicardial potential spreading.

A 256 unipolar electrode matrix fixed at the surface of an isolated rabbit heart was connected to a PC system via an amplifying and analog/digital converting frontend computer. This system allows measurement of 256 electrodes within 100 microseconds with a sampling rate of 0.25 ms. The data are displayed on a PC system either on-line as common ECG-recordings or off-line in projection on a two-dimensional model of the heart surface. Thereby, it is possible to visualize the epicardial potential spreading in a slow-motion presentation on a high resolution computer graphic. The samples are displayed sequentially and can be delayed by choice. This method allows the determination of the origin ("break-through-points") of the epicardial excitation and an analysis of the potential spreading. The electrodes are arranged in four grids with 64 electrodes each at an interelectrode distance of 1 mm. Thereby, it is possible to evaluate the direction of the epicardial excitation wave and the local state of epicardial activation. Furthermore, it is possible to demonstrate irregular pacemakers or re-entry circuits. The method seems to be helpful in analysis of cardiac arrhythmogenesis and mode of action of anti-arrhythmic agents.

Analog-Digital Conversion↗

Drug design with a new type of molecular modeling based on stereochemical complementarity to gene structure.

Why certain chemical structures and not others are present in nature has been a recurring question raised by scientists since the first organic natural products were characterized. Of equal interest has been elucidating what structural features within any given class of organic molecules are responsible for biological activity. Historically, the lack of satisfactory answers to both questions has relegated the development of biologically active molecules either to serendipity or to exhaustive synthesis and biological testing of large numbers of compounds. This frustration is particularly evident in the pharmaceutical industry where the development of drug agonists and antagonists is often time consuming, tedious and expensive. Fortunately, this picture is beginning to change as more information is derived from modern molecular modeling techniques including characterization of the active sites in enzymes and the ligand binding sites in receptors. Over the past 15 years another approach has emerged based upon a series of discoveries made in our laboratories with molecular models. Namely, many biologically active small molecules have been found to possess complementary stereochemical relationships with gene structure. These relationships have proven useful in understanding constraints imposed by nature on the structures of small molecules and in correlating structure with activity among certain classes of compounds. Recently, computer graphics and energy calculations have confirmed salient observations lending credence to what promises to be a powerful and rapidly evolving technology for designing new safe and effective drugs.

Animals↗

A molecular model for the retinol binding protein-transthyretin complex.

A three-dimensional model for the complex between human serum retinol binding protein and transthyretin (formerly named prealbumin) is presented. The model was obtained by interactive rigid-body computer graphics docking and the characterization of the molecular surfaces in terms of fractal dimension. Available experimental data, as well as results from molecular dynamics calculations, support the proposed model.

Computer Graphics↗

Three-dimensional magnetic resonance imaging of the heart.

Three-dimensional surface images of the human heart may be produced from magnetic resonance imaging. These examinations are used in the evaluation of congenital heart disease for preoperative planning and postoperative evaluation. Computer graphics software has been adapted to produce three-dimensional images of the beating heart from contiguous two-dimensional serial EKG-triggered magnetic resonance image data sets. The natural boundary between flowing blood and cardiac tissue serves to outline cardiac structures. The techniques for producing these images and pitfalls in the operation of the system as well as examples of their application to the study of patients with congenital heart disease are outlined in this article.

Adolescent↗