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PubMed2000

Clinical applications of 2D and 3D CT imaging of the airways--a review.

Hardware and software evolution has broadened the possibilities of 2D and 3D reformatting of spiral CT and MR data set. In the study of the thorax, intrinsic benefits of volumetric CT scanning and better quality of reconstructed images offer us the possibility to apply additional rendering techniques to everyday clinical practice. Considering the large number and redundancy of possible post-processing imaging techniques that we can apply to raw CT sections data, it is necessary to precisely set a well-defined number of clinical applications of each of them, by careful evaluation of their benefits and possible pitfalls in each clinical setting. In diagnostic evaluation of pathological processes affecting the airways, a huge number of thin sections is necessary for detailed appraisal and has to be evaluated, and information must then be transferred to referring clinicians. By additional rendering it is possible to make image evaluation and data transfer easier, faster, and more effective. In the study of central airways, additional rendering can be of interest for precise evaluation of the length, morphology, and degree of stenoses. It may help in depicting exactly the locoregional extent of central tumours by better display of relations with bronchovascular interfaces and can increase CT/bronchoscopy sinergy. It may allow closer radiotherapy planning and better depiction of air collections, and, finally, it could ease panoramic evaluation of the results of dynamic or functional studies, that are made possible by increased speed of spiral scanning. When applied to the evaluation of peripheral airways, as a completion to conventional HRCT scans, High-Resolution Volumetric CT, by projection slabs applied to target areas of interest, can better depict the profusion and extension of affected bronchial segments in bronchiectasis, influence the choice of different approaches for tissue sampling by better evaluation of the relations of lung nodules with the airways, or help to detect otherwise overlooked slight pathological findings. In the exploration of the air-spaces of the head and neck, targeted multiplanar study can now be performed without additional scanning by retro-reconstructed sections from original transverse CT slices. Additional rendering can help in surgical planning, by simulation of surgical approaches, and allows better integration with functional paranasal sinuses endoscopic surgery, by endoscopic perspective rendering. Whichever application we perform, the clinical value of 2D and 3D rendering techniques lies in the possibility of overcoming perceptual difficulties and 'slice pollution', by easing more efficient data transfer without loss of information. 3D imaging should not be considered, in the large majority of cases, as a diagnostic tool: looking at reformatted images may increase diagnostic accuracy in only very few cases, but an increase in diagnostic confidence could be not negligible. The purpose of the radiologist skilled in post-processing techniques should be that of modifying patient management, by more confident diagnostic evaluation, in a small number of patients, and, in a larger number of cases, by simplifying communication with referring physicians and surgeons. We will display in detail possible clinical applications of the different 2D and 3D imaging techniques, in the study of the tracheobronchial tree, larynx, nasal cavities and paranasal sinuses by Helical CT, review relating bibliography, and briefly discuss pitfalls and perspectives of CT rendering techniques for each field.

Humans↗
PubMed2000

[Sequestrating senile scleral plaque simulating "necrotizing scleritis". Surgical management].

BACKGROUND: Presentation and surgical treatment of a sequestrating senile scleral plaque, a rare clinical disorder. PATIENT: A 76 year-old-female patient presented with foreign body sensation and epiphora. Half a year before, she had first noticed a "black spot" in her eye which had now progressed to a painless yellow-greyish plaque. CASE HISTORY: The patient had previously undergone a steroid-treatment elsewhere with a diagnosis "necrotizing scleritis" without any improvement. We found a yellow-greyish degenerative plaque sequestrating from the surrounding scleral tissue. In order to prevent superinfection and to secure the tissue defect we surgically removed the plaque and covered the remaining thin inner scleral tissue layers with autologous sclera and conjunctiva. The clinical diagnosis of a calcified senile scleral plaque was histologically confirmed. The patient has been free from any symptoms since the operation. To our knowledge this is the first description of surgical removal of a deeply sequestrating senile sceral plaque. CONCLUSION: Calcified sequesters represent a very rare complication of the otherwise frequent senile scleral plaques. Surgical intervention may be required to prevent superinfection and to cover the deep sceral defect. The clinical picture can be distinguished from necrotizing scleritis or scleromalacia perforans. Sequestrating senile scleraplaques do not tend to perforate. They are, however, a risk for infection and chronic inflammation.

Aged↗
PubMed2000

Computer-assisted three-dimensional surgical planning and simulation: 3D color facial model generation.

A scheme for texture mapping a 3D individualized color photo-realistic facial model from real color portraits and CT data is described. First, 3D CT images including both soft and hard tissues should be reconstructed from sequential CT slices, using a surface rendering technique. Facial features are extracted from 3D soft tissue. A generic mesh is individualized by correspondence matching and interpolation from those feature vertices. Three digitized color portraits with the "third" dimension from reconstructed soft tissue are blended and texture-mapped onto the 3D head model (mesh). A color simulated human head generated from frontal, right and left real color portraits can be viewed from an arbitrary angle in an inexpensive and user-friendly conventional personal computer. This scheme is the basic procedure in 3D computer-assisted simulation surgery.

Color↗
PubMed1979

The symptoms of an amebic abscess of the liver simulating an acute surgical abdomen.

Amebic abscess of the liver has protean manifestations that often resemble causes of an acute surgical abdomen. Patients presenting at University of California, Los Angeles Hospital with acute abdominal injuries who underwent exploratory laparotomy and subsequently were found to have an amebic hepatic abscess were studied. There are various clinical symptoms of amebic hepatic abscess as well as problems of differentiating this pathologic entity from an acute surgical abdomen. Most patients with amebic hepatic abscess that mimics an acute abdomen present as acute cholecystitis or acute appendicitis. All patients recovered uneventfully once the diagnosis was made and appropriate therapy instituted. The salient features of the history, physical examination and laboratory data that can identify the amebic abscess were analyzed. The key to correct diagnosis is cognizance of the condition.

Abdomen, Acute↗
PubMed2006

Simulating staffing needs for surgical instrument distribution in hospitals.

Timely and accurate delivery of surgical instruments to operating rooms is critical for success in surgical operations in hospitals. The National Hospital of Singapore was facing several problems in the process of surgical instrument distribution on ad hoc orders from operating rooms. To solve the problems, the Hospital management considered adopting a new process of surgical instrument distribution on ad hoc orders that involves staffing new healthcare assistants for delivery of surgical instruments to operating rooms. Using computer simulation, this study assessed the efficiency of the new process and recommended the optimal number of healthcare assistants needed for delivery of surgical instruments on ad hoc orders, at which healthcare assistants as well as surgical instruments could be most efficiently utilized. The results show that computer simulation is an effective tool supporting decisions on staffing needs for surgical instrument distribution in hospitals.

Computer Simulation↗
PubMed2002

Estimation of soft-tissue model parameters using registered pre- and postoperative facial surface scans.

Computer-based techniques for the simulation of craniofacial surgical procedures and for the prediction of the surgical outcome have been shown to be very useful. However, the assessment of the accuracy of the simulated surgical outcome is difficult. In this paper, a technique is described which allows to compare the simulated surgical outcome and the actual surgical result. The simulated postoperative patient's appearance is compared to a second surface scan which is obtained postoperatively. The pre- and postoperative surface scans, which are different due to the surgery, are registered employing a robust registration method which minimizes distances of corresponding points. Parameters of the soft-tissue model can be adapted with respect to minimized differences of corresponding points of the simulated postoperative and the actual postoperative surface of a patient's face.

Artifacts↗