Memories of being injured and patients' care trajectory after physical trauma

Background  

The purpose of this study was to acquire a deeper understanding of patients' memories of being injured and the trajectory of care before, during and after their Intensive Care Unit (ICU) stay.     

Automatic preoperative planning of DBS electrode placement using anatomo-clinical atlases and volume of tissue activated

Purpose

Deep brain stimulation (DBS) is a procedure requiring accurate targeting and electrode placement. The two key elements for successful planning are preserving patient safety by ensuring a safe trajectory and creating treatment efficacy through optimal selection of the stimulation point. In this work, we present the first approach of computer-assisted preoperative DBS planning to automatically optimize both the safety of the electrode’s trajectory and location of the stimulation point so as to provide the best clinical outcome.

Methods

Building upon the findings of previous works focused on electrode trajectory, we added a set of constraints guiding the choice of stimulation point. These took into account retrospective data represented by anatomo-clinical atlases and intersections between the stimulation region and sensitive anatomical structures causing side effects. We implemented our method into automatic preoperative planning software to assess if the algorithm was able to simultaneously optimize electrode trajectory and the stimulation point.

Results

Leave-one-out cross-validation on a dataset of 18 cases demonstrated an improvement in the expected outcome when using the new constraints. The distance to critical structures was not reduced. The intersection between the stimulation region and structures sensitive to stimulation was minimized.

Conclusions

Introducing these new constraints guided the planning to select locations showing a trend toward symptom improvement, while minimizing the risks of side effects, and there was no cost in terms of trajectory safety.

     

3D printing based on imaging data: review of medical applications

Purpose  

Generation of graspable three-dimensional objects applied for surgical planning, prosthetics and related applications using 3D printing or rapid prototyping is summarized and evaluated.     

A geodesic deformable model for automatic segmentation of image sequences applied to radiation therapy

Purpose  

Organ motion should be taken into account for image-guided fractionated radiotherapy. A deformable segmentation and registration method was developed for inter-and intra-fraction organ motion planning and evaluation.     

Interactive bone drilling using a 2D pointing device to support Microendoscopic Discectomy planning

Purpose  

To support preoperative planning of bone drilling for Microendoscopic Discectomy, we present a set of interactive bone-drilling methods using a general 2D pointing device.     

An integrated approach for reconstructing a surface model of the proximal femur from sparse input data and a multi-resolution point distribution model: an in vitro study

Background  

Accurate reconstruction of a patient-specific surface model of the proximal femur from preoperatively or intraoperatively available sparse data plays an important role in planning and supporting various computer-assisted surgical procedures.     

Immobilization and catheter guidance for breast brachytherapy

Purpose  

Brachytherapy is an important mode of breast cancer treatment; however, improvements in both treatment planning and delivery are needed. In order to meet these specific needs, integration of pre-operative imaging, supplemented by computerized surgical planning and mathematical optimization were used to develop and test an intra-operative immobilization and catheter guidance system.     

Recommendations on basic requirements for intensive care units: structural and organizational aspects

Objective  

To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine.     

2D Histogram based volume visualization: combining intensity and size of anatomical structures

Purpose  

Surgical planning requires 3D volume visualizations based on transfer functions (TF) that assign optical properties to volumetric image data. Two-dimensional TFs and 2D histograms may be employed to improve overall performance.     

Automated multiple trajectory planning algorithm for the placement of stereo-electroencephalography (SEEG) electrodes in epilepsy treatment

Purpose

About one-third of individuals with focal epilepsy continue to have seizures despite optimal medical management. These patients are potentially curable with neurosurgery if the epileptogenic zone (EZ) can be identified and resected. Stereo-electroencephalography (SEEG) to record epileptic activity with intracranial depth electrodes may be required to identify the EZ. Each SEEG electrode trajectory, the path between the entry on the skull and the cerebral target, must be planned carefully to avoid trauma to blood vessels and conflicts between electrodes. In current clinical practice trajectories are determined manually, typically taking 2–3 h per patient (15 min per electrode). Manual planning (MP) aims to achieve an implantation plan with good coverage of the putative EZ, an optimal spatial resolution, and 3D distribution of electrodes. Computer-assisted planning tools can reduce planning time by quantifying trajectory suitability.

Methods

We present an automated multiple trajectory planning (MTP) algorithm to compute implantation plans. MTP uses dynamic programming to determine a set of plans. From this set a depth-first search algorithm finds a suitable plan. We compared our MTP algorithm to (a) MP and (b) an automated single trajectory planning (STP) algorithm on 18 patient plans containing 165 electrodes.

Results

MTP changed all 165 trajectories compared to MP. Changes resulted in lower risk (122), increased grey matter sampling (99), shorter length (92), and surgically preferred entry angles (113). MTP changed 42 % (69/165) trajectories compared to STP. Every plan had between 1 to 8 (median 3.5) trajectories changed to resolve electrode conflicts, resulting in surgically preferred plans.

Conclusion

MTP is computationally efficient, determining implantation plans containing 7–12 electrodes within 1 min, compared to 2–3 h for MP.

     

A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients

Purpose  

Evidence for chemotherapy-induced cognitive impairment remains inconclusive. This study was designed to determine the trajectory of cognitive function over time in women with breast cancer, who received doxorubicin and cyclophosphamide (AC) alone or followed by a taxane. Associations between changes in cognitive function and potential covariates including anxiety, depression, fatigue, hemoglobin level, menopausal status, and perception of cognitive function were evaluated.     

Optimization of acquisition trajectories for 3D rotational coronary venography

Objective  

Rotational coronary X-ray imaging on C-arm systems provides a multitude of diagnostic projections from the vascular tree with a single contrast agent bolus. The acquisition trajectory is typically limited to a circular arc with a fixed caudo-cranial angulation. This may cause sub- optimal projection directions for specific vessel segments for all acquired views, e.g., those segments orthogonal to the axis of rotation. In this paper, a method is presented to calculate a patient-independent acquisition trajectory with respect to vessel foreshortening and overlap for multiple vessel segments of the coronary tree. This method can be applied to artery as well as vein anatomy.     

Planning and simulation of microsurgical laser bone ablation

Purpose  

Laser ablation of hard tissue is not completely understood until now and not modeled for computer-assisted microsurgery. A precise planning and simulation is an essential step toward the usage of microsurgical laser bone ablation in the operating room.     

GPU-based smart visibility techniques for tumor surgery planning

Purpose  

The rating of distances and infiltrations to vital structures is important for the planning of tumor surgery or interventional procedures. To support such an assessment, the target structures should be clearly emphasized in a 3D visualization by ensuring their visibility.     

Illustrative visualization of 3D planning models for augmented reality in liver surgery

Purpose  

Augmented reality (AR) obtains increasing acceptance in the operating room. However, a meaningful augmentation of the surgical view with a 3D visualization of planning data which allows reliable comparisons of distances and spatial relations is still an open request.     

Impaired physiological function and health-related QOL in patients before hematopoietic stem-cell transplantation

Purpose  

Patients' physiological functions and health-related quality of life (QOL) are useful for planning physical therapy after allogeneic hematopoietic stem-cell transplantation (allo-HSCT), but have not been extensively examined prior to transplantation. We investigated whether physiological functions and health-related QOL were reduced in patients before undergoing allo-HSCT.     

Liver segmentation for contrast-enhanced MR images using partitioned probabilistic model

Purpose  

Liver volume segmentation is important in computer assisted diagnosis and therapy planning of liver tumors. Manual segmentation is time-consuming, tedious and error prone, so automated methods are needed. Automatic segmentation of MR images is more challenging than for CT images, so a robust system was developed.     

Automatic 3D segmentation of individual facial muscles using unlabeled prior information

Purpose  

Segmentation of facial soft tissues is required for surgical planning and evaluation, but this is laborious using manual methods and has been difficult to achieve with digital segmentation methods. A new automatic 3D segmentation method for facial soft tissues in magnetic resonance imaging (MRI) images was designed, implemented, and tested.     

Complete fully automatic model-based segmentation of normal and pathological lymph nodes in CT data

Purpose  

Exact and reproducible knowledge regarding the position, size, and type of the lymph nodes is often needed for tumor computer-aided diagnosis, treatment planning, and follow-up. An automatic segmentation method for CT data was developed that can identify and delineate normal as well as pathologically altered lymph nodes to satisfy this requirement.     

Long-term quality of life in Australian women previously diagnosed with gynaecologic cancer

Purpose  

The purpose of this study is to investigate challenges to quality of life (QOL) among women previously diagnosed with gynaecologic cancer accessing a metropolitan Australian oncology service. Indices of QOL investigated were anxiety, depression, sexual morbidity, body image and supportive care needs. Findings are to inform service planning and research priorities.