In the past, several techniques have been developed to study and analyse the 3D characteristics of the human spine: multi-view radiographic or biplanar 3D reconstructions, CT-scan 3D reconstructions and geometric models. Extensive evaluations of three of these techniques that are routinely used at Sainte-Justine Hospital (Montréal, Canada) are presented. The accuracy of these methods is assessed by comparing them with precise measurements made with a coordinate measuring machine on 17 thoracic and lumbar vertebrae (T1-L5) extracted from a normal cadaveric spine specimen. Multi-view radiographic 3D reconstructions are evaluated for different combinations of X-ray views: lateral (LAT), postero-anterior with normal incidence (PA0 degree) and postero-anterior with 20 degrees angled down incidence (PA20 degrees). The following accuracies are found for these reconstructions obtained from different radiographic setups: 2.1 +/- 1.5 mm for the combination with PA0 degree-LAT views, and 5.6 +/- 4.5 mm for the PA0 degree-PA20 degrees stereopair. Higher errors are found in the postero-anterior direction, especially for the PA0 degree-PA20 degrees view combination. Pedicles are found to be the most precise landmarks. Accuracy for CT-scan 3D reconstructions is about 1.1 +/- 0.8 mm. As for a geometric model built using a multiview radiographic reconstruction based on six landmarks per vertebra, accuracies of about 2.6 +/- 2.4 mm for landmarks and 2.3 +/- 2.0 mm for morphometric parameters are found. The geometric model and 3D reconstruction techniques give accurate information, at low X-ray dose. The accuracy assessment of the techniques used to study the 3D characteristics of the human spine is important, because it allows better and more efficient quantitative evaluations of spinal dysfunctions and their treatments, as well as biomechanical modeling of the spine.
Abstract:We demonstrate a novel approach to enhance the precision of surgical needle shape tracking based on distributed strain sensing using optical frequency domain reflectometry (OFDR). The precision enhancement is provided by using optical fibers with high scattering properties. Shape tracking of surgical tools using strain sensing properties of optical fibers has seen increased attention in recent years. Most of the investigations made in this field use fiber Bragg gratings (FBG), which can be used as discrete or quasi-distributed strain sensors. By using a truly distributed sensing approach (OFDR), preliminary results show that the attainable accuracy is comparable to accuracies reported in the literature using FBG sensors for tracking applications (~1mm). We propose a technique that enhanced our accuracy by 47% using UV exposed fibers, which have higher light scattering compared to un-exposed standard single mode fibers. Improving the experimental setup will enhance the accuracy provided by shape tracking using OFDR and will contribute significantly to clinical applications. Symposium, 2000 IEEE, 2000, pp. 1601-1604. 6. N. D. Inc, (2016, 15 Janvier 2016. Medical Aurora -Medical.Available: http://www.ndigital.com/medical/products/aurora/ 7. T. Bien, M. Li, Z. Salah, and G. Rose, "Electromagnetic tracking system with reduced distortion using quadratic excitation," Int. J. CARS 9(2), 323-332 (2014 387-398 (2014).
We demonstrate a new type of sensor incorporated directly into Corning Gorilla glass, an ultraresistant glass widely used in the screen of popular devices such as smartphones, tablets, and smart watches. Although physical space is limited in portable devices, the screens have been so far neglected in regard to functionalization. Our proof-of-concept shows a new niche for photonics device development, in which the screen becomes an active component integrated into the device. The sensor itself is a near-surface waveguide, sensitive to refractive index changes, enabling the analysis of liquids directly on the screen of a smartphone, without the need for any add-ons, thus opening this part of the device to advanced functionalization. The primary function of the screen is unaffected, since the sensor and waveguide are effectively invisible to the naked eye. We fabricated a waveguide just below the glass surface, directly written without any surface preparation, in which the change in refractive index on the surface-air interface changes the light guidance, thus the transmission of light. This work reports on sensor fabrication, using a femtosecond pulsed laser, and the light-interaction model of the beam propagating at the surface is discussed and compared with experimental measurement for refractive indexes in the range 1.3-1.7. A new and improved model, including input and output reflections due to the effective mode index change, is also proposed and yields a better match with our experimental measurements and also with previous measurements reported in the literature.
Non-melanoma skin cancers are the most prevalent form of cancer, with cutaneous squamous cell carcinoma (cscc) being the 2nd most common type. Patients presenting with high-risk lesions associated with locally advanced or metastatic cscc face high rates of recurrence and mortality. Accurate staging and risk stratification for patients can be challenging because no system is universally accepted, and no Canadian guidelines currently exist. Patients with advanced cscc are often deemed ineligible for either or both of curative surgery and radiation therapy (rt) and, until recently, were limited to off-label systemic cisplatin–fluorouracil or cetuximab therapy, which offers modest clinical benefits and potentially severe toxicity. A new systemic therapy, cemiplimab, has been approved for the treatment of locally advanced and metastatic cscc. In the present review, we provide recommendations for patient classification and staging based on current guidelines, direction for determining patient eligibility for surgery and rt, and an overview of the available systemic treatment options for advanced cscc and of the benefits of a multidisciplinary approach to patient management.
Idiopathic scoliosis involves complex spinal intrinsic deformations such as the wedging of vertebral bodies (VB) and intervertebral disks (ID), and it is obvious that the clinical evaluation obtained by the spinal projections on the two-dimensional (2D) radiographic planes do not give a full and accurate interpretation of scoliotic deformities. This paper presents a method that allows reconstruction in 3D of the vertebral body endplates and measurement of the 3D wedging angles. This approach was also used to verify whether 2D radiographic measurements could lead to a biased evaluation of scoliotic spine wedging. The 3D reconstruction of VB contours was done using calibrated biplanar X-rays and an iterative projection computer procedure that fits 3D oriented ellipses of adequate diameters onto the 3D endplate contours. "3D wedging angles" of the VB and ID (representing the maximum angle between adjacent vertebrae) as well as their angular locations with respect to the vertebral frontal planes were computed by finding the positions of the shortest and longest distances between consecutive endplates along their contour. This method was extensively validated using several approaches: (1) by comparing the 3D reconstructed endplates of a cadaveric functional unit (T 8 -T 9 ) with precise 3D measurements obtained using a coordinate measuring machine for 11 different combinations of vertebral angular positions; (2) by a sensitivity study on 400 different vertebral segments mathematically generated, with errors randomly introduced on the digitized points (standard deviations of 0.5, 1, 2, and 3 mm); (3) by comparing the clinical wedging measurements (on postero-anterior and lateral radiographs) at the thoracic apical level of 34 scoliotic patients (15°< Cobb < 45°) to the computed values.Mean errors for the 11 vertebral positions were 0.5 ± 0.4 mm for VB thickness, less than 2.2°for endplate orientation, and about 11°(3 mm) for the location of the maximum 3D wedging angle along the endplate contour. The errors below 2 mm (introduced on the digitized points) slightly affected the 3D wedging angle (< 2°) and its location (< 4°) for the ID. As for the clinical evaluation, average angular errors were less than 0.4°in the radiographic frontal and lateral planes. The mean 3D wedged angles were about 4.9°± 1.9°for the VB and 6.0°± 1.7°for the ID. Linear relations were found between the 2D and the 3D angles, but the 3D angles were located on diagonal planes statistically different than the radiographic ones (between 100°and 221°). There was no statistical relation between the 2D radiographic angles and the locations of the 3D intervertebral wedging angles. These results clearly indicate that VB and ID endplates are wedged in 3D, and that measurements on plain radiographs allow incomplete evaluation of spinal wedging. Clinicians should be aware of these limitations while using wedging measurements from plain radiographs for diagnosis and/or research on scoliotic deformities.
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