CT2X-IRA: CT to x-ray image registration agent using domain-cross multi-scale-stride deep reinforcement learning.

Objective.In computer-assisted minimally invasive surgery, the intraoperative x-ray image is enhanced by overlapping it with a preoperative CT volume to improve visualization of vital anatomical structures. Therefore, accurate and robust 3D/2D registration of CT volume and x-ray image is highly desired in clinical practices. However, previous registration methods were prone to initial misalignments and struggled with local minima, leading to issues of low accuracy and vulnerability.Approach.To improve registration performance, we propose a novel CT/x-ray image registration agent (CT2X-IRA) within a task-driven deep reinforcement learning framework, which contains three key strategies: (1) a multi-scale-stride learning mechanism provides multi-scale feature representation and flexible action step size, establishing fast and globally optimal convergence of the registration task. (2) A domain adaptation module reduces the domain gap between the x-ray image and digitally reconstructed radiograph projected from the CT volume, decreasing the sensitivity and uncertainty of the similarity measurement. (3) A weighted reward function facilitates CT2X-IRA in searching for the optimal transformation parameters, improving the estimation accuracy of out-of-plane transformation parameters under large initial misalignments.Main results.We evaluate the proposed CT2X-IRA on both the public and private clinical datasets, achieving target registration errors of 2.13 mm and 2.33 mm with the computation time of 1.5 s and 1.1 s, respectively, showing an accurate and fast workflow for CT/x-ray image rigid registration.Significance.The proposed CT2X-IRA obtains the accurate and robust 3D/2D registration of CT and x-ray images, suggesting its potential significance in clinical applications.

Three-Dimensional Postoperative Results Prediction for Orthognathic Surgery through Deep Learning-Based Alignment Network.

To date, for the diagnosis of dentofacial dysmorphosis, we have relied almost entirely on reference points, planes, and angles. This is time consuming, and it is also greatly influenced by the skill level of the practitioner. To solve this problem, we wanted to know if deep neural networks could predict postoperative results of orthognathic surgery without relying on reference points, planes, and angles. We use three-dimensional point cloud data of the skull of 269 patients. The proposed method has two main stages for prediction. In step 1, the skull is divided into six parts through the segmentation network. In step 2, three-dimensional transformation parameters are predicted through the alignment network. The ground truth values of transformation parameters are calculated through the iterative closest points (ICP), which align the preoperative part of skull to the corresponding postoperative part of skull. We compare pointnet, pointnet++ and pointconv for the feature extractor of the alignment network. Moreover, we design a new loss function, which considers the distance error of transformed points for a better accuracy. The accuracy, mean intersection over union (mIoU), and dice coefficient (DC) of the first segmentation network, which divides the upper and lower part of skull, are 0.9998, 0.9994, and 0.9998, respectively. For the second segmentation network, which divides the lower part of skull into 5 parts, they were 0.9949, 0.9900, 0.9949, respectively. The mean absolute error of transverse, anterior-posterior, and vertical distance of part 2 (maxilla) are 0.765 mm, 1.455 mm, and 1.392 mm, respectively. For part 3 (mandible), they were 1.069 mm, 1.831 mm, and 1.375 mm, respectively, and for part 4 (chin), they were 1.913 mm, 2.340 mm, and 1.257 mm, respectively. From this study, postoperative results can now be easily predicted by simply entering the point cloud data of computed tomography.

Volumetric Change in the Masseter and Lateral Pterygoid after Mandibular Setback.

In this study, we evaluated changes in the masseter and lateral pterygoid muscles in the prognathic mandible group after a mandibular setback by comparing the volume-to-length ratios. Preoperative and postoperative 1-year computed tomography was used to calculate the volume-to-length ratio of the lateral pterygoid and masseter muscle in 60 Korean individuals. Three-dimensional images were reconstructed, the results of which showed no significant differences in the volume-to-length ratios of the masseter and lateral pterygoid muscles after a mandibular setback (p > 0.05). This result was found for both vertical ramus osteotomy and sagittal split ramus osteotomy, and for both males and females. No significant differences in the volume-to-length ratio of the masseter and lateral pterygoid muscles were found up to 1 year after a mandibular setback. Therefore, this study can contribute to the prediction of soft-tissue profiles after mandibular setback.

Three-dimensional intraoperative computed tomography imaging for zygomatic fracture repair.

OBJECTIVES: Zygomatic complex (ZMC) fractures comprise up to 40% of all facial fractures. Misaligned bone fragments and misplaced fixation hardware traditionally detected postoperatively on plain radiographs of the skull might require re-operation. The intraoperative O-Arm (Medtronic, USA) is a three-dimensional (3D) computed tomographic imaging system. MATERIALS AND METHODS: This retrospective single-center study evaluated the utility of O-Arm scanning during corrective surgeries for ZMC and zygomatic arch (ZA) fractures from 2018 to 2020. Three females and 16 males (mean age, 31.52 years; range, 22-48 years) were included. Fracture instability (n=6) and facial deformity (n=15) were the most frequent indications for intraoperative 3D O-Arm scan. RESULTS: The images demonstrated that all fracture lines were properly reduced and fixed. Another scan performed at the end of the fixation or reduction stage, however, revealed suboptimal results in five of the 19 cases, and further reduction and fixation of the fracture lines were required. CONCLUSION: Implementation of an intraoperative O-Arm system in ZMC and ZA fracture surgeries assists in obtaining predictable and accurate results and obviates the need for revision surgeries. The device should be considered for precise operations such as ZMC fracture repairs.

COVID-19 findings in chest computed tomography

SUMMARY OBJECTIVE: The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS: The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS: The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS: In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.

Embolism resistance in petioles and leaflets of palms.

BACKGROUND AND AIMS: Hydraulic studies are currently biased towards conifers and dicotyledonous angiosperms; responses of arborescent monocots to increasing temperature and drought remain poorly known. This study aims to assess xylem resistance to drought-induced embolism in palms. METHODS: We quantified embolism resistance via P50 (xylem pressure inducing 50 % embolism or loss of hydraulic conductivity) in petioles and leaflets of six palm species differing in habitat and phylogenetic relatedness using three techniques: in vivo X-ray-based microcomputed tomography, the in situ flow centrifuge technique and the optical vulnerability method. KEY RESULTS: Our results show that P50 of petioles varies greatly in the palm family, from -2.2 ± 0.4 MPa in Dypsis baronii to -5.8 ± 0.3 MPa in Rhapis excelsa (mean ± s.e.). No difference or weak differences were found between petioles and leaf blades within species. Surprisingly, where differences occurred, leaflets were less vulnerable to embolism than petioles. Embolism resistance was not correlated with conduit size (r = 0.37, P = 0.11). CONCLUSIONS: This study represents the first estimate of drought-induced xylem embolism in palms across biomes and provides the first step towards understanding hydraulic adaptations in long-lived arborescent monocots. It showed an almost 3-fold range of embolism resistance between palm species, as large as that reported in all angiosperms. We found little evidence for hydraulic segmentation between leaflets and petioles in palms, suggesting that when it happens, hydraulic segregation may lack a clear relationship with organ cost or replaceability.

Physico-elemental analysis of roasted organic coffee beans from Ethiopia, Colombia, Honduras, and Mexico using X-ray micro-computed tomography and external beam particle induced X-ray emission.

The physico-elemental profiles of commercially attained and roasted organic coffee beans from Ethiopia, Colombia, Honduras, and Mexico were compared using light microscopy, X-ray micro-computed tomography, and external beam particle induced X-ray emission. External beam PIXE analysis detected P, S, Cl, K, Ca, Ti, Mn, Fe, Cu, Zn, Br, Rb, and Sr in samples. Linear discriminant analysis showed that there was no strong association between elemental data and production region, whilst a heatmap combined with hierarchical clustering showed that soil-plant physico-chemical properties may influence regional elemental signatures. Physical trait data showed that Mexican coffee beans weighed significantly more than beans from other regions, whilst Honduras beans had the highest width. X-ray micro-computed tomography qualitative data showed heterogeneous microstructural features within and between beans representing different regions. In conclusion, such multi-dimensional analysis may present a promising tool in assessing the nutritional content and qualitative characteristics of food products such as coffee.

High-fat/high-sucrose diet results in higher bone mass in aged rats.

Intake of high-fat/high-sucrose (HFS) diet or high fat diet influences bone metabolism in young rodents, but its effects on bone properties of aged rodents still remain unclear. This study aimed to examine the effects of HFS diet intake on trabecular bone architecture (TBA) and cortical bone geometry (CBG) in aged rats. Fifteen male Wistar rats over 1 year were randomly divided into two groups. One group was fed a standard laboratory diet (SLD) and the other group was fed a HFS diet for six months. The femur/tibia, obtained from both groups at the end of experimental period, were scanned by micro-computed tomography for TBA/CBG analyses. Serum biochemical analyses were also conducted. Body weight was significantly higher in the HFS group than in the SLD group. In both femur and tibia, the HFS group showed higher trabecular/cortical bone mass in reference to bone mineral content, volume bone mineral density and TBA/CBG parameters compared with the SLD group. In addition, serum calcium, inorganic phosphorus, total protein, triacylglycerol, HDL and TRACP-5b levels were significantly higher in the HFS group than in the SLD group. There were good correlations between body weight and bone parameters in the femur and tibia. These results suggest that HFS diet intake results in higher bone mass in aged rats. Such effects of HFS diet intake might have been induced by increased body weight.

Cambial pinning relates wood anatomy to ecophysiology in the African tropical tree Maesopsis eminii.

A better understanding and prediction of the impact of changing climate on tree stem growth could greatly benefit from the combination of anatomical and ecophysiological knowledge, yet the majority of studies focus on one research field only. We propose an approach that combines the method of pinning (cambial wounding) to timestamp anatomical X-ray computed microtomography images with continuous measurements of sap flow and stem diameter variations. By pinning the cambium of well-watered and drought-treated young African tropical trees of the species Maesopsis eminii Engl. we could quantify wood formation during a specific period of time and relate it to tree physiology and prevailing microclimate. Integrating continuous plant measurements and high-frequency pinning proved very useful to visualize and quantify the effects on stem growth of drought in M. eminii. Wood formation completely stopped during drought, and was associated with a strong shrinkage in stem diameter. Next, an unexpected increase in stem diameter was observed during drought, probably caused by root pressure, but not accompanied by wood formation. Our proposed approach of combining continuous plant measurements with cambial pinning is very promising to relate ecophysiology to stem anatomy and to understand the mechanisms underlying tree stem growth and bridge the gaps between the two research fields.

Fracture of the Posterior Medial Tubercle of the Talus / 中华骨科杂志

Objective\ To study the early diagnosis and treatment of the fracture of posterior medial tubercle of the talus (PMTT).Methods\ Five cases of PMTT fractures had been definitely diagnosed by CT scan. Subtalar joint were involved in three cases, open reduction and internal fixation (ORIF) had been adopted in 2;and 1 had been treated conservatively because of the refusal to surgery by the patient. Plaster cast fixation and excision of fragment was done respectively in one case. Results\ Four out of five cases had been correctly diagnosed and one had been misdiagnosed in the first visit.The mean follow up was 24 months. Non union combined with tenderness and numbness of the sole of the foot was found in the misdiagnosed case after 6 months. Excision of the fragment was carried out for this case and a satisfactory result had been achieved. Three of the other four cases was treated operatively with a good result and one were treated conservatively with a poor result. Conclusion\ The PMTT fractures are rarely seen and often misdiagnosed. Early diagnosis and correct treatment is important to eliminate the nonunion or tarsal tunnel syndrome.