Surgical Planning

Background: While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. We present a case where CT was crucial diagnostically and helpful for pre-surgical planning in a patient presenting with an acute abdomen superimposed on complete congenital gastrointestinal malrotation. Case presentation: A 46-year-old previously healthy male with four days of primarily left-sided abdominal pain, low-grade fevers, nausea and anorexia presented to the Emergency Department. His medical history was significant for poorly controlled diabetes and dyslipidemia. His white blood count at that time was elevated. Initial abdominal plain films suggested small bowel obstruction. A CT scan of the abdomen and pelvis was performed with oral and IV contrast to exclude diverticulitis, revealing acute appendicitis superimposed on congenital intestinal malrotation. Following consultation with the surgical team for surgical planning, the patient went on to laparoscopic appendectomy and did well postoperatively. Atypical presentations of acute abdominal conditions superimposed on asymptomatic gastrointestinal malrotation can result in delays in delivery of definitive therapy and potentially increase morbidity and mortality if not diagnosed in a timely manner. Appropriate imaging can be helpful in hastening diagnosis and guiding intervention.

Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized i...

In the rapidly evolving landscape of precision oncology, the convergence of artificial intelligence (AI) and augmented reality (AR) is redefining cancer surgery with unparalleled accuracy and transformative potential. This review synthesizes a robust body of clinical evidence, drawn from over 80 peer-reviewed studies, to illuminate how AI's sophisticated data analytics and AR's immersive visualization synergize to enhance every phase of oncologic intervention-from preoperative tumor characterization to intraoperative navigation and postoperative monitoring. AI-driven algorithms excel in decoding complex imaging and genomic data, enabling precise tumor staging and risk stratification, while AR overlays provide real-time, dynamic guidance for resecting tumors in challenging anatomical regions like the brain, liver, and lungs. Integrated AI-AR systems, particularly in robotic-assisted procedures, have demonstrated remarkable reductions in operative time, blood loss, and positive margin rates, alongside improved survival and quality-of-life outcomes in cancers such as breast, lung, and kidney. Yet, challenges like data bias, algorithmic transparency, and equitable access, particularly in resource-limited settings, underscore the need for innovative solutions like extended reality and open-source platforms. This manuscript charts a visionary path forward, advocating for collaborative research and policy reforms to democratize these technologies, ensuring that the promise of precision oncology-where every incision is informed by data-driven insight and visual clarity-becomes a global reality, revolutionizing cancer care with precision, equity, and hope.

To evaluate the usefulness of an application when planning total knee arthroplasties (TKA), besides the accuracy when measuring the anatomical-mechanical femoral angle (AMFA), comparing, also, the time spent during planning a TKA manually and by using the application. An interdisciplinary team involving health and computer science areas established activities in order to develop the application. After development, 24 physicians underwent an application usability test. Each one planned a primary total knee arthroplasty (TKA) initially, in a conventional manner and then by using the application. Data concerning AMFA measurement and time spent during planning were collected, in both manners. The Mann-Whitney and Wilcoxon tests were used to evaluate statistical significance related to angle and time. Users considered it important checking AMFA and drawing the bone cut lines orthogonal to the mechanical axis, when planning TKAs. They also assessed that the application could be useful for...

Approaches to integration of medical image and spatial data for computer-assisted surgery are presented. We firstly describe preoperative image analysis for organ modeling, quantification, and surgical planning, then present intraoperative guidance using preoperative planning and intraoperative images such as ultrasonography and endoscopy. Finally, we discuss a framework of a 4D surgical database in which the preoperative, intraoperative, and postoperative data are stored directly from computer-assisted surgery systems.

Intraoperative robotic and computer-guided assistances are now commonly used in total hip arthroplasty (THA) for accurate execution of the preoperative plan. Although the preoperative plan to be accurately executed is critical, it is still interactively prepared in a timeconsuming and subjective manner. In this paper, atlas-based approach to automated surgical planning of the acetabular cup in THA is described to stabilize its quality as well as reduce its time-consuming nature. Surgeon's expertise is embedded in two types of statistical atlases, which are constructed from training datasets of CT-based 3D plans prepared by experienced surgeons. One is a statistical shape model which encodes global spatial relationships between the patient anatomy and implant. The other is the statistical map of residual bone thickness on the implant surface, which encodes local spatial constraints of the anatomy and implant. Given the 3D pelvis shape of the patient, we formulate a procedure to determine the best size and position of the acetabular cup which satisfy the constraints derived from the two statistical atlases. We validated the proposed planning method by retrospective study using the datasets which were actually used in the THA surgery.

The paper elaborates an endeavor on applying the algorithmic information-theoretic computational complexity to meta-social-sciences. It is motivated by the effort on seeking the impact of the well-known incompleteness theorem to the scientific methodology approaching social phenomena. The paper uses the binary string as the model of social phenomena to gain understanding on some problems faced in the philosophy of social sciences or some traps in sociological theories. The paper ends on showing the great opportunity in recent social researches and some boundaries that limit them.

Surgical orthodontics has witnessed significant advancements over the last decade, with innovations spanning diagnostic imaging, virtual surgical planning (VSP), additive manufacturing, patient-specific implants (PSIs), navigation and augmented reality (AR), the surgery-first approach (SFA), aligner integration, airway-centered planning, and perioperative management strategies such as enhanced recovery after surgery (ERAS) and tranexamic acid (TXA). These developments collectively improve surgical accuracy, efficiency, stability, and patient-centered outcomes. This review synthesizes the current literature on seven key advances in surgical orthodontics, highlighting their clinical applications, limitations, and future research priorities.

Objective: Being situated close to the transverse and sigmoid sinus, the asterion has traditionally been viewed as a landmark for surgical approaches to the posterior fossa. Cadaveric studies, however, have shown its variability in relation to underlying anatomic structures. We have used an image-guidance technology to determine the precise anatomic relationship between the asterion and the underlying transverse-sigmoid sinus transition (TST) complex in patients scheduled for posterior fossa surgery. The applicability of three-dimensional (3-D) volumetric image-rendering for presurgical anatomic identification and individualization of a surgical landmark was evaluated. Methods: One-millimeter computed tomographic slices were combined with venous computed tomographic angiography in 100 patients, allowing for 3-D volumetric image-rendering of the cranial bone and the dural vasculature at the same time. The spatial relationship between the asterion and the TST was recorded bilaterally ...

In this paper, we present a haptics-enabled surgical training system integrated with deep learning for characterization of particular procedures of experienced surgeons to guide medical residents-in-training with quantifiable patterns. The prototype of virtual reality surgical system is built for open-heart surgery with specific steps and biopsy operation. Two abstract surgical scenarios are designed to emulate incision and biopsy surgical procedures. Using deep learning algorithm (autoencoder), the two surgical procedures were trained and characterized. Results show that a vector with 30 real-valued components can quantify both surgical patterns. These values can be used to compare how a resident-in-training performs differently as opposed to an experienced surgeon so that quantifiable corrective training guidance can be provided.

In this paper, we present a haptics-enabled surgical training system integrated with deep learning for characterization of particular procedures of experienced surgeons to guide medical residents-in-training with quantifiable patterns. The prototype of virtual reality surgical system is built for open-heart surgery with specific steps and biopsy operation. Two abstract surgical scenarios are designed to emulate incision and biopsy surgical procedures. Using deep learning algorithm (autoencoder), the two surgical procedures were trained and characterized. Results show that a vector with 30 real-valued components can quantify both surgical patterns. These values can be used to compare how a resident-in-training performs differently as opposed to an experienced surgeon so that quantifiable corrective training guidance can be provided.

Surgical techniques for non-missile penetrating brain injuries (PBI) are challenging because they require good preoperative planning. Generally, extraction is performed ipsilaterally at the entry site. In certain cases, the extraction can be performed contralaterally through the inner end of the foreign body; however, this requires special consideration. We present a case report of a patient who had a stab wound on the head via a screwdriver and underwent surgery, during which extraction was performed contralaterally through the inner end of the screwdriver without inducing any neurological deficit. Careful preoperative planning and surgical technique modification are required to minimize morbidity and mortality in patients with PBIs.

Introduction: the tibiofemoral angle (TFA) is an anthropometric parameter used to describe the lower limb alignment and to determine the degree of deformity during malalignment of the knee. This study aimed to evaluate the TFA and its significance among the Bini tribe in Nigeria. Materials and Methods: this study was conducted using the anterior-posterior hip-to-ankle radiographs of 200 adults (100 males and 100 females) between 25 to 55 years. The TFA was evaluated as the angle between the intersection of longitudinal axes of femoral and tibial bones bilaterally. Data was statistically analyzed and presented as mean and standard deviation (SD). Statistical comparisons were conducted across bilateral values and sex groups using t-test with P < 0.05 regarded as statistically significant level. Results: among the study population, the mean TFA values for the the male subjects-169.76 ± 4.23 (right TFA) and 170.42 ± 3.79 (left TFA) were significantly (p < 0.05) lower than the values for the female subjects-174.07 ± 3.55 (right TFA) and 175.44 ± 3.32 (left TFA). The bilateral (combined) mean TFA value among males was 169.58 ± 4.15, among females was 175.26 ± 3.64 while the total mean value among the entire study population was 173.92 ± 3.93. The comparison with other study population indicated alternating outcomes. conclusion: this significant sex-linked variation in the bilateral TFA values bilaterally indicates the significance of the TFA as a parameter for sexual distinction among the study population. This study further presents the reference TFA values for the study population which offers great significance during clinical procedures involving the lower limb or knee articulation and alignment.

Background: Breast Conservation Surgery (BCS) has become the standard of care in the management of early-stage breast cancer, offering outcomes comparable to mastectomy when combined with radiotherapy. In cases with a high tumor-to-breast volume ratio, achieving oncologic safety while preserving cosmesis can be challenging. The Lateral Intercostal Artery Perforator (LICAP) flap is a reliable volume replacement technique in such settings. Objective: To evaluate the outcomes of partial breast reconstruction using the LICAP flap, focusing on operative details, postoperative complications and patient satisfaction. Methods: A retrospective review was conducted at Liaquat National Hospital and Medical College, Karachi, from March 2020 to December 2024. Thirty-three patients undergoing BCS with immediate LICAP flap reconstruction were included. Patient demographics, tumor characteristics, operative time, postoperative morbidities and aesthetic outcomes were recorded. Patient satisfaction was assessed using the SDC1 PROM (Patient-Reported Outcome Measure) scale. Results: The mean patient age was 45.8 years. Most tumors (36.4%) were in the upper outer quadrant. Twelve patients (36.4%) received neoadjuvant chemotherapy and 36.4% underwent axillary dissection. Mean tumor size was 4.6 ± 1.8 cm. The median operative time was 145 minutes. Postoperative complications occurred in 3 patients (9%), including wound dehiscence, hematoma and minor erythema. All patients reported high satisfaction scores with favorable cosmetic outcomes. Conclusion: The LICAP flap is a safe and effective technique for partial breast reconstruction, providing adequate volume replacement and excellent aesthetic outcomes with minimal donor site morbidity.

We are often confronted with severe cases - patients with very aggressive tumours that suppose a complex and in the same time radical approach--in our medical practice. The correct approach and management of such cases ensure both the surgical success and the patient survival. In this paper, we present the case of a young woman, who has been admitted in our clinic with a giant, irradiated tumour involving left axilla, shoulder and scapula. Due to the vast size of the tumour and to the fact that surgical biopsy revealed a poorly differentiated sarcoma; other clinics considered that the case above belongs to surgical therapy. After the clinical examination, blood tests and diagnostic imaging, which allowed the correct evaluation of the case--tumour sizes and neighbouring tissue reports--we decided to perform tumour radical excision, respectively forequarter amputation, when the patient presented a satisfactory metabolic status. The presented case supports the idea that radical excisio...

Radioembolization with yttrium 90 ( 90 Y) microspheres represents an emerging transarterial therapy for the treatment of liver malignancies that continues to generate interest in the medical community. The classic indication of treatment response is a reduction in tumor size; however, parenchymal changes (eg, necrosis, lack of enhancement, specific findings at positron emission tomography and functional magnetic resonance imaging) and other benign findings (pleural effusions, perivascular edema, contralateral hypertrophy, ring enhancement, perihepatic fluid, fibrosis) may occur following treatment, requiring proper image interpretation. With classic imaging findings and surrogates (time to progression, duration of response, disease-free interval), response rates range from 20% to 80% in patients treated for hepatocellular carcinoma or metastatic disease to the liver. Complications of 90 Y radioembolization include cholecystitis, abscess, and bilomas and should be recognized early in the imaging follow-up of these patients. Radiologists who are involved in the posttreatment assessment of patients undergoing 90 Y radioembolization should be familiar with the imaging findings and potential imaging pitfalls associated with this therapy.

Infective endocarditis is a life-threating condition with annual mortality of as much as 40% and is associated with embolic events in as many as 80% of cases. These embolic events have notable prognostic implications and have been linked to increased length of stay in intensive care units and mortality. A vegetation size greater than 10 mm has often been suggested as an optimal cutoff to estimate the risk of embolism, but the evidence is based largely on small observational studies. To study the association of vegetation size greater than 10 mm with embolic events using meta-analytic techniques. A computerized literature search of all publications in the PubMed and EMBASE databases from inception to May 1, 2017, was performed with search terms including varying combinations of infective endocarditis, emboli, vegetation size, pulmonary infarct, stroke, splenic emboli, renal emboli, retinal emboli, and mesenteric emboli. This search was last assessed as being up to date on May 1, 2017...

Objective-In the presurgical workup of MRI-negative (MRI-, or "nonlesional") pharmacoresistant focal epilepsy (PFE) patients, discovering a previously undetected lesion can drastically change the evaluation and likely improve surgical outcome. Our study utilizes a voxelbased MRI post-processing technique, implemented in a morphometric analysis program (MAP), to facilitate detection of subtle abnormalities in a consecutive cohort of MRI-surgical candidates. Methods-Included in this retrospective study was a consecutive cohort of 150 MRI-surgical patients. MAP was performed on T1-weighted MRI, with comparison to a scanner-specific normal database. Review and analysis of MAP were performed blinded to patients' clinical information. The pertinence of MAP+ areas was confirmed by surgical outcome and pathology. Results-MAP showed a 43% positive rate, sensitivity of 0.9 and specificity of 0.67. Overall, patients with MAP+ region completely resected had the best seizure outcomes, followed by the MAP-patients, and patients who had no/partial resection of the MAP+ region had the worst outcome (p<0.001). Subgroup analysis revealed that visually identified subtle findings are more likely correct if also MAP+. False-positive rate in 52 normal controls was 2%. Surgical pathology of the resected MAP+ areas contained mainly non-balloon-cell FCD. Multiple MAP+ regions were present in 7% of patients. Conclusions-MAP can be a practical and valuable tool to: (1) guide the search for subtle MRI abnormalities, and (2) confirm visually identified questionable abnormalities in patients with PFE due to suspected FCD. A MAP+ region, when concordant with the patient's electro-clinical presentation, should provide a legitimate target for surgical exploration.

The objective of the research was to evaluate the distribution of stress produced by surgically assisted rapid maxillary expansion in the maxillary structures using the bone-supported expander device by the Finite Element Method. Material and methods: A three- dimensional model was simulated for surgery with a LeFort I osteotomy with pterygomaxillary disjunction using a bone-supported device model for the 1mm aperture. The results showed a greater opening of the maxilla in the anterior region and a smaller opening in the posterior region. The tension forces showed mainly in all the palatine face and the posterior alveolar bone and tuber, as well as in the epilating zygomatic region above the osteotomy. The stress showed little dissipation for the roots of the molar. The forces of compression were manifested in the pterygoid process and the zygomatic pillar adjacent to the osteotomies, as well as in the expander areas of contact with the palatine bone. The analysis showed that the mo...

This paper introduces the use of spatially adaptive components into the geodesic active contour segmentation method for application to volumetric medical images. These components are derived from local structure descriptors and are used both in regularization of the segmentation and in stabilization of the image-based vector field which attracts the contours to anatomical structures in the images. They are further used to incorporate prior knowledge about spatial location of the structures of interest. These components can potentially decrease the sensitivity to parameter settings inside the contour evolution system while increasing robustness to image noise. We show segmentation results on blood vessels in magnetic resonance angiography data and bone in computed tomography data.

This paper introduces the use of spatially adaptive components into the geodesic active contour segmentation method for application to volumetric medical images. These components are derived from local structure descriptors and are used both in regularization of the segmentation and in stabilization of the image-based vector field which attracts the contours to anatomical structures in the images. They are further used to incorporate prior knowledge about spatial location of the structures of interest. These components can potentially decrease the sensitivity to parameter settings inside the contour evolution system while increasing robustness to image noise. We show segmentation results on blood vessels in magnetic resonance angiography data and bone in computed tomography data.

Background and Objectives: The development of liver fibrosis as a consequence of continuous inflammation represents a turning point in the evolution of chronic liver diseases. The recent developments of artificial intelligence (AI) applications show a high potential for improving the accuracy of diagnosis, involving large sets of clinical data. For this reason, the aim of this systematic review is to provide a comprehensive overview of current AI applications and analyze the accuracy of these systems to perform an automated diagnosis of liver fibrosis. Materials and Methods: We searched PubMed, Cochrane Library, EMBASE, and WILEY databases using predefined keywords. Articles were screened for relevant publications about AI applications capable of diagnosing liver fibrosis. Exclusion criteria were animal studies, case reports, abstracts, letters to the editor, conference presentations, pediatric studies, studies written in languages other than English, and editorials. Results: Our se...

This paper highlights recent advancements in imaging technologies for surgical planning and navigation in tumor biopsy and resection which need high-precision in detection and characterization of lesion margin in preoperative planning and intraoperative navigation. Multimodality image-guided surgery platforms brought great benefits in surgical planning and operation accuracy via registration of various data sets with information on morphology [X-ray, magnetic resonance (MR), computed tomography (CT)], function connectivity [functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), rest-status fMRI], or molecular activity [positron emission tomography (PET)]. These image-guided platforms provide a correspondence between the pre-operative surgical planning and intra-operative procedure. We envisage that the combination of advanced multimodal imaging, three-dimensional (3D) printing, and cloud computing will play increasingly important roles in planning and navigation of surgery for tumor biopsy and resection in the coming years.

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Background: Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible.Objective: To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol.Method: Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for car...

Aim: This study aimed to analyze clinical characteristics and image findings in patients initially diagnosed with renal masses and treated on the Société Internationale d&#39;Oncologie Pédiatrique (SIOP) 2001 protocol for Wilms tumor (WT) that eventually were diagnosed with different pathologies.Methods: We reviewed the preoperative symptoms, laboratory tests, and images of patients who were initially treated for WT and proved to have other diagnoses. Data from these patients were compared to those of the last 10 patients with WT and the last 10 patients with neuroblastoma (NBL) treated at a single institution.Results: From June 2001 to December 2020, we treated 299 patients with NBL and 194 with WT. Five patients treated with preoperative chemotherapy for WT were postoperatively diagnosed with NBL (one patient had bilateral renal masses and one with multifocal xanthogranulomatous pyelonephritis). Three underwent nephrectomy, two biopsies only, and one adrenalectomy due to intraoper...

The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided.

Radiologists should be familiar with the main techniques of knee cartilage repair and the imaging methods available for its evaluation, in order to optimize the postoperative follow-up of patients. The objective of this study was to present a series of clinical cases seen at our facility, illustrating the main techniques necessary for the repair of knee cartilage, as well as the magnetic resonance imaging techniques used in the postoperative evaluation and the relevant radiological findings.

The cementoblastoma is a very rare odontogenic neoplasm characterised by the formation of cementum-like tissue in connection with the root of a tooth. An 18-year-old boy was referred to the Clinic of Oral Pathology of the School of Dentistry, Universidade Federal de Minas Gerais, Brazil, complaining of an irradiating, itching pain from the region of the lower right first molar. He reported that the symptoms began three months prior, with a gradual increase in intensity during this period. The pain episodes were of short duration, with characteristics of toothache originating from the pulp. Upon intra-oral clinical examination, an open bite and slight increase in volume at the buccal alveolar region of the lower right first molar was observed. He also reported palpation and percussion pain symptoms in this region. Electrical, heat and cold pulp vitality tests were performed, and the tooth was vital. Periapical and panoramic radiographs showed radiolucent images with diffuse, poorly defined borders at the mesial root periapex extending to the interradicular region suggesting an inflammatory periapical lesion. In this early presentation, the three-dimensional image was fundamental to the final diagnosis of cementoblastoma.

Summary: Rhinoplasty in facial cleft patients is among the most challenging types of reconstructive facial surgery due to its variability. Advances in 3-dimensional imaging enable improved preoperative assessment in rhinoplasty. In complex cases with bony support irregularities and asymmetry, it is rational to initiate planning with reconstruction of the aberrant substructure (ie, “bottom-up” planning) rather than starting the surgical design with soft-tissue morphing. We present a new comprehensive workflow in which novel advanced technologies are implemented to perform “bottom-up” computer-assisted planning and execution in complex rhinoplasty cases. This workflow enables meticulous planning, use of grafting templates, and 3-dimensional–guided osteotomies with integration of piezotome and intraoperative navigation. Previous reports separately discuss some of these innovations. However, greater benefit lies in the combination of these techniques, with emphasis on preoperative compu...

Background The superficial circumflex iliac artery perforator flap (SCIP) is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. Different planning methods have been described, but these are not yet standardized like in other flaps. The aim of this study is to present a fast, effective, and reliable method for SCIP flap planning using computed tomography angiography (CTA). Patients and Methods Between October 2017 and September 2018, CTA was performed on 40 patients. Preoperative planning of SCIP flaps based on the medial branch was performed analyzing CTA images. The perforating sites of the medial branch on the deep (point D) and superficial fascia (point S) were identified. Distances to those points, from the center of the umbilicus in the “y-axis” and the midline perpendicularly in the “x-axis,” were measured. These measurements were transferred to the patient&#39;s skin as a guide for dissection. Results Eighty areas were studied id...

Currently computational tools are helping and improving the processes and testing procedures in several areas of knowledge. Computed tomography (CT) is a diagnostic tool already consolidated and now beginning to be used as a tool for something even more innovative, creating biomodels. Biomodels are anatomical physical copies of human organs and tissues that are used for diagnosis and surgical planning. The use of tomographic images in the creation of biomodels has been arousing great interest in the medical and bioengineering area. In addition to creating biomodels by computed tomography it is also possible, using this process, to create mathematical models to perform computer simulations and analyses of regions of interest. This paper discusses the creation of a biomodel of the skull-mandibular region of a patient from CT for study and evaluation of efforts in the area of the temporomandibular joint (TMJ) aiming at the design and development of a TMJ custom prosthesis. The evaluation of efforts in the TMJ region due to the forces of mastication was made using the finite element method and the results were corroborated by comparison with mandibular models studied in similar works.

Background-As part of ongoing efforts to develop computerized planning tools for cryosurgery, the current study provides a comparison between two recently developed methods for planning, known as bubble packing and force-field analogy. Methods-For the purpose of comparison, four 3D prostate models were reconstructed from ultrasound imaging. The quality of planning for each method was evaluated based on bioheat transfer simulations. Results-Both methods are shown to be robust planning tools in 3D. Typical results show at least 75% of the target region volume having temperatures below a target temperature isotherm for planning. While the force-field analogy method yields superior planning results, it comes at the expense of an order of magnitude longer run time, with only moderate improvement. Conclusions-Due to time constraints in a clinical setup, bubble packing alone may be considered adequate for computerized planning. Furthermore, only bubble packing is demonstrated to be adequate for intra-operative planning.

Dentofacial deformities usually are surgically treated, and 3D virtual planning has been used to favor accurate outcomes. Cases reported in the present article show that orthognathic surgery carried out to correct facial asymmetries does not comprise only one treatment protocol. 3D virtual planning might be used for surgical planning, but it should also be used to diagnose the deformity, thus allowing for an analysis of the best-recommended possibilities for the orthodontic preparation that suits each individual case.

Biomechanical modeling of the breast is a burgeoning research field that has potential uses across a wide range of healthcare applications. This review describes recent developments regarding multi-modal breast image analysis, and outlines some of the key challenges that researchers face in introducing the models into the clinical arena. Deformable breast models have demonstrated capabilities across a wide range of breast cancer diagnoses and treatments. Specific applications include magnetic resonance (MR) image guided surgery, registration of x-ray and MR images, and breast reduction/augmentation surgery planning. Challenges lie in improving the fidelity of these models, which are presently simplistic and use many unverified parameters. Specific challenges include characterization of individual-specific mechanical properties of breast tissues, precise representation of loading and boundary constraints during different clinical procedures, and validation of modeling techniques used to represent key mechanical aspects such as the suspensory Cooper's ligaments. Scientists must also work towards translating their research tools into the clinical setting by developing efficient tools with user-friendly interactivity. Widespread adoption of such techniques has the potential to significantly reduce the numbers of misdiagnosed breast cancers and enhance surgical planning for patient treatment .  2009 John Wiley & Sons, Inc. WIREs Syst Biol Med 2010 2 293-304 B reast cancer is a leading cause of cancer death among women worldwide. X-ray mammography is considered to be the gold-standard modality for early detection of breast cancer. With its high throughput (scans taking typically 10 s) and relatively low cost (a typical MRI costs four times that of a mammogram), it is presently the only feasible imaging modality for screening. Nevertheless, xray mammograms alone cannot be used to identify and characterize all cancers, partly because of their two-dimensional representation of a 3D compressed breast and also because of their limited applicability to women with dense breasts. Therefore, when a suspicious lesion is identified on a mammogram, clinicians typically acquire additional views of the

Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also...

Descending necrotizing mediastinitis (DNM) is caused by aerobic and anaerobic bacteria as a rare but severe complication of oropharyngeal abscesses developing secondary to odontogenic infections. Patients with hypersensitivity reaction to beta-lactam antibiotics pose challenges in the treatment. To our knowledge, only two cases of postoperative mediastinitis treated with tigecycline have been reported in the English medical literature to date. In this paper, we present a case of descending mediastinitis developing one week after dental extraction. The patient was given tigecycline treatment with the diagnosis of complicated deep neck infection, which progressed to descending mediastinitis because of severe allergic reaction to beta-lactam group antimicrobials. He successfully recovered after early surgical drainage and debridement together with four weeks of tigecycline therapy. Tigecycline may be an alternative option for treatment of odontogenic infections and descending mediastin...

Introduction: The giant cell tumors are characterized by being locally aggressive and are associated with a wide biological spectrum. Proximal humerus tumors represent between 4% and 10% of all primary bone tumors. There are various surgical limb salvage treatment strategies for proximal humeral giant cell tumor such as shoulder arthroplasties, arthrodesis, and massive allografts. In this article, we report a 20-year-old young adult with a giant cell tumor of the right proximal humerus who was managed using a limb salvage technique with the use of a massive allograft. Case presentation: A 20-year-old man presented with right shoulder pain associated with a sensation of a mass. He was diagnosed with a giant cell tumor. One year later, he developed a pathological fracture, and limb salvage surgery was performed, which included resection of the tumor lesion in the proximal humerus and reconstruction with a massive osteochondral allograft. Conclusion: Giant cell tumors of the proximal humerus, although rare, represent a significant diagnostic and therapeutic challenge due to their anatomical location and proximity to crucial vascular and nerve structures. Salvage limb surgery using massive allografts proves to be a viable option for preserving the functionality.

Over the past years, computer-assisted surgery has gained more importance in craniomaxillofacial surgery, especially in primary and secondary treatment of head and neck malignancies. The basis for oncologic treatment of the head and neck region requires detailed planning using computed tomography, cone-beam computed tomography, or magnetic resonance imaging in combination with computer-assisted, infrared-based navigation system. These techniques allow a preplanned image-guided path to the tumor region for taking biopsies, resection, or reconstruction. The aim of this work was to show the advances and technical benefits for tumor surgery in a daily clinical routine from the view of the craniomaxillofacial surgeon. The target of our working group was to develop and clinically evaluate a novel three-dimensional planning and navigation software solution for treatment of craniofacial tumors. This work was carried out on 5 categories for oncologic surgical procedures in which computer-assisted surgery was applied from 2005 to 2011: preplanned trajectorial-guided tumor biopsy, intraoperative imageYcontrolled tumor resection, tumor mapping, reconstruction after tumor surgery (true to original), and oral rehabilitation (backward planning). Successful preoperative planning, import of image data suitable for navigation, and intraoperative precise infraredbased navigation were obtained for all 5 categories without any complications. Image-guided navigation technique for head and neck oncologic surgery provides a precise, safe surgical method with real-time excellent anatomic orientation. Regarding the advantages of computerassisted surgery, this technique will play a major part in craniofacial reconstructive surgery and will address widespread general methodologic solutions that are of great interest in multidisciplinary oncologic treatment.

Background Computed tomography (CT) utilizing computer software technology to generate three-dimensional (3D) rendering of the glenoid has become the preferred method for preoperative planning. It remains largely unknown what benefits this software may have to the intraoperative placement of the components and patient outcomes. Purpose The purpose of this systematic review is to compare 2D CT to 3D CT planning in total shoulder arthroplasty. Study design Systematic review. Methods A systematic database search was conducted for relevant studies evaluating the role of 3D CT planning in total shoulder arthroplasty. The primary outcome was component placement variability, and the secondary outcomes were intra- and inter-observer reliability in the context of preoperative planning. Results Following title-abstract and full-text screening, six eligible studies were included in the review (n = 237). The variability in glenoid measurements between 3D CT and 2D CT planning ranged from no sig...

Image-guided surgery using XR (extended reality: VR/AR/MR) technology has the potential to revolutionize the field of surgery by improving surgical accuracy, reducing procedure time, and enhancing communication and collaboration among the surgical team. We have developed a web-based system, Holoeyes, integrating XR, AI, and metaverse technology to facilitate holographic image-guided surgery. Holoeyes extracts organ shape data from CT or MRI scans and renders them with positional information to obtain X, Y, and Z coordinates. These coordinates are then converted into polygonal information for use in XR technology. The medical device, Holoeyes MD, was developed to create XR applications for surgical planning and navigation. It provides an immersive experience for the surgical team, improving both accuracy and efficiency. The integration of the metaverse in surgery allows for spatial conferencing and review of training, and the avatars replicate the hand and eye movements of the actual...

The use of augmented reality (AR) and virtual reality (VR) for life support training is increasing. These technologies provide an immersive experience that supports learning in a safe and controlled environment. This review focuses on the use of AR and VR for emergency care training for health care providers, medical students, and nonprofessionals. In particular, we analyzed (1) serious games, nonimmersive games, both single-player and multiplayer; (2) VR tools ranging from semi-immersive to immersive virtual and mixed reality; and (3) AR applications. All the toolkits have been investigated in terms of application goals (training, assessment, or both), simulated procedures, and skills. The main goal of this work is to summarize and organize the findings of studies coming from multiple research areas in order to make them accessible to all the professionals involved in medical simulation. The analysis of the state-of-the-art technologies reveals that tools and studies related to the multiplayer experience, haptic feedback, and evaluation of user's manual skills in the foregoing health care-related environments are still limited and require further investigation. Also, there is an additional need to conduct studies aimed at assessing whether AR/VR-based systems are superior or, at the minimum, comparable to traditional training methods.

To evaluate the usefulness of an application when planning total knee arthroplasties (TKA), besides the accuracy when measuring the anatomical-mechanical femoral angle (AMFA), comparing, also, the time spent during planning a TKA manually and by using the application. An interdisciplinary team involving health and computer science areas established activities in order to develop the application. After development, 24 physicians underwent an application usability test. Each one planned a primary total knee arthroplasty (TKA) initially, in a conventional manner and then by using the application. Data concerning AMFA measurement and time spent during planning were collected, in both manners. The Mann-Whitney and Wilcoxon tests were used to evaluate statistical significance related to angle and time. Users considered it important checking AMFA and drawing the bone cut lines orthogonal to the mechanical axis, when planning TKAs. They also assessed that the application could be useful for...

Pre-surgical physician questionnaire regarding surgical approach and procedure. Question Response Choices 1. What kind of tumor removal would you perform? Partial or Radical? 2. How would you perform the procedure? Open or Robotic? 3. What approach would you take in order to perform this procedure? Transperitoneal or Retroperitoneal? 4. What type of clamping would you use? None, Selective, or Complete?