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This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: Fracture dating—the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. Whole spine imaging in suspected abusive head trauma—this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury. Cranial imaging in suspected physical abuse—both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.

The complex anatomy and deep spaces of the head and neck limit physical examination while also offering many points for entry and spread of infection. Radiologic imaging plays a crucial role in managing head and neck infections by defining the location and extent of disease, facilitating abscess drainage, and identifying complications. This review provides essential background and examples for imaging infection throughout the head and neck region.

The cerebrofacial metameric syndromes are a group of congenital syndromes that result in vascular malformations throughout specific anatomical distributions of the brain, cranium and face. Multiple reports of patients with high-flow or low-flow vascular malformations following a metameric distribution have supported this idea. There has been much advancement in understanding of segmental organization and cell migration since the concept of metameric vascular syndromes was first proposed. We aim to give an updated review of these embryological considerations and then propose a more detailed classification system for these syndromes, predominately incorporating the contribution of neural crest cells and somitomeres to the pharyngeal arches.

Strain and strain rate are effective traumatic brain injury metrics. In finite element (FE) head model, thousands of elements were used to represent the spatial distribution of these metrics. Owing that these metrics are resulted from brain inertia, their spatial distribution can be represented in more concise pattern. Since head kinematic features and brain deformation vary largely across head impact types (Zhan et al., 2021), we applied principal component analysis (PCA) to find the spatial co-variation of injury metrics (maximum principal strain (MPS), MPS rate (MPSR) and MPS × MPSR) in four impact types: simulation, football, mixed martial arts and car crashes, and used the PCA to find patterns in these metrics and improve the machine learning head model (MLHM).We applied PCA to decompose the injury metrics for all impacts in each impact type, and investigate the spatial co-variation using the first principal component (PC1). Furthermore, we developed a MLHM to predict PC1 and then inverse-transform to predict for all brain elements. The accuracy, the model complexity and the size of training dataset of PCA-MLHM are compared with previous MLHM (Zhan et al., 2021).PC1 explained variance on the datasets. Based on PC1 coefficients, the corpus callosum and midbrain exhibit high variance on all datasets. Finally, the PCA-MLHM reduced model parameters by 74% with a similar MPS estimation accuracy.The brain injury metric in a dataset can be decomposed into mean components and PC1 with high explained variance.The spatial co-variation analysis enables better interpretation of the patterns in brain injury metrics. It also improves the efficiency of MLHM.

A 58-year-old man with diabetes, alcoholic cirrhosis and a history of cerebral contusion and traumatic subarachnoid haemorrhage visited the hospital after his first convulsion, which lasted for 30 s. He was intubated because of the prolonged disturbance of consciousness caused by his intermittent

A 26-year-old man, suffering from complex congenital cyanotic heart disease (CCHD) with Eisenmenger complex, presented with seizures. Non-contrast CT (NCCT) scan of brain showed chronic infract with encephalomalacic changes in the left high parietal region with vividly hyperdense intracranial

Therapeutic hypothermia (TH) is a common and effective technique to reduce inflammation and induce neuroprotection across a variety of diseases. Focal TH of the brain can avoid the side effects of systemic cooling. The degree and extent of focal TH are a function of cooling probe design and local brain thermoregulation processes. To refine focal TH probe design, with application-specific optimization, we develop precise computational models of brain thermodynamics under intense local cooling. Here, we present a novel multiphysics in silico model that can accurately predict brain response to focal cooling. The model was parameterized from previously described values of metabolic activity, thermal conductivity, and temperature-dependent cerebral perfusion. The model was validated experimentally using data from clinical cases where local cooling was induced intracranially and brain temperatures monitored in real-time with MR thermometry. The validated model was then used to identify optimal design probe parameters to maximize volumetric TH, including considering three stratifications of cooling (mild, moderate, and profound) to produce Volume of Tissue Cooled (VOTC) maps. We report cooling radius increases in a nearly linear fashion with probe length and decreasing probe surface temperature.

To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management.Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019.Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications.A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies,Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.

This Viewpoint examines the approval of the first quality metric for head and neck oncology and potential outcomes for improving quality of care for patients with head and neck squamous cell carcinoma.

Purpose The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a scale to quantify the severity of pharyngeal dysphagia in head and neck cancer (HNC) patients. This study (1) described the training process of the observers for DIGEST in fiberoptic endoscopic evaluation of swallowing (FEES), (2) determined observer agreement on the DIGEST in FEES, (3) explored the effect of bolus consistency on observer agreement, and 4) explored criterion validity of the DIGEST in FEES. Methods Twenty-seven dysphagic HNC patients were enrolled. Two observers completed a training program for DIGEST in FEES. Observer agreement on the Penetration-Aspiration Scale (PAS), percentage of pharyngeal residue (PPR), and DIGEST grades was determined using linearly weighted Cohen’s kappa coefficient (κ). Results Due to insufficient observer agreement after the first measurement attempt, additional training was organized using an elaborated manual with descriptions of the visuoperceptual variables, thereby improving observer agreement. Intraobserver agreement was almost perfect on the PAS (κ = 0.86–0.88) and PPR (κ = 0.84–0.86). Interobserver agreement was substantial on the PAS (κ = 0.78), almost perfect on the PPR (κ = 0.82), substantial on the safety grade (κ = 0.64), almost perfect on the efficiency grade (κ = 0.85), and substantial on the summary grade (κ = 0.71). Bolus consistency had an effect on observer agreement. A significant correlation was found between DIGEST efficiency grade and EAT-10. Conclusion The DIGEST showed to be a reproducible measurement for FEES in terms of observer agreement. However, agreement between novice observers on the DIGEST was only reached after specific observer-tailored training. Observer agreement should be analyzed by taking bolus consistency into account during training, as this might affect the interpretation of the outcome. A manual with well-defined descriptions can optimize the reproducibility of DIGEST measurements.

Twenty-five years of annual Medicare Physician/Supplier Procedure Summary (PSPS) Master File data were used to assess trends in normalized volume and claim denial rates for brain computerized tomography. Alongside growth in utilization of brain computerized tomography (services, denial rates, fell from 1999-2005 and with relatively leveled growth and less denial rate volatility thereafter. More recent trends in denial rates may be related to policy interventions initially aimed at cost and volume reduction.

Small ruminant sinus adenocarcinoma (ENA) is a contagious disease caused by a beta retrovirus called Enzootic Nasal Tumor Virus or ENTV. The first cases were sporadically diagnosed in Morocco in 2018. However, in the last two years, ENTV has appeared enzootic in three herds of the Sardi breed. The annual incidence varied between 5 and 20 %. Most cases involved female animals aged 15 to 42 months. The disease developed within 2 to a maximum of 6 months. Diseased animals presented with progressive weight loss and increased mortality or needed to be slaughtered. The condition associated mainly with unilateral skull deformation, serous or seromucous nasal discharge with dyspnea, and in some individuals an exophthalmos. During pathology tumor-like masses were found in the paranasal sinuses, which showed the growth of an expansive and organized epithelial neoplasm on histopathology. After an overview of the differential diagnoses that can lead to confusion with ANE, the authors investigate why the disease occurs more frequently in Morocco and particularly in the Sardi breed.Das Adenokarzinom der Sinus paranasales bei kleinen Wiederkäuern (ENA) ist eine ansteckende Krankheit, die durch ein Betaretrovirus namens Enzootic Nasal Tumor Virus oder ENTV verursacht wird. Die ersten Fälle wurden in Marokko sporadisch im Jahr 2018 diagnostiziert. In den letzten zwei Jahren trat ENTV jedoch enzootisch in drei Herden der Rasse Sardi auf. Die jährliche Inzidenz schwankte zwischen 5 und 20 %. Die meisten Fälle betrafen weibliche Tiere im Alter von 15 bis 42 Monaten. Die Krankheit entwickelte sich innerhalb von 2 bis maximal 6 Monaten. Die erkrankten Tiere zeigten Gewichtsverlust und eine stark erhöhte Mortalität oder mussten geschlachtet werden. Die Klinik zeigte sich oft in einer einseitigen Schädeldeformation, serösem oder seromukösem Nasenausfluss mit Atemnot und Exophthalmus. Bei der pathologischen Untersuchung wurden tumorartige Massen in den Nasennebenhöhlen festgestellt. Bei der histopathologischen Untersuchung entsprachen die Tumormassen einem expansiven und organisierten epithelialen Neoplasma. Nach einem Überblick über die Differentialdiagnosen zu ANE, diskutieren die Autoren warum die Krankheit in Marokko, insbesondere bei der Rasse Sardi, vermehrt auftritt.L’adénocarcinome des sinus nasaux des petits ruminants (ANE) est une maladie contagieuse, provoquée par un betaretrovirus appelé l’Enzootic Nasal Tumor Virus ou ENTV. Les premiers cas ont sporadiquement été diagnostiqués au Maroc en 2018. Cependant, durant les deux dernières années, l’ANE a sévi de manière enzootique dans trois troupeaux, tous naisseurs, qui exploitent la race Sardi. L’incidence annuelle varie de 5 à 20 %. La majorité des cas étaient des femelles, âgées entre 15 et 42 mois. La maladie évolue en 2 à 6 mois au maximum. Les malades maigrissent progressivement et la quasi-totalité meurt si elle n’est pas abattue avant. L’affection associe principalement des lésions de la face, avec déformation du crâne souvent unilatérale, des écoulements nasaux séreux ou séro-muqueux avec difficulté respiratoire et l’exophtalmie chez certains individus. L’autopsie a permis de mettre en évidence des masses tumorales dans les sinus. A l’examen histopathologique, les masses tumorales correspondent à un néoplasme épithélial expansif et organisé. Les auteurs, après avoir passé en revue les diagnostics différentiels pouvant prêter à confusion avec l’ANE, s’interrogent sur les raisons de sa recrudescence au Maroc, particulièrement chez la race Sardi.L’adenocarcinoma dei seni paranasali dei piccoli ruminanti (ANE) è una malattia contagiosa causata da un betaretrovirus chiamato Enzootic Nasal Tumor Virus o ENTV. I primi casi sono stati diagnosticati sporadicamente in Marocco nel 2018. Tuttavia, negli ultimi due anni, l’ENTV è stato individuato come enzootico in tre mandrie, tutte di bovini di razza Sardi da riproduzione. L’incidenza annuale varia dal 5 al 20%. La maggior parte dei casi era costituita da femmine, di età compresa tra i 15 e i 42 mesi. La malattia progredisce in 2–6 mesi al massimo. Gli animali affetti perdono progressivamente peso e quasi tutti muoiono se non vengono macellati prima. La malattia è principalmente associata a lesioni del muso, spesso con deformità cranica unilaterale, scolo nasale sieroso o sieromucoso con difficoltà respiratorie ed esoftalmo in alcuni individui. All’autopsia sono state riscontrate masse tumorali nei seni paranasali. All’esame istopatologico, le masse tumorali sono risultate coerenti con una neoplasia epiteliale espansiva e organizzata. Gli autori, dopo aver passato in rassegna le diagnosi differenziali che possono portare ad una confusione con l’ANE, si sono domandati per quali ragioni si è trovata questa recrudescenza in Marocco e in particolare nella razza Sardi.

The LIMIT clinical decision instrument (CDI) was published in 2021 to safely reduce neuroimaging in patients with recurrent seizures. The LIMIT CDI had a sensitivity of 90%, negative predictive value of99.9%, and reduced neuroimaging by 13.3%. However, the design of the original LIMIT CDI made it cumbersome to use. The goal of this study was to validate the streamlined LIMIT-NeuroImaging (LIMIT-NI) CDI and compare its performance to the original LIMIT CDI.This was an observational study of patients presenting to three emergency departments with recurrent seizures. The LIMIT-NI CDI was applied to all patients. We calculated the test characteristics of the LIMIT-NI CDI and compared it to unstructured clinical judgement.3401 patients were screened, and 2125 patients were included in the final analysis. 16 patients (0.75%) had positive CTs; Both the LIMIT-NI CDI and clinician judgement identified all 16 patients with a sensitivity of 100.0% and a negative predictive value of 100.0%. Using unstructured clinical judgement, emergency providers ordered 835 brain CTs, while only 499 brain CTs would have been ordered using the CDI, a reduction of 15.8% (relative reduction 40.2%).The LIMIT-NI CDI demonstrated greater ease of application and improved test characteristics compared to the original LIMIT CDI. Compared to unstructured clinician judgement, the LIMIT-NI CDI reduced neuroimaging by 15.8% (relative reduction 40.2%) in recurrent seizure patients. The LIMIT-NI CDI can be used by physicians along with clinical judgement to reduce neuroimaging in the recurrent seizure patient.

The state-of-the-art optical see-through head-mounted displays (OST-HMD) for augmented reality applications lack the ability to render correct light interaction behavior between digital and physical objects, known as mutual occlusion capability. This paper presents a novel optical architecture for enabling a compact, high performance, occlusion-capable optical see-through head-mounted display (OCOST-HMD) with correct, pupil-matched viewing perspective. The proposed design utilizes a single-layer, double-pass architecture, offering a compact OCOST-HMD solution that is capable of rendering per-pixel mutual occlusion, a correctly pupil-matched viewing between virtual and real views, and a very wide see-through field of view (FOV). Based on this architecture, we demonstrate a design embodiment and a compact prototype implementation. The prototype offers a virtual display with an FOV of 34 by 22, an angular resolution of 1.06 arc minutes per pixel, and an average image contrast greater than 40% at the Nyquist frequency of 53 cycles/mm. Further, the prototype system affords a wide see-though FOV of 90 by 50, within which about 40 diagonally is occlusion-enabled, along with an angular resolution of 1.0 arc minutes, comparable to a 20/20 vision and a dynamic range greater than 100:1. Lastly, we composed a quantitative color study that compares the effects of occlusion between a conventional HMD system and our OCOST-HMD system and the resulting response exhibited in different studies.

Most commercially available optical see-through head-mounted displays (OST-HMDs) utilize optical combiners to simultaneously visualize the physical background and virtual objects. The displayed images perceived by users are a blend of rendered pixels and background colors. Enabling high fidelity color perception in mixed reality (MR) scenarios using OST-HMDs is an important but challenging task. We propose a real-time rendering scheme to enhance the color contrast between virtual objects and the surrounding background for OST-HMDs. Inspired by the discovery of color perception in psychophysics, we first formulate the color contrast enhancement as a constrained optimization problem. We then design an end-to-end algorithm to search the optimal complementary shift in both chromaticity and luminance of the displayed color. This aims at enhancing the contrast between virtual objects and the real background as well as keeping the consistency with the original displayed color. We assess the performance of our approach using a simulated OST-HMD environment and an off-the-shelf OST-HMD. Experimental results from objective evaluations and subjective user studies demonstrate that the proposed approach makes rendered virtual objects more distinguishable from the surrounding background, thereby bringing a better visual experience.

Pediatric head and neck tumors are uncommon but the consequences of radical resection are extensive. These tumors, benign and malignant, are uniquely challenging because of their proximity to critical functional and neurovascular structures and intimately affect speech, swallowing, voice, breathing, hearing, and vision. In addition, the psychosocial and emotional trauma from the cosmetic and functional consequences can be enduring. Their relative rarity limits surgeon experience and requires a focused effort to develop individual and programmatic expertise. A practiced multidisciplinary team can facilitate smooth preoperative evaluations, efficient coordinated operative procedures, comprehensive rehabilitation, and recovery, as well as optimal oncologic outcomes.

We previously proposed a Bayesian model of multisensory integration in spatial orientation (1). Using a Gaussian prior, centered on an upright head orientation, this model could explain various perceptual observations in roll-tilted participants, such as the subjective visual vertical, the subjective body tilt (1), the rod-and-frame effect (2), as well as their clinical (3) and age-related deficits (4). Because it is generally assumed that the prior reflects an accumulated history of previous head orientations, and recent work on natural head motion suggests non-Gaussian statistics, we examined how the model would perform with a non-Gaussian prior. In the present study, we first experimentally generalized the previous observations in showing that also the natural statistics of head orientation are characterized by long tails, best quantified as a t-location-scale distribution. Next, we compared the performance of the Bayesian model and various model variants using such a t-distributed prior to the original model with the Gaussian prior on their accounts of previously published data of the subjective visual vertical and subjective body tilt tasks. All of these variants performed substantially worse than the original model, suggesting a special value of the Gaussian prior. We provide computational and neurophysiological reasons for the implementation of such a prior, in terms of its associated precision–accuracy trade-off in vertical perception across the tilt range.New & NoteworthyIt has been argued that the brain uses Bayesian computations to process multiple sensory cues in vertical perception, including a prior centered on upright head orientation which is usually taken to be Gaussian. Here, we show that non-Gaussian prior distributions, although more akin to the statistics of head orientation during natural activities, provide a much worse explanation of such perceptual observations than a Gaussian prior.

In this paper, a 335 W solar panel with a centrifugal pump combined system was simulated in MATLAB Simulink 2018 with fuzzy logic-based MPPT, and the voltage, current, power, and discharge four output responses were determined at different values of solar flux, module temperature, and atmospheric temperature. Further, the output responses voltage, current, power output, and discharge data have been optimized in Response Surface Methodology (RSM). The output data of RSM and MATLAB Simulink is used to determine the solar pump's theoretical performance and overall efficiency. Finally, the RSM-optimized results of solar pumps are validated with the experimental results of the solar pump. The experimental setup consists of 15 panels of 335 W power and a 5 hp submersible pump operated by an AC motor. The experimental data were collected from 15/01/2020 to 15/12/2020. The optimization of the solar pump by the three most important variables solar flux, module temperature, and the atmosphere temperature is very new and unique since the selected input variables maximize the overall performance of the solar pump.

Radiation therapy for cancer using the Bragg peak of an ion beam has been making steady progress after being proposed by Robert Wilson in 1946. At the end of 2020, 12 dedicated treatment devices existed in operation worldwide, and approximately 40,000 patients have been treated with ion beams (mostly carbon ions). To date, ion beam therapy is superior to other treatments for rare cancers in the head and neck as well as bone and soft tissues; however, most recently, evidence submitted in Japan for the 2022 revision of public health insurance shows that ion beam therapy outperforms photon therapy for intractable common cancers such as pancreatic cancer and liver cancer. This may greatly expand its indications. Lawrence Berkeley Laboratory in the United States started research of ion beam therapy, National Institute of Radiological Sciences in Japan built the first dedicated device Heavy Ion Accelerator in Chiba and started systematic clinical research, and GSI in Germany developed the scanning irradiation method and rotating gantry for the first time. This paper presents the history and future challenges of ion beam therapy in three fields: accelerator and beam delivery system, physical/biological model and treatment planning system, and clinical research. This study is divided into three parts describing the achievements and roles of the three laboratories. In Part 1, accelerator and beam delivery system are described.

Objectives: To assess intra- and inter-institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma. Methods: Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase-I (20 cases) utilized each individual's a priori appreciation of the literature. Phase-II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra- and inter-institutional Kappa were calculated at >50% and >75% certainty levels, respectively. Results: The Phase-I intra-institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter-institutional Fleiss' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase-II inter-rater kappa was significantly higher than Phase-I at the same certainty level (both p < 0.001). Conclusion: A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.

Head impact measurement devices enable opportunities to collect impact data directly from humans to study topics like concussion biomechanics, head impact exposure and its effects, and concussion risk reduction techniques in sports when paired with other relevant data. With recent advances in head impact measurement devices and cost-effective price points, more and more investigators are using them to study brain health questions. However, as the field's literature grows, the variance in study quality is apparent. This brief paper aims to provide a high-level set of key considerations for the design and analysis of head impact measurement studies that can help avoid flaws introduced by sampling biases, false data, missing data, and confounding factors. We discuss key points through four overarching themes: study design, operational management, data quality, and data analysis.

Intentional skull deformations have been practiced by every human population, from the prehistoric times until the XXth century. In Europe, they were specifically prevalent in the region of Toulouse, France. The soft-tissue modifications due to such practices are not well characterized in the literature due to the rarity of photographic data. Most studies on skull deformations are thus based on skeletal remains. Here we performed a controlled geometric morphometric assessment of 31 frontal pictures and 70 lateral pictures of individuals from Toulouse with intentional deformations extracted from two XIXth century historical French photographic archives. We also measured the forces exerted on the skull vault by the traditional deformation device from Toulouse using a 3D-printed skull and pressure sensors. We showed that individuals with Toulouse deformations have distinctive facial features, caused by moderate forces exerted on the skull vault. Our results exhibit and quantify for the first time the real face of intentional skull deformations, which are a ubiquitous and distinctive feature of the human species.

Early recognition of free flap vascular impairment is essential for flap salvage attempts. Several methods for surveillance of post-operative flaps are available. Among these, we have extensively used Laser-Doppler Perfusion Flowmetry (LDF) monitoring. We report our experience on this topic and illustrate the advantages and weak points.Over seven years, 110 consecutive free flaps for head and neck reconstruction were monitored using the Periflux System 5000Six of 110 (5.5%) cases of vascular problems were detected and clinically confirmed. In 5 cases, venous thrombosis was present: 4 patients were successfully treated. In 1 case, both arterial and venous thrombosis occurred. Flowmetry data always showed a more or less sudden disappearance of vasomotion.LDF is a highly sensible, specific and reliable method. It is easy to use and interpret at low cost. Remote monitoring could also be developed.Monitoraggio dei lembi liberi mediante flussometria Laser-Doppler nella chirurgia della testa e del collo.Il riconoscimento precoce della compromissione vascolare del lembo libero è essenziale per i tentativi di salvataggio del lembo. Sono disponibili molti metodi per la sorveglianza postoperatoria dei lembi. Tra questi, abbiamo ampiamente utilizzato la flussometria Laser-Doppler (FLD). Lo scopo del presente articolo è di riportare la nostra esperienza, illustrando vantaggi e punti deboli.In un lasso di tempo di sette anni, sono stati monitorati 110 lembi liberi consecutivi per la ricostruzione della testa e del collo utilizzando Periflux System 5000Sono stati rilevati e clinicamente confermati 6/110 (5,5%) casi di disturbi vascolari. In 5 casi si è verificata una trombosi venosa: 4 di questi sono stati trattati con successo. In 1 caso si è verificata sia trombosi arteriosa che venosa. I dati della flussometria hanno sempre mostrato una più o meno improvvisa scomparsa della vasomotricità.FLD è un metodo altamente sensibile e specifico, quindi molto affidabile. È facile da usare e interpretare con un costo contenuto. Potrebbe essere sviluppato il monitoraggio in remoto.

Re-irradiation can be considered for local recurrence or new tumours adjacent to a previously irradiated site to achieve durable local control for patients with cancer who have otherwise few therapeutic options. With the use of new radiotherapy techniques, which allow for conformal treatment plans, image guidance, and short fractionation schemes, the use of re-irradiation for different sites is increasing in clinical settings. Yet, prospective evidence on re-irradiation is scarce and our understanding of the underlying radiobiology is poor. Our consensus on re-irradiation aims to assist in re-irradiation decision making, and to standardise the classification of different forms of re-irradiation and reporting. The consensus has been endorsed by the European Society for Radiotherapy and Oncology and the European Organisation for Research and Treatment of Cancer. The use of this classification in daily clinical practice and research will facilitate accurate understanding of the clinical implications of re-irradiation and allow for cross-study comparisons. Data gathered in a uniform manner could be used in the future to make recommendations for re-irradiation on the basis of clinical evidence. The consensus document is based on an adapted Delphi process and a systematic review of the literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Craniosynostoses affect 1/2000 births and their incidence is currently increasing. Without surgery, craniosynostosis can lead to neurological issues due to restrained brain growth and social stigma due to abnormal head shapes. Understanding growth patterns is essential to develop surgical planning approaches and predict short- and long-term post-operative results. Here we provide a systematic review of normal and pathological cranial vault growth models.The systematic review of the literature identified descriptive and comprehensive skull growth models with the following criteria: full text articles dedicated to the skull vault of children under 2 years of age, without focus on molecular and cellular mechanisms. Models were analysed based on initial geometry, numerical method, age determination method and validation process.A total of 14 articles including 17 models was reviewed. Four descriptive models were assessed, including 3 models using statistical analyses and 1 based on deformational methods. Thirteen comprehensive models were assessed including 7 finite element models and 6 diffusion models. Results from the current literature showed that successful models combined analyses of cranial vault shape and suture bone formation.Growth modelling is central when assessing craniofacial architecture in young patients and will be a key factor in the development of future customized treatment strategies. Recurrent technical difficulties were encountered by most authors when generalizing a specific craniosynostosis model to all types of craniosynostoses, when assessing the role of the brain and when attempting to relate the age with different stages of growth.

Experimental in vivo determination of radiological tissue parameters of organs in the head and pelvis within a large patient cohort, expanding on the current standard human tissue database summarized in ICRU46.Relative electron density (RED), effective atomic number (EAN) and stopping-power ratio (SPR) were obtained from clinical dual-energy CT scans using a clinically validated DirectSPR implementation and organ segmentations of 107 brain-tumor (brain, brainstem, spinal cord, chiasm, optical nerve, lens) and 120 pelvic cancer patients (prostate, kidney, liver, bladder). The impact of contamination by surrounding tissues on the tissue parameters was reduced with a dedicated contour adaption routine. Tissue parameters were characterized regarding the cohort mean value as well as the variation within each patient (2σFor 10 organs, including 4 structures not listed in ICRU46, the mean RED, EAN and SPR as well as their respective intra- and inter-patient variation were determined. SPR intra-patient variation was higher than 1.3% (1.3-4.6%) in all organs and always exceeded the inter-patient variation of the organ mean SPR (0.6-2.1%). For the brain, a significant SPR variation between pediatric and non-pediatric patients was determined.Radiological tissue parameters in the head and pelvis were characterized in vivo for a large patient cohort using dual-energy CT. This reassesses parts of the current standard database defined in ICRU46, furthermore complementing the data described in literature by smaller substructures in the brain as well as by the quantification of organ-specific inter- and intra-patient variation.

Point-of-care ultrasound (POCUS) in the head and neck region plays a particularly significant role in the diagnosis and treatment of upper airway stenosis, swelling, and painful diseases in the neck, and in the evaluation of swallowing function. Therefore, it should be performed in various medical settings beyond the boundaries of the clinical department such as general medicine, emergency medicine, anesthesiology, orthopedics, and pediatrics. The target diseases are salivary gland disease, lymph node disease, pharyngeal disease, laryngeal disease, esophageal disease, thyroid disease, and dysphagia and dyspnea due to various causes. Head and neck POCUS is an extremely useful diagnostic method for both patients and doctors, and its use is expected to become more widespread in the future.

BACKGROUND: Skull radiography, an assessment method for initial diagnosis and post-operative follow-up, requires substantial retaking of various types of radiographs. During retaking, a radiologic technologist estimates a patient’s rotation angle from the radiograph by comprehending the relationship between the radiograph and the patient’s angle for adequate assessment, which requires extensive experience. OBJECTIVE: To develop and test a new deep learning model or method to automatically estimate patient’s angle from radiographs. METHODS: The patient’s position is assessed using deep learning to estimate their angle from skull radiographs. Skull radiographs are simulated using two-dimensional projections from head computed tomography images and used as input data to estimate the patient’s angle, using deep learning under supervised training. A residual neural network model is used where the rectified linear unit is changed to a parametric rectified linear unit, and dropout is added. The patient’s angle is estimated in the lateral and superior-inferior directions. RESULTS: Applying this new deep learning model, the estimation errors are 0.56±0.36° and 0.72±0.52° in the lateral and superior-inferior angles, respectively. CONCLUSIONS: These findings suggest that a patient’s angle can be accurately estimated from a radiograph using a deep learning model leading to reduce retaking time, and then used to facilitate skull radiography.

Wearable devices are increasingly used to measure real-world head impacts and study brain injury mechanisms. These devices must undergo validation testing to ensure they provide reliable and accurate information for head impact sensing, and controlled laboratory testing should be the first step of validation. Past validation studies have applied varying methodologies, and some devices have been deployed for on-field use without validation. This paper presents best practices recommendations for validating wearable head kinematic devices in the laboratory, with the goal of standardizing validation test methods and data reporting. Key considerations, recommended approaches, and specific considerations were developed for four main aspects of laboratory validation, including surrogate selection, test conditions, data collection, and data analysis. Recommendations were generated by a group with expertise in head kinematic sensing and laboratory validation methods and reviewed by a larger group to achieve consensus on best practices. We recommend that these best practices are followed by manufacturers, users, and reviewers to conduct and/or review laboratory validation of wearable devices, which is a minimum initial step prior to on-field validation and deployment. We anticipate that the best practices recommendations will lead to more rigorous validation of wearable head kinematic devices and higher accuracy in head impact data, which can subsequently advance brain injury research and management.

Shoulder-to-helmet (STH) impacts have been shown to cause approximately twenty percent of concussions in football yet little research has investigated shoulder pad design and STH impacts. This study aimed to characterize STH impacts and identify the effect of shoulder pad design on the struck head kinematics. Additional padding was added to a shoulder pad, and was then compared to an unmodified control shoulder pad. Participants performed a series of tests where they struck a helmeted Hybrid III dummy with both shoulder pad variations to compare struck head linear and rotational kinematics. The study found the modified shoulder pad reduced peak linear acceleration by 31% (Δµ = - 9.13 g's (- ∞, - 7.25), (p = 4.10e-08)), rotational acceleration by 28% (Δµ = - 565 rad s

Multi-contrast magnetic resonance imaging can provide comprehensive information for clinical diagnosis. However, multi-contrast imaging suffers from long acquisition time, which makes it inhibitive for daily clinical practice. Subsampling k-space is one of the main methods to speed up scan time. Missing k-space samples will lead to inevitable serious artifacts and noise. Considering the assumption that different contrast modalities share some mutual information, it may be possible to exploit this redundancy to accelerate multi-contrast imaging acquisition. Recently, generative adversarial network shows superior performance in image reconstruction and synthesis. Some studies based on k-space reconstruction also exhibit superior performance over conventional state-of-art method. In this study, we propose a cross-domain two-stage generative adversarial network for multi-contrast images reconstruction based on prior full-sampled contrast and undersampled information. The new approach integrates reconstruction and synthesis, which estimates and completes the missing k-space and then refines in image space. It takes one fully-sampled contrast modality data and highly undersampled data from several other modalities as input, and outputs high quality images for each contrast simultaneously. The network is trained and tested on a public brain dataset from healthy subjects. Quantitative comparisons against baseline clearly indicate that the proposed method can effectively reconstruct undersampled images. Even under high acceleration, the network still can recover texture details and reduce artifacts.

We describe a method for performing mandibular resection and vascularized tissue transfer via an intraoral and contralateral submandibular approach to minimize the risk of wound complications in a radiated field. Surgery on radiated tissue associated with osteoradionecrosis of the mandible can present with oral cutaneous fistulas, dense fibrotic skin, and altered tissue planes to make dissection through this tissue tedious and can place the marginal mandibular nerve at increased risk of injury. The use of custom plates allows surgeons to minimize incisions and depend less on anatomic/visual cues during surgery to obtain an accurate result. Our experience in 8 patients has shown a predictable method for resection and reconstruction of the mandible, while minimizing the potential complications associated with previously radiated and operated patients.

This paper critically reviews the history of research concerning ancient Egyptian interventive dental therapy between the Old Kingdom - Graeco-Roman Period (c. 2686 BCE-AD 323), concentrating on the published osteological evidence.Eight osteological examples reportedly exhibiting markers of interventive dental therapy, including a mandible presenting purported evidence for a drilling procedure for the relief of an abscess; four dental bridges; a maxilla with multiple teeth extracted; and two carious lesion fillings.Previous claims are critically reviewed using a qualitative research method involving collecting and critiquing published data, both primary evidence and relevant secondary literature.Without further scientific analysis, only four specimens can currently be plausibly attributed to ancient Egyptian interventive dental therapy including the Tura el-Asmant Bridge, the enucleation described for a Graeco-Roman child, and two carious lesion fillings identified in the mummified individuals known as the 'Redpath Mummy' (RM2718) and 'Sekhem' (AIG3343).Several enduring historiographical and museological problems within the discourse are identified, revising our understanding of the nature and scope of ancient Egyptian interventive dental therapy based on currently known osteological evidence.This review relies on the published documentation for each osteological example, namely images, which in several cases are poor quality.There is significant opportunity for further scientific analysis of the osteological evidence discussed. In each case, specific potential methods to improve our understanding and interpretation have been identified.

PURPOSE: Laborious and time-consuming tumor segmentations are one of the factors that impede adoption of radiomics in the clinical routine. This study investigates model performance using alternative tumor delineation strategies in models predictive of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC).METHODS: Of 153 OPSCC patients, HPV status was determined using p16/p53 immunohistochemistry. MR-based radiomic features were extracted within 3D delineations by an inexperienced observer, experienced radiologist or radiation oncologist, and within a 2D delineation of the largest axial tumor diameter and 3D spheres within the tumor. First, logistic regression prediction models were constructed and tested separately for each of these six delineation strategies. Secondly, the model trained on experienced delineations was tested using these delineation strategies. The latter methodology was repeated with the omission of shape features. Model performance was evaluated using area under the curve (AUC), sensitivity and specificity.RESULTS: Models constructed and tested using single-slice delineations (AUC/Sensitivity/Specificity: 0.84/0.75/0.84) perform better compared to 3D experienced observer delineations (AUC/Sensitivity/Specificity: 0.76/0.76/0.71), where models based on 4 mm sphere delineations (AUC/Sensitivity/Specificity: 0.77/0.59/0.71) show similar performance. Similar performance was found when experienced and largest diameter delineations (AUC/Sens/Spec: 0.76/0.75/0.65 vs 0.76/0.69/0.69) was used to test the model constructed using experienced delineations without shape features.CONCLUSION: Alternative delineations can substitute labor and time intensive full tumor delineations in a model that predicts HPV status in OPSCC. These faster delineations may improve adoption of radiomics in the clinical setting. Future research should evaluate whether these alternative delineations are valid in other radiomics models.

OBJECTIVES: To compare image quality and radiation dose of computed tomography angiography (CTA) of the head and neck in patients using two Gemstone Spectral Imaging (GSI) scanning protocols. METHODS: A total of 100 patients who underwent head-neck CTA were divided into two groups (A and B) according to the scanning protocols, with 50 patients in each group. The patients in group A underwent GSI scanning protocol 1 (GSI profile: head and neck CTA), while those in group B underwent GSI scanning protocol 2 (GSI profile: chest 80 mm). All images were reconstructed using 40% and 70% pre- and post-adaptive level statistical iterative reconstruction V (pre-ASiR-V and post-ASiR-V) algorithms, respectively. The CT dose index (CTDIvol) and dose-length (DLP) product were recorded and the mean value was calculated and converted to the effective dose. CT values, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of all images were calculated. Additionally, subjective image evaluation was conducted by two independent radiologists using a five-point scoring method. All data were statistically analyzed. RESULTS: There were no significant differences in the CT values, SNR, CNR, and subjective score between groups A and B (p > 0.05); however, the mean effective dose (1.2±0.1 mSv) in group B was 45.5% lower than that in group A (2.2±0.2 mSv) (p

In the routine anatomic measurement study on Asian dry skulls, a skull of atlanto-occipital fusion with other multiple anatomic variations was observed. The entire right half of the atlas vertebra, including the anterior arch, anterior tubercle, posterior arch, and lateral masses, was fused entirely with the occipital bone, while the left fused partly. Besides the atlanto-occipital fusion, the target skull specimen also includes posterior arch defects of the atlas, metopic suture, and wormian bones. So many anatomical variations rarely exist in one specimen. This paper aims to present detailed anatomic case reports and discuss related diseases in an anatomic and clinical study.

Eye contact is essential for human interactions. We investigated whether humans are able to avoid eye contact while navigating crowds. At a science festival, we fitted 62 participants with a wearable eye tracker and instructed them to walk a route. Half of the participants were further instructed to avoid eye contact. We report that humans can flexibly allocate their gaze while navigating crowds and avoid eye contact primarily by orienting their head and eyes towards the floor. We discuss implications for crowd navigation and gaze behavior. In addition, we address a number of issues encountered in such field studies with regard to data quality, control of the environment, and participant adherence to instructions. We stress that methodological innovation and scientific progress are strongly interrelated. ispartof: ATTENTION PERCEPTION & PSYCHOPHYSICS vol:84 issue:8 pages:2623-2640 ispartof: location:United States status: published

This study aimed to investigate the radiation risks in terms of effective dose and the cancer risk probability resulting from computed tomography (CT) scans of the head for traumatic patients and determine how often traumatic abnormalities occur. Data were collected retrospectively for 138 traumatic patients from the picture archiving and communication system, including exposure parameters and clinical findings. The mean values of the dose length product, CT dose index volume and effective dose for the CT head examinations were 787 ± 67.7 mGy•cm, 40.1 ± 1.33 mGy and 1.47 ± 0.12 mSv, respectively. Of the total cases of CT scans of the head, 57.2% (n = 79) exhibited positive findings. The cancer risk probability for the patients was 6.04 × 10−5 per procedure, with no statistically significant differences between positive and negative findings (p = 0.345). Taking into consideration the justification of the examination, the risk of missing positive findings and the radiation risks, the immediate benefit of head CT for trauma patients for guiding medical decisions outweighs the radiation risk that will probably manifest later.

Exosomes derived from solid tumour cells are involved in immune suppression, angiogenesis and metastasis; however, the role of leukaemia-derived exosomes has less been investigated. Hence, changes in immune response-related genes and human T cells apoptosis co-incubated with exosomes isolated from patients' pre-B cell acute lymphoblastic leukaemia were evaluated in this in vitro study. Vein blood sample was obtained from each newly diagnosed acute lymphoblastic leukaemia (ALL) patient prior any therapy. ALL serum exosomes were isolated by ultrafiltration and characterized using Western blotting and transmission electron microscopy. Exosomes were then co-incubated with T lymphocytes and the gene expressions, as well as functions of human T cells were quantified by qRT-PCR. Apoptosis and caspase-3 and caspase-9 protein expression were also evaluated by flowcytometry and Western blotting analysis, respectively. Exosomes isolated from ALL patients affected T lymphocytes and elevated the apoptosis. Moreover, these exosomes altered the T cells profile into regulatory type by increasing the expression of FOXP3 and Tregs-related cytokines, including TGF-B and IL-10. The expression level of Th17-related transcription factors (RoR gamma t) and interleukins (IL-17 and IL-23) decreased after this treatment. According to our findings, exosomes derived from ALL patients' sera carry immunosuppressive molecules, indicating the possible effect of exosomes as liquid biomarkers for cancer staging. The authors would acknowledge the stem cell research center at Tabriz University of Medical Sciences (TUOMS), Tabriz, Iran, for their great help. This work was financially supported by Tabriz University of Medical Sciences [63611 as grant number].

The mammalian skull is an informative and versatile study system critical to research efforts across the broad spectrum of molecular, cellular, organismal and evolutionary sciences. The amount of knowledge concerning mammalian skull continues to grow exponentially, fuelled by the advent of new research methods and new material. Computed microtomography, including X-ray imaging using synchrotron radiation, proved to be an important tool for the descriptive and quantitative analysis of cranial anatomy. A major conceptual change, namely combining genetics and development with evolution into 'evo-devo' studies, also contributed to our knowledge of the mammalian skull enormously. These advances, coupled with novel techniques now allow researchers to integrate the process of cranial development with data from the fossil record, which is also augmented by seminal discoveries from Africa, Asia and both Americas. However, for decades, there has been no comprehensive source covering fundamental aspects of this vibrant field of evolutionary biology. To address this gap, we offer in this theme issue a balanced mix of research papers and reviews from leading experts in the field and a younger generation of scientists from five continents. This article is part of the theme issue 'The mammalian skull: development, structure and function'.

Passive dynamics is an aspect of locomotion which is entirely dependent on the mechanical configuration and linkages of adjacent body segments. Tension distribution along mechanical linkages enables the execution of movement patterns with reduced need for complex neurological pathways and may play a role in reestablishing postural stability following external disturbances. Here we demonstrate a uni-directional mechanical relationship between the equine forelimb, head and neck, which may have implications for balance and forelimb loading in the horse. These observations suggest that forelimb, head and neck movement coordination (observed in the horse during unrestrained locomotion) is significantly influenced by the mechanical linkages between body segments, rather than being entirely dependent on neurological input as previously thought. This highlights the potential significance of research directed at investigating passively induced movements in understanding common locomotory patterns. Additionally, it suggests a mode of postural control which may provide instantaneous adjustments to postural disturbances, thus promoting rapid and efficient locomotion.

A novel biomimetic artificial intervertebral disc (bioAID) replacement implant has been developed containing a swelling hydrogel representing the nucleus pulposus, a tensile strong fiber jacket as annulus fibrosus and tita-nium endplates with pins to primarily secure the device between the vertebral bodies. In this study, the design safety of this novel implant was evaluated based on several biomechanical parameters, namely compressive strength, shear-compressive strength, risk of subsidence and device expulsion as well as identifying the diurnal creep-recovery characteristics of the device. The bioAID remained intact up to 1 kN under static axial compression and only 0.4 mm of translation was observed under a compressive shear load of 20 N. No subsidence was observed after 0.5 million cycles of si-nusoidal compressive loading between 50 and 225 N. After applying 400 N in antero-posterior direction under 100 N axial compressive preload, approximately 2 mm displacement was found, being within the range of displacements reported for other commercially available cervical disc replacement devices. The diurnal creep recovery behavior of the bioAID closely resembled what has been reported for natural intervertebral discs in literature. Overall, these results indicate that the current design can withstand (shear-compression loads and is able to remain fixed in a mechanical design resembling the vertebral bodies. Moreover, it is one of the first implants that can closely mimic the poroelastic and viscoelastic behavior of natural disc under a diurnal loading pattern.

Distraction disrupts Working Memory (WM) performance, but how the brain filters distraction is not known. One possibility is that neural activity associated with distractions is suppressed relative to a baseline/passive task (biased competition). Alternatively, distraction may be denied access to WM, with no suppression. Furthermore, behavioural work indicates separate mechanisms for ignoring distractions which occur (1) while we put information into WM (Encoding Distraction, ED) and (2) while we maintain already encoded information during the WM delay period (Delay Distraction, DD). Here we used fMRI in humans to measure category-sensitive cortical activity and probe the extent to which ED/DD mechanisms involve enhancement/suppression during a WM task. We observed significant enhancement of task-relevant activity, relative to a passive view task, which did not differ according to whether or when distractors appeared. For both ED and DD we found no evidence of suppression, but instead a robust increase in stimulus specific activity in response to additional stimuli presented during the passive view task, which was not seen for the WM task, when those additional stimuli were to be ignored. The results indicate that ED/DD resistance does not necessarily involve suppression of distractor-related activity. Rather, a rise in distractor-associated activity is prevented when distractors are presented, supporting models of input gating, and providing a potential mechanism by which input-gating might be achieved.

Radiation therapy (RT) treatment for head and neck cancer has been associated with dysphagia manifestation leading to worse outcomes and decrease in life quality. In this study, we investigated factors leading to dysphagia and treatment prolongation in patients with primaries arising from oral cavity or oropharynx that were submitted to radiation therapy concurrently with chemotherapy. The records of patients with oral cavity or oropharyngeal cancer that received RT treatment to the primary and bilateral neck lymph nodes concurrently with chemotherapy were retrospectively reviewed. Logistic regression models were used to analyze the potential correlation between explanatory variables and the primary (dysphagia ≥ 2) and secondary (prolongation of total treatment duration ≥ 7 days) outcomes of interest. The Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) were used to evaluate dysphagia. A total of 160 patients were included in the study. Age mean was 63.31 (SD = 8.24). Dysphagia grade ≥ 2 was observed in 76 (47.5%) patients, while 32 (20%) experienced treatment prolongation ≥ 7 days. The logistic regression analysis showed that the volume in the primary site of disease that received dose ≥ 60 Gy (≥118.75 cc, p < 0.001, (OR = 8.43, 95% CI [3.51–20.26]) and mean dose to the pharyngeal constrictor muscles > 40.6 Gy (p < 0.001, OR = 11.58, 95% CI [4.84–27.71]) were significantly associated with dysphagia grade ≥ 2. Treatment prolongation ≥ 7 days was predicted by higher age (p = 0.007, OR = 1.079, 95% CI [1.021–1.140]) and development of grade ≥ 2 dysphagia (p = 0.005, OR = 4.02, 95% CI [1.53–10.53]). In patients with oral cavity or oropharyngeal cancer that receive bilateral neck irradiation concurrently with chemotherapy, constrictors mean dose and the volume in the primary site receiving ≥ 60 Gy should be kept below 40.6 Gy and 118.75 cc, respectively, whenever possible. Elderly patients or those that are considered at high risk for dysphagia manifestation are more likely to experience treatment prolongation ≥ 7 days and they should be closely monitored during treatment course for nutritional support and pain management.

A wireless, wearable magnetic eye tracker is described and characterized. The proposed instrumentation enables simultaneous evaluation of eye and head angular displacements. Such a system can be used to determine the absolute gaze direction as well as to analyze spontaneous eye re-orientation in response to stimuli consisting in head rotations. The latter feature has implications to analyze the vestibulo-ocular reflex and constitutes an interesting opportunity to develop medical (oto-neurological) diagnostics. Details of data analysis are reported together with some results obtained in-vivo or with simple mechanical simulators that enable measurements under controlled conditions., 11 pages, 7 figures, 46 references