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Objectives: Evaluating the effect of shape and size of implant scan body on the accuracy of optical 3D scanning., Materials and Methods: Fifteen PEEK scan bodies were milled, including 1 spherical, 9 cylindrical, and 5 cuboidal. The 3D position and angulation of each scan body were measured using a CMM 3 times and a laboratory scanner 10 times. The linear and angular trueness and precision of the scans were calculated by comparing with the CMM measurements., Results: The linear accuracy of the cylindrical scan bodies (9.5 ± 6.2 µm) was significantly higher than those of the cuboidal (17.7 ± 8.1 µm) and spherical scan bodies (12.5 ± 6.5 µm). The cuboidal (0.050±0.009°) showed significantly better angular accuracy than the cylindrical (0.065±0.040°). In the cylindrical group, the narrow (∅4.8 mm) demonstrated significantly inferior accuracy than the wider (∅5.5 mm and ∅6.5 mm)(p = 0.003). The tall (12 mm) showed significantly higher angular trueness than the shorter (8 and 4 mm)(p < 0.001). In the cuboidal group, the 24 mm 2 exhibited significantly poorer angular trueness compared to the 18 mm 2 and 30 mm 2 (p < 0.001) CONCLUSIONS: The shape and size of the implant scan body significantly affect the scanning accuracy. Spherical scan bodies cannot transfer implant angulation. Scan bodies with a size of >∅4.8 mm and >8 mm seem accurate for transferring the 3D implant position., Clinical Significance: The shape and size of scan bodies directly influence the accuracy of 3D scanning. Well-designed scan bodies offer better transfer results, which is crucial for ensuring passive fit of implant prostheses and improving long-term clinical outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: To measure and compare the accuracy of the linear dimensions of implant sites recorded from cone beam computed tomography (CBCT) images using Blue Sky Plan, coDiagnostiX, and RadiAnt. Materials and Methods: Five human dry skulls were imaged with a CBCT device then sectioned to obtain sample transverse cross-sections of the edentulous ridges, and the height and width of the ridge were measured with a digital caliper to provide the gold standard measurements. The CBCT datasets were exported in DICOM format and imported into the three test software programs which were used to obtain reformatted sectional images corresponding to the sample transverse cross-sections, and the height and width of the edentulous ridge was recorded using the linear measurement tool. Reliability of the measurements were measured using the intraclass correlation coefficient. One-sample t-test (test value: zero) was used to test the statistical significance of the mean of the absolute errors for each software program. Analysis of Variance with Repeated Measures was used to test the statistical significance of the difference between the means of the absolute errors obtained by the different software programs. Statistical significance was set at a p-value of 0.05. Results: The reliability of the gold standard and image measurements were excellent. All three software programs demonstrated a statistically significant mean absolute measurement error of between 0.43 and 0.56 mm (p-value

Objectives: To evaluate the effects of repeated cut-off and rescan procedures on the trueness of three intraoral scanners (IOS)., Methods: A tooth model (#16) with a standard class II cavity was prepared, and the complete-arch was scanned using a laboratory scanner (D2000, 3Shape A/S) to obtain a reference scan. Then the typodont was scanned with three IOSs (3Shape TRIOS 3, CEREC Omnicam, and Medit i500) under two rescanning strategies (full-cut and partial-cut), with varying numbers of repeated cut-off and rescanning procedures (0, 1, 3, 5, 7, or 10). The trueness discrepancy between the reference and experimental digital scan was estimated using root mean square (RMS) calculations. Three regions of interest were selected to represent the rescanning, identification, and non-rescan area. And the discrepancies were analyzed using a linear mixed model (α=0.05)., Results: Cut-off and rescanning procedures significantly decreased the trueness of digital scans in all test conditions compared to the reference. However, no progressive increase in discrepancy was observed under any rescan conditions. Significant influences on trueness were found based on the IOS used, with the 3Shape system exhibiting lower RMS values. The partial-cut strategy showed lower RMS values compared to the full-cut strategy, albeit without statistical significance., Conclusions: While repeated cut-off and rescanning procedures led to a decline in the quality of digital impressions, they did not result in discrepancy accumulation with repeated rescanning., Clinical Significance: To ensure high scanning accuracy in dental practice, it is advisable to minimize the rescanning area when correcting imperfections in digital scans. Additionally, selecting an appropriate scanner can help mitigate the negative effects of the rescanning technique., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

The transfer of a virtual orthognathic surgical plan to the patient still relies on the use of occlusal splints, which have limitations for vertical positioning of the maxilla. The use of real-time navigation has been proposed to enhance surgical accuracy. This systematic review (PROSPERO CRD42024497588) aimed to investigate if surgical navigation can improve the three-dimensional accuracy of orthognathic surgery. The inclusion criteria were orthognathic surgery, use of intra-operative navigation and quantitative assessment of surgical accuracy. The exclusion criteria were non-bimaxillary orthognathic surgeries, non-clinical studies, studies without post-operative 3D analysis and publications not in the English language. A search of PubMed, Embase and Cochrane Library generated 940 records, of which 12 were found relevant. Risk of bias was assessed done using the Joanna Briggs Institute Critical Appraisal Checklist Tool. Among the included studies, there were nine of observational character and three randomized control studies (RCTs). All studies demonstrated promising outcomes with reported good surgical accuracy within a 2 mm difference between the planned and post-surgical result. Meta-analysis of two RCTs was carried out and results were in favor of surgical navigation with a total odds ratio of 4.44 [2.11, 9.37] and an overall effect outcome of Z = 3.92 (p < 0.0001). Navigation was up to 0.60 mm more accurate than occlusal wafers only (p < 0.001). However, there were variations in the application of surgical navigation and methods of analysis, leading to a heterogenous data set. Future studies should focus on standardized protocols and analysis methods to further validate the use of surgical navigation in orthognathic surgery. Despite some limitations, surgical navigation shows potential as a valuable tool in improving the accuracy of orthognathic surgery., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To compare miniscrew versus bone tracing registration methods on dental implant placement accuracy and time efficiency in edentulous jaws using a dynamic computer-assisted implant surgery (d-CAIS) system., Methods: Twelve fully edentulous maxillary models were allocated into two groups: miniscrew tracing (MST) group, where registration was performed by tracing four miniscrews; and bone tracing (BT) group, where registration was conducted by tracing maxillary bone fiducial landmarks. Six implants were placed on each model using the X-Guide® d-CAIS system. Pre- and postoperative cone-beam computed tomography (CBCT) scans were superimposed to evaluate implant placement accuracy. The time required for registration and the overall surgery time were also recorded., Results: Thirty-six implants were placed in each group. The MST group showed significantly lower mean angulation deviations (mean difference (MD): -3.33°; 95 % confidence interval (CI): -6.56 to -0.09); p = 0.044), 3D platform deviations (MD: -1.01 mm; 95 % CI: -1.74 to -0.29; p = 0.006), 2D platform deviations (MD: -0.97 mm; 95 % CI: -1.71 to -0.23; p = 0.010), and 3D apex deviations (MD: -1.18 mm; 95 % CI: -1.92 to -0.44; p = 0.002) versus the BT group. The overall surgery time was similar for both groups (MD: 6.10 min.; 95 % CI: -0.31 to 12.51; p = 0.06), though bone tracing required significantly more time compared with miniscrew registration (MD: 4.79 min.; 95 % CI: 2.96 to 6.62; p < 0.05)., Conclusions: Registration with MST increases the accuracy of implant placement with a d-CAIS system in edentulous jaws compared with the BT method, and slightly reduces the overall surgery time., Clinical Significance: Miniscrew tracing registration improves implant placement accuracy in comparison with bone tracing registration., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare that they have no known competing financial interests or personal relationships directly related with this study. However, they would like to declare the following interests outside the submitted work: Dr. Octavi Camps-Font reports grants and non-financial support from Avinent (Santpedor, Spain), and non-financial support from Nobel Biocare (Zürich, Switzerland) outside the submitted work. Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare (Zürich, Switzerland), personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To develop a new post-processing strategy that utilizes an auxiliary device to adjust intraoral scans and improve the accuracy of 3D models of complete-arch dental implants., Materials and Methods: An edentulous resin model with 6 dental implants was prepared. An auxiliary device, consisting of an opaque base and artificial landmarks, was fabricated and mounted onto the resin model. Twenty intraoral scans (raw scans) were taken using this setup. A new post-processing strategy was proposed to adjust the raw scans using reverse engineering software (verified group). Additionally, ten conventional gypsum casts were duplicated and digitized using a laboratory scanner. The linear and angular trueness and precision of the models were evaluated and compared. The effect of the proposed strategy on the accuracy of complete-arch intraoral scans was analyzed using one-way ANOVA., Results: The linear trueness (29.7 µm) and precision (24.8 µm) of the verified group were significantly better than the raw scans (46.6 µm, 44.7 µm) and conventional casts (51.3 µm, 36.5 µm), particularly in cross-arch sites. However, the angular trueness (0.114°) and precision (0.085°) of the conventional casts were significantly better than both the verified models (0.298°, 0.168°) and the raw scans (0.288°, 0.202°)., Conclusions: The novel post-processing strategy is effective in enhancing the linear accuracy of complete-arch implant IO scans, especially in cross-arch sites. However, further improvement is needed to eliminate the angular deviations., Clinical Significance: Errors generated from intraoral scanning in complete edentulous arches exceed the clinical threshold. The elimination of stitching errors in the raw scans particularly in the cross-arch sites, through the proposed post-processing strategy would enhance the accuracy of complete-arch implant prostheses., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: This study evaluated the effects of 3D-printing build orientation on accuracy, flexural modulus (FM), flexural strength (FS), and microhardness of selected, commercial 3D-printed provisional resins (3DRs)., Material and Methods: PMMA CAD/CAM provisional material (Vita Temp/Vita) served as Control. Four 3DRs (Cosmos-SLA/Yller, Cosmos-DLP/Yller, PriZma-Bioprov/Makertech, Nanolab/Wilcos) were used in three printing orientations (0°, 45°, and 90°). Printed samples were cleaned with isopropyl alcohol prior to post-curing in specific post-curing units. For each group, 20 bar-shaped samples (25 × 2x2 mm) and ten disc-shaped samples (15-mm diameter, 2.5-mm thick) were obtained. The dimensions of bar samples were measured and the mean percent errors were compared to the reference (digital) values to obtain "accuracy" (n = 20). Samples were then aged in distilled water at 37 °C and half were submitted to a three-point bend test in a universal testing machine after 24 h and the other half after 1 year (n = 10). Disc samples were polished prior to microhardness evaluation (n = 10). Microstructure and elemental composition of filler particles in the 3DRs were analyzed using scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS) (n = 3). Accuracy and microhardness were submitted to two way-, and FM and FS to three way-ANOVA, followed by Tukey's tests. Results of experimental groups were compared to a milled PMMA Control using Dunnett's tests, and Student's t-tests compared FM and FS to Control at different aging periods (α = 0.05)., Results: Except for Cosmos-DLP, the 90° orientation demonstrated the best overall accuracy in all dimensions evaluated. The overall accuracy of Cosmos-SLA was not significantly different from Control and higher than other 3DRs. The FM of all 3DRs was lower than Control, regardless of orientation and aging period. After 1 year of aging, FS of 45°-Cosmos-SLA and all orientations of PriZma were not different from Control, while 90°-Cosmos-SLA was higher. Build orientation had no influence on microhardness of the 3DRs: Nanolab was the only resin harder than Control. Very few nanometric spherical filler particles were found in Cosmos-SLA, Cosmos-DLP, and PriZma, while Nanolab presented higher number of particles having irregular shapes and sizes., Conclusions: In general, although build orientation did not influence microhardness results, the 90° -orientation resulted in the best overall accuracy for most 3DRs. After 1-year water storage, Cosmos-SLA printed vertically showed the highest FS, while the PMMA Control obtained the highest FM for both aging periods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The development of ultra-high-resolution CT (U-HRCT) is expected to improve the accuracy of coronary stenosis evaluation. This study aimed to evaluate the accuracy of the stenosis severities of coronary artery phantoms estimated using U-HRCT by comparing them to those estimated with conventional CT., Methods: Coronary artery phantoms with non-calcified and calcified lesions were scanned with conventional CT (64-row ​× ​0.625 ​mm) and U-HRCT (32-row ​× ​0.3125 ​mm). The coronary artery phantoms had lumen diameters of 2.0, 3.0, and 4.0 ​mm with non-calcified lesions representing 0%, 25%, 50%, and 75% stenosis and 3.0 and 4.0 ​mm with calcified lesions representing 0%, 25%, 50%, and 75% stenosis. The lumen diameters at the stenotic and non-stenotic regions were measured, and the stenosis severities were compared with the true values., Results: For non-calcified lesions, conventional CT significantly underestimated the stenosis severity in the phantom showing 75% stenosis with lumen diameters of 2.0 and 3.0 ​mm (p ​< ​0.05), while the estimated stenosis severities were not significantly different from the true values at all settings with U-HRCT. For the calcified lesions, conventional CT overestimated the stenosis severities at all settings (p ​< ​0.05), while U-HRCT yielded estimations closer to the true values, although still with some overestimation (p ​< ​0.05)., Conclusion: By using U-HRCT, the estimated stenosis severities of the coronary artery with non-calcified lesion become almost equal to the true value, while those with calcified lesion are still overestimated although they become closer to the true value., Competing Interests: Declaration of competing interest Sachio Kuribayashi received a grant from General Electric Healthcare Japan. However, the funder was not involved in the design of the study; collection, analysis, and interpretation of the data; or writing of the manuscript. All other authors have no conflict of interest to declare., (Copyright © 2021. Published by Elsevier Inc.)

With the development of three-dimensional (3D) scanning and measurement technologies, the internal adaptation of restorations was measured by the 3D analysis method. The purpose of this study was to explore a novel 3D digital evaluation method to assess the intraoral fitness of removable partial dentures (RPDs) and evaluate the accuracy of this novel digital method in vitro. A 3D digital method to evaluate the clinical fitness of RPD was introduced. A standard stone cast of a partially edentulous mandible simulating the oral tissues and a corresponding RPD were used to evaluate the accuracy of this novel digital method (3D analysis on duplicated polyether cast) and another reported 3D digital evaluation method (3D analysis on RPD directly) for intraoral fitness of RPD in vitro. 12 polyvinyl siloxane (PVS) replica specimens were fabricated in each method in vitro, and the thicknesses of these PVS replicas were measured by 3D analysis on duplicated polyether cast (named Polyether group), 3D analysis on RPD directly (named Denture group), and 3D analysis on the stone cast (named Stone group), respectively. The thicknesses of PVS replicas were compared with analyses of variance (ANOVA) to evaluate the accuracy of these methods (α = 0.05). The accuracy based on the mean thickness of the PVS replicas of Polyether group were better than that of Denture group (P < 0.05) and had no statistical difference with that of Stone group (P > 0.05). 3D analysis on duplicated polyether cast has comparable trueness and precision to 3D analysis on the stone cast and is feasible for evaluating clinical fitness of RPD., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The aim of this in-vitro study was to compare the virtual techniques for registering single-implant position to the physical gold standard using a universal-coordinate system., Materials and Methods: Thirty dentate maxillary resin models with a dental implant inserted in the incisor region were prepared. On each model, a tooth-supported acrylic stent with a 1 cm x 1 cm x 1 cm cubic-corner (CC) was prepared. The Cartesian x,y,z-coordinate of the implant neck and apex were measured physically by a coordinate-measuring machine (CMM) with reference to this CC and served as the gold-standard. The resin models were scanned by a benchtop scanner (Group BS), cone-beam computed tomography (Group CBCT), and intraoral scanner (Group IOS). Stone casts, poured from open-tray polyether impression of the resin models, were scanned by the benchtop scanner (Group BS-cast). The implant neck and apex coordinates with reference to the CC were measured and the differences in the coordinates (∆x, ∆y, ∆z) and distance r from the gold standard were calculated. The data were analyzed by one-sample t-test and one-way ANOVA/Kruskal-Wallis test with the level of significance set at 0.05., Results: The implant neck and apex positions of Group BS were statistically different from that of the CMM, r>0 (p<0.001). Group IOS showed a significant less ∆z and r at the implant neck than Group BS-cast (p = 0.006). No significant difference was found in the coordinates and distance at implant apex among Groups BS, CBCT, IOS and BS-cast., Conclusions: The physical measurements could be adopted as the gold standard in assessing the single-implant positions. The IOS was more accurate in registering the single-implant neck positions than scanning of the cast., Clinical Significance: A universal-coordinate system defined by the cubic-corner allows comparing the virtual techniques in registering single-implant positions to the physical gold standard., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: There is an urgent need for population-based studies on managing patients with pulmonary nodules., Research Question: Is it possible to identify pulmonary nodules and associated characteristics using an automated method?, Study Design and Methods: We revised and refined an existing natural language processing (NLP) algorithm to identify radiology transcripts with pulmonary nodules and greatly expanded its functionality to identify the characteristics of the largest nodule, when present, including size, lobe, laterality, attenuation, calcification, and edge. We compared NLP results with a reference standard of manual transcript review in a random test sample of 200 radiology transcripts. We applied the final automated method to a larger cohort of patients who underwent chest CT scan in an integrated health care system from 2006 to 2016, and described their demographic and clinical characteristics., Results: In the test sample, the NLP algorithm had very high sensitivity (98.6%; 95% CI, 95.0%-99.8%) and specificity (100%; 95% CI, 93.9%-100%) for identifying pulmonary nodules. For attenuation, edge, and calcification, the NLP algorithm achieved similar accuracies, and it correctly identified the diameter of the largest nodule in 135 of 141 cases (95.7%; 95% CI, 91.0%-98.4%). In the larger cohort, the NLP found 217,771 reports with nodules among 717,304 chest CT reports (30.4%). From 2006 to 2016, the number of reports with nodules increased by 150%, and the mean size of the largest nodule gradually decreased from 11 to 8.9 mm. Radiologists documented the laterality and lobe (90%-95%) more often than the attenuation, calcification, and edge characteristics (11%-14%)., Interpretation: The NLP algorithm identified pulmonary nodules and associated characteristics with high accuracy. In our community practice settings, the documentation of nodule characteristics is incomplete. Our results call for better documentation of nodule findings. The NLP algorithm can be used in population-based studies to identify pulmonary nodules, avoiding labor-intensive chart review., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objectives: The present review systematically analyzed the accuracy of three-dimensional (3D) maxillofacial skeletal models generated from desktop and professional 3D printers., Data/sources: Electronic literature search was conducted in the following databases: PubMed, Embase, Web of Science and Cochrane Library up to September 2020. Two reviewers independently performed the study selection, data extraction and quality assessment of the included studies. Risk of bias was assessed using the Joanna Briggs Critical Appraisal Checklist for Diagnostic Test Accuracy., Study Selection/results: The search strategy retrieved 5680 articles. Following removal of duplicates, title and abstract screening and full-text reading, 20 publications were eligible to be included in the review which focused towards the accuracy of skeletal models generated from either desktop or professional printer. Both types of printers were defined based on their cost, size and layer thickness, where desktop printers cost between $1500-$7000, have a build size of 10×10×10 inches or less and a minimum layer thickness of 100 µm. Whereas, the professional printers cost was between $20,000- $200,000 with a build size of 12×12×12 inches or more and a layer thickness of as less as 3 µm. The risk of bias was found to be low to moderate. Meta-analysis results indicated no significant absolute mean difference (AMD) (p = 0.9487) between desktop (0.12 mm, 95% CI: 0.00-0.27 mm) and professional printers (0.10 mm, 95% CI: 0.04-0.16 mm). Amongst the printing technology, material jetting (0.09 mm, 95% CI: 0.00-0.17 mm) and selective laser sintering (0.09 mm, 95% CI: 0.00-0.26 mm) offered the lowest AMD and the highest difference was observed with the fused deposition modeling (0.22 mm, 95% CI: 0.00-0.53 mm)., Conclusions: The maxillofacial skeletal models generated from desktop printers offered comparable accuracy to that acquired with professional printers., Clinical Significance: The desktop 3D printers may be a viable option to print maxillofacial skeletal models for surgical planning, simulation, guide manufacturing and education purposes., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: To compare the geometric accuracy and measurement reliability of 3-dimensional (3D) reconstructed models of the mandible created from cone beam computed tomography (CBCT) images obtained with 0.2-mm and 0.4-mm voxel sizes with the reference standard model and compare the accuracy of the CBCT-based models to each other., Study Design: The reference standard 3D model of a dry human mandible was obtained using a white light scanner. The mandible was scanned with CBCT 10 times at each voxel size. The models created from the CBCT data were compared with the reference standard by using a point-based rigid registration algorithm where the distance differences between the superimposed CBCT models and the reference standard model were recorded. The measurements derived from the 2 CBCT-based scans were also compared., Results: Mean deviations from the reference standard for 0.2-mm and 0.4-mm voxel scans were 0.4342 mm and 0.4580 mm, respectively (P ≥ .16). The CBCT scans with both 0.2-mm and 0.4-mm voxels produced good measurement reliability and did not significantly differ from each other (P ≥ .20)., Conclusions: CBCT scans with 0.2-mm and 0.4-mm voxel sizes delivered similarly accurate models. Larger voxels can be used to minimize radiation exposure., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of <10 and >15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD) in the absence of other clinical signs. Herein, we aimed to validate these criteria in a real-world multicentre study., Methods: We included 5,648 patients (mean age 51 ± 13 years, 53% males) from 10 European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (n = 2,913, 52%), non-alcoholic fatty liver disease (NAFLD, n = 1,073, 19%), alcohol-related liver disease (ALD, n = 946, 17%) or chronic hepatitis B (n = 716, 13%). cACLD was defined as fibrosis stage ≥F3., Results: Overall, 3,606 (66%) and 987 (18%) patients had LS <10 and >15 kPa, respectively, while cACLD was histologically confirmed in 1,772 (31%) patients. The cut-offs of <10 and >15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at <7 and >12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC 0.87; 95% CI 0.86-0.88; p <0.001) was derived. Specifically, for ALD and NAFLD, a low cut-off of 8 kPa can be used (sensitivity=93%). For the unclassified patients, we derived a risk model based on common patient characteristics with better discrimination than LS alone (AUC 0.74 vs. 0.69; p <0.001)., Conclusions: Instead of the Baveno VI proposed <10 and >15 kPa dual cut-offs, we found that the <8 kPa (or <7 kPa for viral hepatitis) and >12 kPa dual cut-offs have better diagnostic accuracy in cACLD., Lay Summary: The term compensated advanced chronic liver disease (cACLD) was introduced in 2015 to describe the spectrum of advanced fibrosis and cirrhosis in asymptomatic patients. It was also suggested that cACLD could be diagnosed or ruled out based on specific liver stiffness values, which can be non-invasively measured by transient elastography. Herein, we assessed the suggested cut-off values and identified alternative values that offered better overall accuracy for diagnosing or ruling out cACLD., Competing Interests: Conflicts of interest Victor de Ledinghen reports consultancy for Echosens and SuperSonic Imagine. All other authors have nothing to disclose. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background & Aims: Wedge hepatic vein pressure (WHVP) accurately estimates portal pressure (PP) in alcohol- or viral hepatitis-related cirrhosis. Whether this also holds true in cirrhosis caused by non-alcoholic steatohepatitis (NASH) is unknown. We aimed to evaluate the agreement between WHVP and PP in patients with NASH cirrhosis in comparison to patients with alcohol- or HCV-related cirrhosis., Methods: All consecutive patients with NASH cirrhosis treated with a transjugular intrahepatic portosystemic shunt (TIPS) in 3 European centres were included (NASH group; n = 40) and matched with 2 controls (1 with alcohol-related and 1 with HCV-related cirrhosis) treated with TIPS contemporaneously (control group; n = 80). Agreement was assessed by Pearson's correlation (R), intra-class correlation coefficient (ICC), and Bland-Altman method. Disagreement between WHVP and PP occurred when both pressures differed by >10% of PP value. A binary logistic regression analysis was performed to identify factors associated with this disagreement., Results: Correlation between WHVP and PP was excellent in the control group (R 0.92; p <0.001; ICC 0.96; p <0.001) and moderate in the NASH group (R 0.61; p <0.001; ICC 0.74; p <0.001). Disagreement between WHVP and PP was more frequent in the NASH group (37.5% vs. 14%; p = 0.003) and was mainly because of PP underestimation. In uni- and multivariate analyses, only NASH aetiology was associated with disagreement between WHVP and PP (odds ratio 4.03; 95% CI 1.60-10.15; p = 0.003)., Conclusions: In patients with decompensated NASH cirrhosis, WHVP does not estimate PP as accurately as in patients with alcohol- or HCV-related cirrhosis, mainly because of PP underestimation. Further studies aimed to assess this agreement in patients with compensated NASH cirrhosis are needed., Lay Summary: Portal pressure is usually assessed by measuring wedge hepatic vein pressure because of solid evidence demonstrating their excellent agreement in alcohol- and viral hepatitis-related cirrhosis. Our results show that in patients with decompensated cirrhosis caused by non-alcoholic steatohepatitis, wedge hepatic vein pressure estimates portal pressure with less accuracy than in patients with other aetiologies of cirrhosis, mainly because of portal pressure underestimation., Competing Interests: Conflict of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background: Strong evidence exists for clinically relevant night-to-night variability of respiratory events in patients with suspected OSA., Research Question: How many sleep study nights are required to diagnose OSA accurately?, Study Design and Methods: Patients with suspected OSA underwent up to 14 nights of pulse oximetry (PO) at home and one night of in-hospital respiratory polygraphy (RP). The accuracy of each of the 13 sleep study nights was analyzed using the mean oxygen desaturation index 3% (ODI 3% ) of all 14 nights as a reference. Multiple regression analyses assessed possible predictors for night-to-night variability., Results: One hundred three patients underwent in-hospital RP. Using only the results of the RP, 19.7% were misdiagnosed using an ODI 3% cutoff of 15/h. One hundred eight patients underwent properly performed PO studies at home with a coefficient of variation (CV) of 31.5% (SD, 14.7%) across all nights. The first PO night demonstrated a sensitivity of 71.4% (95% CI, 55.4%-84.3%) and a specificity of 89.4% (95% CI, 79.4%-95.6%) to diagnose moderate OSA. Using only the first PO night, the negative predictive value was 83.1%. Adding a second recording night increased sensitivity up to 88.1% (95% CI, 74.4%-96.0%) with a slightly lower specificity of 85.9% (95% CI, 74.9%-93.4%). The ODI 3% of the in-hospital RP showed an independent negative association to the log-transformed CV (exponentiated coefficient, 0.989; 95% CI, 0.984-0.995)., Interpretation: One single night of in-hospital RP may miss relevant OSA. Multiple study nights, for example, using ambulatory oxygen saturation monitoring, increase accuracy for diagnosing moderate OSA., Trial Registry: ClinicalTrials.gov; No.: NCT03819361; URL: www.clinicaltrials.gov., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Reference values for cardiac magnetic resonance imaging (cMRI) in children and young adults are scarce. This leads to risk stratification of patients with congenital heart diseases being based on volumes indexed to body surface area (BSA). We aimed to produce cMRI Z score equations for ventricular volumes in children and young adults and to test whether indexing to BSA resulted in an incorrect assessment of ventricular dilation according to sex, body composition, and growth., Methods: We retrospectively included 372 subjects aged < 26 years with either normal hearts or conditions with no impact on ventricular volumes (reference group), and 205 subjects with repaired tetralogy of Fallot (TOF) aged < 26 years. We generated Z score equations by means of multivariable regression modelling. Right ventricular dilation was assessed with the use of Z scores and compared with indexing to BSA in TOF subjects., Results: Ventricular volume Z scores were independent from age, sex, and anthropometric measurements, although volumes indexed to BSA showed significant residual association with sex and body size. In TOF subjects, indexing overestimated dilation in growing children and underestimated dilation in female compared with male subjects, and in overweight compared with lean subjects., Conclusions: Indexed ventricular volumes measured with cMRI did not completely adjust for body size and resulted in a differential error in the assessment of ventricular dilation according to sex and body size. Our proposed Z score equations solved this problem. Future studies should evaluate if ventricular volumes expressed as Z scores have a better prognostic value than volumes indexed to BSA., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Introduction: The quantitative assessment of facial appearance and function is critical in the process of restoring normality and thus minimising morbidity in patients with facial deformities. Three-dimensional (3D) scanners have increasingly been applied in clinical settings to circumvent the issues associated with standard approaches, namely, subjectivity. This study aimed to summarise the current literature on the accuracy, reliability, and usability of 3D scanning technologies for soft-tissue facial assessment., Methodology: Medline, EMBASE, and Web of Science were searched for studies assessing the accuracy, reliability, and/or clinical usability of 3D scanners in assessing facial morphology. All results were filtered by title, abstract, and finally by full text for relevance., Results: Eight hundred and thirty-seven results were filtered down to 41 articles that were included in this review. Articles were categorised depending on the 3D visualising principle of the scanner being tested: laser-based scanning, stereophotogrammetry, structured-light scanning, or RGB-D (red, green, blue-depth) sensors., Discussion: Of the traditional 3D scanners evaluated in the literature, stereophotogrammetric systems most consistently demonstrate excellent accuracy and reliability in the collection of 3D facial scans. Due to their cost, size, and complexity, these systems are often unsuitable for incorporation into clinical environments with limited availability of resources, space, and time. Recently developed RGB-D sensors can collect accurate static and dynamic 3D facial scans without many of these disadvantages. Still, further improvements in their technical specifications and a greater focus on the development of automated facial assessment software is needed before RGB-D sensors can be universally accepted as a new gold-standard for soft-tissue facial assessment., Competing Interests: Declaration of Competing Interest N/A, (Copyright © 2020. Published by Elsevier Ltd.)

Background: Open spina bifida is a major congenital anomaly with an estimated incidence of <1 in 1000. The diagnosis of open spina bifida is usually made during the second trimester, but first-trimester detection rate of spina bifida is increasingly reported. Recently, the mean choroid plexus length to occipitofrontal diameter ratio was reported to be increased in fetuses with open spina bifida. The ratio reflects the so-called dry brain effect caused by cerebrospinal fluid leakage and expansion of the choroid plexus into the lateral ventricles. The mean choroid plexus length to occipitofrontal diameter ratio appears to be a promising tool for early detection of open spina bifida, but its diagnostic accuracy is yet to be determined in a large cohort., Objective: This study aimed to assess the predictive accuracy of mean choroid plexus length to occipitofrontal diameter ratio recorded at 11 to 13 weeks' gestation for the detection of open spina bifida., Study Design: This was a retrospective cohort of patients treated in a tertiary referral center. Fetuses in which open spina bifida was detected at 16 to 24 weeks' gestation and normal fetuses were included in the cohort. Biparietal diameter and occipitofrontal diameter were measured in an axial view. The length of choroid plexus was measured along its longest diameter in the same plane. Ultrasound images were examined offline, and the operator was blinded to the clinical diagnosis. The predictive accuracy was evaluated using the area under the curve and positive and negative predictive values., Results: We included 3300 pregnant women, of whom 24 (0.73%) had the fetuses affected by open spina bifida. The area under the curve values were 0.921 for mean choroid plexus length to occipitofrontal diameter ratio and 0.933 for its multiple of the median. Mean choroid plexus length to biparietal diameter ratio indicated similar results, with area under the curve values of 0.928 and 0.931 for raw ratio and multiple of the median ratio models, respectively. The optimal cutoffs of the mean choroid plexus to occipitofrontal diameter ratio and multiple of the median ratios were 0.662 and 1.263, respectively. The optimal mean choroid plexus to occipitofrontal diameter ratio and multiple of the median ratio cutoffs provided a positive predictive value of 90.9% and a negative predictive value of 99.6%. The number of affected spinal segments was significantly higher in fetuses with a ratio above 0.662 (P=.022)., Conclusion: The mean choroid plexus length to occipitofrontal diameter ratio at 11 to 13 weeks' gestation is a promising tool for the prenatal detection of open spina bifida., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: The objective of the study is to determine the impact of changing reference standards (RS), namely spirometry vs. whole-body plethysmography (WBP), on estimation of the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) and clinical signs and symptoms (CSS) as index tests regarding asthma diagnosis., Study Design and Setting: This was a diagnostic study conducted in 393 patients attending a private practice of pneumologists with complaints suspicious of asthma. First, the index tests were compared with the diagnostic results of spirometry in terms of forced expiratory volume in the first second (FEV 1 ) responsiveness. Second, the index tests were compared with the results of WBP in terms of specific airway resistance and FEV 1 responsiveness. Areas under the curve (AUC) were compared with a generalized estimating equation approach based on binary logistic regression., Results: FeNO values and CSS 'wheezing' and 'allergic rhinitis' showed higher specificities (P < 0.001) and sensitivities (not significant) when evaluated with WBP; also, Youden indices increased in these CSS (P < 0.05). AUC of FeNO in combination with 'wheezing' and 'allergic rhinitis' when WBP was used as RS (AUC = 0.724; 95% confidence interval 0.672 to 0.776) was higher compared with spirometry as RS (AUC = 0.654; 95% confidence interval 0.585 to 0.722) (P < 0.001)., Conclusion: In case of asthma, superior RS led to more favorable assessment of index tests. FeNO measurement might have been underestimated in some previous studies., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Surgical assistance applications for smartphones have the potential to be used in daily practice; however, regular reviews of these tools are required. StereoCheck (Mevis, São Paulo, São Paulo, Brazil) is a mobile application (app) designed to compute stereotactic coordinates as a checking tool. The present study evaluated the accuracy and reliability of the StereoCheck app., Methods: The present observational and prospective study included 26 patients who had undergone frame-based stereotactic brain biopsy. A standard stereotactic planning software (Framelink, version 5.0 [Medtronic, Minneapolis, Minnesota, USA]) was used to define the target coordinates. The surgical planning images were transferred to StereoCheck using 2 image input methods: photographs of the screen monitor and digitally exported images of the screen monitor. Five examiners performed the target coordinate definitions using StereoCheck on 2 occasions. The accuracy and reliability of the app were evaluated in tests that compared the planning methods (app vs. standard software), multiple examiners, and sequential tests., Results: The StereoCheck accuracy using photographs of the screen was 2.71 ± 0.86 mm (95% confidence interval, 2.37-3.06). Using the digitally exported images, it was 0.82 ± 0.61 mm (95% confidence interval, 0.58-1.07). The accuracy between the 2 methods was greater using the exported images (P < 0.01) and was not affected by the clinical and radiological features. The accuracy of StereoCheck among multiple examiners and in sequential tests showed a mean distance between the targets and coordinates of <1.00 mm. Thus, an excellent level of reliability for the StereoCheck coordinates (intraclass correlation coefficient ≥0.8) was verified in all contexts., Conclusion: StereoCheck showed satisfactory accuracy and reliability. The use of photographs to compute the coordinates could lead to a significant decrease in the accuracy of the app., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Evaluation of segmented colon is one of the challenges in Computed Tomography Colonography (CTC). The objective of the study was to measure the segmented colon accurately using image processing techniques., Methods: This was a retrospective study, and the Institutional Ethical clearance was obtained for the secondary dataset. The technique was tested on 85 CTC dataset. The CTC dataset of 100-120 kVp, 100 mA, and ST (Slice Thickness) of 1.25 and 2.5 mm were used for empirical testing. The initial results of the work appear in the conference proceedings. Post colon segmentation, three distance measurement techniques, and one volumetric overlap computation were applied in Euclidian space in which the distances were measured on MPR views of the segmented and unsegmented colons and the volumetric overlap calculation between these two volumes., Results: The key finding was that the measurements on both the segmented and the unsegmented volumes remain same without much difference noticed. This was statistically proved. The results were validated quantitatively on 2D MPR images. An accuracy of 95.265±0.4551% was achieved through volumetric overlap computation. Through pairedt-test, at α=5%, statistical values were p=0.6769, and t=0.4169 which infer that there was no much significant difference., Conclusion: The combination of different validation techniques was applied to check the robustness of colon segmentation method, and good results were achieved with this approach. Through quantitative validation, the results were accepted at α=5%., (Copyright © 2019 Chang Gung University. Published by Elsevier B.V. All rights reserved.)

Background: Catheter navigation and 3-dimensional (3D) cardiac mapping are essential components of minimally invasive electrophysiological procedures., Objective: The purpose of this study was to develop a novel 3D mapping system (KODEX - EPD, EPD Solutions, Best, The Netherlands) that measures changing electric field gradients induced on intracardiac electrodes to enable catheter localization and real-time 3D cardiac mapping., Methods: We first validated the accuracy of the system's measurement and localization capabilities by comparing known and KODEX - EPD-measured distances and locations at 12 anatomical landmarks in both the atria and ventricles of 4 swine. Next, in vivo images of 3D porcine cardiac anatomy generated by KODEX - EPD and widely used CARTO 3 system (Biosense Webster, Inc., Diamond Bar, CA) were compared with gold standard computed tomography images acquired from the same animals. Finally, 3D maps of atrial anatomy were created for 22 patients with paroxysmal atrial fibrillation (Dielectric Unravelling of Radiofrequency ABLation Effectiveness trial)., Results: First, the mean error between known and measured distances was 1.08 ± 0.11 mm (P < .01) and the overall standard deviation between known and measured locations in 12 areas of the porcine heart was 0.35 mm (P < .01). Second, an expert comparison of 3D image quality revealed that KODEX - EPD is noninferior to CARTO 3. Third, the system enabled 3D imaging of atrial anatomy in humans, provided real-time images of atrioventricular valves, and detected important anatomical variations in a subset of patients., Conclusion: The KODEX - EPD system is a novel 3D mapping system that accurately detects catheter location and can generate high-resolution images without the need for preacquired imaging, specialty catheters, or a point-by-point mapping procedure., (Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Objective: Atherosclerosis and its thrombotic complications are major causes of morbidity and mortality worldwide. Plaque stability assessment is considered to be important for both clinical and fundamental applications. The current gold standard method to investigate plaque stability is performed by histological assessment of plaque features using semi-quantitative classifications. However, these assessments can be limited by subjectivity and variability. Thus, the aim was to develop a new digital image analysis method to measure quantitatively individual plaque features that is more precise than existing semi-quantitative methods., Methods: A quantitative method was developed using Image Pro Primer software. Carotid plaque specimens were obtained from patients who underwent carotid endarterectomy and categorised according to stability (definitely stable, probably stable, probably unstable, definitely unstable) based on the gold standard semi-quantitative method that assesses 10 histological plaque features. Using the new quantitative method, plaque features (n = 15) from each stability grade were then analysed by two independent raters. For the semi-quantitative analysis, quadratic weighted Cohen's kappa was used to test intra- and inter-rater reliability, while for the quantitative analysis, intraclass correlation coefficients (ICCs) were assessed., Results: Intra-rater reliability demonstrated almost perfect agreement between both methods (Cohen's kappa range 0.831-0.969, ICC range 0.848-1.000). However, inter-rater reliability demonstrated mainly fair to moderate agreement (Cohen's kappa range 0.341-0.778) for the semi-quantitative analysis, while the digital image analysis method performed most optimally regarding reproducibility, yielding high ICCs close to 1 (ICC range 0.816-0.999). Using quantitative measurements, a statistically significant proportion of the individual plaque features (p < .05) were re-classified from one grade to another (shift by one) under the semi-quantitative classification., Conclusion: A new quantitative digital image analysis was developed for the accurate assessment of histological plaque features, which demonstrated higher precision than the gold standard semi-quantitative methods, as measured by between and within rater analysis. Moreover, quantitative image analysis of histological plaque features provided more detailed insight into plaque morphology and composition., (Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Background: In pulmonary arterial hypertension (PAH), right ventricular (RV) failure is the main cause of mortality. Non-invasive estimation of ventricular-vascular coupling ratio (VVCR), describing contractile response to afterload, could be a valuable tool for monitoring clinical course in children with PAH. This study aimed to test two hypotheses: VVCR by cardiac magnetic resonance (VVCR CMR ) correlates with conventional VVCR by right heart catheterization (VVCR RHC ) and both correlate with disease severity., Methods and Results: Twenty-seven patients diagnosed with idiopathic and associated PAH without post-tricuspid shunt, who underwent RHC and CMR within 17 days at two specialized centers for pediatric PAH were retrospectively studied. Clinical functional status and hemodynamic data were collected. Median age at time of MRI was 14.3 years (IQR: 11.1-16.8), median PVRi 7.6 WU × m 2 (IQR: 4.1-12.2), median mPAP 40 mm Hg (IQR: 28-55) and median WHO-FC 2 (IQR: 2-3). VVCR CMR, defined as stroke volume/end-systolic volume ratio was compared to VVCR RHC by single-beat pressure method using correlation and Bland-Altman plots. VVCR CMR and VVCR RHC showed a strong correlation (r = 0.83, p < 0.001). VVCR CMR and VVCR RHC both correlated with clinical measures of disease severity (pulmonary vascular resistance index [PVRi], mean pulmonary artery pressure [mPAP], mean right atrial pressure [mRAP], and World Health Organization functional class [WHO-FC]; all p ≤ 0.02)., Conclusions: Non-invasively measured VVCR CMR is feasible in pediatric PAH and comparable to invasively assessed VVCR RHC . Both correlate with functional and hemodynamic measures of disease severity. The role of VVCR assessed by CMR and RHC in clinical decision-making and follow-up in pediatric PAH warrants further clinical investigation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: This study aimed to compare the diagnostic accuracy of stress myocardial perfusion imaging between cardiac magnetic resonance (CMR) and nuclear medical imaging, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET), for the diagnosis of hemodynamically significant coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard., Methods and Results: We searched PubMed and Embase for all published studies that evaluated the diagnostic accuracy of stress myocardial perfusion imaging modalities, including CMR, SPECT, and PET, to diagnose hemodynamically significant CAD with FFR as the reference standard. A total of 28 articles met the inclusion criteria and were included in the meta-analysis: 14 CMR, 13 SPECT, and 5 PET articles. The results demonstrated a pooled sensitivity of 0.88 (95% confidence interval [CI]: 0.80-0.93), 0.69 (95% CI: 0.56-0.79), and 0.83 (95% CI: 0.70-0.91), and a pooled specificity of 0.89 (95% CI: 0.85-0.93), 0.85 (95% CI, 0.80-0.89), and 0.89 (95% CI, 0.86-0.91) for CMR, SPECT, and PET, respectively. The area under the curve (AUC) of CMR, PET, and SPECT was 0.94 (95% CI, 0.92-0.96), 0.92 (95% CI, 0.89-0.94), and 0.87 (95% CI, 0.83-0.89), respectively., Conclusions: CMR and PET both have high accuracy and SPECT has moderate accuracy to detect hemodynamically significant CAD with FFR as the reference standard. Furthermore, the diagnostic accuracy of CMR at 3.0 T is superior to 1.5 T., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the feasibility of iterative closest point (ICP) algorithm for assessing the accuracy between virtual surgical planning (VSP) and outcomes in orthognathic surgery., Materials and Methods: VSP and results of surface mesh (SM0 and SM1) from CBCT scans of 25 patients who had been undergone bi-maxillary orthognathic surgery were converted into STL-format files and then imported to Geomagic software for semi-automatic alignment. ICP algorithm was used to calculate mean deviations (MD) and root mean square (3D error) at different calibrations of ±2 mm (T1), ±5 mm (T2) and ±10 mm (T3), with workflow being performed by two evaluators. Colour maps were generated to assess the 3D congruence qualitatively. Linear regression analysis was used to estimate whether SM0 or SM1 could condition the ICP and t-tests were used to assess whether MD and 3D error values were ≤-2 mm and ≥2 mm. Descriptive statistics was used to assess the method's feasibility by comparing T2 to T1 and T3., Results: High intra- and inter-rater correlations supported the workflow reproducibility with the software. SM0 conditioned the ICP algorithm regarding both evaluators, and t-tests demonstrated that MD and 3D error were >-2 mm and <2 mm. MD and 3D error at T3 were 30% higher than those at T1., Conclusions: ICP algorithm provided a reproducible method, but its feasibility was limited due to underestimation or overestimation of the results as they affect the validity of the actual deviations., (Copyright © 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

In forensic intelligence-gathering it would be useful to evaluate if there are differences between static inked bare footprints captured on hard surfaces compared to soft surfaces. This was undertaken using samples from 30 undergraduate students. Initially a static footprint was taken for each participant on a hard surface and this was followed by a static footprint on a soft surface. On both occasions, the participants stood on an inkless mat and then on reactive paper, creating a two-dimensional print. The Reel method was used to analyse each footprint and the print was measured to see whether a difference existed between length and width (forefoot and rearfoot width) on a hard surface compared to a soft surface. The conclusion from this study was there is a statistically significant increase in length and width of a static bare footprint on a soft surface as opposed to a hard surface. If a forensic footprint examiner compares static bare footprints found on a soft surface and compares them to a static bare footprint of the same foot taken later, then the increase in both length and width of the footprints on a soft surface should be considered in the evaluation., (Copyright © 2019 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

In forensic intelligence-gathering it would be useful to be able to estimate the size of a perpetrator's foot from a standing bare footprint found at the scene of crime. Currently, the advice is to add a fixed amount to the length of the footprint (typically 1.5 or 2.0 cm), but there is little evidence for this approach. This study used measured footprint and actual foot lengths from 146 participants from the white British student population of a University in the UK. Data were analysed using multiple regression with foot length as the dependent (outcome) variable and footprint length and sex as the independent variable/factor respectively. Sex was not a significant predictor. The regression equation for the best estimate of the foot length is 19.89 + 0.95 × print length ± 8 mm., (Copyright © 2019 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

Background: The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI-TCL challenging., Objective: The purpose of this study was to investigate a novel maneuver to confirm the PPI-TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias., Methods: We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI-TCL, the AH-corrected PPI-TCL, and estimated the PPI-TCL using "dual-chamber entrainment" calculated as [PPI V - TCL = Stim(A→V) + Stim(V→A) - PPI A ]., Results: The PPI-TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI-TCL (R 2  = 0.79 and 0.96, respectively; P <.001]. A dual-chamber entrainment PPI-TCL value of 80 ms correctly differentiated all AVNRT from septal ORT cases, whereas the standard PPI-TCL and AH-corrected PPI-TCL methods were incorrect in 14% and 6% of cases, respectively. Dual-chamber entrainment identified 3 ± 10 ms of additional decremental conduction beyond AH prolongation, including 4 pathways with significant (>10 ms) decrement., Conclusion: Dual-chamber entrainment estimates the PPI-TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI-TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI-TCL value in challenging cases., (Copyright © 2018 Heart Rhythm Society. All rights reserved.)

Background: Critical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardiorespiratory failure in the ICU. Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. The goal of this study was to characterize the diagnostic accuracy of ccTEE., Methods: This study was a two-center, retrospective comparison between TEE studies performed and interpreted by intensivists and cardiology-led TEE or transthoracic echocardiography (TTE) performed and/or interpreted by cardiologists. The study period was December 2012 to December 2016 for all consecutive ICU patients who received an initial ccTEE and either a cardiology TEE or TTE within 72 h. Using the cardiology-conducted examination as the gold standard, we reported sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ccTEE., Results: Comparisons between ccTEE and cardiology TEE/TTE performed yielded 56 patients (five ccTEE vs cardiology TEE and 51 ccTEE vs cardiology TTE). The comparison between ccTEE and cardiology TEE showed 100% sensitivity, specificity, PPV, NPV, and accuracy for the primary diagnosis and other major findings. For the combined ccTEE and cardiology TEE/TTE comparison, there was a high sensitivity/specificity/PPV/NPV/accuracy for the primary diagnosis (90%-100% range), as well as other major diagnoses (88%-100% range)., Conclusions: This study showed that ccTEE has a high sensitivity, specificity, PPV, NPV, and accuracy compared with the gold standard cardiology TEE or TTEs in critically ill patients, when performed by advanced echocardiogram-trained/experienced intensivists., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Liver macrosteatosis (MS) is a major predictor of graft dysfunction after transplantation. However, frozen section techniques to quantify steatosis are often unavailable in the context of procurements, and the findings of preoperative imaging techniques correlate poorly with those of permanent sections, so that the surgeon is ultimately responsible for the decision. Our aim was to assess the accuracy of a non-invasive pocket-sized micro-spectrometer (PSM) for the real-time estimation of MS., Methods: We prospectively evaluated a commercial PSM by scanning the liver capsule. A double pathological quantification of MS was performed on permanent sections. Initial calibration (training cohort) was performed on 35 livers (MS ≤60%) and an algorithm was created to correlate the estimated (PSM) and known (pathological) MS values. A second assessment (validation cohort) was then performed on 154 grafts., Results: Our algorithm achieved a coefficient of determination R2 = 0.81. Its validation on the second cohort demonstrated a Lin's concordance coefficient of 0.78. Accuracy reached 0.91%, with reproducibility of 86.3%. The sensitivity, specificity, positive and negative predictive values for MS ≥30% were 66.7%, 100%, 100% and 98%, respectively. The PSM could predict the absence (<30%)/presence (≥30%) of MS with a kappa coefficient of 0.79. Neither graft weight nor height, donor body mass index nor the CT-scan liver-to-spleen attenuation ratio could accurately predict MS., Conclusion: We demonstrated that a PSM can reliably and reproducibly assess mild-to-moderate MS. Its low cost and the immediacy of results may offer considerable added-value decision support for surgeons. This tool could avoid the detrimental and prolonged ischaemia caused by the pathological examination of (potentially) marginal grafts. This device now needs to be assessed in the context of a large-scale multicentre study., Lay Summary: Macro-vacuolar liver steatosis is a major prognostic factor for outcomes after liver transplantation. However, it is often difficult for logistical reasons to get this estimation during procurement. Therefore, we developed an algorithm for a commercial, portable and affordable spectrometer to accurately estimate this content in a real-time fashion. This device could be of great interest for clinical decision-making to accept or discard a potential human liver graft., (Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Footprints may be present at crime scenes as physical evidence. This pilot study compares two-dimensional measurements of bare and sock-clad footprints to determine if significant differences or similarities exist. Dynamic footprints were collected from 30 males and 20 females between the ages of 20 and 61 years old (mean of 28.2 years) using the Identicator Inkless Shoe Print Model LE 25P system. A midgait protocol was employed for obtaining footprints. The fifth and sixth footprint of gait were collected for the right and left foot, respectively, in both sock-clad and barefoot trials. The footprint measurements between sock-clad and bare footprints were compared. The results did not indicate any significant difference (p > .05) between bare and sock-clad foot length measurements for right or left feet. Significant differences were seen for the width measurements between bare and sock-clad footprints. These findings have forensic implications, particularly in criminal cases where it is unclear if a footprint impression is from a sock-clad foot or a bare foot. This study shows that such a determination is generally not necessary when utilizing two-dimensional measurements for length comparison between a bare and sock-clad footprint. However, if width measurements are being evaluated, the distinction between bare and sock-clad footprints should be considered., (Copyright © 2018 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

Introduction: This study evaluated the accuracy of 3 electronic apex locators (EALs) (CanalPro [Coltene-Endo, Cuyahoga Falls, OH], Apex ID [SybronEndo, Glendora, CA], and Root ZX Mini [J Morita, Tokyo, Japan]) in curved mesial canals of extracted mandibular molars using micro-computed tomographic (micro-CT) scanning., Methods: The root canal length and the actual working length of 58 canals were measured using the visual method and 3-dimensional micro-CT reconstructions. The measurements of the EALs at marks "APEX/0.0" and "0.5 mark" were recorded as the electronic root canal length and the electronic working length, respectively. The absolute mean values and the percentages of distribution of the electronic measurements were compared with the actual lengths of the canals. The presence of isthmuses, accessory canals, foramen position, and the distance between the apical constriction and the apical foramen were recorded from the micro-CT scans, and their correlation to the accuracy of the EALs was determined., Results: All electronic measurements showed high agreement with their respective gold standard, except the electronic root canal length of the Apex ID (P < .05). No difference in the percentage of precise measurements (within the ±0.5 mm) was found among the devices (χ 2 and z tests, P > .05). Of the anatomic parameters evaluated, the presence of a lateral foramen negatively affected the 0.0 mark of the Apex ID (Wilcoxon test, P < .05)., Conclusions: The Root ZX Mini and CanalPro were precise for both root canal length and working length determination in mesial curved canals of mandibular molars, whereas the Apex ID was accurate for the working length when using the 0.5 mark., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: The measurements used to define pulmonary hypertension (PH) etiology, pulmonary arterial wedge pressure (PAWP), and left ventricular end-diastolic pressure (LVEDP) vary in clinical practice. We aimed to identify clinical features associated with measurement discrepancy between PAWP and LVEDP in patients with PH., Methods: We extracted clinical data and invasive hemodynamics from consecutive patients undergoing concurrent right and left heart catheterization at Vanderbilt University between 1998 and 2014. The primary outcome was discordance between PAWP and LVEDP in patients with PH in a logistic regression model., Results: We identified 2,270 study subjects (median age, 63 years; 53% men). The mean difference between PAWP and LVEDP was -1.6 mm Hg (interquartile range, -15 to 12 mm Hg). The two measurements were moderately correlated by linear regression (R = 0.6, P < .001). Results were similar when restricted to patients with PH. Among patients with PH (n = 1,331), older age (OR, 1.77; 95% CI, 1.23-2.45) was associated with PAWP underestimation in multivariate models, whereas atrial fibrillation (OR, 1.75; 95% CI, 1.08-2.84), a history of rheumatic valve disease (OR, 2.2; 95% CI, 1.36-3.52), and larger left atrial diameter (OR, 1.70; 95% CI, 1.24-2.32) were associated with PAWP overestimation of LVEDP. Results were similar in sensitivity analyses., Conclusions: Clinically meaningful disagreement between PAWP and LVEDP is common. Atrial fibrillation, rheumatic valve disease, and larger left atrial diameter are associated with misclassification of PH etiology when relying on PAWP alone. These findings are important because of the fundamental differences in the treatment of precapillary and postcapillary PH., (Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the value of diameter measurements for prediction of functional dialysis use (FDU) of arteriovenous fistulas (AVF)., Methods: Review of access operations and dialysis databases from January 1, 2007 to August 1, 2015. Follow up until July 1, 2016. FDU defined as six consecutive dialysis sessions with two needles on the AVF. Artery and vein diameters measured by portable ultrasound in access clinic. Contribution of diameter to predict FDU assessed with logistic regression. Diagnostic accuracy assessed by sensitivity, specificity, positive and negative predictive values (PPV and NPV)., Results: 803 AVF operations were analysed: 507 (63%) radiocephalic fistulas (RCAVF), 237 (30%) brachiocephalic fistulas (BCAVF), and 59 (7%) brachiobasilic fistulas (BBAVF). Women had lower FDU in RCAVF (0.65, 95% CI 0.58-0.72 vs. 0.86, 95% CI 0.81-0.89; p < .0001), but not in BCAVF (0.83, 95% CI 0.75-0.89 vs. 0.81, 95% CI 0.73-0.88; p = .75). Female gender was an independent negative predictor of FDU in RCAVF (OR 0.31; 95% CI 0.20-0.49). Vascular kidney disease was an independent negative predictor for FDU in RCAVF (OR 0.33; 95% CI 0.17-0.64) and BCAVF (OR 0.22; 95% CI 0.09-0.57) in multivariable analysis. Artery and vein diameter did not improve the model for RCAVF. Vein diameter as categorical variable improved the model for BCAVF. Diameter cut off of radial artery ≥ 2 mm has 96% sensitivity, 86% PPV, 9% specificity, and 29% NPV in men. Radial artery diameter ≥2 mm had 96% sensitivity, 67% PPV but 13% specificity and 62% NPV in women., Conclusions: Diameter is a poor predictor of FDU of AVF. Arterial diameter measurements add no diagnostic value for BCAVF. Poor specificity suggests a diameter under 2 mm at the wrist should not preclude AVF formation. Vascular kidney disease is an independent negative predictor for FDU in all AVF., (Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.)

Background: Computed tomography coronary angiography (CTCA) image analysis enables plaque characterization and non-invasive fractional flow reserve (FFR) calculation. We analyzed various parameters derived from CTCA images and evaluated their associations with ischemia., Methods: 49 (61 lesions) patients underwent CTCA and invasive FFR. Lesions with diameter stenosis (DS) ≥ 50% were considered obstructive. CTCA image processing incorporating analytical and numerical methods were used to quantify anatomical parameters of lesion length (LL) and minimum lumen area (MLA); plaque characteristic parameters of plaque volume, low attenuation plaque (LAP) volume, dense calcium volume (DCV), normalized plaque volume (NP Vol), plaque burden, eccentricity index and napkin-ring (NR) sign; and hemodynamic parameters of resistance index, stenosis flow reserve (SFR) and FFR B . Ischemia was defined as FFR ≤ 0.8., Results: Plaque burden and plaque volume were inversely related to FFR. Multivariable logistic regression analysis identified the best anatomical, plaque and hemodynamic predictors, respectively, as DS (≥50% vs <50%; OR: 8.0; 95% CI: 1.6-39.4), normalized plaque volume (NP Vol) (≥4.3 vs <4.3; OR: 3.9; 95% CI: 1.1-14.0) and NR Sign (0 vs 1; OR: 13.6; 95% CI: 1.3-146.1), and FFR B (≤0.8 vs >0.8; OR: 44.4; 95% CI: 8.8-224.8). AUC increased from 0.70 with DS as the sole predictor to 0.81 after adding NP Vol and NR Sign; further addition of FFR B increased AUC to 0.93., Conclusion: Normalized plaque volume, napkin-ring derived from plaque analysis, and FFR B from numerical simulations on CTCA images substantially improved discrimination of ischemic lesions, compared to assessment by DS alone., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Sweat chloride testing for diagnosis of cystic fibrosis (CF) involves sweat induction, collection and handling, and measurement in an analytical lab. We have developed a wearable sensor with an integrated salt bridge for real-time measurement of sweat chloride concentration. Here, in a proof-of-concept study, we compare the performance of the sensor to current clinical practice in CF patients and healthy subjects., Method: Sweat was induced on both forearms of 10 individuals with CF and 10 healthy subjects using pilocarpine iontophoresis. A Macroduct sweat collection device was attached to one arm and sweat was collected for 30 min and then sent for laboratory analysis. A sensor was attached to the other arm and the chloride ion concentration monitored in real time for 30 min using a Bluetooth transceiver and smart phone app., Results: Stable sweat chloride measurements were obtained within 15 min following sweat induction using the wearable sensor. We define the detection time as the time at which the standard deviation of the real-time chloride ion concentration remained below 2 mEq/L for 5 min. The sweat volume for sensor measurements at the detection time was 13.1 ± 11.4 μL (SD), in many cases lower than the minimum sweat volume of 15 μL for conventional testing. The mean difference between sweat chloride concentrations measured by the sensor and the conventional laboratory practice was 6.2 ± 9.5 mEq/L (SD), close to the arm-to-arm variation of about 3 mEq/L. The Pearson correlation coefficient between the two measurements was 0.97 highlighting the excellent agreement between the two methods., Conclusion: A wearable sensor can be used to make real-time measurements of sweat chloride within 15 min following sweat induction, requiring a small sweat volume, and with excellent agreement to standard methods., (Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Background: Novel quantification of stroke volume according to mitral inflow and aortic outflow using automated real-time 3-dimensional volume colour flow Doppler echocardiography (3D-RT-VCFDE) is more accurate than 2-dimensional echocardiography and has excellent correlation with cardiac magnetic resonance imaging-based flows in adults. This technology is applied for the first time to the right heart and in children., Methods: 3D-RT-VCFDE was performed in 61 image sets of flow through the aortic (AV), mitral (MV), pulmonary (PV), and tricuspid (TV) valves of 34 children. These were compared with stroke volumes of the right (RV) and left (LV) ventricles and ratio of pulmonary to systemic blood flow determined using the Fick method in 31 children with atrial shunts., Results: The mean age was 8.0 ± 3.3 years, and the mean weight was 27.8 ± 10.0 kg. The mean temporal resolution for flow analyses was ≥ 22 volumes per second. In conditions with no shunt, the correlations were: AV with MV flows (r = 0.98), PV with TV flows (r = 0.96), RV stroke volume with PV flow (r = 0.95), and with TV flow (r = 0.93), LV stroke volume with AV flow (r = 0.87), and with MV flow (r = 0.89). Fick ratio of pulmonary to systemic blood flow correlations were: PV/AV ratio (r = 0.84), TV/MV ratio (r = 0.87), and RV/LV ratio (r = 0.70)., Conclusions: Stroke volume determined using automated 3D-RT-VCFDE is feasible in children and in the right side of the heart. This technique potentially provides a noninvasive alternative to historically invasively acquired hemodynamic data and to cardiac magnetic resonance imaging., (Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the accuracy of infrared temporal artery thermometry with axillary thermometry in a cohort of preterm neonates between 28 and 36 weeks postmenstrual age., Design: Descriptive repeated measures design with randomization to temperature measurement order., Setting: Level III NICU in the Central/Southeastern United States., Participants: Sixty-eight neonates born between 28 weeks and 36 weeks postmenstrual age cared for in incubators or open cribs., Methods: Neonates were randomly assigned to temperature measurement order (axillary followed by temporal artery or temporal artery followed by axillary). Temperature pairs were taken once during the day shift and once during the night shift. Behavioral states were assessed before, during, and after temperature measurement., Results: Neonates were predominantly female (64.7%) with a mean age of 6.6 days and a mean gestational age of 32.7 weeks, and most were cared for in incubators (n = 55). Noninferiority was observed between the two temperature methods (Holm-Bonferroni criterion = .025, p < .001). There was no statistically significant difference in the behavioral states of the neonates between the two temperature methods. It took nurses significantly longer to use the axillary thermometer than to use the temporal artery thermometer (p < .001)., Conclusion: Temporal artery temperature measurements were as accurate as axillary temperature measurements in low-birth-weight neonates in the NICU. Nurses spent less time measuring with the temporal artery method than with the axillary method., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: The aim was to assess more accurately the net flow of the lower limb perforating veins (PVs)., Material and Methods: This was an observational prospective study. Two hundred and twenty one limbs with chronic venous disease (C1-6EpAs,pPr) of 193 patients underwent a duplex ultrasound (DUS). All identified PVs were scanned also by means of quality Doppler profile (QDP) multigate analysis in order to determine their net inward and outward flow direction. A comparison between the traditional pulsed wave Doppler analysis and QDP was performed to detect potential discrepancy between the traditional definition of PV incompetence and a net outward flow., Results: The DUS investigation identified 774 PVs. Only 7.7% of the PVs showed an outward flow lasting more than 500 ms. Among the PVs showing a longer than 500 ms outward flow, QDP assessment revealed net outward flow in only 84% of the PVs along the thigh and in 28.6% along the lower leg. Among the PVs showing a shorter than 500 ms outward flow, QDP assessment reported a net outward flow in 2.4% of the PVs along the thigh and in 47.3% of those along the lower leg. The sensitivity of an outward flow lasting more than 500 ms in detecting an actual net outward flow was 13.9% (9-20.1%). The specificity of an outward flow lasting less than 500 ms in detecting a net inward flow was 96.4% (93.2-98.3%)., Conclusions: A lack of overlap exists between the finding of a PV outward flow lasting more than 500 ms and the net outward flow of the same vessel. The traditional definition of PV incompetence is challenged by the reported data and further investigations are required to identify a gold standard assessment., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Introduction: Superimposition of 2 cone-beam computed tomography images is possible by using landmarks, surfaces, or density information (voxel-based). Voxel-based superimposition is automated and uses the most image content, providing accurate results. Until recently, this superimposition was extremely laborious, but a user-friendly voxel-based superimposition has recently been introduced. Our aim was to evaluate the precision and reliability of Dolphin 3-dimensional voxel-based superimposition (Dolphin Imaging, Chatsworth, Calif)., Methods: This was a retrospective study using existing scans of 31 surgical orthodontic patients with a mean age of 21 ± 8 years (range, 15-47 years). Each patient had a presurgical and a postsurgical scan taken within 12 months. Surgical patients were used since the reference area for superimposition was not affected by growth or surgical procedures. The volumes were superimposed using voxel-based methods from Dolphin Imaging and a tested method used previously. This method uses 2 open-source programs and takes about 3 hours to complete, whereas the Dolphin method takes under 5 minutes. The postsurgical scan was superimposed on the presurgical scan at the cranial base. Postsurgical registrations for both methods were compared with each other using the absolute closest point color map, with emphasis on 7 regions (nasion, A-point, B-point, bilateral zygomatic arches, and bilateral gonions)., Results: Intraclass correlations showed excellent reliability (0.96). The mean differences between the 2 methods were less than 0.21 mm (voxel size, 0.38). The smallst difference was in the left zygomatic area at 0.09 ± 0.07 mm, and the largest was in the right gonial region at 0.21 ± 0.13 mm., Conclusions: Dolphin 3-dimensional voxel-based superimposition, a fast and user-friendly method, is precise and reliable., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: Previous studies have proposed various ways to assess scapular dyskinesis. In clinic, assessment tools designed to measure the posterior displacement of the inferior angle of the scapula with reference to the posterior thoracic cage are needed., Objectives: A novel scapulometer was developed to measure scapular medial border and inferior angle prominence., Methods: A novel scapulometer was designed to measure the distance from the root of the spine (ROS) and the inferior angle (INF) of the scapula to the thorax wall in 29 participants with scapular dyskinesis bilaterally. Two raters measured the ROS and INF distance of the scapula 3 times bilaterally. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to determine the inter-rater and intra-rater reliability. Validity was based on correlations (convergent: ROS and internal/external rotation, and INF and tilt; divergent: ROS/INF and upward rotation of the scapula) using a FASTRAK Polhemus 3-D motion tracking system assessing scapular tilt, internal/external rotation, and upward/downward rotation., Results: The average ROS and INF displacements were 13.7 ± 5.0 mm and 12.5 ± 6.3 mm, respectively. The results showed excellent intra-rater and inter-rater reliability, with ICC = 0.88-0.99 and 0.95-0.99 (SEM = 0.7-0.8 mm), respectively. Correlations were 0.35/0.19 (convergent validity) and 0.07/0.09 (divergent validity)., Conclusions: The novel scapulometer has excellent reliability and fair validity to quantify medial border and inferior angle prominence of the scapula. Further research utilizing this instrument is recommended., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Various measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values., Study Design: Two experts rated 407 3D craniofacial images of children aged between 3 and 36 months old using the Argenta classification. We then measured the following asymmetry-related variables from the images: Oblique Cranial Length Ratio (OCLR), Diagonal Difference (DD), Posterior Cranial Asymmetry Index (PCAI), and weighted Asymmetry Score (wAS). We created receiver operating characteristic curves to evaluate the accuracy of these variables., Results: All variables performed well, but OCLR consistently provided the best discrimination in terms of area under the curve values. Subject's age had no clear effect on the cut-off values for OCLR, PCAI, and wAS; however, the cut-off for DD increased monotonically with age. When subjects with discrepant expert ratings were excluded, the optimal cut-off values for DP (Argenta class ≥ 1) across all age-groups were 104.0% for OCLR (83% sensitivity, 97% specificity), 10.5% for PCAI (90% sensitivity, 90% specificity), and 24.5 for wAS (88% sensitivity, 90% specificity)., Conclusion: We recommend using OCLR as the primary measurement, although PCAI and wAS may also be useful in monitoring cranial asymmetry. The threshold of relative asymmetry required for a deformation to appear clinically significant is not affected by the child's age, and DD has no additional utility in monitoring DP compared to using only OCLR., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)