Search

Introduction: Central venous catheter (CVC) tip placement guided by chest X‐ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X‐ray landmarks. Methods: Chest CTs of 100 patients were retrospectively assessed. CT images were converted to a 'virtual CXR' using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes. Results: The mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup‐RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat‐RHB) was 18.4 mm below the CAJ. A new landmark: the mid‐superior right heart border, defined as the mid‐point between the Sup‐RHB and Lat‐RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ. Conclusion: We propose that the CVC tip can be placed at the mid‐superior right heart border landmark. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to assess the clinical validity and accuracy of a deep learning-based automatic landmarking algorithm for cone-beam computed tomography (CBCT). Three-dimensional (3D) CBCT head measurements obtained through manual and automatic landmarking were compared. Materials and Methods: A total of 80 CBCT scans were divided into 3 groups: non-surgical (39 cases); surgical without hardware, namely surgical plates and mini-screws (9 cases); and surgical with hardware (32 cases). Each CBCT scan was analyzed to obtain 53 measurements, comprising 27 lengths, 21 angles, and 5 ratios, which were determined based on 65 landmarks identified using either a manual or a 3D automatic landmark detection method. Results: In comparing measurement values derived from manual and artificial intelligence landmarking, 6 items displayed significant differences: R U6CP-L U6CP, R L3CP-L L3CP, S-N, Or_R-R U3CP, L1L to Me-GoL, and GoR-Gn/S-N (P<0.05). Of the 3 groups, the surgical scans without hardware exhibited the lowest error, reflecting the smallest difference in measurements between human- and artificial intelligence-based landmarking. The time required to identify 65 landmarks was approximately 40-60 minutes per CBCT volume when done manually, compared to 10.9 seconds for the artificial intelligence method (PC specifications: GeForce 2080Ti, 64GB RAM, and an Intel i7 CPU at 3.6 GHz). Conclusion: Measurements obtained with a deep learning-based CBCT automatic landmarking algorithm were similar in accuracy to values derived from manually determined points. By decreasing the time required to calculate these measurements, the efficiency of diagnosis and treatment may be improved. [ABSTRACT FROM AUTHOR]

Context: Angiography catheterization through the femoral artery (FA) carries risks of vascular complications. The optimal site for puncture is above the common FA bifurcation (CFAB) and below the inferior epigastric artery. Aims: This study aims to assess the relationship of the inguinal skin crease with the position of the femoral head and the CFAB. Settings: From March 2014 to March 2015, this study was conducted in a single center. Materials and Methods: Patients above 18 years were eligible for coronary angiography through the trans-FA. The FA cannulation was carried out using an 18G needle. A contrast medium was injected to visualize the common FA (CFA), the CFAB, and the inferior epigastric artery. A reference point was placed tangent to the inguinal skin crease. Results: There were 185 patients, with a mean age of 61.47 ± 8.95 years, and 53.2% were men. CFAB was inferior to the midline of the femoral head in 94.6% of patients and, in relation to the inguinal skin crease, was inferior, equal, and superior in about one-third of patients; the position of the inguinal skin crease was inferior to the midline of the femoral head in 98.1%. The position of the inferior epigastric artery was superior to the femoral head in all patients. There was no significant difference based on gender or body mass index comparison. Conclusions: Because femoral head fluoroscopy is less commonly used as a landmark for a puncture during FA cannulation, the inguinal skin crease may be an applicable point for CFA puncture.

Background: Researchers have noted that the advent of artificial intelligence (AI) heralds a promising era, with potential to significantly enhance diagnostic and predictive abilities in clinical settings. The aim of this meta-analysis is to evaluate the discrepancies in identifying anatomical landmarks between AI and manual approaches. Methods: A comprehensive search strategy was employed, incorporating controlled vocabulary (MeSH) and free-text terms. This search was conducted by two reviewers to identify published systematic reviews. Three major electronic databases, namely, Medline via PubMed, the Cochrane database, and Embase, were searched up to May 2024. Results: Initially, 369 articles were identified. After conducting a comprehensive search and applying strict inclusion criteria, a total of ten studies were deemed eligible for inclusion in the meta-analysis. The results showed that the average difference in detecting anatomical landmarks between artificial intelligence and manual approaches was 0.35, with a 95% confidence interval (CI) ranging from −0.09 to 0.78. Additionally, the overall effect between the two groups was found to be insignificant. Upon further analysis of the subgroup of cephalometric radiographs, it was determined that there were no significant differences between the two groups in terms of detecting anatomical landmarks. Similarly, the subgroup of cone-beam computed tomography (CBCT) revealed no significant differences between the groups. Conclusions: In summary, the study concluded that the use of artificial intelligence is just as effective as the manual approach when it comes to detecting anatomical landmarks, both in general and in specific contexts such as cephalometric radiographs and CBCT evaluations. [ABSTRACT FROM AUTHOR]

Objectives This systematic review and meta-analysis aimed to investigate the accuracy and efficiency of artificial intelligence (AI)-driven automated landmark detection for cephalometric analysis on two-dimensional (2D) lateral cephalograms and three-dimensional (3D) cone-beam computed tomographic (CBCT) images. Search methods An electronic search was conducted in the following databases: PubMed, Web of Science, Embase, and grey literature with search timeline extending up to January 2024. Selection criteria Studies that employed AI for 2D or 3D cephalometric landmark detection were included. Data collection and analysis The selection of studies, data extraction, and quality assessment of the included studies were performed independently by two reviewers. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A meta-analysis was conducted to evaluate the accuracy of the 2D landmarks identification based on both mean radial error and standard error. Results Following the removal of duplicates, title and abstract screening, and full-text reading, 34 publications were selected. Amongst these, 27 studies evaluated the accuracy of AI-driven automated landmarking on 2D lateral cephalograms, while 7 studies involved 3D-CBCT images. A meta-analysis, based on the success detection rate of landmark placement on 2D images, revealed that the error was below the clinically acceptable threshold of 2 mm (1.39 mm; 95% confidence interval: 0.85–1.92 mm). For 3D images, meta-analysis could not be conducted due to significant heterogeneity amongst the study designs. However, qualitative synthesis indicated that the mean error of landmark detection on 3D images ranged from 1.0 to 5.8 mm. Both automated 2D and 3D landmarking proved to be time-efficient, taking less than 1 min. Most studies exhibited a high risk of bias in data selection (n  = 27) and reference standard (n  = 29). Conclusion The performance of AI-driven cephalometric landmark detection on both 2D cephalograms and 3D-CBCT images showed potential in terms of accuracy and time efficiency. However, the generalizability and robustness of these AI systems could benefit from further improvement. Registration PROSPERO: CRD42022328800. [ABSTRACT FROM AUTHOR]

Fractures of the orbit are frequently noted in craniomaxillofacial trauma. The complexity of the anatomy and the proximity to various vital structures often complicates the surgical management of these fractures. The authors have thus attempted to review the literature on anatomy of the bony orbit and its soft tissue envelope in a simplified manner with due emphasis on surgical anatomy and exploration of the orbit with a surgical perspective. The contents of this narrative literature review may be useful for young maxillofacial surgeons and will aid in the process of management of orbital fractures. [ABSTRACT FROM AUTHOR]

Purpose: Traditional CT acquisition planning is based on scout projection images from planar anterior-posterior and lateral projections where the radiographer estimates organ locations. Alternatively, a new scout method utilizing ultra-low dose helical CT (3D Landmark Scan) offers cross-sectional imaging to identify anatomic structures in conjunction with artificial intelligence based Anatomic Landmark Detection (ALD) for automatic CT acquisition planning. The purpose of this study is to quantify changes in scan length and radiation dose of CT examinations planned using 3D Landmark Scan and ALD and performed on next generation wide volume CT versus examinations planned using traditional scout methods. We additionally aim to quantify changes in radiation dose reduction of scans planned with 3D Landmark Scan and performed on next generation wide volume CT. Methods: Single-center retrospective analysis of consecutive patients with prior CT scan of the same organ who underwent clinical CT using 3D Landmark Scan and automatic scan planning. Acquisition length and dose-length-product (DLP) were collected. Data was analyzed by paired t-tests. Results: 104 total CT examinations (48.1 % chest, 15.4 % abdomen, 36.5 % chest/abdomen/pelvis) on 61 individual consecutive patients at a single center were retrospectively analyzed. 79.8 % of scans using 3D Landmark Scan had reduction in acquisition length compared to the respective prior acquisition. Median acquisition length using 3D Landmark Scan was 26.7 mm shorter than that using traditional scout methods (p < 0.001) with a 23.3 % median total radiation dose reduction (245.6 (IQR 150.0–400.8) mGy cm vs 320.3 (IQR 184.1–547.9) mGy cm). CT dose index similarly was overall decreased for scans planned with 3D Landmark and ALD and performed on next generation CT versus traditional methods (4.85 (IQR 3.8–7) mGy vs. 6.70 (IQR 4.43–9.18) mGy, respectively, p < 0.001). Conclusion: Scout imaging using reduced dose 3D Landmark Scan images and Anatomic Landmark Detection reduces acquisition range in chest, abdomen, and chest/abdomen/pelvis CT scans. This technology, in combination with next generation wide volume CT reduces total radiation dose.

Accurate 3D models of the cochlea are useful tools for research in the relationship between the electrode array and nerve fibres. The internal geometry of the cochlear canal plays an important role in understanding and quantifying that relationship. Predicting the location and shapes of the geometry is done by measuring histologic sections and fitting equations that can be used to predict parameters that fully define the geometry. A parameter sensitivity analysis is employed to prove that the size and location of the spiral lamina are the characteristics that most influence current distribution along target nerve fibres. The proposed landmark prediction method more accurately predicts the location of the points defining the spiral lamina in the apical region of the cochlea than methods used in previous modelling attempts. Thus, this technique can be used to generate 2D geometries that can be expanded to 3D models when high-resolution imaging is not available. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Tibial plateau fractures are common intra-articular fractures that pose classification and treatment challenges for orthopedic surgeons. Objective: This study examines the value of 3D printing for classifying and planning surgery for complex tibial plateau fractures. Methods: We reviewed 54 complex tibial plateau fractures treated at our hospital from January 2017 to January 2019. Patients underwent preoperative spiral CT scans, with DICOM data processed using Mimics software. 3D printing technology created accurate 1:1 scale models of the fractures. These models helped subdivide the fractures into seven types based on the tibial plateau's geometric planes. Surgical approaches and simulated operations, including fracture reduction and plate placement, were planned using these models. Results: The 3D models accurately depicted the direction and extent of fracture displacement and plateau collapse. They facilitated the preoperative planning, allowing for precise reconstruction strategies and matching intraoperative details with the pre-printed models. Post-surgery, the anatomical structure of the tibial plateau was significantly improved in all 54 cases. Conclusion: 3D printing effectively aids in the classification and preoperative planning of complex tibial plateau fractures, enhancing surgical outcomes and anatomical restoration. Level of Evidence IV, Prospective Study.

Background: When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI. Methods: Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated. Results: Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior. Conclusion: The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this. Clinical Relevance: Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance. [ABSTRACT FROM AUTHOR]

Objectives: This study aims at a fully automatic pipeline for measuring the magnetic resonance parkinsonism index (MRPI) using deep learning methods. Methods: MRPI is defined as the product of the pons area to the midbrain area ratio and the middle cerebellar peduncle (MCP) width to the superior cerebellar peduncle (SCP) width ratio. In our proposed pipeline, we first used nnUNet to segment the brainstem and then employed HRNet to identify two key boundary points so as to sub-divide the whole brainstem into midbrain and pons. HRNet was also employed to predict the MCP endpoints for measuring the MCP width. Finally, we segmented the SCP on an oblique coronal plane and calculated its width. A total of 400 T1-weighted magnetic resonance images (MRIs) were used to train the nnUNet and HRNet models. Five-fold cross-validation was conducted to evaluate our proposed pipeline's performance on the training dataset. We also evaluated the performance of our proposed pipeline on three external datasets. Two of them had two raters manually measuring the MRPI values, providing insights into automatic accuracy versus inter-rater variability. Results: We obtained average absolute percentage errors (APEs) of 17.21%, 18.17%, 20.83%, and 22.83% on the training dataset and the three external validation datasets, while the inter-rater average APE measured on the first two external validation datasets was 11.31%. Our proposed pipeline significantly improved the MRPI quantification accuracy over a representative state-of-the-art traditional approach (p < 0.001). Conclusion: The proposed automatic pipeline can accurately predict MRPI that is comparable with manual measurement. Clinical relevance statement: This study presents an automated magnetic resonance parkinsonism index measurement tool that can analyze large amounts of magnetic resonance images, enhance the efficiency of Parkinsonism-Plus syndrome diagnosis, reduce the workload of clinicians, and minimize the impact of human factors on diagnosis. Key Points: • We propose an automatic pipeline for measuring the magnetic resonance parkinsonism index from magnetic resonance images. • The effectiveness of the proposed pipeline is successfully established on multiple datasets and comparisons with inter-rater measurements. • The proposed pipeline significantly outperforms a state-of-the-art quantification approach, being much closer to ground truth. [ABSTRACT FROM AUTHOR]

Background: The ability to detect and recognize abnormal patterns in diagnostic images requires sufficient knowledge in studying radiographic images. By teaching oral radiology, dentists must know basic skills for interpreting images inside or outside the mouth. Therefore, this study aimed to assess the clinical competence of dental students in recognizing landmarks and radiological lesions of the jaw and face.Methods: In this cross-sectional study conducted during the academic year 2021, the authors included general dentistry students in their 5th and 6th years of study at Yasuj University of Medical Sciences dental school. Initially, an objective structured clinical exam with 18 stations was designed to assess six different radiology students’ competencies with the help of the radiology department’s faculty members. Due to Covid-19 disease, 19 tests were held in absentia through the university’s Faradid system. After this test, the results were analyzed using SPSS software version 26.Results: The mean skill levels of dental students at Yasouj University of Medical Sciences in the diagnosis of different categories were as follows: Diagnosis of Dental Anomalies: 0.19±0.70, Diagnosis of Bone Anomalies: 0.34±0.44, Diagnosis of Anatomical Landmarks: 0.29±0.75, Diagnosis of Radiographic Techniques: 0.13±0.92, Diagnosis of Radiopaque Lesions: 0.5±0.31, Diagnosis of Radiolucent Lesions: 0.26±0.45.Conclusion: The lowest level of students’ skills belonged to the diagnosis of bone anomalies and radiolucent diagnosis. It is suggested that radiology professors take some effective measures to improve education regarding bone anomalies and radiolucent diagnosis.

Abstract Background Panoramic radiographs, in which anatomic landmarks can be observed, are used to detect cases closely related to pediatric dentistry. The purpose of the study is to investigate the success and reliability of the detection of maxillary and mandibular anatomic structures observed on panoramic radiographs in children using artificial intelligence. Methods A total of 981 mixed images of pediatric patients for 9 different pediatric anatomic landmarks including maxillary sinus, orbita, mandibular canal, mental foramen, foramen mandible, incisura mandible, articular eminence, condylar and coronoid processes were labelled, the training was carried out using 2D convolutional neural networks (CNN) architectures, by giving 500 training epochs and Pytorch-implemented YOLO-v5 models were produced. The success rate of the AI model prediction was tested on a 10% test data set. Results A total of 14,804 labels including maxillary sinus (1922), orbita (1944), mandibular canal (1879), mental foramen (884), foramen mandible (1885), incisura mandible (1922), articular eminence (1645), condylar (1733) and coronoid (990) processes were made. The most successful F1 Scores were obtained from orbita (1), incisura mandible (0.99), maxillary sinus (0.98), and mandibular canal (0.97). The best sensitivity values were obtained from orbita, maxillary sinus, mandibular canal, incisura mandible, and condylar process. The worst sensitivity values were obtained from mental foramen (0.92) and articular eminence (0.92). Conclusions The regular and standardized labelling, the relatively larger areas, and the success of the YOLO-v5 algorithm contributed to obtaining these successful results. Automatic segmentation of these structures will save time for physicians in clinical diagnosis and will increase the visibility of pathologies related to structures and the awareness of physicians.

Background: Researchers have noted that the advent of artificial intelligence (AI) heralds a promising era, with potential to significantly enhance diagnostic and predictive abilities in clinical settings. The aim of this meta-analysis is to evaluate the discrepancies in identifying anatomical landmarks between AI and manual approaches. Methods: A comprehensive search strategy was employed, incorporating controlled vocabulary (MeSH) and free-text terms. This search was conducted by two reviewers to identify published systematic reviews. Three major electronic databases, namely, Medline via PubMed, the Cochrane database, and Embase, were searched up to May 2024. Results: Initially, 369 articles were identified. After conducting a comprehensive search and applying strict inclusion criteria, a total of ten studies were deemed eligible for inclusion in the meta-analysis. The results showed that the average difference in detecting anatomical landmarks between artificial intelligence and manual approaches was 0.35, with a 95% confidence interval (CI) ranging from −0.09 to 0.78. Additionally, the overall effect between the two groups was found to be insignificant. Upon further analysis of the subgroup of cephalometric radiographs, it was determined that there were no significant differences between the two groups in terms of detecting anatomical landmarks. Similarly, the subgroup of cone-beam computed tomography (CBCT) revealed no significant differences between the groups. Conclusions: In summary, the study concluded that the use of artificial intelligence is just as effective as the manual approach when it comes to detecting anatomical landmarks, both in general and in specific contexts such as cephalometric radiographs and CBCT evaluations.

Background: Panoramic radiographs, in which anatomic landmarks can be observed, are used to detect cases closely related to pediatric dentistry. The purpose of the study is to investigate the success and reliability of the detection of maxillary and mandibular anatomic structures observed on panoramic radiographs in children using artificial intelligence. Methods: A total of 981 mixed images of pediatric patients for 9 different pediatric anatomic landmarks including maxillary sinus, orbita, mandibular canal, mental foramen, foramen mandible, incisura mandible, articular eminence, condylar and coronoid processes were labelled, the training was carried out using 2D convolutional neural networks (CNN) architectures, by giving 500 training epochs and Pytorch-implemented YOLO-v5 models were produced. The success rate of the AI model prediction was tested on a 10% test data set. Results: A total of 14,804 labels including maxillary sinus (1922), orbita (1944), mandibular canal (1879), mental foramen (884), foramen mandible (1885), incisura mandible (1922), articular eminence (1645), condylar (1733) and coronoid (990) processes were made. The most successful F1 Scores were obtained from orbita (1), incisura mandible (0.99), maxillary sinus (0.98), and mandibular canal (0.97). The best sensitivity values were obtained from orbita, maxillary sinus, mandibular canal, incisura mandible, and condylar process. The worst sensitivity values were obtained from mental foramen (0.92) and articular eminence (0.92). Conclusions: The regular and standardized labelling, the relatively larger areas, and the success of the YOLO-v5 algorithm contributed to obtaining these successful results. Automatic segmentation of these structures will save time for physicians in clinical diagnosis and will increase the visibility of pathologies related to structures and the awareness of physicians. [ABSTRACT FROM AUTHOR]

Objective: To present and validate an open‐source fully automated landmark placement (ALICBCT) tool for cone‐beam computed tomography scans. Materials and Methods: One hundred and forty‐three large and medium field of view cone‐beam computed tomography (CBCT) were used to train and test a novel approach, called ALICBCT that reformulates landmark detection as a classification problem through a virtual agent placed inside volumetric images. The landmark agents were trained to navigate in a multi‐scale volumetric space to reach the estimated landmark position. The agent movements decision relies on a combination of DenseNet feature network and fully connected layers. For each CBCT, 32 ground truth landmark positions were identified by 2 clinician experts. After validation of the 32 landmarks, new models were trained to identify a total of 119 landmarks that are commonly used in clinical studies for the quantification of changes in bone morphology and tooth position. Results: Our method achieved a high accuracy with an average of 1.54 ± 0.87 mm error for the 32 landmark positions with rare failures, taking an average of 4.2 second computation time to identify each landmark in one large 3D‐CBCT scan using a conventional GPU. Conclusion: The ALICBCT algorithm is a robust automatic identification tool that has been deployed for clinical and research use as an extension in the 3D Slicer platform allowing continuous updates for increased precision. [ABSTRACT FROM AUTHOR]

The establishment of anthropometric measurements is of fundamental importance for the correct identification of human bodies. The objective of this study was to evaluate the accuracy and reliability of two-dimensional craniometric landmarks obtained from three-dimensional cone beam computed tomography reconstructions for forensic identification of humans. Computed tomography images with voxel sizes of 0.25, 0.3, and 0.4 mm were obtained using i-CAT® three-dimensional equipment. Ten landmarks were randomly selected, and 10 measurements were demarcated in the three-dimensional reconstruction to evaluate the mandibular condyle, ramus, and body. This study demonstrated that protocols with voxels of 0.3 mm should be preferentially indicated for the evaluation of linear and angular measurements. Implementing our methodology using prototypes for clinical and forensic simulations allows comparisons with human databases in identification issues. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to compare the efficacy of artificial intelligence use in oral radiology learning in the undergraduate dental students. Materials amp;Methods: Fifty third-year students in the University of Lokman Hekim were detected images with the artificial intelligence method (AI) and standard lecture method (SL) for anatomical landmarks in panoramic radiographs. SL consisted of a frontal lecture through a standardized presentation. CranioCatch model (Eskisehir, Turkey) was used as deep learning-based artificial intelligence model. One panoramic image was loaded to the application and anatomic landmarks were detected by teacher, students were asked to mark. AI recorded and scored students answers. A questionnaire study was conducted for the perception of students in terms of validity and reliability regarding assessment and evaluation for each methods. Results: 50 undergraduate students (26 female,24 male) answered 7questions, 5-point Likert type. The conformity to the normal distribution was evaluated with the Shapiro-Wilk test and the graphical approach (Normal Q-Q Plot). The values did not conform to the normal distribution. As a result of the reliability analysis performed for the measurement tool, the Cronbach’s Alpha coefficient was found 0.828. Wilcoxon Test was used to test the significance of the difference between each methods. There is a statistically significant difference between the mean values of evaluation measurements(p=0.014). AI was higher than the mean of evaluation measurement values compared to SL. Conclusion: AI models have performed very well in measurement and evaluation in oral radiology learning.

Objectives: Skeletal malocclusions are common, and severe malocclusions are treated by invasive surgeries. Recently, jaw bone length has been shown to be developmentally controlled by osteoclasts. Our objective was to determine the effect of inhibiting osteoclast‐secreted proteolytic enzymes on lower jaw bone length of avian embryos by pharmacologically inhibiting matrix metalloproteinase‐9 (MMP9) or cathepsin K (CTSK). Methods: Quail (Coturnix coturnix japonica) embryos were given a single dose of an inhibitor of MMP9 (iMMP9), an inhibitor CTSK (iCTSK), or vehicle at a developmental stage when bone deposition is beginning to occur. At a developmental stage when the viscerocranium is largely calcified, the heads were scanned via micro‐computed tomography and reproducible landmarks were placed on 3D‐reconstructed skulls; the landmark coordinates were used to quantify facial bone dimensions. Results: Approximately half of the quail given either iMMP9 or iCTSK demonstrated an overt lower jaw phenotype, characterized by longer lower jaw bones and a greater lower to upper jaw ratio than control embryos. Additionally, iMMP9‐treated embryos exhibited a significant change in midface length and iCTSK‐treated embryos had significant change in nasal bone length. Conclusion: MMP9 and CTSK play a role in osteoclast‐mediated determination of lower jaw bone length. Pharmacological inhibition of MMP9 or CTSK may be a promising therapeutic alternative to surgery for treating skeletal jaw malocclusions, but more preclinical research is needed prior to clinical translation. [ABSTRACT FROM AUTHOR]

The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ©RSNA, 2020.

The present study is the first to evaluate the spiral ganglion neurons (SGNs) and the linear and angular measurements of the cochlea in temporal bones of cochlear implant (CI) recipients. There are no studies evaluating the morphometric measures in subjects after long-term CI use, and this study fills in this gap in current knowledge, greatly important for the design of CI electrodes. Amira based 3-D reconstructions of the cochlea were generated from stained histopathological slides of 15 celloidin-embedded human temporal bones. The SGN angular distance from the round window exhibited a narrow range from 684°-704°, corresponding to linear distances of 17.87 and 34.48 mm along the inner and outer wall of the scala tympani. The first turn measured an average of 14.21 mm along the inner wall and 23.92 mm along the outer wall. The outer wall average for the second turn was 11.11 mm and for the partial third apical turn was only 4.49 mm. The range for cochlear duct angular distance was 876° to 1051°, with a mean of 2.63 turns, corresponding to an average linear distance of 39.53 mm, ranging from 35.44 mm to 43.57 mm 6 out of 15 temporal bones demonstrated better preservation of SGN in the middle and apical segments of Rosenthal's canal. The present study demonstrates that the anatomy of the cochlea of CI patients does not differ significantly from that of normative subjects and establishes measurements using the round window as the 0° reference point, an important surgical landmark. The relevance of the measurements to cochlear implant design are discussed.

Aim: Correct orientation of the occlusal plane plays a vital role in achieving the perfect occlusal balance and function of complete dentures. This study aimed to evaluate the most reliable posterior reference point of the ala-tragus line (ATL) concerning occlusal plane (OP) in a sample of the dentate Sudanese population. Materials and Methods: A total of 150 subjects with healthy and well-aligned permanent teeth were randomly selected. Right lateral profile photographs were taken with subjects having a fox plane placed intra-orally, contacting the occlusal plane. Reference points corresponding to inferior, middle, and superior borders of the tragus and inferior border of the ala of the nose were marked on photographs. The angles between the lines were measured using the Auto-CAD software program, and the most parallel relationship was determined. Descriptive statistics in terms of means and standard deviations were presented. Independent t-test and one-way ANOVA tests were used to compare as appropriate. A p-value < 0.05 was considered significant. Results: The mean angle formed by the OP and ATL was 8.5±3.69º for the superior level, 4.68±3.13º for the middle line, and 2.89±2.57º for the inferior line. A significant difference was found between the means of the three angles (p< 0.001), while no significant difference (p> 0.05) was found between both genders regarding the measured angles. Conclusions: The line joining the inferior border of the ala of the nose with the inferior border of the tragus of the ear was the most reliable line in terms of parallelism to determine the occlusal plane orientation.

Objective To explore the application value of skull surface markers which are easy to be exposed in the operation of retrosigmoid sinus approach to establish coordinate system in the location of key holes. Methods The thin slice CT of 80 patients with trigeminal neuralgia or hemifacial spasm from the image database of Linyi Central Hospital of Shandong Province from January 2019 to January 2020 were selected for three⁃dimensional (3D) imaging. The coordinate system was constructed by the vertex of digastric sulci (point A), the intersection of temporal scale and parietal lacustrine suture (point B) and star point (point C). A total of 60 patients who were hospitalized in our hospital from May 2020 to May 2022 and required retrosigmoid sinus approach for microvascular decompression (MVD) were selected and randomly divided into reconstruction group, non⁃reconstruction group and control group, with 20 cases in each group. In reconstruction group, after the construction of the coordinate system during the surgery, the center of key hole in 3D skull model constructed before surgery was used to locate the location. In non⁃reconstructed group, after the intraoperative construction of coordinate system, the key hole positioning law of the imaging model was used as the center of the key hole. In control group, no coordinate system was established during the operation, and the center of the key hole was taken as the star point. After the center of the key hole was determined, MVD was performed routinely in all groups. The 3D skull model was constructed after surgery, and bone window area, bone defect area, the actual center of key hole (R0) and the center of ideal key hole (R, D value) were measured. Results The results of the imaging model showed the average coordinates of point R were [(4.60±3.89) mm, (4.88±4.14) mm], and the approximate coordinates were (5 mm, 5 mm) after the establishment of the coordinate system with the vertex of digastric sulcus (point A), the intersection of temporal scale and parietal lacustrine suture (point B) and star point (point C). The coincidence rate between the intersection of temporal scale and parietal lacustrine suture and the transverse sinus groove was 95.63% (153/160), and the coincidence rate between the intersection of temporal scale and parietal lacustrine suture and the vertex of digastric sulcus and the superior curve of sigmoid sinus groove was 93.13% (149/160). The coincidence rate between the intersection of temporal scale and parietal lacustrine suture and the vertex line of digastric sulcus and the superior and vertical segment of sigmoid sulcus was 71.25% (114/160). The results showed the bone window area, bone defect area and D value were significantly different among 3 groups (P=0.000, for all), and the bone window area, bone defect area and D value in reconstruction group and non⁃reconstruction group were all smaller than those in control group (P＜0.01, for all). Bone window area (P=0.009) and D value (P=0.000) in reconstructed group were also smaller than those in non⁃reconstructed group. Conclusions In the absence of preoperative CT 3D reconstruction of the skull, a coordinate system was established with the vertex of the digastric sulcus (point A), the intersection of temporal scale and parietal lacustrine suture (point B) and star point (point C), and a bone window was formed with the coordinate point (5 mm, 5 mm) as the center of the key hole to better locate the location of the key hole.

Abstract Background In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice. Methods For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow‐up. Results PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%. Conclusion The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy.

Background Of the three common central access sites, subclavian vein catheterization has the lowest risk of infection but the highest risk of pneumothorax. The main disadvantage of the short-axis ultrasound guided approach is difficult needle-tip visualization. We describe use of the hydrolocation technique to improve needle-tip localization. Case Two females, an 81-year-old and a 72-year-old, presented for coronary artery bypass grafting requiring central vein cannulation. To confirm that the needle tip was visualized and not the shaft, needle advancement was paused and 1 ml of saline injected. The appearance of a small anechoic pocket superficial to the subclavian vein helped to visualize the needle tip. Negative aspiration was then re-applied and slight advancement resulted in aspiration of blood and successful subclavian vein puncture. Conclusions The use of hydrolocation for subclavian vein access was easily implemented, required little modification in setup and technique, and provided improved localization of the needle tip.

Introduction. Customizing surgical radicality is a crucial element in contemporary cervical cancer surgery. Currently, anatomic structures are characterized based on many anatomic interpretations. In order to suggest its general applicability, this study proposes to standardize the definitions and anatomic landmarks of the various types of radical hysterectomy. Methodology. This paper is a literature review in which we selected relevant articles from PubMed database, starting with the year of publication 2010 until 2023, using the following keywords: "cervical cancer", "radical hysterectomy", "classification of radical hysterectomy", "anatomic landmarks", "tailoring surgery", "nerve-sparing procedure". Results. The lateral extent of resection serves as the basis for the updated Querleu-Morrow classification. The three-dimensional anatomic template used to define the resection limits is based on the precise anatomy of the paracolpium and parametrium. The main anatomic landmarks and avascular spaces of the pelvis serve as the basis for the oncologic procedures, including nerve-sparing techniques. There are four different types of radical hysterectomy, each type described with three-dimensional landmarks. There are three main objectives that never change: excising the central tumor with clear margins, removal of any possible lymph dissemination sites, and the control of metastatic disease. Conclusions. It is essential to base research evaluating radicality in the surgical treatment of cervical cancer on precise and generally accepted nomenclature and descriptions. Since the degree of parametrium excision affects late morbidity, particularly bladder and rectal dysfunctions, the thorough explanation and understanding of the many forms of radical hysterectomy are crucial. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this retrospective study was to assess the prevalence and morphometric features of the mastoid foramen (MF) and mastoid emissary canal (MEC) using cone-beam computed tomography (CBCT), as well as their relationship with age, sex, and side. Methods: CBCT scans of 500 patients aged 8–87 years were examined retrospectively. The presence and number of MF, mean diameter of the MEC and MF, MF location, and the distance between MF and asterion were all examined. The collected data were subjected to appropriate statistical analysis. P values < 0.05 were accepted as statistically significant at a 95% confidence interval. Results: The study included 472 patients. MF was present in 82% and absent bilaterally in 18% of the 472 patients. The prevalence of MF was 67.8% on the right side and 65.7% on the left. The mean diameter of the MF was 3.39 ± 1.48 mm and the number of the MF ranged from zero to four. The mean diameter of the MEC was 2.05 ± 1.06 mm and the distance between MF and asterion was 22,46 ± 5,18 mm. 52.4% of the MF was observed on the occipito-mastoid suture. Conclusion: To prevent surgical complications, particularly those that concern the temporal and mastoid areas, radiologists should report the results of the preoperative examination of the morphometry of the MF and MEC. CBCT imaging is a reliable diagnostic method that can be used to evaluate the MEC and MF before surgical procedures. [ABSTRACT FROM AUTHOR]

GoalTo document the role of the styloglossus muscle (SG) in head and neck oncology and at the time of surgical treatment and mandibular preservation surgery for squamous cell carcinoma of the lateral oropharynx (SCCLO).MethodBased on a search conducted within the Pubmed, Embase, and Cochrane databases, using the key words SG muscle, parapharyngeal space and oropharynx, the authors discuss the embryology, physiology, anatomy and radiology of this muscle as well as its role in the oncologic staging surgery of SCCLO.ResultsThe most specific radiologic exam to evaluate the involvement of SG muscle in SCCLO is magnetic resonance imaging (MRI). According to the eigth international staging classification systems, radiologic invasion of the SG muscle, at the time of MRI, leads to reclassify as T4a many tumors considered as T1-3 at the time of clinical and/or on computerized tomography evaluation. This must lead to extreme care when comparing oncologic results from series published prior and after the MRI era. When transoral resection of the SG muscle is advocated for SCCLO, one must know that this maneuver brings numerous arterial and venous structures within the operative field. If difficulties to achieve safe margins of resection and/or to control bleeding are encountered, a simple trans cervical maneuver described herein is most useful.ConclusionThe importance of the SG muscle should be emphasized as a touchstone for staging and surgeon's guide to mandibular preservation surgery of SCCLO. The various approaches allowing the control of this muscle and its vascular environment must be taught at the time of initial training.

Recurrent patellar dislocation is a commonly encountered patellofemoral disease. Prompt surgical intervention is indicated for recurrent dislocation to restore patellofemoral stability. As one of the most preferred procedures, medial patellofemoral ligament (MPFL) reconstruction has been implemented on a large scale. Femoral tunnel placement remains a crucial technical issue during MPFL reconstruction and is critical to ensure the isometry and proper tension of the graft. Currently, visual–palpatory anatomic landmarks and fluoroscopy-guided radiographic landmarks comprise the main approaches to intraoperative femoral tunnel positioning. However, the accuracy of both methods has been questioned. This article introduces an arthroscopic femoral tunnel placement technique. Apart from traditional anteromedial and anterolateral portals, two auxiliary arthroscopic portals are specially designed. The adductor tubercle, the medial epicondyle and the posterior edge are selected as main anatomic landmarks and are directly visualized in sequence under arthroscope. The relative position between the femoral attachment of the MPFL and the three landmarks is measured on preoperative three-dimensional computed tomography, providing semi-quantified reference for intraoperative localization. This technique achieves minimally invasive tunnel placement without X-ray exposure, and especially suits obese patients for whom palpatory methods are difficult to perform. [ABSTRACT FROM AUTHOR]

Objective: To summarize the scientific evidence on anatomical landmarks on radiography used to evaluate the distal tip of the peripherally inserted central catheter in newborns. Methods: This is an integrative literature review performed between 2017 and 2021 in Web of Science, National Library of Medicine (PubMed/MEDLINE) and Scopus databases. Results: Thirteen out of 263 documents found in the databases met the eligibility criteria and were selected for analysis. Of these, 12 were observational studies and one was experimental. As for the country of origin, only one study was published in Brazil, five in China, two in the United States of America; and Italy, Germany, Canada, Iran and India with one study each. The evidence found demonstrated the existence of seven anatomical landmarks used in radiography to visualize the tip of the percutaneous catheter in newborns, and the vertebral body as the predominant guiding reference. Conclusion: For catheters inserted in the upper limbs, the anatomical landmarks closer to the cavo-atrial junction are the fifth and seventh thoracic vertebrae, or two vertebral bodies below the level of the carina. For the lower limbs, the catheter tip should be positioned between the ninth and tenth thoracic vertebrae or above the fourth lumbar vertebra. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the diagnostic yield of dental radiography (Rad method) and 3 cone-beam CT (CBCT) methods for the identification of predefined anatomic landmarks in brachycephalic dogs. ANIMALS 19 client-owned brachycephalic dogs admitted for evaluation and treatment of dental disease. PROCEDURES 26 predefined anatomic landmarks were evaluated separately by use of the RAD method and 3 CBCT software modules (serial CBCT slices and custom cross sections, tridimensional rendering, and reconstructed panoramic views). A semiquantitative scoring system was used, and mean scores were calculated for each anatomic landmark and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant, the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the 6 possible pairs of diagnostic methods. RESULTS Differences of diagnostic yield among the Rad and 3 CBCT methods were significant for 19 of 26 anatomic landmarks. For these landmarks, Rad scores were significantly higher than scores for reconstructed panoramic views for 4 of 19 anatomic landmarks, but Rad scores were significantly lower than scores for reconstructed panoramic views for 8 anatomic landmarks, tridimensional rendering for 18 anatomic landmarks, and serial CBCT slices and custom cross sections for all 19 anatomic landmarks. CONCLUSIONS AND CLINICAL RELEVANCE CBCT methods were better suited than dental radiography for the identification of anatomic landmarks in brachycephalic dogs. Results of this study can serve as a basis for CBCT evaluation of dental disorders in brachycephalic dogs.

To evaluate the relationship between the oculomotor nerve (CNIII) and the internal carotid artery (ICA) as a new anatomic-radiologic landmark for distinguishing the exact location of a paraclinoid intracranial aneurysm (IA). Microanatomic dissections were performed in 20 cavernous sinuses to evaluate the ICA paraclinoid region. Based on anatomic observations, a new magnetic resonance (MRI) protocol to classify paraclinoid aneurysms was proposed. MRI of 42 IAs from 34 patients was independently analyzed and classified as intracavernous, extracavernous, or transitional by 2 neuroradiologists. To validate the proposed MRI protocol, each IA was classified by a three-dimensionally (3D) printed biomodel and agreement with the radiologic classifications was evaluated. Of 42 IAs, 23 undergoing microsurgeries were also classified by direct visualization. We observed that the true cavernous sinus roof is defined by the carotid-oculomotor membrane, which has an intimate relationship with the intersection between the superior limit of the CNIII and the ICA. Based on this intersection, all 42 IAs were radiologically classified and agreement with the 3D printed biomodels was observed in 95% IAs. Concordance tests showed a statistically significant (P < 0.05) agreement between the classifications. All 23 IAs treated had the radiologic and 3D biomodel classification confirmed. The intersection between the ICA and the CNIII, which crosses it transversely in its entire diameter, is a reliable anatomic-radiologic landmark to correctly classify paraclinoid aneurysms. Through a new MRI protocol, it is possible to radiologically identify this intersection and to easily distinguish the intracavernous and extracavernous ICA paraclinoid aneurysms. [ABSTRACT FROM AUTHOR]

Background: Of the three common central access sites, subclavian vein catheterization has the lowest risk of infection but the highest risk of pneumothorax. The main disadvantage of the short-axis ultrasound guided approach is difficult needle-tip visualization. We describe use of the hydrolocation technique to improve needle-tip localization. Case: Two females, an 81-year-old and a 72-year-old, presented for coronary artery bypass grafting requiring central vein cannulation. To confirm that the needle tip was visualized and not the shaft, needle advancement was paused and 1 ml of saline injected. The appearance of a small anechoic pocket superficial to the subclavian vein helped to visualize the needle tip. Negative aspiration was then re-applied and slight advancement resulted in aspiration of blood and successful subclavian vein puncture. Conclusions: The use of hydrolocation for subclavian vein access was easily implemented, required little modification in setup and technique, and provided improved localization of the needle tip. [ABSTRACT FROM AUTHOR]

Background: In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice. Methods: For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow‐up. Results: PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%. Conclusion: The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy. [ABSTRACT FROM AUTHOR]

The increasing use of 3-dimensional (3D) imaging by orthodontists and maxillofacial surgeons to assess complex dentofacial deformities and plan orthognathic surgeries implies a critical need for 3D cephalometric analysis. Although promising methods were suggested to localize 3D landmarks automatically, concerns about robustness and generalizability restrain their clinical use. Consequently, highly trained operators remain needed to perform manual landmarking. In this retrospective diagnostic study, we aimed to train and evaluate a deep learning (DL) pipeline based on SpatialConfiguration-Net for automatic localization of 3D cephalometric landmarks on computed tomography (CT) scans. A retrospective sample of consecutive presurgical CT scans was randomly distributed between a training/validation set (n = 160) and a test set (n = 38). The reference data consisted of 33 landmarks, manually localized once by 1 operator(n = 178) or twice by 3 operators (n = 20, test set only). After inference on the test set, 1 CT scan showed "very low" confidence level predictions; we excluded it from the overall analysis but still assessed and discussed the corresponding results. The model performance was evaluated by comparing the predictions with the reference data; the outcome set included localization accuracy, cephalometric measurements, and comparison to manual landmarking reproducibility. On the hold-out test set, the mean localization error was 1.0 ± 1.3 mm, while success detection rates for 2.0, 2.5, and 3.0 mm were 90.4%, 93.6%, and 95.4%, respectively. Mean errors were -0.3 ± 1.3° and -0.1 ± 0.7 mm for angular and linear measurements, respectively. When compared to manual reproducibility, the measurements were within the Bland-Altman 95% limits of agreement for 91.9% and 71.8% of skeletal and dentoalveolar variables, respectively. To conclude, while our DL method still requires improvement, it provided highly accurate 3D landmark localization on a challenging test set, with a reliability for skeletal evaluation on par with what clinicians obtain. [ABSTRACT FROM AUTHOR]

Background: Performing spinal anesthesia in elderly patients with spine degeneration is challenging for novice practitioners. This stratified randomized controlled trial aims to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) performed by novice practitioners in elderly patients., Methods: This prospective, single-center, stratified, blocked, parallel randomized controlled trial will include 168 patients (aged ≥ 65 years) scheduled for elective surgery involving spinal anesthesia. All spinal punctures will be performed by anesthesiology interns and residents trained at Huadong Hospital. Patients will be randomly assigned to the MRasp group (n = 84) or the LGsp group (n = 84). Based on each intern/resident's experience in spinal puncture, participants will be stratified into three clusters: the primary group, intermediate group, and advanced group. The primary outcome will be the comparison of the rate of successful first-attempt needle insertion between the MRasp group and the LGsp group. Secondary outcomes will include the number of needle insertion attempts, the number of redirection attempts, the number of passes, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. A stratified subgroup analysis will also be conducted for interns/residents at different experience levels., Discussion: The findings from this trial establish the effectiveness of MRasp by novice practitioners in elderly patients. This trial may provide experimental evidence for exploring an effective visualization technology to assist in spinal puncture., Trial Registration: Chinese Clinical Trials Registry ChiCTR2300075291. Registered on August 31, 2023. https://www.chictr.org.cn/bin/project/edit?pid=189622 ., Competing Interests: Declarations Ethics approval and consent to participate {24} Ethics approval has been obtained from the Medical Ethics Committee of Huadong Hospital affiliated to Fudan University, China (approval no. 20220140, Chairperson Prof Yinghao Sha; date of approval, 1st December 2022) (Additional file 2) and conforms to the principles of the Helsinki Declaration. The investigators will obtain written informed consent (available from the corresponding author) from all participants (Additional file 3). Consent for publication {32} If images of an individual person are used for publication of the trial, written consent will be obtained from that person for the publication of these details. Competing interests {28} The authors declare that they have no competing interests., (© 2024. The Author(s).)

Purpose: The Madrid Posterior Component Separation technique (Madrid PCS) is an approach for abdominal wall reconstruction that leverages anatomical landmarks to optimize outcomes. This manuscript describes ten essential steps for performing the Madrid PCS, focusing on technique, safety, and efficiency., Methods: A comprehensive step-by-step approach is outlined, beginning with the initial incision and adhesiolysis, progressing through retromuscular dissection, and concluding with lateral release and subxiphoid dissection. Emphasis is placed on key anatomical landmarks, tissue planes, and surgical maneuvers critical for each phase. Detailed tips and tricks, challenging scenarios, and potential risks are provided to enhance the reproducibility and safety of the procedure., Results: Applying these ten steps provides an organized and methodical approach to the Madrid PCS. The focus on anatomical landmarks minimizes the risk of complications such as nerve injury, peritoneal tears, and inadvertent organ damage, while ensuring for the optimal placement of prosthetic materials., Conclusion: Adherence to these ten steps, based on anatomical landmarks, significantly improves the safety and effectiveness of the Madrid PCS technique. By understanding the nuances of the procedure, surgeons can achieve consistent and reproducible results in complex abdominal wall reconstructions., Competing Interests: Declarations There are not financial or non-financial interests that are directly or indirectly related to this work. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The iPhone contains a high-fidelity 3-dimensional (3D) scanner and is widely distributed in the United States. Presently, 3D analysis of the breast necessitates ownership of cost-prohibitive cameras and software packages such as the Vectra (Canfield Scientific Inc., Parsippany, NJ) system., Objectives: We compared the accuracy of 3D photographs of the breast obtained with the iPhone X 3D scanner (Apple Inc., Cupertino, CA) with the Canfield Vectra H2 in an effort to expand access to 3D technology in plastic surgery., Methods: Twenty breasts (n = 20) were 3D photographed with the iPhone X and the Vectra H2 and compared by colormap analysis and by measuring distances across the models between key anatomical landmarks. These distances included sternal notch to nipple (SN-N), midchest to nipple (M-N), nipple to midinframammary fold (N-IMF), and inframammary fold width (IMF). Statistical tests included the Bland-Altman plot analysis., Results: When comparing absolute differences in distances between key anatomical landmarks, the average discrepancy in measurements between the iPhone and Vectra image pairs were the following: SN-N: 0.94 mm, M-N: 0.81 mm, N-IMF 0.91 mm, and IMF 0.98 mm. Colormap analysis demonstrated an average error of 1.53 mm, mean of 0.53 mm, and standard deviation of ±1.81 mm. Bland-Altman plot revealed a mean difference of 0.13 mm and an agreement interval between -1.90 and 2.17 mm., Conclusions: The iPhone is capable of capturing 3D photographs with a high level of fidelity when compared with the Vectra. Three-dimensional scans obtained with the iPhone may be helpful for planning nipple position, measuring the breast footprint, choosing implants, and performing other functions with 3D technology that are typically performed with the more expensive systems., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

To achieve precise Couinaud liver segmentation in preoperative planning for hepatic surgery, accommodating the complex anatomy and significant variations, optimizing surgical approaches, reducing postoperative complications, and preserving liver function.This research presents a novel approach to automating liver segmentation by identifying seven key anatomical landmarks using portal venous phase images from contrast-enhanced magnetic resonance imaging (CE-MRI). By employing a multi-task learning framework, we synchronized the detection of these landmarks with the segmentation process, resulting in accurate and robust delineation of the Couinaud segments.To comprehensively validate our model, we included multiple patient types in our test set-those with normal livers, diffuse liver diseases, and localized liver lesions-under varied imaging conditions, including two field strengths, two devices, and two contrast agents. Our model achieved an average Dice Similarity Coefficient (DSC) of 85.29%, surpassing the next best-performing models by 3.12%.Our research presents a pioneering automated approach for segmenting Couinaud segments using CE-MRI. By correlating landmark detection with segmentation, we enhance surgical planning precision. This method promises improved clinical outcomes by accurately adapting to anatomical variability and reducing potential postoperative complications.Clinical impact: The application of this technique in clinical settings is poised to enhance the precision of liver surgical planning. This could lead to more tailored surgical interventions, minimization of operative risks, and preservation of healthy liver tissue, culminating in improved patient outcomes and potentially lowering the incidence of postoperative complications.Clinical and Translational Impact Statement: This research offers a novel automated liver segmentation technique, enhancing preoperative planning and potentially reducing complications, which may translate into better postoperative outcomes in hepatic surgery., (© 2024 The Authors.)

Aim: The purpose of this study was to assess the accuracy of two web-based automated cephalometric landmark identification and analysis programs. Manual landmark identification using Dolphin Imaging software was used as reference., Materials and Methods: 105 cephalograms were selected and divided into three groups of 35 subjects each, Class I, II and III. Radiographs were traced using Dolphin imaging software. WebCeph™ (South Korea) and Cephio™ (Poland) were used for the automated cephalometric analysis. Bland-Altman limits of agreement and the concordance correlation coefficient (CCC) were calculated. Kruskal Wallis test was used to compare the accuracy of WebCeph™ and Cephio™ measurements between the three groups. Mann-Whitney U test was used to compare the absolute difference between cephalometric measurements obtained using WebCeph™ and Cephio™., Results: The mean difference (MD) between AI and manually-derived measurements was less than 1 mm/degree and ranged from 0.01 to 0.8 except for upper lip protrusion (MD 1.35°), nasolabial angle (MD 5.01°), SN-GoGn (MD 1.41°), Ramus height (MD 1.46°), and IMPA (MD 1.94°). The mean CCC was 0.91 (range 0.60 to 0.96). No statistically significant differences were found between the three malocclusion groups for most of the measurements (P > 0.05)., Conclusions: For most of the measurements, automated cephalometric measurements were clinically acceptable. Few differences were found between Webceph™ and Cephio™ for most measurements. Measurements including SNA, SN-PP, IMPA as well as soft tissue measurements require extra consideration and manual adjustment of respective landmarks for higher precision and improved efficiency., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: This study aimed to examine and analyze the presence of sexual dimorphism and symmetry/asymmetry in fixed cadaveric heads and their contributions to clinical practice., Methods: Measurements were conducted on 6 cadavers and 24 fixed cadaveric heads (n = 30) using a digital microcaliper to assess cranial dimensions, including surgical landmarks, facial index (FI), orbital index (OI), and the danger triangle of the face, offering crucial references for surgeons during surgical interventions., Results: Analyses were conducted on cadavers consisting of 10 females (33.3%) and 20 males (66.7%). Males demonstrated significantly higher values than females in terms of Zy-Zy (Zy = Zygion), nasal body, and width/length of the columella. Hyperleptoprosop types were the most frequently observed, followed by the leptoprosop type. Females exhibited megaseme characteristics according to OI on both sides. Additionally, the danger triangle of the face was greater in males compared than in females, suggesting a higher risk of infection in this region among males., Conclusion: The observed sex differences in facial and nasal dimensions, along with facial indices, are crucial for customizing surgical procedures to individual patients. For example, the greater distance in the danger triangle among males highlights the importance of considering anatomical variations to avoid complications, such as septic cavernous sinus thrombosis. Integrating these measurements into preoperative planning can enhance the precision of facial reconstruction and aesthetic surgeries, thereby improving patient outcomes and safety., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Facial approximation is a technique that involves constructing the facial muscles and applying a suitable facial soft tissue depth (FSTD) dataset. To date, several FSTD studies have been conducted for varying population groups. This study aims to establish a FSTD dataset of an adult Greek population sample for the first time. The facial depths of subjects were measured on 100 head CT scans of 50 male and 50 female subjects aged from 18 to 99. The 3D head and skull models of subjects were segmented in Amira 6.1 by using histogram method. FSTDs were measured at 22 cranial landmarks (5 mid-sagittal, 17 bilateral). The FSTD dataset was generated by considering the age and sex of subjects. The impact of age and sex on the FSTD was limited. Slight inter-population depth variations were reported. Facial asymmetry calculated between the bilateral landmarks was insignificant for both male and female subjects., (© 2024. The Author(s).)

Orthognathic surgery primarily corrects skeletal anomalies and malocclusion to enhance facial aesthetics, aiming for an improved facial appearance. However, this traditional skeletal-driven approach may result in undesirable residual asymmetry. To address this issue, a soft tissue-driven planning methodology has been proposed. This technique estimates bone movements based on the envisioned optimal facial appearance, thereby enhancing surgical accuracy and effectiveness. This study investigates the initial implementation phase of the soft tissue-driven approach, simulating the patient's ideal appearance by realigning distorted facial landmarks to an ideal state. The algorithm employs symmetrization and weighted optimization strategies, aligning projected optimal landmarks with standard cephalometric values for both facial symmetry and form, which are essential in orthognathic surgery for facial aesthetics. It also incorporates regularization to preserve the patient's facial characteristics. Validation through retrospective analysis of preoperative patients and normal subjects demonstrates this method's efficacy in achieving facial symmetry, particularly in the lower face, and promoting a natural, harmonious contour. Adhering to soft tissue-driven principles, this novel approach shows promise in surpassing traditional methods, potentially leading to enhanced facial outcomes and patient satisfaction in orthognathic surgery., Competing Interests: Competing interests None., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to investigate the stability of the proximal mandibular reference structures that have been proposed in the literature for superimposition. Forty proximal mandibular segments of 20 patients who underwent bilateral sagittal split osteotomy (BSSO) for advancement were reconstructed from a pair of pre- and postoperative (2 years) cone beam computed tomography scans, and spatially divided into the mandibular condyle, the coronoid process, and 20 mandibular ramus regions. To assess the stability of the anatomical regions, the volumetric and surface discrepancy between the superimposed pre- and postoperative regions were calculated. One-sample t-tests were applied to analyse the statistical stability of the individual regions. Two statistically stable (P < 0.05) structures in the proximal segment of the mandible following BSSO were identified: (1) the posterior part of the mandibular ramus above the gonial angle and below the condylar neck, and (2) the sub-coronoid area below the coronoid process/mandibular notch. Using these stable structures for superimposition resulted in an assessment discrepancy in the condylar displacement of up to 1.1 mm and in the volumetric change of up to 2.8%. Hence, it is suggested that these two identified stable structures are used as reference areas when assessing condylar displacement and change using superimposition., Competing Interests: Competing interests None. Competing Interests No competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: No definitive procedures have been proposed for orbital floor fractures extending to the slope of the posterior end, which is a challenging problem. This study demonstrates the effectiveness of an orbital reconstruction procedure based on anatomical landmarks that we developed, called the three landmarks procedure (TLP)., Methods: This study is a single-center retrospective cohort study conducted by the Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital. Data were collected from April 2000 to December 2023. The effect of TLP and the balloon procedure (BP) on ocular movement was compared. The prevalence of postoperative enophthalmos after TLP was examined., Results: The study included 17 patients who underwent TLP and 25 patients who underwent BP. Postoperative mean Hess area ratio (HAR%) was 98.3 (95% confidence interval (CI), 97.0-99.6) in the TLP group and 88.6 (95% CI 83.2-94.0) in the BP group. Among study patients with fractures extending to the posterior slope, 14 underwent TLP and 16 underwent BP. Postoperative mean HAR% was 98.5 (95% CI 97.3-99.7) in the TLP group and 89.2 (95% CI 82.4-95.8) in the BP group. Among all patients who underwent TLP, mean postoperative enophthalmos was 0.06 mm (95% CI - 0.32 to 0.44). It was 0.14 mm (95% CI - 0.31 to 0.59) among patients with fractures extending to the posterior slope., Conclusion: TLP resulted in better postoperative ocular movements than BP. Furthermore, TLP is an effective technique for treating fractures extending to the posterior slope, which are challenging to reconstruct., (© 2024. The Author(s).)

To compare lower lip changes after Le Fort I advancement surgery in patients with a cleft., Single institution, retrospective review., Academic tertiary referral hospital., Skeletally mature patients with a cleft who underwent one-piece Le Fort I advancement surgery who had a lateral cephalogram or cone-beam computed tomography (CBCT) scan preoperatively and at least 6 months postoperatively. Patients who underwent concomitant mandibular surgery or genioplasty were excluded. 64 patients were included: 45 male and 19 female, 25 with BCLP and 39 with UCLP. The mean age at surgery was 18.4 years., Single jaw one-piece Le Fort I advancement surgery., Standard lateral cephalometric landmarks of the bony skeleton and soft tissue were compared before and after Le Fort I advancement. Pearson correlation coefficients (r) were calculated to measure the correlation between lower lip position and other soft and hard tissue changes., After comparable maxillary advancements [BCLP: 7.2 mm (95% CI: 6.2-8.3 mm), UCLP: 6.4 mm (95% CI: 5.7-7.0 mm)] the horizontal upper-to-lower lip discrepancy significantly improved in both groups. The lower lip became thinner and more posteriorly positioned. Changes in lower lip position correlated strongly with mandibular bony landmarks and moderately with upper lip position, but poorly with maxillary landmarks., Le Fort I advancement results in posterior displacement of the lower lip and better lip competence, thereby improving facial harmony. This lower lip change is not predictable by degree of maxillary advancement, and does not differ in patients with BCLP vs. UCLP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: It is necessary to determine whether the sequence of maxillary and mandibular surgeries in bimaxillary orthognathic surgery affects the accuracy of surgical outcomes., Purpose: The study aimed to measure and compare the accuracy among patients who underwent maxilla-first versus mandible-first bimaxillary surgery to correct a class III skeletal pattern., Study Design, Setting, Sample: This retrospective cohort study included consecutive patients treated by a single surgeon at one center using Le Fort I and bilateral sagittal split osteotomy surgery. Exclusions included patients scheduled for one-jaw or maxilla-segmental surgery and those with craniofacial syndromes, such as clefts., Predictor Variable: The predictor variable was operative sequence for bimaxillary operations, divided into maxilla- or mandible-first groups., Outcome Variable: The outcome variable was accuracy, measured using linear discrepancies between landmarks in the virtual plan and actual operative outcomes. The measurement of linear discrepancy that was closer to 0 was considered the more accurate result., Covariates: Sex, age, maxilla sagittal rotation degree, amount of posterior maxilla impaction, mandibular autorotation (°), and intermediate splint thickness (mm) were the covariates., Analyses: Statistical analysis was performed using Student's t-test and Pearson's correlation, with statistical significance set at P < .05., Results: The sample comprised 60 patients with a mean age of 22.8 ± 3.7 years, of whom 36 (60%) were male. In the maxilla-first group, there were 30 subjects (60% male; mean age: 23.1 ± 4.2 years), with a mean mandibular autorotation of 0.41° (range: 0°-2.5°). The mandible-first group comprised 30 patients (60% male; mean age: 22.6 ± 3.3 years), with a mean mandibular autorotation of 5.46° (range: 1.9°-9.2°). The linear discrepancies for all landmarks did not significantly differ between mandible- and maxilla-first groups (P > .18). The mean three-dimensional discrepancies for all landmarks in maxilla-first group was 1.23 ± 0.5 mm and 1.23 ± 0.33 mm in mandible-first group, with no significant difference observed between the groups (P > .98). The amount of mandibular autorotation for intermediate splint application showed no significant correlation with the linear discrepancies (P > .58)., Conclusion and Relevance: In patients with skeletal class III malocclusion, mandible-first surgery in bimaxillary orthognathic surgery demonstrates accurate outcomes comparable to maxilla-first surgery., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The cannulation of the arteriovenous fistula (AVF) for hemodialysis (HD) has traditionally depended on the nurse's tactile sensation, which has been associated with suboptimal needle placement and detrimental effects on vascular access (VA) longevity. While the introduction of ultrasound (US) has proven beneficial in mapping the AVF outflow vein and assisting in cannulation planning, aneurysmal deformations remain a common occurrence resulting from various factors, including inadequate cannulation techniques. Within this context, the utilization of skin pigmentation as a clinical landmark has emerged as a potential approach to enhance cannulation planning in HD., Methods: A prospective longitudinal study was undertaken to investigate the correlation between the occurrence of venous morphological deformations and the cannulation technique guided by skin pigmentation after a 2-month period of implementation., Results: Thirty patients were enrolled in the study with 433 cannulations being described within the first 2 months of AVF use. The overall rate of cannulation-related adverse events was 21.9%. Comparative analysis demonstrated a statistically significant relationship ( p  < 0.001) between aneurysmal deformation and non-compliance with the proposed cannulation technique, resulting in cannulation outside the designated points. Non-compliance was primarily attributed to nurse's decision (57.1%)., Conclusion: The integration of US mapping of the AVF outflow vein and the utilization of skin pigmentation as a guiding tool have shown promising results in enhancing cannulation planning over time. Consistent adherence to a cannulation technique other than the area technique has been found to reduce the risk of AVF morphological deformation. These findings underscore the potential benefits of incorporating skin pigmentation as a clinical landmark in cannulation practices, highlighting its ability to impact positively cannulation outcomes., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.