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Treat RM, Hsiao SK, Ismail A, Javan R. The US Government's Latest Presidential Executive Order on Artificial Intelligence: Potential Implications in Radiology. J Am Coll Radiol 2024:S1546-1440(24)00355-7. [PMID: 38599359 DOI: 10.1016/j.jacr.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Affiliation(s)
| | - Sabrina Kelly Hsiao
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ahmed Ismail
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ramin Javan
- Associate Professor of Radiology; Director of Advanced Brain Imaging, GenAI and 3D Innovations Lab; and Medical Student Radiology Clerkship Director, Department of Radiology, George Washington University Hospital, Washington, DC.
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Ismail A, Javan R. Reply to "New Horizons: The Potential Role of OpenAI's ChatGPT in Clinical Radiology". J Am Coll Radiol 2024; 21:547-548. [PMID: 38052353 DOI: 10.1016/j.jacr.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Ahmed Ismail
- George Washington University of Health Sciences and Medicine, Washington, DC
| | - Ramin Javan
- Director of Advanced Brain Imaging and 3D Innovations Lab and Medical Student Radiology Clerkship Director.
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Javan R, Mostaghni N. AI-powered Hyperrealism: Next Step in Cinematic Rendering? Radiology 2024; 310:e231971. [PMID: 38289206 DOI: 10.1148/radiol.231971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Recent advancements in artificial intelligence (AI)-powered image generation present opportunities to enhance three-dimensional medical images. Diffusion, an iterative denoising process, represents the standard of many of the current tools used for this purpose. Purpose To demonstrate the current capabilities of diffusion technology by using Midjourney, version 5.2, a text-to-image generative AI tool, and present a practical guide for its use. Materials and Methods This exploratory study investigates the principles, parameters, and prompt engineering techniques for generating images focusing on Midjourney from July 27 to August 3, 2023. Step-by-step instructions show the innate capability of this technology in creating realistic medical images. Results Thirty images were selected, including eye, skin, and vascular aneurysm images. Varying prompt phrasing and weighting techniques allowed for the customization of output image characteristics. Although the details of Midjourney's model training are confidential, it is estimated that it was trained on at least hundreds of millions of images from the web. Anatomic fidelity was not always maintained because the training data set is not necessarily based on accurate medical images. There are shortcomings in this nascent technology regarding its ability to create entities such as digits of the hand or precise text. Conclusion AI image generation has the potential to improve three-dimensional medical images for certain applications through added visual detail and appeal but ongoing collaboration is needed between radiologists and AI developers due to the overreliance on art and photography in the training data, which may result in inaccurate anatomic results. Moreover, the evolving landscape of ethical discussions and copyright stipulations warrants close attention. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Ramin Javan
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC 20037 (R.J.); and California University of Science and Medicine School of Medicine, Colton, Calif (N.M.)
| | - Navid Mostaghni
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC 20037 (R.J.); and California University of Science and Medicine School of Medicine, Colton, Calif (N.M.)
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Melnyk O, Ismail A, Ghorashi NS, Heekin M, Javan R. Generative Artificial Intelligence Terminology: A Primer for Clinicians and Medical Researchers. Cureus 2023; 15:e49890. [PMID: 38174178 PMCID: PMC10762565 DOI: 10.7759/cureus.49890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Generative artificial intelligence (AI) is rapidly transforming the medical field, as advanced tools powered by large language models (LLMs) make their way into clinical practice, research, and education. Chatbots, which can generate human-like responses, have gained attention for their potential applications. Therefore, familiarity with LLMs and other promising generative AI tools is crucial to harness their potential safely and effectively. As these AI-based technologies continue to evolve, medical professionals must develop a strong understanding of AI terminologies and concepts, particularly generative AI, to effectively tackle real-world challenges and create solutions. This knowledge will enable healthcare professionals to utilize AI-driven innovations for improved patient care and increased productivity in the future. In this brief technical report, we explore 20 of the most relevant terminology associated with the underlying technology behind LLMs and generative AI as they relate to the medical field and provide some examples of how these topics relate to healthcare applications to help in their understanding.
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Affiliation(s)
- Oleksiy Melnyk
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Ahmed Ismail
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Nima S Ghorashi
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Mary Heekin
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - Ramin Javan
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington D.C., USA
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Ghorashi NS, Rahimi M, Sirous R, Javan R. The Intersection of Radiology With Blockchain and Smart Contracts: A Perspective. Cureus 2023; 15:e46941. [PMID: 38021752 PMCID: PMC10640909 DOI: 10.7759/cureus.46941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Although blockchain technology and smart contracts are garnering attention in various sectors, their applications and familiarity within the realm of radiology remain largely unexplored. Blockchain, a decentralized digital ledger technology, offers secure, transparent, and resilient data management by distributing the verification process across a network of independent entities. This decentralized technology presents a possible solution for a range of healthcare challenges, from secure data transfer to automated verification processes. To address such challenges in the context of medical imaging, blockchain could provide different approaches, including smart contracts, machine learning algorithms, and the secure dissemination of large files among key stakeholders such as patients, healthcare providers, and institutions. This manuscript aims to explore the current attitudes and perspectives of trainees and radiologists to the utilization of blockchain technology and smart contracts in clinical radiology. Additionally, the study provides an in-depth analysis of the potential applications for incorporating blockchain into radiology. METHODS After obtaining The George Washington University Committee on Human Research Institutional Review Board (IRB) approval, we conducted a 10-question survey among radiologists and trainees at several institutions and private practices. Surveys were created via the Google Forms application and were emailed to potential participants. Participants were asked about their current academic level (medical student, resident/fellow, academic radiologist, private practice radiologist, others), their knowledge level about the field of imaging informatics and blockchain and smart contract technologies, their level of interest in learning more about blockchain and smart contracts, and their opinion about possible applications of blockchain and smart contract in the future of medical imaging. RESULTS A total of 118 survey requests were distributed; 83 were returned, reflecting a 70.3% overall response rate. Of these, 19 were sent to private practices with a 15.8% response rate (3/19), and 99 to academic centers, yielding an 80.8% response rate (80/99). The survey respondents demonstrated a strong interest and need to further understand these technologies among radiologists and trainees. This study focuses on key components of this technology as it relates to healthcare and the practice of radiology, including data storage, patient care, secure communication, and automation, as well as strengths, weaknesses, opportunities, and threats (SWOT) analysis. DISCUSSION To our knowledge, this is the first study to investigate and establish a baseline for the current perspectives on the application of blockchain technology and smart contracts in clinical radiology amongst trainees and radiologists across academic and private settings. Incorporating blockchain and smart contracts technologies into the field of radiology has the potential to achieve greater efficiency, security, and patient empowerment. However, the adoption of this technology comes with challenges, such as infrastructure, interoperability, scalability, and regulatory compliance. Collaboration between radiologists, hospital administration, policymakers, technology developers, and patient advocacy organizations will help guide and advance our understanding of the potential applications of blockchain and smart contracts in radiology and healthcare.
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Affiliation(s)
- Nima S Ghorashi
- Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Murwarit Rahimi
- Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Reza Sirous
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
- Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Ramin Javan
- Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
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Barkovich EJ, Batheja V, Hong T, Rao J, Javan R. Pearls and pitfalls in emergency CT neuroangiography through the lens of bias and error. Emerg Radiol 2023; 30:525-537. [PMID: 37291368 DOI: 10.1007/s10140-023-02143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023]
Abstract
Computed tomography angiography (CTA) of the head and neck is central in emergency department (ED) evaluation of clinically suspected acute stroke and intracranial hemorrhage. Timely and accurate detection of acute findings is crucial for best clinical outcomes; missed or delayed diagnosis can be devastating. Our pictorial essay presents twelve CTA cases that provided significant diagnostic dilemmas to on-call trainees while reviewing current bias and error classifications in radiology. Among others, we discuss anchoring, automation, framing, satisfaction of search, scout neglect and zebra-retreat bias. Each imaging vignette depicts a potential diagnostic "pitfall" while introducing types of cognitive bias/error before concluding with a concrete "pearl" for CTA interpretation. We believe that familiarity with bias and error is particularly important in the ED setting where high case volume, high acuity and radiologist fatigue intersect. Particular attention to personal cognitive biases and these potential CTA pitfalls may help emergency radiologists transition from habit-driven pattern recognition to analytical thinking, ultimately improving diagnostic decision making.
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Affiliation(s)
- Emil Jernstedt Barkovich
- Dept of Radiology, George Washington University Hospital, 900 23rd St NW First Floor, Washington, DC, 20037, USA.
| | - Vivek Batheja
- George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Thomas Hong
- George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Jhanavi Rao
- Dept of Radiology, George Washington University Hospital, 900 23rd St NW First Floor, Washington, DC, 20037, USA
| | - Ramin Javan
- Dept of Radiology, George Washington University Hospital, 900 23rd St NW First Floor, Washington, DC, 20037, USA
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Ghorashi N, Ismail A, Ghosh P, Sidawy A, Javan R. AI-Powered Chatbots in Medical Education: Potential Applications and Implications. Cureus 2023; 15:e43271. [PMID: 37692629 PMCID: PMC10492519 DOI: 10.7759/cureus.43271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Artificial intelligence (AI) is anticipated to have a considerable impact on the routine practice of medicine, spanning from medical education to clinical practice across specialties and, ultimately, patient care. With the imminent widespread adoption of AI in medical practice, it is imperative that medical schools adapt to the use of these advanced technologies in their curriculum to produce future healthcare professionals who can seamlessly integrate these tools into practice. Chatbots, AI systems programmed to process and generate human language, are currently being evaluated for various tasks in medical education. This paper explores the potential applications and implications of chatbots in medical education, specifically in learning and research. With their capability to summarize, simplify complex concepts, automate the creation of memory aids, and serve as an interactive tutor and point-of-care medical reference, chatbots have the potential to enhance students' comprehension, retention, and application of medical knowledge in real-time. While the integration of AI-powered chatbots in medical education presents numerous advantages, it is crucial for students to use these tools as assistive tools rather than relying on them entirely. Chatbots should be programmed to reference evidence-based medical resources and produce precise and trustworthy content that adheres to medical science standards, scientific writing guidelines, and ethical considerations.
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Affiliation(s)
- Nima Ghorashi
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Ahmed Ismail
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Pritha Ghosh
- Department of Neurology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Anton Sidawy
- Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Ramin Javan
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, USA
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Javan R, Mostaghni N. From Canvas to Screen: Resurrecting Artists of the Past. Radiology 2023; 308:e231118. [PMID: 38363850 DOI: 10.1148/radiol.231118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Ramin Javan
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC 20037 (R.J.); and California University of Science and Medicine School of Medicine, Colton, Calif (N.M.)
| | - Navid Mostaghni
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC 20037 (R.J.); and California University of Science and Medicine School of Medicine, Colton, Calif (N.M.)
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Ismail A, Ghorashi NS, Javan R. New Horizons: The Potential Role of OpenAI's ChatGPT in Clinical Radiology. J Am Coll Radiol 2023; 20:696-698. [PMID: 36972862 DOI: 10.1016/j.jacr.2023.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/28/2023]
Affiliation(s)
- Ahmed Ismail
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nima S Ghorashi
- George Washington University School of Medicine and Health Sciences, Washington, DC, and Radiology Interest Group President
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, Washington, DC, and Director of Advanced Brain Imaging and 3D Innovations Lab and Medical Student Radiology Clerkship Director.
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Park I, Joshi AS, Javan R. Potential role of ChatGPT in clinical otolaryngology explained by ChatGPT. Am J Otolaryngol 2023; 44:103873. [PMID: 37004317 DOI: 10.1016/j.amjoto.2023.103873] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Isabel Park
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Arjun S Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, Washington, DC, USA
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Abstract
ChatGPT, a large language model by OpenAI, has been adopted in various domains since its release in November 2022, but its application in ophthalmology remains less explored. This editorial assesses ChatGPT's potential applications and limitations in ophthalmology across clinical, educational, and research settings. In clinical settings, ChatGPT can serve as an assistant, offering diagnostic and therapeutic suggestions based on patient data and assisting in patient triage. However, its tendencies to generate inaccurate results and its inability to keep up with recent medical guidelines render it unsuitable for standalone clinical decision-making. Data security and compliance with the Health Insurance Portability and Accountability Act (HIPAA) also pose concerns, given ChatGPT's potential to inadvertently expose sensitive patient information. In education, ChatGPT can generate practice questions, provide explanations, and create patient education materials. However, its performance in answering domain-specific questions is suboptimal. In research, ChatGPT can facilitate literature reviews, data analysis, manuscript development, and peer review, but issues of accuracy, bias, and ethics need careful consideration. Ultimately, ensuring accuracy, ethical integrity, and data privacy is essential when integrating ChatGPT into ophthalmology.
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Affiliation(s)
- Jason Dossantos
- Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Jella An
- Ophthalmology, Johns Hopkins University School of Medicine Wilmer Eye Institute, Baltimore, USA
| | - Ramin Javan
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, USA
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Javan R, Kim T, Mostaghni N, Sarin S. ChatGPT's Potential Role in Interventional Radiology. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03448-4. [PMID: 37127733 DOI: 10.1007/s00270-023-03448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23Rd St NW, Suite G2092, Washington, DC, 20037, USA.
| | - Theodore Kim
- George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, USA
| | - Navid Mostaghni
- School of Medicine, California University of Science and Medicine, Colton, CA, 92324, USA
| | - Shawn Sarin
- Department of Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
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Harris P, Fleisher M, Liu M, Javan R, Olan W, Rosner M. An Unusual Case of Neurenteric Cyst in a Patient with Split Cord Malformation. J Neurol Surg Rep 2023; 84:e37-e39. [PMID: 37009202 PMCID: PMC10063386 DOI: 10.1055/s-0043-1764460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 01/26/2023] [Indexed: 04/04/2023] Open
Abstract
Neurenteric cyst in a split cord malformation is a rare finding. We report an adult female becoming acutely symptomatic secondary to an expanding neurenteric cyst, though previous imaging had demonstrated stability. We discuss our workup and management with surgical resection and possible etiologies of her acute decline.
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Affiliation(s)
- Peter Harris
- Department of Neurosurgery, George Washington University Hospital, Washington, District of Columbia, United States
- Address for correspondence Peter Harris, MD Department of Neurosurgery, George Washington University Hospital
2150 Pennsylvania Avenue, 7
Floor, Washington, DC 20037
United States
| | - Max Fleisher
- Department of Neurosurgery, George Washington University Hospital, Washington, District of Columbia, United States
| | - Matthew Liu
- Department of Radiology, George Washington University Hospital, Washington, District of Columbia, United States
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, Washington, District of Columbia, United States
| | - Wayne Olan
- Department of Neurosurgery, George Washington University Hospital, Washington, District of Columbia, United States
| | - Michael Rosner
- Department of Neurosurgery, George Washington University Hospital, Washington, District of Columbia, United States
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Rehman M, Arsenault L, Javan R. Organs in Color: Utilizing Free Software and Emerging Multi Jet Fusion Technology to Color and Surface Label 3D-Printed Anatomical Models. J Digit Imaging 2022; 35:1611-1622. [PMID: 35711071 PMCID: PMC9712840 DOI: 10.1007/s10278-022-00656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/30/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
Abstract
3D printing (3DP) is a rapidly evolving innovative technology that has already been utilized for the development of educational anatomic models. Until recently, it was difficult and tedious to create multi-colored models and especially labels due to technological constraints. In this technical note, a comprehensive guide for creating labeled and color-coded anatomic models was created using free software, Blender. We have composed a step-by-step process for taking an existing 3D model and adding labeling and color that is compatible with modern high-quality 3D printing technologies (Multi Jet Fusion). We provided colored and labeled 3D renderings of the surface anatomy of the brain, ventricular system of the brain, the segments of the liver, and coronary arteries as examples of the diverse potential of this technology. Additionally, we 3D printed actual models of the surface anatomy of the brain and ventricles of the brain using HP Multi Jet Fusion to demonstrate the potential of this technology in the creation of anatomic models.
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Affiliation(s)
- Muhammad Rehman
- George Washington University of Health Sciences and School of Medicine, Washington, DC 20037 USA
| | - Lauren Arsenault
- George Washington University of Health Sciences and School of Medicine, Washington, DC 20037 USA
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC 20037 USA
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Fleming C, Yepuri A, Watane G, Salman A, Desai S, Zeman M, Javan R. Effectiveness of a conceptual three-dimensionally printed model of the middle ear in teaching complex neuroanatomy to radiology trainees. Annals of 3D Printed Medicine 2022. [DOI: 10.1016/j.stlm.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Johnson DR, Glenn CA, Javan R, Olson JJ. Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of imaging in the management of progressive glioblastoma in adults. J Neurooncol 2022; 158:139-165. [PMID: 34694565 DOI: 10.1007/s11060-021-03853-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/21/2021] [Indexed: 12/27/2022]
Abstract
TARGET POPULATION These recommendations apply to adults with glioblastoma who have been previously treated with first-line radiation or chemoradiotherapy and who are suspected of experiencing tumor progression. QUESTION In patients with previously treated glioblastoma, is standard contrast-enhanced magnetic resonance imaging including diffusion weighted imaging useful for diagnosing tumor progression and differentiating progression from treatment-related changes? LEVEL II Magnetic resonance imaging with and without gadolinium enhancement including diffusion weighted imaging is recommended as the imaging surveillance method to detect the progression of previously diagnosed glioblastoma. QUESTION In patients with previously treated glioblastoma, does magnetic resonance spectroscopy add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement? LEVEL II Magnetic resonance spectroscopy is recommended as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma. QUESTION In patients with previously treated glioblastoma, does magnetic resonance perfusion add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement? LEVEL III Magnetic resonance perfusion is suggested as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma. QUESTION In patients with previously treated glioblastoma, does the addition of single-photon emission computed tomography (SPECT) provide additional useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement? LEVEL III Single-photon emission computed tomography imaging is suggested as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma. QUESTION In patients with previously treated glioblastoma, does 18F-fluorodeoxyglucose positron emission tomography add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement? LEVEL III The routine use of 18F-fluorodeoxyglucose positron emission tomography to identify progression of glioblastoma is not recommended. QUESTION In patients with previously treated glioblastoma, does positron emission tomography with amino acid agents add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement? LEVEL III It is suggested that amino acid positron emission tomography be considered to assist in the differentiation of progressive glioblastoma from treatment related changes.
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Affiliation(s)
- Derek Richard Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Chad Allan Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ramin Javan
- Department of Neuroradiology, George Washington University Hospital, Washington, DC, USA
| | - Jeffrey James Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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Javan R, Rao A, Jeun BS, Herur-Raman A, Singh N, Heidari P. From CT to 3D Printed Models, Serious Gaming, and Virtual Reality: Framework for Educational 3D Visualization of Complex Anatomical Spaces From Within-the Pterygopalatine Fossa. J Digit Imaging 2021; 33:776-791. [PMID: 31916019 DOI: 10.1007/s10278-019-00315-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We describe the framework for capturing the internal view of complex anatomical spaces via multiple media and haptic platforms, exemplified by realistic and conceptual representations of the pterygopalatine fossa (PPF). A realistic three-dimensional (3D) mesh of the PPF was developed by segmenting the osseous anatomy on computed tomography (CT) using Materialize InPrint. Subsequently in Autodesk 3D Studio Max, the realistic mesh was enhanced with graphically designed neurovascular anatomy and additionally a conceptual representation of the PPF with its connections and contents was created. An interactive web-compatible Adobe Flash tutorial using ActionScript was developed, allowing users to advance through a series of educational slides that contained interactive rotatable interior camera views and scrollable CT cross-sectional content, incorporating both the realistic and conceptual models. Both models were also 3D printed using polyamide material. In the realistic model, the neurovasculature was colored with water-based acrylic paint. A 3-piece modular design with embedded magnets allows for internal visualization and seamless assembly. A serious gaming environment of the conceptual PPF was also developed using Truevision3D application programming interface, where users can freely move around rooms and hallways that represent various spaces. Lastly, the realistic model was incorporated into a headset-based virtual reality environment, Surgical Theater, allowing visualization and fly-through inside and outside the model. Multiple 3D techniques for visualization of complex 3D anatomical spaces from within were described, with the necessary software and skills detailed. A rough estimate of the time and cost needed to develop these tools as well as multiple supplementary source and end result files are also made available. Educators could utilize multiple advanced delivery methods to incorporate custom digital 3D models of complex anatomical spaces understood from inside.
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Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
| | - Aditya Rao
- Department of Radiology, Yale New Haven Hospital, New Haven, CT, USA
| | - Bryan S Jeun
- Department of Radiology, Cox Medical Center South, Springfield, MO, USA
| | | | - Neha Singh
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.,Department of Radiology, University of Pittsburg Medical Center, Pittsburgh, PA, USA
| | - Parisa Heidari
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.,Department of Neurology, George Washington University Hospital, Washington, DC, USA
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Javan R, Schickel M, Zhao Y, Agbo T, Fleming C, Heidari P, Gholipour T, Shields DC, Koubeissi M. Using 3D-Printed Mesh-Like Brain Cortex with Deep Structures for Planning Intracranial EEG Electrode Placement. J Digit Imaging 2021; 33:324-333. [PMID: 31512018 DOI: 10.1007/s10278-019-00275-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Surgical evaluation of medically refractory epilepsy frequently necessitates implantation of multiple intracranial electrodes for the identification of the seizure focus. Knowledge of the individual brain's surface anatomy and deep structures is crucial for planning the electrode implantation. We present a novel method of 3D printing a brain that allows for the simulation of placement of all types of intracranial electrodes. We used a DICOM dataset of a T1-weighted 3D-FSPGR brain MRI from one subject. The segmentation tools of Materialise Mimics 21.0 were used to remove the osseous anatomy from brain parenchyma. Materialise 3-matic 13.0 was then utilized in order to transform the cortex of the segmented brain parenchyma into a mesh-like surface. Using 3-matic tools, the model was modified to incorporate deep brain structures and create an opening in the medial aspect. The final model was then 3D printed as a cerebral hemisphere with nylon material using selective laser sintering technology. The final model was light and durable and reflected accurate details of the surface anatomy and some deep structures. Additionally, standard surgical depth electrodes could be passed through the model to reach deep structures without damaging the model. This novel 3D-printed brain model provides a unique combination of visualizing both the surface anatomy and deep structures through the mesh-like surface while allowing repeated needle insertions. This relatively low-cost technique can be implemented for interdisciplinary preprocedural planning in patients requiring intracranial EEG monitoring and for any intervention that requires needle insertion into a solid organ with unique anatomy and internal targets.
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Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA. .,George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | | | - Yuanlong Zhao
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Terry Agbo
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Cullen Fleming
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Parisa Heidari
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
| | - Taha Gholipour
- Department of Neurology, George Washington University Hospital, Washington, DC, USA
| | - Donald C Shields
- Department of Neurosurgery, George Washington University Hospital, Washington, DC, USA
| | - Mohamad Koubeissi
- Department of Neurology, George Washington University Hospital, Washington, DC, USA
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Shu L, Bahri F, Mostaghni N, Yu G, Javan R. The Time Has Come: a Paradigm Shift in Diagnostic Radiology Education via Simulation Training. J Digit Imaging 2020; 34:212-227. [PMID: 33269448 DOI: 10.1007/s10278-020-00405-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/22/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Current radiology training for medical students and residents predominantly consists of reviewing teaching files, attending lectures, reading textbooks and online sources, as well as one-on-one teaching at the workstation. In the case of medical schools, radiology training is quite passive. In addition, the variety of important and high-yield cases that trainees are exposed to may be limited in scope. We utilized an open-source dcm4chee-based Picture Archiving and Communication System (PACS) named "Weasis" in order to simulate a radiologist's practice in the real world, using anonymized report-free complete cases that could easily be uploaded live during read-outs for training purposes. MySQL was used for database management and JBOSS as application server. In addition, we integrated Weasis into a web-based reporting system through Java programming language using the MyEclipse development environment. A freeware, platform-independent, image database was established to simulate a real-world PACS. The sever was implemented on a dedicated non-workstation PC connected to the hospital secure network. As the client access is through a webpage, the cases can be viewed from any computer connected to the hospital network. The reporting system allows for evaluation purposes and providing feedback to the trainees. Brief survey results are available. Implementation of such a low-cost, versatile, and customizable tool provides a new opportunity for training programs in offering medical students with an active and more realistic radiology experience, junior radiology residents with potentially better preparation for independent call, and senior resident and fellows with the ability to fine-tune high-level specialty-level knowledge.
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Affiliation(s)
- Liqi Shu
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Faraien Bahri
- Department of Radiology, Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Navid Mostaghni
- Department of Otolaryngology, University of California, Irvine, CA, USA
| | - Gang Yu
- Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310053, Zhejiang, China
- National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou, 310053, Zhejiang, China
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
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Fleming C, Sadaghiani MS, Stellon MA, Javan R. Effectiveness of Three-Dimensionally Printed Models in Anatomy Education for Medical Students and Resident Physicians: Systematic Review and Meta-Analysis. J Am Coll Radiol 2020; 17:1220-1229. [PMID: 32603662 DOI: 10.1016/j.jacr.2020.05.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Despite a surge in the use of three-dimensional printing (3DP) in medical education, a comprehensive evaluation of randomized trials in its effectiveness is lacking. Radiologic studies play an integral role in affording educators the ability to create customized realistic anatomic models. This systematic review and meta-analysis sought to assess the effect of 3DP versus traditional 2-D methods for anatomy education. METHODS PubMed, Scopus, Cochrane Library, ERIC, and IEEE Xplore were queried to identify randomized controlled trials that quantitatively investigated anatomy education via postintervention assessments of medical students or resident physicians who were exposed to 3DP versus traditional methods. Criteria for the meta-analysis required that studies additionally included a pre-intervention assessment. RESULTS A total of 804 articles were reviewed, identifying 8 and 7 studies for systematic reviews of medical students and resident physicians, respectively, of which 4 and 7 were included in the meta-analyses. 3DP models were associated with higher anatomy examination scores for medical students (P < .0001), but for resident physicians were statistically not significant (P = .53). DISCUSSION The 3DP models are shown to positively impact medical students especially given their limited fund of knowledge in anatomy. It is postulated that the lack of a statistically significant result for the resident physicians was multifactorial, in part because of the small test group sizes introducing noise and nonrepresentative samples, as well as relative simplicity of the 3DP models used with resident physicians, which were below their level of training. More trials are required to evaluate the usefulness of highly customized 3DP models.
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Affiliation(s)
- Cullen Fleming
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Michael A Stellon
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ramin Javan
- George Washington University Hospital, Department of Radiology, Washington, DC.
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Abstract
A 60-year-old woman was referred to the otolaryngologist for 18 months of left-sided tongue pain and taste changes. Surgeon-performed ultrasound of the submandibular region revealed a hyperechoic mass. Wharton's duct was dilated proximally and the submandibular gland demonstrated normal vascularity. While these findings were highly suspicious for submandibular gland sialolith, an in-office attempt at sialolithotomy suggested an alternate process or mass. After imaging failed to further elucidate an aetiology, surgical exploration revealed a well-circumscribed submandibular mass associated with the lingual nerve. The mass was removed en-bloc and pathology revealed a schwannoma of the lingual nerve.
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Affiliation(s)
- Alexander J Straughan
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Christopher Badger
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ramin Javan
- Division of Neuroradiology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andrew Fuson
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Arjun S Joshi
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Gibby J, Cvetko S, Javan R, Parr R, Gibby W. Use of augmented reality for image-guided spine procedures. Eur Spine J 2020; 29:1823-1832. [DOI: 10.1007/s00586-020-06495-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/07/2020] [Accepted: 05/31/2020] [Indexed: 12/14/2022]
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DeVeau KM, Brown KM, Spencer M, Javan R, Fleming C. Evaluating the Use of 3D Printed Models in Graduate and Undergraduate Human Neuroanatomy Courses. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.03498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Javan R, Ellenbogen AL, Greek N, Haji-Momenian S. A prototype assembled 3D-printed phantom of the glenohumeral joint for fluoroscopic-guided shoulder arthrography. Skeletal Radiol 2019; 48:791-802. [PMID: 29948036 DOI: 10.1007/s00256-018-2979-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the methodology of constructing a three-dimensional (3D) printed model of the glenohumeral joint, to serve as an interventional phantom for fluoroscopy-guided shoulder arthrography training. MATERIALS AND METHODS The osseous structures, intra-articular space and skin surface of the shoulder were digitally extracted as separate 3D meshes from a normal CT arthrogram of the shoulder, using commercially available software. The osseous structures were 3D-printed in gypsum, a fluoroscopically radiopaque mineral, using binder jet technology. The joint capsule was 3D printed with rubber-like TangoPlus material, using PolyJet technology. The capsule was secured to the humeral head and glenoid to create a sealed intra-articular space. A polyamide mold of the skin was printed using selective laser sintering. The joint was stabilized inside the mold, and the surrounding soft tissues were cast in silicone of varying densities. Fluoroscopically-guided shoulder arthrography was performed using anterior, posterior, and rotator interval approaches. CT arthrographic imaging of the phantom was also performed. RESULTS A life-size phantom of the glenohumeral joint was constructed. The radiopaque osseous structures replicated in-vivo osseous corticomedullary differentiation, with dense cortical bone and less dense medullary cancellous bone. The glenoid labrum was successfully integrated into the printed capsule, and visualized on CT arthrography. The phantom was repeatedly used to perform shoulder arthrography using all three conventional approaches, and simulated the in vivo challenges of needle guidance. CONCLUSIONS 3D printing of a complex capsule, such as the glenohumeral joint, is possible with this technique. Such a model can serve as a valuable training tool.
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Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
| | - Amy L Ellenbogen
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
| | - Nicholas Greek
- Clinical Learning and Simulation Skills (CLASS) Center, George Washington University School of Medicine, 2300 I (Eye) Street, NW, Ross Hall 405, Washington, DC, USA
| | - Shawn Haji-Momenian
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
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Gibby JT, Swenson SA, Cvetko S, Rao R, Javan R. Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography. Int J Comput Assist Radiol Surg 2018; 14:525-535. [PMID: 29934792 DOI: 10.1007/s11548-018-1814-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Augmented reality has potential to enhance surgical navigation and visualization. We determined whether head-mounted display augmented reality (HMD-AR) with superimposed computed tomography (CT) data could allow the wearer to percutaneously guide pedicle screw placement in an opaque lumbar model with no real-time fluoroscopic guidance. METHODS CT imaging was obtained of a phantom composed of L1-L3 Sawbones vertebrae in opaque silicone. Preprocedural planning was performed by creating virtual trajectories of appropriate angle and depth for ideal approach into the pedicle, and these data were integrated into the Microsoft HoloLens using the Novarad OpenSight application allowing the user to view the virtual trajectory guides and CT images superimposed on the phantom in two and three dimensions. Spinal needles were inserted following the virtual trajectories to the point of contact with bone. Repeat CT revealed actual needle trajectory, allowing comparison with the ideal preprocedural paths. RESULTS Registration of AR to phantom showed a roughly circular deviation with maximum average radius of 2.5 mm. Users took an average of 200 s to place a needle. Extrapolation of needle trajectory into the pedicle showed that of 36 needles placed, 35 (97%) would have remained within the pedicles. Needles placed approximated a mean distance of 4.69 mm in the mediolateral direction and 4.48 mm in the craniocaudal direction from pedicle bone edge. CONCLUSION To our knowledge, this is the first peer-reviewed report and evaluation of HMD-AR with superimposed 3D guidance utilizing CT for spinal pedicle guide placement for the purpose of cannulation without the use of fluoroscopy.
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Affiliation(s)
- Jacob T Gibby
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Samuel A Swenson
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Steve Cvetko
- Novarad Corporation, 752 East 1180 South, Suite 200, American Fork, UT, 84003, USA
| | - Raj Rao
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA.,Department of Orthopedic Surgery, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
| | - Ramin Javan
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA. .,Department of Neuroradiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
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Abstract
In this second article, we continue the review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. The discussion in this article is focused on topics pertaining to levels 4 and 5, which are the more advanced levels of competency defined by the Accreditation Council for Graduate Medical Education Neuroradiology Milestones on Health Care Economics and System Based Practice.
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Affiliation(s)
- S L Weiner
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - R Tu
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - R Javan
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - M R Taheri
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC.
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27
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Abstract
Few resources are available in the medical literature for a comprehensive review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. Therefore, we present a comprehensive review article as a study guide for fellows to learn from and gain competence in the Accreditation Council for Graduate Medical Education neuroradiology milestones on health care economics.
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Affiliation(s)
- S L Weiner
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - R Tu
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - R Javan
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC
| | - M R Taheri
- From the Neuroradiology Section, Department of Radiology, George Washington University Hospital, Washington, DC.
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Abstract
We present a case in which intraocular silicone injection for complex retinal detachment resulted in migration and distribution of silicone along the intracranial visual pathway, and ultimately throughout the ventricular system. Misinterpretation of this material as intracranial hemorrhage on outside computed tomography imaging delayed emergent repair of a Type A aortic dissection until the diagnosis was made on repeat imaging. A discussion of this case and salient computed tomography and magnetic resonance imaging characteristics of silicone is provided.
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Affiliation(s)
- Dani Sarohia
- Department of Radiology, George Washington University Hospital, Washington D.C., USA
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, Washington D.C., USA
| | - Salim Aziz
- Department of Cardiothoracic Surgery, George Washington University Hospital, Washington D.C., USA
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Javan R, Herrin D, Tangestanipoor A. Understanding Spatially Complex Segmental and Branch Anatomy Using 3D Printing: Liver, Lung, Prostate, Coronary Arteries, and Circle of Willis. Acad Radiol 2016; 23:1183-9. [PMID: 27283072 DOI: 10.1016/j.acra.2016.04.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) manufacturing is shaping personalized medicine, in which radiologists can play a significant role, be it as consultants to surgeons for surgical planning or by creating powerful visual aids for communicating with patients, physicians, and trainees. This report illustrates the steps in development of custom 3D models that enhance the understanding of complex anatomy. MATERIALS AND METHODS We graphically designed 3D meshes or modified imported data from cross-sectional imaging to develop physical models targeted specifically for teaching complex segmental and branch anatomy. The 3D printing itself is easily accessible through online commercial services, and the models are made of polyamide or gypsum. RESULTS Anatomic models of the liver, lungs, prostate, coronary arteries, and the Circle of Willis were created. These models have advantages that include customizable detail, relative low cost, full control of design focusing on subsegments, color-coding potential, and the utilization of cross-sectional imaging combined with graphic design. CONCLUSIONS Radiologists have an opportunity to serve as leaders in medical education and clinical care with 3D printed models that provide beneficial interaction with patients, clinicians, and trainees across all specialties by proactively taking on the educator's role. Complex models can be developed to show normal anatomy or common pathology for medical educational purposes. There is a need for randomized trials, which radiologists can design, to demonstrate the utility and effectiveness of 3D printed models for teaching simple and complex anatomy, simulating interventions, measuring patient satisfaction, and improving clinical care.
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Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St. NW, Suite G2092, Washington, D C 20037.
| | - Douglas Herrin
- Department of Radiology, George Washington University Hospital, 900 23rd St. NW, Suite G2092, Washington, D C 20037
| | - Ardalan Tangestanipoor
- Department of Radiology, George Washington University Hospital, 900 23rd St. NW, Suite G2092, Washington, D C 20037
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Abstract
The end-user of mobile device apps in the practice of clinical radiology should be aware of security measures that prevent unauthorized use of the device, including passcode policies, methods for dealing with failed login attempts, network manager-controllable passcode enforcement, and passcode enforcement for the protection of the mobile device itself. Protection of patient data must be in place that complies with the Health Insurance Portability and Accountability Act and U.S. Federal Information Processing Standards. Device security measures for data protection include methods for locally stored data encryption, hardware encryption, and the ability to locally and remotely clear data from the device. As these devices transfer information over both local wireless networks and public cell phone networks, wireless network security protocols, including wired equivalent privacy and Wi-Fi protected access, are important components in the chain of security. Specific virtual private network protocols, Secure Sockets Layer and related protocols (especially in the setting of hypertext transfer protocols), native apps, virtual desktops, and nonmedical commercial off-the-shelf apps require consideration in the transmission of medical data over both private and public networks. Enterprise security and management of both personal and enterprise mobile devices are discussed. Finally, specific standards for hardware and software platform security, including prevention of hardware tampering, protection from malicious software, and application authentication methods, are vital components in establishing a secure platform for the use of mobile devices in the medical field.
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Affiliation(s)
- Asim F Choudhri
- From the Departments of Radiology (A.F.C., A.R.C.), Ophthalmology (A.F.C.), and Neurosurgery (A.F.C.), University of Tennessee Health Science Center, Memphis, Tenn; Department of Radiology, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103 (A.F.C.); Department of Radiology, Duke University Medical Center, Durham, NC (R.J.); Departments of Radiology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Md (M.G.R.); and Department of Radiology, Weill Cornell Medical College, New York, NY (G.S.)
| | - Arindam R Chatterjee
- From the Departments of Radiology (A.F.C., A.R.C.), Ophthalmology (A.F.C.), and Neurosurgery (A.F.C.), University of Tennessee Health Science Center, Memphis, Tenn; Department of Radiology, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103 (A.F.C.); Department of Radiology, Duke University Medical Center, Durham, NC (R.J.); Departments of Radiology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Md (M.G.R.); and Department of Radiology, Weill Cornell Medical College, New York, NY (G.S.)
| | - Ramin Javan
- From the Departments of Radiology (A.F.C., A.R.C.), Ophthalmology (A.F.C.), and Neurosurgery (A.F.C.), University of Tennessee Health Science Center, Memphis, Tenn; Department of Radiology, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103 (A.F.C.); Department of Radiology, Duke University Medical Center, Durham, NC (R.J.); Departments of Radiology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Md (M.G.R.); and Department of Radiology, Weill Cornell Medical College, New York, NY (G.S.)
| | - Martin G Radvany
- From the Departments of Radiology (A.F.C., A.R.C.), Ophthalmology (A.F.C.), and Neurosurgery (A.F.C.), University of Tennessee Health Science Center, Memphis, Tenn; Department of Radiology, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103 (A.F.C.); Department of Radiology, Duke University Medical Center, Durham, NC (R.J.); Departments of Radiology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Md (M.G.R.); and Department of Radiology, Weill Cornell Medical College, New York, NY (G.S.)
| | - George Shih
- From the Departments of Radiology (A.F.C., A.R.C.), Ophthalmology (A.F.C.), and Neurosurgery (A.F.C.), University of Tennessee Health Science Center, Memphis, Tenn; Department of Radiology, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103 (A.F.C.); Department of Radiology, Duke University Medical Center, Durham, NC (R.J.); Departments of Radiology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Md (M.G.R.); and Department of Radiology, Weill Cornell Medical College, New York, NY (G.S.)
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Abstract
Acute pulmonary embolism is a serious condition and despite diagnostic and therapeutic advances, mortality is still high. Anticoagulation, thrombolytic therapy, catheter embolectomy, and open pulmonary embolectomy are therapeutic options. Surgical embolectomy was considered the management of last resort, but recent studies show the effectiveness of this therapeutic modality. We reviewed our 7-year experience of pulmonary embolectomy in patients with acute massive pulmonary embolism from 1997 to 2004. Eleven patients underwent open embolectomy, 7 (64%) were male, and the mean age was 45.6 years. Pulmonary embolism occurred after major surgery in 5 patients (46%), 2 were diagnosed with malignancy and spinal cord injury, and no risk factors were detected in 4. The diagnosis was made by spiral computed tomography alone in 4 patients, and by angiography in 7. Cardiac arrest occurred in 3 patients preoperatively; 2 of them survived. Open pulmonary embolectomy is the most effective treatment for acute massive pulmonary embolism. Cardiac arrest is the worst prognostic factor. Less aggressive clot evacuation in patients who are diagnosed late appears to be effective in minimizing postoperative hemoptysis.
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Affiliation(s)
- Ahmad A Amirghofran
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Faghihi Hospital, Shiraz, Iran.
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Bashir MR, Mody R, Neville A, Javan R, Seaman D, Kim CY, Gupta RT, Jaffe TA. Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases. J Magn Reson Imaging 2013; 40:113-8. [DOI: 10.1002/jmri.24330] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 07/10/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mustafa R. Bashir
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Rekha Mody
- Department of Radiology; Cleveland Clinic; Cleveland Ohio USA
| | - Amy Neville
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Ramin Javan
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Danielle Seaman
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Charles Y. Kim
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Rajan T. Gupta
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Tracy A. Jaffe
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
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Javan R, Horvath JJ, Case LE, Austin S, Corderi J, Dubrovsky A, Kishnani PS, Bashir MR. Generating color-coded anatomic muscle maps for correlation of quantitative magnetic resonance imaging analysis with clinical examination in neuromuscular disorders. Muscle Nerve 2013; 48:293-5. [DOI: 10.1002/mus.23780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Ramin Javan
- Department of Radiology; Duke University Medical Center; DUMC 3808 Durham North Carolina 27710 USA
| | - Jeffrey J. Horvath
- Department of Radiology; Duke University Medical Center; DUMC 3808 Durham North Carolina 27710 USA
| | - Laura E. Case
- Department of Community and Family Medicine, Division of Physical Therapy; Duke University Medical Center; Durham North Carolina USA
| | - Stephanie Austin
- Department of Pediatrics; Duke University Medical Center; Durham North Carolina USA
| | - Jose Corderi
- Institute of Neuroscience, Fundacion Favaloro; Buenos Aires Argentina
| | - Alberto Dubrovsky
- Institute of Neuroscience, Fundacion Favaloro; Buenos Aires Argentina
| | - Priya S. Kishnani
- Department of Pediatrics; Duke University Medical Center; Durham North Carolina USA
| | - Mustafa R. Bashir
- Department of Radiology; Duke University Medical Center; DUMC 3808 Durham North Carolina 27710 USA
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Abstract
BACKGROUND Pneumocephalus usually results from trauma, infection, neoplasm, or iatrogenic causes. Barotrauma-induced spontaneous pneumocephalus is extremely rare, usually seen in divers or occassionally with air travel. CASE REPORT We report a case of a 61-yr-old female presenting with confusion, fever, and respiratory failure one day after developing sudden nausea, vomiting, and headache during descent on a commercial airliner. Pneumocephalus and meningitis were present on admission. Sinus computed tomography (CT) showed pansinusitis and a tiny bone defect in the posterior wall of the right sphenoid sinus, through which a cisternogram later showed free communication with the prepontine cistern. An orbital CT 2 yr earlier after a fall showed the bone defect, with no other areas of abnormality or fracture. After repair of defects by otolaryngology and appropriate antibiotics, she did well and was eventually discharged. DISCUSSION Changes in aircraft cabin pressure likely resulted in rupture of dura and arachnoid layers beneath the pre-existing bony defect, predisposed by existing sinus disease. The pathophysiology, implications, and potential sources of spontaneous pneumocephalus, as well as risks of postcraniotomy and post-trauma air-travel, are discussed.
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Affiliation(s)
- Ramin Javan
- Baptist Memorial Hospital, Department of Radiology, Memphis, TN, USA.
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Affiliation(s)
- Andre Grisham
- Department of Surgery, Baptist Memorial Hospital, Memphis, Tennessee 38107, USA.
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Punja M, Mark DG, McCoy JV, Javan R, Pines JM, Brady W. Electrocardiographic manifestations of cardiac infectious-inflammatory disorders. Am J Emerg Med 2010; 28:364-77. [PMID: 20223398 DOI: 10.1016/j.ajem.2008.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 12/13/2008] [Indexed: 02/07/2023] Open
Abstract
Inflammatory disorders of the heart, although uncommon in the general population, often present initially to the emergency department. Symptoms and clinical manifestations are shared with other more common cardiopulmonary diseases, particularly acute coronary syndrome and congestive heart failure, making prompt diagnosis challenging. This review will highlight some of the clinical and electrocardiographic features that will help early diagnosis and differentiation of inflammatory cardiac disorders from other more common conditions.
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Affiliation(s)
- Mohan Punja
- Department of Emergency Medicine, University of Virginia, Charlottesville, 22908, USA
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Jeun BS, Javan R, Gay SB, Olazagasti JM, Bassignani MJ. An Inexpensive Distance Learning Solution for Delivering High-Quality Live Broadcasts. Radiographics 2008; 28:1251-8. [DOI: 10.1148/rg.285085701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Emaminia A, Amirghofran AA, Shafa M, Moaref A, Javan R. Ascending aortic pseudoaneurysm after aortic valve replacement: Watch the tip of the cardioplegia cannula! J Thorac Cardiovasc Surg 2008; 137:1285-6. [PMID: 19380010 DOI: 10.1016/j.jtcvs.2008.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 04/13/2008] [Indexed: 11/27/2022]
Affiliation(s)
- Abbas Emaminia
- Division of Cardiovascular Surgery, Department of Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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