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He KH, Bruse JL, Rodriguez-Florez N, Dunaway D, Jeelani O, Schievano S, Borghi A. Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study. R Soc Open Sci 2024; 11:231158. [PMID: 38577216 PMCID: PMC10987985 DOI: 10.1098/rsos.231158] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 11/03/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024]
Abstract
Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn's head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull-distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.
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Affiliation(s)
- K. H. He
- Ningbo University, Ningbo, People's Republic of China
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J. L. Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - N. Rodriguez-Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, San Sebastian, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - D. Dunaway
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - O. Jeelani
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - A. Borghi
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Engineering, Durham University, Durham, UK
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Sivera R, Clark AE, Dall'Asta A, Ghi T, Schievano S, Lees CC. Fetal face shape analysis from prenatal 3D ultrasound images. Sci Rep 2024; 14:4411. [PMID: 38388522 PMCID: PMC10884000 DOI: 10.1038/s41598-023-50386-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024] Open
Abstract
3D ultrasound imaging of fetal faces has been predominantly confined to qualitative assessment. Many genetic conditions evade diagnosis and identification could assist with parental counselling, pregnancy management and neonatal care planning. We describe a methodology to build a shape model of the third trimester fetal face from 3D ultrasound and show how it can objectively describe morphological features and gestational-age related changes of normal fetal faces. 135 fetal face 3D ultrasound volumes (117 appropriately grown, 18 growth-restricted) of 24-34 weeks gestation were included. A 3D surface model of each face was obtained using a semi-automatic segmentation workflow. Size normalisation and rescaling was performed using a growth model giving the average size at every gestation. The model demonstrated a similar growth rate to standard head circumference reference charts. A landmark-free morphometry model was estimated to characterize shape differences using non-linear deformations of an idealized template face. Advancing gestation is associated with widening/fullness of the cheeks, contraction of the chin and deepening of the eyes. Fetal growth restriction is associated with a smaller average facial size but no morphological differences. This model may eventually be used as a reference to assist in the prenatal diagnosis of congenital anomalies with characteristic facial dysmorphisms.
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Affiliation(s)
- Raphael Sivera
- Institute of Cardiovascular Science, University College London, London, UK
| | - Anna E Clark
- Institute of Reproductive and Development Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK
| | - Christoph C Lees
- Institute of Reproductive and Development Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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Garate Andikoetxea B, Ajami S, Rodriguez-Florez N, Jeelani NUO, Dunaway D, Schievano S, Borghi A. Towards a radiation free numerical modelling framework to predict spring assisted correction of scaphocephaly. Comput Methods Biomech Biomed Engin 2023:1-10. [PMID: 38108140 DOI: 10.1080/10255842.2023.2294262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
Sagittal Craniosynostosis (SC) is a congenital craniofacial malformation, involving premature sagittal suture ossification; spring-assisted cranioplasty (SAC) - insertion of metallic distractors for skull reshaping - is an established method for treating SC. Surgical outcomes are predictable using numerical modelling, however published methods rely on computed tomography (CT) scans availability, which are not routinely performed. We investigated a simplified method, based on radiation-free 3D stereophotogrammetry scans.Eight SAC patients (age 5.1 ± 0.4 months) with preoperative CT and 3D stereophotogrammetry scans were included. Information on osteotomies, spring model and post-operative spring opening were recorded. For each patient, two preoperative models (PREOP) were created: i) CT model and ii) S model, created by processing patient specific 3D surface scans using population averaged skin and skull thickness and suture locations. Each model was imported into ANSYS Mechanical (Analysis System Inc., Canonsburg, PA) to simulate spring expansion. Spring expansion and cranial index (CI - skull width over length) at times equivalent to immediate postop (POSTOP) and follow up (FU) were extracted and compared with in-vivo measurements.Overall expansion patterns were very similar for the 2 models at both POSTOP and FU. Both models had comparable outcomes when predicting spring expansion. Spring induced CI increase was similar, with a difference of 1.2%±0.8% for POSTOP and 1.6%±0.6% for FU.This work shows that a simplified model created from the head surface shape yields acceptable results in terms of spring expansion prediction. Further modelling refinements will allow the use of this predictive tool during preoperative planning.
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Affiliation(s)
| | - Sara Ajami
- University College London, United Kingdom
- Great Ormond Street Hospital, London, United Kingdom
| | | | | | - David Dunaway
- Great Ormond Street Hospital, London, United Kingdom
| | - Silvia Schievano
- University College London, United Kingdom
- Great Ormond Street Hospital, London, United Kingdom
| | - Alessandro Borghi
- University College London, United Kingdom
- Great Ormond Street Hospital, London, United Kingdom
- Department of Engineering, Durham University, Durham, United Kingdom
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Deliège L, Ramdat Misier K, Silva D, James G, Ong J, Dunaway D, Jeelani NUO, Schievano S, Borghi A. Spring-assisted posterior vault expansion: a parametric study to improve the intracranial volume increase prediction. Sci Rep 2023; 13:21371. [PMID: 38049445 PMCID: PMC10695940 DOI: 10.1038/s41598-023-48143-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
Spring-assisted posterior vault expansion has been adopted at the London Great Ormond Street Hospital for Children to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly causing the premature fusion of skull sutures. This procedure involves elastic distractors used to dynamically reshape the skull and increase the intracranial volume (ICV). In this study, we developed and validated a patient-specific model able to predict the ICV increase and carried out a parametric study to investigate the effect of surgical parameters on that final volume. Pre- and post-operative computed tomography data relative to 18 patients were processed to extract simplified patient-specific skull shape, replicate surgical cuts, and simulate spring expansion. A parametric study was performed to quantify each parameter's impact on the surgical outcome: for each patient, the osteotomy location was varied in a pre-defined range; local sensitivity of the predicted ICV to each parameter was analysed and compared. Results showed that the finite element model performed well in terms of post-operative ICV prediction and allowed for parametric optimization of surgical cuts. The study indicates how to optimize the ICV increase according to the type of procedure and provides indication on the most robust surgical strategy.
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Affiliation(s)
| | | | | | | | - Juling Ong
- Great Ormond Street Hospital, London, UK
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Mansell SK, Devani N, Shah A, Schievano S, Main E, Mandal S. Current treatment strategies in managing side effects associated with domiciliary positive airway pressure (PAP) therapy for patients with sleep disordered breathing: A systematic review and meta-analysis. Sleep Med Rev 2023; 72:101850. [PMID: 37812972 DOI: 10.1016/j.smrv.2023.101850] [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: 03/21/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Sleep disordered breathing is commonly treated with positive airway pressure therapy. Positive airway pressure therapy is delivered via a tight-fitting mask with common side effects including: leak, ineffective treatment, residual sleep disordered breathing, eye irritation, nasal congestion, pressure ulcers and poor concordance with therapy. This systematic review and meta-analysis aimed to identify the effectiveness of current treatment strategies for managing side effects associated with positive airway pressure therapy. Five databases were searched and 10,809 articles were screened, with 36 articles included in the review. Studies investigated: dressings, nasal spray/douche, chin straps, heated humidification and interfaces. No intervention either improved or detrimentally affected: positive airway pressure concordance, Epworth Sleepiness Score, residual apnoea hypopnea index or interface leak. The review was limited by study heterogeneity, particularly for outcome measures. Additionally, patient demographics were not reported, making it difficult to apply the findings to a broad clinical population. This review highlights the paucity of evidence supporting treatment strategies to manage side effects of positive airway pressure therapy.
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Affiliation(s)
| | | | - Amar Shah
- University College London, UK; Royal Free London NHS Foundation Trust, UK
| | | | | | - Swapna Mandal
- University College London, UK; Royal Free London NHS Foundation Trust, UK
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Borghi A, Heutinck P, Rodriguez-Florez N, Koudstaal M, Ruggiero F, Ajami S, Schievano S, Jeelani N, Dunaway D. The Esthetic Perception of Morphological Severity in Scaphocephalic Patients is Correlated With Specific Head Geometrical Features. Cleft Palate Craniofac J 2023; 60:1591-1599. [PMID: 35786009 PMCID: PMC10588271 DOI: 10.1177/10556656221111307] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the relationship between perception of craniofacial deformity, geometric head features, and 3D head shape analyzed by statistical shape modeling (SSM). PATIENTS A total of 18 unoperated patients with scaphocephaly (age = 5.2 ± 1.1m)-6 were followed-up after spring-assisted cranioplasty (SAC) (age = 9.6 ± 1.5m)-and 6 controls (age = 6.7 ± 2.5m). MAIN OUTCOME MEASURES 3D head shapes were retrieved from 3D scans or computed tomography (CTs). Various geometrical features were measured: anterior and posterior prominence, take-off angle, average anterior and posterior lateral and horizontal curvatures, cranial index (CI) (cranial width over length), and turricephaly index (TI) (cranial height over length). SSM and principal component analysis (PCA) described shape variability. All models were 3D printed; the perception of deformity was blindly scored by 9 surgeons and 1 radiologist in terms of frontal bossing (FB), occipital bulleting (OB), biparietal narrowing (BN), low posterior vertex (LPV), and overall head shape (OHS). RESULTS A moderate correlation was found between FB and anterior prominence (r = 0.56, P < .01) and take-off angle (r = - 0.57, P < .01). OB correlated with average posterior lateral curvature (r = 0.43, P < 0.01) similarly to BPN (r = 0.55, P < .01) and LPV (r = 0.43, P < .01). OHS showed strong correlation with CI (r = - 0.68, P < .01) and TI (r = 0.63, P< .01). SSM Mode 1 correlated with OHS (r = 0.66, p < .01) while Mode 3 correlated with FB (r = - 0.58, P < .01). CONCLUSIONS Esthetic cranial appearance in craniofacial patients is correlated to specific geometric parameters and could be estimated using automated methods such as SSM.
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Affiliation(s)
- Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - P. Heutinck
- UCL Great Ormond Street Institute of Child Health, London, UK
- Erasmus University Hospital, Rotterdam, the Netherlands
| | - N. Rodriguez-Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - M. Koudstaal
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
- Erasmus University Hospital, Rotterdam, the Netherlands
| | - F. Ruggiero
- Great Ormond Street Hospital for Children, London, UK
- DIBIDEM, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S. Ajami
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - N.U.O. Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - D. Dunaway
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
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Rickart AJ, van de Lande LS, O' Sullivan E, Bloch K, Arnaud E, Schievano S, Jeelani NUO, Paternoster G, Khonsari R, Dunaway DJ. Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification. Plast Reconstr Surg 2023; 152:612-622. [PMID: 36847681 DOI: 10.1097/prs.0000000000010331] [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: 03/01/2023]
Abstract
BACKGROUND Crouzon syndrome is characterized by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-center retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates whether the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphologic outcomes. METHODS Patients with Crouzon syndrome who underwent FFMBA with internal distraction [Hôpital Necker-Enfants Malades (Paris, France)] or external distraction [Great Ormond Street Hospital for Children (London, United Kingdom)] were compared. Digital Imaging and Communications in Medicine files of preoperative and postoperative computed tomographic scans were converted to three-dimensional bone meshes and skeletal movements were assessed using nonrigid iterative closest point registration. Displacements were visualized using color maps and statistical analysis of the vectors was undertaken. RESULTS Fifty-one patients met the strict inclusion criteria. Twenty-five underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement, whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant ( P < 0.01). CONCLUSIONS Morphologic changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Alexander J Rickart
- From the UCL Great Ormond Street Institute of Child Health
- Craniofacial Unit, Great Ormond Street Hospital for Children
| | - Lara S van de Lande
- From the UCL Great Ormond Street Institute of Child Health
- Craniofacial Unit, Great Ormond Street Hospital for Children
| | | | - Kevin Bloch
- Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique
- Faculté de Médecine, Université de Paris
| | - Eric Arnaud
- Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique
- Faculté de Médecine, Université de Paris
| | - Silvia Schievano
- From the UCL Great Ormond Street Institute of Child Health
- Craniofacial Unit, Great Ormond Street Hospital for Children
| | - Noor Ul Owase Jeelani
- From the UCL Great Ormond Street Institute of Child Health
- Craniofacial Unit, Great Ormond Street Hospital for Children
| | - Giovanna Paternoster
- Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique
- Faculté de Médecine, Université de Paris
| | - Roman Khonsari
- Unité de Chirurgie Cranio-faciale, Service de Neurochirurgie, Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales (CRANIOST), Hôpital Necker-Enfants Malades, Assistance Publique
- Faculté de Médecine, Université de Paris
| | - David J Dunaway
- From the UCL Great Ormond Street Institute of Child Health
- Craniofacial Unit, Great Ormond Street Hospital for Children
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Lesage R, Van Oudheusden M, Schievano S, Van Hoyweghen I, Geris L, Capelli C. Mapping the use of computational modelling and simulation in clinics: A survey. Front Med Technol 2023; 5:1125524. [PMID: 37138727 PMCID: PMC10150234 DOI: 10.3389/fmedt.2023.1125524] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
In silico medicine describes the application of computational modelling and simulation (CM&S) to the study, diagnosis, treatment or prevention of a disease. Tremendous research advances have been achieved to facilitate the use of CM&S in clinical applications. Nevertheless, the uptake of CM&S in clinical practice is not always timely and accurately reflected in the literature. A clear view on the current awareness, actual usage and opinions from the clinicians is needed to identify barriers and opportunities for the future of in silico medicine. The aim of this study was capturing the state of CM&S in clinics by means of a survey toward the clinical community. Responses were collected online using the Virtual Physiological Human institute communication channels, engagement with clinical societies, hospitals and individual contacts, between 2020 and 2021. Statistical analyses were done with R. Participants (n = 163) responded from all over the world. Clinicians were mostly aged between 35 and 64 years-old, with heterogeneous levels of experience and areas of expertise (i.e., 48% cardiology, 13% musculoskeletal, 8% general surgery, 5% paediatrics). The CM&S terms "Personalised medicine" and "Patient-specific modelling" were the most well-known within the respondents. "In silico clinical trials" and "Digital Twin" were the least known. The familiarity with different methods depended on the medical specialty. CM&S was used in clinics mostly to plan interventions. To date, the usage frequency is still scarce. A well-recognized benefit associated to CM&S is the increased trust in planning procedures. Overall, the recorded level of trust for CM&S is high and not proportional to awareness level. The main barriers appear to be access to computing resources, perception that CM&S is slow. Importantly, clinicians see a role for CM&S expertise in their team in the future. This survey offers a snapshot of the current situation of CM&S in clinics. Although the sample size and representativity could be increased, the results provide the community with actionable data to build a responsible strategy for accelerating a positive uptake of in silico medicine. New iterations and follow-up activities will track the evolution of responses over time and contribute to strengthen the engagement with the medical community.
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Affiliation(s)
| | - Michiel Van Oudheusden
- Centre for Sociological Research, Life Sciences and Society Lab, KU Leuven, Leuven, Belgium
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ine Van Hoyweghen
- Centre for Sociological Research, Life Sciences and Society Lab, KU Leuven, Leuven, Belgium
| | - Liesbet Geris
- Virtual Physiological Human Institute, Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
- Biomechanics Section, KU Leuven, Leuven, Belgium
- Biomechanics Research Unit, GIGA in Silico Medicine, University of Liège, Liège, Belgium
| | - Claudio Capelli
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Pajaziti E, Montalt-Tordera J, Capelli C, Sivera R, Sauvage E, Quail M, Schievano S, Muthurangu V. Shape-driven deep neural networks for fast acquisition of aortic 3D pressure and velocity flow fields. PLoS Comput Biol 2023; 19:e1011055. [PMID: 37093855 PMCID: PMC10159343 DOI: 10.1371/journal.pcbi.1011055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/04/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Computational fluid dynamics (CFD) can be used to simulate vascular haemodynamics and analyse potential treatment options. CFD has shown to be beneficial in improving patient outcomes. However, the implementation of CFD for routine clinical use is yet to be realised. Barriers for CFD include high computational resources, specialist experience needed for designing simulation set-ups, and long processing times. The aim of this study was to explore the use of machine learning (ML) to replicate conventional aortic CFD with automatic and fast regression models. Data used to train/test the model consisted of 3,000 CFD simulations performed on synthetically generated 3D aortic shapes. These subjects were generated from a statistical shape model (SSM) built on real patient-specific aortas (N = 67). Inference performed on 200 test shapes resulted in average errors of 6.01% ±3.12 SD and 3.99% ±0.93 SD for pressure and velocity, respectively. Our ML-based models performed CFD in ∼0.075 seconds (4,000x faster than the solver). This proof-of-concept study shows that results from conventional vascular CFD can be reproduced using ML at a much faster rate, in an automatic process, and with reasonable accuracy.
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Affiliation(s)
- Endrit Pajaziti
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Javier Montalt-Tordera
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Claudio Capelli
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Raphaël Sivera
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Emilie Sauvage
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Michael Quail
- Great Ormond Street Hospital, Cardiac Unit, London, United Kingdom
| | - Silvia Schievano
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Vivek Muthurangu
- University College London, Institution of Cardiovascular Science, London, United Kingdom
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Capelli C, Bertolini M, Schievano S. 3D-printed and computational models: a combined approach for patient-specific studies. 3D Print Med 2023. [DOI: 10.1016/b978-0-323-89831-7.00011-0] [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: 01/28/2023] Open
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Belitsis G, Pajaziti E, Schievano S, Capelli C, Cook A, Kostolny M. Use of virtual reality in complex double outlet right ventricle cases. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36503703 DOI: 10.1510/mmcts.2022.085] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Virtual reality has been incorporated into clinical practice for planning complex congenital cardiac operations at the Great Ormond Street Hospital for Children since 2018 [1]. Virtual reality allows for 3-dimensional exploration of patient-specific models, created through the segmentation of 3-dimensional imaging data sets. Along with 3-dimensional printed models and 3-dimensional PDFs, this technology has enabled a new approach in planning and reviewing surgical interventions. It is particularly important in intracardiac repairs involving ventricular septal defects [2] and double outlet right ventricle cases presenting with various phenotypes of interventricular communication [3,4]. We present the virtual reality environment of two complex cases of double outlet right ventricle, illustrating the potential of virtual reality as a clinical tool to aid anatomical understanding and surgical planning of complex congenital heart disease.
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Affiliation(s)
- Georgios Belitsis
- University College London and Great Ormond Street Hospital, London, UK
| | - Endrit Pajaziti
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | - Silvia Schievano
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | - Claudio Capelli
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
| | - Andrew Cook
- Institute of Cardiovascular Science, Department of Children's Cardiovascular Disease, University College London, London, United Kingdom
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12
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Rickart A, Rickart A, van de Lande L, O' Sullivan E, Bloch K, Arnaud E, Schievano S, ul Owase Jeelani N, Paternoster G, Khonsari R, Dunaway D. 10. Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.020] [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: 12/24/2022]
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13
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Montalt-Tordera J, Pajaziti E, Jones R, Sauvage E, Puranik R, Singh AAV, Capelli C, Steeden J, Schievano S, Muthurangu V. Automatic segmentation of the great arteries for computational hemodynamic assessment. J Cardiovasc Magn Reson 2022; 24:57. [PMID: 36336682 PMCID: PMC9639271 DOI: 10.1186/s12968-022-00891-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Computational fluid dynamics (CFD) is increasingly used for the assessment of blood flow conditions in patients with congenital heart disease (CHD). This requires patient-specific anatomy, typically obtained from segmented 3D cardiovascular magnetic resonance (CMR) images. However, segmentation is time-consuming and requires expert input. This study aims to develop and validate a machine learning (ML) method for segmentation of the aorta and pulmonary arteries for CFD studies. METHODS 90 CHD patients were retrospectively selected for this study. 3D CMR images were manually segmented to obtain ground-truth (GT) background, aorta and pulmonary artery labels. These were used to train and optimize a U-Net model, using a 70-10-10 train-validation-test split. Segmentation performance was primarily evaluated using Dice score. CFD simulations were set up from GT and ML segmentations using a semi-automatic meshing and simulation pipeline. Mean pressure and velocity fields across 99 planes along the vessel centrelines were extracted, and a mean average percentage error (MAPE) was calculated for each vessel pair (ML vs GT). A second observer (SO) segmented the test dataset for assessment of inter-observer variability. Friedman tests were used to compare ML vs GT, SO vs GT and ML vs SO metrics, and pressure/velocity field errors. RESULTS The network's Dice score (ML vs GT) was 0.945 (interquartile range: 0.929-0.955) for the aorta and 0.885 (0.851-0.899) for the pulmonary arteries. Differences with the inter-observer Dice score (SO vs GT) and ML vs SO Dice scores were not statistically significant for either aorta or pulmonary arteries (p = 0.741, p = 0.061). The ML vs GT MAPEs for pressure and velocity in the aorta were 10.1% (8.5-15.7%) and 4.1% (3.1-6.9%), respectively, and for the pulmonary arteries 14.6% (11.5-23.2%) and 6.3% (4.3-7.9%), respectively. Inter-observer (SO vs GT) and ML vs SO pressure and velocity MAPEs were of a similar magnitude to ML vs GT (p > 0.2). CONCLUSIONS ML can successfully segment the great vessels for CFD, with errors similar to inter-observer variability. This fast, automatic method reduces the time and effort needed for CFD analysis, making it more attractive for routine clinical use.
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Affiliation(s)
| | | | - Rod Jones
- Great Ormond Street Hospital, London, UK
| | - Emilie Sauvage
- UCL Institute of Cardiovascular Science, UCL, London, UK
| | - Rajesh Puranik
- Children’s Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aakansha Ajay Vir Singh
- Children’s Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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14
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Arya N, Schievano S, Caputo M, Taylor AM, Biglino G. Relationship between Pulmonary Regurgitation and Ventriculo-Arterial Interactions in Patients with Post-Early Repair of Tetralogy of Fallot: Insights from Wave-Intensity Analysis. J Clin Med 2022; 11:jcm11206186. [PMID: 36294505 PMCID: PMC9604580 DOI: 10.3390/jcm11206186] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the effect of pulmonary regurgitation (PR) on left ventricular ventriculo-arterial (VA) coupling in patients with repaired tetralogy of Fallot (ToF). It was hypothesised that increasing PR severity results in a smaller forward compression wave (FCW) peak in the aortic wave intensity, because of right-to-left ventricular interactions. The use of cardiovascular magnetic resonance (CMR)-derived wave-intensity analysis provided a non-invasive comparison between patients with varying PR degrees. A total of n = 201 patients were studied and both hemodynamic and wave-intensity data were compared. Wave-intensity peaks and areas of the forward compression and forward expansion waves were calculated as surrogates of ventricular function. Any extent of PR resulted in a significant reduction in the FCW peak. A correlation was found between aortic distensibility and the FCW peak, suggesting unfavourable (VA) coupling in patients that also present stiffer ascending aortas. Data suggest that VA coupling is affected by increased impedance.
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Affiliation(s)
- Nikesh Arya
- Faculty of Mathematical and Physical Sciences, University College London, London WC1E 6BT, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3HJ, UK
| | - Massimo Caputo
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - Andrew M. Taylor
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3HJ, UK
| | - Giovanni Biglino
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
- Correspondence: ; Tel.: +44-117-342-3287
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15
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Bruno C, Moumneh R, Sauvage E, Stronach L, Waters K, Simcock I, Arthurs O, Schievano S, Capelli C, Shroff R. Central Venous Catheter Malfunction in Children: A Bioengineering Approach. Clin J Am Soc Nephrol 2022; 17:1382-1384. [PMID: 35817475 PMCID: PMC9625107 DOI: 10.2215/cjn.01470222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Claudia Bruno
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rayan Moumneh
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Emilie Sauvage
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Lynsey Stronach
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kathryn Waters
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ian Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Owen Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Rukshana Shroff
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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16
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Bakaya K, Paracha W, Schievano S, Bozkurt S. Assessment of cardiac dimensions in children diagnosed with hypertrophic cardiomyopathy. Echocardiography 2022; 39:1233-1239. [PMID: 35978451 DOI: 10.1111/echo.15437] [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: 03/27/2022] [Revised: 06/18/2022] [Accepted: 07/23/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is an inherited autosomal dominant heart disease, characterized by increased left ventricular wall thickness and abnormal loading conditions. Imaging modalities are the first choice for diagnosis and risk stratification. Although heart dimensions have been characterized widely in HCM adults from cardiac imaging, there is limited information about children affected by HCM. The aim of this study is to evaluate left ventricular function and left heart dimensions in a small population of children diagnosed with HCM. METHODS A total of 16 (seven male, nine female) pediatric patients with an average age of 14.0 ± 2.5 years diagnosed with HCM at Great Ormond Street Hospital for Children were included in this study. Cardiac magnetic resonance (CMR) images were used to measure left and right ventricular dimensions, and septal and left ventricular free wall thicknesses in Simpleware ScanIP. The gender groups were compared using student t-test or non-parametric Mann-Whitney U-test depending on the sample distribution. RESULTS Differences in heart rate, left ventricular end-diastolic volume and end-diastolic volume index, left ventricular stroke volume and stroke volume index, left ventricular end-systolic long axis length, left ventricular end-systolic long axis length index, left ventricular end-diastolic mid-cavity diameter, left ventricular end-diastolic free wall thickness, left ventricular end-diastolic free wall thickness index, right ventricular end-diastolic long axis length were statistically significant in males and females. CONCLUSION Left ventricular wall and intraventricular septal thickness increase affecting left ventricle cavity dimensions and there may be differences in anatomical and physiological parameters in males and females affected by HCM.
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Affiliation(s)
| | - Waleed Paracha
- UCL Medical School, University College London, London, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK
| | - Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, UK
- School of Engineering, Ulster University, Newtownabbey, UK
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17
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Traynor G, Shearn AIU, Milano EG, Ordonez MV, Velasco Forte MN, Caputo M, Schievano S, Mustard H, Wray J, Biglino G. The use of 3D-printed models in patient communication: a scoping review. J 3D Print Med 2022; 6:13-23. [PMID: 35211330 PMCID: PMC8852361 DOI: 10.2217/3dp-2021-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022]
Abstract
3D models have been used as an asset in many clinical applications and a variety of disciplines, and yet the available literature studying the use of 3D models in communication is limited. This scoping review has been conducted to draw conclusions on the current evidence and learn from previous studies, using this knowledge to inform future work. Our search strategy revealed 269 papers, 19 of which were selected for final inclusion and analysis. When assessing the use of 3D models in doctor-patient communication, there is a need for larger studies and studies including a long-term follow up. Furthermore, there are forms of communication that are yet to be researched and provide a niche that may be beneficial to explore.
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Affiliation(s)
- Gemma Traynor
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Andrew IU Shearn
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Elena G Milano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Silvia Schievano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6DD, UK
| | - Hannah Mustard
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- National Heart & Lung Institute, Imperial College London, London, SW3 6LY, UK
- Author for correspondence: Tel.: +44 117 342 3287;
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18
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Khera B, van de Lande L, Sidpra J, Knoops P, Borghi A, Ong J, James G, Hayward R, Schievano S, Mankad K, Dunaway D, Jeelani N, Breakey W. 73 Computed Tomography Imaging to Determine Reduction in Intracrainal Pressure Before & After Posterior Vault Expansion in Apert Syndrome. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Apert syndrome is an autosomal dominant malformation syndrome, accounting for 4.5% of all craniosynostoses. Raised intracranial pressure (ICP) in Apert syndrome has a multifactorial aetiology, with an incidence of up to 45% if left untreated [1, 2]. Raised ICP can be determined clinically, with non-invasive and invasive methods. In this study, we want to assess whether the use of CT scans is reliable in identifying changes in ICP.
Method
Pre and postoperative CT scans for 13 Apert syndrome patients who had posterior vault expansion were assessed and graded for severity of intracranial pressure (ICP). The grading system used was departmental specific and the assessment was carried out by a single clinician on different brain structures. This process was repeated on the same patients, using the same CT scans, 4 months later to determine consistency and repeatability. The relationship between the pre and postoperative scans was explored using the chi squared test. Intra-observer variability was assessed using Kappa statistics [SS1].
Results
There was no statistically significant difference between the pre and postoperative CT scan grading. Across instances, only one assessed structure had a p-value <0.05. The Kappa interobserver reliability test did not identify a strong agreement in the comparison of the two instances of data analysis.
Conclusions
Assessment of CT scans is not a reliable method to determine changes in intracranial pressure in Apert syndrome patients who have had a posterior vault expansion.
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Affiliation(s)
- B. Khera
- Department of Plastic Surgery, Oxford, United Kingdom
| | - L. van de Lande
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - J. Sidpra
- Department of Plastic, Great Ormond Street, London, United Kingdom
| | - P. Knoops
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - A. Borghi
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - J. Ong
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - G. James
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - R. Hayward
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - S. Schievano
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - K. Mankad
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - D. Dunaway
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - N.u.O. Jeelani
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
| | - W. Breakey
- Department of Plastic & Craniofacial Surgery, Great Ormond Street, London, United Kingdom
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19
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O' Sullivan E, van de Lande LS, Papaioannou A, Breakey RWF, Jeelani NO, Ponniah A, Duncan C, Schievano S, Khonsari RH, Zafeiriou S, Dunaway DJ. Convolutional mesh autoencoders for the 3-dimensional identification of FGFR-related craniosynostosis. Sci Rep 2022; 12:2230. [PMID: 35140239 PMCID: PMC8828904 DOI: 10.1038/s41598-021-02411-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Clinical diagnosis of craniofacial anomalies requires expert knowledge. Recent studies have shown that artificial intelligence (AI) based facial analysis can match the diagnostic capabilities of expert clinicians in syndrome identification. In general, these systems use 2D images and analyse texture and colour. They are powerful tools for photographic analysis but are not suitable for use with medical imaging modalities such as ultrasound, MRI or CT, and are unable to take shape information into consideration when making a diagnostic prediction. 3D morphable models (3DMMs), and their recently proposed successors, mesh autoencoders, analyse surface topography rather than texture enabling analysis from photography and all common medical imaging modalities and present an alternative to image-based analysis. We present a craniofacial analysis framework for syndrome identification using Convolutional Mesh Autoencoders (CMAs). The models were trained using 3D photographs of the general population (LSFM and LYHM), computed tomography data (CT) scans from healthy infants and patients with 3 genetically distinct craniofacial syndromes (Muenke, Crouzon, Apert). Machine diagnosis outperformed expert clinical diagnosis with an accuracy of 99.98%, sensitivity of 99.95% and specificity of 100%. The diagnostic precision of this technique supports its potential inclusion in clinical decision support systems. Its reliance on 3D topography characterisation make it suitable for AI assisted diagnosis in medical imaging as well as photographic analysis in the clinical setting.
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Affiliation(s)
- Eimear O' Sullivan
- UCL Great Ormond Street Institute of Child Health, London, UK.,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France.,Department of Computing, Imperial College London, London, UK
| | - Lara S van de Lande
- UCL Great Ormond Street Institute of Child Health, London, UK. .,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France. .,Department of Maxillofacial Surgery and Plastic Surgery, Necker - Enfants Malades University Hospital, Paris, France.
| | - Athanasios Papaioannou
- UCL Great Ormond Street Institute of Child Health, London, UK.,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France.,Department of Computing, Imperial College London, London, UK
| | - Richard W F Breakey
- UCL Great Ormond Street Institute of Child Health, London, UK.,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France
| | - N Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK.,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France
| | - Allan Ponniah
- Department of Plastic Surgery, Royal. Free Hospital, London, UK
| | | | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, London, UK.,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, Necker - Enfants Malades University Hospital, Paris, France
| | | | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health, London, UK.,Assistance Publique - Hôpitaux de Paris, Faculty of Medicine, University of Paris, Paris, France
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20
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Bruno C, Sauvage E, Simcock I, Redaelli A, Schievano S, Shroff R, Capelli C. Computational investigation of the haemodynamics shows criticalities of central venous lines used for chronic haemodialysis in children. Front Pediatr 2022; 10:1055212. [PMID: 36389366 PMCID: PMC9659647 DOI: 10.3389/fped.2022.1055212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Haemodialysis is a life-saving treatment for children with kidney failure. The majority of children have haemodialysis through central venous lines (CVLs). The use of CVLs in pediatric patients is often associated to complications which can lead to their replacement. The aim of this study is to investigate haemodynamics of pediatric CVLs to highlight the criticalities of different line designs. METHODS Four models of CVLs for pediatric use were included in this study. The selected devices varied in terms of design and sizes (from 6.5 Fr to 14 Fr). Accurate 3D models of CVLs were reconstructed from high-resolution images including venous and arterial lumens, tips and side holes. Computational fluid dynamics (CFD) analyses were carried out to simulate pediatric working conditions of CVLs in ideal and anatomically relevant conditions. RESULTS The arterial lumens of all tested CVLs showed the most critical conditions with the majority of blood flowing through the side-holes. A zone of low flow was identified at the lines' tip. The highest shear stresses distribution (>10 Pa) was found in the 8 Fr line while the highest platelet lysis index in the 10 Fr model. The analysis on the anatomical geometry showed an increase in wall shear stress measured in the 10 F model compared to the idealised configuration. Similarly, in anatomical models an increased disturbance and velocity of the flow was found inside the vein after line placement. CONCLUSION This study provided a numerical characterization of fluid dynamics in pediatric CVLs highlighting performance criticalities (i.e. high shear stresses and areas of stagnation) associated to specific sizes (8 Fr and 10 Fr) and conditions (i.e. anatomical test).
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Affiliation(s)
- Claudia Bruno
- Institute of Child Health, University College London, London, United Kingdom
| | - Emilie Sauvage
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ian Simcock
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Rukshana Shroff
- Institute of Child Health, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, United Kingdom.,Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
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21
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O' Sullivan E, van de Lande LS, Oosting AJC, Papaioannou A, Jeelani NO, Koudstaal MJ, Khonsari RH, Dunaway DJ, Zafeiriou S, Schievano S. The 3D skull 0-4 years: A validated, generative, statistical shape model. Bone Rep 2021; 15:101154. [PMID: 34917697 PMCID: PMC8645852 DOI: 10.1016/j.bonr.2021.101154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study aims to capture the 3D shape of the human skull in a healthy paediatric population (0-4 years old) and construct a generative statistical shape model. Methods The skull bones of 178 healthy children (55% male, 20.8 ± 12.9 months) were reconstructed from computed tomography (CT) images. 29 anatomical landmarks were placed on the 3D skull reconstructions. Rotation, translation and size were removed, and all skull meshes were placed in dense correspondence using a dimensionless skull mesh template and a non-rigid iterative closest point algorithm. A 3D morphable model (3DMM) was created using principal component analysis, and intrinsically and geometrically validated with anthropometric measurements. Synthetic skull instances were generated exploiting the 3DMM and validated by comparison of the anthropometric measurements with the selected input population. Results The 3DMM of the paediatric skull 0-4 years was successfully constructed. The model was reasonably compact - 90% of the model shape variance was captured within the first 10 principal components. The generalisation error, quantifying the ability of the 3DMM to represent shape instances not encountered during training, was 0.47 mm when all model components were used. The specificity value was <0.7 mm demonstrating that novel skull instances generated by the model are realistic. The 3DMM mean shape was representative of the selected population (differences <2%). Overall, good agreement was observed in the anthropometric measures extracted from the selected population, and compared to normative literature data (max difference in the intertemporal distance) and to the synthetic generated cases. Conclusion This study presents a reliable statistical shape model of the paediatric skull 0-4 years that adheres to known skull morphometric measures, can accurately represent unseen skull samples not used during model construction and can generate novel realistic skull instances, thus presenting a solution to limited availability of normative data in this field.
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Affiliation(s)
- Eimear O' Sullivan
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Computing, Imperial College London, London, UK
| | - Lara S. van de Lande
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Anne-Jet C. Oosting
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Athanasios Papaioannou
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Computing, Imperial College London, London, UK
| | - N. Owase Jeelani
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Maarten J. Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Roman H. Khonsari
- Oral and Maxillofacial Surgery Department, Hospital Necker, Enfants Malades, Paris, France
| | - David J. Dunaway
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Silvia Schievano
- Great Ormond Street Institute of Child Health, University College London & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Corresponding author at: The Zayad Centre for Research, 20 Guilford St, London WC1N 1DZ, UK.
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22
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Ruggiero F, Dunaway D, Budden C, Smith L, Jeelani NUO, Schievano S, Ong J, Borghi A. Finite element method for the design of implants for temporal hollowing. JPRAS Open 2021; 32:18-23. [PMID: 35242984 PMCID: PMC8857408 DOI: 10.1016/j.jpra.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/13/2021] [Indexed: 10/25/2022] Open
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23
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Milano EG, Kostolny M, Pajaziti E, Marek J, Regan W, Caputo M, Luciani GB, Mortensen KH, Cook AC, Schievano S, Capelli C. Enhanced 3D visualization for planning biventricular repair of double outlet right ventricle: a pilot study on the advantages of virtual reality. Eur Heart J Digit Health 2021; 2:667-675. [PMID: 36713107 PMCID: PMC9707861 DOI: 10.1093/ehjdh/ztab087] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/27/2021] [Indexed: 02/01/2023]
Abstract
Aims We aim to determine any additional benefit of virtual reality (VR) experience if compared to conventional cross-sectional imaging and standard three-dimensional (3D) modelling when deciding on surgical strategy in patients with complex double outlet right ventricle (DORV). Methods and results We retrospectively selected 10 consecutive patients with DORV and complex interventricular communications, who underwent biventricular repair. An arterial switch operation (ASO) was part of the repair in three of those. Computed tomography (CT) or cardiac magnetic resonance imaging images were used to reconstruct patient-specific 3D anatomies, which were then presented using different visualization modalities: 3D pdf, 3D printed models, and VR models. Two experienced paediatric cardiac surgeons, blinded to repair performed, reviewed each case evaluating the suitability of repair following assessment of each visualization modalities. In addition, they had to identify those who had ASO as part of the procedure. Answers of the two surgeons were compared to the actual operations performed. There was no mortality during the follow-up (mean = 2.5 years). Two patients required reoperations. After review of CT/cardiac magnetic resonance images, the evaluators identified the surgical strategy in accordance with the actual surgical plan in 75% of the cases. When using 3D pdf this reached only 70%. Accordance improved to 85% after revision of 3D printed models and to 95% after VR. Use of 3D printed models and VR facilitated the identification of patients who required ASO. Conclusion Virtual reality can enhance understanding of suitability for biventricular repair in patients with complex DORV if compared to cross-sectional images and other 3D modelling techniques.
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Affiliation(s)
- Elena Giulia Milano
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK.,Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Martin Kostolny
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK.,Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Endrit Pajaziti
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Jan Marek
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - William Regan
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Westminster Bridge Rd, SE1 7EH, London, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, Bristol Medical School, University of Bristol, St Michael's Hill, BS2 8DZ, Bristol, UK
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Kristian H Mortensen
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Andrew C Cook
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Silvia Schievano
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
| | - Claudio Capelli
- UCL Institute for Cardiovascular Science and Great Ormond Street Hospital, 20c Guilford St, London WC1N 1DZ, UK
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Ajami S, Rodriguez-Florez N, Ong J, Jeelani NUO, Dunaway D, James G, Angullia F, Budden C, Bozkurt S, Ibrahim A, Ferretti P, Schievano S, Borghi A. Mechanical and morphological properties of parietal bone in patients with sagittal craniosynostosis. J Mech Behav Biomed Mater 2021; 125:104929. [PMID: 34773914 DOI: 10.1016/j.jmbbm.2021.104929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 12/13/2022]
Abstract
Limited information is available on the effect of sagittal craniosynostosis (CS) on morphological and material properties of the parietal bone. Understanding these properties would not only provide an insight into bone response to surgical procedures but also improve the accuracy of computational models simulating these surgeries. The aim of the present study was to characterise the mechanical and microstructural properties of the cortical table and diploe in parietal bone of patients affected by sagittal CS. Twelve samples were collected from pediatric patients (11 males, and 1 female; age 5.2 ± 1.3 months) surgically treated for sagittal CS. Samples were imaged using micro-computed tomography (micro-CT); and mechanical properties were extracted by means of micro-CT based finite element modelling (micro-FE) of three-point bending test, calibrated using sample-specific experimental data. Reference point indentation (RPI) was used to validate the micro-FE output. Bone samples were classified based on their macrostructure as unilaminar or trilaminar (sandwich) structure. The elastic moduli obtained using RPI and micro-FE approaches for cortical tables (ERPI 3973.33 ± 268.45 MPa and Emicro-FE 3438.11 ± 387.38 MPa) in the sandwich structure and diploe (ERPI1958.17 ± 563.79 MPa and Emicro-FE 1960.66 ± 492.44 MPa) in unilaminar samples were in strong agreement (r = 0.86, p < .01). We found that the elastic modulus of cortical tables and diploe were correlated with bone mineral density. Changes in the microstructure and mechanical properties of bone specimens were found to be irrespective of patients' age. Although younger patients are reported to benefit more from surgical intervention as skull is more malleable, understanding the material properties is critical to better predict the surgical outcome in patients <1 year old since age-related changes were minimal.
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Affiliation(s)
- Sara Ajami
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom.
| | - Naiara Rodriguez-Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, Spain; Ikerbasque, Basque Foundation of Science, Spain
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom
| | | | - David Dunaway
- Craniofacial Unit, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom
| | - Greg James
- Craniofacial Unit, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom
| | - Freida Angullia
- Craniofacial Unit, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom
| | - Curtis Budden
- Craniofacial Unit, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom
| | - Selim Bozkurt
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom; UCL Institute of Cardiovascular Science, London WC1E 6BT, United Kingdom
| | - Amel Ibrahim
- Biomaterials and Biomimetics, NYU College of Dentistry, United States
| | - Patrizia Ferretti
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom
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25
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Ramjeeawon A, van de Lande L, O'Sullivan E, Bloch K, Khonsari R, Schievano S, Dunaway D, Bulstrode N. 1249 A 3D Morphable Model of the Apert Mandible. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Assess the three-dimensional Morphable Model (3DMM) of the Apert mandible, investigate differences between sex and age, and characterise growth by age. Additionally, compare with a healthy mandible 3DMM.
Method
High-quality CT scans of children with Apert’s Syndrome (without previous mandibular surgery) between November1987-January2020 were sourced from Great Ormond Street (GOSH) and Necker Hospitals. DICOM files were constructed to 3D meshes through isolation of mandibles and artifact removal (MeshMixer, Mimics) and annotation using standardized landmarks (Wrapped). A 3DMM was constructed using an existing pipeline, and experiments performed to compare with the healthy mandible 3DMM, investigating differences between sex and age, and to characterise growth by age. A healthy mandible 3DMM has been created by our team using healthy mandible CT scans sourced from a GOSH database.
Results
A 3DMM of the unoperated Apert mandible was successfully constructed from 276 Apert CT scans, male=137 (aged0-20), female=139 (aged0-23), and the first components of the morphable model identified.
Conclusions
Apert’s Syndrome is a rare genetic condition, with characteristic extremity (syndactyly) and craniofacial features (craniosynostosis), however breathing problems, sleep apnoea, relative prognathism and Angle class III malocclusion have been reported. Few studies have analysed the potential role of the Apert mandible. 3DMMs are statistical tools used to represent 3D shapes and have been used to create shape and texture parameters for anatomical areas. The 3DMM of the unoperated Apert mandible has potential applications for further understanding of Apert’s Syndrome, diagnostic purposes and may be used to develop further management of these patients, such as surgical planning.
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Affiliation(s)
- A Ramjeeawon
- University College London, London, United Kingdom
| | | | | | - K Bloch
- Necker Hospital, Paris, France
| | | | - S Schievano
- University College London, London, United Kingdom
| | - D Dunaway
- University College London, London, United Kingdom
| | - N Bulstrode
- Great Ormond Street Hospital, London, United Kingdom
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26
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Boumpouli M, Sauvage EL, Capelli C, Schievano S, Kazakidi A. Characterization of Flow Dynamics in the Pulmonary Bifurcation of Patients With Repaired Tetralogy of Fallot: A Computational Approach. Front Cardiovasc Med 2021; 8:703717. [PMID: 34660711 PMCID: PMC8514754 DOI: 10.3389/fcvm.2021.703717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
The hemodynamic environment of the pulmonary bifurcation is of great importance for adult patients with repaired tetralogy of Fallot (rTOF) due to possible complications in the pulmonary valve and narrowing of the left pulmonary artery (LPA). The aim of this study was to computationally investigate the effect of geometrical variability and flow split on blood flow characteristics in the pulmonary trunk of patient-specific models. Data from a cohort of seven patients was used retrospectively and the pulmonary hemodynamics was investigated using averaged and MRI-derived patient-specific boundary conditions on the individualized models, as well as a statistical mean geometry. Geometrical analysis showed that curvature and tortuosity are higher in the LPA branch, compared to the right pulmonary artery (RPA), resulting in complex flow patterns in the LPA. The computational analysis also demonstrated high time-averaged wall shear stress (TAWSS) at the outer wall of the LPA and the wall of the RPA proximal to the junction. Similar TAWSS patterns were observed for averaged boundary conditions, except for a significantly modified flow split assigned at the outlets. Overall, this study enhances our understanding about the flow development in the pulmonary bifurcation of rTOF patients and associates some morphological characteristics with hemodynamic parameters, highlighting the importance of patient-specificity in the models. To confirm these findings, further studies are required with a bigger cohort of patients.
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Affiliation(s)
- Maria Boumpouli
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Emilie L. Sauvage
- Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, NHS Foundation Trust, University College London, London, United Kingdom
| | - Claudio Capelli
- Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, NHS Foundation Trust, University College London, London, United Kingdom
| | - Silvia Schievano
- Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, NHS Foundation Trust, University College London, London, United Kingdom
| | - Asimina Kazakidi
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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27
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Ruggiero F, Badiali G, Bevini M, Marchetti C, Ong J, Bolognesi F, Schievano S, Dunaway D, Bianchi A, Borghi A. Parametrizing the genioplasty: a biomechanical virtual study on soft tissue behavior. Int J Comput Assist Radiol Surg 2021; 17:55-64. [PMID: 34533757 PMCID: PMC8739543 DOI: 10.1007/s11548-021-02489-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/15/2021] [Accepted: 08/30/2021] [Indexed: 12/04/2022]
Abstract
Purpose Sliding genioplasty is used to surgically correct a retruded or misaligned chin: in this procedure, an osteotomy is performed and the bony segment is repositioned. In this study we investigate the effect of surgical parameters (bony segment movement, osteotomy design) on postop soft tissue changes in a patient cohort. Methods Seven patients were retrospectively recruited. Cone beam computed tomography data were obtained and soft tissue and bone shape reconstructions were performed. 3D models were created and surgical cuts were replicated according to postop scans. Each model was imported in ANSYS 2019R1 (Ansys Inc, USA) for simulation: the effect of variation in osteotomy plane as well as extent of bony segment movement were assessed by means of design of experiment: surgical parameters were varied in a surgically acceptable range and the soft tissue predictions were evaluated as displacement output of five craniometric landmarks. Results Simulation results show the overall changes of the lower third of the face are sensitive to changes in horizontal and vertical displacement of the bony segment as well as segment rotation. No significant changes in the soft tissue response were to attribute to the osteotomy design. Conclusions Our results are consistent with experimental findings reported in the literature: when planning genioplasty in orthognathic surgery, particular focus on the segment movement (horizontal translation, vertical translation and rotation), rather than on the design of the osteotomy itself, should be considered.
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Affiliation(s)
- F Ruggiero
- DIBINEM Alma Mater Studiorum Bologna, Bologna, Italy.,Craniofacial Group, UCL Great Ormond Street Institute of Child Health-The Zayed Centre for Research, 20 Guilford Street, London, WC1N 1DZ, UK
| | - G Badiali
- DIBINEM Alma Mater Studiorum Bologna, Bologna, Italy
| | - M Bevini
- DIBINEM Alma Mater Studiorum Bologna, Bologna, Italy
| | - C Marchetti
- DIBINEM Alma Mater Studiorum Bologna, Bologna, Italy
| | - J Ong
- Division of Craniofacial and Plastic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - F Bolognesi
- DIBINEM Alma Mater Studiorum Bologna, Bologna, Italy
| | - S Schievano
- Craniofacial Group, UCL Great Ormond Street Institute of Child Health-The Zayed Centre for Research, 20 Guilford Street, London, WC1N 1DZ, UK
| | - D Dunaway
- Craniofacial Group, UCL Great Ormond Street Institute of Child Health-The Zayed Centre for Research, 20 Guilford Street, London, WC1N 1DZ, UK.,Division of Craniofacial and Plastic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - A Bianchi
- Oral and Maxillo-facial Unit, University of Catania, Catania, Italy
| | - A Borghi
- Craniofacial Group, UCL Great Ormond Street Institute of Child Health-The Zayed Centre for Research, 20 Guilford Street, London, WC1N 1DZ, UK.
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28
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Deliège L, Misier KR, Bozkurt S, Breakey W, James G, Ong J, Dunaway D, Jeelani NUO, Schievano S, Borghi A. Validation of an in-silico modelling platform for outcome prediction in spring assisted posterior vault expansion. Clin Biomech (Bristol, Avon) 2021; 88:105424. [PMID: 34303069 DOI: 10.1016/j.clinbiomech.2021.105424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spring-Assisted Posterior Vault Expansion has been adopted at Great Ormond Street Hospital for Children, London, UK to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly which causes premature fusion of skull sutures. This procedure aims at normalising head shape and augmenting intracranial volume by means of metallic springs which expand the back portion of the skull. The aim of this study is to create and validate a 3D numerical model able to predict the outcome of spring cranioplasty in patients affected by syndromic craniosynostosis, suitable for clinical adoption for preoperative surgical planning. METHODS Retrospective spring expansion measurements retrieved from x-ray images of 50 patients were used to tune the skull viscoelastic properties for syndromic cases. Pre-operative computed tomography (CT) data relative to 14 patients were processed to extract patient-specific skull shape, replicate surgical cuts and simulate spring insertion. For each patient, the predicted finite element post-operative skull shape model was compared with the respective post-operative 3D CT data. FINDINGS The comparison of the sagittal and transverse cross-sections of the simulated end-of-expansion calvaria and the post-operative skull shapes extracted from CT images showed a good shape matching for the whole population. The finite element model compared well in terms of post-operative intracranial volume prediction (R2 = 0.92, p < 0.0001). INTERPRETATION These preliminary results show that Finite Element Modelling has great potential for outcome prediction of spring assisted posterior vault expansion. Further optimisation will make it suitable for clinical deployment.
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Affiliation(s)
- Lara Deliège
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Karan Ramdat Misier
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Selim Bozkurt
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - William Breakey
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Juling Ong
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - David Dunaway
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - N U Owase Jeelani
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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29
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van de Lande LS, O'Sullivan E, Knoops PGM, Papaioannou A, Ong J, James G, Jeelani NO, Schievano S, Dunaway DJ. Local Soft Tissue and Bone Displacements Following Midfacial Bipartition Distraction in Apert Syndrome - Quantification Using a Semi-Automated Method. J Craniofac Surg 2021; 32:2646-2650. [PMID: 34260460 DOI: 10.1097/scs.0000000000007875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Patients with Apert syndrome experience midfacial hypoplasia, hypertelorism, and downslanting palpebral fissures which can be corrected by midfacial bipartition distraction with rigid external distraction device. Quantitative studies typically focus on quantifying rigid advancement and rotation postdistraction, but intrinsic shape changes of bone and soft tissue remain unknown. This study presents a method to quantify these changes. Pre- and post-operative computed tomography scans from patients with Apert syndrome undergoing midfacial bipartition distraction with rigid external distraction device were collected. Digital Imaging and Communications in Medicine files were converted to three-dimensional bone and soft tissue reconstructions. Postoperative reconstructions were aligned on the preoperative maxilla, followed by nonrigid iterative closest point transformation to determine local shape changes. Anatomical point-to-point displacements were calculated and visualized using a heatmap and arrow map. Nine patients were included.Zygomatic arches and frontal bone demonstrated the largest changes. Mid-lateral to supra-orbital rim showed an upward, inward motion. Mean bone displacements ranged from 3.3 to 12.8 mm. Soft tissue displacements were relatively smaller, with greatest changes at the lateral canthi. Midfacial bipartition distraction with rigid external distraction device results in upward, inward rotation of the orbits, upward rotation of the zygomatic arch, and relative posterior motion of the frontal bone. Local movements were successfully quantified using a novel method, which can be applied to other surgical techniques/syndromes.
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Affiliation(s)
- Lara S van de Lande
- UCL Great Ormond Street Institute of Child Health; Craniofacial Unit, Great Ormond Street Hospital for Children Department of Computing, Imperial College London, London, UK
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30
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Heutinck P, Knoops P, Florez NR, Biffi B, Breakey W, James G, Koudstaal M, Schievano S, Dunaway D, Jeelani O, Borghi A. Statistical shape modelling for the analysis of head shape variations. J Craniomaxillofac Surg 2021; 49:449-455. [PMID: 33712336 DOI: 10.1016/j.jcms.2021.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/07/2019] [Revised: 01/24/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is, firstly, to create a population-based 3D head shape model for the 0 to 2-year-old subjects to describe head shape variability within a normal population and, secondly, to test a combined normal and sagittal craniosynostosis (SAG) population model, able to provide surgical outcome assessment. 3D head shapes of patients affected by non-cranial related pathologies and of SAG patients (pre- and post-op) were extracted either from head CTs or 3D stereophotography scans, and processed. Statistical shape modelling (SSM) was used to describe shape variability using two models - a normal population model (MODEL1) and a combined normal and SAG population model (MODEL2). Head shape variability was described via principal components analysis (PCA) which calculates shape modes describing specific shape features. MODEL1 (n = 65) mode 1 showed statistical correlation (p < 0.001) with width (125.8 ± 13.6 mm), length (151.3 ± 17.4 mm) and height (112.5 ± 11.1 mm) whilst mode 2 showed correlation with cranial index (83.5 mm ± 6.3 mm, p < 0.001). The remaining 9 modes showed more subtle head shape variability. MODEL2 (n = 159) revealed that post-operative head shape still did not achieve full shape normalization with either spring cranioplasty or total calvarial remodelling. This study proves that SSM has the potential to describe detailed anatomical variations in a paediatric population.
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Affiliation(s)
- Pam Heutinck
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK; Erasmus MC Hospital, Rotterdam, the Netherlands
| | - Paul Knoops
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Naiara Rodriguez Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, San Sebastian, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | | | - William Breakey
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Greg James
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | | | - Silvia Schievano
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK; UCL Institute of Cardiovascular Science, London, UK
| | - David Dunaway
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Owase Jeelani
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Alessandro Borghi
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK.
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31
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Breakey RWF, van de Lande LS, Sidpra J, Knoops PM, Borghi A, O’Hara J, Ong J, James G, Hayward R, Schievano S, Dunaway DJ, Jeelani NUO. Spring-assisted posterior vault expansion-a single-centre experience of 200 cases. Childs Nerv Syst 2021; 37:3189-3197. [PMID: 34554301 PMCID: PMC8510948 DOI: 10.1007/s00381-021-05330-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Children affected by premature fusion of the cranial sutures due to craniosynostosis can present with raised intracranial pressure and (turri)brachycephalic head shapes that require surgical treatment. Spring-assisted posterior vault expansion (SA-PVE) is the surgical technique of choice at Great Ormond Street Hospital for Children (GOSH), London, UK. This study aims to report the SA-PVE clinical experience of GOSH to date. METHODS A retrospective review was carried out including all SA-PVE cases performed at GOSH between 2008 and 2020. Demographic and clinical data were recorded including genetic diagnosis, craniofacial surgical history, surgical indication and assessment, age at time of surgery (spring insertion and removal), operative time, in-patient stay, blood transfusion requirements, additional/secondary (cranio)facial procedures, and complications. RESULTS Between 2008 and 2020, 200 SA-PVEs were undertaken in 184 patients (61% male). The study population consisted of patients affected by syndromic (65%) and non-syndromic disorders. Concerns regarding raised intracranial pressure were the surgical driver in 75% of the cases, with the remainder operated for shape correction. Median age for SA-PVE was 19 months (range, 2-131). Average operative time for first SA-PVE was 150 min and 87 for spring removal. Median in-patient stay was 3 nights, and 88 patients received a mean of 204.4 ml of blood transfusion at time of spring insertion. A single SA-PVE sufficed in 156 patients (85%) to date (26 springs still in situ at time of this analysis); 16 patients underwent repeat SA-PVE, whilst 12 underwent rigid redo. A second SA-PVE was needed in significantly more cases when the first SA-PVE was performed before age 1 year. Complications occurred in 26 patients with a total of 32 events, including one death. Forty-one patients underwent fronto-orbital remodelling at spring removal and 22 required additional cranio(maxillo)facial procedures. CONCLUSIONS Spring-assisted posterior vault expansion is a safe, efficient, and effective procedure based on our 12-year experience. Those that are treated early in life might require a repeat SA-PVE. Long-term follow-up is recommended as some would require additional craniomaxillofacial correction later in life.
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Affiliation(s)
- R. William F. Breakey
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Lara S. van de Lande
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Jai Sidpra
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Paul M. Knoops
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Justine O’Hara
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Juling Ong
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Richard Hayward
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - David J. Dunaway
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - N ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK ,Paediatric Neurosurgeon, Great Ormond Street Hospital for Children, Craniofacial Unit, Great Ormond Street, London, WC1N 3JH UK
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Eley KA, Rossi-Espagnet MC, Schievano S, Napolitano A, Ong J, Secinaro A, Borro L, Dunaway D, Marras CE, Rennie A, Robertson F, Picardo S, Longo D, Inserra A, Rollo M, Cooper J, Mankad K, Jeelani NO, D'Arco F. Multiparametric Imaging for Presurgical Planning of Craniopagus Twins: The Experience of Two Tertiary Pediatric Hospitals with Six Sets of Twins. Radiology 2020; 298:18-27. [PMID: 33141005 DOI: 10.1148/radiol.2020202216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Conjoined twins are rare and pose a challenge to radiologists and surgeons. Craniopagus twins, where conjunction involves the cranium, are especially rare. Even in large pediatric centers, radiologists are unlikely to encounter more than one such event in their medical careers. This rarity makes it daunting to select a CT and MRI protocol for these infants. Using the experience of two tertiary pediatric hospitals with six sets of craniopagus twins, this multidisciplinary and multimodal integrated imaging approach highlights the key questions that need addressing in the decision-making process for possible surgical intervention.
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Affiliation(s)
- Karen A Eley
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Maria Camilla Rossi-Espagnet
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Silvia Schievano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Antonio Napolitano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Juling Ong
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Aurelio Secinaro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Luca Borro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - David Dunaway
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Carlo Efisio Marras
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Adam Rennie
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Fergus Robertson
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Sergio Picardo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Daniela Longo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Alessandro Inserra
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Massimo Rollo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Jessica Cooper
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Kshitij Mankad
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Noor-Owase Jeelani
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Felice D'Arco
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
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Clark AE, Biffi B, Sivera R, Dall'Asta A, Fessey L, Wong TL, Paramasivam G, Dunaway D, Schievano S, Lees CC. Developing and testing an algorithm for automatic segmentation of the fetal face from three-dimensional ultrasound images. R Soc Open Sci 2020; 7:201342. [PMID: 33391808 PMCID: PMC7735327 DOI: 10.1098/rsos.201342] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
Fetal craniofacial abnormalities are challenging to detect and diagnose on prenatal ultrasound (US). Image segmentation and computer analysis of three-dimensional US volumes of the fetal face may provide an objective measure to quantify fetal facial features and identify abnormalities. We have developed and tested an atlas-based partially automated facial segmentation algorithm; however, the volumes require additional manual segmentation (MS), which is time and labour intensive and may preclude this method from clinical adoption. These manually refined segmentations can then be used as a reference (atlas) by the partially automated segmentation algorithm to improve algorithmic performance with the aim of eliminating the need for manual refinement and developing a fully automated system. This study assesses the inter- and intra-operator variability of MS and tests an optimized version of our automatic segmentation (AS) algorithm. The manual refinements of 15 fetal faces performed by three operators and repeated by one operator were assessed by Dice score, average symmetrical surface distance and volume difference. The performance of the partially automatic algorithm with difference size atlases was evaluated by Dice score and computational time. Assessment of the manual refinements showed low inter- and intra-operator variability demonstrating its suitability for optimizing the AS algorithm. The algorithm showed improved performance following an increase in the atlas size in turn reducing the need for manual refinement.
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Affiliation(s)
- A. E. Clark
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - B. Biffi
- Imperial College London, London, UK
| | | | - A. Dall'Asta
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Italy
| | | | - T.-L. Wong
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
| | - G. Paramasivam
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - D. Dunaway
- University College London GOS Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- University College London GOS Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - C. C. Lees
- Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London, UK
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Bozkurt S, Borghi A, van de Lande LS, Jeelani NUO, Dunaway DJ, Schievano S. Computational modelling of patient specific spring assisted lambdoid craniosynostosis correction. Sci Rep 2020; 10:18693. [PMID: 33122820 PMCID: PMC7596227 DOI: 10.1038/s41598-020-75747-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Lambdoid craniosynostosis (LC) is a rare non-syndromic craniosynostosis characterised by fusion of the lambdoid sutures at the back of the head. Surgical correction including the spring assisted cranioplasty is the only option to correct the asymmetry at the skull in LC. However, the aesthetic outcome from spring assisted cranioplasty may remain suboptimal. The aim of this study is to develop a parametric finite element (FE) model of the LC skulls that could be used in the future to optimise spring surgery. The skull geometries from three different LC patients who underwent spring correction were reconstructed from the pre-operative computed tomography (CT) in Simpleware ScanIP. Initially, the skull growth between the pre-operative CT imaging and surgical intervention was simulated using MSC Marc. The osteotomies and spring implantation were performed to simulate the skull expansion due to the spring forces and skull growth between surgery and post-operative CT imaging in MSC Marc. Surface deviation between the FE models and post-operative skull models reconstructed from CT images changed between ± 5 mm over the skull geometries. Replicating spring assisted cranioplasty in LC patients allow to tune the parameters for surgical planning, which may help to improve outcomes in LC surgeries in the future.
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Affiliation(s)
- Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, UK. .,University College London, Great Ormond Street Institute of Child Health, London, UK.
| | - Alessandro Borghi
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Lara S van de Lande
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - N U Owase Jeelani
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - David J Dunaway
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
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35
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Fanni BM, Sauvage E, Celi S, Norman W, Vignali E, Landini L, Schievano S, Positano V, Capelli C. A Proof of Concept of a Non-Invasive Image-Based Material Characterization Method for Enhanced Patient-Specific Computational Modeling. Cardiovasc Eng Technol 2020; 11:532-543. [PMID: 32748364 DOI: 10.1007/s13239-020-00479-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 07/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Computational models of cardiovascular structures rely on their accurate mechanical characterization. A validated method able to infer the material properties of patient-specific large vessels is currently lacking. The aim of the present study is to present a technique starting from the flow-area (QA) method to retrieve basic material properties from magnetic resonance (MR) imaging. METHODS The proposed method was developed and tested, first, in silico and then in vitro. In silico, fluid-structure interaction (FSI) simulations of flow within a deformable pipe were run with varying elastic modules (E) between 0.5 and 32 MPa. The proposed QA-based formulation was assessed and modified based on the FSI results to retrieve E values. In vitro, a compliant phantom connected to a mock circulatory system was tested within MR scanning. Images of the phantom were acquired and post-processed according to the modified formulation to infer E of the phantom. Results of in vitro imaging assessment were verified against standard tensile test. RESULTS In silico results from FSI simulations were used to derive the correction factor to the original formulation based on the geometrical and material characteristics. In vitro, the modified QA-based equation estimated an average E = 0.51 MPa, 2% different from the E derived from tensile tests (i.e. E = 0.50 MPa). CONCLUSION This study presented promising results of an indirect and non-invasive method to establish elastic properties from solely MR images data, suggesting a potential image-based mechanical characterization of large blood vessels.
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Affiliation(s)
- B M Fanni
- BioCardioLab, Bioengineering Unit, Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100, Massa, Italy.,Department of Information Engineering, University of Pisa, Via Girolamo Caruso 16, 56122, Pisa, Italy
| | - E Sauvage
- UCL Institute of Cardiovascular Science, 20c Guilford Street, London, WC1N 1DZ, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Great Ormond Street, London, WC1N 3JH, UK
| | - S Celi
- BioCardioLab, Bioengineering Unit, Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100, Massa, Italy.
| | - W Norman
- UCL Institute of Cardiovascular Science, 20c Guilford Street, London, WC1N 1DZ, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Great Ormond Street, London, WC1N 3JH, UK
| | - E Vignali
- BioCardioLab, Bioengineering Unit, Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100, Massa, Italy.,Department of Information Engineering, University of Pisa, Via Girolamo Caruso 16, 56122, Pisa, Italy
| | - L Landini
- BioCardioLab, Bioengineering Unit, Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100, Massa, Italy.,Department of Information Engineering, University of Pisa, Via Girolamo Caruso 16, 56122, Pisa, Italy
| | - S Schievano
- UCL Institute of Cardiovascular Science, 20c Guilford Street, London, WC1N 1DZ, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Great Ormond Street, London, WC1N 3JH, UK
| | - V Positano
- BioCardioLab, Bioengineering Unit, Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100, Massa, Italy
| | - C Capelli
- UCL Institute of Cardiovascular Science, 20c Guilford Street, London, WC1N 1DZ, UK.,Great Ormond Street Hospital for Children, NHS Foundation Trust, 30 Great Ormond Street, London, WC1N 3JH, UK
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Abstract
Abstract
Funding Acknowledgements
La Fondation Dassault Systèmes, British Heart Foundation
Background
Virtual reality (VR) provides a unique possibility to interact with three-dimensional objects. Still in its infancy, the integration of VR with advanced cardiovascular imaging technology allows users to handle patient-specific cardiac models.
Purpose
The purpose of this study was to evaluate the potential role of VR in teaching cardiac morphology of congenital heart diseases to healthcare professionals.
Methods
From October 2018 to April 2019, a VR application was developed in-house and incorporated within the Cardiac Morphology courses run monthly at our centre. The VR software included patient-specific 3D models which were reconstructed from 3D imaging datasets (micro-CT, CT, CMR or 3D echo data). The most important cardiac structures were labelled to allow easier identification of anatomical features (Figure 1). Each participant had the possibility to evaluate 6 different patient specific models including: a foetal normal heart, a foetal Transposition of the Great Arteries, a foetal Atrioventricular septal defect, a four-month-old Tetralogy of Fallot, a four-month-old Double Outlet Right Ventricle with uncommitted ventricular septal defect and a one-year-old Patent Ductus Arteriosus. All the attendees could evaluate the models individually for 5 to 15 minutes. A short survey with six questions was administered at the end of the session. The survey included sections asking for professional background information, prior VR experience and feedback on the VR experience which was assessed with a 5 points Likert-type scale (from 1 to 5).
Results
The VR session was attended by 20 delegates with mixed professional backgrounds including cardiac surgeons, cardiologists, cardiac anaesthesiologists, paediatricians, pathologists and medical students. Only 2 out of 20 had tried a virtual reality application before, although neither of those prior VR experiences had a medical focus. The VR application was considered ‘’extremely helpful’’ (5/5) in understanding the anatomy by 44% of participants, and ‘’very helpful’’(4/5) by another 44%. The methods of interaction (e.g. grabbing objects, using a cutting tool) were considered "extremely intuitive’’ (5/5) by 72% of attendees, and "very intuitive"(4/5) by 27%. In 94% of the cases, the attendees responded to be "very willing"(4/5) or "extremely willing"(5/5) to implement a VR setup at their own institutions for the purpose of evaluating cardiac anatomies.
Conclusion
The use of the VR station in cardiac morphology courses was very well received by the attendees, as it is frequently considered easy to use and very helpful in aiding the understanding of congenital heart diseases. The survey highlighted a great potential for implementing this tool in educational programmes.
Abstract P369 Figure 1
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Affiliation(s)
- E G Milano
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Pajaziti
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Schievano
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Cook
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Capelli
- University College London, London, United Kingdom of Great Britain & Northern Ireland
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37
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Biffi B, Gritti M, Grasso A, Milano EG, Fontana M, Alkareef H, Davar J, Jeetley P, Whelan C, Anderson S, Lorusso D, Sauvage E, Maria Bosi G, Schievano S, Capelli C. A workflow for patient-specific fluid-structure interaction analysis of the mitral valve: A proof of concept on a mitral regurgitation case. Med Eng Phys 2019; 74:153-161. [PMID: 31653498 DOI: 10.1016/j.medengphy.2019.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/24/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022]
Abstract
The mechanics of the mitral valve (MV) are the result of the interaction of different anatomical structures complexly arranged within the left heart (LH), with the blood flow. MV structure abnormalities might cause valve regurgitation which in turn can lead to heart failure. Patient-specific computational models of the MV could provide a personalised understanding of MV mechanics, dysfunctions and possible interventions. In this study, we propose a semi-automatic pipeline for MV modelling based on the integration of state-of-the-art medical imaging, i.e. cardiac magnetic resonance (CMR) and 3D transoesophageal-echocardiogram (TOE) with fluid-structure interaction (FSI) simulations. An FSI model of a patient with MV regurgitation was implemented using the finite element (FE) method and smoothed particle hydrodynamics (SPH). Our study showed the feasibility of combining image information and computer simulations to reproduce patient-specific MV mechanics as seen on medical images, and the potential for efficient in-silico studies of MV disease, personalised treatments and device design.
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Affiliation(s)
- Benedetta Biffi
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK; Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
| | - Maurizio Gritti
- The National Amyloidosis Centre, Division of Medicine, UCL Medical School, Royal Free Hospital, London, UK
| | - Agata Grasso
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Elena G Milano
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Marianna Fontana
- The National Amyloidosis Centre, Division of Medicine, UCL Medical School, Royal Free Hospital, London, UK
| | - Hamad Alkareef
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Joseph Davar
- Department of Cardiology, Royal Free Hospital, London, UK
| | | | - Carol Whelan
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Sarah Anderson
- The National Amyloidosis Centre, Division of Medicine, UCL Medical School, Royal Free Hospital, London, UK
| | - Donatella Lorusso
- The National Amyloidosis Centre, Division of Medicine, UCL Medical School, Royal Free Hospital, London, UK
| | - Emilie Sauvage
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Giorgia Maria Bosi
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Claudio Capelli
- Centre for Clinical Cardiovascular Engineering, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
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Borghi A, Rodriguez Florez N, Ruggiero F, James G, O'Hara J, Ong J, Jeelani O, Dunaway D, Schievano S. A population-specific material model for sagittal craniosynostosis to predict surgical shape outcomes. Biomech Model Mechanobiol 2019; 19:1319-1329. [PMID: 31571084 PMCID: PMC7424404 DOI: 10.1007/s10237-019-01229-y] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/17/2019] [Indexed: 11/26/2022]
Abstract
Sagittal craniosynostosis consists of premature fusion (ossification) of the sagittal suture during infancy, resulting in head deformity and brain growth restriction. Spring-assisted cranioplasty (SAC) entails skull incisions to free the fused suture and insertion of two springs (metallic distractors) to promote cranial reshaping. Although safe and effective, SAC outcomes remain uncertain. We aimed hereby to obtain and validate a skull material model for SAC outcome prediction. Computed tomography data relative to 18 patients were processed to simulate surgical cuts and spring location. A rescaling model for age matching was created using retrospective data and validated. Design of experiments was used to assess the effect of different material property parameters on the model output. Subsequent material optimization-using retrospective clinical spring measurements-was performed for nine patients. A population-derived material model was obtained and applied to the whole population. Results showed that bone Young's modulus and relaxation modulus had the largest effect on the model predictions: the use of the population-derived material model had a negligible effect on improving the prediction of on-table opening while significantly improved the prediction of spring kinematics at follow-up. The model was validated using on-table 3D scans for nine patients: the predicted head shape approximated within 2 mm the 3D scan model in 80% of the surface points, in 8 out of 9 patients. The accuracy and reliability of the developed computational model of SAC were increased using population data: this tool is now ready for prospective clinical application.
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Affiliation(s)
- Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
| | - Naiara Rodriguez Florez
- Surface Technologies Group, Department of Biomedical Engineering, Mondragon Unibertsitatea, Mondragón, Spain
| | - Federica Ruggiero
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Justine O'Hara
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Juling Ong
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - David Dunaway
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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39
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Knoops PGM, Papaioannou A, Borghi A, Breakey RWF, Wilson AT, Jeelani O, Zafeiriou S, Steinbacher D, Padwa BL, Dunaway DJ, Schievano S. A machine learning framework for automated diagnosis and computer-assisted planning in plastic and reconstructive surgery. Sci Rep 2019; 9:13597. [PMID: 31537815 PMCID: PMC6753131 DOI: 10.1038/s41598-019-49506-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
Current computational tools for planning and simulation in plastic and reconstructive surgery lack sufficient precision and are time-consuming, thus resulting in limited adoption. Although computer-assisted surgical planning systems help to improve clinical outcomes, shorten operation time and reduce cost, they are often too complex and require extensive manual input, which ultimately limits their use in doctor-patient communication and clinical decision making. Here, we present the first large-scale clinical 3D morphable model, a machine-learning-based framework involving supervised learning for diagnostics, risk stratification, and treatment simulation. The model, trained and validated with 4,261 faces of healthy volunteers and orthognathic (jaw) surgery patients, diagnoses patients with 95.5% sensitivity and 95.2% specificity, and simulates surgical outcomes with a mean accuracy of 1.1 ± 0.3 mm. We demonstrate how this model could fully-automatically aid diagnosis and provide patient-specific treatment plans from a 3D scan alone, to help efficient clinical decision making and improve clinical understanding of face shape as a marker for primary and secondary surgery.
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Affiliation(s)
- Paul G M Knoops
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Plastic and Oral Surgery, Boston Children's Hospital & Harvard School of Dental Medicine, Boston, MA, USA
| | - Athanasios Papaioannou
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Computing, Imperial College London, London, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Richard W F Breakey
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alexander T Wilson
- Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Derek Steinbacher
- Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Bonnie L Padwa
- Department of Plastic and Oral Surgery, Boston Children's Hospital & Harvard School of Dental Medicine, Boston, MA, USA
| | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, London, UK.
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK.
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40
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Pontecorboli G, Biglino G, Milano EG, Sophocleous F, Biffi B, Dastidar AG, Schievano S, Di Mario C, Bucciarelli-Ducci C. Beyond apical ballooning: computational modelling reveals morphological features of Takotsubo cardiomyopathy. Comput Methods Biomech Biomed Engin 2019; 22:1103-1106. [PMID: 31269802 PMCID: PMC6816475 DOI: 10.1080/10255842.2019.1632836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 10/26/2022]
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient myocardial dysfunction, typically at the left ventricular (LV) apex. Its pathophysiology and recovery mechanisms remain unknown. We investigated LV morphology and deformation in n = 28 TCM patients. Patients with MRI within 5 days from admission ("early TCM") showed reduced LVEF and higher ventricular volumes, but no differences in ECG, global strains or myocardial oedema. Statistical shape modelling described LV size (Mode 1), apical sphericity (Mode 2) and height (Mode 3). Significant differences in Mode 1 suggest that "early TCM" LV remodeling is mainly influenced by a change in ventricular size rather than apical sphericity.
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Affiliation(s)
- Giulia Pontecorboli
- Bristol Heart Institute, University Hospitals Bristol NHS Trust , Bristol , UK.,Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy
| | - Giovanni Biglino
- Bristol Heart Institute, University Hospitals Bristol NHS Trust , Bristol , UK.,Translational Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK
| | - Elena Giulia Milano
- Bristol Heart Institute, University Hospitals Bristol NHS Trust , Bristol , UK.,Department of Medicine, Section of Cardiology, University of Verona , Verona , Italy.,Institute of Cardiovascular Science, University College London , London , UK
| | - Froso Sophocleous
- Translational Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK
| | - Benedetta Biffi
- Institute of Cardiovascular Science, University College London , London , UK
| | | | - Silvia Schievano
- Institute of Cardiovascular Science, University College London , London , UK
| | - Carlo Di Mario
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University Hospitals Bristol NHS Trust , Bristol , UK.,Translational Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK
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41
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Affiliation(s)
- Elena Giulia Milano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Endrit Pajaziti
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Emilie Sauvage
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Andrew Cook
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Andrew M Taylor
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Jan Marek
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK (E.G.M., K.H.M., A.M.T., J.M.)
| | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK (M.K.)
- Slovak Medical University, Bratislava, Slovakia (M.K.)
| | - Claudio Capelli
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK (E.G.M., E.P., E.S., A.C., S.S., A.M.T., J.M., C.C.)
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42
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Borghi A, Ruggiero F, Tenhagen M, Schievano S, Ponniah A, Dunaway D, O'Hara J, Ong J, Britto JA. Design and manufacturing of a patient-specific nasal implant for congenital arhinia: Case report. JPRAS Open 2019; 21:28-34. [PMID: 32158883 PMCID: PMC7061611 DOI: 10.1016/j.jpra.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
Arhinia (congenital absence of the nose) is a congenital rare disease, which has been reported in less than 60 cases in the literature. It consists of the absence of external nose, nasal cavities and olfactory apparatus and is generally associated with midline defects, microphthalmia, blepharophimosis and hypotelorism. Aesthetic problems as well as associated functional anomalies can potentially impact on the development and interpersonal relationships of the child at a later stage in life. Arhinia requires extensive management in early life in order to ensure airway patency and protection by means of tracheostomy, and to allow adequate pharyngeal and feeding function to the child. Aesthetic issues are managed with reconstructive surgery or an external prosthesis. There is no previous description in Literature of internal prosthetic devices used to sequentially shape soft tissues in complex reconstruction. We present an example of design and manufacturing of a bespoke nose implant produced by means of 3D printing and directly assessed on-table by means of 3D surface scanning.
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Affiliation(s)
- Alessandro Borghi
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Federica Ruggiero
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Maik Tenhagen
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Silvia Schievano
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Allan Ponniah
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London NW3 2QG. UK
| | - David Dunaway
- Developmental Biology and Cancer Programme, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Justine O'Hara
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 1JH, UK
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Milano EG, Pajaziti E, Sauvage E, Taylor AM, Marek J, Mortensen K, Cook A, Schievano S, Kostolny M, Capelli C. P358Taking surgery out of reality: a repair of double outlet right ventricle planned by means of virtual reality. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.001] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- E G Milano
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - E Pajaziti
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - E Sauvage
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - A M Taylor
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - J Marek
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | - K Mortensen
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | - A Cook
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - S Schievano
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
| | - M Kostolny
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | - C Capelli
- University College London, Institute of Cardiovascular Science, LONDON, United Kingdom of Great Britain & Northern Ireland
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44
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Formato G, Hart E, Hamilton M, Manghat N, Bucciarelli-Ducci C, Caputo M, Schievano S, Auricchio F, Conti M, Biglino G. 283Morphometric analysis of internal carotid arteries in hypertensives implementing a semi-automatic measurement platform for magnetic resonance imaging data. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez114.001] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - E Hart
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Hamilton
- University Hospitals Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - N Manghat
- University Hospitals Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Caputo
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Schievano
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain & Northern Ireland
| | | | - M Conti
- University of Pavia, Pavia, Italy
| | - G Biglino
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
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45
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Biglino G, Milano EG, Capelli C, Wray J, Shearn AI, Caputo M, Bucciarelli-Ducci C, Taylor AM, Schievano S. Three-dimensional printing in congenital heart disease: Considerations on training and clinical implementation from a teaching session. Int J Artif Organs 2019; 42:595-599. [PMID: 31104546 DOI: 10.1177/0391398819849074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/03/2023]
Abstract
In light of growing interest for three-dimensional printing technology in the cardiovascular community, this study focused on exploring the possibilities of providing training for cardiovascular three-dimensional printing in the context of a relevant international congress and providing considerations on the delivery of such courses. As a second objective, the study sought to capture preferences in relation to three-dimensional printing uses and set-ups from those attending the training session. A survey was administered to n = 30 professionals involved or interested in three-dimensional printing cardiovascular models following a specialised teaching session. Survey results suggest the potential for split training sessions, with a broader introduction for those with no prior experience in three-dimensional printing followed by a more in-depth and hands-on session. All participants agreed on the potential of the technology in all its applications, particularly for aiding decision-making around complex surgical or interventional cases. When exploring setting up an in-house three-dimensional printing service, the majority of participants reported that their centre was already equipped with an in-house facility or expressed a desire that such a facility should be available, with a minority preferring consigning models to an external third party for printing.
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Affiliation(s)
- Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Elena G Milano
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Surgery, Dentistry, Paediatrics and Obstetrics/Gynaecology, University of Verona, Verona, Italy
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Iu Shearn
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew M Taylor
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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46
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Van de Lande L, Papaioannou A, Breakey R, Schievano S, Dunaway D. A new 3D statistical model for treacher collins syndrome using machine learning techniques to quantify facial shape differences from the normal. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.504] [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: 10/26/2022]
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47
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Knoops P, Borghi A, Breakey R, Ong J, Jeelani N, Bruun R, Schievano S, Dunaway D, Padwa B. Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling. Int J Oral Maxillofac Surg 2019; 48:511-518. [DOI: 10.1016/j.ijom.2018.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/08/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
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48
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Sophocleous F, Biffi B, Milano EG, Bruse J, Caputo M, Rajakaruna C, Schievano S, Emanueli C, Bucciarelli-Ducci C, Biglino G. Aortic morphological variability in patients with bicuspid aortic valve and aortic coarctation. Eur J Cardiothorac Surg 2019; 55:704-713. [PMID: 30380029 PMCID: PMC6459283 DOI: 10.1093/ejcts/ezy339] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/10/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Benedetta Biffi
- Institute of Cardiovascular Science, University College London, London, UK
| | - Elena Giulia Milano
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK.,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jan Bruse
- Vicomtech-IK4, Data Intelligence for Energy and Industrial Processes, Donostia/San Sebastián, Spain
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Cha Rajakaruna
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Costanza Emanueli
- Bristol Medical School, University of Bristol, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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49
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Milano EG, Capelli C, Wray J, Biffi B, Layton S, Lee M, Caputo M, Taylor AM, Schievano S, Biglino G. Current and future applications of 3D printing in congenital cardiology and cardiac surgery. Br J Radiol 2018; 92:20180389. [PMID: 30325646 DOI: 10.1259/bjr.20180389] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Three-dimensional (3D) printing technology in congenital cardiology and cardiac surgery has experienced a rapid development over the last decade. In presence of complex cardiac and extra-cardiac anatomies, the creation of a physical, patient-specific model is attractive to most clinicians. However, at the present time, there is still a lack of strong scientific evidence of the benefit of 3D models in clinical practice and only qualitative evaluation of the models has been used to investigate their clinical use. 3D models can be printed in rigid or flexible materials, and the original size can be augmented depending on the application the models are needed for. The most common applications of 3D models at present include procedural planning of complex surgical or interventional cases, in vitro simulation for research purposes, training and communication with patients and families. The aim of this pictorial review is to describe the basic principles of this technology and present its current and future applications.
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Affiliation(s)
- Elena Giulia Milano
- 1 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children , London , UK.,2 Department of Medicine, Section of Cardiology, University of Verona , Verona , Italy
| | - Claudio Capelli
- 1 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children , London , UK
| | - Jo Wray
- 3 Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Benedetta Biffi
- 1 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children , London , UK
| | - Sofie Layton
- 3 Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust , London , UK
| | - Matthew Lee
- 4 Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol , UK
| | - Massimo Caputo
- 4 Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol , UK
| | - Andrew M Taylor
- 1 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children , London , UK
| | - Silvia Schievano
- 1 Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children , London , UK
| | - Giovanni Biglino
- 4 Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol , UK.,5 National Heart and Lung Institute, Imperial College London , London , United Kingdom
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50
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Shelmerdine SC, Simcock IC, Hutchinson JC, Aughwane R, Melbourne A, Nikitichev DI, Ong JL, Borghi A, Cole G, Kingham E, Calder AD, Capelli C, Akhtar A, Cook AC, Schievano S, David A, Ourselin S, Sebire NJ, Arthurs OJ. 3D printing from microfocus computed tomography (micro-CT) in human specimens: education and future implications. Br J Radiol 2018; 91:20180306. [PMID: 29698059 DOI: 10.1259/bjr.20180306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Microfocus CT (micro-CT) is an imaging method that provides three-dimensional digital data sets with comparable resolution to light microscopy. Although it has traditionally been used for non-destructive testing in engineering, aerospace industries and in preclinical animal studies, new applications are rapidly becoming available in the clinical setting including post-mortem fetal imaging and pathological specimen analysis. Printing three-dimensional models from imaging data sets for educational purposes is well established in the medical literature, but typically using low resolution (0.7 mm voxel size) data acquired from CT or MR examinations. With higher resolution imaging (voxel sizes below 1 micron, <0.001 mm) at micro-CT, smaller structures can be better characterised, and data sets post-processed to create accurate anatomical models for review and handling. In this review, we provide examples of how three-dimensional printing of micro-CT imaged specimens can provide insight into craniofacial surgical applications, developmental cardiac anatomy, placental imaging, archaeological remains and high-resolution bone imaging. We conclude with other potential future usages of this emerging technique.
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Affiliation(s)
- Susan C Shelmerdine
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Ian C Simcock
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - John Ciaran Hutchinson
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Rosalind Aughwane
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Andrew Melbourne
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Daniil I Nikitichev
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK.,5 Department of Medical Physics and Biomedical Engineering, University College London , London , UK
| | - Ju-Ling Ong
- 6 Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | | | | | - Emilia Kingham
- 8 UCL Culture, Bidborough House, 38-50 Bidborough Street, London UK
| | - Alistair D Calder
- 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Claudio Capelli
- 9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Aadam Akhtar
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Andrew C Cook
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Silvia Schievano
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Anna David
- 11 Institute for Women's Health, University College London , London , UK
| | - Sebastian Ourselin
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Neil J Sebire
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Owen J Arthurs
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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