Segmentation and Volumetric Analysis of Heart from Cardiac CT Images

PURPOSE

Cardiac CT is a valuable diagnostic tool in evaluating cardiovascular diseases. Accurate segmentation of the heart and its structures from cardiac CT and MRI images is essential for diagnosing functional abnormalities, treatment plans and cardiovascular diseases management. Accurate segmentation and quantitative assessments are still a challenge. Manual delineation of the heart from the scan images is labour-intensive, time-consuming, and error prone as it depends on the radiologist's experience. Thus, automated techniques are highly desirable as they can significantly improve the efficiency and accuracy of image analysis.

METHOD

This work addresses the above problems. A new, image-driven, fast, and fully automatic segmentation method was developed to segment the heart from CT images using a processing pipeline of adaptive median filter, multi-level thresholding, active contours, mathematical morphology, and the knowledge of human anatomy to delineate the regions of interest.

RESULTS

The algorithm proposed is simple to implement and validate and requires no human intervention. The method is tested on the 'Image CHD' DICOM images (multi-centre, clinically approved single-phase de-identified images), and the results obtained were validated against the ground truths provided with the dataset. The results show an average Dice score, Jaccard score, and Hausdorff distance of 0.866, 0.776, and 33.29 mm, respectively, for the segmentation of the heart's chambers, aorta, and blood vessels. The results and the ground truths were compared using Bland-Altmon plots.

CONCLUSION

The heart was correctly segmented from the CT images using the proposed method. Further this segmentation technique can be used to develop AI based solutions for segmentation.

Subjective effects of broadband water sounds with inaudible high-frequency components

This study aimed to investigate the effects of reproducing an ultrasonic sound above 20 kHz on the subjective impressions of water sounds using psychological and physiological information obtained by the semantic differential method and electroencephalography (EEG), respectively. The results indicated that the ultrasonic component affected the subjective impression of the water sounds. In addition, regarding the relationship between psychological and physiological aspects, a moderate correlation was confirmed between the EEG change rate and subjective impressions. However, no differences in characteristics were found between with and without the ultrasound component, suggesting that ultrasound does not directly affect the relationship between subjective impressions and EEG energy at the current stage. Furthermore, the correlations calculated for the left and right channels in the occipital region differed significantly, which suggests functional asymmetry for sound perception between the right and left hemispheres.

Dermatology Life Quality Index in Thai Patients with Facial Port-Wine Stains

INTRODUCTION

Port-wine stains (PWS) are congenital capillary abnormalities caused by immature, venule-like vasculature that progressively dilates due to poor endothelial cell differentiation. PWS affects between 0.3% and 0.9% of newborns, with 90% of cases occurring on the face. Individuals with facial PWS and their parents had a significant negative impairment on their quality of life (QoL) and also suffered from psychological disabilities.

METHODS

This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaires included demographic data, subjective evaluation (SE), and the Dermatology Life Quality Index (DLQI). The questionnaire was performed with a full scale and adjusted scale of validity and reliability test of DLQI using factor analysis and Cronbach's alpha. The study outcome was a subjective evaluation and DLQI in patients who received pulsed dye laser (PDL) treatment.

RESULTS

Of the 54 patients, 35.2% (19) are male, and 64.8% (35) are female. Regarding age groups, 64.8% (35) are below 5 years old, and 35.2% (19) are older than 5 years. SE results showed that males evaluated an improvement of the facial PWS lesion significantly better than females (P < 0.05). The older age group graded the percentage of improvement better than the younger age group (P < 0.01). The result of the DLQI showed no difference in DLQI between gender. Older age result resulted in a significantly different DLQI compared with younger age (P < 0.01). Parent-reported DLQI improvement was less than self-reported DLQI improvement in patients with PWS treated with PDL (P < 0.05). Concerning the instrument of the study, the validity and reliability analysis of the DLQI questionnaire using factor analysis and Cronbach's alpha have been performed. The adjusted scale with the 5-item DLQI questionnaire is more appropriate in terms validity and reliability.

CONCLUSION

This study demonstrates that facial PWS reduces the QoL as measured by DLQI. We discovered that the QoL of patients and parents with PWS was significantly impaired. The main influencing factors were older age, the improved perception between gender, and PDL treatments. In addition, we found only five questions that are reliable for PWS. The adjusted five-item DLQI questionnaires are more appropriate regarding validity and reliability.

TRIAL REGISTRATION NUMBER

TCTR20230210001, COA no. si 1059/2020.

Subjective evaluation of facial asymmetry with three-dimensional simulated images among the orthodontists and laypersons: a cross-sectional study

OBJECTIVES

We used three-dimensional (3D) virtual images to undertake a subjective evaluation of how different factors affect the perception of facial asymmetry among orthodontists and laypersons with the aim of providing a quantitative reference for clinics.

MATERIALS AND METHODS

A 3D virtual symmetrical facial image was acquired using FaceGen Modeller software. The left chin, mandible, lip and cheek of the virtual face were simulated in the horizontal (interior/exterior), vertical (up/down), or sagittal (forward or backward) direction in 3, 5, and 7 mm respectively with Maya software to increase asymmetry for the further subjective evaluation. A pilot study was performed among ten volunteers and 30 subjects of each group were expected to be included based on 80% sensitivity in this study. The sample size was increased by 60% to exclude incomplete and unqualified questionnaires. Eventually, a total of 48 orthodontists and 40 laypersons evaluated these images with a 10-point visual analog scale (VAS). The images were presented in random order. Each image would stop for 30 s for observers with a two-second interval between images. Asymmetry ratings and recognition accuracy for asymmetric virtual faces were analyzed to explore how different factors affect the subjective evaluation of facial asymmetry. Multivariate linear regression and multivariate logistic regression models were used for statistical data analysis.

RESULTS

Orthodontists were found to be more critical of asymmetry than laypersons. Our results showed that observers progressively decreased ratings by 1.219 on the VAS scale and increased recognition rates by 2.301-fold as the degree of asymmetry increased by 2 mm; asymmetry in the sagittal direction was the least noticeable compared with the horizontal and vertical directions; and chin asymmetry turned out to be the most sensitive part among the four parts we simulated. Mandible asymmetry was easily confused with cheek asymmetry in the horizontal direction.

CONCLUSIONS

The degree, types and parts of asymmetry can affect ratings for facial deformity as well as the accuracy rate of identifying the asymmetrical part. Although orthodontists have higher accuracy in diagnosing asymmetrical faces than laypersons, they fail to correctly distinguish some specific asymmetrical areas.

Vocal Fatigue Index in Finnish-Speaking Population

BACKGROUND AND OBJECTIVE

Vocal fatigue is an important complaint that may indicate a voice disorder or a risk thereof. There is a need for a reliable tool to detect and quantify vocal fatigue and distinguish dysphonic and vocally healthy speakers. The Vocal Fatigue Index (VFI) questionnaire has been found valid and reliable among speakers of different languages. This study aims to validate it for speakers of Finnish.

STUDY DESIGN

Experimental comparative study.

METHODS

The VFI questionnaire was translated from English to Finnish according to the WHO recommendations. Next, it was subjected to the validation procedure. In total, 160 Finnish speakers volunteered to participate in the study. Hundred-and-eight were voice patients (83 males, 25 females) and 52 were vocally healthy controls (37 females, 15 males). As a comparison, the Voice Handicap Index (VHI) questionnaire was completed and voice samples were recorded to enable Acoustic Voice Quality Index (AVQI03.01_FIN) analysis.

RESULTS

Results from the first and second completions of the VFI(F) questionnaire correlated strongly (Spearman's rho 0.901, P = 0.01). Answers to the individual questions the VFI(F) also correlated strongly, showing high internal consistency. Factor 1 (Tiredness of voice and avoidance of voice use) of the VFI correlated strongly with the VHI, and the two other factors (Physical discomfort associated with voicing and Improvement of symptoms) correlated moderately with the VHI. Factor one of the VFI(F) correlated moderately with AVQI03.01_FIN and its sub-parameters, CPPS, HNR, and shimmer. The VFI(F) showed good construct validity, differentiating voice patients and controls at cut-off 13.5, with sensitivity of 0.963 and specificity of 0.885. Discriminatory power was strong for all factors: F1 A_ROC = 0.985, F2 A_ROC = 0.864, and F3 A_ROC = 0.821.

CONCLUSION

The VFI(F) correlates with the VHI and with AVQI01.01_FIN and it is a valid and reliable tool for detecting vocal fatigue in Finnish speakers.

Resident performance in simulation module is associated with operating room performance for laparoscopic cholecystectomy

BACKGROUND

Simulation is an important tool in surgical training. However, the transferability of skills obtained in the simulation setting to the operating room (OR) is uncertain. This study explores the association between resident simulation performance and OR performance in a laparoscopic cholecystectomy (LC) simulation module.

METHODS

A simulation module focused on LC utilizing a virtual reality simulator was completed by general surgery residents. Simulation performance was evaluated using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Technical Skills (OSATS), as well as a LC-specific simulation assessment form (LC-SIM). Resident subsequent OR performances of LC were measured by the Surgical Training and Assessment Tool (STAT), an online mobile-based evaluation completed by attending surgeons.

RESULTS

Twenty-one residents who completed the simulation module and also with STAT data on LC from 2016 to 2020 were included. Higher scores on incision/port placement on LC-SIM is associated with better tissue handling (coefficient 0.20, p = 0.048) and better time & economy of motion on STAT (coefficient 0.22, p = 0.037). However, higher scores on time and motion on OSATS are associated with worse tissue handling (- 0.28, p = 0.046), worse time & economy of motion (- 0.37, p = 0.009), and worse overall grade (- 0.21, p = 0.044). Higher scores on overall performance on OSATS is associated with worse time & economy of motion (- 0.80, p = 0.008). Higher scores on depth perception on GOALS are associated with worse tissue handling (- 0.28, p = 0.044).

CONCLUSION

We found significant positive and negative associations between resident simulation performance and OR performance, particularly in tissue handling and economy of motion. This could suggest that simulation performance does not reliably predict OR performance. However, this could highlight the concept of excessive caution in the real OR environment and longer operative time which could be interpreted as worse time and economy of motion by the attending surgeons.

An online feedback system for laparoscopic training during the COVID-19 pandemic: evaluation from the trainer perspective

Objective

A system to provide feedback for laparoscopic training using an online conferencing system during the COVID-19 pandemic was developed. The purpose of this study is to evaluate this system from the trainer perspective.

Design

A procedural feedback system using an online conferencing system was devised.

Setting

Surgical training was observed using an online conferencing system (Zoom). Feedback was provided while viewing suture videos which are, as a feature of this system, pre-recorded. Feedback was then recorded. Trainer comments were then converted into text, summarized as feedback items, and sorted by suture phase which facilitates reflection. Trainers completed a questionnaire concerning the usability of the online feedback session.

Results

Eleven trainers were selected. Physicians had an average experience of 21.9 ± 5.9 years (mean ± standard deviation). The total number of feedback items obtained by classifying each phase was 32. Based on questionnaire results, 91% of trainers were accustomed to the use of Zoom, and 100% felt that online procedural education was useful. In questions regarding system effectiveness, more than 70% of trainers answered positively to all questions, and in questions about efficiency, more than 70% of trainers answered positively. Only 55% of the trainers felt that this system was easy to use, but 91% were satisfied as trainers.

Conclusions

The results of the questionnaire suggest that this system has high usability for training. This online system could be a useful tool for providing feedback in situations where face-to-face education is difficult.

Quantitative analysis of facial symmetry by using three-dimensional technology

Background

Facial symmetry is becoming increasingly important in today's orthodontic treatment. But the asymmetrical boundary is not clearly demarcated. Stereophotogrammetry has a clear advantage in measuring facial asymmetry. The aim of this study was to quantify the facial asymmetry by three-dimensional (3D) technology as well as to study whether the evaluation by non-experts about facial asymmetry was consistent with the analysis by 3D technology.

Methods

The facial symmetry of 330 patients was evaluated by 10 non-experts. 3D facial images were taken using 3dMD stereophotogrammetry equipment. The original face and its mirror shell were divided into 7 regions and the surface matching was measured in the whole face and all regional areas. The degree of symmetry was calculated by the software 3-matic STL 9.0. The difference between the two groups was analyzed by Independent-Samples T Test and the diagnostic efficiency of symmetry degree was analyzed by ROC curve analysis. The consistency between the symmetric degree and the result of evaluation was analyzed by Pearson correlation analysis.

Results

The ROC analysis revealed significant diagnostic values in the determination of the facial asymmetry of lip, chin, cheek and lateral mandible areas. The cut-off values of symmetry degree were between 60 and 80%. The evaluation was middle correlation with the symmetric degree of the whole face.

Conclusions

The chin and lateral mandible contribute most significantly to the facial symmetry. The objective measurement of facial symmetry, 3D technology, is reliable.

Corrective derotation osteotomies to treat congenital radioulnar synostosis in children: results of a systematic review and meta-analysis

BACKGROUND

The primary objective of this review is to estimate the rotational correction after corrective derotation osteotomies (CDO) for congenital radioulnar synostosis (CRUS). The secondary objective of this review is to identify the complications with CDO in CRUS.

METHODS

We included studies in the English literature from electronic bibliographic databases Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Directory of Open access journals (DOAJ), EMBASE, MEDLINE, ProQuest, PubMed, and Scopus up to December 2020 that determined the effects of CDO in CRUS for two or more cases with a mean follow-up of 1 year or more. We used the National Institutes of health quality assessment tool for case series (interventional) and Modified Coleman methodology Score for assessment of risk of bias in the included studies.

RESULTS

We pooled 383 forearms (318 participants) from 23 studies with mean age of 6.28 ± 1.75 years. The mean pronation deformity was 72.83 ± 15.64° from 22 studies. The CDO derotated forearm to 10.4 ± 5.90° of mean pronation in 12 studies and 13.47 ± 9.51° of mean supination in nine studies. One study corrected the forearms to a neutral position. The mean derotation from CDO was 73.13 ± 16.54° (35° supination to 130° pronation). The overall mean difference was - 68.26° [95% CI - 86.87, - 49.66] of correction favoring supination. There were eight transient nerve palsies and six compartment syndromes from synostosis site osteotomies (four studies).

DISCUSSION

We had poor-quality studies at a high risk of bias on the described tools of assessment. We could estimate the directional effect of CDO in CRUS favoring correction from pronation to supination; however, due to the heterogeneity among studies, we cannot comment on the most efficient and least harmful CDO techniques. The single bone osteotomies seem to be efficient, simple, and reportedly low on complications but need evaluation. We cannot define the indications for correction and expected improvement in functional outcomes from osteotomy techniques.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-021-00582-4.

Estimating subjective evaluation of low-contrast resolution using convolutional neural networks

To develop a convolutional neural network-based method for the subjective evaluation of computed tomography (CT) images having low-contrast resolution due to imaging conditions and nonlinear image processing. Four radiological technologists visually evaluated CT images that were reconstructed using three nonlinear noise reduction processes (AIDR 3D, AIDR 3D Enhanced, AiCE) on a CT system manufactured by CANON. The visual evaluation consisted of two items: low contrast detectability (score: 0-9) and texture pattern (score: 1-5). Four AI models with different convolutional and max pooling layers were constructed and trained on pairs of CANON CT images and average visual assessment scores of four radiological technologists. CANON CT images not used for training were used to evaluate prediction performance. In addition, CT images scanned with a SIEMENS CT system were input to each AI model for external validation. The mean absolute error and correlation coefficients were used as evaluation metrics. Our proposed AI model can evaluate low-contrast detectability and texture patterns with high accuracy, which varies with the dose administered and the nonlinear noise reduction process. The proposed AI model is also expected to be suitable for upcoming reconstruction algorithms that will be released in the future.

Developing a functional assessment tool for the auditory performance of Arabic-speaking Egyptian hearing impaired children

BACKGROUND

Auditory performance outcome of children with hearing impairment has been widely studied, and the related factors of the performance have been explored among different age groups for English speaking hearing impaired children.

OBJECTIVES

The objective of this study was to construct Arabic questionnaires for the evaluation of the auditory abilities of hearing impaired Egyptian Arabic-speaking children.

METHODS

Three Arabic questionnaires targeting the auditory abilities were constructed by selecting items from different English-based questionnaires and translating them into Arabic and adapted to Egyptian culture. The questionnaires were administered to 210 Arabic-speaking Egyptian children in the age range 1-12 years who were divided into three age groups. They included 90 hearing impaired children fitted with hearing aids and 30 hearing impaired children with a cochlear implant and 90 children with normal hearing (as a control group). Participants' responses were statistically analyzed to assess the validity and reliability of the questionnaires and to compare hearing impaired children with normal hearing children.

RESULTS

There were non-significant differences between cochlear implanted children and children with hearing aids regarding auditory abilities performances. Language age and aided pure tone audiometry were considered the best predictors of auditory abilities of hearing impaired Egyptian children.

CONCLUSION

The constructed Arabic questionnaires proved to be reliable and valid functional assessment tools that provide information about auditory behaviors of hearing impaired Egyptian children in everyday life and would complement other objective test results in evaluating and monitoring the performance of these children.

A review of the methods used for subjective evaluation of De Qi

De Qi refers to a series of sensations experienced when acupuncture is performed at acupoints. De Qi comprises needling sensations felt by the patient, and the sensations perceived by the acupuncturist. Classical Traditional Chinese Medicine theory states that De Qi is closely related to curative effect. In modern studies, the main index that researchers have used to evaluate De Qi was the needling sensation reported by the patient. Between 1st Aug and 31st Oct 2014, we conducted an electronic database search of all fields in Chinese and English to select literature assessing acupuncture needle sensations. We then reviewed the methods used within these studies to evaluate De Qi. The methods included simple evaluation, and the use of a De Qi scale/questionnaire. The simple evaluation, a qualitative evaluation, was judged by typical sensations felt by the patient after needling at acupoints, such as soreness, numbness, fullness, and heaviness. This method was easy and practicable, and had been adopted widely by Chinese researchers. In contrast, the De Qi scale/questionnaire, a quantitative evaluation, had multiple compiling methods available for evaluating the intensity of De Qi. The standardization and objectification of the De Qi scale/questionnaire effectively improved the quality of studies on De Qi, thereby these scales/questionnaires have been acknowledged and applied by most researchers. The present review analyzed and compared the scales/questionnaires used to evaluate De Qi; furthermore, we provided suggestions for the development and improvement of these questionnaires through integration with classical De Qi theory.

Essential Anatomy and Evaluation for Functional Rhinoplasty

The nose, a prominent facial feature in defining facial beauty, is responsible for the fundamental physiologic functions of heating, humidifying, and filtering inspired air. When the normal balance of laminar and turbulent airflow become disturbed due to anatomic abnormalities, nasal obstruction may result. To successfully restore these basic physiologic functions, the surgeon must have a detailed understanding of the nasal anatomy and be able to successfully identify the specific cause of the nasal obstruction. This article discusses the fundamental surgical anatomy and the various diagnostic techniques and instruments at the surgeon's disposal.

Effect of quantity and intensity of pulsed light on human non-visual physiological responses

Background

Exposure to pulsed light results in non-visual physiological responses in humans. The present study aims to investigate whether such non-visual effects are influenced to a greater extent by the intensity of lighting or by the power (quantity) of lighting.

Methods

>Twelve healthy young male participants (23 ± 0.3 years, 21–24 age range) were recruited for the present study. Participants were exposed to light of varying levels of intensity and quantity whose frequency was held constant across the conditions, which consisted of exposure to blue (different intensity, constant quantity) and white (constant intensity, different quantity) LEDs. Pupillary constriction, electroencephalogram (EEG) alpha band ratio, subjective sleepiness, concentration and perception of blueness were measured.

Results

Pupillary constriction and subjective concentration were significantly greater under the high-intensity and short pulse width (HS) condition than under the low-intensity and long pulse width (LL) conditions at three time points during exposure to high-intensity light. However, no significant differences were observed among the results at the three time points during exposure to different quantities of pulsed light.

Conclusions

The results of the present study indicate that non-visual influences of pulsed light on physiological function are mainly determined not by the quantity but by the intensity of the emitted light, with relatively higher levels of intensity producing more significant physiological changes, suggesting potent excitation of intrinsically photosensitive retinal ganglion cells.

Electronic supplementary material

The online version of this article (doi:10.1186/s40101-017-0137-7) contains supplementary material, which is available to authorized users.

Development and evaluation of wheel-controlled pitch-adjustable electrolarynx

Tone is important in tonal languages, especially in Mandarin. However, there is presently no commercially available electrolarynx (EL) for laryngectomized Mandarin speakers. Moreover, few studies have focused on this area. Our purpose is to design an EL that produces the four Mandarin tones and to evaluate its performance. We designed a wheel-controlled pitch-adjustable EL and manufactured a prototype (Wheel-EL). Using monosyllables, disyllabic segments, and frequently used phrases, we evaluated speech produced by Wheel-EL and by monotone (M-TruTone) and variable-frequency modes (V-TruTone) of the commercially available TruTone EL. The pitch contours of the high-level (HL), middle-rising (MR), and falling-rising (FR) tones produced by Wheel-EL most closely matched the natural speech characteristics of a native speaker. However, redundant sounds were generated in the high-falling (HF) tone. The statistical accuracy of Wheel-EL's tone and word perception was significantly higher than that of other EL types. However, no significant differences existed in acceptability among the three EL speech types. Wheel-EL produces better HL, MR, and FR tones in Mandarin than either M-TruTone or V-TruTone. Nevertheless, redundant sounds affect HF phonation. Accurate tone judgment can improve the intelligibility of EL speech in Mandarin but has no obvious effect on acceptability.

Forced knee extension test is a manual test that correlates with the unstable feelings of patients with ACL injury before and after reconstruction

BACKGROUND

To investigate fear in patients with anterior cruciate ligament (ACL) injury before and after reconstruction, a forced knee extension (FKE) test was performed. The correlation of the test results was evaluated with the subjective function, sports performance and objective parameters.

METHODS

The study included 102 patients with unilateral ACL reconstruction using a semitendinosus tendon with full clinical evaluation. This study was retrospective and determined the longitudinal results of the FKE test and investigated the effects on the subjective and objective outcomes at 2years.

RESULTS

Preoperatively, 47% of patients showed positive FKE tests. The number of positive FKE tests was 31% at six months and 15% at 24months after ACL reconstruction. At two years, there were statistically significant differences between the FKE test positives and negatives regarding both subjective knee recovery (P=0.0095) and sports performance (P=0.0006).

CONCLUSIONS

A new manual test, called the forced knee extension test, for fear in patients with ACL injury before and after reconstruction was introduced. The apprehension remained positive in 15% of the patients two years after ACL reconstruction, which affected subjective recovery of knee function and sports performance.

Assessment Tools for Facial Rejuvenation Treatment: A Review

BACKGROUND

In the field of cosmetic medicine, patient satisfaction is an important and common indicator used to measure the efficacy of the treatment. However, it is insufficient to prove objectively that the benefit of the specific factors involved in the cosmetic outcomes. The practitioner should be aware of these assessment tools, in particular in case of demanding or litigious patients.

OBJECTIVE

The aim of this review was to establish a list and discuss the subjective and objective methods used to assess facial aesthetic rejuvenation treatments.

METHODS

A systematic literature search was performed using the Pubmed search engine. Studies published over the last 5 years, i.e. between January 2010 and January 2015 were considered for review. The following keywords were used: "aesthetic treatment", "facial rejuvenation", and "subjective evaluation" or "objective evaluation".

RESULTS

Of the 446 articles identified by the search strategy, 47 articles focused specifically on facial rejuvenation and on the efficacy of aesthetic medical treatments were retrieved for review. Thirty-seven articles used quantitative methods to assess aesthetic treatment outcomes and only 12 used subjective methods. The different assessment methods were listed according to the tools used and treatment indications.

CONCLUSION

This review will help in choosing adequate methods to assess facial rejuvenation medical treatment. It is important to combine these tools adequately to improve the assessment. There is no current consensus on assess facial rejuvenation treatments but we noted that objective assessment methods seem helpful.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .