scholarly journals Measurement of the Endotracheal Tube Diameter Using Computed Tomography Images for Pediatric Patients: Comparison with Classic Formulas

2021 ◽  
Author(s):  
Hatice Dilek Özcanoğlu ◽  
Berna Türkay ◽  
Neşe Kutlutürk Şahin ◽  
Zahide Özlem Ulubay ◽  
Ayşe Sevinç Revanlı ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endotracheal Tube ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Transverse Diameter ◽  
External Diameter ◽  
Old Patients ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
The Mean

Objective: In this retrospective study, we aimed to evaluate the compatibility of endotracheal tube (ETT) size used during surgery with tracheal diameter measured by computed tomography(CT) and classic formulas in children who underwent CT imaging preoperatively due to surgical indications. Methods: The study included preoperatively CT scanned, 0-3 year-old patients who were operated due to congenital heart diseases between June 1-October 1, 2018.Using the CT scans, transverse and anteroposterior tracheal diameters were measured from the subglottic level. As these diameters reflect the external diameter of the ETT, the inner diameter-which corresponds the ETT size-was calculated using a correction formula. Besides, Cole’s formula was used to calculate the ETT size for each child, and the tube sizes used during surgeries were obtained from anesthesia charts.ETT sizes were compared. Results: 43 patients (22 girls [51.2%],21 boys [48.8%]) were included.The mean age was 10.5±9.6 months. 18 patients (41.9%) had cyanotic, 25 patients (58.1%) had acyanotic heart disease.Mean corrected transverse and anteroposterior tracheal diameters at CT images were 4.35±0.69mm and 4.30±0.71 mm, respectively. The mean diameter calculated by Cole’s formula was 4.22±0.20 mm. The mean tube size used during surgeries was 4.37±0.60 mm. There was no statistically significant difference between the tube sizes used during the surgeries and the corrected transverse tracheal diameters from CT measurements (p>0.05). But the tube sizes used during the surgeries found significantly larger than the diameters obtained by Cole’s formula (p<0.05). Conclusion: In 0-3 years of age pediatric patients who undergo a congenital heart surgery,corrected tracheal transverse diameter measured by CT is more effective,reliable and less invasive than classic formulas for determining appropriate ETT size

scholarly journals Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging

2020 ◽  
pp. 014556131990039
Author(s):  
Yousef Aljathlany ◽  
Abdullah Aljasser ◽  
Abdullah Alhelali ◽  
Manal Bukhari ◽  
Mohammed Almohizea ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Regression Analysis ◽  
Endotracheal Tube ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Transverse Diameter ◽  
Cross Sectional ◽  
The Mean

Objectives: We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart. Study Design: Retrospective chart review. Setting: Tertiary care center. Materials and Methods: The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size. Results: One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm2 and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm2 and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively. Conclusion: One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.

Sella Turcica Dimensions and Morphology in a Yoruba Ethnic Population: A Computed Tomography Study

2021 ◽  
Vol 11 (9) ◽  
pp. 270-276
Author(s):  
Okon Etim Bassey ◽  
Hyacienth Uche Chiegwu ◽  
Chistopher Chukwuemeka Ohagwu
Keyword(s):  
Computed Tomography ◽  
Sella Turcica ◽  
Ct Images ◽  
Cranial Computed Tomography ◽  
Transverse Diameter ◽  
Ethnic Population ◽  
Male And Female ◽  
Anteroposterior Diameter ◽  
Significant Difference ◽  
The Mean

Background: Several sellar and parasellar pathologies affect the size and shape of sella turcica. A deviation from normal dimensions of sella turcica could be an indication of a pathological condition of the structure itself or the pituitary gland. Aim: This study was designed to assess the dimensions and morphology of the sella turcica of Yoruba ethnic population using cranial computed tomography (CT) images. Materials and Methods: This was a retrospective study involving 321 cranial CT images of the Yoruba subjects acquired in a tertiary health institution between January 2020 and April 2021. The sella turcica length, depth and anteroposterior diameter were measured using the digital calipers of the CT system while sella morphological shape was determined qualitatively by observing the floor of sella in the midsagittal slice and quantitatively by taking the ratio of superoinferior diameter to the transverse diameter. Result: In general, the mean and standard deviation value of sella turcica length was 12.2±`2.35mm. The mean sella length for males was 12.62`±2.50 and that for females was 11.69 ±`2.04mm. The result showed that males’ sella length differed significantly from that of females (t=3.635, p=0.000). A significant difference was noted between the sella depths of the two genders (p=0.032). The total mean anteroposterior diameter (APD) of sella turcica was 13.4`± 2.47mm. Male and female mean diameters were 13.6`± 2.45mm and 13.3±`2.17mm respectively. No significant difference was noted in sella length and APD across the age categories but sella depth showed a significant difference, which was noted to only exist between early adulthood (≤34 years) and late adulthood (≥65) (p=0.027). No statistically significant association was noted between sella shape and gender (c2=3.124, p=0.210) as well as age (c2=9.336, p=0.156). Conclusion: Only the mean sella length and depth differ significantly between male and female genders. Anteroposterior diameter is the same irrespective of gender. The sella turcica dimensions obtained from this study will serve as reference values for physicians in the assessment of sellar and parasellar pathologies in the study population. Key words: Computed tomography, sella turcica, morphology.

scholarly journals Comparing the Use of 3D Photogrammetry and Computed Tomography in Assessing the Severity of Single-Suture Nonsyndromic Craniosynostosis

2017 ◽  
Vol 25 (2) ◽  
pp. 78-83 ◽  
Author(s):  
Olivia A. Ho ◽  
Nikoo Saber ◽  
Derek Stephens ◽  
April Clausen ◽  
James Drake ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Confidence Interval ◽  
Three Dimensional ◽  
Computed Tomography Images ◽  
Younger Age ◽  
Significant Difference ◽  
3D Photogrammetry ◽  
The Mean ◽  
Single Suture

Purpose: Single-suture nonsyndromic craniosynostosis is diagnosed using clinical assessment and computed tomography (CT). With increasing awareness of the associated risks of radiation exposure, the use of CT is particularly concerning in patients with craniosynostosis since they are exposed at a younger age and more frequently than the average child. Three-dimensional (3D) photogrammetry is advantageous—it involves no radiation, is conveniently obtainable within clinic, and does not require general anaesthesia. This study aims to assess how 3D photogrammetry compares to CT in the assessment of craniosynostosis severity, to quantify surgical outcomes, and analyze the validity of 3D photogrammetry in craniosynostosis. Methods: Computed tomography images and 3D photographs of patients who underwent craniosynostosis surgery were assessed and aligned to best fit. The intervening area between the CT and 3D photogrammetry curves at the supraorbital bar (bandeau) level in axial view was calculated. Statistical analysis was performed using Student t test. Ninety-five percent confidence intervals were determined and equivalence margins were applied. Results: In total, 41 pairs of CTs and 3D photographs were analyzed. The 95% confidence interval was 198.16 to 264.18 mm2 and the mean was 231.17 mm2. When comparisons were made in the same bandeau region omitting the temporalis muscle, the 95% confidence interval was 108.94 to 147.38 mm2, and the mean was 128.16 mm2. Although statistically significant difference between the modalities was found, they can be attributable to the dampening effect of soft tissue. Conclusion: Within certain error margins, 3D photogrammetry is comparable to CT in assessing the severity of single-suture nonsyndromic craniosynostosis. However, a dampening effect can be attributable to the soft tissue. Three-dimensional photogrammetry may be more applicable for severe cases of craniosynostosis but not milder deformity. It may also be beneficial for assessing the overall appearance and aesthetics but not for determining underlying bony severity.

scholarly journals The effect of hydroxychloroquine against SARS-CoV-2 infection in rheumatoid arthritis patients

2020 ◽  
Author(s):  
Okan Küçükakkaş ◽  
Teoman Aydın
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
Intensive Care ◽  
Laboratory Parameters ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
The Mean ◽  
Positive Effect ◽  
Adequate Data ◽  
Rheumatology Practice

Abstract INTRODUCTION: The effectiveness of hydroxychloroquine in SARS-CoV-2 prophylaxis and treatment is still controversial. In this study, our aim is to investigate the potential effects of hydroxychloroquine therapy on patients with diagnosed with rheumatoid arthritis and a confirmed SARS-CoV-2 infection.METHOD: We included patients who were followed up with a diagnosis of rheumatoid arthritis and whose SARS-CoV-2 infection was confirmed. The patients were divided into two groups as those who previously used hydroxychloroquine and those who did not, and were compared in terms of clinical and laboratory data.RESULTS: Our study included 17 patients with adequate data (2 males, 15 females). The mean age of the patients was 57.2 ± 11.6 years. 7 (41.2%) patients were receiving hydroxychloroquine regularly for the last 6 months. When the effect of hydroxychloroquine on clinical and laboratory parameters of patients was examined, there was no significant difference between the groups of patients using and not using hydroxychloroquine. The patients using and not using hydroxychloroquine were compared for the presence of typical SARS-CoV-2 infection findings on computed tomography images, admission to the hospital and intensive care. No significant differences were observed between these two groups.CONCLUSIONS: Many studies on the effectiveness of hydroxychloroquine use in SARS-CoV-2 infection are still ongoing. Due to its importance in rheumatology practice, it is very important to clarify the position of hydroxychloroquine in SARS-CoV-2 therapy. Our findings suggest that having previously used hydroxychloroquine does not have any negative or positive effect on the infection.

scholarly journals Three-dimensional assessment of the anterior and inferior loop of the inferior alveolar nerve using computed tomography images in patients with and without mandibular asymmetry

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jae-Young Kim ◽  
Michael D. Han ◽  
Kug Jin Jeon ◽  
Jong-Ki Huh ◽  
Kwang-Ho Park
Keyword(s):  
Computed Tomography ◽  
Symmetry Group ◽  
Three Dimensional ◽  
Inferior Alveolar Nerve ◽  
Mental Foramen ◽  
3D Analysis ◽  
Mandibular Asymmetry ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
Mandibular Body

Abstract Background The purpose of this study was to investigate the differences in configuration and dimensions of the anterior loop of the inferior alveolar nerve (ALIAN) in patients with and without mandibular asymmetry. Method Preoperative computed tomography images of patients who had undergone orthognathic surgery from January 2016 to December 2018 at a single institution were analyzed. Subjects were classified into two groups as “Asymmetry group” and “Symmetry group”. The distance from the most anterior and most inferior points of the ALIAN (IANant and IANinf) to the vertical and horizontal reference planes were measured (dAnt and dInf). The distance from IANant and IANinf to the mental foramen were also calculated (dAnt_MF and dInf_MF). The length of the mandibular body and symphysis area were measured. All measurements were analyzed using 3D analysis software. Results There were 57 total eligible subjects. In the Asymmetry group, dAnt and dAnt_MF on the non-deviated side were significantly longer than the deviated side (p < 0.001). dInf_MF on the non-deviated side was also significantly longer than the deviated side (p = 0.001). Mandibular body length was significantly longer on the non-deviated side (p < 0.001). There was no significant difference in length in the symphysis area (p = 0.623). In the Symmetry group, there was no difference between the left and right sides for all variables. Conclusion In asymmetric patients, there is a difference tendency in the ALIAN between the deviated and non-deviated sides. In patients with mandibular asymmetry, this should be considered during surgery in the anterior mandible.

Presentation and Referral Patterns in Pediatric Closed Hand Fractures

Hand ◽  
2021 ◽  
pp. 155894472110085
Author(s):  
Landis R. Walsh ◽  
Laura C. Nuzzi ◽  
Amir H. Taghinia ◽  
Brian I. Labow
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Old Patients ◽  
Hand Surgeon ◽  
Hand Fractures ◽  
The Mean

Background Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non–hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns. Methods The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed. Results There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( P = .007), fewer required surgery ( P < .001). Conclusions Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.

scholarly journals Multi-Cycle-Consistent Adversarial Networks for Edge Denoising of Computed Tomography Images

2021 ◽  
Vol 17 (4) ◽  
pp. 1-16
Author(s):  
Xiaowe Xu ◽  
Jiawei Zhang ◽  
Jinglan Liu ◽  
Yukun Ding ◽  
Tianchen Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Denoising ◽  
Ct Images ◽  
High Dose ◽  
Ct Image ◽  
Paired Data ◽  
High Quality ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
Global Cycle

As one of the most commonly ordered imaging tests, the computed tomography (CT) scan comes with inevitable radiation exposure that increases cancer risk to patients. However, CT image quality is directly related to radiation dose, and thus it is desirable to obtain high-quality CT images with as little dose as possible. CT image denoising tries to obtain high-dose-like high-quality CT images (domain Y ) from low dose low-quality CT images (domain X ), which can be treated as an image-to-image translation task where the goal is to learn the transform between a source domain X (noisy images) and a target domain Y (clean images). Recently, the cycle-consistent adversarial denoising network (CCADN) has achieved state-of-the-art results by enforcing cycle-consistent loss without the need of paired training data, since the paired data is hard to collect due to patients’ interests and cardiac motion. However, out of concerns on patients’ privacy and data security, protocols typically require clinics to perform medical image processing tasks including CT image denoising locally (i.e., edge denoising). Therefore, the network models need to achieve high performance under various computation resource constraints including memory and performance. Our detailed analysis of CCADN raises a number of interesting questions that point to potential ways to further improve its performance using the same or even fewer computation resources. For example, if the noise is large leading to a significant difference between domain X and domain Y , can we bridge X and Y with a intermediate domain Z such that both the denoising process between X and Z and that between Z and Y are easier to learn? As such intermediate domains lead to multiple cycles, how do we best enforce cycle- consistency? Driven by these questions, we propose a multi-cycle-consistent adversarial network (MCCAN) that builds intermediate domains and enforces both local and global cycle-consistency for edge denoising of CT images. The global cycle-consistency couples all generators together to model the whole denoising process, whereas the local cycle-consistency imposes effective supervision on the process between adjacent domains. Experiments show that both local and global cycle-consistency are important for the success of MCCAN, which outperforms CCADN in terms of denoising quality with slightly less computation resource consumption.

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

scholarly journals PREVALENCE OF MANDIBULAR ASYMMETRY IN SKELETAL CLASS I ADULT PATIENTS

2014 ◽  
Vol 2 (2) ◽  
pp. 189 ◽  
Author(s):  
Bruno Frazão Gribel ◽  
Guilherme Thiesen ◽  
Tássia Silvana Borges ◽  
Maria Perpétua Mota Freitas
Keyword(s):  
Computed Tomography ◽  
Calculation Method ◽  
Significant Error ◽  
Adult Patients ◽  
Class I ◽  
Cone Beam ◽  
Skeletal Class ◽  
Mandibular Asymmetry ◽  
Computed Tomography Images ◽  
Significant Difference

AIM: The objective of this study was evaluating the prevalence of mandibular asymmetry in skeletal Class I adult patients. MATERIALS AND METHODS: The sample was composed by cone-beam computed tomography images of 250 skeletal Class I patients with age from 18 to 70 years old. The side deviation of mandibular asymmetry was evaluated (right and left), as well as the intensity of this asymmetry. People with gnathic deviation until 2mm were considered as patients with slight asymmetry; deviation between 2 and 5mm was considered moderate asymmetry and those higher than 5mm as severe asymmetries. The error calculation method was performed and there was not significant error in the measurements. To verify the association between the prevalence of mandibular asymmetry and the gender of individuals, the Χ2 was carried out and the significant level adopted was 5% (p<0.05). RESULTS: The results showed that mandibular deviation occurred more frequently to the left side in both genders (male 56.5% e female 58.2%), without statistically significant difference between them (p=0.792). Besides, the prevalence of slight, moderate and severe asymmetries were, respectively 61%, 27% and 12% for males and 54%, 28% and 18% for female; and there was not statistically significant difference (p=0.366) between the gender of the sample evaluated. CONCLUSION: In this study, both deviation and intensity of mandibular asymmetry did not present preference regarding to the gender.

scholarly journals Comparison of the Hounsfield Unit Values Obtained From Cone-Beam Computed Tomography (CBCT) and Multidetector Computed Tomography (MDCT) Images for Different Bone Densities

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Atefeh Khavid ◽  
Mojgan Sametzadeh ◽  
Mostafa Godiny ◽  
Mohammad Mehdi Moarrefpour
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Pearson Correlation ◽  
Hounsfield Unit ◽  
Cone Beam ◽  
Ct Scanner ◽  
Significance Level ◽  
Dental Practitioners ◽  
Significant Difference ◽  
The Mean

Background and objective: In recent years, cone-beam computed tomography (CBCT) has become a key diagnostic tool in dentistry. CBCT can provide 3D images of the maxillofacial area to help dental practitioners in diagnosis and treatment, especially implant placement and treatment of pathogenic lesions. This study aimed to compare the Hounsfield Unit (HU) values obtained from CBCT images for bones of different densities with the corresponding HU values from MDCT images. Materials and methods: cube-shaped bone blocks of identical size were cut from the middle section of the cow ribs and femur area such that they had a layer of cortical bone in their buccal, lingual, and top surfaces and trabecular bone in the middle. MDCT scans were performed using a Somatom Sensation Ct Scanner. After determining HU from the results of these scans, nine suitable specimens from different ranges of HU were chosen for comparison. HU of the CBCT images was computed by the dedicated software of the CBCT machine. Finally, HU values obtained from MDCT and CBCT were compared. Data analysis was performed using SPSS version 25 at the 0.05 significance level. Results: The results showed a statistically significant difference between the mean HU from MDCT images and the mean HU from CBCT images (P<0.05). For similar specimens, CBCT produced higher mean HU values than MDCT. The Pearson correlation test detected a significant direct relationship between the HU values of specimens in MDCT and CBCT (P<0.05). Conclusion: For the tools and software used in this study, there was no significant difference between the HU values obtained from MDCT and CBCT, but the mean HU obtained from CBCT was higher than that from MDCT.

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