Estimating pulmonary function after surgery for adolescent idiopathic scoliosis using biplanar radiographs of the chest with 3D reconstruction

Aims This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction? Methods A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. Results All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. Conclusion 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112–119.

Tools and Techniques in Preparation of Coloured Bones and Skeletons for Effective Teaching, Learning and Museums

Background: Teaching veterinary osteology and arthrology has been performed with free bones collected from various animals after processing and preserving them for long duration. The profession of teaching Anatomy to undergraduate and postgraduate students in veterinary colleges not only requires the knowledge on Veterinary Gross Anatomy but also the methods of preparation of specimen for laboratory use. This article explains the methods and steps in preparation of coloured skulls, bones of forelimb, hindlimb, rib cage, digits and whole mounted skeletons, to be used in the anatomy laboratory to increase the efficiency of both teaching and learning. Methods: A carcass of adult horse donated by a farmer was utilized for making complete coloured skeleton. The bones were collected from the carcass by natural maceration technique followed by cleaning with mild chemicals. The metallic paints and commonly available tools were used for colouring and mounting of horse skeleton. The parts of bones viz. process, fossa, articular area, foramen, the origin and insertion of various muscles were prepared with colours and labels on the surfaces of bones for teaching and museum purpose. The sequential step by step procedure for skeleton preparation in quickest possible time was standardized and explained using various tools. Result: The natural maceration in open water tank was found to be most effective way of maceration of carcasses for collection of bones with their normal colour. The bones were processed mainly with washing soap powder and calcium carbonate followed by drying in natural sunlight which increased the brightness of the bone without any damage to the structure. The coloured skulls, bones of forelimb, hindlimb, rib cage, digits and whole mounted skeletons were prepared with available tools and chemical as this work consumes less time and cost and increases the students’ learning efficiency, which will also be an asset and center of attraction for any Institution.

3D Digital Imagery a Solution for the Teaching of Osteology: Example of the Thoracic cage

Osteology is a fundamental discipline, its classical teaching becomes difficult because of plethora of students and shortage of bony parts. It’s in this context that we have made, from 3D volume imaging, a modeling of the rib cage as a test using a software for post-treatment of CT images in order to propose a pedagogical tool for studying thorax’s skeletal and adding descriptions with the help of classical works. This was a prospective study involving 27 patients aged between 35 and 45 years. The scanners used were HITACHI ECLOS 16 cuts. Once the CT scan was selected, the DICOM data was transmitted to the post-processing console. The images were processed on the console "Aquarius Intuition Edition Version 4. 4. 7. 855113", for one patient we used Veiwer Osirix 10.6.8 Mac. All bones have been dynamically described thanks to the volume rendering. We thus obtained volumetric reconstructions of three-dimensional CT images of the different bone structures superimposed on those taught in classical anatomy practical work. We obtained a scenario of practical work in the form of a slide show that the teacher can use for works with or without model and even remotely. The virtual reality obtained with the 3D reconstructions of CT scans of the rib cage is a tool for self-learning of osteology for students but also a way for teachers to do practical work without having to use models, and even at a distance. KEY WORDS: 3D imaging, Teaching, Tomodensitometry, Osteology.

Mesenchymal Hamartoma: A Review of Literature

Mesenchymal Hamartoma is a rare, benign osseous tumor that typically involves the rib cage and presents during the first year of life. There is a case of this tumor originating in the cervical spine, described in literature. I document a brief literature review. In this review, there are not figures and outcomes.

Developments of Adapted Clothing for Physically Disabled People with Scoliosis Using 3D Geometrical Model

Scoliosis is a deformity of the spine that causes disorders of the rib cage. This makes it difficult to design clothes for affected people without following the shape of the rib cage. This paper presents a new 3D clothing design method based on virtual reality for women with physical disabilities such as scoliosis. The current design method is a variation of the draping techniques commonly used by fashion designers to design clothes on a mannequin or human body. However, the current design process highly considers the skeleton and body scan of the person. The skeleton is used to detect the anthropometric points of the patient, while the body scan allows us to detect the morphological contours at the onset of scoliosis. Thus, both allow us to accurately track the patient’s morphology and atypical shape. The position of the morphological contours is indicated by reference marks that are closely associated with the skeleton. This helps to automatically adapt the garment to the evolution of the patient’s pathology over time. The process of creating the 3D garment was processed based on the 3D model of the thorax, which helps to easily determine the anthropometric points and the morphological curves. Using this data, the geometrical model of the garment could be created with 3D ease allowances. The 2D block pattern was then obtained by flattening the 3D patterns using flattening methods. Finally, various tests were performed considering the evolution of pathology to predict the future garment. These tests validate our geometrical model of the garment with 3D ease allowances by comparing the results with previous work.

Effect of portable non-invasive ventilation on thoracoabdominal volumes in recovery from intermittent exercise in patients with COPD

Background: We previously showed that use of portable non-invasive ventilation (pNIV) during recovery periods within intermittent exercise improved breathlessness and exercise tolerance in COPD patients compared to pursed-lip breathing (PLB). However, in a minority of patients recovery from dynamic hyperinflation (DH) was better with PLB, based on inspiratory capacity. We further explored this using Optoelectronic Plethysmography to assess total and compartmental thoracoabdominal volumes. Methods: Fourteen COPD patients (mean±SD) (FEV1: 55±22% predicted) underwent, in a balanced order sequence, two intermittent exercise protocols on the cycle ergometer consisting of five repeated 2-min exercise bouts at 80% peak capacity, separated by 2-min recovery periods, with application of pNIV or PLB in the first minute of recovery.Results: Our findings identified 7 patients showing clinically meaningful recovery in DH with pNIV (DH responders) while 7 showed similar or better recovery in DH with PLB. When pNIV was applied, DH responders compared to DH non-responders exhibited greater tidal volume (by 0.8±0.3 L, p=0.015), inspiratory flow rate (by 0.6±0.5 L/sec, p=0.049), prolonged expiratory time (by 0.6±0.5 sec, p=0.006) and duty cycle (by 0.7±0.6 sec, p=0.007). DH responders showed a clinically meaningful reduction in end-expiratory thoracoabdominal DH (by 265±633 ml) predominantly driven by reduction in the abdominal compartment (by 210±494 ml); this effectively offset end-inspiratory rib-cage DH. Compared to DH non-responders, DH responders had significantly greater BMI by 8.4±3.2, p=0.022 and tended towards less severe resting hyperinflation by 0.3±0.3 L.Conclusion: COPD patients who mitigate end-expiratory rib-cage DH by expiratory abdominal muscle recruitment benefit from pNIV application.