• Archives of Plastic Surgery
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• v.50 no.3
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• pp.248-253
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• 2023

Metal fixation systems for cranial bone flaps cut by a drill are convenient devices for cranioplasty, but cause several complications. We use modified craniotomy using a fine diamond-coated threadwire saw (diamond T-saw) to reduce the bone defect, and osteoplasty calcium phosphate cement without metal fixation. We report our outcomes and tips of this method. A total of 78 consecutive patients underwent elective frontotemporal craniotomy for clipping of unruptured intracranial aneurysms between 2015 and 2019. The follow-up periods ranged from 13 to 66 months. The bone fixation state was evaluated by bone computed tomography (CT) and three-dimensional CT (3D-CT). The diamond T-saw could minimize the bone defect. Only one wound infection occurred within 1 week postoperatively, and no late infection. No pain, palpable/cosmetically noticeable displacement of the bone flap, fluid accumulations, or other complications were observed. The condition of bone fixation and the cosmetic efficacy were thoroughly satisfactory for all patients, and bone CT and 3D-CT demonstrated that good bone fusion. No complication typical of metal fixation occurred. Our method is technically easy and safety, and achieved good mid-term bone flap fixation in the mid-term course, so has potential for bone fixation without the use of metal plates.

• Korean Journal of Radiology
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• v.20 no.4
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• pp.599-608
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• 2019

Objective: To evaluate the effectiveness of computed tomography (CT) Hounsfield unit histogram analysis (HUHA) in postoperative pancreatic fistula (PF) prediction. Materials and Methods: Fifty-four patients (33 males and 21 females; mean age, 65.6 years; age range, 37-89 years) who had undergone preoperative CT and pancreaticoduodenectomy were included in this retrospective study. Two radiologists measured mean CT Hounsfield unit (CTHU) values by drawing regions of interest (ROIs) at the level of the pancreaticojejunostomy site on preoperative pre-contrast images. The HUHA values were arbitrarily divided into three categories, comprising HUHA-A ≤ 0 HU, 0 HU < HUHA-B < 30 HU, and HUHA-C ≥ 30 HU. Each HUHA value within the ROI was calculated as a percentage of the entire area using commercial 3-dimensional analysis software. Pancreas texture was evaluated as soft or hard by manual palpation. Results: Fifteen patients (27.8%) had clinically relevant PFs. The PF group had significantly higher HUHA-A (p < 0.01) and significantly lower mean CTHU (p < 0.01) values than those of the non-PF group. The HUHA-A value had a moderately strong correlation with PF occurrence (r = 0.60, p < 0.01), whereas the mean CTHU had a weak negative correlation with PF occurrence (r = -0.27, p < 0.01). The HUHA-A and mean CTHU areas under the curve (AUCs) for predicting PF occurrence were 0.86 and 0.65, respectively, with significant difference (p < 0.01). The HUHA-A and mean CTHU AUCs for predicting pancreatic softness were 0.86 and 0.64, respectively, with significant difference (p < 0.01). Conclusion: The HUHA-A values on preoperative pre-contrast CT images demonstrate a strong correlation with PF occurrence.

• Journal of the Korean Society of Radiology
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• v.81 no.6
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• pp.1523-1528
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• 2020

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiac anomaly that can be difficult to detect and often remains undiagnosed. PAPVR is diagnosed using non-invasive imaging techniques such as echocardiography, CT, and MRI. Image data are reviewed on a 2-dimensional (D) monitor, which may not facilitate a good understanding of the complex 3D heart structure. In recent years, 3D printing technology, which allows the creation of physical cardiac models using source image datasets obtained from cardiac CT or MRI, has been increasingly used in the medical field. We report a case involving a 3D-printed model of PAPVR with a biatrial connection. This model demonstrated separate drainages of the right upper and middle pulmonary veins into the lower superior vena cava (SVC) and the junction between the SVC and the right atrium, respectively, with biatrial communication through the right middle pulmonary vein.

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.1
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• pp.60-69
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• 2016

Purpose: The objective of this study was to compare the accuracy of digital models from 3 dimentional (3D) optical scanner and cone beam computed tomography (CBCT). Materials and Methods: We obtained digital models from 11 pairs of stone casts using a 3D optical scanner and a CBCT, and compared the accuracy of the models. Results: The error range of average positive distance was 0.059 - 0.117 mm and negative distance was 0.066 - 0.146 mm. Statistically (P < 0.05), average positive distance was larger than $70{\mu}m$ and shorter than $100{\mu}m$, and that of negative distance was larger than $100{\mu}m$ and shorter than $120{\mu}m$. Conclusion: We concluded that the accuracy of digital models generated from CBCT is not appropriate to make final prostheses. However, it may be acceptable for provisional restorations and orthodontic diagnoses with respect to the accuracy of the digitalization.

• KIPS Transactions on Software and Data Engineering
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• v.3 no.8
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• pp.329-334
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• 2014

In this study, a new method that automatically segments trabecular bone for its morphological analysis using micro-computed tomography imaging was proposed. In the proposed method, the bone region was extracted using a threshold value, and the outer boundary of the bone was detected. The sphere of maximum size with the corresponding voxel as the center was obtained by applying the sphere-fitting method to each voxel of the bone region. If this sphere includes the outer boundary of the bone, the voxels included in the sphere are classified as cortical bone; otherwise, they are classified as trabecular bone. The proposed method was applied to images of the distal femurs of 15 mice, and comparative experiments, with results manually divided by a person, were performed. Four morphological parameters-BV/TV, Tb.Th, Tb.Sp, and Tb.N-for the segmented trabecular bone were measured. The results were compared by regression analysis and the Bland-Altman method; BV/TV, Tb.Th, Tb.Sp, and Tb.N were all in the credible range. In addition, not only can the sphere-fitting method be simply implemented, but trabecular bone can also be divided precisely by using the three-dimensional information.

• Conservation Science in Museum
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• v.25
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• pp.63-84
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• 2021

In order to investigate the diverse physicochemical changes that occurred in traditional Korean pottery during its production, including before and after firing, this study produced six replicas of a celadon maebyeong inlaid with cloud-and-crane designs, respectively corresponding to the process of shaping, carving, inlaying designs, first firing, glazing and second firing, respectively. It then conducted a scientific study of these six replicas and analyzed their images through high-resolution three-dimensional transmission imaging. The materials used for the replicas show different mineral phases and even colors depending on the components of each material. For example, black inlay with a high content of iron oxide (Fe₂O₃) shows dark colors and white inlay with a high alumina (Al₂O₃) content appears white. Physicochemical properties such as chromaticity and magnetic susceptibility and major components of the replicas were confirmed by the differences in the density in the computed tomography (CT) images. The characteristics of fired products such as fine structure, absorption ratio, apparent porosity, and other characteristics of the major mineral components were identified by the presence of pores and the formation of cracks inside the replicas in the image analysis.

• Journal of Korean Neurosurgical Society
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• v.57 no.6
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• pp.460-464
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• 2015

Objective : Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. Methods : Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. Results : Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. Conclusion : Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.

• Progress in Medical Physics
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• v.30 no.1
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• pp.32-38
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• 2019

Purpose: The objective of this study is to evaluate the geometrical accuracy of a patient-specific bolus based on a three-dimensional (3D) printed mold and casting method. Materials and Methods: Three breast cancer patients undergoing treatment for a superficial region were scanned using computed tomography (CT) and a designed bolus structure through a treatment planning system (TPS). For the fabrication of patient-specific bolus, we cast harmless certified silicone into 3D printed molds. The produced bolus was also imaged using CT under the same conditions as the patient CT to acquire its geometrical shape. We compared the shapes of the produced bolus with the planned bolus structure from the TPS by measuring the average distance between two structures after a surface registration. Results and Conclusions: The result of the average difference in distance was within 1 mm and, as the worst case, the absolute difference did not exceed ${\pm}2mm$. The result of the geometric difference in the cross-section profile of each bolus was approximately 1 mm, which is a similar property of the average difference in distance. This discrepancy was negligible in affecting the dose reduction. The proposed fabrication of patient-specific bolus is useful for radiation therapy in the treatment of superficial regions, particularly those with an irregular shape.

• Journal of Veterinary Clinics
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• v.39 no.6
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• pp.294-301
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• 2022

Three-dimensional (3D) printing technique has been widely used for accurate screw and pin placement in orthopedic surgery and neurosurgery. However, there are few reports comparing the accuracy between the patient-specific guides and freehand Kirschner wire (K-wire) placement in toy, small and medium breed dogs. This study aimed to assess the accuracy of 3D printed patient-specific guides (PSGs) in pin insertion in the thoracolumbar vertebrae of toy breed dogs and compare the outcomes between novice and experienced surgeons. The experiment was conducted on the thoracolumbar vertebrae of 21 euthanized toy breed dogs (median weight, 5.95 kg). The optimal insertion angle placement was determined and patient-specific guides for K-wire insertion were designed and 3D printed using computed tomography (CT) and a 3D computer-aided design program of three vertebrae (Thoracic 12-Lumbar 1). K-wire tracts were made by experienced and novice surgeons and compared to assess the accuracy based on postoperative CT. Based on postoperative CT, in the experienced group, 61 out of 63 pins (96.8%) were fully contained inside the vertebral body and lamina, whereas two pins (3.2%) had perforated the vertebral canal (grade 3, 2-4 mm breach). However, all the pins in the novice group were fully contained. The use of 3D printed PSGs for pin insertion in the thoracolumbar region is an accurate and safe alternative to freehand screw placement by novice surgeons in toy, small and medium breed dogs. Operations with 3D printed PSGs allow novice surgeons to achieve better or similar outcomes in accurate placement of pin/screws in vertebrae.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.376-381
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• 2019

Objective : To define optimal method that calculate the safe direction of cervical pedicle screw placement using computed tomography (CT) image based three dimensional (3D) cortical shell model of human cervical spine. Methods : Cortical shell model of cervical spine from C3 to C6 was made after segmentation of in vivo CT image data of 44 volunteers. Three dimensional Cartesian coordinate of all points constituting surface of whole vertebra, bilateral pedicle and posterior wall were acquired. The ideal trajectory of pedicle screw insertion was defined as viewing direction at which the inner area of pedicle become largest when we see through the biconcave tubular pedicle. The ideal trajectory of 352 pedicles (eight pedicles for each of 44 subjects) were calculated using custom made program and were changed from global coordinate to local coordinate according to the three dimensional position of posterior wall of each vertebral body. The transverse and sagittal angle of trajectory were defined as the angle between ideal trajectory line and perpendicular line of posterior wall in the horizontal and sagittal plane. The averages and standard deviations of all measurements were calculated. Results : The average transverse angles were $50.60^{\circ}{\pm}6.22^{\circ}$ at C3, $51.42^{\circ}{\pm}7.44^{\circ}$ at C4, $47.79^{\circ}{\pm}7.61^{\circ}$ at C5, and $41.24^{\circ}{\pm}7.76^{\circ}$ at C6. The transverse angle becomes more steep from C3 to C6. The mean sagittal angles were $9.72^{\circ}{\pm}6.73^{\circ}$ downward at C3, $5.09^{\circ}{\pm}6.39^{\circ}$ downward at C4, $0.08^{\circ}{\pm}6.06^{\circ}$ downward at C5, and $1.67^{\circ}{\pm}6.06^{\circ}$ upward at C6. The sagittal angle changes from caudad to cephalad from C3 to C6. Conclusion : The absolute values of transverse and sagittal angle in our study were not same but the trend of changes were similar to previous studies. Because we know 3D address of all points constituting cortical shell of cervical vertebrae. we can easily reconstruct 3D model and manage it freely using computer program. More creative measurement of morphological characteristics could be carried out than direct inspection of raw bone. Furthermore this concept of measurement could be used for the computing program of automated robotic screw insertion.