BACKGROUND: Cross-sectional anatomy is a challenging yet a vital foundation to clinical practice. The traditional teachings of gross anatomy cadaveric dissections do not cover adequate training of recognizing anatomical structures on CT, MRI and sonographic cross-sections. New modern technologies are emerging as teaching tools in anatomy aiming to deliver visual interactive experience. The Visible Human Project provides a library of cross-sectional images compiled from cryosectioned body donors that was utilized by modern technologies such as the virtual dissection table (Anatomage) in constructing 3D software applications visualizing the internal composition of the human body virtually. Hereby, this article explores an integrative approach utilizing the Visible Human Project based applications and basic radiological modalities. PURPOSE: The purpose of our newly implemented teaching approach was to test and assure technology fitness to the medical curriculum and its potential influence on students' performance in learning gross as well as cross-sectional anatomy in much depth. BASIC PROCEDURES: A three years (2021-2024) observational study was conducted by implanting a practical cross-sectional anatomy optional course by selectively utilizing Anatmage interactively beside CT, MRI and ultrasound practice. The performance of 50 participants was evaluated in the form of a written test comprised of labeling of ten cross-sectional images and drawing of two cross-section schemes. Their optional course test scores were compared to their obligatory anatomy subject test scores; and to a non-participants control group of 50 retrospective obligatory anatomy subject test scores. In addition, the participants' attitude toward the training lessons was assessed through a survey focused on satisfaction level, competence and ability to recognize structures on radiological images. MAIN FINDINGS: The participants reported a high level of practical engagement. The test scores in the anatomy obligatory subject were positively influenced by this implemented practical course. Students showed improved test scores in the standardized labeling keyword questions, while the scheme questions showed discrepancy. PRINCIPAL CONCLUSIONS: Integrating Visible Human Project based applications with radiological modalities showed positive efficacy on the students' engagement and learning performance. Inevitably, cadaveric dissection and prosection remain the cornerstone of gross anatomy education. Integrating both modalities of teaching would excel students' practical skills in applied clinical anatomy.
- MeSH
- Anatomy, Cross-Sectional * education MeSH
- Anatomy education MeSH
- Dissection education MeSH
- Adult MeSH
- Curriculum * MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Young Adult MeSH
- Cadaver MeSH
- Visible Human Projects * MeSH
- Cross-Sectional Studies MeSH
- Schools, Medical MeSH
- Students, Medical MeSH
- Education, Medical, Undergraduate methods MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
OBJECTIVES: To assess the feasibility of acquiring adequate transperineal ultrasound (TPUS) volumes of the anal sphincter (AS) immediately after vaginal birth, the reproducibility of its measurements, and detecting defects therein. METHODS: Secondary analysis of TPUS volumes of the AS, acquired immediately after vaginal birth with a transversely oriented convex probe. Two independent experts ranked off-line image quality as "inadequate," "adequate," or "ideal" using the Point-of-Care Ultrasound Image Quality scale. On "adequate" and "ideal" quality volumes, the length of the external AS at 6 and 12 o'clock, and the volume of the external and internal AS were measured. Additionally, volumes were screened for AS defects on tomographic ultrasound imaging. Subsequently, we rated the intra- and interrater agreement on those findings. RESULTS: Of 183 volumes, 162 were considered "adequate" or of "ideal" quality (88.5%). Reasons for "inadequacy" were shadow artifacts (16/21), poor resolution (3/21), incomplete acquisition (1/21), or aberrant AS morphology (1/21). The intrarater reliability of two-dimensional (2D) and three-dimensional (3D) measurements was excellent, whereas interrater reliability was fair to good for 2D measurements and good for 3D measurements. In those tomographic ultrasound imaging (TUI) sequences including AS defects, the intra- and interrater reliability of the defect measurement were excellent [intraclass correlation coefficient (ICC) = 0.92 (0.80-0.94)] and moderate [ICC = 0.72 (0.63-0.79)]. In this cohort, there were only few (4/48; 8.3%) AS defects. However, grading them was poorly reproducible between experts. CONCLUSION: TPUS of the AS immediately after vaginal birth yields adequate image quality and allows for reproducible measurements. In the few patients with AS defects, there was good agreement on the presence, but it was poor for the extent of defects.
- MeSH
- Anal Canal * diagnostic imaging MeSH
- Adult MeSH
- Humans MeSH
- Perineum diagnostic imaging MeSH
- Reproducibility of Results MeSH
- Feasibility Studies * MeSH
- Pregnancy MeSH
- Ultrasonography * methods MeSH
- Imaging, Three-Dimensional * methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE: Utility of prostate-specific antigen density (PSAd) for risk-stratification to avoid unnecessary biopsy remains unclear due to the lack of standardization of prostate volume estimation. We evaluated the impact of ellipsoidal formula using multiparametric magnetic resonance (MRI) and semi-automated segmentation using tridimensional ultrasound (3D-US) on prostate volume and PSAd estimations as well as the distribution of patients in a risk-adapted table of clinically significant prostate cancer (csPCa). METHODS: In a prospectively maintained database of 4841 patients who underwent MRI-targeted and systematic biopsies, 971 met inclusions criteria. Correlation of volume estimation was assessed by Kendall's correlation coefficient and graphically represented by scatter and Bland-Altman plots. Distribution of csPCa was presented using the Schoots risk-adapted table based on PSAd and PI-RADS score. The model was evaluated using discrimination, calibration plots and decision curve analysis (DCA). RESULTS: Median prostate volume estimation using 3D-US was higher compared to MRI (49cc[IQR 37-68] vs 47cc[IQR 35-66], p < 0.001). Significant correlation between imaging modalities was observed (τ = 0.73[CI 0.7-0.75], p < 0.001). Bland-Altman plot emphasizes the differences in prostate volume estimation. Using the Schoots risk-adapted table, a high risk of csPCa was observed in PI-RADS 2 combined with high PSAd, and in all PI-RADS 4-5. The risk of csPCa was proportional to the PSAd for PI-RADS 3 patients. Good accuracy (AUC of 0.69 and 0.68 using 3D-US and MRI, respectively), adequate calibration and a higher net benefit when using 3D-US for probability thresholds above 25% on DCA. CONCLUSIONS: Prostate volume estimation with semi-automated segmentation using 3D-US should be preferred to the ellipsoidal formula (MRI) when evaluating PSAd and the risk of csPCa.
- MeSH
- Risk Assessment MeSH
- Clinical Decision-Making MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Multiparametric Magnetic Resonance Imaging MeSH
- Prostatic Neoplasms * pathology diagnostic imaging MeSH
- Prospective Studies MeSH
- Prostate * pathology diagnostic imaging MeSH
- Prostate-Specific Antigen * blood MeSH
- Aged MeSH
- Image-Guided Biopsy methods MeSH
- Organ Size MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
Computed tomography 3D reconstruction of a patient with Bland-White-Garland syndrome showing a dilated right coronary artery and thin left coronary artery.
Cieľ: Porovnať zmeny v cirkulácii v dolnom segmentne maternice pomocou trojdimenzionálneho power Dopplerovho ultrazvuku (3DPD) u pacientok po cisárskom reze (SC) a po nekomplikovanom vaginálnom pôrode (VAG). Materiál/metódy: Ultrazvukové vyšetrenie podstúpilo 60 pacientok po SC a 60 pacientok po vaginálnom pôrode, ktoré boli hospitalizované na Gynekologicko-pôrodníckej klinike, Jesseniovej lekárskej fakulty v Martine, Univerzity Komenského v Bratislave a Univerzitnej nemocnici v Martine od novembra 2021 do februára 2023. Pomocou 3DPD zobrazenia bol získaný vopred daný objem, a to 15 cm 3 . Ultrazvukový softvér VOCAL (Virtual Organ Computer-aided Analysis) následne automaticky kalkuloval 3 vaskulárne indexy: index vaskularizácie (VI), index prietoku (FI) a kombináciu oboch spomenutých indexov (VFI). Následne bol vyšetrený index pulzatility (PI) v oboch uterinných artériách (UtA). Všetky merania boli realizované 48 hodín po pôrode. Výsledky: V tejto pilotnej štúdii sme pozorovali signifikantné rozdiely vo všetkých troch vaskulárnych indexoch medzi skupinou pacientok po SC a po vaginálnom pôrode s p ˂ 0,001. V skupine pacientok po vaginálom pôrode sme zaznamenali inverznú koreláciu medzi vaskulárnymi indexami a hodnotami PI v UtA s p ˂ 0,001. Podobný výsledok sme však v skupine pacientok po SC nepozorovali. Záver: V súčasnosti predstavujú cirkulačné zmeny maternice v puerpériu stále pomerne málo preštudovanú problematiku. Naše výsledky dokázali signifikantné rozdiely vo vaskulárnych indexoch medzi oboma skupinami. V budúcnosti by mohla táto metodika slúžiť na monitorovanie hojenia jazvy alebo jej výslednej kvality zhojenia. Podľa súčasného prehľadu literatúry doteraz nebola publikovaná žiadna podobná štúdia.
Objective: To evaluate circulation of the lower uterine segment (LUS) using three-dimensional power Doppler ultrasound (3DPD) in patients after Cesarean section (CS) and uncomplicated vaginal delivery (VD). Study design: We evaluated 60 patients after CS and 60 patients after uncomplicated VD by ultrasound admitted at the Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Slovakia, from November 2021 to February 2023. A spherical volume of 15 cc was captured for each patient with a 3D transabdominal probe. We used an ultrasound software program Virtual Organ Computer-aided Analysis (VOCAL) to calculate three vascular indices – vascularization index (VI), flow index (FI), and vascularization-flow index (VFI). We also assessed Doppler indices in the uterine arteries (UtA). The measurements were taken 48 hours postpartum. Results: There was a significant difference in all three vascular indices between the studied and controlled group with a p-value ˂ 0.001. We observed a significant inverse correlation between vascular indices and pulsatility index (PI) in UtA in the VD group, but we found no such correlation in the CS group. Conclusion: Although it is still not well understood, 3DPD can be a suitable ultrasound method to study postpartum uterine circulation. Our results proved significant differences in vascularization and perfusion in LUS in patients after CS vs. VD. Therefore, 3DPD may be useful in the ultrasound assessment of healing areas after CS. To the best of our knowledge, this is the first study analyzing vascular indices in LUS during puerperium in patients both after VD and CS.
Hepatopancreatobiliary surgery belongs to one of the most complex fields of general surgery. An intricate and vital anatomy is accompanied by difficult distinctions of tumors from fibrosis and inflammation; the identification of precise tumor margins; or small, even disappearing, lesions on currently available imaging. The routine implementation of ultrasound use shifted the possibilities in the operating room, yet more precision is necessary to achieve negative resection margins. Modalities utilizing fluorescent-compatible dyes have proven their role in hepatopancreatobiliary surgery, although this is not yet a routine practice, as there are many limitations. Modalities, such as photoacoustic imaging or 3D holograms, are emerging but are mostly limited to preclinical settings. There is a need to identify and develop an ideal contrast agent capable of differentiating between malignant and benign tissue and to report on the prognostic benefits of implemented intraoperative imaging in order to navigate clinical translation. This review focuses on existing and developing imaging modalities for intraoperative use, tailored to the needs of hepatopancreatobiliary cancers. We will also cover the application of these imaging techniques to theranostics to achieve combined diagnostic and therapeutic potential.
- Publication type
- Journal Article MeSH
- Review MeSH
OBJECTIVE: Precise control over the ultrasound field parameters experienced by biological samples during sonication experiments in vitro may be quite challenging. The main goal of this work was to outline an approach to construction of sonication test cells that would minimize the interaction between the test cells and ultrasound. METHODS: Optimal dimensions of the test cell were determined through measurements conducted in a water sonication tank using 3D-printed test objects. The offset of local acoustic intensity variability inside the sonication test cell was set to value of ±50% of the reference value (i.e., local acoustic intensity measured at last axial maximum in the free-field condition). The cytotoxicity of several materials used for 3D printing was determined using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay. RESULTS: The sonication test cells were 3D printed from polylactic acid material, which was not toxic to the cells. Silicone membrane HT-6240, which was used to construct the bottom of the test cell, was found to reduce ultrasound energy minimally. Final ultrasound profiles inside the sonication test cells indicated the desired variability of local acoustic intensity. The cell viability in our sonication test cell was comparable to that of commercial culture plates with bottoms constructed with silicone membrane. CONCLUSION: An approach to construction of sonication test cells minimizing the interaction of the test cell and ultrasound has been outlined.
- MeSH
- Biopsy methods MeSH
- Adult MeSH
- Granulomatous Mastitis * diagnosis pathology therapy MeSH
- Histological Techniques MeSH
- Humans MeSH
- Mammography methods MeSH
- Prednisone administration & dosage adverse effects therapeutic use MeSH
- Ultrasonography methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Biological Therapy methods MeSH
- Genes, erbB-2 MeSH
- Immunohistochemistry MeSH
- Humans MeSH
- Mammography MeSH
- Antibodies, Monoclonal administration & dosage therapeutic use MeSH
- Breast Neoplasms * diagnosis genetics pathology therapy MeSH
- Antineoplastic Agents therapeutic use MeSH
- Antineoplastic Protocols MeSH
- Receptor, ErbB-2 antagonists & inhibitors MeSH
- Ultrasonography, Mammary MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- MeSH
- Diagnostic Techniques, Obstetrical and Gynecological MeSH
- Child MeSH
- Mullerian Ducts abnormalities diagnostic imaging MeSH
- Humans MeSH
- Adolescent MeSH
- Ultrasonography methods instrumentation MeSH
- Uterus * abnormalities diagnostic imaging MeSH
- Vagina * abnormalities diagnostic imaging MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Female MeSH
