Radiation therapy manages pancreatic cancer in various settings; however, the proximity of gastrointestinal (GI) luminal organs at risk (OARs) poses challenges to conventional radiation therapy. Proton beam therapy (PBT) may reduce toxicities compared to photon therapy. This consensus statement summarizes PBT's safe and optimal delivery for pancreatic tumors. Our group has specific expertise using PBT for GI indications and has developed expert recommendations for treating pancreatic tumors with PBT. Computed tomography (CT) simulation: Patients should be simulated supine (arms above head) with custom upper body immobilization. For stomach/duodenum filling consistency, patients should restrict oral intake within 3 hours before simulation/treatments. Fiducial markers may be implanted for image guidance; however, their design and composition require scrutiny. The reconstruction field-of-view should encompass all immobilization devices at the target level (CT slice thickness 2-3 mm). Four-dimensional CT should quantify respiratory motion and guide motion mitigation. Respiratory gating is recommended when motion affects OAR sparing or reduces target coverage. Treatment planning: Beam-angle selection factors include priority OAR-dose minimization, water-equivalent-thickness stability along the beam path, and enhanced relative biological effect consideration due to the increased linear energy transfer at the proton beam end-of-range. Posterior and right-lateral beam angles that avoid traversing GI luminal structures are preferred (minimizing dosimetric impacts of variable anatomies). Pencil beam scanning techniques should use robust optimization. Single-field optimization is preferable to increase robustness, but if OAR constraints cannot be met, multifield optimization may be used. Treatment delivery: Volumetric image guidance should be used daily. CT scans should be acquired ad hoc as necessary (at minimum every other week) to assess the dosimetric impacts of anatomy changes. Adaptive replanning should be performed as required. Our group has developed recommendations for delivering PBT to safely and effectively manage pancreatic tumors.

• MeSH
• celková dávka radioterapie MeSH
• čtyřrozměrná počítačová tomografie MeSH
• dýchání MeSH
• imobilizace metody   MeSH
• konsensus MeSH
• kritické orgány * diagnostické zobrazování   účinky záření   MeSH
• lidé MeSH
• nádory slinivky břišní * radioterapie   diagnostické zobrazování   MeSH
• plánování radioterapie pomocí počítače metody   MeSH
• pohyb vnitřních orgánů MeSH
• pohyb MeSH
• protonová terapie * metody   škodlivé účinky   normy   MeSH
• radiační poranění prevence a kontrola   MeSH
• radioterapie řízená obrazem metody   MeSH
• žaludek diagnostické zobrazování   MeSH
• zaměřovací značky pro radioterapii MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH

BACKGROUND: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure. METHODS: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group. RESULTS: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years. CONCLUSION: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.

• MeSH
• dávka záření MeSH
• dospělí MeSH
• fluoroskopie metody   MeSH
• ganglion trigeminale chirurgie   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuralgie trigeminu * chirurgie   diagnostické zobrazování   radioterapie   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• radiační expozice * prevence a kontrola   MeSH
• retrospektivní studie MeSH
• rizotomie * metody   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. DESIGN AND INTERVENTION: International online survey. RESULTS: Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%-98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique. CONCLUSIONS: Although LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline.

• MeSH
• jednotky intenzivní péče o novorozence * MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   MeSH
• lidé MeSH
• novorozenec MeSH
• plíce * diagnostické zobrazování   MeSH
• průzkumy a dotazníky MeSH
• syndrom respirační tísně novorozenců diagnostické zobrazování   terapie   MeSH
• ultrasonografie * metody   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Precise positioning of the acetabular component during total hip replacement is the key to achieving optimal implant function and ensuring long-term patient comfort. However, different anatomical variations, degenerative changes, dysplasia, and other diseases make it difficult. In this study, we discuss a method based on the three-dimensional direction of the transverse ligament, predicting native acetabular anteversion with higher accuracy. METHODS: Angular positions of the acetabulum and direction of the transverse ligament were automatically calculated from routine computed tomography data of 270 patients using a registration algorithm. The relationship between acetabular angles and ligament direction and their relationship with sex, age, and pelvic tilt were sought. These relationships were then modelled using multilinear regression. RESULTS: Including the direction of the transverse ligament in the sagittal and transverse planes as a regressor in the multilinear model explained the variation in acetabular anteversion (R2 = 0.76 for men, R2 = 0.63 for women; standard deviation in prediction: men, 3.92° and women, 4.00°). CONCLUSIONS: The results indicate that the ligament was suitable as a guidance structure almost insensitive to the ligament in the sagittal and transverse planes must be considered. Estimation based on the direction in only 1 plane was not sufficiently accurate. The operative acetabular inclination was not correlated with the direction of the ligament. The correlations were higher in men than in women.

• MeSH
• acetabulum * diagnostické zobrazování   chirurgie   MeSH
• anteverze kosti diagnostické zobrazování   MeSH
• dospělí MeSH
• kloubní ligamenta * diagnostické zobrazování   anatomie a histologie   MeSH
• kyčelní kloub diagnostické zobrazování   anatomie a histologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * metody   MeSH
• počítačová rentgenová tomografie * MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Three-dimensional (3D) printing has gained popularity across various domains but remains less integrated into medical surgery due to its complexity. Existing literature primarily discusses specific applications, with limited detailed guidance on the entire process. The methodological details of converting Computed Tomography (CT) images into 3D models are often found in amateur 3D printing forums rather than scientific literature. To address this gap, we present a comprehensive methodology for converting CT images of bone fractures into 3D-printed models. This involves transferring files in Digital Imaging and Communications in Medicine (DICOM) format to stereolithography format, processing the 3D model, and preparing it for printing. Our methodology outlines step-by-step guidelines, time estimates, and software recommendations, prioritizing free open-source tools. We also share our practical experience and outcomes, including the successful creation of 72 models for surgical planning, patient education, and teaching. Although there are challenges associated with utilizing 3D printing in surgery, such as the requirement for specialized expertise and equipment, the advantages in surgical planning, patient education, and improved outcomes are evident. Further studies are warranted to refine and standardize these methodologies for broader adoption in medical practice.

• MeSH
• 3D tisk * MeSH
• anatomické modely MeSH
• fraktury kostí * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie * metody   MeSH
• radiologické informační systémy organizace a řízení   MeSH
• traumatologie MeSH
• zobrazování trojrozměrné metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Understanding the risk factors leading to intracranial aneurysm (IA) rupture have still not been fully clarified. They are vital for proper medical guidance of patients harboring unruptured IAs. Clarifying the hemodynamics associated with the point of rupture could help could provide useful information about some of the risk factors. Thus far, few studies have studied this issue with often diverging conclusions. METHODS: We identified a point of rupture in patients operated for an IAs during surgery, using a combination of preoperative computed tomography (CT) and computed tomography angiography (CTA). Hemodynamic parameters were calculated both for the aneurysm sac as a whole and the point of rupture. In two cases, the results of CFD were compared with those of the experiment using particle image velocimetry (PIV). RESULTS: We were able to identify 6 aneurysms with a well-demarcated point of rupture. In four aneurysms, the rupture point was near the vortex with low wall shear stress (WSS) and high oscillatory shear index (OSI). In one case, the rupture point was in the flow jet with high WSS. In the last case, the rupture point was in the significant bleb and no specific hemodynamic parameters were found. The CFD results were verified in the PIV part of the study. CONCLUSION: Our study shows that different hemodynamic scenarios are associated with the site of IA rupture. The numerical simulations were confirmed by laboratory models. This study further supports the hypothesis that various pathological pathways may lead to aneurysm wall damage resulting in its rupture.

• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Open (incisional) biopsies have long been accepted as the gold standard in diagnosing bone and soft tissue tumors. However, the main disadvantage of this method is that it can lead to increased contamination, hematoma, infection, and pathological fracture. Compared to open biopsies, percutaneous core needle biopsies are less invasive, do not require hospitalization, have low costs and low complication rates, and there is no need for wound healing in cases that require radiotherapy. This study evaluated the diagnostic accuracy and reliability of percutaneous core needle biopsy. MATERIAL AND METHODS: The study included the results of 250 percutaneous core needle biopsies of 244 patients who presented at the tertiary university hospital between September 2012 - September 2022 and were diagnosed with a bone or soft tissue tumor using the percutaneous core needle biopsy method and then underwent surgical excision in the Orthopaedics and Traumatology Clinic. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy rates were calculated for the percutaneous core needle biopsy method according to the compatibility of the results. RESULTS: A fluoroscopy-guided percutaneous Jamshidi needle biopsy performed by an orthopedist for lesions originating from the bone has a diagnostic accuracy of 96%. CT-guided percutaneous Jamshidi needle biopsy performed by a radiologist for lesions originating from the bone has a diagnostic accuracy of 88.9%. Percutaneous Tru-cut needle biopsy performed by an orthopedist without imaging guidance for lesions originating from soft tissue has a diagnostic accuracy of 92%. USGguided percutaneous Tru-cut needle biopsy performed by a radiologist for lesions originating from soft tissue has a diagnostic accuracy of 96,7% (p<0.001). DISCUSSION: The diagnostic accuracy of open biopsies ranges from 91% to 99% in the literature. Additionally, the diagnostic accuracy of core needle biopsies in recent studies ranges from 76% to 99%. Compared to the literature, our study has shown that biopsies performed by orthopedic specialists have a high diagnostic power (96% for bone-derived lesions; 92% for soft tissue-derived lesions). CONCLUSIONS: Percutaneous core needle biopsy is highly effective and reliable in diagnosing bone and soft tissue tumors. Managing patients by a team using a multidisciplinary approach will increase diagnostic success. KEY WORDS: core needle biopsy, percutaneous, diagnostic accuracy, radiology guided biopsy, bone and soft tissue tumors.

• MeSH
• biopsie dutou jehlou metody   MeSH
• dospělí MeSH
• fluoroskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory kostí * patologie   diagnóza   chirurgie   MeSH
• nádory měkkých tkání * patologie   diagnóza   MeSH
• počítačová rentgenová tomografie metody   MeSH
• prediktivní hodnota testů MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• senzitivita a specificita * MeSH
• ultrazvukem navigovaná biopsie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Magnetic nanorobots offer wireless navigation capability in hard-to-reach areas of the human body for targeted therapy and diagnosis. Though in vivo imaging is required for guidance of the magnetic nanorobots toward the target areas, most of the imaging techniques are inadequate to reveal the potential locomotion routes. This work proposes the use of radiopaque magnetic nanorobots along with microcomputed tomography (microCT) for localized in vivo imaging applications. The nanorobots consist of a contrast agent, barium sulfate (BaSO4 ), magnetized by the decoration of magnetite (Fe3 O4 ) particles. The magnetic features lead to actuation under rotating magnetic fields and enable precise navigation in a microfluidic channel used to simulate confined spaces of the body. In this channel, the intrinsic radiopacity of the nanorobots also provides the possibility to reveal the internal structures by X-ray contrast. Furthermore, in vitro analysis indicates nontoxicity of the nanorobots. In vivo experiments demonstrate localization of the nanorobots in a specific part of the gastrointestinal (GI) tract upon the influence of the magnetic field, indicating the efficient control even in the presence of natural peristaltic movements. The nanorobots reported here highlight that smart nanorobotic contrast agents can improve the current imaging-based diagnosis techniques by providing untethered controllability in vivo.

• MeSH
• gastrointestinální trakt * diagnostické zobrazování   MeSH
• kontrastní látky * chemie   MeSH
• lidé MeSH
• magnetismus MeSH
• rentgenová mikrotomografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The presented study investigates the application of bi-arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC). AIMS: The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations. METHODS: Preprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. RESULTS: Of 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in 45.3%, and antero-inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane. CONCLUSIONS: In vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one-third of the optimal TSP sites were anterior.

• MeSH
• 3D tisk MeSH
• fibrilace síní * terapie   chirurgie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• punkce metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• síňové ouško * diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND AIMS: Despite the undeniable ongoing development of cross-sectional imaging methods, not all focal liver lesions (FLLs) have a typical pattern. An image-guided biopsy using a percutaneous approach might safely provide a final histological diagnosis of the FLLs. We aimed to evaluate the accuracy, efficiency, complication rate, technical features, and relationships between the followed parameters of computed tomography (CT)-guided percutaneous biopsies of FLLs using a retrospective approach. METHODS: 303 percutaneous biopsy procedures in 295 patients were carried out in patients with suspected or indeterminate FLLs over a 10-year period. The median size of the tumors was 44 mm (15 - 144 mm). Median age of patients was 67 years (25 to 87 years). Skin-to-lesion distance was variable, from 30 mm to 138 mm (median length 59 mm). In 200 procedures (66%) malignant disease was known from the patients ́ clinical history. RESULTS: In 288 biopsies (95%) the results were true positive or true negative; 15 procedures (4.95%) resulted in a histologically false negative and had to be confirmed using other approaches. Metastatic disease to hepatic parenchyma of various origins was the most frequent histological diagnosis (55.4%). Cholangiocarcinoma was the most common individual result (13.5%). In total 14 complications (4.6%) were confirmed, 4 of which were severe haemorrhages that needed angiographic treatment and in one case surgical revision. The mortality rate in our group was 0.3%. A statistically significant relationship between lesion size and diagnostic accuracy (p < 0.01) was revealed. The use of a 16 G needle calibre and at least two samples were suitable for hypo- and hypervascular lesions without a significant increase in the complication rate. CONCLUSIONS: Core needle biopsy using a percutaneous approach and a CT-guidance performed on patients with indetermined FLLs had a high overall accuracy in determining the final histological diagnosis including subtyping. Concurrently, the complication incidence was low.

• MeSH
• lidé MeSH
• nádory jater * diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• ultrazvukem navigovaná biopsie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH