Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

Three-dimensional Imaging of Multi-slice Spiral CT in Bronchial Artery Correlative Study on Blood Supply of Central Lung Cancer and Its Clinical Significance

Objective: To evaluate three-dimensional bronchial artery imaging charactersin central lung cancer and applied values with multi-slice spiral CT (MSCT) to provide theoreticalevidence on blood supply and intervention therapy. Methods: Eighteen patients with central lungcancer underwent MSCT with real time helical thin-slice CT scanning. Three-dimensional bronchialartery reconstruction was done at the console work-station. The space anatomical characters ofbronchial artery were observed through different rotations. Results: For 6 cases, thethree-dimensional images of bronchial artery (33.33%) could exactly show the origins, the routes(lung inner segment and mediatism segment) and the diameters of bronchial arteries. Vision rate ofbronchial arteries was the highest in pulmonary artery stricture and truncation groups, and thevessels' diameter became larger apparently. These characters demonstrated blood supply of this kindof central lung cancer come from bronchial artery. Volume rendering images were the best ones amongthree-dimensional images. Conclusion: Three-dimensional imaging with MSCT in bronchial artery canreveal the anatomical characters of bronchial artery and provide theoretical evidence on bloodsupply and intervention therapy of central lung cancer.

Diameters and form of skull base foramen ovale measured by three-dimensional spiral CT thin-slice scan in healthy adults

BACKGROUND： The accurate measurements of various data of the bone diameters of foramen ovale of living person can change the methods of puncturing trigeminal gasserian ganglion via foramen ovale for treating trifacial neuralgia from the experience of puncture operator only to puncture by taking the objective data of measurement as the evidence, which is good for improving the accuracy of puncturing trigeminal ganglion and reducing side effects. OBJECTIVE ： To observe the forms of foramen ovales in healthy adults displayed by volume rendering and multi-planar reconstruction after three-dimensional spiral CT thin-slice scan of skull base, and measure the longitudinal diameter and transverse diameter. DESIGN ： A repetitive observation and measurement SETTINGS ： Department of Neurosurgery and Department of Medical Imaging, Foshan Hospital of Traditional Chinese Medicine. PARTICIPANTS： Fifty healthy adults （100 sides）, who were examined with three-dimensional spiral CT scan, were randomly selected from the Department of Medical Imaging, Foshan Hospital of Traditional Chinese Medicine from January 2005 to January 2006, including 26 males and 24 females, aged 25-68 years with an average of 48 years old. They were all informed and agreed with the examination. METHODS ： The subjects were examined with the Philips 16-slice spiral CT-Mx 8000 IDT CT apparatus （Philips Company, Holland）, the scanning ranged from 2 cm below the canthomeatal line to the level of suprasellar cistem. The width of collimator was 0.75 mm, pitch was 0.663; tube current was 350 mA, voltage was 120 kV, resolution was 512×512 matrix; slice thickness of reconstruction was 1 mm, and interval was 0.5 mm. After the three-dimensional spiral CT thin-slice scan of skull base, the image post-processing techniques including volume rendering and multi-planar reconstruction were applied to observe the forms of foramen ovales, and measure the size, longitudinal diameter and transverse diameter of the foramen ovales. The figures of the foramen ovales were drawn with mouse along the boundary of bone porous margin and soft tissue. According to the indications, the diameters were measured with computer to observe the forms of foramen ovales. MAIN OUTCOME MEASURES ： The longitudinal diameter, transverse diameter and form of foramen ovales were observed. RESULTS： All the 50 healthy adults （100 sides） were involved in the analysis of results. （1） It was observed in the volume rendering images that foramen ovales had four forms of oval shape （77 sides）, kidney shape （12 sides）, round shape （7 sides）, ribbon shape （4 sides）. （2） The longitudinal diameters of left and right foramen ovales were （7.67±1.32） and （7.98±1.45） mm, and the transverse diameters were （4.04±0.83）, （4.09±1.07） mm; There was no obvious difference between left and right longitudinal diameters （t = 1.63, P = 0.11 ）, and left and right transverse diameters were close （t = 0.45, P= 0.65）. CONCLUSION ： The non-invasive techniques of volume rendering and multi-planar reconstruction after three-dimensional spiral CT thin-slice scan can clearly display the formand size of foramen ovale in healthy adults.

Digital measurement of bone tumor volume by CT three-dimensional reconstruction technology

Objective To discuss the measurement of bone tumor volume on the basis of three dimensional images segmentation technology. Methods Twenty patients with lacunar bone tumor from Tianjin Hospital and Tongji Hospital were included in the

A three-dimensional digital visualization model of cervical nerves in a healthy person

Three-dimensional reconstruction nerve models are classically obtained from two-dimensional images of ＂visible human＂ frozen sections. However, because of the flexibility of nerve tissues and small color differences compared with surrounding tissues, the integrity and validity of nerve tissues can be impaired during milling. Thus, in the present study, we obtained two-dimensional data from a healthy volunteer based on continuous CT angiography and magnetic resonance myelography. Semi-automatic segmentation and reconstruction were then conducted at different thresholds in different tissues using Mimics software. Small anatomical structures such as muscles and cervical nerves were reconstructed using the medical computer aided design module. Three-dimensional digital models of the cervical nerves and their surrounding structures were successfully developed, which allowed visualization of the spatial relation of anatomical structures with a strong three-dimensional effect, distinct appearance, clear distribution, and good continuity, precision, and integrality. These results indicate the validity of a three-dimensional digital visualization model of healthy human cervical nerves, which overcomes the disadvantages of milling, avoids data loss, and exhibits a realistic appearance and three-dimensional image.

Three-Dimensional Computerized Tomography-Assisted Identification of Necrotic Volume, Distribution, Shape and Prognosis of Collapse in ONFH

Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Method: Totally 92 hips (59 cases) with ONFH (44 males, 15 females) were included, with mean age of 37.5 years (range from 26 to 58). Totally 20 cases (35 hips) were induced by corticosteroid (CTSs), 31 (49 hips) induced by alcohol, 4 (4 hips) induced by trauma and 4 (4 hips) idiopathic. All the hips were categorized into stage ARCO II. Finally diagnosed by MRI, all hips were scanned by CT to acquire data in DICOM format. The images were imported into software to extract 3D-shape of femoral heads, necrotic foci, their volumes and distribution in each quadrant. Deviation of volumes between digital image and biopsy specimen was analyzed by SAS9.1 package. Correlativity between collapse and volume of necrosis under specific pathogeneses was also analyzed. Among the cases necessitating total hip arthroplasty (THA) due to advancing to ARCO III, we randomly selected 8 of them to perform 3D-CT scanning thrice prior to surgical operation. Total femoral heads harvested were torn asunder. Cubic capacity of femoral heads and necrotic foci were hereby measured and compared with those acquired from digital models. Result: Through the digital model, necrotic foci were found mainly locating within the super lateral portion of femoral head, coinciding with those observed in biopsy specimen. Average volumetric ratio of digitally acquired necrosis focus/femoral head in 58 collapsed hips was 36.8%. The ratio of the 34 hips without collapse was 17.3%. In collapsed femoral heads, the distribution of necrosis focus was 23.4% in quadrant 1 (q1), 23.6% in q2, 12.1% in q3, 14.4% in q4, 9.0% in q5, 11.8% in q6, 1.6% in q7 and 3.9% in q8. In femoral heads without collapse, the distribution was 34.2% in q1, 29.6% in q2, 11.8% in q3, 11.3% in q4, 6.0% in q5, 6.0% in q6, 0.5% in q7 and 0.4% in q8. As for the average cubic capacities of femoral heads and necrotic foci, those acquired from the digital model and biopsy specimen had no significant difference in matched-pairs test (t = -1.49, P = 0.179 for femoral heads and t = -1.52, P = 0.172 for necrotic foci). There was significant difference (F = 2.720, P = 0.035 P was respectively 0.0001 and 0.0005). Decision tree model showed that 94.6% (53/56) hips would progress into collapse if the volumetric ratio of necrotic tissue was over 23.48%. Otherwise, if distribution in q2 was over 45.13%, 83.3% (5/6) hips would progress into collapse. No collapse (0/30) would occur if the distribution of necrotic tissue in q2 was under 45.13%. Conclusion: Digital 3D-model reconstructed from CT scanning can precisely incarnate spatial orientation of necrotic foci in femoral head. Multinomial logistic regression and decision-making tree shows that volumetric ratio of necrotic tissues plays an important role in anticipating collapse of femoral head.

Morphological evolution and flow conduction characteristics of fracture channels in fractured sandstone under cyclic loading and unloading

In coal mining,rock strata are fractured under cyclic loading and unloading to form fracture channels.Fracture channels are the main flow narrows for gas.Therefore,expounding the flow conductivity of fracture channels in rocks on fluids is significant for gas flow in rock strata.In this regard,graded incremental cyclic loading and unloading experiments were conducted on sandstones with different initial stress levels.Then,the three-dimensional models for fracture channels in sandstones were established.Finally,the fracture channel percentages were used to reflect the flow conductivity of fracture channels.The study revealed how the particle size distribution of fractured sandstone affects the formation and expansion of fracture channels.It was found that a smaller proportion of large blocks and a higher proportion of small blocks after sandstone fails contribute more to the formation of fracture channels.The proportion of fracture channels in fractured rock can indicate the flow conductivity of those channels.When the proportion of fracture channels varies gently,fluids flow evenly through those channels.However,if the proportion of fracture channels varies significantly,it can greatly affect the flow rate of fluids.The research results contribute to revealing the morphological evolution and flow conductivity of fracture channels in sandstone and then provide a theoretical basis for clarifying the gas flow pattern in the rock strata of coal mines.

Permeability differences based on three-dimensional geometrical information of void spaces

In this study,the permeabilities of Berea and Otway sandstones were measured under different confining pressures,and porosity was investigated through mercury intrusion porosimetry(MIP).The total porosities of the Berea and Otway sandstones were approximately 17.4%and 25%,respectively.Pore size distributions of each sandstone were almost the same,but the pores in the Otway sandstone were slightly narrower.However,the permeability of the Otway sandstone was smaller than that of the Berea sandstone by one order of magnitude.Three-dimensional(3D)void geometry and geometrical properties of the void spaces relevant to flow were compared to obtain the relation between the permeability differences and porosities of the two sandstones.The 3D geometrical analysis using microfocus X-ray computed tomography(CT)was performed,and the pore geometries of both sandstones were compared using the 3D medial axis(3DMA)method.Pore and throat radii,pore coordination number,tortuosity,number of connecting paths,connecting path volume,and other factors were determined using 3DMA.The Otway sandstone was characterized by a small effective throat/pore radius ratio.Based on the fluid flow mechanism,the lower effective throat/pore radius ratio results in a lower permeability induced by the fluid energy loss,which means that the 3D geometrical shape of void spaces affects the permeability value.

Research on CT characteristics reconstruction technology

The traditional computed tomography(CT)reconstruction methods are noisy,low resolution,poor contrast,and generally not suitable to detect the smaller flaws.Besides,the filter design is also difficult.The CT characteristics reconstruction technology was brought forward to improve in these aspects,which is defined to directly reconstruct the characteristics of the projection for the best requirements not the overall image quality.The two-dimension(2D)and three-dimension(3D)CT characteristics reconstruction algorithm were firstly introduced,then by detailed analysis,experimental results and comparsion of parameters calculated,its advantages in keeping better high-frequency feature,better noise immunity,short time-consuming and easier design are verified.

螺旋CT技术与临床应用

1989年螺旋CT的问世,使CT成像技术跨入了新的阶段,为临床应用开辟了广阔的前景。 1 螺旋CT技术 螺旋CT是连续式扫描,扫描床匀速移动的同时X线管360度连续旋转曝光,在人体表形成了螺旋轨迹(故称螺旋CT)。

Study of the impact of CT/CT image fusion radiotherapy on V_(20) and radiation pneumonitis of non-small cell lung cancer

Objective:The aim of our study was to investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer(NSCLC) and the impact on V20 and radiation pneumonitis(RP).Methods:Patients who were pathologically or cytologically diagnosed of stage IIIA and IIIB NSCLC were treated with three-dimensional conformal radiation therapy(4000 cGy).Forty patients got at least 25% tumor reduction were randomly divided into two groups:group A of regular shrink field radiotherapy(20 cases) and group B of CT/CT image fused shrink field radiotherapy(20 cases).Dosage reached 6600 cGy.Clinical data,V20 and RP were observed within 3 months after radiotherapy.Statistical analysis was conducted for the NSCLC patients.Results:22.5%(9/40) patients got RP during follow-up.Group A accounted for 6 cases(30%),and group B had 3 cases(15%).There was no marked difference between the two groups(P = 0.256),univariate analysis revealed that the IV20 of A and B groups,and IV20 and CV20 of all patients were statistically related to the incidence of RP(P < 0.05).With Wilcoxon method assay,the ipsilateral lung V20 and contralateral lung V20 had statistical significance between the two groups(P < 0.05).Conclusion:The CT/CT image infusion treatment planning could increase the radical dosage with better tumor control probability but won't increase adverse reaction.

Multi-Schlieren CT Measurements of Supersonic Microjets from Circular and Square Micro Nozzles

Instantaneous three-dimensional (3D) density distributions of a shock-cell structure of perfectly and imperfectly expanded supersonic microjets escaping into an ambient space are measured. For the 3D observation of supersonic microjets, non-scanning 3D computerized tomography (CT) technique using a 20-directional quantitative schlieren optical system with flashlight source is employed for simultaneous schlieren photography. The 3D density distributions data of the microjets are obtained by 3D-CT reconstruction of the projection’s images using maximum likelihood-expectation maximization. Axisymmetric convergent-divergent (Laval) circular and square micro nozzles with operating nozzle pressure ratio 5.0, 4.5, 4.0, 3.67, and 3.5 have been studied. This study examines perfectly expanded, overexpanded, and underexpanded supersonic microjets issued from micro nozzles with fully expanded jet Mach numbers Mj ranging from 1.47 - 1.71, where the design Mach number is Md = 1.5. A complex phenomenon for free square microjets called axis switching is clearly observed with two types “upright” and “diagonal” of “cross-shaped”. The initial axis-switching is 45° within the first shock-cell range. In addition, from the symmetry and diagonal views of square microjets for the first shock-cells, two different patterns of shock waves are viewed. The shock-cell spacing and supersonic core length for all nozzle pressure ratios are investigated and reported.

Inversion of Ionospheric Electron Density from GPS Beacon Observations

This paper studies the mathematical foundation of time-dependent three-dependent three-dimensional (3-D) computerized ionospheric tomography (CIT) for reconstructing ionospheric electron density,N_e,from ground-based GPS beacon obser\|vations,After simplifying the relation between N_e and time, the time-dependent 3-D inversion in consideration is reduced to a 3-D tomography with incomplete projections. To see clearly the effects of the incompleteness on the quality of reconstruction under 3-D condition,the fromula of 3-D parallelbeam tomography is deduced theoretically. After establishing the mathematical foundation,simulations based on actual GPS ray paths with the help of the IRI-90 model are performed, and reasonable time-dependent 3-D distribution images of N_e are obtained when taking proper layout of the network and allowing variable resolutions. The quality of the reconstruction is rather good when compared with the images from the IRI90 model directly. Therefore, results in this paper demonstrate that imaging of the ionospheric electron density distribution from GPS beacon observations is reasonable in theory and feasible in pratice.

Multislice spiral CT angiography in evaluation of liver transplantation candidates

BACKGROUND: Orthotopic liver transplantation has be- come the treatment of choice for patients with end-stage liver disease. This study was designed to study whether multislice spiral CT angiography (MSCTA) could be used for preoperative evaluation for orthotopic liver transplanta- tion candidates. METHODS: Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di- mensional CT angiography (3DCTA). The arterial-phase was used to create vascular maps of the celiac axis (inclu- ding the origin of the hepatic common artery, left gastric artery and splenic artery) and origin of the superior mesen- teric artery. The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein. Statistical analyses were made using the chi- square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients. Appearance of MSCTA and operative results of 16 patients were analyzed. RESULTS; Sixty-two patients (77.5%) showed conven- tional and 18 (22.5%) nonconventional hepatic arterial anatomy. A significant difference was found between the two groups in anatomy of the hepatic artery (P <0.05). Celiac axis stenosis was observed in 6 patients, SA aneu- rysm in 2, small-caliber hepatic arterial vessels in 2, and portal vein thrombosis in 15. Vascular structures of 16 ope- rative patients were well defined. CONCLUSION: As a noninvasive examination, MSCTA can provide a comprehensive preoperative vascular evalua- tion for liver transplantation candidates.

Computer-Aided Simulation of Mastoidectomy

Objective To establish a three-dimensional model of the temporal bone using CT scan images for study of temporal bone structures and simulation of mastoidectomy procedures. Methods CT scan images from 6 individuals (12 temporal bones) were used to reconstruct the Fallopian canal, internal auditory canal, cochlea, semicircular canals, sigmoid sinus, posterior fossa floor and jugular bulb on a computer platform. Their anatomical relations within the temporal bone were restored in the computed model. The same model was used to simulate mastoidectomy procedures. Results The reconstructed computer model provided accurate and clear three-dimensional images of temporal bone structures. Simulation of mastoidectomy using these images provided procedural experiences closely mimicking the real surgical procedure. Conclusion Computer-aided three dimensional reconstruction of temporal bone structures using CT scan images is a useful tool in surgical simulation and can aid surgical procedure planning.

Clinical Study on CT-guided Modified Akupotomye in the Treatment of Lumbar Nerve Posterior Branch Compression

Objective: To observe the clinical effect of modified akupotomye closed lysis under CT guidance on compression of posterior lumbar nerve branch.Methods: Patients were diagnosed by HRCT 3-D reconstruction combined with clinical symptoms and signs.After HRCT three-dimensional reconstruction combined with clinical symptoms and signs, the patients were confirmed as posterior lumbar nerve compression.After CT accurate surface positioning, CT-guided modified akupotomye was used for closed lysis of the posterior lumbar nerve branch.Oswestry Dysfunction Index Questionnaire(ODI) was used for quantitative scoring, 7 days before and after treatment and 6 months after treatment.Results: In 62 cases, 20 cases were cured, with 25 cases markedly effective, 11 cases effective, and 36 cases ineffective.The total effective rate was 90.3%.ODI score: Self-paired t test 7 days before after treatment, P < 0.01;Before treatment and 6 months after treatment, self-paired t test(P < 0.01);Self-paired t-test was performed 7 days after treatment and 6 months after treatment(P > 0.05).Conclusion: With CT precise positioning, the modified akupotomye can be used to do closed lysis, to relieve the adhesion and compression, so that the low back pain can be relieved, with good clinical.The akupotomye closed lysis, combined with modern imaging technology has not only achieved good clinical effect, but also can improve the accuracy, safety and scientificity of akupotomye treatment.

Three-dimensional modeling and simulation of asphalt concrete mixtures based on X-ray CT microstructure images

X-ray CT （computed tomography） was used to scan asphalt mixture specimen to ob- tain high resolution continuous cross-section images and the meso-structure. According to the theory of three-dimensional （3D） reconstruction, the 3D reconstruction algorithm was investi- gated in this paper. The key to the reconstruction technique is the acquisition of the voxel posi- tions and the relationship between the pixel element and node. Three-dimensional numerical model of asphalt mixture specimen was created by a self-developed program. A splitting test was conducted to predict the stress distributions of the asphalt mixture and verify the rationality of the 3D model.

Experimental investigation of junction growth of rough contacts using X-ray computed tomography

The real contact area(RCA)of randomly rough contacts has received a great deal of attention because it correlates strongly with friction,lubrication,sealing,and conductivity.Simulations have revealed that the RCA associated with deterministic normal squeezing loads increases when tangential loads are also applied,in a phenomenon called junction growth.However,experimental investigations of the junction growth of randomly rough contacts are rare.Here,we used X-ray computed tomography(CT)to measure junction growth when two aluminum alloy surfaces were in contact.A high-resolution experimental setup was used to apply loads and observe contact behaviors at a resolution of 4μm.The RCA and average contact gaps were computed using a three-dimensional(3D)geometric model constructed from gray CT images using the Otsu thresholding method.The results showed that the RCA increased as the normal load increased.The RCA increased by 22.67%after a tangential load was applied(junction growth),and the average gap decreased by 14.01%after a tangential load was applied.Thus,X-ray CT accurately measured the junction growth as a novel quantitative method.

Research Progress on the Application of Three-dimensional CT Imaging Technology in Oral and Maxillofacial Region and Radiation Protection

The anatomic relationship of oral and maxillofacial region is very com-plex,due to the large number of sinuses,cavities and spaces,and also closely related to the brain.The diagnosis of oral and maxillofacial lesions usually depends on the imaging examination.The conventional imaging methods are common CT and X-ray plain films.In recent years,with the rapid development of medical science and technology,more intuitive and vivid three-dimensional images have been applied in the diagnosis and treatment of oral and maxillofacial diseases.Therefore,CT three-dimensional imaging technology has been widely used in clinical practice.This paper reviews this topic.

胸腔镜下肺亚段切除术临床可行性研究

目的:通过与胸腔镜下肺段切除术比较,探讨胸腔镜下肺亚段切除术在临床实践中的可行性及安全性。方法:收集行胸腔镜解剖性亚肺叶切除术的单发肺小结节病人90例,根据手术方式分为胸腔镜下肺亚段切除术组(亚段组)34例和胸腔镜下肺段切除术组(肺段组)56例,比较2组病人围手术期相关指标和早期疗效。结果:亚段组病人切除亚段数、术中出血量、标本切缘距离均明显少于肺段组(P<0.01),2组手术时间、术后胸腔引流量、术后置管时间、术后住院时间差异均无统计学意义(P>0.05)。2组病人术后并发症、病理诊断、TNM分期差异均无统计学意义(P>0.05),亚段组Ⅰ期切除淋巴结站数明显少于肺段组(P<0.01)。2组术后随访期间均无肿瘤复发及转移。结论:以亚段为单位行胸腔镜下肺亚段切除能在保证切缘前提下切除更少的肺组织,可用于早期非小细胞肺癌的治疗。