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Background The purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures. Methods For each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella. Results For the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n = 3), inexpert (n = 3) and the entire group of observers (n = 6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor. Conclusions The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.

Background: Long-term results after stenting aorto-coronary ostial lesions (AOL) are worse than those achieved in non-ostial locations. AOL interventions still pose a substantial challenge for interventional cardiologists. The aim of the study was to determine the optimal fluoroscopic viewing angles of the left and right coronary ostia, based on multislice computed tomography (MSCT) data. Methods: Cardiac MSCT exams of 30 patients with clinical suspicion of coronary artery disease were analyzed. En face angles of both coronary ostia, as well as their optimal projection curves, were determined by 2 independent observers in a standard Dicom viewer, without any additional, specialized software add-ons, using a systematic, step-by-step approach. Spatial relations between the ostial plane and the aorta were also assessed. Results: The average en face angle of the left coronary ostium was RAO 23°, CAU 45°; for the right coronary ostium RAO 18°, CRA 5°. The mean inter-observer differences for the en face angles of the left and right coronary arteries were 5° and 7°, respectively. Conclusion: Multislice computed tomography data provide precise spatial information on the orientation of the coronary ostia and their relation to the aortic root. Their utilization for determining the patient-specific viewing angle may substantially facilitate percutaneous coronary interventions in AOL.

Introduction Currently, there is a wide range of commercially available devices for endovascular aneurysm repair (EVAR) that differ in terms of both anatomical requirements and the technology and technique of deployment. Aim To assess the applicability of currently commercially available devices for EVAR in the treatment of an asymptomatic abdominal aneurysm (AAA). Material and methods The study group included 100 patients with infrarenal AAA with a maximum diameter ≥ 50 mm, qualified for invasive treatment at the University Hospital in 2013–2014. The aortoiliac morphological characteristics of the AAA were evaluated on preoperative computed tomography angiograms using the OsiriX DICOM viewer in the 3D-MPR mode. The morphological applicability of 14 types of CE-marked and FDA-approved stent grafts was determined based on their instructions for use (IFU). Results EVAR was feasible with at least one of the analysed devices in 68% of patients. The morphological applicability was as follows: Excluder Conformable (65%), Ovation iX (51%), Endurant II (47%), Treo (45%), Excluder C3 (45%), AFX 2 (45%), Incraft (44%), E-tegra (44%), Zenith Alfa (41%), Zenith Flex (40%), Anaconda (39%) Aorfix (37%), Altura (34%), and E-vita (20%). The differences in the stent graft applicability were statistically significant (p < 0.001). A wide diameter of the common iliac artery, angulated proximal neck, and diameter of proximal neck out of range constituted the most frequent causes of EVAR inapplicability. Conclusions The IFU-based applicability of currently available AAA stent graft systems differs significantly. Despite the constant evolution of EVAR technology, at least 32% of AAA will require a different therapeutic approach.

Objective Lumbar spondylolisthesis (LS) is a common lumbar disease, and the prevalence of LS in different countries or regions was not consistent in the past. This study intends to make statistics on the prevalence of lumbar spondylolisthesis in middle‐aged people in Beijing community. Methods This is an epidemiological study. 4548 people in Beijing community aged 50 to 64 years were recruited from the local communities by advertisements placed in housing estates and community centres for people to take part in a prospective cohort study from August from September 2013 to March 2014. There is no intervention on the subjects. RadiAnt DICOM Viewer is adopted to read the lateral CT positioning images of all the studied objects, adjust the image as bone window, observe and evaluate the slide of L1 to L5 vertebra in the lateral CT positioning image. Results Among the 4,548 subjects included in the study, 2,490 (54.75%) were male and 2,058 (45.25%) were female. A total of 785 subjects had lumbar spondylolisthesis, with a total incidence of 17.26%. There was no significant difference between prevalence of males and females in the subgroup 50‐54 years old (13.55% males / 12.53% females) and 55‐59 years old (14.77% males / 14.93% females). But the prevalence of LS in 60‐64 years old females (28.57%) increased significantly, compared with 55‐59 years old females (14.93%) and 60‐64 years old males (18.76%). There were 847 levels that had slipped, L5S1 > L4/5 > L3/4 > L2/3 > L1/2. The retrolisthesis was the most, accounting for 61.51% (521/847), and the anterolisthesis was 38.49% (326/847), including anterolisthesis gradeI for 95.71% (312/326), anterolisthesis gradeII for 4.29% (14/326). Neither of anterolisthesis and retrolisthesis presented more than grade III. Among all the subjects, 318 had anterolisthesis, with a total incidence of 6.99%, and 467 subjects only had retrolisthesis. Conclusion The total prevalence of LS in the middle‐aged people in Beijing community was 17.26%, 15.98% in males and 18.80% in females, and women are more likely to suffer from LS after 60 years old., This study analyzed the prevalence of lumbar spondylolisthesis (LS) in middle‐aged people in the Beijing community, compared the result with previous studies, and summarized the characteristics of LS in middle‐aged and elderly people.

It was researched on the application of Anoda Heel Effect (AHE) with a step wedge on the effect of Signal To Noise Ratio (SNR) on Computed Radiography (CR) has been carried out. This research was conducted on a 21 step wedge with two treatments, namely the application of AHE and without the application of AHE. This measurement is repeated three times on radiographs to obtain a total image of six images (without the application of AHE as many as three images and with the application of AHE as many as three images). The results of taking radiographs using AHE and without AHE were measured using the RadiAnt Dicom Viewer program. The SNR value on the step wedge image without the AHE application has an average of 26.89. The SNR value on the step wedge image using AHE is 60.54. The results of the correlation test (Pearson correlation test) on the SNR showed that there was a significant and very strong effect of the application of AHE on the step wedge on the SNR in CR (p-value

Background:Gender determination is one of the important parameters in forensic identification. Study of anthropometric characters is of fundamental importance to solve problems related to such cases. Paranasal sinuses and particularly the frontal sinuses have been utilized for this purpose. The unique nature and irregular shape of the paranasal air sinuses make them suitable for this purpose. In cases of mass disaster and criminal cases, paranasal sinuses remain intact even if the skull and other bones are badly blemished.Objectives: The present study was designed to determine sex by the use of frontal and maxillary air sinuses dimensions from CT scans of paranasal sinuses. Methods: The present work included 100 adult patients (50 males and 50 females). The measurements of the length and width of the maxillary and frontal air sinuses were done using CT scan on DICOM images using Electronic Caliper inbuilt in the DICOM viewer software. Results: Right frontal air sinus width was the most specific (specificity 86 %) and right frontal air sinus length was the most sensitive (sensitivity 94%) measure to discriminate between both genders. ROC analysis indicated that the highest sensitivity rate was obtained for left maxillary air sinus length (sensitivity 100%) and the highest specificity rate was obtained for right maxillary air sinus length (specificity 100%). The right frontal air sinus length was the best discriminate variable between genders with overall accuracy of 80% in females and 92% in males. The maxillary air sinus length was the best predictor of gender in males and females with accuracy (100% in females and 98% in males).Conclusion:The mean values of frontal and maxillary air sinuses widths and lengths for both right and left sides were statistically higher in males in comparison to females. The mean values of right side frontal and maxillary air sinuses lengths and widths were higher than those of the left side in males and females. The left maxillary air sinus length is the most specific and sensitive parameter to predict gender

Background: Knowledge about the type & position of mental foramen is very much important landmark for dentists to perform any surgical procedure in the vicinity of mental foramen. The pur­pose of this study was to determine the most frequently occurring type & position of the mental foramen in Chitwan population using digital Panoramic Radiograph. Methods: This cross-sectional retrospective study was conducted on 500 (250 Male& 250 Female) digital panoramic radiograph which were collected from the department of Oral Medicine & Radi­ology. The type & position of Mental Foramen was analysed with Dicom viewer. The data obtained was statistically analyzed by with descriptive and inferential statistics using SPSS Version 20. Result: The most common type of mental foramen was Type 3 (diffuse with a distinct border of the foramen) & the test showed significant difference by gender. The most common position of mental foramen was position 4 (in line with second premolar) followed by position 3 (Between the first & second premolar) with no significant difference with gender with p-value

Purpose Extended reality (XR) technology enhances learning in medical education. The purpose of this study was to develop and apply a case-based approach for teaching radiological anatomy utilizing XR technology for improved student exploration and engagement. Methods The workflow consisted of MRI scanning cadavers followed by radiological, pathological, and anatomical assessment, and finally case presentation based on XR visualizations and student interaction. Case information (Subject, History, and Physical Exam) was presented to student groups who generated and recorded hypotheses using Google Forms. Results Use of all components of the system was voluntary and a total of 74 students responded to the survey request (response rate= 95%). Assessment of the experience was conducted through a qualitative survey comprising four Likert scale questions (1-5, 1 lowest), three binary questions, and open-ended comments. Mean, standard deviation, and overall agreement (mean ± SD, OA) showed that students found MRI scans of cadavers to be helpful for dissections (4.14 ± 1.1, 74.3%) and provided an understanding of relevant anatomy (4.32 ± 0.9, 79.7%), while 78.4% of students used the DICOM viewer to visualize scans of cadavers. The difficulty of use was found to be average (2.90 ± 1.0, 23%). zSpace visualizations were used by 40.5% of students, generally agreeing that an understanding of spatial relationships improved as a result (3.60 ± 1.0, 43.2%). More case-based sessions were favored by 97.3% of students. Conclusions Results suggest that cadaveric MRI radiological visualization and XR technology enhance understanding of case-based anatomical dissections and encourage student exploration and engagement.

The space of 3D modelling is an everchanging landscape where technology is constantly innovating and as such programs dedicated to 3-dimensional rendering along with the associated firmware that they are built to operate upon have very short half-lives. This research is dedicated to explore more recent technological innovations that have occurred in the space of 3-dimensional graphics rendering and to integrate it into the development of next generation programs that can develop photo-realistic 3-dimensional models generated from data obtained via a CT modality. The goal of this project is to develop an open source program that can render 3D models from CT datasets. Rendering programme is designed using Vulkan rendering engine which is a low-overhead platform agnostic Application Programming Interface. These programs serve as an alternative to open source programs that exist in the market today such as Slicer 3D which are built upon the older OpenGL standard. Programs built on Vulkan reduce computational time, increase energy efficiency and reduce overload. These programs also allow for the implementation of more advanced computational workflows such as neural networks or cinematic rendering which implements photorealistic detail to the model that is rendered. A working Vulcan based engine was developed and compared with other opensource tools . Due to the nature of Vulcan engine, performance benchmarks were proven to be in favor of the latter. Also an option of exporting models to glTF allowed for a multiplatform compatibility, including mobile devices., 3D modeliavimo sritis yra nuolat besikeičianti, kurioje nuolat diegiamos naujos technologijos, o programos, skirtos trimačiam modelių atvaizdavimui, kartu su susijusia programine aparatine įranga, turi labai trumpą gyvavimo periodą ir yra keičiamos naujomis. Šis tyrimas skirtas ištirti ir pritaikyti technologines naujoves, atsiradusias erdvinės grafikos perteikime, ir integruoti jas į naujos kartos programą, galinčią sukurti fotorealistinius trimačius modelius, iš duomenų gaunamų kompiuterinės tomografijos metu. Šio projekto tikslas yra sukurti atviro kodo programą, kuri galėtų atvaizduoti 3D modelius iš KT duomenų rinkinių. Atvaizdavimo programa yra sukurta naudojant „Vulkan“ grafikos variklį, kuris yra efektyvus ir taikytinas kaip aplikacijų programavimo sąsaja. Ši programa galėtų būti alternatyva šiandien rinkoje egzistuojančioms atvirojo kodo programoms, tokioms kaip „Slicer 3D“, kurios yra sukurtos remiantis senesniu „OpenGL“ standartu. „Vulkan“ pagrindu sukurtos programos sumažina skaičiavimo laiką, padidina energijos vartojimo efektyvumą ir sumažina techninius reikalavimus kompiuterinėms sistemoms. Vulkan taip pat leidžia įgyvendinti pažangesnes skaičiavimo darbo eigas, tokias kaip neuroniniai tinklai ar kinematografinis perteikimas, kuris yra ypatingai svarbus fotorealistiniam modelių pateikimui. Buvo sukurtas veikiantis „Vulcan“ grafikos variklis, kuris buvo lyginamas su kitais atvirojo kodo įrankiais. Įrodyta, kad dėl „Vulcan“ variklio charakteristikų efektyvumo rodikliai yra naudingi pastarajam. Taip pat galimybė eksportuoti modelius į „glTF“ formatą, leidžia naudoti gautus modelius įvairiose platformose, įskaitant ir mobiliuosius įrenginius.

This study aimed to obtain the length, medial-anterior angulation and basis-apex coordinates of the styloid process in patients with Eagle syndrome by three-dimensional computed tomography. This study was performed on three-dimensional computed tomography images obtained from the hospital picture archiving and communication system (by obtaining 3D images by a RadiAnt DICOM viewer 4.6.9 version). In this study, the anterior and lateral lengths of the styloid process, its anterior and medial angulation, and the coordinate values on the x, y, and z-axes of 24 patients (14 males, 10 females) diagnosed with Eagle syndrome were examined. The mean anterior lengths were found to be 41.45 mm on the right and 36.07 mm on the left sides, while the mean lateral lengths were found to be 42.15 mm on the right and 37.59 mm on the left sides. The mean medial angulation was measured to be 62.91° on the right and 63.42° on the left, while mean anterior angulation was measured to be 28.01° on the right and 30.43° on the left. The styloid process basis coordinates were determined as (right: x = − 41.30, y = 0, z = 0, left: x = 40.79, y = 0, z = 0), and apex coordinates were determined as (right: x = − 22.61, y = − 36.86, z = − 19.52, left: x = 24.90, y = − 32.14, z = − 18.65). Knowing the styloid process basis and apex coordinates in addition to knowing the its length and angulation will be useful in diagnosing Eagle syndrome. We think that these results in relation to the coordinates of the styloid process will bring a new perspective to clinicians who investigate the length and angulation of the styloid process.

Background and objectives: Determination of the age of majority is a major problem in forensics. This study aimed to evaluate the usefulness of Demirjian’s stages of teeth development in estimating the age of majority from the left mandibular molar among a sample of the Egyptian populationMethods: A prospective cross-sectional study included a sample of 134 digital panoramic radiographs of participants aged 15-26 years. The left lower third molars were analyzed using Navegatium DICOM viewer software for the medical sector. e version 1.10.0.0 applicable on Microsoft. The effectiveness of Demirjian’s stages was assessed by using accuracy, sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios, and positive and negative predictive valuesResults: The test showed better specificity for stage H (90.91% for males, and 63.64% for females), and better sensitivity for stage G (98% for males, and 95.16% for females) for adult age. The accuracy of the test was (85.25% for males and 72.60% for females) in stage H, and (93.44% for males and 87.67%for females) in stage G.Conclusion: Demirjian’s stages G and H are fairly reliable method for estimating the age of majority among Egyptians.

Introduction The cochlear anatomy varies in each individual, and that has an impact on decisions regarding the insertion of electrodes. The measurement of the cochlear size is the routine examination required to choose the proper cochlear implant (CI) electrodes. Objective To acquire normative data on the size of the cochlea (length, width, height, scala timpani [ST] height, cochlear duct length [CDL]) of CI candidates in Medan, Indonesia. Methods This descriptive study was conducted based on high-resolution computed tomography (HRCT) temporal bone data and on HRCT temporal data manipulated to reconstruct three-dimensional (3D) multiplanar images with OsiriX MD DICOM Viewer version 9.5.1 (Pixmeo SARL, Bernex, Geneva, Switzerland) viewer of 18 patients (36 ears) who were CI candidates in Medan, Indonesia, in order to determine cochlear length (A), cochlear width, cochlear height, ST height and CDL, calculated through a simple mathematical function. Results The average cochlear length (A) was 8.75 mm (standard deviation [SD] = 0.31 mm); the average cochlear width was 6.53 mm (SD = 0.35 mm); the average cochlear height was 3.26 mm (SD = 0.24 mm) and the average ST height at the basal cochlea was 1.00 mm (SD = 0.1 mm); and 0.71 mm (SD = 0.1 mm) at the half turn of cochlea. The average total CDL was 32.45 mm (SD = 1.31 mm; range: 30.01–34.83 mm). Conclusion The cochlear size varies in each individual; therefore, the temporal bone measurement of CI candidates using HRCT is essential: for the selection of suitable implant electrodes; to minimize cochlear damages at the insertion of the electrode arrays; and to maximize the hearing improvements.

At the Zurich Institute of Forensic Medicine, post-mortem computed tomography (PMCT) has an important role. During an autopsy, access to the PMCT images can be important to localize findings. We present an approach to overcome the limitations of current systems for displaying medical image data during autopsy. The presented system uses augmented reality to display DICOM image stacks with basic functionality. In addition, we report the first test of the system during autopsy.

Orthodontic therapy could lead to marginal bone resorption in cases where the teeth are moved outside the envelope of bone. The purpose of this case series was to test corticotomy with a guided bone regeneration (GBR) procedure to regenerate bone in the direction of movement outside the original bony housing. Ten adult patients (60 anterior teeth), all presenting with severe anterior crowding, were enrolled in the study. Orthodontic therapy in all investigated sites was associated with selective surgical corticotomies and a simultaneous GBR procedure. CBCT examinations were performed before starting orthodontic treatment (T0) and at the end of treatment (T1; mean: 7 months; range: 6 to 9 months). Pre- and postoperative CBCTs were superimposed with a DICOM viewer (3D Slicer) and studied with an image-processing software (ImageJ, National Institutes of Health) to measure the area of interest of the buccal plate. The average area was found to be 0.58 ± 0.22 mm2 at T0 and 1.76 ± 0.4 mm2 at T1, with a statistically significant difference (P < .05). The combination of corticotomy and a regenerative procedure seems to have the ability to augment the original osseous anatomy when the root is moved outside of the original bony envelope.

This retrospective study aims to evaluate the correlation between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture using computed tomography. Medical records of patients diagnosed with unilateral condylar fractures from the year 2012-2019 were reviewed. The shape of the condylar head on the non - fractured side was analysed using a Radiant Dicom Viewer. The analysis was done using both visual and analytical methods. In the analytical method, a horizontal line was drawn at the base of the curvature of the condylar head. The highest peak point of the head was marked, and a perpendicular line was drawn connecting the highest point to the horizontal line. The shape was categorized into four types as convex, flat, angled, and round based on these lines. 201 CT scans were examined, of which 69 were excluded as they did not meet the inclusion criteria. The remaining 132 were included in our study. On examining the shape, flat-shaped condyle was seen in 57 scans (43.2%), followed by convex in 31 scans (23.4%), angled in 30 (22.7%) and round in 14 scans (10.6%). The relationship between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture was analysed using a chi-square test, which showed high statistical significance (p value 0.0001). The flat-shaped condylar head was more prone to fracture, and the round-shaped condylar head was least prone to fracture. In conclusion, the shape of the mandibular condylar head had a statistically significant association with the incidence of unilateral condylar fracture. The assessment of the shape of the condylar head can be taken as a guide to suspect condylar fractures and other associated mandibular fractures.

Background Advent of Cone Beam Computed Tomography (CBCT) in dentistry has brought us to a new era of precise imaging. Radiographic evaluation of a CBCT image is more informational when compared to CT. The density measurements in CBCT images are based on greyscale values, which are more accurate in CT and these values are inconsistent across various CBCT machines. Hence, we aim at standardizing a single CBCT scanner to evaluate or determine tissue density from the greyscale values. Methods A total of 8 halves of undamaged, dry goat mandibles are included in the study. Scans of the bone are obtained using the KODAK CBCT unit and the PHILLIPS CT machine respectively. Densities are evaluated at 96 points on both the CT scans and the CBCT scans, respectively, using the Radiant Dicom viewer. The obtained data is entered into the excel spreadsheet and subjected to statistical analysis. Results The greyscale values are obtained from each of the CBCT scans. Hounsfield units are calculated from CT images coinciding with the same points on CBCT scans. The collected data is subjected to linear regression analysis and an equation is derived to determine Hounsfield units (calculated HU units) from greyscale values of CBCT images. We found no significant difference between the mean original HU units and the mean calculated HU units, thus making the equation reliable for calculating HU units from CBCT greyscale values. Conclusions Our results conclude that the technique was effective in calculating the Original density of tissues using grey standards of CBCT scans.

In limestone caves, environmental processes often cause alterations of human or animal skeletal remains, complicating classical analytical methods. Exemplary, a proximal femoral skeletal fragment, enclosed by a thick layer of speleothemic calcite deposits, was discovered during the exploration of the Bedara cave in Žumberak, Croatia. An examination without removal of the surrounding mineral deposits, possibly leading to damage of the specimen, was, therefore, desirable.We describe and discuss the applied techniques, including clinical computed tomography, virtual cleaning by a specially developed segmentation protocol using an open-source DICOM viewer, and virtual visualisation and dimensioning using computer-aided design software, so that this “hidden” specimen could be non-invasively examined in great detail. We also report on the circumstances and origin of the find, the results of radiocarbon dating, and its anatomical and taxonomic identification, according to which, the bone fragment belonged to a wild boar (Sus scrofa) from the timeframe of the Middle Eneolithic Retz-Gajary culture in the region (4,781 ± 35 years before present). This study provides a reference for future paleontological and anthropological analyses, seeking to unlock the enormous potential of anatomical studies of comparable skeletal remains that are either petrified or enclosed in speleothemic deposits.

Background Local recurrence (LR) of retroperitoneal soft tissue sarcoma (RPS) is a common and life-threatening event. The evaluation of the exact anatomical patterns of local recurrence might help to improve local treatment in RPS. Methods Of our local database we extracted ten patients with LR of RPS with axial MRI and/or CT datasets of the primary tumor (PT) and the LR. Using the Osirix DICOM viewer Version v.3.9.4 64-bit (Pixmeo, Geneva, Switzerland) we performed a three-step fusion algorithm consisting of: a) 3-point co-registration of the axial datasets depicting the PT and the LR using three abdominal landmarks b) re-orientation of the datasets and c) image fusion. We evaluated the feasibility of this technique with regard to categorizing the localization of LR as within or distant from the PT. Results Fusion imaging was feasible in seven out of ten patients. In the other three patients anatomical shifting of organs after surgery led to a relevant mismatch of anatomical landmarks and impeded interpretation of the fused images. In five of seven patients with successful fusion imaging, local recurrences were located within the anatomical borders of the primary tumor, in two out of seven patients local recurrences were distant to the primary. Conclusions Fusion imaging of primary tumors and local recurrences is feasible in most patients with RPS. Most local recurrences occurred within the anatomical localization of the primary tumor. For further investigations validation of the technique in larger patient cohorts is required.

Rationale and objectives During the COVID-19 pandemic, medical educators and students are facing unprecedented challenges while navigating the new virtual landscape that social-distancing policies mandate. In response to these challenges, a new virtual introduction to radiology elective was established with unique online resources and curriculum. Materials and methods A previously in-person 2-week introductory radiology elective was converted into a completely virtual experience using an internally developed, open-source, peer-reviewed, web-based teaching modules combined with virtual lectures, interdisciplinary conferences, and readout sessions of de-identified cases loaded to a DICOM viewer. Students from the first four months of course enrollment completed a multiple choice pre- and post-course knowledge assessments and a 5-point Likert Scale survey as part of their educational experience. Results In total, 26 4th-year medical students participated over 4 separate 2-week sessions from July to October of 2020. This included 12 students from the home intuition and 14 visiting students. On average, students scored 62.2% on the 55-question pre-test and 89.0% on the same test upon completion of the course, a statistically significant increase (p, Highlights • The COVID-19 pandemic has greatly impacted medical education, requiring adaptation to a new virtual learning environment. • We successfully converted our in-person radiology elective into a completely virtual experience. • We offer the curriculum and online resources necessary to provide a similar remote learning experience at other institutions.

BACKGROUND Viewing cone beam computed tomography (CBCT) scans at multiple locations and on multiple devices continues to present challenges. Several clinicians use smartphones to look at specific images for reference, especially intraoperatively. Currently, smartphone use is limited to viewing selected images or small videos at best. No applications were available until recently to view DICOM files on smartphones. The evolution of DICOM viewer apps for smartphones is a new feature. No studies currently exist that have tested the diagnostic efficacy of such platforms or their ease of use. OBJECTIVE(S) The objective was to evaluate the diagnostic efficacy of 2 smartphone-based DICOM viewers in their ability to depict anatomy and pathology of the maxillofacial region. STUDY DESIGN An Android-compliant DICOM viewer app was used on an Honor 6X smartphone and an IOS-compliant app was used on an iPhone 11 to evaluate 7 CBCT scans. Scans were evaluated for anatomy and pathology. Five anatomic landmarks were identified in each plane and scored. The scoring criteria were as follows: (1) cannot be visualized, (2) visualized but not of diagnostic quality, and (3) well visualized and of diagnostic quality. The same scale was used to evaluate pathology. These scans were also evaluated on a PACS monitor that served as the gold standard for comparative evaluation. Two oral radiology residents evaluated the images on all 3 modalities and a comparative evaluation was done using Cohen's kappa analysis. RESULTS The quality of the scan was comparable on both devices. Both apps demonstrated scans in axial, sagittal, and coronal planes and were of diagnostic quality. However, the IOS app had features that improved the ease of use and allowed simultaneous visualization and navigation including measurement capability. DISCUSSION/CONCLUSIONS Smartphone-based DICOM viewers can facilitate visualization of anatomy and pathology in the maxillofacial region and can serve as valuable adjuncts for viewing CBCT scans.

STUDY DESIGN Radiologic analysis. OBJECTIVE The objective was to compare C2 pedicle diameter and screw feasibility on reconstructed axial computed tomography (CT) cuts created "Inline" (IL) with the intended pedicle screw tract versus unaltered "Standard" (STD) axial cuts. BACKGROUND DATA Axial CT cuts through the C2 pedicle are commonly evaluated when planning pedicle screw fixation as medial aberrancies of the vertebral artery can significantly narrow pedicle diameter. STD axial CT cuts provided by radiology departments are typically formatted orthogonal to the long axis of the neck or the vertical plumb, which is often not IL with the axis of the intended C2 pedicle screw tract. MATERIALS AND METHODS A total of 89 cervical spine CT scans obtained by a single radiology department over 2 years (35 male, 54 female; mean age 64.9 y) were reviewed. STD axial cuts were not manipulated but were assessed as provided. IL axial cuts were created along the intended C2 pedicle screw tract using free, open-source DICOM viewer software. Inner and outer pedicle diameters were measured on axial cuts most closely approximating the isthmus of the intended tract. RESULTS On STD cuts, the mean outer and inner pedicle diameters were 5.05±1.45 and 2.01±1.31 mm, respectively. By contrast, IL measurements yielded significantly larger outer and inner diameters: 5.85±1.78 and 2.68±1.47 mm (P

Purpose New teaching formats are required to implement competency-based teaching in radiology teaching. Therefore, we have established and evaluated two practical competency-based radiological courses. Materials and Methods The courses were held in a multimedia room with 25 computers and a professional DICOM viewer. Students were taught basic image analysis and presented clinical cases with a DICOM viewer under supervision of an instructor using desktop monitoring software. Two courses (elective course and obligatory course) were evaluated by the students (n = 160 and n = 100) and instructors (n = 9) using an anonymized online survey. Results Courses were evaluated positively by the students and instructors. From the perspective of the students, the courses increased understanding of cross-sectional anatomy (elective/obligatory course: 97 %/95 %) and radiologic findings (97 %/99 %). Furthermore, the course increased the students’ interest in radiology (61 %/65 %). The students considered this way of teaching to be relevant to their future occupation (92 % of students in the obligatory course). The higher incidence of teacher-student interaction and the possibility of independent image analysis were rated positively. The majority of instructors did not observe increased distractibility due to the computers (67 %) or notice worse preparation for MC tests (56 %). However, 56 % of instructors reported greater preparation effort. Conclusion Practical competency-based radiological teaching using a DICOM viewer is a feasible innovative approach with high acceptance among students and instructors. It fosters competency-based learning as proposed by the model curriculum of the German Radiological Society (DRG) and the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). Key Points Citation Format

Magnetic resonance guided laser induced thermal therapy (LITT) is a minimally invasive method to treat a wide range of intracranial pathologies. The Arrhenius model is used to generate a thermal damage estimate (TDE) predicting ablation extent.Evaluation and correlation of the TDE to magnetic resonance imaging (MRI)-estimated ablation extent in human cases.The Medtronic Visualase system (Medtronic Inc, Dublin, Ireland) was utilized. Postablation axial T1-contrast enhanced images were acquired and intraoperative TDE image was obtained from the Visualase console. OsiriX DICOM Viewer (Pixmeo Inc, Bernex, Switzerland) was utilized to calculate cross-sectional area on MRI. ImageJ (National Institutes of Health, Bethesda, Maryland) was utilized for TDE area. Two blinded raters performed all measures. Statistical testing included Pearson correlation and the Student's t-test.Twenty-two cases including tumor and epilepsy were evaluated. Average MRI predicted tumor ablation area was 4.72 ± 2.22 cm2 and average predicted epilepsy ablation area was 4.12 ± 1.89 cm2. Average tumor TDE was 4.02 ± 1.95 cm2 and average epilepsy TDE was 4.36 ± 2.21 cm2. Rater 1's ablation areas and TDEs correlated with r = 0.89 (P.0001) and no significant difference (P.5). Rater 2's ablation areas and TDEs correlated with r = 0.91 (P.0001) and no significant difference (P.7). Rater 1 vs Rater 2 showed a strong correlation for TDE (r = 0.98, P.000001) and ablation area (r = 0.96, P.0001) and no significant difference (P.5).The TDE is an accurate and reliable measure of ablated area in LITT in human cases as assessed on postoperative MRI. Future studies should be larger and assess reliability of the TDE when multiple lasers and planes are used.

Retained third molars are teeth linked to several conditions of the mouth, therefore, in most cases, surgical extraction is required. Surgical procedures undertaken to extract retained third molars bring about surgical procedures effects. The aim of the present study was to determine healing effectiveness in bone and gingival tissue with use of platelet rich fi brin in surgical procedures involving lower third molar extraction performed at the Surgical Center of the School of Dentistry, Central University of Ecuador in the period comprised May-September 2015. A comparative study was performed of 30 patients meeting inclusion criteria. Eight days after extraction, patients were controlled by means of direct observation of surgical site; 60 days after extraction, a digital panoramic X-ray of the jaws was taken and analyzed with software RadiAnt DICOM Viewer. For soft tissue, healing results were obtained with χ2 test p < 0.001, and for bone tissue results were obtained with t-Student test p = 0.015.

The purpose of this study was to compare the observer participation and satisfaction as well as interobserver reliability between two online platforms, Science of Variation Group (SOVG) and Traumaplatform Study Collaborative, for the evaluation of complex tibial plateau fractures using computed tomography in MPEG4 and DICOM format. A total of 143 observers started with the online evaluation of 15 complex tibial plateau fractures via either the SOVG or Traumaplatform Study Collaborative websites using MPEG4 videos or a DICOM viewer, respectively. Observers were asked to indicate the absence or presence of four tibial plateau fracture characteristics and to rate their satisfaction with the evaluation as provided by the respective online platforms. The observer participation rate was significantly higher in the SOVG (MPEG4 video) group compared to that in the Traumaplatform Study Collaborative (DICOM viewer) group (75 and 43%, respectively; P

Study Design: This study was a radiographic observational study for C1–C2 anthropometry. Purpose: The purpose of the study was to understand the anatomic relationship of C1–C2 in view of transarticular screw (TAS) fixation, to overcome the difficulties related with TAS placement, and to minimize the technique-related complications. Materials and Methods: It was an anthropometric observational study with retrospectively obtained anatomical data of randomly selected 116 patients from a single center. The anatomical measurements such as pars width, pars height, screw trajectory, and length were evaluated on the axial, sagittal, and three-dimensional reconstructed cervical CT scan using the radiant DICOM viewer software by the two fellowship trained spine surgeons which were blind to the study group details. The intra- and interobserver reliability with regard to the measured parameters was statistically analyzed. Results: The mean age of male and female was 28 and 29 years. The average BMI was calculated to be 23.5 and 25 for males and females, respectively. The mean right pars width in males was 5.78 ± 0.93 (range: 3.1–6.5 mm), while in female, it was 5.84 ± 0.95 (range: 3.1–6.5). The mean left pars width in males was 5.95 ± 1.13 (range: 3.8–8.1 mm), while in females, it was 5.70 ± 1.18 (range: 3.7–8.1 mm). Right side mean pars height in males was 5.90 ± 1.2 (range: 3.7–9.4 mm), and in females, it was 6.11 ± 1.04 (range: 3.8–9.3 mm). Left-sided mean pars height in males was 6.0 ± 1.1 (range: 3.2–9.4 mm) as compared to females, in which it was 5.77 ± 1.23 (range: 4.1–9.3 mm). The mean lateral angulation angle in males was 9.99° ± 1.70° (8.1°–15°), while in females, it was 10.15° ± 1.73° (8.1°–15°). The mean sagittal angulation in males was 26.33° ± 3.32° (21.0°–32.80°), while in females, it was 27.18 ± 3.05 (21.0°–32.10°). The average screw length in males was 41.74 ± 5.63 (34–54.8 mm), whereas in females, it was 41.35 ± 4.77 (34–54.8 mm). Conclusion: This study provides a morphometric database which is characteristic of the C1–C2 vertebrae in the normal Indian population with regard to the anatomic feasibility of the TAS fixation for various C1–C2 pathologies. The C2 pars width and height measured in the current study can guide the selection of TAS screws in the Indian population. This study could serve in providing the baseline anatomic parameters assessed in the healthy individuals to design and develop customized screws and related implant assembly which might provide wider clinical applicability.

Objective Augmented reality techniques are being used in clinical medicine and have been suggested for use in forensic medicine as well. In this article, we investigate the feasibility of using a head mounted AR display for conducting virtual autopsies and for augmenting autopsy under realistic conditions. Materials and Methods For this study we used the Microsoft HoloLens (Microsoft Corp., Redmond, USA) as augmented reality device and DICOM-Viewer. We conducted this study in 2 phases with 5 participants. In phase 1, we conducted virtual autopsies on PMCT datasets using the AR device. In phase 2, participants performed 6 AR augmented autopsies. The time needed was recorded and the participants were interviewed about this new concept after each autopsy. Results In phase 1 (AR Virtopsy), all participants were able to determine the main pathology for all cases, requiring an average of 122 seconds per case. Participants who expressed that they are more comfortable with technology were usually faster. In phase 2 (AR autopsy), most interactions happened in the first half an hour of the internal examination of the autopsy, with the interactions becoming less frequent and shorter over time. Conclusion While AR headsets might not be useful to read and analyse CT images, AR headsets could help to bring image data such as PMCT into the autopsy hall. In such a scenario, this technology seems to be most useful in the first half an hour of the internal examination during autopsy.

PURPOSE To describe the change of lacrimal gland volumes in Korean patients with thyroid-associated ophthalmopathy (TAO) via computed tomography (CT). METHODS A retrospective review of CT images from 217 TAO patients and 135 control subjects was performed. The TAO patients were diagnosed between May 2005 and May 2014 and had a CT performed on initial presentation (330 orbital CT scans). These images were compared with 270 orbital CT scans from the control group, obtained between May 2013 and May 2014. An open source DICOM viewer was used to calculate the volume of the lacrimal gland. RESULTS The mean volume of the lacrimal gland in TAO patients was 0.816 cm3 in the right orbit (standard deviation [SD], 0.048) and 0.811 cm3 in the left orbit (SD, 0.051), with no significant difference between right and left (p = 0.192). However, significant differences were observed between TAO patients and healthy individuals (p < 0.001). There was no significant difference between mean lacrimal gland volumes of males (0.812 cm3; SD, 0.037) and females (0.816 cm3; SD, 0.029) (p = 0.513). There was a negative correlation between gland volume and age in TAO patients (Pearson r = -0.479, p = 0.00). The subjective tearing (right: r = 0.244, p = 0.018; left: r = 0.226, p = 0.024), corneal superficial punctate keratopathy (right: r = 0.192, p = 0.040; left: r = 0.206, p = 0.036), and exophthalmometry (right: r = 0.182, p = 0.032; left: r = 0.180, p = 0.046) correlated with lacrimal gland volume. CONCLUSIONS This study is the first to use CT images to calculate the lacrimal gland volume of Korean TAO patients. In TAO patients, the lacrimal gland volume was notably increased compared to control subjects. The lacrimal gland volume decreased with age, but there was no difference between gender and no difference between left and right. The lacrimal gland volume correlated with subjective tearing, corneal superficial punctate keratopathy and exophthalmometry.