A pediatric airway atlas and its application in subglottic stenosis

Young children with upper airway problems are at risk for hypoxia, respiratory insufficiency and long term morbidity. Computational models and quantitative analysis would reveal airway growth patterns and benefit clinical care. To capture expected growth patterns we propose a method to build a pediatric airway atlas as a function of age. The atlas is based on a simplified airway model in combination with kernel regression. We show experimental results on children with subglottic stenosis to demonstrate that our method is able to track and measure the stenosis in pediatric airways

Quantitative assessment of the upper airway in infants and children with subglottic stenosis

OBJECTIVES/HYPOTHESIS: Determine whether quantitative geometric measures and a computational fluid dynamic (CFD) model derived from medical imaging of children with subglottic stenosis (SGS) can be effective diagnostic and treatment planning tools. STUDY DESIGN: Retrospective chart and imaging review in a tertiary care hospital. METHODS: Computed tomography scans (n = 17) of children with SGS were analyzed by geometric and CFD methods. Polysomnograms (n = 15) were also analyzed. Radiographic data were age/weight flow normalized and were compared to an atlas created from radiographically normal airways. Five geometric, seven CFD, and five polysomnography measures were analyzed. Statistical analysis utilized a two-sample t test with Bonferroni correction and area under the curve analysis. RESULTS: Two geometric indices (the ratio of the subglottic to midtracheal airway, the percent relative reduction of the subglottic airway) and one CFD measure (the percent relative reduction of the hydraulic diameter of the subglottic airway) were significant for determining which children with SGS received surgical intervention. Optimal cutoffs for these values were determined. Polysomnography, the respiratory effort-related arousals index, was significant only prior to Bonferroni correction for determining which children received surgical intervention. CONCLUSIONS: Geometric and CFD variables were sensitive at determining which patients with SGS received surgical intervention. Discrete quantitative assessment of the pediatric airway was performed, yielding preliminary data regarding possible objective thresholds for surgical versus nonsurgical treatment of disease. This study is limited by its small, retrospective, single-institution nature. Further studies to validate these findings and possibly optimize treatment threshold recommendations are warranted

The Virtual Pediatric Airways Workbench

The Virtual Pediatric Airways Workbench (VPAW) is a patient-centered surgical planning software system targeted to pediatric patients with airway obstruction. VPAW provides an intuitive surgical planning interface for clinicians and supports quantitative analysis regarding prospective surgeries to aid clinicians deciding on potential surgical intervention. VPAW enables a full surgical planning pipeline, including importing DICOM images, segmenting the airway, interactive 3D editing of airway geometries to express potential surgical treatment planning options, and creating input files for offline geometric analysis and computational fluid dynamics simulations for evaluation of surgical outcomes. In this paper, we describe the VPAW system and its use in one case study with a clinician to successfully describe an intended surgery outcome

Quantitative assessment of the upper airway in infants and children with subglottic stenosis: Upper Airway in Infants and Children With SGS

Determine whether quantitative geometric measures and a computational fluid dynamic (CFD) model derived from medical imaging of children with subglottic stenosis (SGS) can be effective diagnostic and treatment planning tools

Statistical atlas construction via weighted functional boxplots

Atlas-building from population data is widely used in medical imaging. However, the emphasis of atlas-building approaches is typically to estimate a spatial alignment to compute a mean / median shape or image based on population data. In this work, we focus on the statistical characterization of the population data, once spatial alignment has been achieved. We introduce and propose the use of the weighted functional boxplot. This allows the generalization of concepts such as the median, percentiles, or outliers to spaces where the data objects are functions, shapes, or images, and allows spatio-temporal atlas-building based on kernel regression. In our experiments, we demonstrate the utility of the approach to construct statistical atlases for pediatric upper airways and corpora callosa revealing their growth patterns. We also define a score system based on the pediatric airway atlas to quantitatively measure the severity of subglottic stenosis (SGS) in the airway. This scoring allows the classification of pre- and post-surgery SGS subjects and radiographically normal controls. Experimental results show the utility of atlas information to assess the effect of airway surgery in children

Pediatric sleep-related breathing disorders: advances in imaging and computational modeling

We understand now that sleep of sufficient length and quality is required for good health. This is particularly true for infants and children, who have the added physiologic task of growth and development, as compared to their adult counterparts. Sleep-related breathing disorders (SRBDs) are common in childhood and if unrecognized and not treated can result in significant morbidity. For example, children with obstructive sleep apnea (OSA) can exhibit behavioral, mood, and learning difficulties. If left untreated, alterations in the function of the autonomic nervous system and a chronic inflammatory state result, contributing to the risk of heart disease, stroke, glucose intolerance, and hypertension in adulthood

Surgical Training on Ex Vivo Ovine Model in Otolaryngology Head and Neck Surgery: A Comprehensive Review

Background: Nowadays, head and neck surgical approaches need an increased level of anatomical knowledge and practical skills; therefore, the related learning curve is both flat and long. On such procedures, surgeons must decrease operating time as much as possible to reduce the time of general anesthesia and related stress factors for patients. Consequently, little time can be dedicated for training skills of students and young residents in the operating theater. Fresh human cadavers offer the most obvious surrogate for living patients, but they have several limitations, such as cost, availability, and local regulations. Recently, the feasibility of using ex vivo animal models, in particular ovine ones, have been considered as high-fidelity alternatives to cadaveric specimens. Methods: This comprehensive review explores all of head and neck otolaryngology applications with this sample. We analyzed studies about ear surgery, orbital procedures, parotid gland and facial nerve reanimation, open laryngeal and tracheal surgery, microlaryngoscopy procedures, laryngotracheal stenosis treatment, and diagnostic/operative pediatric endoscopy. For each different procedure, we underline the main applications, similarities, and limitations to human procedures so as to improve the knowledge of this model as a useful tool for surgical training. Results: An ovine model is easily available and relatively inexpensive, it has no limitations associated with religious or animal ethical issues, and it is reliable for head and neck surgery due to similar consistencies tissues and neurovascular structures with respect to humans. However, some other issues should be considered, such as differences about some anatomical features, the risk of zoonotic diseases, and the absence of bleeding during training. Conclusion: This comprehensive review highlights the potentials of an ex vivo ovine model and aims to stimulate the scientific and academic community to further develop it for other applications in surgical education

Surgical Training on Ex Vivo Ovine Model in Otolaryngology Head and Neck Surgery: A Comprehensive Review.

Background: Nowadays, head and neck surgical approaches need an increased level of anatomical knowledge and practical skills; therefore, the related learning curve is both flat and long. On such procedures, surgeons must decrease operating time as much as possible to reduce the time of general anesthesia and related stress factors for patients. Consequently, little time can be dedicated for training skills of students and young residents in the operating theater. Fresh human cadavers offer the most obvious surrogate for living patients, but they have several limitations, such as cost, availability, and local regulations. Recently, the feasibility of using ex vivo animal models, in particular ovine ones, have been considered as high-fidelity alternatives to cadaveric specimens. Methods: This comprehensive review explores all of head and neck otolaryngology applications with this sample. We analyzed studies about ear surgery, orbital procedures, parotid gland and facial nerve reanimation, open laryngeal and tracheal surgery, microlaryngoscopy procedures, laryngotracheal stenosis treatment, and diagnostic/operative pediatric endoscopy. For each different procedure, we underline the main applications, similarities, and limitations to human procedures so as to improve the knowledge of this model as a useful tool for surgical training. Results: An ovine model is easily available and relatively inexpensive, it has no limitations associated with religious or animal ethical issues, and it is reliable for head and neck surgery due to similar consistencies tissues and neurovascular structures with respect to humans. However, some other issues should be considered, such as differences about some anatomical features, the risk of zoonotic diseases, and the absence of bleeding during training. Conclusion: This comprehensive review highlights the potentials of an ex vivo ovine model and aims to stimulate the scientific and academic community to further develop it for other applications in surgical education

Obstruction in the Pedriatic Airway: diagnostic and therapeutic aspects

Pediatric Laryngology in a referral hospital for children such as the Sophia Children's Hospital is to a large extent concerned with patients suffering from airway obstruction, most of whom, owing to the nature of the disorder, are treated in an Intensive Care Unit (lCU). The otorhinolaryngologist, in close cooperation with ICU-pediatricians, is confronted with a great variety of airway pathology: intubation or tracheotomy related problems, post-intubation injury, cicatricial laryngeal stenosis, congenital laryngeal stenosis, subglottic hemangioma, choanal atresia, pharyngeal obstruction, epiglottitis, subglottic laryngitis, tracheomalacia, etc. Laryngobronchoscopy (LBS) is the most important tool in the diagnosis of such disorders in children

Image and Shape Analysis for Spatiotemporal Data

In analyzing brain development or identifying disease it is important to understand anatomical age-related changes and shape differences. Data for these studies is frequently spatiotemporal and collected from normal and/or abnormal subjects. However, images and shapes over time often have complex structures and are best treated as elements of non-Euclidean spaces. This dissertation tackles problems of uncovering time-varying changes and statistical group differences in image or shape time-series. There are three major contributions: 1) a framework of parametric regression models on manifolds to capture time-varying changes. These include a metamorphic geodesic regression approach for image time-series and standard geodesic regression, time-warped geodesic regression, and cubic spline regression on the Grassmann manifold; 2) a spatiotemporal statistical atlas approach, which augments a commonly used atlas such as the median with measures of data variance via a weighted functional boxplot; 3) hypothesis testing for shape analysis to detect group differences between populations. The proposed method for cross-sectional data uses shape ordering and hence does not require dense shape correspondences or strong distributional assumptions on the data. For longitudinal data, hypothesis testing is performed on shape trajectories which are estimated from individual subjects. Applications of these methods include 1) capturing brain development and degeneration; 2) revealing growth patterns in pediatric upper airways and the scoring of airway abnormalities; 3) detecting group differences in longitudinal corpus callosum shapes of subjects with dementia versus normal controls.Doctor of Philosoph