POP-Q Versus Upright MRI Distance Measurements:A Prospective Study in Patients with POP

Introduction and Hypothesis: The gold standard for quantifying pelvic organ prolapse is the pelvic organ prolapse quantification (POP-Q) system; however, upright magnetic resonance imaging (MRI) is a promising new method. The objective of this study was to determine the correlation between POP-Q and MRI measurements of the bladder and cervix. Methods: This prospective study included patients with prolapse in whom POP-Q points Aa or Ba and C were measured as standard care. MRI scans were performed in an upright position, and the distances of the lowest points of the bladder and cervix to the Pelvic Inclination Correction System (PICS) were calculated. Correlations between POP-Q and MRI-PICS measurements were determined using the Pearson correlation coefficient for normally distributed data and the Spearman’s rank correlation coefficient for non-normally distributed data. Results: A total of 63 patients were suitable for analysis. There was a moderate positive correlation between the POP-Q and MRI-PICS measurements for bladder (r(61) = 0.480, r &lt; 0.001) and uterus (r(61) = 0.527, p &lt; 0.001). Measurement differences between POP-Q and MRI-PICS of the bladder and uterus vary from −3.2 cm to 7.1 cm, and from −2.1 cm to 8.5 cm respectively. In 71.4% of patients more descent was seen on upright MRI than with POP-Q measurement for both bladder and uterus. For patients with similar POP-Q measurements, a high variation in MRI measurements of the bladder and uterus was found. Conclusion: Despite a moderate positive correlation, upright MRI shows a larger POP extent in 71.4% of the patients than POP-Q. A high variation in MRI measurements for patients with the same POP-Q measurement was seen.</p

Three-Dimensional Volume Rendering of Pelvic Floor Anatomy with Focus on Fibroids in Relation to the Lower Urogenital Tract Based on Cross-Sectional MRI Images.

We aimed to assess the feasibility of developing three-dimensional (3D) models of pelvic organs using cross-sectional MRI images of patients with uterine fibroids and urinary symptoms and of obtaining anatomical information unavailable in 2D imaging modalities. We also aimed to compare two image processing applications. We performed a feasibility study analysing MRI scans from three women, aged 30 to 58 years old, with fibroids and urinary symptoms. Cross-sectional images were used to render 3D models of pelvic anatomy, including bladder, uterus and fibroids, using 3D Slicer and OsiriX. Dimensions, volumes and anatomical relationships of the pelvic organs were evaluated. Comparisons between anatomical landmarks and measurements obtained from the two image processing applications were undertaken. Rendered 3D pelvic models yielded detailed anatomical information and data on spatial relationships that were unobtainable from cross-sectional images. Models were rendered in sufficient resolution to aid understanding of spatial relationships between urinary bladder, uterus and fibroid(s). Measurements of fibroid volumes ranged from 5,336 to 418,012 mm3 and distances between the fibroid and urinary bladder ranged from 0.10 to 83.60 mm. Statistical analysis of measurements showed no significant differences in measurements between the two image processing applications. To date, limited data exist on the use of 3D volume reconstructions of routine MRI scans, to investigate pelvic pathologies such as fibroids in women with urinary symptoms. This study suggests that post-MRI image processing can provide additional information over standard MRI. Further studies are required to assess the role of these data in clinical practice, surgical planning and training. Three-dimensional reconstruction of routine two-dimensional magnetic resonance imaging provides additional anatomical information and may improve our understanding of anatomical relationships, their role in clinical presentations and possibly guide clinical and surgical management

Intensity modulated radiation therapy and arc therapy: validation and evolution as applied to tumours of the head and neck, abdominal and pelvic regions

Intensiteitsgemoduleerde radiotherapie (IMRT) laat een betere controle over de dosisdistributie (DD) toe dan meer conventionele bestralingstechnieken. Zo is het met IMRT mogelijk om concave DDs te bereiken en om de risico-organen conformeel uit te sparen. IMRT werd in het UZG klinisch toegepast voor een hele waaier van tumorlocalisaties. De toepassing van IMRT voor de bestraling van hoofd- en halstumoren (HHT) vormt het onderwerp van het eerste deel van deze thesis. De planningsstrategie voor herbestralingen en bestraling van HHT, uitgaande van de keel en de mondholte wordt beschreven, evenals de eerste klinische resultaten hiervan. IMRT voor tumoren van de neus(bij)holten leidt tot minstens even goede lokale controle (LC) en overleving als conventionele bestralingstechnieken, en dit zonder stralingsgeïnduceerde blindheid. IMRT leidt dus tot een gunstiger toxiciteitprofiel maar heeft nog geen bewijs kunnen leveren van een gunstig effect op LC of overleving. De meeste hervallen van HHT worden gezien in het gebied dat tot een hoge dosis bestraald werd, wat erop wijst dat deze “hoge dosis” niet volstaat om alle clonogene tumorcellen uit te schakelen. We startten een studie op, om de mogelijkheid van dosisescalatie op geleide van biologische beeldvorming uit te testen. Naast de toepassing en klinische validatie van IMRT bestond het werk in het kader van deze thesis ook uit de ontwikkeling en het klinisch opstarten van intensiteitgemoduleerde arc therapie (IMAT). IMAT is een rotationele vorm van IMRT (d.w.z. de gantry draait rond tijdens de bestraling), waarbij de modulatie van de intensiteit bereikt wordt door overlappende arcs. IMAT heeft enkele duidelijke voordelen ten opzichte van IMRT in bepaalde situaties. Als het doelvolume concaaf rond een risico-orgaan ligt met een grote diameter, biedt IMAT eigenlijk een oneindig aantal bundelrichtingen aan. Een planningsstrategie voor IMAT werd ontwikkeld, en type-oplossingen voor totaal abdominale bestraling en rectumbestraling werden onderzocht en klinisch toegepast

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[ES] El aumento de los procedimientos usando la robótica quirúrgica en la última década demanda un alto número de cirujanos, capaces de teleoperar sistemas avanzados y complejos y, al mismo tiempo, de aprovechar los beneficios de la Cirugía Asistida por Robot de forma segura y efectiva. En la actualidad, los planes de formación se basan en la Realidad Virtual y entornos simulados para lograr un establecimiento escalable, rentable y completo del conjunto de habilidades quirúrgicas robóticas. Este trabajo se centra en el desarrolloo de un una escenario clínico mediante sensores que asistan al ciruajano durante su entrenamiento con el daVinci®, implementados en un entorno físico impreso en 3D. Esta investigación busca la obtención de un modelo segmentado, la impresión 3D del modelo para simular el escenraio clínico real y así abituar al cirujano a la interacción de los órganos y tejidos con el robot; y la implementación de sensores con que asistir al cirjuano en el entrenamiento. Para ello, con el fin de demostrar la eficacia de la asistencia durante los entrenamientos, así como la validez de los ejercicios de la operación simulada se ha realizado un estudio con doce voluntarios.Tanto la asistencia visual como el uso de fantomas 3D muestran ser una alternativa óptima para el aprendizaje de la habilidades requeridas en la cirugía robótica: manifestandose un paso adelante hacia un entrenamiento personlizado para cada cirujano.[EN] The increase of surgical procedures using robotic technology in the last decade demands a high number of surgeons capable of teleoperating advanced and complex systems while safely and effectively taking advantage of Robot-Assisted Surgery benefits. Currently, training plans rely on Virtual Reality and simulated environments to achieve a scalable, cost-effective, and comprehensive establishment of robotic surgical skills. This work focuses on the development of a clinical scenario through sensors that assist the surgeon during their training with the daVinci® system, implemented in a 3D-printed physical environment. This research aims to obtain a segmented model, 3D printing the model to simulate the real clinical scenario, thus familiarizing the surgeon with the interaction of organs and tissues with the robot. Additionally, sensors are implemented to assist the surgeon during training. Therefore, to demonstrate the effectiveness of the assistance during the training sessions and the validity of the exercises in the simulated operation, a study was conducted with twelve volunteers. Both visual assistance and the use of 3D phantoms prove to be an optimal alternative for learning the required skills in robotic surgery, representing a significant step forward towards personalized training for each surgeon.Castillo Rosique, P. (2023). Development sensorized 3D-printed realistic phantom to scale for surgical training with a daVinci robot. Universitat Politècnica de València. http://hdl.handle.net/10251/19804

Pelvic kinematics as confounding factor for cam hip impingement

The purpose of this thesis was to explore a range of biomechanical factors linked to the development of symptoms and potentially early onset hip OA in people with cam hip impingement. This was achieved through shape analysis on 3D bone models (segmented from medical images), and motion analysis performed during walking and squatting. Following ethical approval, kinematic and morphological variables were obtained from 19 pre-operative hip impingement patients and 18 healthy controls, and these were compared between groups. Patients demonstrated reduced neck-shaft-angles (-6.0°, p<.01) and increased anterior pelvic tilt during gait (+3.2°, p=.04) which are thought to predispose to impingement by decreasing the proximity between the cam and acetabular rim and making abutment more likely. The transverse pelvic plane is used to measure pelvic tilt during motion analysis, it is therefore interesting that the angle between the transverse and anterior pelvic plane is increased (+4.6°, p=.03) in patients, emphasising that the interplay between shape and function is a priority for further research. Avoidance of hip extension (-5.9°, p<.01) was also observed, which could be a compensatory mechanism to prevent further damages to the hip. Furthermore, large cams are thought to act as a mechanical constraint and limit rotation movement allowed within the acetabulum, as demonstrated by reduced peak hip internal rotation (during squat, -8.5°, p=.03). Controls were regrouped based on morphology to allow comparison between asymptomatic (CAM-; n=11) and symptomatic (CAM+, n=16) cams. Symptomatic cams have an increased width (+41.4°, p<.01), and start more superiorly (-29.4°, p<.01). Increased sagittal pelvic mobility (e.g. during a squat; -11.2° for CAM+, p<.01) is thought to be protective against hip impingement symptoms, as during high flexion angles the pelvic tilts backwards reducing the risk of abutment. These findings highlight the need to establish thresholds taking confounding factors into account.Open Acces