Multidisciplinary computational anatomy and its application to highly intelligent diagnosis and therapy

金沢大学医薬保健研究域保健学系本研究では，胸部領域の筋・骨格・臓器・組織の動態機能の中でも，呼吸機能と密接な関係のある肋骨を含めた胸郭運動ならびに横隔膜運動に注目した．その動態機能の理解と評価を可能にする画像解析法を開発するために，今年度は「横隔膜運動の理解：正常な胸郭・横隔膜運動のパターン化と異常な胸郭・横隔膜運動の特徴ならびに肺野内濃度変化との関連の検証」に取り組んだ．対象は，基礎疾患として慢性閉塞性肺疾患（COPD），間質性肺炎，肺線維症，気管支喘息，気胸，肺癌，心不全，脊椎側弯症などを有する125症例（2015年12月～2017年10月に撮影，うち60症例は肺葉切除等の手術前後で撮影）ならびに，豚の無気肺モデル（6匹）とした．管電圧120 kV，パルス線量4.0 mAs/pulse，撮影レート15 fps，撮影距離2.0mにて，呼吸過程を10秒間撮影し，合計150枚のX線動画像を取得した．今回は新たに深層学習を用いた胸部X線動画像のための肺セグメンテーション技術を開発し，呼吸による肺面積変化や変化率を解析項目に加えた．臨床研究では，肺面積変化や変化率と肺機能（肺活量）との間に高い相関があることを確認した．また，肺機能障害を肺面積変化量の減少として検出できることを明らかにした．さらに，肺葉切除症例については切除部位と手術前後変化の関連を検証し，術後の経過観察における横隔膜運動計測の有用性を示す結果を得た．豚の無気肺モデルを対象とした動物実験では，異常肺の横隔膜・胸郭運動が健側肺に比べて有意に減少することを確認した．これらの研究成果を国内外の学会で発表し，英語論文2本として公開した．さらに本研究の成果の一部を実用化につなげた．研究課題/領域番号:17H05286, 研究期間(年度):2017-04-01 – 2019-03-3

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

'Clinical Triad' findings in Klippel-feil patients

E-Poster - Congenital Deformity: no. 530It has been propagated that Klippel-Feil Syndrome (KFS) is associated with the clinical triad findings (CTF) of short neck, low posterior hairline, and limited range of motion. This study noted that CTFs are not consistently noted in KFS patients. KFS patients with extensive congenitally fused cervical segments were more likely to exhibit one of the components of CTF.postprin

Selection of fusion levels in adolescent idiopathic scoliosis (AIS) using the fulcrum bending radiograph prediction: verification based on pedicle screw strategy

E-Poster - Adolescent Idiopathic Scoliosis: no. 297Utilizing the fulcrum bending radiographic technique to assess curve flexibility to aid in the selection of fusion levels, a prospective radiographic study was performed to assess the safety and effectiveness of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. This study suggests that ALSS obtains greater deformity correction than hook and hybrid systems, and improves balance without compromising fusion levels.postprin

The safety and efficacy of a remotely distractible, magnetic controlled growing rod (MCGR) for the treatment of scoliosis in children: a prospective case series with minimum two year follow-up

Concurrent Session 2B - Early Onset Scoliosis: paper no. 26SUMMARY: The growing rod has been the gold standard for the treatment of scoliosis in young children. However, such management requires multiple open surgeries under general anesthesia for rod distraction and is associated with numerous postoperative complications. To avoid such pitfalls, we utilized a magnetically-controlled growing rod (MCGR) implant. Our study found that the MCGR was safe and effective, allowing for distractions on a non-invasive out-patient basis at monthly intervals, eliminating the need for surgeries and their associated complications. Introduction: Traditionally, growing rods are the standard of treatment for young children with severe spinal deformities and significant residual growth potential. However, this requires repeated open distractions under general anesthesia and is associated with numerous post-operative complications. This report addresses the safety and efficacy of the MCGR implant for non-invasive out-patient distractions for scoliosis correction in young children. METHODS: This was a prospective, patient series of the MCGR procedure. From November 2009 to March 2011, five patients (n=3 female; n=2 male) were treated with the MCGR. In this study, we report the first three patients (2 females and 1 male) with minimum 2 years follow-up. All cases were non-invasively distracted using an external magnet on a monthly basis. Pre and post distraction radiographs were carried out to assess the Cobb’s angle, predicted versus achieved rod distraction length and spinal length. Clinical outcome assessment was performed with the pain score (Visual Analogue Scale) and the SRS-30 questionnaire. All procedural or rod related complications were recorded. RESULTS: The main correction of the Cobb’s angle was obtained in the initial surgery and was maintained. The mean monthly increase in T1-T12, T1-S1 and instrumented segment length was 1.6mm, 2.5mm and 1.2mm, respectively. Predicted versus actual length gain per distraction were similar. One case had a superficial wound infection and there was one event of loss of distraction. On last follow-up, no pain was noted and SRS-30 scores remained unchanged to baseline. CONCLUSION: The MCGR is a safe and effective procedure for the surgical treatment of scoliosis in children. The MCGR provides external distractions on an out-patient basis without the need for sedation or anesthesia, and that remote distraction allows more frequent lengthening of the rod that may more closely mimic physiologic growth.postprin

The Use of CT to Assess Shoulder Kinematics and Measure Glenohumeral Arthrokinematics

Recently, studies have started employing dynamic four-dimensional computed tomography (4DCT) imaging as a biomechanical assessment tool. These studies would benefit from the valuable work that has been done in the past using three-dimensional computed tomography (3DCT). Thus, a structured review was conducted to examine the extent and range of methods employing CT imaging to measure shoulder kinematics. The findings of the review were utilized to conduct a study that employed 4DCT imaging to measure glenohumeral joint congruency and arthrokinematics during internal rotation to the back in a population of healthy individuals. The results of this work show the importance of anterior-posterior translation throughout the motion to achieve maximum range of motion. In conclusion, the use of 4DCT as a biomechanical measuring tool has shown to be a reliable technique in quantifying joint congruency and arthrokinematics of the glenohumeral joint and shows promise for future studies