Contact area, pressure distribution and mechanical stability in external arthrodesis of the ankle joint

The ankle joint is often affected by arthritis, giving a joint that is painful, stiff, and restricts movement. This can result in a huge loss of mobility for the sufferer. Unlike replacement of the hip, the replacement of a diseased ankle joint is not as straightforward and the outcomes do not reach the same success levels. The preferred surgical choice is arthrodesis, a procedure whereby the two bones forming the joint are fused together to eliminate the joint and hence pain. The success of the procedure is dependent upon several factors, two of the most significant being the levels of contact area and pressure achieved during the compression period, during which bone growth occurs across the two bones being compressed together. These factors influence joint stability and micromotion at the bone to bone interface during this growth phase. This study investigates the levels of contact areas and pressures that can be achieved for different arthodesis variables. These variables include the joint shape, which can be curved or flat, and the position of the compression pin within the talus, namely anteriorly or centrally positioned with reference to the talar dome. Influence of the Achilles tendon in joint stability is also investigated. A test rig was developed allowing load/deflection curves to be determined for various configurations of these variables. Models representing the bones under consideration, together with pressure sensitive film, allowed measurement of contact areas and pressures within the joint under compression, achieved using pins and instrumented compression rods. Results indicate there is little significant variation in contact area and pressure for the different shaped joint cuts, however, if the talar pin is placed in a more anterior position then the contact area can be improved over a centrally positioned pin. Anterior pin placement also gives increased resistance to motion and mechanical stability. It has been established that the athrodesis construct is especially weak in terms of rotation about the tibial axis, and the results from this study indicate that through the use of a curved joint shape the resistance to this motion can be improved greatly

Projector - a partially typed language for querying XML

We describe Projector, a language that can be used to perform a mixture of typed and untyped computation against data represented in XML. For some problems, notably when the data is unstructured or semistructured, the most desirable programming model is against the tree structure underlying the document. When this tree structure has been used to model regular data structures, then these regular structures themselves are a more desirable programming model. The language Projector, described here in outline, gives both models within a single partially typed algebra and is well suited for hybrid applications, for example when fragments of a known structure are embedded in a document whose overall structure is unknown. Projector is an extension of ECMA-262 (aka JavaScript), and therefore inherits an untyped DOM interface. To this has been added some static typing and a dynamic projection primitive, which can be used to assert the presence of a regular structure modelled within the XML. If this structure does exist, the data is extracted and presented as a typed value within the programming language

A Clinical Guideline Driven Automated Linear Feature Extraction for Vestibular Schwannoma

Vestibular Schwannoma is a benign brain tumour that grows from one of the balance nerves. Patients may be treated by surgery, radiosurgery or with a conservative "wait-and-scan" strategy. Clinicians typically use manually extracted linear measurements to aid clinical decision making. This work aims to automate and improve this process by using deep learning based segmentation to extract relevant clinical features through computational algorithms. To the best of our knowledge, our study is the first to propose an automated approach to replicate local clinical guidelines. Our deep learning based segmentation provided Dice-scores of 0.8124 +- 0.2343 and 0.8969 +- 0.0521 for extrameatal and whole tumour regions respectively for T2 weighted MRI, whereas 0.8222 +- 0.2108 and 0.9049 +- 0.0646 were obtained for T1 weighted MRI. We propose a novel algorithm to choose and extract the most appropriate maximum linear measurement from the segmented regions based on the size of the extrameatal portion of the tumour. Using this tool, clinicians will be provided with a visual guide and related metrics relating to tumour progression that will function as a clinical decision aid. In this study, we utilize 187 scans obtained from 50 patients referred to a tertiary specialist neurosurgical service in the United Kingdom. The measurements extracted manually by an expert neuroradiologist indicated a significant correlation with the automated measurements (p < 0.0001).Comment: SPIE Medical Imagin

Semantically Linking In Silico Cancer Models

Multiscale models are commonplace in cancer modeling, where individual models acting on different biological scales are combined within a single, cohesive modeling framework. However, model composition gives rise to challenges in understanding interfaces and interactions between them. Based on specific domain expertise, typically these computational models are developed by separate research groups using different methodologies, programming languages, and parameters. This paper introduces a graph-based model for semantically linking computational cancer models via domain graphs that can help us better understand and explore combinations of models spanning multiple biological scales. We take the data model encoded by TumorML, an XML-based markup language for storing cancer models in online repositories, and transpose its model description elements into a graph-based representation. By taking such an approach, we can link domain models, such as controlled vocabularies, taxonomic schemes, and ontologies, with cancer model descriptions to better understand and explore relationships between models. The union of these graphs creates a connected property graph that links cancer models by categorizations, by computational compatibility, and by semantic interoperability, yielding a framework in which opportunities for exploration and discovery of combinations of models become possible

Deep learning for automatic segmentation of vestibular schwannoma: a retrospective study from multi-center routine MRI

Automatic segmentation of vestibular schwannoma (VS) from routine clinical MRI has potential to improve clinical workflow, facilitate treatment decisions, and assist patient management. Previous work demonstrated reliable automatic segmentation performance on datasets of standardized MRI images acquired for stereotactic surgery planning. However, diagnostic clinical datasets are generally more diverse and pose a larger challenge to automatic segmentation algorithms, especially when post-operative images are included. In this work, we show for the first time that automatic segmentation of VS on routine MRI datasets is also possible with high accuracy. We acquired and publicly release a curated multi-center routine clinical (MC-RC) dataset of 160 patients with a single sporadic VS. For each patient up to three longitudinal MRI exams with contrast-enhanced T1-weighted (ceT1w) (n = 124) and T2-weighted (T2w) (n = 363) images were included and the VS manually annotated. Segmentations were produced and verified in an iterative process: (1) initial segmentations by a specialized company; (2) review by one of three trained radiologists; and (3) validation by an expert team. Inter- and intra-observer reliability experiments were performed on a subset of the dataset. A state-of-the-art deep learning framework was used to train segmentation models for VS. Model performance was evaluated on a MC-RC hold-out testing set, another public VS datasets, and a partially public dataset. The generalizability and robustness of the VS deep learning segmentation models increased significantly when trained on the MC-RC dataset. Dice similarity coefficients (DSC) achieved by our model are comparable to those achieved by trained radiologists in the inter-observer experiment. On the MC-RC testing set, median DSCs were 86.2(9.5) for ceT1w, 89.4(7.0) for T2w, and 86.4(8.6) for combined ceT1w+T2w input images. On another public dataset acquired for Gamma Knife stereotactic radiosurgery our model achieved median DSCs of 95.3(2.9), 92.8(3.8), and 95.5(3.3), respectively. In contrast, models trained on the Gamma Knife dataset did not generalize well as illustrated by significant underperformance on the MC-RC routine MRI dataset, highlighting the importance of data variability in the development of robust VS segmentation models. The MC-RC dataset and all trained deep learning models were made available online