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Medical Physics Jun 2021Current prostate brachytherapy uses transrectal ultrasound images for implant guidance, where contours of the prostate and organs-at-risk are necessary for treatment...
PURPOSE
Current prostate brachytherapy uses transrectal ultrasound images for implant guidance, where contours of the prostate and organs-at-risk are necessary for treatment planning and dose evaluation. This work aims to develop a deep learning-based method for male pelvic multi-organ segmentation on transrectal ultrasound images.
METHODS
We developed an anchor-free mask convolutional neural network (CNN) that consists of three subnetworks, that is, a backbone, a fully convolutional one-state object detector (FCOS), and a mask head. The backbone extracts multi-level and multi-scale features from an ultrasound (US) image. The FOCS utilizes these features to detect and label (classify) the volume-of-interests (VOIs) of organs. In contrast to the design of a previously investigated mask regional CNN (Mask R-CNN), the FCOS is anchor-free, which can capture the spatial correlation of multiple organs. The mask head performs segmentation on each detected VOI, where a spatial attention strategy is integrated into the mask head to focus on informative feature elements and suppress noise. For evaluation, we retrospectively investigated 83 prostate cancer patients by fivefold cross-validation and a hold-out test. The prostate, bladder, rectum, and urethra were segmented and compared with manual contours using the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD ), mean surface distance (MSD), center of mass distance (CMD), and volume difference (VD).
RESULTS
The proposed method visually outperforms two competing methods, showing better agreement with manual contours and fewer misidentified speckles. In the cross-validation study, the respective DSC and HD results were as follows for each organ: bladder 0.75 ± 0.12, 2.58 ± 0.7 mm; prostate 0.93 ± 0.03, 2.28 ± 0.64 mm; rectum 0.90 ± 0.07, 1.65 ± 0.52 mm; and urethra 0.86 ± 0.07, 1.85 ± 1.71 mm. For the hold-out tests, the DSC and HD results were as follows: bladder 0.76 ± 0.13, 2.93 ± 1.29 mm; prostate 0.94 ± 0.03, 2.27 ± 0.79 mm; rectum 0.92 ± 0.03, 1.90 ± 0.28 mm; and urethra 0.85 ± 0.06, 1.81 ± 0.72 mm. Segmentation was performed in under 5 seconds.
CONCLUSION
The proposed method demonstrated fast and accurate multi-organ segmentation performance. It can expedite the contouring step of prostate brachytherapy and potentially enable auto-planning and auto-evaluation.
Topics: Humans; Image Processing, Computer-Assisted; Male; Neural Networks, Computer; Pelvis; Prostate; Retrospective Studies; Ultrasonography
PubMed: 33894057
DOI: 10.1002/mp.14895 -
BMJ Case Reports Jul 2021A 58-year-old asymptomatic woman was referred to our gynecologic oncology unit for the management of a left adnexal mass found during a routine gynecologic examination....
A 58-year-old asymptomatic woman was referred to our gynecologic oncology unit for the management of a left adnexal mass found during a routine gynecologic examination. Her personal history included an emergency splenectomy at the age of 4 years old, following traumatic splenic laceration after a car accident. The patient's work-up (including transvaginal ultrasound and MRI) confirmed a pelvic solid mass, which was reported as suspicious for malignancy and classified as Ovarian-Adnexal Reporting & Data System-MRI 5. An exploratory laparoscopy was performed, showing a reddish blue lesion located at the left broad ligament. Histologic analysis showed the presence of splenic tissue and normal adnexa. The postoperative follow-up was uneventful.Pelvic splenosis is a challenging diagnosis rarely made preoperatively due to concern for malignancy. In the presence of a pelvic mass, the collection of a detailed patient's history, including information about previous splenic rupture, might raise suspicion for pelvic splenosis.
Topics: Adnexal Diseases; Diagnosis, Differential; Female; Humans; Middle Aged; Pelvis; Splenectomy; Splenosis
PubMed: 34257126
DOI: 10.1136/bcr-2021-243505 -
The Spine Journal : Official Journal of... Jan 2018To date, many studies have examined how pelvic position affects the spinal curvature and spinopelvic parameters. However, these studies focus on a static relationship,...
BACKGROUND CONTEXT
To date, many studies have examined how pelvic position affects the spinal curvature and spinopelvic parameters. However, these studies focus on a static relationship, comparing pelvis and spine in a relaxed or baseline position only. Indeed, the spinopelvic connection is dynamic, as subjects can easily be taught to rotate their pelvis anteriorly or posteriorly on the femoral head, all while maintaining an erect posture. Therefore, for a true understanding of pelvic influence on the spinal column, it is necessary to examine spinopelvic parameters in multiple pelvic positions within the same subject.
PURPOSE
The objective of this study was to examine the dynamic effect of pelvic motion on the spine and associated radiographic parameters.
STUDY DESIGN
This is a single-center, cross-sectional study of 50 healthy, asymptomatic volunteers.
PATIENT SAMPLE
Subjects were recruited and screened based on the following criteria: between 18 and 79 years of age; no known spinal, pelvic, or lower extremity pain lasting for >48 hours; no history of spinal, pelvic, or lower extremity dysfunction requiring medical care; no radiographic evidence of spinal or pelvic abnormality, scoliosis deformity, or other associated spinal pathologies; not currently pregnant and with no possibility of being pregnant; and a body mass index of <30. 64. The subjects were screened and 14 were excluded for a total of 50 subjects.
OUTCOME MEASURES
The outcome measures included thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI).
MATERIALS AND METHODS
This study was funded by a Small Exploratory Research Grant from the Scoliosis Research Society. Each subject was instructed and observed to stand in three different positions: pelvic resting, anterior pelvic rotation, and posterior pelvic rotation. Lateral standing radiographs were taken in each position and each image was examined by an orthopedic spine surgeon who digitally measured the TK, LL, SVA, PT, SS, and PI. The data were then statistically examined to determine the affect of pelvic position on each parameter.
RESULTS
Subjects demonstrated a measurable, statistically significant change in each parameter with pelvic rotation. There was a clear pattern of change for LL, PT, and SS with the anterior and posterior pelvic rotations. A change in LL demonstrated a strong correlation with changes in all measured parameters with pelvic rotation.
CONCLUSIONS
In asymptomatic subjects, pelvic motion affects the position of the spinal column and resultant spinopelvic parameters. The results of this study demonstrate that one can intentionally change the position of the pelvis and the adjacent spinal column in space. Knowledge of this relationship is important to the understanding of sagittal balance and could influence the treatment of patients with spinal deformity.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Movement; Pelvis; Posture; Range of Motion, Articular; Spine
PubMed: 28821443
DOI: 10.1016/j.spinee.2017.08.234 -
Injury Aug 2021Fractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be...
AIMS
Fractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be life-threatening or life changing injuries. No published data exists comparing body mass index (BMI) and mortality for this patient group. The aim of this study was to identify if low BMI (<18.5) was a predictor of morbidity and mortality for patients with these injuries.
PATIENTS AND METHODS
Of the 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre (MTC) over a 4.5-year period (August 2015 - January 2020); we retrospectively analysed data for all admitted patients. Data was collected on demographics, injury pattern, operative intervention and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not. Both in-hospital and post discharge complications were recorded including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.
RESULTS
569 patients admitted to the MTC with a pelvic or acetabular fracture were included in our analysis. Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with triple the in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).
CONCLUSION
This is the first published study that demonstrates a statistically significant increase in mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should carefully consider appropriate peri-operative optimisation for these patients. Further investigation into the effects of low BMI and response to trauma is required.
Topics: Acetabulum; Aftercare; Body Mass Index; Fractures, Bone; Hip Fractures; Humans; Patient Discharge; Pelvic Bones; Pelvis; Retrospective Studies; Risk Factors
PubMed: 34083023
DOI: 10.1016/j.injury.2021.04.066 -
The American Journal of Case Reports Jun 2020BACKGROUND The aim of this study was to report the clinical diagnosis and treatment of a case of pelvic actinomycosis in our hospital and provide a review of recent... (Review)
Review
BACKGROUND The aim of this study was to report the clinical diagnosis and treatment of a case of pelvic actinomycosis in our hospital and provide a review of recent literature. CASE REPORT The patient was a 54-year-old woman who was admitted to our hospital due to "bilateral lower abdominal tenderness accompanied with anorexia and vomiting for 3 months". After admission, a variety of imaging examinations found pelvic space-occupying lesions, which were considered as malignant. She underwent surgery and pelvic actinomycosis was diagnosed by postoperative pathology. Postoperatively, she was treated with a high-dose sufficient course of penicillin (20 million U, iv gtt) for 14 days and she is currently under close follow-up for 1 year, with no recurrent symptoms. CONCLUSIONS Pelvic actinomycosis is rare and often forms mass invasion into the tissue structure around the pelvic cavity, which is easily misdiagnosed as ovarian malignant tumor. The criterion standard for diagnosing an infection is culture, with histopathology aiding the diagnosis.
Topics: Actinomycosis; Anti-Bacterial Agents; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Intrauterine Devices; Middle Aged; Pelvis; Penicillins
PubMed: 32532952
DOI: 10.12659/AJCR.922601 -
Military Medicine Nov 2023Combat-related injuries from improvised explosive devices occur commonly to the lower extremity and spine. As the underbody blast impact loading traverses from the seat...
INTRODUCTION
Combat-related injuries from improvised explosive devices occur commonly to the lower extremity and spine. As the underbody blast impact loading traverses from the seat to pelvis to spine, energy transfer occurs through deformations of the combined pelvis-sacrum-lumbar spine complex, and the time factor plays a role in injury to any of these components. Previous studies have largely ignored the role of the time variable in injuries, injury mechanisms, and warfighter tolerance. The objective of this study is to relate the time or temporal factor using a multi-component, pelvis-sacrum-lumbar spinal column complex model.
MATERIALS AND METHODS
Intact pelvis-sacrum-spine specimens from pre-screened unembalmed human cadavers were prepared by fixing at the superior end of the lumbar spine, pelvis and abdominal contents were simulated, and a weight was added to the cranial end of the fixation to account for torso effective mass. Prepared specimens were placed on the platform of a custom vertical accelerator device and aligned in a seated soldier posture. An accelerometer was attached to the seat platen of the device to record the time duration to peak velocity. Radiographs and computed tomography images were used to document and associate injuries with time duration.
RESULTS
The mean age, stature, weight, body mass index, and bone density of 12 male specimens were as follows: 65 ± 11 years, 1.8 ± 0.01 m, 83 ± 13 kg, 27 ± 5.0 kg/m2, and 114 ± 21 mg/cc. They were equally divided into short, medium, and long time durations: 4.8 ± 0.5, 16.3 ± 7.3, and 34.5 ± 7.5 ms. Most severe injuries associated with the short time duration were to pelvis, although they were to spine for the long time duration.
CONCLUSIONS
With adequate time for the underbody blast loading to traverse the pelvis-sacrum-spine complex, distal structures are spared while proximal/spine structures sustain severe/unstable injuries. The time factor may have implications in seat and/or seat structure design in future military vehicles to advance warfighter safety.
Topics: Humans; Male; Middle Aged; Aged; Sacrum; Spinal Injuries; Explosions; Pelvis; Lumbar Vertebrae; Cadaver; Blast Injuries; Biomechanical Phenomena
PubMed: 37948210
DOI: 10.1093/milmed/usad168 -
Clinical Spine Surgery Nov 2017A systematic review with meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
A systematic review with meta-analysis.
OBJECTIVE
To combine published data, focusing on the development of optimal spinopelvic parameters in adult asymptomatic subjects without spine deformity while taking into consideration the impact of potential confounders.
SUMMARY OF BACKGROUND DATA
A well-grounded approach to define the optimal spinopelvic parameters is necessary for planning surgical correction of spine deformity.
MATERIALS
Selection criteria: (1) randomized and nonrandomized prospective, cross-sectional, and retrospective studies; (2) participants: asymptomatic subjects without spine deformity aged above 18 years; (3) studied parameters: lumbar lordosis (LL), pelvic incidence, sacral slope, and pelvic tilt; (4) potential confounders: method of measurement, sex, age, ethnicity, weight, height, and body mass index. Search method: Ovid MEDLINE (1946-current) and EMBASE (1980-current), all years through October 2015 were included. Data were collected: number of enrolled subjects, means of the studied characteristics, SD, SE of the means, 95% confidence intervals. A meta-analysis was performed to evaluate the pooled means and range of optimal values (pooled mean±pooled SD) taking into consideration the impact of confounders. The GRADE approach was applied to evaluate the level of evidence.
RESULTS
Seventeen of 1018 studies were included (2926 subjects from 9 countries). The pooled means and the optimal ranges were: LL (L1-S1), 54.6 (42-67) degrees; LL (L1-L5), 37.0 (22-53) degrees; pelvic incidence, 50.6 (39-62) degrees; sacral slope, 37.7 (28-48) degrees; pelvic tilt, 12.6 (3-22) degrees. The pooled results were statistically significant (P<0.001), but heterogeneous. Impact of the following confounders was revealed: method of measurement, ethnicity, age, and body mass index. A methodology was created to define an individualized optimal value and range of each studied parameter taking into consideration the influence of confounders.
CONCLUSIONS
The pooled results and developed methodology can be used as diagnostic criteria for evaluation of the spinopelvic parameters, planning of surgical interventions and evaluation of the treatment effect.
Topics: Humans; Pelvis; Publication Bias; Regression Analysis; Spinal Diseases; Spine
PubMed: 28368866
DOI: 10.1097/BSD.0000000000000533 -
British Journal of Hospital Medicine... Oct 2020Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an...
Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an intrauterine device. The constellation of signs and symptoms associated with its typical clinical presentation include palpable mass, weight loss and malaise. It can be misdiagnosed as a result and often as a malignant process. Left unrecognised, pelvic actinomycosis can lead to sequelae such as severe abscess, fistula formation and even infertility. Removal of the intrauterine device and a prolonged course (6-12 months) of antibiotic treatment form the cornerstone of management. Surgery can be required in select cases. This article provides an overview of pelvic actinomycosis, including its background, presentation, investigations and management.
Topics: Abscess; Actinomycosis; Female; Humans; Intrauterine Devices; Pelvic Pain; Pelvis
PubMed: 33135910
DOI: 10.12968/hmed.2020.0190 -
Journal of Vascular Surgery. Venous and... Mar 2022The use of iliac vein stenting for the treatment of pelvic pain secondary to pelvic venous insufficiency has significantly increased. In women of childbearing age, the...
BACKGROUND
The use of iliac vein stenting for the treatment of pelvic pain secondary to pelvic venous insufficiency has significantly increased. In women of childbearing age, the effect of the gravid uterus on stent function and patency is unclear. The purpose of this investigation was to determine the effect of pregnancy on stent patency and reintervention rate in women with iliac vein stents.
METHODS
A retrospective chart review and email survey was performed to identify women treated at the Center for Vascular Medicine who were treated with iliac vein stenting and who had subsequent pregnancies. Medical and surgical comorbidities, stent type, location, length, number of stents, reintervention rates, number of pregnancies after stenting, anticoagulation usage during pregnancy, and type of delivery were assessed.
RESULTS
From January 2014 to December 2020, 15 women with 16 iliac vein stents and who had 17 subsequent pregnancies were identified. The average age at stenting was 35.3 ± 4.13 years. The average interval between stenting and conception was 350 ± 287 days. Before pregnancy, stent location was in the right common/right external iliac veins in 1 patient and left common/external iliac veins in 14 patients. The average stent diameter and length were 19.6 ± 3 and 79.5 ± 20.3 mm, respectively. Thirteen Boston Scientific Wallstents and three Bard Venovo stents were used before pregnancy. One patient with a Wallstent required a stent extension before pregnancy and one patient had two stents placed at the initial procedure. Two women were pregnant twice after stenting for a total of 17 pregnancies. There were 16 term and 1 premature delivery of single infants. Patients were treated with enoxaparin (Lovenox) for stent-related thrombosis prophylaxis in 11 of 17 pregnancies, 5 had no prophylaxis, and the status of 1 pregnancy is unknown. One asymptomatic patient underwent a stent venoplasty after delivery.
CONCLUSIONS
Iliac vein stents tolerate a gravid uterus well. No stents thrombosed during or after pregnancy and none required reintervention secondary to pregnancy-related compression. Anticoagulation with low-molecular-weight heparin should be considered for stent thrombosis prophylaxis. Potential pregnancy should not be considered a contraindication to iliac vein stenting for the treatment of symptomatic pelvic venous insufficiency.
Topics: Adult; Anticoagulants; Electronic Health Records; Endovascular Procedures; Female; Humans; Iliac Vein; Parity; Pelvis; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Time Factors; Time-to-Pregnancy; Treatment Outcome; United States; Vascular Patency; Venous Insufficiency
PubMed: 34587526
DOI: 10.1016/j.jvsv.2021.09.005 -
American Journal of Human Biology : the... Aug 2022Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides...
OBJECTIVES
Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides high-resolution images, but is more expensive than dual-energy X-ray absorptiometry (DXA). We sought to compare pelvic breadth measurements collected from the same individuals using both methods, to investigate if there are systematic differences in pelvic measurement between these imaging methods.
METHODS
Three pelvic breadth dimensions (bi-iliac breadth, bi-acetabular breadth, medio-lateral inlet breadth) were collected from MRI and DXA scans of a cross-sectional sample of healthy, nulliparous adult women of South Asian ancestry (n = 63). Measurements of MRI and DXA pelvic dimensions were collected four times in total, with one baseline data collection session and three replications. Data collected from these sessions were averaged, used to calculate technical error of measurement and entered into a Bland-Altman analysis. Linear regression models were fitted with a given MRI pelvic measurement regressed on the same measurement collected from DXA scans, as well as MRI mean bias regressed on DXA mean bias.
RESULTS
Technical error of measurement was higher in DXA measurements of bi-iliac breadth and medio-lateral pelvic inlet breadth and higher for MRI measurements of bi-acetabular breadth. Bland Altman analyses showed no statistically significant relationship between the mean bias of MRI and DXA, and the differences between MRI and DXA pelvic measurements.
CONCLUSIONS
DXA measurements of pelvic breadth are comparable to MRI measurements of pelvic breadth. DXA is a less costly imaging technique than MRI and can be used to collect measurements of skeletal elements in living people.
Topics: Absorptiometry, Photon; Adult; Body Mass Index; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Pelvis
PubMed: 35460113
DOI: 10.1002/ajhb.23753