Technology and Health Care - Volume 30, issue 5

Authors: Zor, Zeynep Fatma | Kılınç, Yeliz | Erkmen, Erkan | Kurt, Ahmet

Article Type: Research Article

Abstract: BACKGROUND: The effect of different thread designs and diameters on the all-on-four concept is unclear. OBJECTIVE: The aim of the study was to clarify the differences in stress distribution of dental implants with various thread designs and diameters based on the all-on-four concept with three dimensional (3D) finite element analysis (FEA). METHODS: A 3D model of a totally edentulous mandible was used to perform the FEA. Four different models (M1, M2, M3, and M4) including 3.5 and 4.3 mm diameter dental implants with active and passive threaded designs were generated. The dental implants …were positioned according to the all-on-four concept. The Von Mises stresses on dental implants and maximum and minimum principal stresses (Pmax and Pmin) on bony structures were calculated under vertical, oblique and horizontal loads. RESULTS: For Von Mises stresses, the highest stress values were detected on the distal implants for all models. Distal implants had also the highest stress values for vertical loading. The Von Mises stresses were found to be concentrated around the implant’s neck. In all models the highest Pmax and Pmin stresses occurred in the bone surrounding the distal implant. It was noted that the active threaded implants showed the highest Pmax and Pmin stress values. CONCLUSION: The implant thread design and diameter might have a strong influence on the stress values in the all-on-four concept. Show more

Keywords: All-on-four, dental implant, diameter, finite element analysis, thread design

DOI: 10.3233/THC-213072

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1031-1042, 2022

Authors: Zhou, Qian | Xu, Ping | Ding, Hong | Wang, Yong | Fu, Lina | Wang, Bo | Liu, Danru

Article Type: Research Article

Abstract: BACKGROUND: The global prevalence of thyroid cancer has increased significantly in recent years. Ultrasonography is the preferred method for differentiating benign and malignant thyroid nodules preoperatively and is recommended by guidelines. OBJECTIVE: To assess the application value of gray-scale ultrasound and shear wave elastography in distinguishing small thyroid nodules. METHODS: A retrospective analysis of 228 thyroid nodules, all of which were confirmed by pathology after surgery or FNA from January 2019 to January 2020, was carried out. All nodules were divided into a ⩽ 5 mm group and a > …5 mm group according to their maximum size. We compared the differences in the gray scale and elastography of the nodules between the two groups and the accuracy of different diagnostic methods. RESULTS: The accuracies of gray-scale ultrasound and shear wave elastography in the ⩽ 5 mm group were found to be lower than those in the > 5 mm group, and the gray-scale accuracy was slightly higher than that of shear wave elastography in both groups (p < 0.05). The largest AUC (area under the curve) of elastic parameters in the ⩽ 5 mm and > 5 mm groups was found for Emax and Esd, respectively. Based on a combination of these two parameters, the accuracies of the two groups were significantly higher than those of the parameters or gray scale alone (p < 0.05) and were 84.62% and 85.48%, respectively. CONCLUSION: Shear wave elastography is valuable in the diagnosis of benign and malignant thyroid nodules using ultrasonography. When combining gray-scale ultrasound and shear wave elastography, the diagnostic accuracy is obviously improved, especially for ⩽ 5 mm small thyroid nodules. Show more

Keywords: Thyroid nodules, diagnostic imaging, ultrasonography, elasticity imaging techniques

DOI: 10.3233/THC-213137

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1043-1054, 2022

Authors: Chen, Gary Yu-Hsin | Chen, Ping-Shun | Tsai, Tzu-Tao

Article Type: Research Article

Abstract: BACKGROUND: Medical staff scheduling problems are complex and involve numerous constraints. OBJECTIVE: This research uses the task-technology fit (TTF) model to measure the technology characteristics of information technology (IT) systems as a reference for constructing a prototype for a medical staff scheduling system to identify function requirements and design human interfaces. METHOD: After the evaluation of the proposed scheduling system, this research excludes compatibility from the 13 technology characteristics and adds two technology characteristics for consideration: customization and scalability. RESULTS: Based on the revised technology characteristics of the TTF model, …this research develops flexible scheduling functions to satisfy daily manpower requirements and allow predetermined schedules and day-off reservations for a hospital’s radiological technologists. Characterized by flexibility, customization, and scalability, the system can accommodate several algorithms to generate a better schedule that satisfies hard and soft constraints. Furthermore, the scheduler can choose the required hard and soft constraints from all constraints. The prototype of the scheduling system will be easily extended to add or modify constraints in the case of requirement or regulation changes. CONCLUSION: The results of this study provide a prototype for system developers to design a customized staff scheduling system for each medical unit. Show more

Keywords: Medical staff scheduling system, task-technology fit (TTF) model, staff scheduling, customization, hard and soft constraints, technology characteristic

DOI: 10.3233/THC-213260

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1055-1075, 2022

Authors: Shi, Jian | Chen, Luzeng | Wang, Bin | Zhang, Hong | Xu, Ling | Ye, Jingming | Liu, Yinhua | Shao, Yuhong | Sun, Xiuming | Zou, Yinghua

Article Type: Research Article

Abstract: BACKGROUND: Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%) in the global cancer statistics 2020. OBJECTIVE: To evaluate the diagnostic value of ultrasound elastography combined with multi-parameters in differentiating category 4 benign and malignant lesions in the breast imaging reporting and data system (BI-RADS). METHODS: This study retrospectively analyzed 206 patients (213 breast lesions) who visited the Department of Breast Surgery and underwent a breast core needle biopsy in the Department of Ultrasound in Peking University First hospital from April …to December 2019. The shear wave velocity (SWV) values were collected at the following locations by virtual touch tissue imaging quantification (VTIQ): breast lesion interior, breast lesion margin, surrounding glands, and surrounding fat. Simultaneously, the strain ratio (SR) of breast lesions to glands and the area ratio (AR) of breast lesions were collected under strain elastography and a two-dimensional ultrasound mode. RESULTS: Univariate analysis found that the SWV value, measured by ultrasound elastography parameters, and the AR between the elasticity and the two-dimensional ultrasound breast lesions showed statistical differences when differentiating benign and malignant lesions (p < 0.05). Binary logistic regression analysis found that the SWV values of the lesion interior and the surrounding glands were statistically significant. The joint predictors were calculated and analyzed by Receiver Operating Characteristic (ROC), and it was found that the joint predictors and the SWV values of the lesion interior have great diagnostic value. The cut-off value, sensitivity and specificity of the joint predictor and the SWV value of the lesion interior were > 3.65, 88.35% and 76.36% and > 5.55 m/s, 79.61% and 82.73%, respectively. CONCLUSIONS: Ultrasound elastography combined with multi-parameters has good diagnostic value in differentiating BI-RADS 4 breast lesions. Show more

Keywords: Ultrasound elastography, strain elastography, ARFI, VTIQ, SWV, breast lesion

DOI: 10.3233/THC-213272

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1077-1089, 2022

Authors: Guleken, Zozan | Kanber, Eyüp Murat | Sarıbal, Devrim | Depciuch, Joanna

Article Type: Research Article

Abstract: BACKGROUND: The venous disease of the legs is a common disease among adults that may lead to a deterioration in the structure and concentration of biomolecules. N-Butyl Cyanoacrylate Ablation Surgery (NBCA) or cyanoacrylate embolization (CAE) technique to adhesive the saphenous vein is an alternative method for the treatment of venous disease. OBJECTIVE: We aimed to show what kind of changes occurs after CAE surgery using FTIR spectroscopy combined chemometrics. We compared before and after surgery blood sera of patients to find whether a correlation between spectral data and laboratory indexes. We studied the blood sera of …those who suffered from varicose veins and treated them by CAE technique. METHODS: In order to examine the molecular profiles in blood sera who underwent the CAE technique of the great saphenous vein for the treatment we used Fourier Transform InfraRed spectroscopy (FTIR) spectroscopy of blood samples of patients before and after surgery as a fast diagnostic technique. To obtain information about the spectra variation among the types of samples Principal component analysis (PCA) was performed for fingerprint, amide II with amide I regions. To find normality among variations Partial Least Square P-P plot of residual was performed. RESULTS: Absorbance values were statistically significant only in amide II, amide I, and OH vibrations. In the blood collected before surgery, higher peaks area of α -helix and β -harmonica were noticed. However, in both groups of samples, a higher amount of β -harmonica was visible. Pearson correlation analysis showed that the value of white blood cells (WBC) correlate with absorbance at 2858 cm - 1 wavenumber. Moreover, a correlation between neutrophil (NEU) and OH vibrations, and between hematocrit (HCT) and 1082 cm - 1 , were found. Furthermore, a high correlation Platelets (PLT) and FTIR peak at 1165 cm - 1 , was noticed. CONCLUSIONS: This methodology suggests with PCA analysis CAE caused structural and quantitative chemical changes in blood samples of patients. Show more

Keywords: Varicose veins, Cyanoacrylate Ablation Surgery, blood parameters, Fourier Transform InfraRed spectroscopy, Principal component analysis

DOI: 10.3233/THC-213642

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1091-1106, 2022

Authors: Meng, Yinghui | Dong, Minghao | Dai, Xumin | Tang, Haipeng | Zhao, Chen | Jiang, Jingfeng | Xu, Shun | Zhou, Ying | Zhu, Fubao | Xu, Zhihui | Zhou, Weihua

Article Type: Research Article

Abstract: BACKGROUND: Automatic identification of proper image frames at the end-diastolic (ED) and end-systolic (ES) frames during the review of invasive coronary angiograms (ICA) is important to assess blood flow during a cardiac cycle, reconstruct the 3D arterial anatomy from bi-planar views, and generate the complementary fusion map with myocardial images. The current identification method primarily relies on visual interpretation, making it not only time-consuming but also less reproducible. OBJECITVE: In this paper, we propose a new method to automatically identify angiographic image frames associated with the ED and ES cardiac phases. METHOD: A …detection algorithm is first used to detect the key points (i.e. landmarks) of coronary arteries, and then an optical flow method is employed to track the trajectories of the selected key points. The ED and ES frames are identified based on all these trajectories. Our method was tested with 62 ICA videos from two separate medical centers. RESULTS: Comparing consensus interpretations by two human expert readers, excellent agreement was achieved by the proposed algorithm: the agreement rates within a one-frame range were 92.99% and 92.73% for the automatic identification of the ED and ES image frames, respectively. CONCLUSION: The proposed automated method showed great potential for being an integral part of automated ICA image analysis. Show more

Keywords: Coronary artery disease, invasive coronary angiography, cardiac cycle, optical flow

DOI: 10.3233/THC-213693

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1107-1116, 2022

Authors: Al Ahmari, Nasser M.

Article Type: Research Article

Abstract: BACKGROUND: The success of dental implants depend on implant design, surgical technique, bone density, implant morphology and postoperative care. Initial stability is utmost importance and is of concern in low density bone. The osseo-densification strategy enhance primary stability by raising density of the osteotomy site walls by non-subtractive drilling, unlike conventional technique. OBJECTIVE: The aim of this in vivo study was to assess and compare the osseo-densification implant drilling technique with conventional implant drilling in terms of primary implant stability along with other factors, plaque index, bleeding on probe, pocket depth and radiographic assessment of …bone density, marginal bone loss using CBCT. METHOD: A total of 20 patients aged between 40 and 59 years were included in this research. A split-mouth configuration of 40 implants was used. In the osseo-densification group, specialized (Densah) bur kit was used to insert 20 implants on one side. In the conventional group, standard bur kit was used to insert 20 implants on the opposite side of the jaw. For each patient, clinical and radiographic assessment was performed at regular intervals at the beginning (immediately after surgery), seven months, and a year following surgery. RESULTS: With the exception of bone density, which was statistically significant in favour of the osseo-densification group immediately after surgery, primary and secondary stability, plaque index, bleeding on probe, pocket depth and even marginal bone loss were not significantly different between the two groups in this investigation. CONCLUSION: Osseo-densification technique provided a better primary stability in the low density bone cases thus, can be consider as a trustworthy treatment for speeding up the healing process while also maintaining marginal bone integrity following loading. Use of specialized bur while drilling procedure improves the density around the implants. Show more

Keywords: Osseo-densification, low density bone, primary stability, implant success

DOI: 10.3233/THC-220048

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1117-1124, 2022

Authors: Soliman, Osama | Pflugmacher, Robert | Koch, Ernst MW | Mohamed, Hesham | van der Beck, Susanne | Abdallah, Hany | Bornemann, Rahel

Article Type: Research Article

Abstract: BACKGROUND: While pain in the severe sacroiliac joint (SIJ) is a common cause of lower back pain, SIJ disease is often overlooked as a diagnosis. OBJECTIVE: This study examines the extent of sufficient long-term pain relief and functional improvement in patients with SIJ syndrome that are treated with thermocoagulation. Some patients treated with thermocoagulation noted initial improvement, but the functionality and pain relief had limited duration and efficacy. Patients with insufficient improvement were recommended to undergo fusion surgery as an option for better and longer lasting results. METHOD: Patients with a long history …of back or pelvic problems were selected for the study. Endoscopic thermal coagulation of the SIJ was carried out. The follow-up examinations took place after 1, 3, 6, 12 months. In patients with insufficient pain relief and functionality after thermocoagulation, a fusion surgery was performed. The results of the fusion surgery were documented over a 12-month follow-up period. To carry out the statistical evaluation visual analog scale (VAS), Oswestry-Disability-Index (ODI) and the consumption of opioids were recorded. RESULTS: Forty-eight patients were included. The mean VAS values 12 months after thermocoagulation were 68.9. The ODI after 12 months was very near or somewhat higher than their baseline prior to the thermocoagulation. Thus, a fusion surgery was recommended. Thirty-three patients agreed to the fusion operation. The VAS values 12 months after fusion surgery decreased to 53.1. Analogous to the VAS values, the Oswestry index (ODI) showed a significant improvement after the fusion operation. CONCLUSION: The success of surgical intervention in 88% of the SIJ syndrome patients with inadequate results 12 months after thermocoagulation proves the superiority of SIJ fusion surgery. This study showed long-lasting pain relief by an average of 65% and a median improvement in functional impairments of 60%. In view of these results, fusion surgery should be considered for patients without sufficient success of thermocoagulation. Show more

Keywords: SIJ, thermal coagulation, fusion surgery, sacroiliac joints syndrome, implant systems, iFuse

DOI: 10.3233/THC-213183

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1125-1138, 2022

Authors: Kasapovic, Adnan | Schwetje, Desirée | Ali, Thaer | Jaenisch, Max | Gathen, Martin | Bornemann, Rahel | Abdallah, Hany | Vieweg, Uwe

Article Type: Research Article

Abstract: BACKGROUND: Sacroiliac joint (SIJ) painful dysfunction is a common source of low back pain (LBP). Several surgical treatment options for SIJ fusion were described. A promising treatment option with demonstrated clinical improvement is the minimally-invasive SIJ fusion. OBJECTIVE: The aim of this case study was to document the effectiveness and safety of the new SIJ system (Torpedo ® ) over a period of 6 months after the minimally invasive implantation. METHODS: Patients with failed conservative treatment of painful SIJ dysfunction were enrolled successively in two centers. The Diagnosis was made …by positive response to SIJ-injection with local anesthetic and at least by two positive SIJ provocation tests. The Torpedo ® Implant system was used for the implantation. This workpiece made of titanium alloy is characterized by a helical profile geometry (CST: chronical spinal turn) with a hydrophilic surface. The evaluated endpoints LBP and grade of disability were assessed using a 0–10 numerical rating scale (NRS), and Oswestry Disability Index (ODI) preoperatively and at one, three and six months postoperatively. RESULTS: 15 patients (10 female, 5 male; mean age 59 ± 13 years) were operated on one after the other. The pain intensity decreased in all 15 patients. After 6 months, a decrease in the median values of 70% (quartiles 1–3: 65–79%) was calculated. The median values of the Oswestry Disability Index after 6 months were 62% (quartiles 1–3: 53–67) lower than before the operation. Before surgery, 13 patients (87%) were taking opioids for pain management. Six months after the operation, opioids were only needed by 3 patients (20%). Implant malpositioning was not detected on plain radiograph. No surgical site infections or perioperative complications occurred. CONCLUSIONS: The clinical improvement in early follow up and the absence of surgery related complications demonstrate a high grade of device-related safety and effectiveness of the treatment with a novel minimally-invasive SIJ fusion system. Show more

Keywords: SIJ-syndrome, SIJ-pain, chronic pain, low back pain, SIJ-fusion

DOI: 10.3233/THC-213348

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1139-1145, 2022

Authors: Takahashi, Tsuneari | Sugimoto, Kazutaka | Ae, Ryusuke | Saito, Tomohiro | Kimura, Yuya | Kubo, Tatsuya | Handa, Mikiko | Takeshita, Katsushi

Article Type: Research Article

Abstract: BACKGROUND: Total knee arthroplasty (TKA) is a widely performed procedure to alleviate pain and restore function of patients with end-stage knee osteoarthritis. OBJECTIVE: The study aim was to determine if tibia-first (TF) total knee arthroplasty (TKA) using a novel computer-assisted surgery (CAS) system can yield better anterior and posterior (AP) knee stability. METHODS: Patients with knee osteoarthritis with obvious varus knee who met the indication for and underwent TKA from May 2019 to November 2020 were included. Forty-one measured resection (MR)-TKAs and 32 TF-TKAs were compared. The varus-valgus ligament balance and joint tension …at a joint center-gap setting equal to the tibial-baseplate thickness were measured, and appropriate polyethylene inserts with 0 ∘ , 30 ∘ , 45 ∘ , 60 ∘ , 90 ∘ , and 120 ∘ of knee flexion were placed. A Kneelax 3 arthrometer was used to measure knee AP laxity in the postoperative anesthetized patients with 30 ∘ and 90 ∘ of knee flexion. RESULTS: The horizontal gap balance was significantly closer in the TF-TKA group than the MR-TKA group for 0 ∘ , 30 ∘ , 45 ∘ , and 60 ∘ of knee flexion. In contrast, no significant differences were observed for 90 ∘ and 120 ∘ of knee flexion. No significant differences in joint-gap tensions among all knee-flexion angles were observed. Translation was significantly smaller in the TF-TKA group than the MR-TKA group for AP laxity with 30 ∘ of knee flexion (8.8 ± 2.9 mm vs. 10.7 ± 3.1 mm, P = 0.0079). In contrast, no significant AP laxity was observed with 90 ∘ of knee flexion (7.2 ± 2.8 mm vs. 7.2 ± 3.5 mm). CONCLUSION: TF-TKA using a novel CAS system provided better AP knee stability with close to horizontal gap balances. Show more

Keywords: Total knee arthroplasty, computer-assisted surgery, tibia-first technique, anterior and posterior knee stability, gap balance

DOI: 10.3233/THC-213535

Citation: Technology and Health Care, vol. 30, no. 5, pp. 1147-1154, 2022