Foot ulcers are a frequent and costly problem in people with diabetes mellitus and can lead to amputations. Prevention of these ulcers is therefore of paramount importance. Claw/hammer toe deformities are commonly seen in people with diabetes. These deformities increase the risk of ulcer development specifically at the (tip of) the toe. Percutaneous needle tenotomy of the tendon of the m. flexor digitorum longus (tendon tenotomy) can be used to reduce the severity of claw/hammer toe deformity with the goal to prevent ulcer recurrence. The main objective of this randomized controlled trial is to assess the efficacy of flexor tenotomy to prevent recurrence of toe ulcers in people with diabetes and a history of toe (pre-)ulcers. Additionally, we aim to assess interphalangeal joints (IPJ) and metatarsophalangeal joint (MTPJ) angles in a weight-bearing and non-weight-bearing position, barefoot plantar pressure during walking, cost-effectiveness and quality of life before and after the intervention and compare intervention and control study groups. Sixty-six subjects with diabetes and claw/hammer toe deformity and a recent history of (pre-)ulceration on the tip of the toe will be included and randomized between flexor tenotomy of claw/hammer toes (intervention) versus standard of care including orthosis and shoe offloading (controls) in a mono-center randomized controlled trial.
UNASSIGNED: NCT05228340.

Head and neck radiotherapy induces important toxicity, and its efficacy and tolerance vary widely across patients. Advancements in radiotherapy delivery techniques, along with the increased quality and frequency of image guidance, offer a unique opportunity to individualize radiotherapy based on imaging biomarkers, with the aim of improving radiation efficacy while reducing its toxicity. Various artificial intelligence models integrating clinical data and radiomics have shown encouraging results for toxicity and cancer control outcomes prediction in head and neck cancer radiotherapy. Clinical implementation of these models could lead to individualized risk-based therapeutic decision making, but the reliability of the current studies is limited. Understanding, validating and expanding these models to larger multi-institutional data sets and testing them in the context of clinical trials is needed to ensure safe clinical implementation. This review summarizes the current state of the art of machine learning models for prediction of head and neck cancer radiotherapy outcomes.

UNASSIGNED: The objective of this study was to use cone-beam computed tomography (CBCT) for intraoperative imaging of a pulmonary wedge resection line that contributes to securing the required surgical margin in patients undergoing thoracoscopic surgery for indistinct intrapulmonary lesions.
UNASSIGNED: Data of 16 consecutive patients with potentially impalpable intrapulmonary lesions were retrospectively reviewed. Preoperatively, we simulated a rhomboidal cut line on the surface of a 3-dimensional lung model with reference to multiplanar reconstruction computed tomography images. Intraoperatively, we imaged the rhomboid on the real lung surface using trial and error adjustment with CBCT. Wedge resection was performed thoracoscopically by stapling along the outline of the rhomboid.
UNASSIGNED: The mean consolidation diameter and mean distance between the tumor and the visceral pleura were 2 mm and 11 mm, respectively. In all cases, we only performed single CBCT scanning to localize the rhomboid on the real lung surface. The mean radiological distance between the approximate location and the correct location was 8 mm (range, 0-34 mm). Wedge resection was successful with a mean surgical margin of 11 mm (range, 7-16 mm), without conversion to anatomical resection or open conversion. This simulation was also helpful for planning port placement for the use of an autostapler.
UNASSIGNED: We established a novel procedure for imaging the cut line on the lung surface with intraoperative CBCT, which facilitated the performance of wedge resection with the required surgical margin in patients with potentially impalpable intrapulmonary small lesions. Our method might be beneficial for patients and surgeons because it can be applied without preoperative intervention.

UNASSIGNED: To evaluate the safety and efficacy of a novel wireless localization technique that uses radiofrequency identification markers for small and deep lung lesions.
UNASSIGNED: Preliminary use of the device was retrospectively evaluated in 2 Japanese centers. Under general anesthesia, a marker was placed as close as possible to the tumor via computed tomography-guided bronchoscopy in a hybrid operation theater. Surgeons located the marker without lung palpation using a detection probe the tone of which changed to indicate the marker-probe distance. Efficacy was defined as functional marker placement (bronchoscopy time and marker position) and deep margin distance.
UNASSIGNED: Twelve markers were placed for 11 lesions (mean size, 6.8 ± 2.7 mm) located at a mean depth from the pleura of 11.4 ± 8.4 mm (range = 0-26.0 mm). Of 12 markers, 7 markers (58.3%) were placed within 10 mm from the lesion in 25.5 ± 14.4 minutes. For the 11 wedge resections, markers were placed at a mean distance of 6.7 mm (range, 0-13.0 mm) from the lesion and a mean distance of 14.4 mm (range, 3.0-42.0 mm) from the pleura. All markers were recovered without complications, and all tumors were resected with negative margins. For 5 lesions >10 mm deep to the pleura (mean depth, 18.9 ± 5.5 mm; range, 11.0-26.0 mm), the median depth of the surgical margin was 11.6 ± 2.1 mm (range, 9.0-14.0 mm).
UNASSIGNED: Radiofrequency identification marking was safe and precisely localized small lung lesions, including their depth.

UNASSIGNED: To determine whether CT-to-body divergence can be overcome to improve the diagnostic yield of peripheral pulmonary nodules with the combination of shape-sensing robotic-assisted bronchoscopy (SSRAB) and portable 3-dimensional (3D) imaging.
UNASSIGNED: A single-center, prospective, pilot study was conducted from February 9, 2021, to August 4, 2021, to evaluate the combined use of SSRAB and portable 3D imaging to visualize tool-in-lesion as a correlate to diagnostic yield.
UNASSIGNED: Thirty lesions were subjected to biopsy in 17 men (56.7%) and 13 women (43.3%). The median lesion size was 17.5 mm (range, 10-30 mm), with the median airway generation of 7 and the median distance from pleura of 14.9 mm. Most lesions were in the upper lobes (18, 60.0%). Tool-in-lesion was visualized at the time of the procedure in 29 lesions (96.7%). On the basis of histopathologic review, 22 (73.3%) nodules were malignant and 6 (20.0%) were benign. Two (6.7%) specimens were suggestive of inflammation, and the patients elected observation. The mean number of spins was 2.5 (±1.6) with a mean fluoroscopy time of 8.7 min and a mean dose area product of 50.3 Gy cm2 (±32.0 Gy cm2). There were no episodes of bleeding or pneumothorax. The diagnostic yield was 93.3%.
UNASSIGNED: This pilot study shows that the combination of mobile 3D imaging and SSRAB of pulmonary nodules appears to be safe and feasible. In conjunction with appropriate anesthetic pathways, nodule motion and divergence can be overcome in most patients.
UNASSIGNED: https://clinicaltrials.gov Identifier NCT04740047.

OBJECTIVE: The prevalence of the middle distal (MD) canal in the mandibular molar is significantly low among countries including the USA, Spain, Turkey, and Jordan; however, analysis of its prevalence and configuration has not been performed in Saudi Arabia. Therefore, we aimed to assess the prevalence and configuration of the MD canal in Saudi Arabia.
METHODS: A retrospective analysis of 132 cone-beam computed tomography (CBCT) images was performed to evaluate the presence of the MD canal in patients visiting the Radiology Department of The College of Dentistry in King Saud University between July 2018 and July 2019. The canal was examined if it was confluent with the distobuccal (DB) or distolingual (DL) canals, fin, or independent. Moreover, the distances from the MD canal to the DL and DB canals and cementoenamel junction (CEJ) were recorded.
RESULTS: One MD canal (0.7%) was observed in 145 teeth. It was confluent with the DL canal. No statistical significance was observed among sex and age. The distances from the MD canal to the DL canal, DB canal, and CEJ were 1.4 mm, 1.9 mm, and 3.1 mm, respectively.
CONCLUSIONS: The prevalence of the MD canal was significantly low in a Saudi subpopulation (0.7%). Careful evaluation of CBCT images and the pulpal floor is significantly important to detect the MD canal to ensure a good prognosis.

Calcinosis is frequently observed in patients with systemic sclerosis (SSc). The fundamental treatment of calcinosis has not yet been established. During follow-up, calcinosis in the subcutaneous surface is often spontaneously extracted or remains confined by fibrous tissues. We previously identified a new symptom in SSc patients, multiple external root resorption (MERR), and these patients had calcifications in the nasal spine. Here, we report for the first time that calcinosis at the nasal spine in patients with MERR can be replaced by cancellous bone-like tissue. Patients 1 and 2 were a 62-year-old Japanese female and a 45-year-old Japanese female (respectively) with MERR who had been previously treated for SSc (Patient 1: limited type, positive for anti-centromere antibody; Patient 2: diffuse type, positive for anti-Scl70 and anti-SS-A antibodies). Patient 3 was a 57-year-old female with MERR who had been previously treated for SSc (diffuse type, positive anti-Scl-70 antibody) and underwent denosumab injection for osteoporosis. Cone-beam computed tomography (CBCT) and CT images in the calcifications at the nasal spine in Patient 1 and 2 were replaced with cancellous bone-like tissue, but not in Patient 3. Serum laboratory examination was performed to assess the systemic bone disease. All three patients had normal clinical data within the references, apart from slightly higher 1,25-dihydroxyvitamin D levels in Patient 1. SSc patients with calcinosis in the maxillofacial area need to be examined carefully for bone replacement using CBCT or CT.

OBJECTIVE: Explore the longitudinal CT-based radiomics to demonstrate the changing trend of radiotherapy response and to determine at which point after the onset of treatment radiomics exhibit the greatest change for stage III NSCLC patients.
METHODS: Ten stage III NSCLC patients in line with inclusion criteria were enrolled retrospectively, each of whom received radiotherapy or concurrent chemo-radiotherapy and performed eight series of follow-up CT imaging. Longitudinal radiomics were extracted on region of interest from the eight registered images, then two steps were conducted to select significant features as indicators of tumor change: 1) stable features were selected by Kendall rank correlation; 2) texture feature types with a steadily changing trend were retained and intensity features with stable change trends were selected to represent the large number of them. Next, the trend and rate of tumor change were analyzed using the Delta method and Curve-fitting method. Finally, the statistics in the distribution of stable features in patients were calculated.
RESULTS: 675 stable features were selected from a total number of 1371 radiomics features, then 12 texture features types were retained and three intensity features were chosen to represent their own category. Among the final selected feature types, it was found that the two time points were weeks 1 and 3 with the higher rate of change. One patient had very few stable tumor features out of a total of 101 features, and the rate of change of features of another patient was conspicuously higher than the average level with number of 301 features.
CONCLUSIONS: The longitudinal CT radiomics could demonstrate the change trend of tumor and at which point exhibit the greatest change during radiotherapy, and potentially be used for treatment decisions concerning adaptive radiotherapy.

We describe an 81-year-old man with end-stage renal disease and central venous occlusion who was referred for dialysis access creation. This case illustrates a novel percutaneous image fusion-guided recanalization of an occluded right subclavian vein and brachiocephalic vein stent in a patient with limited remaining dialysis access sites. (Level of Difficulty: Advanced.).

UNASSIGNED: To investigate the potential of texture analysis and machine learning to predict treatment response to transarterial radioembolization (TARE) on pre-interventional cone-beam computed tomography (CBCT) images in patients with liver metastases.
UNASSIGNED: In this IRB-approved retrospective single-center study 36 patients with a total of 104 liver metastases (56 % male, mean age 61.1 ± 13 years) underwent CBCT prior to TARE and follow-up imaging 6 months after therapy. Treatment response was evaluated according to RECIST version 1.1 and dichotomized into disease control (partial response/stable disease) versus disease progression (progressive disease). After target lesion segmentation, 104 radiomics features corresponding to seven different feature classes were extracted with the pyRadiomics package. After dimension reduction machine learning classifications were performed on a custom artificial neural network (ANN). Ten-fold cross validation on a previously unseen test data set was performed.
UNASSIGNED: The average administered cumulative activity from TARE was 1.6 Gbq (± 0.5 Gbq). At a mean follow-up of 5.9 ± 0.8 months disease control was achieved in 82 % of metastases. After dimension reduction, 15 of 104 (15 %) texture analysis features remained for further analysis. On a previously unseen set of liver metastases the Multilayer Perceptron ANN yielded a sensitivity of 94.2 %, specificity of 67.7 % and an area-under-the receiver operating characteristics curve of 0.85.
UNASSIGNED: Our study indicates that texture analysis-based machine learning may has potential to predict treatment response to TARE using pre-treatment CBCT images of patients with liver metastases with high accuracy.