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"Moore, Randy"
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Deep-learning method for fully automatic segmentation of the abdominal aortic aneurysm from computed tomography imaging
Abdominal aortic aneurysm (AAA) is one of the leading causes of death worldwide. AAAs often remain asymptomatic until they are either close to rupturing or they cause pressure to the spine and/or other organs. Fast progression has been linked to future clinical outcomes. Therefore, a reliable and efficient system to quantify geometric properties and growth will enable better clinical prognoses for aneurysms. Different imaging systems can be used to locate and characterize an aneurysm; computed tomography (CT) is the modality of choice in many clinical centers to monitor later stages of the disease and plan surgical treatment. The lack of accurate and automated techniques to segment the outer wall and lumen of the aneurysm results in either simplified measurements that focus on few salient features or time-consuming segmentation affected by high inter- and intra-operator variability. To overcome these limitations, we propose a model for segmenting AAA tissues automatically by using a trained deep learning-based approach. The model is composed of three different steps starting with the extraction of the aorta and iliac arteries followed by the detection of the lumen and other AAA tissues. The results of the automated segmentation demonstrate very good agreement when compared to manual segmentation performed by an expert.
Journal Article
Low Earth Orbit Communication Satellites: A Positively Disruptive Technology That Could Change the Delivery of Health Care in Rural and Northern Canada
Canada is a progressive nation that endeavors to provide comprehensive, universal, and portable health care to all its citizens. This is a challenge for a country with a population of 40 million living within a land expanse of 10 million km2 and where 18% live in rural or highly remote locations. The combined population of Yukon, Northwest Territories, and Nunavut is only 128,959 (0.32% of the population), living within 3.92 million km2, and many of these citizens live in isolated communities with unique health needs and social issues. The current solution to providing health care in the most remote locations has been to transport the patient to the health care provider or vice versa, which incurs considerable financial strain on our health care system and personal stress to the patient and provider. The recent global deployment of low Earth orbit communication satellites (LEO-ComSats) will change the practice and availability of online medicine everywhere, especially in northern Canada. The deployment of LEO-ComSats could result in disruptive but positive changes in medical care for underserved communities in remote geographic locations across Canada. LEO-ComSats can be used to demonstrate online medical encounters between a patient and a doctor in Canada, separated by thousands of kilometers. Most certainly, the academic medical centers in lower Canada could perform online telementored medical care to our northern communities like the remote care provided to many Canadians during the COVID-19 pandemic. An online health care model requires effective design, testing, and validation of the policies, standards, requirements, procedures, and protocols. Although the COVID-19 pandemic was the initial prime mover across all of Canada in the use of online medical encounters and creating rapidly devised reimbursement models, it was nonetheless created reactively, using real-time managerial fiat and poorly defined procedures based on minimal pedagogical experience, which made it “difficult to prove it was universally safe.” It is essential to proactively derive the medical policies, standards, and procedures for telementored medicine and “prove it is safe” before LEO-ComSat technology is ubiquitously deployed in northern Canada. This viewpoint was written by subject matter experts who have researched online and internet-based medicine for many years, sometimes 3 decades. In many cases, a literature review was not necessary since they already had the articles in the bibliography or knowledge in their possession. In many cases, internet search engines (ie, Google or PubMed) and Canadian government documents were used to provide corroborating evidence.
Journal Article
Complications of cerebrospinal fluid drainage in thoracoabdominal aortic procedures
Cerebrospinal fluid (CSF) drainage is used to reduce spinal cord ischemia (SCI) in patients undergoing thoracoabdominal aortic procedures. Recent literature has found high rates of complication associated with CSF drainage, which has led to changes in practice. The aim of this study was to investigate rates of CSF drain-related complications in patients undergoing a thoracoabdominal aortic procedure with perioperative placement of a CSF drain.
We conducted a single-centre retrospective cohort study. We defined major complications as intracranial hemorrhage, epidural hematoma or abscess, meningitis, and catheter retention requiring a reoperation. Minor complications assessed included drain-induced neurologic deficits, CSF leak, postdural puncture headache, asymptomatic blood in the CSF, drain failure, and catheter retention not requiring a reoperation. We recorded postoperative neurologic deficits as secondary outcomes.
There were 129 patients who met the inclusion criteria. We found 5 cases of permanent paraplegia in the overall cohort (3.9%), with only 2 occurring in the patients with prophylactic CSF drains (1.6%). There were no major CSF drain-related complications. The rate of minor complications was 17.8%. We found no association between complication rates and indication for procedure or type of operation.
The lack of major complications in this series adds to existing variability in recent literature and provides support for continued use of this adjunct for SCI prevention. Further research is required to identify the etiology of significant differences in CSF drain complication rates seen at other centres.
Journal Article
The Joneses
The Joneses, a seemingly perfect family, are the envy of their posh, suburban neighborhood filled with all the trappings of the upper middle class. They are the ultimate trend setters with an endless supply of high-tech toys, designer clothes, fast cars and the latest gadgets. But as the neighbors try to keep up with the Joneses, none are prepared for the truth about this all too perfect family.
DVD
Local Quantification of Wall Thickness and Intraluminal Thrombus Offer Insight into the Mechanical Properties of the Aneurysmal Aorta
Wall stress is a powerful tool to assist clinical decisions in rupture risk assessment of abdominal aortic aneurysms. Key modeling assumptions that influence wall stress magnitude and distribution are the inclusion or exclusion of the intraluminal thrombus in the model and the assumption of a uniform wall thickness. We employed a combined numerical-experimental approach to test the hypothesis that abdominal aortic aneurysm (AAA) wall tissues with different thickness as well as wall tissues covered by different thrombus thickness, exhibit differences in the mechanical behavior. Ultimate tissue strength was measured from
in vitro
tensile testing of AAA specimens and material properties of the wall were estimated by fitting the results of the tensile tests to a histo-mechanical constitutive model. Results showed a decrease in tissue strength and collagen stiffness with increasing wall thickness, supporting the hypothesis of wall thickening being mediated by accumulation of non load-bearing components. Additionally, an increase in thrombus deposition resulted in a reduction of elastin content, collagen stiffness and tissue strength. Local wall thickness and thrombus coverage may be used as surrogate measures of local mechanical properties of the tissue, and therefore, are possible candidates to improve the specificity of AAA wall stress and rupture risk evaluations.
Journal Article
Did Humans Live with Dinosaurs? Excavating “Man Tracks” Along the Paluxy River
The alleged “man tracks” beside dinosaur tracks near Glen Rose, Texas, are among the most enduring pieces of evidence used by young-Earth creationists to reject evolution. Despite the tracks' fame, their most persistent advocate — that is, Carl Baugh of the Creation Evidence Museum — has published neither (1) peer-reviewed papers in scientific journals about the tracks nor (2) clear, convincing, unenhanced photographs of unaltered tracks taken during an excavation. I participated in an excavation sponsored by Baugh's Creation Evidence Museum that uncovered three “man tracks” that Baugh and his assistants verified as being made by humans. These “tracks” are presented here and are among the first clear, unenhanced photographs of freshly uncovered “man tracks” taken during a Baugh-led excavation. They look no different than any of the countless other scuffs, cracks, and erosion marks in the area.
Journal Article