Publications by authors named "Walter Wiggins"

Accurate, automated MRI series identification is important for many applications, including display ("hanging") protocols, machine learning, and radiomics. The use of the series description or a pixel-based classifier each has limitations. We demonstrate a combined approach utilizing a DICOM metadata-based classifier and selective use of a pixel-based classifier to identify abdominal MRI series.

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The transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a novel approach available for the management of lumbar spondylolisthesis. It avoids the need to manipulate either of the exiting or traversing nerve roots, both protected by the bony boundaries of the approach. With the advancement in operative technologies such as navigation, mapping, segmentation, and augmented reality (AR), surgeons are prompted to utilize these technologies to enhance their surgical outcomes.

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Article Synopsis
  • - The study aimed to determine if earlier brain MRIs from patients receiving multiple courses of stereotactic radiosurgery (SRS) showed signs of undetected brain metastases that later needed treatment.
  • - Researchers reviewed MRIs from 683 patients, finding that 128 of the 345 treated metastases in follow-up courses corresponded to retrospectively identified lesions, or "retrospectively identified metastases" (RIMs), which were classified based on imaging criteria.
  • - Results indicated that many RIMs could indicate future treatment needs; specifically, a significant percentage of RIMs met diagnostic criteria, suggesting improved detection methods could lead to earlier intervention and fewer SRS sessions.
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  • The study focuses on severe central nervous system (CNS) manifestations, such as seizures and encephalopathy, in six children with infantile-onset Pompe disease (IOPD), which typically is treated with enzyme replacement therapy (ERT) that does not affect the brain.
  • All six patients, treated with ERT for 12-15 years, showed significant white matter hyperintensities (WMHI) on MRI scans, which occurred before the onset of neurological symptoms, with seizure onset at a median age of 11.9 years.
  • The findings indicate a need for further research into CNS-related issues in IOPD, as cognitive evaluations suggest developmental plateaus and there may be a link between CNS symptoms and WMHI
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Background And Objectives: There has been a rise in minimally invasive methods to access the intervertebral disk space posteriorly given their decreased tissue destruction, lower blood loss, and earlier return to work. Two such options include the percutaneous lumbar interbody fusion through the Kambin triangle and the endoscopic transfacet approach. However, without accurate preoperative visualization, these approaches carry risks of damaging surrounding structures, especially the nerve roots.

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The Duke Liver Dataset contains 2146 abdominal MRI series from 105 patients, including a majority with cirrhotic features, and 310 image series with corresponding manually segmented liver masks.

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Meningiomas are the most common primary intracranial tumor in adults and can be associated with significant morbidity and mortality. Radiologists, neurosurgeons, neuro-oncologists, and radiation oncologists rely on multiparametric MRI (mpMRI) for diagnosis, treatment planning, and longitudinal treatment monitoring; yet automated, objective, and quantitative tools for non-invasive assessment of meningiomas on mpMRI are lacking. The BraTS meningioma 2023 challenge will provide a community standard and benchmark for state-of-the-art automated intracranial meningioma segmentation models based on the largest expert annotated multilabel meningioma mpMRI dataset to date.

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  • Automated brain tumor segmentation methods have reached a level of performance that is clinically useful, relying on MRI modalities like T1, T2, and FLAIR images.
  • These methods often face challenges due to missing sequences caused by issues like time constraints and patient motion, making it crucial to find ways to substitute missing modalities for better segmentation.
  • The Brain MR Image Synthesis Benchmark (BraSyn) was established to evaluate image synthesis techniques that can generate these missing MRI modalities, aiming to enhance the automation of brain tumor segmentation processes.
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Background: There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy.

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Article Synopsis
  • Gliomas are the most common and deadliest primary brain tumors, with a survival rate under 2 years post-diagnosis, and pose significant challenges in diagnosis and treatment, especially in low- and middle-income countries.
  • While research has improved treatment outcomes in wealthier regions, survival rates remain poor in places like Sub-Saharan Africa due to late diagnosis and lower-quality MRI technology.
  • The BraTS-Africa Challenge aims to integrate glioma MRI cases from Sub-Saharan Africa into global efforts to develop advanced computer-aided diagnostic tools that could improve detection and treatment in resource-limited healthcare settings.
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The translation of AI-generated brain metastases (BM) segmentation into clinical practice relies heavily on diverse, high-quality annotated medical imaging datasets. The BraTS-METS 2023 challenge has gained momentum for testing and benchmarking algorithms using rigorously annotated internationally compiled real-world datasets. This study presents the results of the segmentation challenge and characterizes the challenging cases that impacted the performance of the winning algorithms.

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Objective: While Kambin's Triangle has become an ever more important anatomic window given its proximity to the exiting nerve root, there have been limited studies examining the effect of disease on the corridor. Our goal was to better understand how pathology can affect Kambin's Triangle, thereby altering the laterality of approach for percutaneous lumbar interbody fusion (percLIF).

Methods: The authors performed a single-center retrospective review of patients evaluated for percLIF.

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Purpose: To investigate the effect of training data type on generalizability of deep learning liver segmentation models.

Materials And Methods: This Health Insurance Portability and Accountability Act-compliant retrospective study included 860 MRI and CT abdominal scans obtained between February 2013 and March 2018 and 210 volumes from public datasets. Five single-source models were trained on 100 scans each of T1-weighted fat-suppressed portal venous (dynportal), T1-weighted fat-suppressed precontrast (dynpre), proton density opposed-phase (opposed), single-shot fast spin-echo (ssfse), and T1-weighted non-fat-suppressed (t1nfs) sequence types.

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Pediatric tumors of the central nervous system are the most common cause of cancer-related death in children. The five-year survival rate for high-grade gliomas in children is less than 20%. Due to their rarity, the diagnosis of these entities is often delayed, their treatment is mainly based on historic treatment concepts, and clinical trials require multi-institutional collaborations.

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Background: For percutaneous lumbar fusion (percLIF), magnetic resonance imaging and computed tomography are critical to defining surgical corridors. Currently, these scans are performed separately, and surgeons then use fluoroscopy or neuromonitoring to guide instruments through Kambin's triangle. However, anatomic variations and intraoperative positional changes are possible, meaning that safely accessing Kambin's triangle remains a challenge because nerveroot visualization without endoscopes has not been thoroughly described.

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Non-contrast head CT (NCCT) is extremely insensitive for early (< 3-6 h) acute infarct identification. We developed a deep learning model that detects and delineates suspected early acute infarcts on NCCT, using diffusion MRI as ground truth (3566 NCCT/MRI training patient pairs). The model substantially outperformed 3 expert neuroradiologists on a test set of 150 CT scans of patients who were potential candidates for thrombectomy (60 stroke-negative, 90 stroke-positive middle cerebral artery territory only infarcts), with sensitivity 96% (specificity 72%) for the model versus 61-66% (specificity 90-92%) for the experts; model infarct volume estimates also strongly correlated with those of diffusion MRI (r > 0.

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Objective: The authors sought to analyze the current literature to determine dimensional trends across the lumbar levels of Kambin's triangle, clarify the role of imaging techniques for preoperative planning, and understand the effect of inclusion of the superior articular process (SAP). This compiled knowledge of the triangle is needed to perform successful procedures, reduce nerve root injuries, and help guide surgeons in training.

Methods: The authors performed a search of multiple databases using combinations of keywords: Kambin's triangle, size, measurement, safe triangle, and bony triangle.

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Purpose: We sought to develop a computer-aided detection (CAD) system that optimally augments human performance, excelling especially at identifying small inconspicuous brain metastases (BMs), by training a convolutional neural network on a unique magnetic resonance imaging (MRI) data set containing subtle BMs that were not detected prospectively during routine clinical care.

Methods And Materials: Patients receiving stereotactic radiosurgery (SRS) for BMs at our institution from 2016 to 2018 without prior brain-directed therapy or small cell histology were eligible. For patients who underwent 2 consecutive courses of SRS, treatment planning MRIs from their initial course were reviewed for radiographic evidence of an emerging metastasis at the same location as metastases treated in their second SRS course.

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As the role of artificial intelligence (AI) in clinical practice evolves, governance structures oversee the implementation, maintenance, and monitoring of clinical AI algorithms to enhance quality, manage resources, and ensure patient safety. In this article, a framework is established for the infrastructure required for clinical AI implementation and presents a road map for governance. The road map answers four key questions: Who decides which tools to implement? What factors should be considered when assessing an application for implementation? How should applications be implemented in clinical practice? Finally, how should tools be monitored and maintained after clinical implementation? Among the many challenges for the implementation of AI in clinical practice, devising flexible governance structures that can quickly adapt to a changing environment will be essential to ensure quality patient care and practice improvement objectives.

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Artificial intelligence (AI) tools are rapidly being developed for radiology and other clinical areas. These tools have the potential to dramatically change clinical practice; however, for these tools to be usable and function as intended, they must be integrated into existing radiology systems. In a collaborative effort between the Radiological Society of North America, radiologists, and imaging-focused vendors, the Imaging AI in Practice (IAIP) demonstrations were developed to show how AI tools can generate, consume, and present results throughout the radiology workflow in a simulated clinical environment.

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Background: Minimally invasive spine surgery (MISS) has the potential to further advance with the use of robot-assisted (RA) techniques. While RA pedicle screw placement has been extensively investigated, there is a lack of literature on the use of the robot for other tasks, such as accessing Kambin's triangle in percutaneous lumbar interbody fusion (percLIF).

Objective: To characterize the surgical feasibility and preliminary outcomes of an initial case series of 10 patients receiving percLIF with RA cage placement via Kambin's triangle.

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This report presents a hands-on introduction to natural language processing (NLP) of radiology reports with deep neural networks in Google Colaboratory (Colab) to introduce readers to the rapidly evolving field of NLP. The implementation of the Google Colab notebook was designed with code hidden to facilitate learning for noncoders (ie, individuals with little or no computer programming experience). The data used for this module are the corpus of radiology reports from the Indiana University chest x-ray collection available from the National Library of Medicine's Open-I service.

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