Purpose Bisphophonate-related osteonecrosis of the jaw (BRONJ) is an emerging problem. Extensive osteonecrosis of the jaw needs free flap reconstruction. Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction. The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla. In this study, four consecutive BRONJ patients who underwent fibula free flap reconstruction using simulation surgery were reviewed. Materials and Methods Four BRONJ patients who underwent free fibula reconstruction between May 2006 and September 2014 were included in this study. Male to female ratio was 1:3 and average age was 67.3 years old (62-70). All patients need mandibular bone reconstruction. Three patients suffered from osteoporosis and one male patient had multiple myeloma. Postoperative flap survival, functional reconstruction, esthetic results, food taking were evaluated. Results Three osseous flaps and one osteocutaneous flap were used. All the fibular flaps were survived and patients were recovered without complications. Oro-cutaneous fistula was resolved after operation. All patients were satisfied with the esthetic results. Patients reported improved solid food intake after operation with partial denture. One fully edentulous patient had semi-fluid diet after operation. Conclusion Treatment of the BRONJ is difficult due to lack of standard protocol. Fibular free flap using simulation surgery is the workhorse flap for mandibular hard and soft tissue reconstruction, especially in stage III BRONJ patient. In this study, functional and esthetic results were successful in all patients. Normal diet was possible with partial dentures.

Purpose In the many face-related application such as head pose estimation, 3D face modeling, facial appearance manipulation, the robust and fast facial feature extraction is necessary. We present the facial feature extraction method based on shape regression and feature selection for real-time facial feature extraction. Materials and Methods The facial features are initialized by statistical shape model and then the shape of facial features are deformed iteratively according to the texture pattern which is selected on the feature pool. Results We obtain fast and robust facial feature extraction result with error less than 4% and processing time less than 12 ms. The alignment error is measured by average of ratio of pixel difference to inter-ocular distance. Conclusion The accuracy and processing time of the method is enough to apply facial feature based application and can be used on the face beautification or 3D face modeling.

Purpose It has been stated that patient satisfaction is the crucial factor for determining success in plastic surgery. The convergence of medical science and computer vision has made easier to satisfy patients who wants to have plastic surgery. In this paper, we try to apply 3D face modeling in plastic surgical area. Materials and Methods The author introduces a method for accurate 3D face modeling techniques using a statistical model-based 3D face modeling approach in a mirror system. Results We could successfully obtain highly accurate 3D face shape results. Conclusion The method suggested could be used for acquiring 3D face models from 2D face image and the result obtained from this could be effectively used for plastic surgical areas.

Purpose We conducted a study on the reconstruction of the head's shape in 3D using the ToF depth sensor. A time-of-flight camera (ToF camera) is a range imaging camera system that resolves distance based on the known speed of light, measuring the time-of-flight of a light signal between the camera and the subject for each point of the image. The above method is the safest way of measuring the head shape of plagiocephaly patients in 3D. The texture, appearance and size of the head were reconstructed from the measured data and we used the SDF method for a precise reconstruction. Materials and Methods To generate a precise model, mesh was generated by using Marching cube and SDF. Results The ground truth was determined by measuring 10 people of experiment participants for 3 times repetitively and the created 3D model of the same part from this experiment was measured as well. Measurement of actual head circumference and the reconstructed model were made according to the layer 3 standard and measurement errors were also calculated. As a result, we were able to gain exact results with an average error of 0.9 cm, standard deviation of 0.9, min: 0.2 and max: 1.4. Conclusion The suggested method was able to complete the 3D model by minimizing errors. This model is very effective in terms of quantitative and objective evaluation. However, measurement range somewhat lacks 3D information for the manufacture of protective helmets, as measurements were made according to the layer 3 standard. As a result, measurement range will need to be widened to facilitate production of more precise and perfectively protective helmets by conducting scans on all head circumferences in the future.

Purpose In this paper, we propose a robust 3D vessel tracking algorithm by utilizing an active contour model and unscented Kalman filter which are the two representative algorithms on segmentation and tracking. Materials and Methods The proposed algorithm firstly accepts user input to produce an initial estimate of vessel boundary segmentation. On each Computed Tomography Angiography (CTA) slice, the active contour is applied to segment the vessel boundary. After that, the estimation process of the unscented Kalman filter is applied to track the vessel boundary of the current slice to estimate the inter-slice vessel position translation and shape deformation. Finally both active contour and unscented Kalman filter are inter-operated for vessel segmentation of the next slice. Results The arbitrarily shaped blood vessel boundary on each slice is segmented by using the active contour model, and the Kalman filter is employed to track the translation and shape deformation between CTA slices. The proposed algorithm is applied to the 3D visualization of chest CTA images using graphics hardware. Conclusion Through this algorithm, more opportunities, giving quick and brief diagnosis, could be provided for the radiologist before detailed diagnosis using 2D CTA slices, Also, for the surgeon, the algorithm could be used for surgical planning, simulation, navigation and rehearsal, and is expected to be applied to highly valuable applications for more accurate 3D vessel tracking and rendering.

Purpose When a surgeon examines the morphology of skull of patient, locations of craniometric landmarks of 3D computed tomography(CT) volume are one of the most important information for surgical purpose. The locations of craniometric landmarks can be found manually by surgeon from the 3D rendered volume or 2D sagittal, axial, and coronal slices which are taken by CT. Since there are many landmarks on the skull, finding these manually is time-consuming, exhaustive, and occasionally inexact. These inefficiencies raise a demand for a automatic localization technique for craniometric landmark points. So in this paper, we propose a novel method through which we can automatically find these landmark points, which are useful for surgical purpose. Materials and Methods At first, we align the experimental data (CT volumes) using Frankfurt Horizontal Plane (FHP) and Mid Sagittal Plane(MSP) which are defined by 3 and 2 cranial landmark points each. The target landmark of our experiment is the anterior nasal spine. Prior to constructing a statistical cubic model which would be used for detecting the location of the landmark from a given CT volume, reference points for the anterior nasal spine were manually chosen by a surgeon from several CT volume sets. The statistical cubic model is constructed by calculating weighted intensity means of these CT sets around the reference points. By finding the location where similarity function (squared difference function) has the minimal value with this model, the location of the landmark can be found from any given CT volume. Results In this paper, we used 5 CT volumes to construct the statistical cubic model. The 20 CT volumes including the volumes, which were used to construct the model, were used for testing. The range of age of subjects is up to 2 years (24 months) old. The found points of each data are almost close to the reference point which were manually chosen by surgeon. Also it has been seen that the similarity function always has the global minimum at the detection point. Conclusion Through the experiment, we have seen the proposed method shows the outstanding performance in searching the landmark point. This algorithm would make surgeons efficiently work with morphological informations of skull. We also expect the potential of our algorithm for searching the anatomic landmarks not only cranial landmarks.

Purpose The head of infants under 24 months old who has Craniosynostosis grows extraordinarily that makes head shape unusual. To diagnose the Craniosynostosis, surgeon has to inspect computed tomography(CT) images of the patient in person. It's very time consuming process. Moreover, without a surgeon, it's difficult to diagnose the Craniosynostosis. Therefore, we developed technique which detects Craniosynostosis automatically from the CT volume. Materials and Methods At first, rotation correction is performed to the 3D CT volume for detection of the Craniosynostosis. Then, cranial area is extracted using the iterative thresholding method we proposed. Lastly, we diagnose Craniosynostosis by analyzing centroid relationships of clusters of cranial bone which was divided by cranial suture. Results Using this automatical cranial detection technique, we can diagnose Craniosynostosis correctly. The proposed method resulted in 100% sensitivity and 90% specificity. The method perfectly diagnosed abnormal patients. Conclusion By plugging-in the software on CT machine, it will be able to warn the possibility of Craniosynostosis. It is expected that early treatment of Craniosynostosis would be possible with our proposed algorithm.

Purpose Usability is an important factor in our life. This paper presents an approach to design the clinical work-flow for ultrasound system. And, we tried to apply this work-flow in diagnosis ultrasound system. Materials and Methods For user learnability, we follow international standard IEC 60601-1-1 and IEC 62366 which describes usability of medical instrument. User requirement are applied by 10 clinicians who are well aware of usability. We considered user environment and designed clinical work-flow into two types: general use and emergency use. The designed clinical work-flow was evaluated by 10 clinicians and results derived from the evaluation were analyzed. Results We could successfully design optimized clinical workflow of ultrasound system. Conclusion This paper suggests usability testing for optimized ultrasound clinical workflow. Using this clinical work flow, users can enhance their clinical performance and reduce operation time.

Recent progress on CT such as multi-detector row CT, oral contrast agents and multiplanar reconstruction have markedly improved the image quality as well as diagnostic performance of gastric cancer. Multiplanar reformatted images at predetermined orientations can be easily performed and embedded into routine CT protocol without increasing medical expense or labor. Currently, many institutions have adopted routine multiplanar reformatted protocols and therefore knowledge on them can improve the diagnostic accuracy of gastric cancer.