MRI is preferred over CT in paediatric imaging because it avoids ionising radiation, but its use in spine deformity assessment is largely limited by the lack of automated, high-resolution 3D bony reconstruction, which continues to rely on CT. MRI-based 3D reconstruction remains impractical due to manual workflows and the scarcity of labelled full-spine datasets. This study introduces an AI framework that enables fully automated thoracolumbar spine (T1-L5) segmentation and 3D reconstruction from MRI alone. Historical low-dose CT scans from adolescent idiopathic scoliosis (AIS) patients were converted into MRI-like images using a GAN and combined with existing labelled thoracic MRI data to train a U-Net-based model. The resulting algorithm accurately generated continuous thoracolumbar 3D reconstructions, improved segmentation accuracy (88

Background:Adolescent idiopathic scoliosis (AIS) is the most common three-dimensional spinal deformity, predominantly affecting females aged 10-16 years. Although no single etiological factor has been definitively identified, alterations in bone quality and biomechanical properties have been proposed as contributing factors to AIS development. Methods:We developed a surgical protocol to obtain trabecular bone biopsies from the apex vertebra during anterior corrective surgery for AIS. Multimodal analysis was performed on samples from eight AIS participants (14.8 ± 1.5 years), including microstructural assessment via micro-computed tomography (micro-CT), bone mineral density distribution (BMDD) via quantitative backscattered electron imaging (qBEI), and mechanical characterization via nanoindentation. Correlations with major curve angle, apical wedge angle, and Risser grade were investigated. Results:Mean trabecular bone volume fraction (BV/TV) was 0.146 ± 0.029, comparable to values reported in healthy populations. Mean trabecular thickness (Tb.Th) was 0.146 ± 0.011 mm, suggesting slightly thicker trabeculae than typically reported in healthy young cohorts. BMDD analysis revealed CaPeak values of 23.34 ± 1.02 wt% Ca, and greater CaWidth values (4.26 ± 0.33 wt% Ca) compared to healthy adolescent and adult reference data. CaPeak was significantly negatively correlated with apical wedge angle, indicating lower mineralization with increasing vertebral wedging. Nanoindentation showed a negative association between reduced modulus (13.37 ± 2.5 GPa) and apical wedge angle, with hardness values of 0.412 ± 0.079 GPa. Conclusions:These findings provide novel insights into vertebral trabecular bone alterations in AIS and their association with deformity severity. To our knowledge, this is the first study to integrate micro-CT, qBEI, and nanoindentation analyses in AIS vertebral biopsies, revealing structural, compositional, and mechanical differences that may contribute to the pathogenesis and progression of AIS.

This study investigates blood pressure variations and clinical outcomes in paediatric neuromuscular scoliosis patients after deformity correction surgery to mitigate the risk of ischaemic spinal cord injury (SCI). Hypotension is proposed as an aetiological mechanism for delayed SCI, but there is limited evidence regarding the frequency, severity, duration, and clinical effect of hypotension exposure in the immediate post-operative period. This is a retrospective review of 94 patients with cerebral palsy or CP-like conditions, who underwent posterior spinal instrumentation at Queensland Children's Hospital. Post-operative mean arterial pressure (MAP) variations and associations with tissue perfusion markers were analysed. Hypotension was described using area under threshold (AUT) and time under threshold (TUT) for MAP thresholds of 40–80 mmHg. 14.9

Identification of adolescent idiopathic scoliosis (AIS) patients with mild curvatures who pose significant risk of progressing to severe levels of curvatures is of paramount importance for clinical care. This study aimed to compare segmental deformity changes in AIS sub-cohorts that are dichotomised by progression status. Thirty-six female participants with Lenke 1 AIS curves were investigated with sequential MRIs during growth. Scans were reformatted to measure orthogonal segmental parameters, including sagittal/coronal wedging angles and axial rotation angles. Participants were dichotomised by progression. Two-tailed, independent sample t-tests were used to compare sub-cohort multi-segmental and segmental deformity parameters. Measurements were compared at each scan number and variable rates of change were determined using actual time between measures. AIS progression status sub-cohorts were comparable at scan 1 for multi-segmental deformity parameters (e.g. major thoracic curve angle, rib hump, kyphosis) (P > 0.05). However, apical measures of coronal IVD wedging, axial IVD rotation and axial vertebral rotation were segmental parameters at scan 1 which were larger for participants whose AIS would later go on to clinically progress (all P < 0.05). Measures of segmental hypokyphosis were comparable between groups. As development was tracked at each subsequent scan, coronal and axial plane differences between groups increased in both magnitude and number of differences. Initial disparity and then subsequent increasing magnitude of change of axial rotation may indicate a higher propensity to clinically progress in the future. This knowledge hopes to provide useful management information for AIS care providers and prognostic education for patients alike. II.

An accurate estimation of maximal voluntary muscle activation is critical for normalisation in scientific studies. Only a handful of studies appropriately normalise muscle activation data when investigating paraspinal muscle activity in populations such as adolescent idiopathic scoliosis (AIS). This neglect compromises the ability to interpret data. The aim of this study was to determine the type of trunk extension task that reliably achieves peak paraspinal muscle activation in participants with and without AIS. Adolescent females with typically developing spines (controls: n = 20, mean[SD] age 13.1[1.8]years), or primary right thoracic AIS (n = 24, age: 13.8[1.5]years, Cobb angle thoracic: 39.5[16.4]°, lumbar: 28.0[11.6]°) performed a series of 3x unresisted and 3x resisted maximal voluntary trunk extensions in prone. Paraspinal muscle activation was recorded bilaterally at two thoracic levels and one lumbar level using surface electromyography (EMG). Muscle activation was highly repeatable within task [ICC 0.77-0.95, all p < 0.01]. At group level, there were no differences in peak muscle activation between tasks irrespective of side (left/right) or vertebral level (Estimate 0.98, 95%CI 0.36 to 2.65, p=0.97). Peak activation was achieved with the unresisted task in 40.5%, and resisted task in 59.5% of the total outcomes (6 recording locations, 44 participants). Individual participant maximum amplitude varied up to 64% (mean[SD]:18[13]%) between the unresisted and resisted tasks. We recommend that both the resisted and unresisted trunk extension tasks are used to increase confidence that a maximum voluntary activation of paraspinal muscles is achieved. Failure to do so could introduce large error in the estimations of muscle activation.

Study Design. A prospective cohort study. Objective. Detail typical three-dimensional segmental deformities and their rates of change that occur within developing adolescent idiopathic scoliosis (AIS) spines over multiple timepoints. Summary of Background Data. AIS is a potentially progressive deforming condition that occurs in three dimensions of the scoliotic spine during periods of growth. However, there remains a gap for multiple timepoint segmental deformity analysis in AIS cohorts during development. Materials and Methods. Thirty-six female patients with Lenke 1 AIS curves underwent two to six sequential magnetic resonance images. Scans were reformatted to produce images in orthogonal dimensions. Wedging angles and rotatory values were measured for segmental elements within the major curve. Two-tailed, paired t tests compared morphologic differences between sequential scans. Rates of change were calculated for variables given the actual time between successive scans. Pearson correlation coefficients were determined for multidimensional deformity measurements. Results. Vertebral bodies were typically coronally convexly wedged, locally lordotic, convexly axially rotated, and demonstrated evidence of local mechanical torsion. Between the first and final scans, apical measures of coronal wedging and axial rotation were all greater in both vertebral and intervertebral disk morphology than nonapical regions (all reaching differences where P<0.05). No measures of sagittal deformity demonstrated a statistically significant change between scans. Cross-planar correlations were predominantly apparent between coronal and axial planes, with sagittal plane parameters rarely correlating across dimensions. Rates of segmental deformity changes between earlier scans were characterized by coronal plane convex wedging and convexly directed axial rotation. The major locally lordotic deformity changes that did occur in the sagittal plane were static between scans. Conclusions. This novel investigation documented a three-dimensional characterization of segmental elements of the growing AIS spine and reported these changes across multiple timepoints. Segmental elements are typically deformed from initial presentation, and subsequent changes occur in separate orthogonal planes at unique times.

ABSTRACT Scoliosis is a complex 3D spine deformity characterised by an abnormal lateral curvature of the spine and associated rotation of the spine and ribcage. The rotational aspect of scoliosis is most commonly quantified in the Adam’s forward flexed position using an analog scoliometer. The scoliometer has a known user error of 5-8°, which is largely dependent on examiner experience, location of curve, patient positioning and BMI. The device is also limited by the 30° scale and parallax errors. Additionally, the scoliometer loses accuracy when the patient’s torso cannot be positioned parallel to the ground . This study describes the development of the first digital twin for the analog scoliometer to enable fast, gravity-independent reliable and accurate digital measurements of the Angle of Torso Rotation (ATR) from patient-specific 3D virtual models. A robust semi-automated algorithm of generative design which measures ATR from surface topography was developed. With an operating time of just a few seconds, it provides quick and reliable ATR measurements from simple parametric user inputs. 150 calibrated 3D virtual models of AIS patients treated at the Queensland Children’s Hospital Spine Clinic (QCHSC) obtained from our existing database of 3D surface scans (3DSS) and healthy non-scoliotic controls recruited for this study were used to validate the digital scoliometer tool. The tool showed excellent reliability in both intra-user (0.99) and inter-user (0.98) conditions. The digital values had a high positive correlation (0.897) and agreement (92.7%) with the analog ATR measurements made clinically. The tool also showed high sensitivity (95.83%) and specificity (76.76%). The development and validation of this virtual digital tool is significant for telehealth implementation in paediatric spine deformity management and is expected to enhance the remote health management of scoliosis.

Study Design. A prospective cohort study.Objective. Detail typical three-dimensional segmental deformities and their rates of change that occur within developing adolescent idiopathic scoliosis (AIS) spines over multiple timepoints.Summary of Background Data. AIS is a potentially progressive deforming condition that occurs in three dimensions of the scoliotic spine during periods of growth. However, there remains a gap for multiple timepoint segmental deformity analysis in AIS cohorts during development.Materials and Methods. Thirty-six female patients with Lenke 1 AIS curves underwent two to six sequential magnetic resonance images. Scans were reformatted to produce images in orthogonal dimensions. Wedging angles and rotatory values were measured for segmental elements within the major curve. Two-tailed, paired t tests compared morphologic differences between sequential scans. Rates of change were calculated for variables given the actual time between successive scans. Pearson correlation coefficients were determined for multidimensional deformity measurements.Results. Vertebral bodies were typically coronally convexly wedged, locally lordotic, convexly axially rotated, and demonstrated evidence of local mechanical torsion. Between the first and final scans, apical measures of coronal wedging and axial rotation were all greater in both vertebral and intervertebral disk morphology than nonapical regions (all reaching differences where P<0.05). No measures of sagittal deformity demonstrated a statistically significant change between scans. Cross-planar correlations were predominantly apparent between coronal and axial planes, with sagittal plane parameters rarely correlating across dimensions. Rates of segmental deformity changes between earlier scans were characterized by coronal plane convex wedging and convexly directed axial rotation. The major locally lordotic deformity changes that did occur in the sagittal plane were static between scans.Conclusions. This novel investigation documented a three-dimensional characterization of segmental elements of the growing AIS spine and reported these changes across multiple timepoints. Segmental elements are typically deformed from initial presentation, and subsequent changes occur in separate orthogonal planes at unique times.

Anterior vertebral body tethering (AVBT) is a growth modulating procedure used to manage idiopathic scoliosis by applying a flexible tether to the convex surface of the spine in skeletally immature patients. The purpose of this study is to determine the preliminary clinical outcomes for an adolescent patient cohort. 18 patients with scoliosis were selected using a narrow selection criteria to undergo AVBT. Of this cohort, 11 had reached a minimum follow up of 2 years, 4 had reached 18 months, and 3 had reached 6 months. These patients all demonstrated a primary thoracic deformity that was too severe for bracing, were skeletally immature, and were analysed in this preliminary study of coronal plane deformity correction. Using open-source image analysis software (ImageJ, NIH) PA radiographs taken pre-operatively and at regular follow-up visits post-operatively were used to measure the coronal plane deformity of the major and compensatory curves. Pre-operatively, the mean age was 12.0 years (S.D. 10.7 – 13.3), mean Sanders score 2.6 (S.D. 1.8-3.4), all Risser 0 and pre-menarchal, with mean main thoracic Cobb angle of 52° (S.D. 44.2-59.8°). Post-operatively the mean angle decreased to 26.4° (S.D. 18.4-32°) at 1 week, 30.4° (S.D. 21.3-39.6°) at 2 months, 25.7° (S.D. 18.7-32.8°) at 6 months, 27.9° (S.D. 16.2-39.6°) at 12 months, and 36.8° (S.D. 22.6– 51.0°) at 18 months and 38.2° (S.D. 27.6-48.7°) at 2 years. The change in curve at 2 years post-operative was statistically significant (P=0.004). There were 4 tether breakages identified that did not require return to theatre as yet, one patient underwent a posterior spinal instrumented fusion due to curve progression. AVBT is a promising new growth modulation technique for skeletally immature patients with progressive idiopathic scoliosis. This study has demonstrated a reduction in scoliosis severity.

Adolescent Idiopathic Scoliosis (AIS) is a 3D spine deformity that also causes ribcage and torso distortion. While clinical metrics are important for monitoring disorder progression, patients are often most concerned about their cosmesis. The aim of this study was to automate the quantification of AIS cosmesis metrics, which can be measured reliably from patient-specific 3D surface scans (3DSS). An existing database of 3DSS for pre-operative AIS patients treated at the Queensland Children's Hospital was used to create 30 calibrated 3D virtual models. A modular generative design algorithm was developed on the Rhino-Grasshopper software to measure five key AIS cosmesis metrics from these models-shoulder, scapula and hip asymmetry, torso rotation and head-pelvis shift. Repeat cosmetic measurements were calculated from user-selected input on the Grasshopper graphical interface. InterClass-correlation (ICC) was used to determine intra- and inter-user reliability. Torso rotation and head-pelvis shift measurements showed excellent reliability (> 0.9), shoulder asymmetry measurements showed good to excellent reliability (> 0.7) and scapula and hip asymmetry measurements showed good to moderate reliability (> 0.5). The ICC results indicated that experience with AIS was not required to reliably measure shoulder asymmetry, torso rotation and head-pelvis shift, but was necessary for the other metrics. This new semi-automated workflow reliably characterises external torso deformity, reduces the dependence on manual anatomical landmarking, and does not require bulky/expensive equipment.

Vertebral body tethering (VBT) is a recent procedure to correct and reduce spinal curves in skeletally immature patients with adolescent idiopathic scoliosis (AIS). The purpose of this systematic review and meta-analysis is to determine the expected curve reduction and potential complications for adolescent patients after VBT. PubMed, Embase, Google Scholar and Cochrane databases were searched until February 2022. Records were screened against pre-defined inclusion and exclusion criteria. Data sources were prospective and retrospective studies. Demographics, mean differences in Cobb angle, surgical details and complication rates were recorded. Meta-analysis was conducted using a random-effects model. This systematic review includes 19 studies, and the meta-analysis includes 16 of these. VBT displayed a statistically significant reduction in Cobb angle from pre-operative to final (minimum 2 years) measurements. The initial mean Cobb angle was 47.8° (CI 95 VBT results in a significant reduction of AIS at 2 years of follow-up. Overall complication rate was relatively high although the consequences of the complications are unknown. Further research is required to explore the reasons behind the complication rate and determine the optimal timing for the procedure. VBT remains a promising new procedure that is effective at reducing scoliotic curves and preventing spinal fusion in the majority of patients. Systematic review of Therapeutic Studies with evidence level II–IV.

To understand how the axial plane deformity contributes to progression of the three-dimensional spinal deformity of Adolescent Idiopathic Scoliosis (AIS), with a main thoracic curve type, using a series of sequential magnetic resonance images (MRI). Twenty-seven AIS patients (at scan 1: mean 12.4 years (± 1.5), mean Cobb angle 29.1°(± 8.8°)) had 3 MRI scans (T4-L1) performed at intervals of mean 0.7 years (± 0.4). The outer profile of the superior and inferior endplates were traced on a reformatted axial image using ImageJ (NIH). Endplate AVR, and intravertebral rotation (IVR), defined as the difference between superior and inferior endplate AVR, was calculated for each vertebral level. For all patients and scans, the mean AVR was greatest at the curve apex, with AVR diminishing in a caudal and cephalic direction from the apex. At scan 3 the mean apical AVR was 15.1°(± 4.6°) with a mean change in apical AVR between MRI 1 and 3 of 2.7°(± 2.9°). The increase in standing height between MRI 1 and 3 was mean 7.4 cm (± 4.6). Linear regression showed a positive correlation between apical AVR and Cobb angle (R2 = 0.57, P < 0.001), and a positive correlation between apical AVR and rib hump (R2 = 0.54, p < 0.001). The mean change in IVR was greater 3 vertebral levels cephalic and caudal to the apex (1.4°(± 4.1°) and 1.2°(± 2.0°), respectively), compared to the apex (0.4°(± 3.1°)). AVR increased, during curve progression, most markedly at the curve apex. The greatest IVR was observed at the periapical levels, with the apex by contrast having only a modest degree of rotation, suggesting the periapical vertebral levels of the scoliosis deformity may be a significant driver in the progression of AIS.

Introduction3D Non-Contact surface scanning (3DSS) is used in both biomechanical and clinical studies to capture accurate 3D images of the human torso, and to better understand the shape and posture of the spine-both healthy and pathological. This study sought to determine the efficacy and accuracy of using 3DSS of the posterior torso, to determine the curvature of the spinal column in the lateral lying position. MethodsA cohort of 50 healthy adults underwent 3DSS and Magnetic Resonance Imaging (MRI) to correlate the contours of the external spine surface with the internal spinal column. The correlation analysis was composed of two phases: (1) MRI vertebral points vs MRI external spine surface markers; and (2) MRI external spine surface markers vs 3DSS external spine surface markers. The first phase compared the profiles of fiducial markers (vitamin capsules) adhered to the skin surface over the spinous processes against the coordinates of the spinous processes-assessing the linear distance between the profiles, and similarity of curvature, in the sagittal and coronal planes. The second phase compared 3DSS external spine surface markers with the MRI external spine surface markers in both planes, with further qualitative assessment for postural changes. ResultsThe distance between the MRI vertebral points and MRI external spine surface markers showed strong statistically significant correlation with BMI in both sagittal and coronal planes. Kolmogorov-Smirnov (KS) tests showed similar no significant difference in curvature, k, in almost all participants on both planes. In the second phase, the coronal 3DSS external spine surface profiles were statistically different to the MRI external spine surface markers in 44% of participants. Qualitative assessment showed postural changes between MRI and 3DSS measurements in these participants. ConclusionThese study findings demonstrate the utility and accuracy of using anatomical landmarks overlaid on the spinous processes, to identify the position of the spinal bones using 3DSS. Using this method, it will be possible to predict the internal spinal curvature from surface topography, provided that the thickness of the overlaying subcutaneous adipose layer is considered, thus enabling postural analysis of spinal shape and curvature to be carried out in biomechanical and clinical studies without the need for radiographic imaging.

This study aimed to investigate the use of EOS (bi-planer) imaging and SterEOS reconstruction software to study the efficacy of spinal bracing in adolescent idiopathic scoliosis (AIS).EOS images of scoliosis patients being treated with bracing were obtained both in and out of their brace.These images were processed using SterEOS software to allow 3D representation, which was then compared to traditional coronal 2D parameters.Over a 12-month period 29 patients were recruited for participation.Of these participants, 25 had a single episode of EOS imaging out of and in their brace.Additionally, 19 of the 25 participants had further episodes of EOS imaging within the study period, separated by mean 144+/-44 days.This allowed a total of 44 EOS single scan episodes for parameter analysis out of, and in the brace.Longitudinal analysis was also performed on the 19 patients who had sequential scans.Participants were mean 13.8 ± 1.1 years old at the first scan.Coronal 2D parameters, specifically Cobb Angle measurement, were accurately reproducible with SterEOS 3D measurements.Across all EOS scans (n = 44) the mean major coronal curve measurement was 42.3 ± 13.3° out of brace and 37.2 ± 13.8° in the brace.This produced a mean correction of 4.6 ± 4.4° (p < 0.05).The correction achieved in this cohort with bracing appeared more modest than those reported in previous studies using traditional 2D coronal curve measurements [1-3].The mean axial vertebral rotation (AVR) was 10.6 ± 7.1° out of the brace and 9.6 ± 6.8° in the brace, with a mean correction of 1.4 ± 5.3°(p = 0.14).The current study results suggested no significant change in axial vertebral rotation with brace treatment.Notably, in 17 of the 44 AVR measured, the differences were negative.That is, the AVR worsened in the brace.There was a significant moderate correlation between 3D coronal Cobb angle measured and AVR measured out of the brace for all curves.However, the change in Cobb and change in AVR with bracing did not correlate.Over sequential EOS episodes (n = 19), there appeared no significant progression of 3D parameters.There appeared to be a consistent reduction in the scoliosis Cobb angle of the major curve with brace treatment.AVR demonstrated no significant change with bracing, with instances of worsening of AVR in the brace, which was not reflected by Cobb angle measurement.Despite this, bracing appears to have limited curve progression in sequential scans, though not in the anticipated manner of immediate in-brace curve correction.

Purpose. This study aimed to investigate the efficacy of spinal bracing in treating progressive scoliosis deformity utilizing EOS (bi-planer) imaging and SterEOS reconstruction software. Methods. EOS images of scoliosis patients being treated with bracing were obtained both in and out of their brace. These images were processed using SterEOS software to allow 3D representation, which was then compared to traditional coronal 2D parameters. Between January 2019 and January 2020, 29 patients were recruited for participation. Of these participants, 25 had a single episode of EOS imaging out of and in their brace. Additionally, 19 of the 25 participants had further episodes of EOS imaging within the study period, separated by mean 144+/-44 days. This allowed a total of 44 EOS single scan episodes for parameter analysis out of, and in the brace. Longitudinal analysis was also performed on the 19 patients who had sequential scans. Results. Participants were mean 13.8±1.1 years old at the first scan. Coronal 2D parameters, specifically Cobb Angle measurement, were accurately reproducible with SterEOS 3D measurements. Across all EOS scans (n=44) the mean major coronal curve measurement was 42.3±13.3° out of brace and 37.2±13.8° in the brace. This produced a mean correction of 4.6±4.4° (p<0.05). The correction achieved in this cohort with bracing appeared more modest than those reported in previous studies using traditional 2D coronal curve measurements 1–3 . The mean axial vertebral rotation (AVR) was 10.6±7.1° out of the brace and 9.6±6.8° in the brace, with a mean correction of 1.4±5.3°(p=0.14). The current study results suggested no significant change in axial vertebral rotation with brace treatment. Notably, in 17 of the 44 AVR measured, the differences were negative. That is, the AVR worsened in the brace. There was a significant moderate correlation between 3D coronal Cobb angle measured and AVR measured out of the brace for all curves. However, the change in Cobb and change in AVR with bracing did not correlate.Over sequential EOS episodes (n=19), there appeared no significant progression of 3D parameters, interpreted as the brace preventing curve progression. Conclusions. There appeared to be a consistent reduction in the scoliosis Cobb angle of the major curve with brace treatment. AVR demonstrated no significant change with bracing, with instances of worsening of AVR in the brace, which was not reflected by Cobb angle measurement. Despite this, bracing appears to have been effective with limited curve progression in sequential scans, though not in the anticipated manner of immediate in-brace curve correction.

MRI is a non-ionising imaging modality that could be used as an alternative to Xray-based imaging methods to accurately assess the 3D morphology of the vertebral anatomy of scoliosis patients. However, a major caveat in utilising MRI is the significant amount of time required to manually segment the anatomy of interest. To overcome this limitation, we implemented a fully automatic method for the 3D segmentation of thoracic vertebrae, including vertebral body and posterior elements, of healthy adolescents and patients with Adolescent Idiopathic Scoliosis (AIS) using MRI data. 62 MRI scans were obtained from 3 healthy volunteers and 25 patients with AIS. A state-of-the-art deep-learning network for segmentation was trained using image patches of the apical vertebra (T7, T8, T9 or T10) extracted from 20 AIS patient MRIs. Ad-hoc data augmentation was adopted to represent the unlabeled vertebral levels in the dataset (T5-T6, T11-T12). The vertebral levels T5-T12 were then segmented for the remaining MRI datasets by feeding to the network the MRI patches generated by translating a window of fixed size and stride onto the MRI volume. The mean dice score coefficient for the AIS patient vertebral levels T5-T12 was of 87% ± 4.3%, which was comparable to the performance achieved by two experts. On average, 93% and 97% of the MRI segmented slices were considered clinically acceptable morphological reconstructions of AIS and healthy volunteer vertebrae, respectively. The proposed method can be considered as the first step towards more routine MRI-based imaging of AIS osseous deformities, reducing the cumulative exposure of young patients to ionising radiation.

Preoperative serial imaging of the torso is typically carried out in the supine position (e.g. magnetic resonance imaging [MRI], CT), however, intraoperative patient positioning is often lateral, and for some procedures may involve deflation and/or ventilation of the lungs. This study examined the differences in lung anatomy between the supine and lateral decubitus positions. MRI data for 10 healthy female adult volunteers lying in supine and left lateral decubitus positions were analysed. 2D measurements in coronal, transverse and sagittal planes were used to calculate the cross-sectional area, height and width of the lungs and the shape of the diaphragm. 3D surface reconstructions of the lungs and bronchi were created to determine the volume change between positions. The volume of the right lung was found to increase due to the caudal shift of the insertion points of the right hemidiaphragm (mean volume increase of 25% +/- 11, p MUCH LESS-THAN 0.05). There was minimal change in the left lung parameters with no significant change in left lung volume between positions (mean volume change = 0% +/- 44%, p > 0.05). This study presents new information characterising anatomical changes in the respiratory system when a patient is positioned in the lateral decubitus compared to supine position.

Machine Learning (ML) and Digital Twins (DT) are at the heart of today’s different industries, ranging from advanced manufacturing to biomedical systems to resilient ecosystems, civil infrastructures, smart cities, and healthcare. They have become indispensable for solving complex problems in science, engineering, and technology development. The purpose of the MMLDT-CSET 2021 conference is to facilitate the transition of ML and DT from fundamental research to mainstream fields and technologies through advanced data science, mechanistic methods, and computational technologies. This 3-day conference features technical tracks of emerging ML-DT fields and applications, special public lectures, short courses, and demonstrations. The conference will be held in a hybrid format, featuring both on-site and virtual sessions.

Study design Prospective cohort study. Objectives Investigate the progressive changes in pedicle morphometry and the spatial relationship between the pedicles and neurovascular structures in patients with AIS during growth. Summary of background data Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spine deformity. AIS pedicles are known to be asymmetrical when compared to adolescents without scoliosis. Defining the anatomical changes occurring progressively in scoliosis as it increases with time and growth is essential for understanding the pathophysiology of scoliosis and for treatment planning. MRI is the ideal method to study the growing spine without ionising radiation. Methods 24 females with AIS (mean 12.6 years, right sided main thoracic curves) and 20 non-scoliotic females (mean 11.5 years) were selected from an ongoing database. Participants underwent two 3D MRI scans (3 T scanner, T1, 0.5 mm isotropic voxels) approximately 1 year apart (AIS: mean 1.3 ± 0.05 years, control: mean 1.0 ± 0.1 years). The pedicle width, chord length, pedicle height, transverse pedicle angle, sagittal pedicle angle, distance from vertebrae to aorta and distance from pedicle to dural sac were measured from T5 to T12. Inter- and intra-observer variability was assessed. Results From scans 1–2 in the AIS group, the dural sac became closer to the left pedicle ( p < 0.05, T6, T8–T10 and T12) while the distance from the vertebrae to the aorta increased ( p < 0.05, T6–T10). No significant changes in these measurements were observed in the non-scoliotic group. Between scans, the AIS chord length and transverse pedicle angle increased on the left side around the apex ( p < 0.05) creating asymmetries not seen in the non-scoliotic cohort. The mean pedicle height increased symmetrically in the non-scoliosis cohort ( p < 0.05) and asymmetrically in the AIS group with the right side growing faster than the left at T6–T7 ( p < 0.05). Conclusion Asymmetrical growth patterns occur in the vertebral posterior elements of AIS patients compared to the symmetrical growth patterns found in the non-scoliotic participants. Level of evidence Level II prospective comparative study.