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Article: Recent Advances in Coupled MBS and FEM Models of the Spine-A Review.

Nispel, Kati / Lerchl, Tanja / Senner, Veit / Kirschke, Jan S

2023 Volume 10, Issue 3

Abstract: How back pain is related to intervertebral disc degeneration, spinal loading or sports-related overuse remains an unanswered question of biomechanics. Coupled MBS and FEM simulations can provide a holistic view of the spine by considering both the ... ...

Abstract	How back pain is related to intervertebral disc degeneration, spinal loading or sports-related overuse remains an unanswered question of biomechanics. Coupled MBS and FEM simulations can provide a holistic view of the spine by considering both the overall kinematics and kinetics of the spine and the inner stress distribution of flexible components. We reviewed studies that included MBS and FEM co-simulations of the spine. Thereby, we classified the studies into unidirectional and bidirectional co-simulation, according to their data exchange methods. Several studies have demonstrated that using unidirectional co-simulation models provides useful insights into spinal biomechanics, although synchronizing the two distinct models remains a key challenge, often requiring extensive manual intervention. The use of a bidirectional co-simulation features an iterative, automated process with a constant data exchange between integrated subsystems. It reduces manual corrections of vertebra positions or reaction forces and enables detailed modeling of dynamic load cases. Bidirectional co-simulations are thus a promising new research approach for improved spine modeling, as a main challenge in spinal biomechanics is the nonlinear deformation of the intervertebral discs. Future studies will likely include the automated implementation of patient-specific bidirectional co-simulation models using hyper- or poroelastic intervertebral disc FEM models and muscle forces examined by an optimization algorithm in MBS. Applications range from clinical diagnosis to biomechanical analysis of overload situations in sports and injury prediction.
Language	English
Publishing date	2023-03-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2746191-9
ISSN	2306-5354
ISSN	2306-5354
DOI	10.3390/bioengineering10030315
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Article ; Online: Impact of ischemic stroke topography on early clinical outcome of basilar artery occlusion: a retrospective study.

Hernandez Petzsche, Moritz R / Maegerlein, Christian / Wunderlich, Silke / Ikenberg, Benno / Zimmer, Claus / Kirschke, Jan S / Boeckh-Behrens, Tobias / Berndt, Maria

European radiology

2024

Abstract: Objectives: Basilar artery occlusion (BAO) may be etiologically attributed to embolism or in situ thrombosis due to basilar stenosis (BS). Patients with BAO due to BS (BAOS) are known to have worse outcomes than patients with embolic occlusions (BAOE). ... ...

Abstract	Objectives: Basilar artery occlusion (BAO) may be etiologically attributed to embolism or in situ thrombosis due to basilar stenosis (BS). Patients with BAO due to BS (BAOS) are known to have worse outcomes than patients with embolic occlusions (BAOE). BAOS occurs more proximally in the basilar artery (BA) than BAOE. We hypothesize that differing brain stem infarct patterns contribute to outcome differences between these stroke etiologies. Methods: This retrospective study includes 199 consecutive patients with BAO who received endovascular treatment at a single center. Final infarction in brain parenchyma dependent on the posterior circulation was graded semiquantitatively on magnetic resonance imaging (MRI). Associations to underlying stenosis and angiographic and clinical outcome variables were tested. The primary endpoint was early good clinical outcome (EGCO, mRS score ≤ 3 at discharge). Results: Infarct extension of the medulla oblongata (OR = 0.25; 95% CI = 0.07-0.86; p = 0.03), the inferior pons (OR = 0.328; 95% CI = 0.17-0.63; p = 0.001), the superior pons (OR = 0.57; 95% CI = 0.33-0.99; p = 0.046), and the occipital lobes (OR = 0.46; 95% CI = 0.26-0.80; p = 0.006) negatively predicted EGCO. Infarct extension for other posterior-circulation-dependent brain regions was not independently associated with unfavorable early outcomes. Patients with BAOS had more proximal occlusions and greater infarct volumes in the inferior brain stem. Successful reperfusion (mTICI 2b-3) occurred more often in patients with BAOE than in BAOS (BAOE: 131 (96.3%); BAOS: 47 (83.9%), p = 0.005). Conclusion: Unfavorable early outcomes in patients with BAOS may be explained by a higher likelihood of inferior brain stem infarcts and lower rates of reperfusion success. Clinical relevance statement: Basilar artery occlusion due to underlying stenosis is associated with a poorer prognosis than that caused by embolism; these results suggest that aggressive endovascular therapy, usually involving the placement of a permanent stent, may be warranted in these patients. Key points: Inferior brain stem and occipital infarcts are prognostically unfavorable in basilar artery occlusion. Basilar artery occlusion due to stenosis occurs more proximally and is associated with worse outcomes. Differentiating etiologies of basilar artery occlusion may influence how aggressively treated the occlusion is.
Language	English
Publishing date	2024-04-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-024-10755-y
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Article: Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges.

Lerchl, Tanja / Nispel, Kati / Baum, Thomas / Bodden, Jannis / Senner, Veit / Kirschke, Jan S

Bioengineering (Basel, Switzerland)

2023 Volume 10, Issue 2

Abstract: Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in ... ...

Abstract	Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.
Language	English
Publishing date	2023-02-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2746191-9
ISSN	2306-5354
ISSN	2306-5354
DOI	10.3390/bioengineering10020202
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Article ; Online: Detecting CTP truncation artifacts in acute stroke imaging from the arterial input and the vascular output functions.

de la Rosa, Ezequiel / Sima, Diana M / Kirschke, Jan S / Menze, Bjoern / Robben, David

PloS one

2023 Volume 18, Issue 3, Page(s) e0283610

Abstract: Background: Current guidelines for CT perfusion (CTP) in acute stroke suggest acquiring scans with a minimal duration of 60-70 s. But even then, CTP analysis can be affected by truncation artifacts. Conversely, shorter acquisitions are still widely used ...

Abstract	Background: Current guidelines for CT perfusion (CTP) in acute stroke suggest acquiring scans with a minimal duration of 60-70 s. But even then, CTP analysis can be affected by truncation artifacts. Conversely, shorter acquisitions are still widely used in clinical practice and may, sometimes, be sufficient to reliably estimate lesion volumes. We aim to devise an automatic method that detects scans affected by truncation artifacts. Methods: Shorter scan durations are simulated from the ISLES'18 dataset by consecutively removing the last CTP time-point until reaching a 10 s duration. For each truncated series, perfusion lesion volumes are quantified and used to label the series as unreliable if the lesion volumes considerably deviate from the original untruncated ones. Afterwards, nine features from the arterial input function (AIF) and the vascular output function (VOF) are derived and used to fit machine-learning models with the goal of detecting unreliably truncated scans. Methods are compared against a baseline classifier solely based on the scan duration, which is the current clinical standard. The ROC-AUC, precision-recall AUC and the F1-score are measured in a 5-fold cross-validation setting. Results: The best performing classifier obtained an ROC-AUC of 0.982, precision-recall AUC of 0.985 and F1-score of 0.938. The most important feature was the AIFcoverage, measured as the time difference between the scan duration and the AIF peak. When using the AIFcoverage to build a single feature classifier, an ROC-AUC of 0.981, precision-recall AUC of 0.984 and F1-score of 0.932 were obtained. In comparison, the baseline classifier obtained an ROC-AUC of 0.954, precision-recall AUC of 0.958 and F1-Score of 0.875. Conclusions: Machine learning models fed with AIF and VOF features accurately detected unreliable stroke lesion measurements due to insufficient acquisition duration. The AIFcoverage was the most predictive feature of truncation and identified unreliable short scans almost as good as machine learning. We conclude that AIF/VOF based classifiers are more accurate than the scans' duration for detecting truncation. These methods could be transferred to perfusion analysis software in order to increase the interpretability of CTP outputs.
MeSH term(s)	Humans ; Tomography, X-Ray Computed/methods ; Artifacts ; Stroke ; Arteries ; Algorithms ; Brain Ischemia
Language	English
Publishing date	2023-03-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283610
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Article ; Online: Radiation doses and accuracy of navigated pedicle screw placement in cervical and thoracic spine surgery: a comparison of sliding gantry CT and mobile cone-beam CT in a homogeneous cohort.

Baumgart, Lea / Ille, Sebastian / Kirschke, Jan S / Meyer, Bernhard / Krieg, Sandro M

Journal of neurosurgery. Spine

2023 Volume 39, Issue 3, Page(s) 363–369

Abstract: Objective: Multiple solutions for navigation-guided pedicle screw placement are currently available. Intraoperative imaging techniques are invaluable for spinal surgery, but often there is little attention paid to patient radiation exposure. This study ... ...

Abstract	Objective: Multiple solutions for navigation-guided pedicle screw placement are currently available. Intraoperative imaging techniques are invaluable for spinal surgery, but often there is little attention paid to patient radiation exposure. This study aimed to compare the applied radiation doses of sliding gantry CT (SGCT)- and mobile cone-beam CT (CBCT)-based pedicle screw placement for spinal instrumentation. Methods: The authors retrospectively analyzed 183 and 54 patients who underwent SGCT- or standard CBCT-based pedicle screw placement, respectively, for spinal instrumentation at their department between June 2019 and January 2020. SGCT uses an automated radiation dose adjustment. Results: Baseline characteristics, including the number of screws per patient and the number of instrumented levels, did not significantly differ between the two groups. Although the accuracy of screw placement according to Gertzbein-Robbins classification did not differ between the two groups, more screws had to be revised intraoperatively in the CBCT group (SGCT 2.7% vs CBCT 6.0%, p = 0.0036). Mean (± SD) radiation doses for the first (SGCT 484.0 ± 201.1 vs CBCT 687.4 ± 188.5 mGycm, p < 0.0001), second (SGCT 515.8 ± 216.3 vs CBCT 658.3 ± 220.1 mGycm, p < 0.0001), third (SGCT 531.3 ± 237.5 vs CBCT 641.6 ± 177.3 mGycm, p = 0.0140), and total (SGCT 1216.9 ± 699.3 vs CBCT 2000.3 ± 921.0 mGycm, p < 0.0001) scans were significantly lower for SGCT. This was also true for radiation doses per scanned level (SGCT 461.9 ± 429.3 vs CBCT 1004.1 ± 905.1 mGycm, p < 0.0001) and radiation doses per screw (SGCT 172.6 ± 110.1 vs CBCT 349.6 ± 273.4 mGycm, p < 0.0001). Conclusions: The applied radiation doses were significantly lower using SGCT for navigated pedicle screw placement in spinal instrumentation. A modern CT scanner on a sliding gantry leads to lower radiation doses, especially through automated 3D radiation dose adjustment.
MeSH term(s)	Humans ; Retrospective Studies ; Pedicle Screws ; Spine/surgery ; Cone-Beam Computed Tomography/methods ; Surgery, Computer-Assisted/methods ; Radiation Dosage ; Spinal Fusion/methods
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2023.4.SPINE23174
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Article: MDCT-Based Finite Element Analysis for the Prediction of Functional Spine Unit Strength-An In Vitro Study.

Rayudu, Nithin Manohar / Baum, Thomas / Kirschke, Jan S / Subburaj, Karupppasamy

Materials (Basel, Switzerland)

2021 Volume 14, Issue 19

Abstract: 1) Objective: This study aimed to analyze the effect of ligaments on the strength of functional spine unit (FSU) assessed by finite element (FE) analysis of anatomical models developed from multi-detector computed tomography (MDCT) data. (2) Methods: ... ...

Abstract	(1) Objective: This study aimed to analyze the effect of ligaments on the strength of functional spine unit (FSU) assessed by finite element (FE) analysis of anatomical models developed from multi-detector computed tomography (MDCT) data. (2) Methods: MDCT scans for cadaveric specimens were acquired from 16 donors (7 males, mean age of 84.29 ± 6.06 years and 9 females, mean age of 81.00 ± 11.52 years). Two sets of FSU models (three vertebrae + two disks), one with and another without (w/o) ligaments, were generated. The vertebrae were segmented semi-automatically, intervertebral disks (IVD) were generated manually, and ligaments were modeled based on the anatomical location. FE-predicted failure loads of FSU models (with and w/o ligaments) were compared with the experimental failure loads obtained from the uniaxial biomechanical test of specimens. (3) Results: The mean and standard deviation of the experimental failure load of FSU specimens was 3513 ± 1029 N, whereas of FE-based failure loads were 2942 ± 943 N and 2537 ± 929 N for FSU models with ligaments and without ligament attachments, respectively. A good correlation (ρ = 0.79, and ρ = 0.75) was observed between the experimental and FE-based failure loads for the FSU model with and with ligaments, respectively. (4) Conclusions: The FE-based FSU model can be used to determine bone strength, and the ligaments seem to have an effect on the model accuracy for the failure load calculation; further studies are needed to understand the contribution of ligaments.
Language	English
Publishing date	2021-10-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2487261-1
ISSN	1996-1944
ISSN	1996-1944
DOI	10.3390/ma14195791
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Article ; Online: Synthetic T2-weighted fat sat based on a generative adversarial network shows potential for scan time reduction in spine imaging in a multicenter test dataset.

Schlaeger, Sarah / Drummer, Katharina / El Husseini, Malek / Kofler, Florian / Sollmann, Nico / Schramm, Severin / Zimmer, Claus / Wiestler, Benedikt / Kirschke, Jan S

European radiology

2023 Volume 33, Issue 8, Page(s) 5882–5893

Abstract: Objectives: T2-weighted (w) fat sat (fs) sequences, which are important in spine MRI, require a significant amount of scan time. Generative adversarial networks (GANs) can generate synthetic T2-w fs images. We evaluated the potential of synthetic T2-w ... ...

Abstract	Objectives: T2-weighted (w) fat sat (fs) sequences, which are important in spine MRI, require a significant amount of scan time. Generative adversarial networks (GANs) can generate synthetic T2-w fs images. We evaluated the potential of synthetic T2-w fs images by comparing them to their true counterpart regarding image and fat saturation quality, and diagnostic agreement in a heterogenous, multicenter dataset. Methods: A GAN was used to synthesize T2-w fs from T1- and non-fs T2-w. The training dataset comprised scans of 73 patients from two scanners, and the test dataset, scans of 101 patients from 38 multicenter scanners. Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured in true and synthetic T2-w fs. Two neuroradiologists graded image (5-point scale) and fat saturation quality (3-point scale). To evaluate whether the T2-w fs images are indistinguishable, a Turing test was performed by eleven neuroradiologists. Six pathologies were graded on the synthetic protocol (with synthetic T2-w fs) and the original protocol (with true T2-w fs) by the two neuroradiologists. Results: aSNR and aCNR were not significantly different between the synthetic and true T2-w fs images. Subjective image quality was graded higher for synthetic T2-w fs (p = 0.023). In the Turing test, synthetic and true T2-w fs could not be distinguished from each other. The intermethod agreement between synthetic and original protocol ranged from substantial to almost perfect agreement for the evaluated pathologies. Discussion: The synthetic T2-w fs might replace a physical T2-w fs. Our approach validated on a challenging, multicenter dataset is highly generalizable and allows for shorter scan protocols. Key points: • Generative adversarial networks can be used to generate synthetic T2-weighted fat sat images from T1- and non-fat sat T2-weighted images of the spine. • The synthetic T2-weighted fat sat images might replace a physically acquired T2-weighted fat sat showing a better image quality and excellent diagnostic agreement with the true T2-weighted fat images. • The present approach validated on a challenging, multicenter dataset is highly generalizable and allows for significantly shorter scan protocols.
MeSH term(s)	Humans ; Spine/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Radionuclide Imaging
Language	English
Publishing date	2023-03-16
Publishing country	Germany
Document type	Multicenter Study ; Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-023-09512-4
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Article: Implementation of GAN-Based, Synthetic T2-Weighted Fat Saturated Images in the Routine Radiological Workflow Improves Spinal Pathology Detection.

Schlaeger, Sarah / Drummer, Katharina / Husseini, Malek El / Kofler, Florian / Sollmann, Nico / Schramm, Severin / Zimmer, Claus / Kirschke, Jan S / Wiestler, Benedikt

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 5

Abstract: 1) Background and Purpose: In magnetic resonance imaging (MRI) of the spine, T2-weighted (T2-w) fat-saturated (fs) images improve the diagnostic assessment of pathologies. However, in the daily clinical setting, additional T2-w fs images are frequently ... ...

Abstract	(1) Background and Purpose: In magnetic resonance imaging (MRI) of the spine, T2-weighted (T2-w) fat-saturated (fs) images improve the diagnostic assessment of pathologies. However, in the daily clinical setting, additional T2-w fs images are frequently missing due to time constraints or motion artifacts. Generative adversarial networks (GANs) can generate synthetic T2-w fs images in a clinically feasible time. Therefore, by simulating the radiological workflow with a heterogenous dataset, this study's purpose was to evaluate the diagnostic value of additional synthetic, GAN-based T2-w fs images in the clinical routine. (2) Methods: 174 patients with MRI of the spine were retrospectively identified. A GAN was trained to synthesize T2-w fs images from T1-w, and non-fs T2-w images of 73 patients scanned in our institution. Subsequently, the GAN was used to create synthetic T2-w fs images for the previously unseen 101 patients from multiple institutions. In this test dataset, the additional diagnostic value of synthetic T2-w fs images was assessed in six pathologies by two neuroradiologists. Pathologies were first graded on T1-w and non-fs T2-w images only, then synthetic T2-w fs images were added, and pathologies were graded again. Evaluation of the additional diagnostic value of the synthetic protocol was performed by calculation of Cohen's ĸ and accuracy in comparison to a ground truth (GT) grading based on real T2-w fs images, pre- or follow-up scans, other imaging modalities, and clinical information. (3) Results: The addition of the synthetic T2-w fs to the imaging protocol led to a more precise grading of abnormalities than when grading was based on T1-w and non-fs T2-w images only (mean ĸ GT versus synthetic protocol = 0.65; mean ĸ GT versus T1/T2 = 0.56;
Language	English
Publishing date	2023-03-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13050974
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Article: A deep learning approach to predict collateral flow in stroke patients using radiomic features from perfusion images.

Tetteh, Giles / Navarro, Fernando / Meier, Raphael / Kaesmacher, Johannes / Paetzold, Johannes C / Kirschke, Jan S / Zimmer, Claus / Wiest, Roland / Menze, Bjoern H

Frontiers in neurology

2023 Volume 14, Page(s) 1039693

Abstract: Collateral circulation results from specialized anastomotic channels which are capable of providing oxygenated blood to regions with compromised blood flow caused by arterial obstruction. The quality of collateral circulation has been established as a ... ...

Abstract	Collateral circulation results from specialized anastomotic channels which are capable of providing oxygenated blood to regions with compromised blood flow caused by arterial obstruction. The quality of collateral circulation has been established as a key factor in determining the likelihood of a favorable clinical outcome and goes a long way to determining the choice of a stroke care model. Though many imaging and grading methods exist for quantifying collateral blood flow, the actual grading is mostly done through manual inspection. This approach is associated with a number of challenges. First, it is time-consuming. Second, there is a high tendency for bias and inconsistency in the final grade assigned to a patient depending on the experience level of the clinician. We present a multi-stage deep learning approach to predict collateral flow grading in stroke patients based on radiomic features extracted from MR perfusion data. First, we formulate a region of interest detection task as a reinforcement learning problem and train a deep learning network to automatically detect the occluded region within the 3D MR perfusion volumes. Second, we extract radiomic features from the obtained region of interest through local image descriptors and denoising auto-encoders. Finally, we apply a convolutional neural network and other machine learning classifiers to the extracted radiomic features to automatically predict the collateral flow grading of the given patient volume as one of three severity classes - no flow (0), moderate flow (1), and good flow (2). Results from our experiments show an overall accuracy of 72% in the three-class prediction task. With an inter-observer agreement of 16% and a maximum intra-observer agreement of 74% in a similar experiment, our automated deep learning approach demonstrates a performance comparable to expert grading, is faster than visual inspection, and eliminates the problem of grading bias.
Language	English
Publishing date	2023-02-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1039693
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Article ; Online: Impact of radiation dose reduction and iterative image reconstruction on CT-guided spine biopsies.

Paprottka, Karolin J / Kupfer, Karina / Schultz, Vivian / Beer, Meinrad / Zimmer, Claus / Baum, Thomas / Kirschke, Jan S / Sollmann, Nico

Scientific reports

2023 Volume 13, Issue 1, Page(s) 5054

Abstract: This study aimed to systematically evaluate the impact of dose reduction on image quality and confidence for intervention planning and guidance regarding computed tomography (CT)-based intervertebral disc and vertebral body biopsies. We retrospectively ... ...

Abstract	This study aimed to systematically evaluate the impact of dose reduction on image quality and confidence for intervention planning and guidance regarding computed tomography (CT)-based intervertebral disc and vertebral body biopsies. We retrospectively analyzed 96 patients who underwent multi-detector CT (MDCT) acquired for the purpose of biopsies, which were either derived from scanning with standard dose (SD) or low dose (LD; using tube current reduction). The SD cases were matched to LD cases considering sex, age, level of biopsy, presence of spinal instrumentation, and body diameter. All images for planning (reconstruction: "IMR1") and periprocedural guidance (reconstruction: "iDose4") were evaluated by two readers (R1 and R2) using Likert scales. Image noise was measured using attenuation values of paraspinal muscle tissue. The dose length product (DLP) was statistically significantly lower for LD scans regarding the planning scans (SD: 13.8 ± 8.2 mGycm, LD: 8.1 ± 4.4 mGycm, p < 0.01) and the interventional guidance scans (SD: 43.0 ± 48.8 mGycm, LD: 18.4 ± 7.3 mGycm, p < 0.01). Image quality, contrast, determination of the target structure, and confidence for planning or intervention guidance were rated good to perfect for SD and LD scans, showing no statistically significant differences between SD and LD scans (p > 0.05). Image noise was similar between SD and LD scans performed for planning of the interventional procedures (SD: 14.62 ± 2.83 HU vs. LD: 15.45 ± 3.22 HU, p = 0.24). Use of a LD protocol for MDCT-guided biopsies along the spine is a practical alternative, maintaining overall image quality and confidence. Increasing availability of model-based iterative reconstruction in clinical routine may facilitate further radiation dose reductions.
MeSH term(s)	Humans ; Drug Tapering ; Retrospective Studies ; Radiation Dosage ; Multidetector Computed Tomography ; Image-Guided Biopsy ; Image Processing, Computer-Assisted/methods ; Radiographic Image Interpretation, Computer-Assisted/methods
Language	English
Publishing date	2023-03-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-32102-9
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