Semi-automated ultrasound facial soft tissue depth registration: method and validation

A mobile and fast, semi-automatic ultrasound (US) system was developed for facial soft tissue depth registration. The system consists of an A-Scan ultrasound device connected to a portable PC with interfacing and controlling software. For 52 cephalometric landmarks, the system was tested for repeatability and accuracy by evaluating intra-observer agreement and comparing ultrasound and CT-scan results on 12 subjects planned for craniofacial surgery, respectively. A paired t-test evaluating repeatability of the ultrasound measurements showed 5.7% (n = 3) of the landmarks being significantly different (p < 0.01). US and CT-scan results showed significant differences (p < 0.01) using a Wilcoxon signed rank test analysis for 11.5% (n = 6) of the landmarks. This is attributed to a difference in the volunteer's head position between lying (CT) and sitting (US). Based on these tests, we conclude that the proposed registration system and measurement protocol allows relatively fast (52 landmarks/20 min), non-invasive, repeatable and accurate acquisition of facial soft tissue depth measurements.     

Computerized craniofacial reconstruction using CT-derived implicit surface representations

In forensic craniofacial reconstruction, facial features of an unknown individual are estimated from an unidentified skull, based on a mixture of experimentally obtained guidelines on the relationship between soft tissues and the underlying skeleton. In this paper, we investigate the possibility of using full 3D cross-sectional CT images for establishing a reference database of densely sampled distances between the external surfaces of the skull and head for automated craniofacial reconstruction. For each CT image in the reference database, the hard tissue (skull) and soft tissue (head) volumes are automatically segmented and transformed into signed distance transform (sDT) images, representing for each voxel in this image the Euclidean distance to the closest point on the skull and head surface, respectively, distances being positive (negative) for voxels inside (outside) the skull/head. Multiple craniofacial reconstructions are obtained by first warping each reference skull sDT maps to the target skull sDT using a B-spline based free form deformation algorithm and subsequently applying these warps to the reference head sDT maps. A single reconstruction of the target head surface is defined as the zero level set of the arithmetic average of all warped reference head sDT maps, but other reconstructions are possible, biasing the result to subject specific attributes (age, BMI, gender). Both qualitative and quantitative tests (measuring the similarity between the 3D reconstructed and corresponding original head surface) on a small (N = 20) database are presented to proof the validity of the concept.     

Large-scale in-vivo Caucasian facial soft tissue thickness database for craniofacial reconstruction

A large-scale study of facial soft tissue depths of Caucasian adults was conducted. Over a 2-years period, 967 Caucasian subjects of both sexes, varying age and varying body mass index (BMI) were studied. A user-friendly and mobile ultrasound-based system was used to measure, in about 20min per subject, the soft tissue thickness at 52 facial landmarks including most of the landmarks used in previous studies. This system was previously validated on repeatability and accuracy [S. De Greef, P. Claes, W. Mollemans, M. Loubele, D. Vandermeulen, P. Suetens, G. Willems, Semi-automated ultrasound facial soft tissue depth registration: method and validation. J. Forensic Sci. 50 (2005)]. The data of 510 women and 457 men were analyzed in order to update facial soft tissue depth charts of the contemporary Caucasian adult. Tables with the average thickness values for each landmark as well as the standard deviation and range, tabulated according to gender, age and BMI are reported. In addition, for each landmark and for both sexes separately, a multiple linear regression of thickness versus age and BMI is calculated. The lateral asymmetry of the face was analysed on an initial subset of 588 subjects showing negligible differences and thus warranting the unilateral measurements of the remaining subjects. The new dataset was statistically compared to three datasets for the Caucasian adults: the traditional datasets of Rhine and Moore [J.S. Rhine, C.E. Moore, Tables of facial tissue thickness of American Caucasoids in forensic anthropology. Maxwell Museum Technical series 1 (1984)] and Helmer [R. Helmer, Sch?delidentifizierung durch elektronische bildmischung, Kriminalistik Verlag GmbH, Heidelberg, 1984] together with the most recent in vivo study by Manhein et al. [M.H. Manhein, G.A. Listi, R.E. Barsley, R. Musselman, N.E. Barrow, D.H. Ubelbaker, In vivo facial tissue depth measurements for children and adults. J. Forensic Sci. 45 (2000) 48-60]. The large-scale database presented in this paper offers a denser sampling of the facial soft tissue depths of a more representative subset of the actual Caucasian population over the different age and body posture subcategories. This database can be used as an updated chart for manual and computer-based craniofacial approximation and allows more refined analyses of the possible factors affecting facial soft tissue depth.     

Effect of Lower Third Molar Segmentations on Automated Tooth Development Staging using a Convolutional Neural Network

Staging third molar development is commonly used for age estimation in subadults. Automated developmental stage allocation to the mandibular left third molar in panoramic radiographs has been examined in a pilot study. This method used an AlexNet Deep Convolutional Neural Network (CNN) approach to stage lower left third molars, which had been selected by manually drawn bounding boxes around them. This method (bounding box AlexNet = BA) still contained parts of surrounding structures which may have affected the automated stage allocation performance. We hypothesize that segmenting only the third molar could further improve the automated stage allocation performance. Therefore, the current study aimed to determine and validate the effect of lower third molar segmentations on automated tooth development staging. Retrospectively, 400 panoramic radiographs were collected, processed and segmented in three ways: bounding box (BB), rough (RS), and full (FS) tooth segmentation. A DenseNet201 CNN was used for automated stage allocation. Automated staging results were compared with reference stages – allocated by human observers – overall and per stage. FS rendered the best results with a stage allocation accuracy of 0.61, a mean absolute difference of 0.53 stages and a Cohen's linear κ of 0.84. Misallocated stages were mostly neighboring stages, and DenseNet201 rendered better results than AlexNet by increasing the percentage of correctly allocated stages by 3% (BA compared to BB). FS increased the percentage of correctly allocated stages by 7% compared to BB. In conclusion, full tooth segmentation and a DenseNet CNN optimize automated dental stage allocation for age estimation.     

Harmonization of IP litigation practice--still a long road ahead

Legal context. Notwithstanding the advanced level of harmonizationof IP laws, these substantive laws are still not applied ina harmonized way because of the vast differences in proceduralrules amongst the member states of the European Union. For example,the speed, type of relief, costs and potential drawbacks ofa legal action still vary substantially between countries. Thesedifferences continue to influence the choice of venue for manyIP owners and their adversaries. Key points. When a national or Community IP right is infringedand the potential acts of infringement (or infringers) are locatedin more than one jurisdiction, the situation might give riseto multiple parallel litigation in a number of countries. Awell-informed IP specialist will not advise on such a decisionwithout considering a number of issues, analysed in this article:(1) how and where to find evidence of the infringement, andits potential trans-border use; (2) whether the questions ofvalidity and infringement are inseparable (particularly forpatents); (3) the availability of injunctions reaching acrossnational borders; (4) the availability of so-called "torpedo"actions; (5) the recoverability of costs and attorneys' fees;and (6) the ability to protect confidential proprietary informationduring the litigation. Practical significance. As long as differences continue to existbetween Member States, the level of IP enforcement will continueto vary from one jurisdiction to another, and the type of reliefthat is sought by the IP owner will never be exactly the same.Of course this creates disparities and disadvantages. The advantageof this situation is that an IP owner, when he is confrontedwith a multi-jurisdictional IP dispute, can pick and choosethe best available procedural tools and remedies that are availablein each jurisdiction. So forum shopping is still the name ofthe game, as every experienced litigator knows.