Fabian Rengier

Bio: Fabian Rengier is an academic researcher from University Hospital Heidelberg. The author has contributed to research in topics: Medicine & Angiography. The author has an hindex of 20, co-authored 81 publications receiving 2247 citations. Previous affiliations of Fabian Rengier include German Cancer Research Center & University Hospital of Basel.

3D printing based on imaging data: review of medical applications

Abstract: Generation of graspable three-dimensional objects applied for surgical planning, prosthetics and related applications using 3D printing or rapid prototyping is summarized and evaluated. Graspable 3D objects overcome the limitations of 3D visualizations which can only be displayed on flat screens. 3D objects can be produced based on CT or MRI volumetric medical images. Using dedicated post-processing algorithms, a spatial model can be extracted from image data sets and exported to machine-readable data. That spatial model data is utilized by special printers for generating the final rapid prototype model. Patient–clinician interaction, surgical training, medical research and education may require graspable 3D objects. The limitations of rapid prototyping include cost and complexity, as well as the need for specialized equipment and consumables such as photoresist resins. Medical application of rapid prototyping is feasible for specialized surgical planning and prosthetics applications and has significant potential for development of new medical applications.

Dynamic contrast-enhanced magnetic resonance imaging: fundamentals and application to the evaluation of the peripheral perfusion

Abstract: Introduction: The ability to ascertain information pertaining to peripheral perfusion through the analysis of tissues’ temporal reaction to the inflow of contrast agent (CA) was first recognized in the early 1990’s. Similar to other functional magnetic resonance imaging (MRI) techniques such as arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) MRI, dynamic contrast-enhanced MRI (DCE-MRI) was at first restricted to studies of the brain. Over the last two decades the spectrum of ailments, which have been studied with DCE-MRI, has been extensively broadened and has come to include pathologies of the heart notably infarction, stroke and further cerebral afflictions, a wide range of neoplasms with an emphasis on antiangiogenic treatment and early detection, as well as investigations of the peripheral vascular and musculoskeletal systems. Applications to peripheral perfusion: DCE-MRI possesses an unparalleled capacity to quantitatively measure not only perfusion but also other diverse microvascular parameters such as vessel permeability and fluid volume fractions. More over the method is capable of not only assessing blood flowing through an organ, but in contrast to other noninvasive methods, the actual tissue perfusion. These unique features have recently found growing application in the study of the peripheral vascular system and most notably in the diagnosis and treatment of peripheral arterial occlusive disease (PAOD). Review outline: The first part of this review will elucidate the fundamentals of data acquisition and interpretation of DCE-MRI, two areas that often remain baffling to the clinical and investigating physician because of their complexity. The second part will discuss developments and exciting perspectives of DCE-MRI regarding the assessment of perfusion in the extremities. Emerging clinical applications of DCE-MRI will be reviewed with a special focus on investigation of physiology and pathophysiology of the microvascular and vascular systems of the extremities.

Ultralow dose CT for pulmonary nodule detection with chest x-ray equivalent dose – a prospective intra-individual comparative study

Abstract: To prospectively evaluate the accuracy of ultralow radiation dose CT of the chest with tin filtration at 100 kV for pulmonary nodule detection. 202 consecutive patients undergoing clinically indicated chest CT (standard dose, 1.8 ± 0.7 mSv) were prospectively included and additionally scanned with an ultralow dose protocol (0.13 ± 0.01 mSv). Standard dose CT was read in consensus by two board-certified radiologists to determine the presence of lung nodules and served as standard of reference (SOR). Two radiologists assessed the presence of lung nodules and their locations on ultralow dose CT. Sensitivity and specificity of the ultralow dose protocol was compared against the SOR, including subgroup analyses of different nodule sizes and types. A mixed effects logistic regression was used to test for independent predictors for sensitivity of pulmonary nodule detection. 425 nodules (mean diameter 3.7 ± 2.9 mm) were found on SOR. Overall sensitivity for nodule detection by ultralow dose CT was 91%. In multivariate analysis, nodule type, size and patients BMI were independent predictors for sensitivity (p < 0.001). Ultralow dose chest CT at 100 kV with spectral shaping enables a high sensitivity for the detection of pulmonary nodules at exposure levels comparable to plain film chest X-ray. • 91% of all lung nodules were detected with ultralow dose CT • Sensitivity for subsolid nodule detection is lower in ultralow dose CT (77.5%) • The mean effective radiation dose in 202 patients was 0.13 mSv • Ultralow dose CT seems to be feasible for lung cancer screening

Clinical Standardized fMRI Reveals Altered Language Lateralization in Patients with Brain Tumor

Abstract: BACKGROUND AND PURPOSE: Brain tumors affecting language-relevant areas may influence language lateralization. The purpose of this study was to systematically investigate language lateralization in brain tumor patients using clinical language fMRI, comparing the results with a group of healthy volunteers. MATERIALS AND METHODS: Fifty-seven strictly right-handed patients with left-hemispheric-space intracranial masses (mainly neoplastic) affecting either the Broca area ( n = 19) or Wernicke area ( n = 38) were prospectively enrolled in this study. Fourteen healthy volunteers served as a control group. Standardized clinical language fMRI, using visually triggered sentence- and word-generation paradigms, was performed on a 1.5T MR scanner. Semiautomated analyses of all functional data were conducted on an individual basis using BrainVoyager. A regional lateralization index was calculated for Broca and Wernicke areas separately versus their corresponding right-hemisphere homologs. RESULTS: In masses affecting the Broca area, a significant decrease in the lateralization index was found when performing word generation ( P = .0017), whereas when applying sentence generation, the decrease did not reach statistical significance ( P = .851). Masses affecting the Wernicke area induced a significant decrease of the lateralization index when performing sentence generation ( P = .0007), whereas when applying word generation, the decrease was not statistically significant ( P = .310). CONCLUSIONS: Clinical language fMRI was feasible for patients with brain tumors and provided relevant presurgical information by localizing essential language areas and determining language dominance. A significant effect of the brain masses on language lateralization was observed, with a shift toward the contralesional, nondominant hemisphere. This may reflect compensatory mechanisms of the brain to maintain communicative abilities.

I and i

Abstract: There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality. Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Abstract: Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

3D printing of polymer matrix composites: A review and prospective

Abstract: The use of 3D printing for rapid tooling and manufacturing has promised to produce components with complex geometries according to computer designs. Due to the intrinsically limited mechanical properties and functionalities of printed pure polymer parts, there is a critical need to develop printable polymer composites with high performance. 3D printing offers many advantages in the fabrication of composites, including high precision, cost effective and customized geometry. This article gives an overview on 3D printing techniques of polymer composite materials and the properties and performance of 3D printed composite parts as well as their potential applications in the fields of biomedical, electronics and aerospace engineering. Common 3D printing techniques such as fused deposition modeling, selective laser sintering, inkjet 3D printing, stereolithography, and 3D plotting are introduced. The formation methodology and the performance of particle-, fiber- and nanomaterial-reinforced polymer composites are emphasized. Finally, important limitations are identified to motivate the future research of 3D printing.

The status, challenges, and future of additive manufacturing in engineering

Abstract: Additive manufacturing (AM) is poised to bring about a revolution in the way products are designed, manufactured, and distributed to end users. This technology has gained significant academic as well as industry interest due to its ability to create complex geometries with customizable material properties. AM has also inspired the development of the maker movement by democratizing design and manufacturing. Due to the rapid proliferation of a wide variety of technologies associated with AM, there is a lack of a comprehensive set of design principles, manufacturing guidelines, and standardization of best practices. These challenges are compounded by the fact that advancements in multiple technologies (for example materials processing, topology optimization) generate a "positive feedback loop" effect in advancing AM. In order to advance research interest and investment in AM technologies, some fundamental questions and trends about the dependencies existing in these avenues need highlighting. The goal of our review paper is to organize this body of knowledge surrounding AM, and present current barriers, findings, and future trends significantly to the researchers. We also discuss fundamental attributes of AM processes, evolution of the AM industry, and the affordances enabled by the emergence of AM in a variety of areas such as geometry processing, material design, and education. We conclude our paper by pointing out future directions such as the "print-it-all" paradigm, that have the potential to re-imagine current research and spawn completely new avenues for exploration. The fundamental attributes and challenges/barriers of Additive Manufacturing (AM).The evolution of research on AM with a focus on engineering capabilities.The affordances enabled by AM such as geometry, material and tools design.The developments in industry, intellectual property, and education-related aspects.The important future trends of AM technologies.

A Review of Additive Manufacturing

Abstract: Additive manufacturing processes take the information from a computer-aided design (CAD) file that is later converted to a stereolithography (STL) file. In this process, the drawing made in the CAD software is approximated by triangles and sliced containing the information of each layer that is going to be printed. There is a discussion of the relevant additive manufacturing processes and their applications. The aerospace industry employs them because of the possibility of manufacturing lighter structures to reduce weight. Additive manufacturing is transforming the practice of medicine and making work easier for architects. In 2004, the Society of Manufacturing Engineers did a classification of the various technologies and there are at least four additional significant technologies in 2012. Studies are reviewed which were about the strength of products made in additive manufacturing processes. However, there is still a lot of work and research to be accomplished before additive manufacturing technologies become standard in the manufacturing industry because not every commonly used manufacturing material can be handled. The accuracy needs improvement to eliminate the necessity of a finishing process. The continuous and increasing growth experienced since the early days and the successful results up to the present time allow for optimism that additive manufacturing has a significant place in the future of manufacturing.