Interact CardioVasc Thorac Surg 2008;7:363-364. doi:10.1510/icvts.2008.179549
© 2008 European Association of Cardio-Thoracic Surgery
Imagination turns real, or vice versa?
Ludwig K. von Segesser*
Department of Cardio-Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
*Tel.: +41 21 314 22 79; fax: +41 21 314 22 78 E-mail address: ludwig.von-segesser{at}chuv.ch Web: www.cardiovasc.net.
Scientific publishing has made great strides in recent years, and this not only in diffusion of the final article compositions over the web and in print, but also in manuscript preparation, uploading of text and figures, correction of proofs and on-line discussion [1, 2]. What has been less apparent is the steady improvement not only of the fonts and lay-out [3], but much more so of the illustrations. In the first issue of the European Journal of Cardio-thoracic Surgery (EJCTS: www.ejcts.org) which appeared in 1987 and had 37 articles, there were 94 figures with an average of 2.6 per article out of which 46 were line graphs, bar graphs, or drawings (49%), and 47 photographic reproductions (51%).
In contrast, the last issue of the European Journal of Cardiothoracic Surgery published in 2007 had 38 communications including nine letters to the editor. There were 76 figures with an average of 2.7 per article out of which 38 were line graphs, bar graphs, or drawings (50%), and 38 were photographic reproductions or scans (50%). Interestingly, there were eight three-dimensional reconstructions/images [4] one of which included a video [5]. Likewise, the last issue of Interactive Thoracic and CardioVascular Surgery in 2007 (ICVTS: www.icvts.org) carried 43 articles, including eight e-comments, the on-line equivalent of letters to the editor. There were 41 figures and two videos with an average of 1.2 figures per article out of which eight were line graphs, bar graphs, or drawings (20%), and 33 were photographic reproductions or scans (80%). Together with three 3-dimensional reconstructions/images and two videos, there is an obvious trend away from line drawings towards more sophisticated types of illustrations for ICVTS as well as the more recent issues of the EJCTS.
As a matter of fact, most anatomical situations and operative sites can be displayed pretty well with simple line drawings. Although three-dimensional images are often more explicit, they are also more complex undertakings. This has somewhat changed with the advent of computer assisted design (CAD), where a complex anatomical and pathological situation can be modelled in silico. There are various technical approaches for generation of impressive three-dimensional structures which represent bodily parts including vectorizing and other modifications of data-sets realized with clinical imaging equipment like CT and MRI. Alternatively, extrusion from geometric primitives with consecutive subtraction, fusion, morphing, and rendering can also yield impressive results. An example of an aorta modelled geometrically from primitives (Fig. 1) some years ago (1995) exhibiting an infant type coarctation is shown in Fig. 2 at various stages of extrusion. A ray cast rendered version after application of several shaders, lights, and optimizing the viewing angle is displayed in Fig. 3.
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Fig. 1. Geometrical modelling with wire drawings based on primitives (spheres, cylinders) after fusion (for construction of the aortic root) and extrusion (for construction of the aortic arch).
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Fig. 2. Geometrical model after assembling the aortic root with the aortic arch and the supra-aortic vessels.
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Fig. 3. Ray cast rendered view after application of shaders and lights following the addition of the dilated descending thoracic aorta with post-stenotic dilatation (artists impression).
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Three-dimensional reconstruction of CT-scans are nowadays routine in the clinical setting and obviously catch-up with the imagination mentioned above as shown by Bastarrika G et al. in their article [6] entitled ‘Incidental dual source CT imaging of ductal coarctation, left subclavian artery stenosis and bicuspid aortic valve in a patient admitted for atypical chest pain’. Even more impressive is the recently introduced addition of imaginary flow-path lines based on flow sensitive MRI acquisitions as reported by Frydrychowitz [7] with the corresponding video http://icvts.ctsnetjournals.org/cgi/content/full/icvts.2006.129577/DC1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Frydrychowicz&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT.
For more illustrations go to www.icvts.org and www.ejcts.org
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References
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- von Segesser LK. Enhanced virtual conferencing on ICVTS: introduction of DOIs makes eComments citable. Interact Cardiovasc Thorac Surg 2006;5:331–332.[Free Full Text]
- von Segesser LK. Interactive CardioVascular and Thoracic Surgery (ICVTS) has been selected to be indexed and included in MEDLINE/PubMed. Interact Cardiovasc Thorac Surg 2007;6:579.[Free Full Text]
- von Segesser LK. Changes in font design – should surgeons align? Eur J Cardiothorac Surg 2005;27:1–2.[Free Full Text]
- Heye T, Karck M, Richter G, Hosch W. Visualization of entry and re-entry tears in a complex type A aortic dissection by 64-slice dual source computer tomography. Eur J Cardiothorac Surg 2007;32:935.[Free Full Text]
- Feuchter G, Junker D, Bonatti J, Friedrich G. Right coronary fistula into left ventricle: dynamic compression shown by multislice computed tomography. Eur J Cardiothorac Surg 2007;32:933.[Free Full Text]
- Bastarrika G, De Cecco CN, Anselmi A, Herreros J. Incidental dual source computed tomography imaging of ductal coarctation, left subclavian artery stenosis and bicuspid aortic valve in a patient admitted for atypical chest pain. Interact Thorac CardioVasc Surg 2008;7:504–505.[CrossRef]
- Frydrychowicz A, Weigang E, Langer M, Markl M. Flow-sensitive 3D magnetic resonance imaging reveals complex blood flow alterations in aortic Dacron graft repair. Interact Thorac CardioVasc Surg 2006;5:340–342.[CrossRef]
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References