DOCSLIB.ORG

The Potential of Computational Fluid Dynamics Simulations of Airflow in the Nasal Cavity

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Potential of Computational Fluid Dynamics Simulations of Airflow in the Nasal Cavity Berger et al., J Neurobiol Physiol 2021; Journal of Neurobiology and Physiology 3(1):10-15. Short Communication The potential of computational fluid dynamics simulations of airflow in the nasal cavity Berger M1,2, Pillei M1,3, Freysinger W2* 1Department of Environmental, Process Abstract & Energy Engineering, MCI – The Entrepreneurial School, Austria Computational Fluid Dynamics (CFD) is a well-established and accepted tool for simulation and prediction of complex physical phenomena e.g., in combustion, aerodynamics or blood circulation. 2University Hospital of Recently CFD has entered the medical field due to the readily available high computational power of Otorhinolaryngology, Medical current graphics processing units, GPUs. Efficient numerical codes, commercial or open source, are University Innsbruck, Austria available now. Thus, a wide range of medical themes is available for CFD almost in real-time in the 3Department of Fluid Mechanics, medical environment now. Friedrich-Alexander University The available methods are on the point of reaching a usability status ready for everyday clinical use Erlangen-Nuremberg, Germany as a potential medical decision support system, provided adherence to the appropriate patient data *Author for correspondence: protection rules and proper certification as a medical device. Email: wolfgang.freysinger@i-med. ac.at This contribution outlines the current range of activities in our clinic in the field of Lattice-Boltzmann CFD based on CT and / or MR imagery and flashlights the following three areas: simulating the effect Received date: November 05, 2020 of nasal stents on breathing, predicting clinical Rhinomanometry and Rhinometry, and the numerical Accepted date: February 23, 2021 estimation of resection volumes for surgery to improve nasal breathing. The set of required methods is outlined, the three areas are discussed and summarized. The results presented are very preliminary insights into current research and need to be subject to further detailed evaluation, of course. Copyright: © 2021 Berger M, et al. This The results presented are very promising first steps in the direction of both digital patient diagnosis and is an open-access article distributed therapy prediction. However, thorough and in-depth evaluation of the methods themselves and proper under the terms of the Creative clinical studies to assess the merits of the technology are still required. Commons Attribution License, which permits unrestricted use, distribution, Keywords: Nasal airflow, Laser Doppler anemometry, Computational fluid dynamics, Breathing and reproduction in any medium, simulation, Nasal airflow optimization, Rhinomanometry, Surgery, Simulation, Diagnosis prediction provided the original author and source are credited. Abbreviations 3D: Three-dimensional; CFD: Computational Fluid Dynamics; CT: Computer Tomography; HPDR: High Pressure Drop Region; MRI: Magnetic Resonance Imaging; CT: Computed Tomography; LB: Lattice Boltzmann; LDA: Laser Doppler Anemometry Introduction Numerical prediction of complex physical phenomena in the medical domain almost always implies complex geometries, boundary conditions and challenging physical questions. Paradigmatically, nasal airflow is of interest as this might be a tool to improve the current success rate of septoplasty and sinus surgery [1,2] as patient satisfaction studies suggest [3]. According to current clinical guidelines preoperative planning of surgery of the nasal cavity is, in addition to 2D/3D radiologic imaging and nasal endoscopy more and more including additional Rhinomanometry and acoustic Rhinometry data [4]. The success of surgical intervention in general and specifically in optimizing nasal breathing (i.e., airflow), strongly depends on the surgeon’s experience. It might thus be worthy to investigate whether digital aids could help doctors to improve this situation. Citation: Berger M, Pillei M, Freysinger Moreover, consequent use of available digital patient data eventually could help advancing the W. The potential of computational fluid current state of medical practice. dynamics simulations of airflow in the Lattice Boltzmann (LB) fluid flow simulations are simple and fast [5] to simulate nasal airflow. nasal cavity. J Neurobiol Physiol 2021; 3(1):10-15. In the microscopic description state of a gas/fluid by a Newtonian fluid model every particle is assigned position and velocity. As this is impossible to realize in numerical simulations the This article is originally published by ProBiologist LLC., and is freely available at probiologists.com J Neurobiol Physiol 2021; 3(1):10-15. 10 Citation: Berger M, Pillei M, Freysinger W. The potential of computational fluid dynamics simulations of airflow in the nasal cavity. J Neurobiol Physiol 2021; 3(1):10-15. computational model builds on statistical considerations on base of spatial resolution 0.3 ×0.3 ×0.3 mm³, 536 × 536 × 440) velocity distribution functions. Medical imaging data As with any simulation tool, LB simulations need to be validated The study was conducted in accordance with local ethical against ground truth. This was done in a thorough investigation where simulations and Laser Doppler Anemometry, LDA, of a guidelines as stipulated by the 7th revision of the Declaration physical (3D printed) and a 3D reconstruction of a 3D-CT image of Helsinki. No ethics committee approval for this anonymized stack was performed [6]. A simplified phantom and an anonymous retrospective study was needed. All anonymous data used in the patient CT data set were segmented to show only tissue and air [7] computations originate from patients who voluntarily agreed to of which the tissue part was 3D printed [8]. This allowed a realistic anonymized use of their data for further scientific purposes; some reproduction of the paranasal sinuses, especially the main nasal data were acquired at different times and therefore not all physiologic cavity that is providing the predominant nasal airflow for breathing states of relevance (e.g., status of the nasal cycle) are known. For one at the zones of the inferior/middle turbinates. LDA measurements patient CT and MR data, Rhinomanometry and Rhinometry were and CFD simulations were found to be in good agreement. It is thus available to allow a comparison of clinical and computed diagnoses. justified to use the LB simulation tool in this context. CT data were acquired with swollen nasal mucosa (i.e., with present infection or acute allergic state); MR data were acquired in a normal A novel medical device for treating snoring conditions is finding condition of the nasal mucosa. The actual state of the nasal cycle was more and more patient acceptance [9]; this nasal stent made from not taken into consideration. Nitinol widens the nasal air passage between lower and middle turbinate during overnight use. Currently daytime use for sports The computational time of one simulation was about 4 minutes activities of this device seems to be a new field of use. Available on a CPU XEON (E5 1650 V3) with twelve threads and 32 GB anonymous MR imagery were used in CFD simulations to assess RAM (4 × 8 GB DDR4-2133) and a NVIDIA RTX 2080 Ti the physical effects of these stents on nasal airflow with and without graphics card (GPU). The fluid flow simulations were performed on the nasal stent. In addition, the prediction tool for surgery was run GPU. The Rhinomanometry curve was simulated within less than on these data sets. 3 hours. For an exceptional single case CT and MR imagery, and Preparation of radiologic 3D data Rhinomanometry and Rhinometry data, all anonymous, allowed All data sets were thresholded and segmented [7,10] to show an initial test run of the LB simulation framework for predicting air and tissue spaces only. At the in- and outlets (i.e., nostrils and clinical diagnoses. nasopharynx) cuboids (60 × 40 × 20 mm³) were added as proper The basic idea behind all these approaches is to use CFD to boundary volumes for the LB simulations. The resulting mesh form calculate streamlines and pressure drops with given boundary this volume was obtained with [11] and was saved in .stl format for conditions of pressure, flow, and anatomy. Analysis of the effects of the simulations. Nasal airflow cross-sections were obtained from the the Alaxo Stents and the prediction of surgical resection volumes segmented data in coronal views in steps of 5 mm from the nostrils relies on the determination of certain high-pressure-drop regions in posterior direction with 3D Slicer [10] and were compared to the along streamlines (see Materials and Methods section), whereas the data of acoustic Rhinometry. simulations of Rhinomanometry and Rhinometry basically employ evaluating the volume flux and the cross-sections of the paranasal LB simulation and optimization sinuses in coronal slice orientations, respectively. Inhalation was simulated with a constant air flow rate of 0.6 The investigations were predominately based on anonymous l/s for reasons of computational stability with Sailfish CFD [5]. CT datasets, being the clinical standard imagery; CT and MR Inlet and outlet were set to ambient pressure, respectively, and at imaging were used for predicting diagnostic Rhinomanometry and the outlet a flow boundary condition was set. Simulations started Rhinometry data; MR data were used for simulating the Alaxo stents. with velocity increasing from zero until a quasi-stationary solution The nature of the 3D imaging modality used to generate the three- was achieved. The physical situation gives a Reynolds number
Load more

Recommended publications
  • Nasal Airflow Measured by Rhinomanometry Correlates with Feno in Children with Asthma
    RESEARCH ARTICLE Nasal Airflow Measured by Rhinomanometry Correlates with FeNO in Children with Asthma I-Chen Chen1☯, Yu-Tsai Lin2☯, Jong-Hau Hsu1,3, Yi-Ching Liu1, Jiunn-Ren Wu1,3, Zen- Kong Dai1,3* 1 Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, 2 Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 3 Department of Pediatrics, School of Medicine, College of Medicine, a11111 Kaohsiung Medical University, Kaohsiung, Taiwan ☯ These authors contributed equally to this work. * [email protected] Abstract OPEN ACCESS Citation: Chen I-C, Lin Y-T, Hsu J-H, Liu Y-C, Wu Background J-R, Dai Z-K (2016) Nasal Airflow Measured by Rhinitis and asthma share similar immunopathological features. Rhinomanometry is an Rhinomanometry Correlates with FeNO in Children with Asthma. PLoS ONE 11(10): e0165440. important test used to assess nasal function and spirometry is an important tool used in doi:10.1371/journal.pone.0165440 asthmatic children. The degree to which the readouts of these tests are correlated has yet Editor: Stelios Loukides, National and Kapodistrian to be established. We sought to clarify the relationship between rhinomanometry measure- University of Athens, GREECE ments, fractional exhaled nitric oxide (FeNO), and spirometric measurements in asthmatic Received: September 3, 2016 children. Accepted: October 11, 2016 Methods Published: October 28, 2016 Patients' inclusion criteria: age between 5 and 18 years, history of asthma with nasal symp- Copyright: © 2016 Chen et al. This is an open toms, and no anatomical deformities. All participants underwent rhinomanometric evalua- access article distributed under the terms of the Creative Commons Attribution License, which tions and pulmonary function and FeNO tests.
    [Show full text]
  • Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy
    Medical Coverage Policy Effective Date ............................................. 7/10/2021 Next Review Date ....................................... 3/15/2022 Coverage Policy Number .................................. 0554 Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy Table of Contents Related Coverage Resources Overview .............................................................. 1 Balloon Sinus Ostial Dilation for Chronic Sinusitis and Coverage Policy ................................................... 2 Eustachian Tube Dilation General Background ............................................ 3 Drug-Eluting Devices for Use Following Endoscopic Medicare Coverage Determinations .................. 10 Sinus Surgery Coding/Billing Information .................................. 10 Rhinoplasty, Vestibular Stenosis Repair and Septoplasty References ........................................................ 28 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence
    [Show full text]
  • Medical Policy Directory of Documents Policy Number: 411
    Medical Policy Directory of Documents Policy Number: 411 Q: How do I comment on the documents? A: You can email us at [email protected]. Q: How do I find out which documents have changed? A: New and updated documents are posted to the system every week. To find out what has changed see the Provider Focus newsletter. Drugs ∙ Treatments ∙ Devices and Equipment ∙ Surgeries ∙ Other Drugs Medical Technology Assessment Investigational (Non-Covered) Services List 400 Ampyra™ (dalfampridine) 246 Antihyperlipidemics: A Prescription Drug Therapy Guideline 013 ↳Prior Authorization/ Formulary Exception Form 434 Anti-Parkinsonism Drugs 054 Antisense Oligonucleotide Medications 027 Asthma and Chronic Obstructive Pulmonary Disease Medication Management 011 ↳Prior Authorization/ Formulary Exception Form 434 Benign Prostatic Hyperplasia (BPH) 040 Bisphosphonate, Oral 058 Botulinum Toxin Injections 006 B-Type Natriuretic Peptide 031 Anti-Migraine Policy 021 CNS Stimulants and Psychotherapeutic Agents 019 Compound Exclusion List for Pharmacy Medical Policy 579, Compounded Medications 705 Compound Inclusion List for Pharmacy Medical Policy 579, Compounded Medications 704 Compounded Medications 579 Cox II Inhibitor Drugs 002 Diabetes Step Therapy 041 Dificid (fidaxomicin) 700 Drug Management and Prior Authorization 251 ↳Prior Authorization/ Formulary Exception Form 434 Drugs for Cystic Fibrosis 408 Entresto Step Therapy 063 Erythropoietin, Recombinant Human; Epoetin Alpha (Epogen and Procrit); Darbepoetin Alpha 262 (Aranesp) Esketamine Nasal Spray (Spravato)
    [Show full text]
  • And Post-Pyriform Plasty Nasal Airflow
    Braz J Otorhinolaryngol. 2018;84(3):351---359 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Evaluation of pre- and post-pyriform plasty nasal airflowଝ ∗ Oscimar Benedito Sofia , Ney P. Castro Neto, Fernando S. Katsutani, Edson I. Mitre, José E. Dolci Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil Received 29 November 2016; accepted 28 March 2017 Available online 6 May 2017 KEYWORDS Abstract Introduction: Nasal obstruction; Nasal obstruction is a frequent complaint in otorhinolaryngology outpatient clin- Rhinomanometry; ics, and nasal valve incompetence is the cause in most cases. Scientific publications describing Acoustic rhinometry surgical techniques on the upper and lower lateral cartilages to improve the nasal valve are also quite frequent. Relatively few authors currently describe surgical procedures in the piri- form aperture for nasal valve augmentation. We describe the surgical technique called pyriform plasty and evaluate its effectiveness subjectively through the NOSE questionnaire and objec- tively through the rhinomanometry evaluation. Objective: To compare pre- and post-pyriform plasty nasal airflow variations using rhinomanom- etry and the NOSE questionnaire. Methods: Eight patients submitted to pyriform surgery were studied. These patients were screened in the otorhinolaryngology outpatient clinic among those who complained of nasal obstruction, and who had a positive response to Cottle maneuver. They answered the NOSE questionnaire and were submitted to preoperative rhinomanometry. After 90 days, they were reassessed through the NOSE questionnaire and the postoperative rhinomanometry. The results of these two parameters were compared pre- and postoperatively. Results: Regarding the subjective measure, the NOSE questionnaire, seven patients reported improvement, of which two reported marked improvement, and one patient reported an unchanged obstructive condition.
    [Show full text]
  • Alteraes Na Mucosa Nasal Provocadas Pela Presso Atmosfrica, Oxignio E
    ALTERAÇÕES NA MUCOSA NASAL PROVOCADAS PELA PRESSÃO ATMOSFÉRICA, OXIGÉNIO E OUTROS FACTORES PAULO SÉRGIO ALVES VERA-CRUZ PINTO Dissertação de doutoramento em Ciências Médicas 2009 PAULO SÉRGIO ALVES VERA-CRUZ PINTO ALTERAÇÕES NA MUCOSA NASAL PROVOCADAS PELA PRESSÃO ATMOSFÉRICA, OXIGÉNIO E OUTROS FACTORES Dissertação de candidatura ao grau de Doutor em Ciências Médicas, submetida ao Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto. Orientador – Professor Doutor Carlos Zagalo, professor do Instituto de Ciências da Saúde Egas Moniz. Co-Orientador – Professor Doutor Artur Águas, professor catedrático do Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto. Porto 2009 2 À Carla, ao Gonçalo e ao Bernardo 3 4 “Try and leave this world a little better than you found it and when your turn come to die, you can die happy in feeling that at any rate you have not wasted your time but have done your best.” Lord Robert Baden-Powell's Last Message to Scouts, 1941 5 6 ÍNDICE Preceitos legais ...................................................................................................................9 Agradecimentos.................................................................................................................10 INTRODUÇÃO...................................................................................................................12 1- Anatomia das Fossas Nasais no Humano ................................................................12 2 - Anatomia das Fossas Nasais no Rato .....................................................................14
    [Show full text]
  • Partitioning of Inhaled Ventilation Between the Nasal and Oral Routes During Sleep in Normal Subjects
    J Appl Physiol 94: 883–890, 2003. First published November 1, 2002; 10.1152/japplphysiol.00658.2002. Partitioning of inhaled ventilation between the nasal and oral routes during sleep in normal subjects MICHAEL F. FITZPATRICK, HELEN S. DRIVER, NEELA CHATHA, NHA VODUC, AND ALISON M. GIRARD Department of Medicine, Queen’s University, Kingston, Ontario, Canada K7L 3N6 Submitted 18 July 2002; accepted in final form 28 October 2002 Fitzpatrick, Michael F., Helen S. Driver, Neela the snore vibration, which can originate from the soft Chatha, Nha Voduc, and Alison M. Girard. Partitioning palate or from the tongue base (30), may vary during of inhaled ventilation between the nasal and oral routes the night (10). In patients with obstructive sleep apnea during sleep in normal subjects. J Appl Physiol 94: 883–890, (OSA), one study demonstrated a change in the pri- 2003. First published November 1, 2002; 10.1152/jappl- mary site of upper airway obstruction with sleep stage, physiol.00658.2002.—The oral and nasal contributions to from the velopharyngeal level in non-REM sleep to the inhaled ventilation were simultaneously quantified during sleep in 10 healthy subjects (5 men, 5 women) aged 43 Ϯ 5 yr, hypopharyngeal level during REM sleep (4). Ϫ1 Ϫ1 The advent of the nasal cannula pressure transducer with normal nasal resistance (mean 2.0 Ϯ 0.3 cmH2O⅐l ⅐s ) by use of a divided oral and nasal mask. Minute ventilation as the preferred device for airflow measurement during awake (5.9 Ϯ 0.3 l/min) was higher than that during sleep sleep, because of its higher sensitivity for detection of (5.2 Ϯ 0.3 l/min; P Ͻ 0.0001), but there was no significant airflow limitation (27), is also predicated on the as- difference in minute ventilation between different sleep sumption that airflow during sleep is primarily via the stages (P ϭ 0.44): stage 2 5.3 Ϯ 0.3, slow-wave 5.2 Ϯ 0.2, and nasal route, regardless of sleep stage.
    [Show full text]
  • Proceedings of the British Thoracic Society
    Thorax 1983;38:700-719 Thorax: first published as 10.1136/thx.38.9.700 on 1 September 1983. Downloaded from Proceedings of the British Thoracic Society The 1983 Summer Meeting of the British Thoracic Society was held on 27-29 June in the University of Cambridge BTS smoking withdrawal study: fators assodated with four there was continuing "active" disease at the time of giving up smoking death. The average follow-up in this supplementary series is six years and to date there has been only one simple IA CAMPBELL for BTS Research Committee In the British tumour (neurilemmoma). Thoracic Society's smoking withdrawal study 9-7% of 1550 patients successfully gave up smoking. Reasons for wanting to stop smoking, apart from improvement in Treatment of pneumothorax by simple aspiration health, were expense (30%), dislike of addiction (20%) and "dirty habit" (18%). Concern about weight gain was AAD HAMILTON, GJ ARCHER All the patients admitted to expressed by 41% of men and 59% of women. Men were Stepping Hill Hospital with an uncomplicated more successful than women and success in both sexes pneumothorax requiring treatment during the 12 months increased with age. Men with ischaemic heart disease did up to January 1983 were admitted to the study. These best (21% success). Married or single men were more patients, numbering 10, were treated by simple aspiration likely to give up smoking than divorced or separated men. of air using a plastic cannula used for intravenous insertion. Patients whose "most important other person" was a non- In seven patients the procedure was successful.
    [Show full text]
  • Upper and Lower Respiratory Disease, Edited by J
    UPPER AND LOWER R ESP1RAT0 RY DISEASE Edited by Jonathan Corren Allergy Research Foundation, Inc. Los Angeles, California, U.S.A. Alkis Togias Johns Hopkins Asthma and Allergy Center Baltimore, Maryland, U.S.A. Jean Bousquet Hdpital Arnaud de Villeneuve Montpellier, France MARCEL MARCELDEKKER, INC. NEWYORK RASEL DEKKER Although great care has been taken to provide accurate and current information, neither the author(s) nor the publisher, nor anyone else associated with this publica- tion, shall be liable for any loss, damage, or liability directly or indirectly caused or alleged to be caused by this book. The material contained herein is not intended to provide specific advice or recommendations for any specific situation. Trademark notice: Product or corporate names may be trademarks or registered trade- marks and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. ISBN: 0-8247-0723-0 This book is printed on acid-free paper. Headquarters Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016, U.S.A. tel: 212-696-9000; fax: 212-685-4540 Distribution and Customer Service Marcel Dekker, Inc., Cimarron Road, Monticello, New York 12701, U.S.A. tel: 800-228-1160; fax: 845-796-1772 Eastern Hemisphere Distribution Marcel Dekker AG, Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland tel: 41-61-260-6300; fax: 41-61-260-6333 World Wide Web http://www.dekker.com The publisher offers discounts on this book when ordered in bulk quantities.
    [Show full text]
  • Thieme: Ear, Nose, and Throat Diseases
    445 Subject Index Page numbers in italics denote figures and those in bold denote tables A adenomas, salivarygland 428 –430, anosmia 125,136 abscesses 429, 432 anotia 49, 49 brain see under brain pleomorphic see pleomorphic anterior rhinoscopy129 –131, 131 cervical soft tissue 388 adenoma antibiotic(s) epidural 188, 188 adhesive otitis 76, 76 aminoglycoside 95–96 nasal septal 199–200 aerosol inhalation 158 ototoxic 95–96 oral floor 256, 260, 260 aerotitis 87 resistance 440 orbital 186,187,187 age-related hearing loss 17 rhinosinusitis management 160 peritonsillar 270,270–272, 271 agnosia, acoustic 104 topical 144 retropharyngeal 273, 273 agranulocytosis 265 upper respiratory/digestive tract subdural 188,188–189 AIDS (acquired immune deficiency diseases 159 subperiosteal 66, 66, 186,187 syndrome) 251,251–252 antiseptics, topical 144 achalasia 362,371 aids, hearing 106, 106,107,107 antrostomy175, 176 cricopharyngeal 371–372 air conduction 28 anulus fibrosus 4, 5,69 acid burns airflow, nasal 126,126–127 aperiodic vibration 15, 15 esophageal 362,365–366 alae, nasal, anomalies 215, 217 aphasia 340–342, 341, 343 oral/pharyngeal 277–278 alkali burns aphthae 252 acinic cell tumors, salivary432 esophageal 362,365–366 articulation disorder 336 acoustic agnosia 104 oral/pharyngeal 277–278 arytenoidectomy, partial 305, 307 acoustic end organ see cochlea allergens, ear 54, 54 ataxia 20 acoustic neuroma 92,92,93, 94 allergic glossitis 256–257 atresia acoustic rhinomanometry136 allergic rhinitis 150–151, 151 choanal 211–212 acoustic trauma, acute 88 allergic
    [Show full text]
  • Omnibus Codes – Commercial Medical Policy
    UnitedHealthcare® Commercial Medical Policy Omnibus Codes Policy Number: 2021T0535III Effective Date: May 1, 2021 Instructions for Use Table of Contents Page Community Plan Policy Coverage Summary........................................................................... 1 • Omnibus Codes Coverage Rationale/Clinical Evidence .........................................12 Policy History/Revision Information........................................... 171 Instructions for Use ...................................................................... 174 Coverage Summary All CPT/HCPCS codes/services addressed in this policy are noted in the table below. Click the code link to be directed to the full coverage rationale and clinical evidence applicable to each of the listed procedures. CPT® is a registered trademark of the American Medical Association Code Description Conclusion 0042T Cerebral perfusion analysis using computed tomography with contrast Proven in certain administration, including post-processing of parametric maps with circumstances determination of cerebral blood flow, cerebral blood volume, and mean transit time 0061U Transcutaneous measurement of five biomarkers (tissue oxygenation [StO2], Unproven oxyhemoglobin [ctHbO2], deoxyhemoglobin [ctHbR], papillary and reticular dermal hemoglobin concentrations [ctHb1 and ctHb2]), using spatial frequency domain imaging (SFDI) and multi-spectral analysis 0100T Placement of a subconjunctival retinal prosthesis receiver and pulse Unproven generator, and implantation of intra-ocular retinal
    [Show full text]
  • Airway Abnormalities in Very Early Treated Infantile‐Onset Pompe
    Received: 12 July 2019 Revised: 8 December 2019 Accepted: 16 December 2019 DOI: 10.1002/ajmg.a.61481 ORIGINAL ARTICLE Airway abnormalities in very early treated infantile-onset Pompe disease: A large-scale survey by flexible bronchoscopy Chia-Feng Yang1,2 | Dau-Ming Niu1,2 | Shyh-Kuan Tai2,3 | Ting-Hao Wang1,2 | Hsiao-Ting Su4 | Ling-Yi Huang1 | Wen-Jue Soong1,2,5 1Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan Abstract 2School of Medicine, National Yang-Ming Early enzyme replacement therapy (ERT) improve long-term outcomes in patients University, Taipei, Taiwan with infantile-onset Pompe disease (IOPD). Our cohort of patients with IOPD at Tai- 3Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan pei Veterans General Hospital (TVGH) joined Taiwan Pompe newborn screening pro- 4Department of Audiology and Speech gram from 2008, testing more than one million newborns until 2018. By 2010, we Language Pathology, Mackay Medical College, had established rapid diagnostic strategies. Now, the average age of ERT initiation Taipei, Taiwan starts at an average age of <10 days-old, the earliest group in the world. However, 5Children's Hospital, China Medical University, Taichung, Taiwan they still presented some airway problems. We present a retrospective study focused on airway abnormalities in these patients along 8 years of observation. Fifteen Correspondence Wen-Jue Soong, Department of Pediatrics, patients with IOPD, who received very early treatment at a mean age of 8.94 Taipei Veterans General Hospital, No.201, Sec. ± 3.75 days, underwent flexible bronchoscopy (FB) for dynamic assessment of the 2, Shipai Rd., Beitou District, Taipei City, Taiwan 11217, China.
    [Show full text]
  • Comparison of Different Rhinomanometry Methods in the Measurement of Nasal Airway
    Comparison of different rhinomanometry methods in the measurement of nasal airway resistance Submitted to the Cardiff University for the degree of Master of Philosophy Eugene Hung Chih Wong MB ChB MRCS (Gen) MRCS (ENT) Cardiff School of Biosciences Cardiff University, Cardiff June 2014 “Remember to breathe. It is after all, the secret of life.” -Gregory Maguire To my parents Mark and Lily and my sister Sylvia, for their endless love, support and encouragement. Acknowledgements I would like to express my gratitude to Professor Ron Eccles for his guidance, support and encouragement during this work and the opportunity to work at the Common Cold Centre. I would also like to thank SuSu, Ben, Martez and Edyta at the Common Cold Centre, for their support and friendship. Finally, I would like to thank Eric Greig (GM Instruments, UK) for providing the model noses for this study. DECLARATION This work has not been submitted in substance for any other degree or award at this or any other university or place of learning, nor is being submitted concurrently in candidature for any degree or other award. Signed ……………………… (Eugene HC Wong) Date ………………….. STATEMENT 1 This thesis is being submitted in partial fulfillment of the requirements for the degree of MPhil Signed ……………………… (Eugene HC Wong) Date ………………….. STATEMENT 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. The views expressed are my own. Signed ……………………… (Eugene HC Wong) Date ………………….. STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations.
    [Show full text]