O sucesso da cirurgia ortognática está relacionado com diversos fatores como análise facial precisa e acurada, e exames de imagem com alta qualidade. Atualmente, diversos programas de imagens tridimensionais, comerciais e abertos, estão disponíveis no auxílio diagnóstico, elaboração do plano de tratamento e simulação do procedimento cirúrgico para correção das deformidades dentofaciais. Entretanto, estudos avaliando os diferentes métodos de mensuração linear empregados pelos programas de imagem por meio da reconstrução 3D no planejamento da osteotomia tipo Le Fort I são escassos e, maiores esclarecimentos sobre sua precisão e a acurácia são necessários. O objetivo deste estudo foi estabelecer: a) precisão e acurácia de medidas lineares tridimensionais para osteotomia tipo Le Fort I obtidas por meio da tomografia computadorizada multislice (TCMS) e feixe cônico (TCFC) e b) comparar a precisão e acurácia de medidas lineares para osteotomia tipo Le Fort I realizadas por meio de três programas de imagem utilizando a 3D-TCFC. A amostra foi constituída por onze crânios secos submetidos à TCMS 64 canais e TCFC. As reconstruções tridimensionais (3D-TC) foram geradas, e medidas lineares (n=11) baseadas em estruturas e pontos anatômicos de interesse à osteotomia tipo Le Fort I foram realizados independentemente, por dois radiologistas experientes, duas vezes cada, utilizando programa Vítrea 3.8.1 em reconstruções 3D-TCMS e 3D-TCFC e os programas OsiriX 1.2 64-bit e Dolphin Imaging versão 11.5.04.35 por meio da 3D-TCFC. Sequencialmente, um terceiro observador experiente e calibrado, que não participou da análise das imagens, realizou as medidas sobre os crânios secos utilizando paquímetro digital (padrão ouro) com quais as medidas foram comparadas. A análise intra e inter-observadores assim como as correlações individuais de cada medida foram realizadas utilizando o coeficiente de correlação intra-classe (CCI), sendo o intervalo de confiança adotado de 95%. Os resultados demonstraram na análise intra-observador, utilizando o programa Vítrea, correlação excelente para todas as medidas variando de 0,87 a 0,96 e 0,82 a 0,98 para os observadores 1 e 2 respectivamente utilizando a TCMS e de 0,84 a 0,98 e 0,80 a 0,98 utilizando a TCFC. A análise inter-observadores variou de 0,85 a 0,98 para a TCMS e de 0,80 a 0,99 para a TCFC. A análise intra-observador utilizando os diferentes programas de imagem na TCFC apresentou variações de 0,90 a 0,97 (Vítrea), 0,65 a 0,97 (OsiriX) e 0,51 a 0,94 (Dolphin). Na análise inter-obsevador obtivemos valores de 0,92 a 0,99 e 0,88 a 0,98 para os observadores 1 e 2 respectivamente utilizando o Vítrea, 0,58 a 0,90 e 0,48 a 0,85 para o programa OsiriX e de 0,80 a 0,96 e 0,57 a 0,92 com o programa Dolphin. O programa Vítrea não apresentou diferenças estatisticamente significante nas análises intra e inter-observador e medidas físicas utilizando a TCMS e TCFC. Em relação à análise dos programas, diferenças estatisticamente foram constatadas com o programa OsiriX e Dolphin em relação ao padrão ouro. / The success of orthognathic surgery depends on many factors as precise and accurate facial analysis and high quality imaging exams. Nowadays a lot of commercial and open-source three-dimensional software programs currently available to assist diagnosis, elaboration of treatment planning, and to predict outcomes related to orthognathic surgery. The aim of this study was to establish: a) the precision and accuracy of three-dimensional linear measurements for Le Fort I osteotomy, obtained from multislice computed tomography (MSCT) and cone-beam computed tomography (CBCT) scans and b) compare the precision and accuracy of linear measurements for Le Fort I osteotomy performed by three different imaging software programs and obtained from 3D-CBCT images. The study population consisted of 11 dried skulls submitted to 64-row MSCT and CBCT scans. Three-dimensional reconstructed images (3D-CT) were generated, and linear measurements (n = 11) based on anatomical structures and landmarks of interest for Le Fort I osteotomy were performed independently by 2 oral and maxillofacial radiologists, twice each, using Vítrea 3.8.1 software for 3D-MSCT and 3D-CBCT and OsiriX 1.2 64-bit and Dolphin Imaging version 11.5.04.35 from 3D-CBCT. Subsequently, a third examiner expert in anatomical analysis and calibrated, who did not evaluate the images, performed measurements on dry skulls using a digital caliper (gold standard) with which the measurements were compared. The analyses of intra- and inter-observer as well as the individual correlations of each measurement were performed using the coefficient of intra-class correlation (ICC), with a confidence interval of 95 %. The intra-observer results showed that using the Vitrea program, excellent correlation for all measurements were reached with ICC values ranging from 0.87 to 0.96 and 0.82 0.98 for observers 1 and 2 respectively using the MSCT and 0.84 to 0.98 and 0.80 to 0.98 using CBCT. Inter-observer analysis ranged from 0.85 to 0.98 for MSCT and 0.80 to 0.99 for CBCT. The intra-observer analysis using the different programs using CBCT images varied from 0.90 to 0.97 for Vitrea, 0.65 to 0.97 for OsiriX and 0.51 to 0.94 using Dolphin. Inter-observer analysis demonstrated values ranging from 0.92 to 0.99 and 0.88 0.98 for observers 1 and 2 respectively using the Vitrea; 0.58 to 0.90 and 0.48 to 0.85 for OsiriX, and 0.80 to 0.96 and 0.57 to 0.92 using Dolphin. Vítrea software showed no statistically significant differences for intra-and inter-observer analysis and physical measurements using MSCT and CBCT. Regarding the analysis of softwares, statistical differences were found with the program OsiriX and Dolphin in comparison to gold standard.

Os dentes incisivos inferiores apresentam, em sua maioria, canal radicular único, que pode ter conformações distintas. De acordo com a literatura científica, a presença de um segundo canal radicular pode ser constatada em 10 a 40% dos casos. A não-detecção do segundo canal é um importante fator para o insucesso do tratamento endodôntico. Esta pesquisa foi realizada com os seguintes objetivos: 1) comparar a eficácia na identificação de padrões anatômicos internos em incisivos inferiores permanentes extraídos com uso de imagem radiográfica periapical digital e de tomografia computadorizada de feixe cônico (TCFC); e 2) determinar a prevalência de 2 canais radiculares em incisivos inferiores em imagens de TCFC de um banco de dados de exames previamente realizados, associando com localização do dente, gênero e idade do paciente. Na primeira etapa da pesquisa, 40 dentes incisivos inferiores foram submetidos a escaneamento em microtomógrafo computadorizado da FOB-USP (Skyscan 1074) para estabelecer o padrão ouro do tipo anatômico interno de cada dente. Os dentes foram então classificados em: Tipo I (1 canal radicular regular, n=12), Tipo Ia (1 canal radicular oval, n=12) e Tipo III (2 canais radiculares, n=16). Em seguida, os dentes foram divididos em 10 grupos de 4 dentes e posicionados em alvéolos de uma mandíbula humana para exposição radiográfica periapical digital direta com duas tomadas variando o ângulo horizontal de incidência (Schick CDR) e para escaneamento em 3 tomógrafos (Kodak 9000 3D, Veraviewepocs 3De e NewTom 5G) da Universidade de Loma Linda, CA, EUA. Dois examinadores treinados classificaram o tipo anatômico de cada dente e suas respostas foram comparadas ao padrão ouro estabelecido por microtomografia. Para descrição dos resultados, utilizou-se a porcentagem (%) de respostas certas / erradas. Aplicou-se o teste do qui-quadrado (X2), com nível de significância estatística de 5%, para verificação da associação entre variáveis. As concordâncias inter e intraexaminador foram determinadas por teste de kappa. Na segunda etapa da pesquisa, foram interpretadas imagens de incisivos inferiores de 100 pacientes, cujos exames estavam disponíveis no banco de dados do tomógrafo i-CAT Classic da FOB-USP. Dois examinadores avaliaram a anatomia interna de incisivos inferiores, em reconstruções axiais, sagitais e coronais, classificando-a de acordo com o número de canais radiculares. A prevalência de 2 canais radiculares foi relacionada à localização do dente e ao gênero e idade do paciente. Para descrição dos dados coletados, utilizou-se a porcentagem (%). Para verificar a associação entre variáveis, utilizou-se o teste do qui-quadrado (X2), com nível de significância estatística de 5%. Para a concordância intra e interexaminador, utilizou-se o teste de kappa. Como resultado da primeira etapa da pesquisa, obteve-se alto índice de detecção de tipos anatômicos para todos os métodos avaliados (p <0,05). Para dentes com Tipo I (1 canal radicular regular), as imagens de TCFC foram superiores em comparação à radiografia periapical digital com dupla exposição (RP= 67% de acerto; TCFC= 98% de acerto, p <0,05). Considerando os 3 aparelhos de TCFC, não houve diferença estatística significante entre eles para identificação do Tipo I. Já para dentes com Tipo Ia (1 canal radicular oval), houve diferença estatística significante somente entre radiografia periapical digital com dupla exposição e o tomógrafo NewTom (RP= 44% de acerto; TCFC NewTom= 88% de acerto). Não houve diferença significante entre os outros 2 tomógrafos e radiografia periapical ou entre os 3 tomógrafos. Considerando dentes com Tipo III (2 canais radiculares), não houve diferença estatística significante entre nenhum dos métodos. Todos os métodos apresentaram números de respostas certas semelhantes para o Tipo III, sugerindo que a radiografia periapical com dupla angulação é suficiente para identificação de 2 canais radiculares em incisivos inferiores. A concordância intraexaminador para radiografia periapical foi regular (kappa=0,40 a 0,66) e de boa a excelente para os aparelhos de TCFC (kappa=0,62 a 0,85). A concordância interexaminador para radiografia periapical foi de ruim a regular (kappa=0,25 a 0,32) e de boa a excelente para os aparelhos de TCFC (kappa=0,62 a 0,92). Na segunda etapa da pesquisa, o total de 386 incisivos inferiores foi avaliado, sendo 192 incisivos centrais e 194 incisivos laterais. A prevalência de 2 canais radiculares constatada no total de dentes foi de 16,5%, sendo de 13% em incisivos centrais e de 20% nos incisivos laterais (p >0,05). Não houve diferença estatisticamente significante entre gêneros e idades. A concordância intra e interexaminador foi regular (kappa intra=0,60; kappa inter=0,57). Como conclusão da primeira etapa da pesquisa, observou-se que a identificação do número de canais radiculares foi efetiva em todos os métodos. No entanto, limitações foram encontradas para a diferenciação da forma do canal radicular. Na segunda etapa da pesquisa, concluiuse que a presença de 2 canais radiculares em incisivos inferiores de pacientes da região de Bauru é de aproximadamente 20% e não depende da localização do dente ou de gênero e idade do paciente. / Mandibular incisors most commonly have a single root canal, which can present with different anatomic configurations. According to the literature, the presence of a second root canal can be observed in 10 - 40% of the teeth. Difficulty in detecting the second root canal is an important factor for the endodontic treatment failure. The aim of this research was: 1) to compare the efficacy of digital periapical radiography (PA) with double exposure and cone beam computed tomography (CBCT) in the identification of internal anatomic patterns in mandibular incisors, and 2) to determine the prevalence of 2 root canals in mandibular incisors using cone beam computed tomographic images of a patient database, comparing to tooth position and patients gender and age. In the first part of this research, 40 extracted mandibular incisors underwent microcomputed tomographic (micro-CT) scanning (Skyscan 1074) in order to establish the gold standard for internal anatomic pattern. The teeth were classified according to: Type I (1 regular root canal, n=12), Type Ia (1 oval root canal, n=12), and Type III (2 root canals, n=16). Then, the teeth were divided into 10 groups of 4 teeth and placed in a preserved human mandible for direct digital periapical radiographic double exposure (Schick CDR) and CBCT scans using Kodak 9000 3D, Veraviewepocs 3De and NewTom 5G. Two blinded examiners classified the anatomic pattern of each tooth and their answers were compared to the gold standard (microtomographic images). Percentage (%) of right / wrong answers was used for the statistical analysis of the results. Chi-square test (X2) was used to verify the association between variables (p <.05). Inter and intraexaminer agreements were determined using kappa values. In the second part of this research, CBCT images of a 100 patients database from FOB-USP were examined. Two examiners assessed the internal anatomy of mandibular incisors in axial, sagittal and coronal reconstructions and classified the teeth according to the number of root canals. The prevalence of 2 root canals was related to the tooth location and patients gender and age. Percentage (%) was used to describe the collected data. Chi-square test (X2) was used to verify the association between variables (p <.05). Inter and intraexaminer agreements were determined using kappa values. The results of the first part of the research showed a high level of identification of anatomic patterns for all the methods (p <0.05). Considering Type I (1 regular root canal), CBCT images were better in comparison to PA (PA= 67%; CBCT= 98%, p <0.05). There was no significant difference between the 3 CBCT scanners. For Type Ia (1 oval root canal), there was a significant difference between PA and CBCT imaging using the NewTom unit only (PA= 44%, NewTom CBCT= 88%). No significant differences were found between the other 2 CBCT units and PA or between the 3 CBCT units. Considering Type III (2 root canals), there was no significant difference between the various methods. All the methods presented similar corrected answers index for Type III, which may suggest that PA with double exposure is sufficient for the identification of 2 root canals in mandibular incisors. The intraexaminer agreement was fair for PA (kappa=0.40 to 0.66) and good to very good for the CBCT units (kappa=0.62 to 0.85). The interexaminer agreement was poor to fair for PA (kappa=0.25 to 0.32) and good to very good for CBCT units (kappa=0.62 to 0.92). In the second part of this research, the total amount of 386 mandibular incisors was assessed in CBCT images (192 mandibular central incisors and 194 mandibular lateral incisors). The overall prevalence of 2 root canals was 16.5%, and 13% in mandibular central incisors and 20% in mandibular lateral incisors (p >0.05). There was no significant difference between gender and age. The intra and interexaminer agreement was fair (kappa intra=0.60; kappa inter=0.57). For the first part of this research, it is possible to conclude that the identification of the number of root canals was effective using all the methods. However, limitations were found in differentiating the shape of the root canal. As a conclusion of the second part of this research, the presence of 2 root canals in mandibular incisors of Bauru region patients is approximately 20% and it does not depend on tooth location or patients gender and age.

O propósito deste estudo foi avaliar a acurácia do exame de tomografia computadorizada multislice (TCM) e tomografia computadorizada por feixe cônico (TCFC) na identificação de lesões simuladas em mandíbula, em situações com e sem a presença de artefatos metálicos, em diversos protocolos de observação. Foram realizados exames de TCM e TCFC de mandíbulas secas, nas quais foram executadas perfurações simulando lesões. As imagens foram realizadas em dois momentos: na presença e na ausência de restaurações dentárias metálicas. Dois observadores, previamente calibrados, observaram as imagens avaliando-as quanto à presença ou ausência de lesão, número de lojas das lesões e a existência ou não de invasão medular. Os mesmos utilizaram programas de manipulação de imagens instalados em estações de trabalho independentes, para reconstruir as imagens nos seguintes protocolos de avaliação: axial, sagital + coronal, 3D, conjunto (axial+sagital+coronal+3D) e parassagital. A sensibilidade e especificidade (validade) da tomografia computadorizada multislice (64 cortes) (TCM) e da tomografia computadorizada por feixe cônico (TCFC) para diagnóstico de lesões ósseas (simuladas) em mandíbula, utilizando estação de trabalho independente foram demonstradas à medida que os valores encontrados foram superiores a 95% desde que com o protocolo de observação adequado. A influência de artefatos dentários metálicos foi pouco significativa na interpretação de lesões ósseas mandibulares, já que os valores de acurácia nas análises com e sem artefato foram bastante próximas. Os protocolos com aquisição por TCM sofreram mais influência dos artefatos do que os adquiridos por TCFC (valores sutilmente menores), exceto nas reconstruções em 3D, em que as originadas de aquisição por TCFC, apresentaram valores menores de acurácia. O melhor protocolo de pós processamento para interpretação de lesões ósseas simuladas foi o denominado RMP+3D. O protocolo que apresentou os piores resultados foi o que utilizou as reconstruções parassagitais. / The purpose of this study was to evaluate the accuracy of multislice computed tomography (MSCT) and cone-beam computed tomography (CBCT) in identification of simulated mandibular lesions in situations with and without metallic artifacts in several observation protocols. MSCT and CBCT examinations were performed in dry mandibles, in which holes were performed simulating lesions. The images were taken in two stages: in the presence and absence of metal dental restorations. Two observers, previously calibrated, observed the images by evaluating the images for the presence or absence of lesion, loci number and whether there were medullary invasion. Observers used image manipulation softwares, installed on independent workstations, to reconstruct the images in the following evaluation protocols: axial, sagittal + coronal, 3D, sets (axial+ coronal + sagittal + 3 D) and parasagittal. The sensitivity and specificity of MSCT (64 slices) and CBCT for diagnosis of simulated bone lesions in the mandible, using independent workstation were demonstrated as the values obtained were greater than 95% using the appropriate observation protocol. The influence of dental metallic artifacts was negligible in the interpretation of mandibular bone lesions, since the values of accuracy in the analysis with and without artifact were quite close. The images acquired with MCT suffered more influence of artifacts than the protocols acquired by TCFC, although the values were all high and quite close. Except for 3D reconstructions, which originated from the CBCT, showed the lowest accuracy. The best protocol for post-processing and interpretation of simulated bone lesions was called RMP +3 D. The protocol that showed the worst results was parasagital.

La tomographie par rayons X multi-énergétiques (MECT) permet d'obtenir plus d'information concernant la structure interne de l'objet par rapport au scanner CT classique. Un de ses intérêts dans l’imagerie médicale est d'obtenir les images de fractions d’eau et d’os. Dans l'état de l'art, les intérêts de MECT n'est pas encore découvert largement. Les approches de reconstruction existantes sont très limitées dans leurs performances. L'objectif principal de ce travail est de proposer des approches de reconstruction de haute qualité qui pourront être utilisés dans la MECT afin d’améliorer la qualité d’imagerie.Ce travail propose deux approches de reconstruction bayésiennes. La première est adaptée au système avec un détecteur discriminant en énergie. Dans cette approche, nous considérons que les polychromaticités de faisceaux sont négligeables. En utilisant le modèle linéaire de la variance et la méthode d'estimation maximum à postériori (MAP), l'approche que nous avons proposé permets de prendre en compte les différents niveaux de bruit présentés sur les mesures multi-énergétiques. Les résultats des simulations montrent que, dans l'imagerie médicale, les mesures biénergies sont suffisantes pour obtenir les fractions de l'eau et de l'os en utilisant l'approche proposée. Des mesures à la troisième énergie est nécessaire uniquement lorsque l'objet contient des matériaux lourdes. Par exemple, l’acier et l'iode. La deuxième approche est proposée pour les systèmes où les mesures multi-énergétiques sont obtenues avec des faisceaux polychromatiques. C'est effectivement la plupart des cas dans l'état actuel du practice. Cette approche est basée sur un modèle direct non-linéaire et un modèle bruit gaussien où la variance est inconnue. En utilisant l’inférence bayésienne, les fractions de matériaux de base et de la variance d'observation pourraient être estimées à l'aide de l'estimateur conjoint de MAP. Sous réserve à un modèle a priori Dirac attribué à la variance, le problème d'estimation conjointe est transformé en un problème d'optimisation avec une fonction du coût non-quadratique. Pour le résoudre, l'utilisation d'un algorithme de gradient conjugué non-linéaire avec le pas de descente quasi-optimale est proposée.La performance de l'approche proposée est analysée avec des données simulées et expérimentales. Les résultats montrent que l'approche proposée est robuste au bruit et aux matériaux. Par rapport aux approches existantes, l'approche proposée présente des avantages sur la qualité de reconstruction. / Multi-Energy Computed Tomography (MECT) makes it possible to get multiple fractions of basis materials without segmentation. In medical application, one is the soft-tissue equivalent water fraction and the other is the hard-matter equivalent bone fraction. Practical MECT measurements are usually obtained with polychromatic X-ray beams. Existing reconstruction approaches based on linear forward models without counting the beam polychromaticity fail to estimate the correct decomposition fractions and result in Beam-Hardening Artifacts (BHA). The existing BHA correction approaches either need to refer to calibration measurements or suffer from the noise amplification caused by the negative-log pre-processing and the water and bone separation problem. To overcome these problems, statistical DECT reconstruction approaches based on non-linear forward models counting the beam polychromaticity show great potential for giving accurate fraction images.This work proposes a full-spectral Bayesian reconstruction approach which allows the reconstruction of high quality fraction images from ordinary polychromatic measurements. This approach is based on a Gaussian noise model with unknown variance assigned directly to the projections without taking negative-log. Referring to Bayesian inferences, the decomposition fractions and observation variance are estimated by using the joint Maximum A Posteriori (MAP) estimation method. Subject to an adaptive prior model assigned to the variance, the joint estimation problem is then simplified into a single estimation problem. It transforms the joint MAP estimation problem into a minimization problem with a non-quadratic cost function. To solve it, the use of a monotone Conjugate Gradient (CG) algorithm with suboptimal descent steps is proposed.The performances of the proposed approach are analyzed with both simulated and experimental data. The results show that the proposed Bayesian approach is robust to noise and materials. It is also necessary to have the accurate spectrum information about the source-detector system. When dealing with experimental data, the spectrum can be predicted by a Monte Carlo simulator. For a variety of materials, less than 5% estimation errors are observed on their average decomposition fractions.The proposed approach is a statistical reconstruction approach based on a non-linear forward model counting the full beam polychromaticity and applied directly to the projections without taking negative-log. Compared to the approaches based on linear forward models and the BHA correction approaches, it has advantages in noise robustness and reconstruction accuracy.

The purpose of this project was to explore the performance of methods for estimating stopping power ratio (SPR) from Hounsfield units (HU) using dual energy CT scans, rather than the standard single energy CT scans, with the aim of finding a method which could outperform the current single energy stoichiometric method. Such a method could reduce the margin currently added to the target volume during treatment which is defined as 3.5 % of the range to the target volume + 1 mm . Three such methods, by Taasti, Zhu, and, Lalonde and Bouchard, were chosen and implemented in MATLAB. A phantom containing 10 tissue-like inserts was scanned and used as a basis for the SPR estimation. To investigate the variation of the SPR from day-to-day the phantom was scanned once a day for 12 days. The resulting SPR of all methods, including the stoichiometric method, were compared with theoretical SPR values which were calculated using known elemental weight fractions of the inserts and mean excitation energies from the National Institute of Standards and Technology (NIST). It was found that the best performing method was the Taasti method which had, at best, an average percentage difference from the theoretical values of only 2.5 %. The Zhu method had, at best, 4.8 % and Lalonde-Bouchard 15.6% including bone tissue or 6.3 % excluding bone. The best average percentage difference of the stoichiometric method was 3.1 %. As the Taasti method was the best performing method and shows much promise, future work should focus on further improving its performance by testing more scanning protocols and kernels to find the ones yielding the best performance. This should then be supplemented with testing different pairs of energies for the dual energy scans. The fact that the Zhu and Lalonde-Bouchard method performed poorly could indicate problems with the implementation of those methods in this project. Investigating and solving those problems is also an important goal for future projects. Lastly the Lalonde-Bouchard method should be tested with more than two energy spectra.

O sucesso da cirurgia ortognática está relacionado com diversos fatores como análise facial precisa e acurada, e exames de imagem com alta qualidade. Atualmente, diversos programas de imagens tridimensionais, comerciais e abertos, estão disponíveis no auxílio diagnóstico, elaboração do plano de tratamento e simulação do procedimento cirúrgico para correção das deformidades dentofaciais. Entretanto, estudos avaliando os diferentes métodos de mensuração linear empregados pelos programas de imagem por meio da reconstrução 3D no planejamento da osteotomia tipo Le Fort I são escassos e, maiores esclarecimentos sobre sua precisão e a acurácia são necessários. O objetivo deste estudo foi estabelecer: a) precisão e acurácia de medidas lineares tridimensionais para osteotomia tipo Le Fort I obtidas por meio da tomografia computadorizada multislice (TCMS) e feixe cônico (TCFC) e b) comparar a precisão e acurácia de medidas lineares para osteotomia tipo Le Fort I realizadas por meio de três programas de imagem utilizando a 3D-TCFC. A amostra foi constituída por onze crânios secos submetidos à TCMS 64 canais e TCFC. As reconstruções tridimensionais (3D-TC) foram geradas, e medidas lineares (n=11) baseadas em estruturas e pontos anatômicos de interesse à osteotomia tipo Le Fort I foram realizados independentemente, por dois radiologistas experientes, duas vezes cada, utilizando programa Vítrea 3.8.1 em reconstruções 3D-TCMS e 3D-TCFC e os programas OsiriX 1.2 64-bit e Dolphin Imaging versão 11.5.04.35 por meio da 3D-TCFC. Sequencialmente, um terceiro observador experiente e calibrado, que não participou da análise das imagens, realizou as medidas sobre os crânios secos utilizando paquímetro digital (padrão ouro) com quais as medidas foram comparadas. A análise intra e inter-observadores assim como as correlações individuais de cada medida foram realizadas utilizando o coeficiente de correlação intra-classe (CCI), sendo o intervalo de confiança adotado de 95%. Os resultados demonstraram na análise intra-observador, utilizando o programa Vítrea, correlação excelente para todas as medidas variando de 0,87 a 0,96 e 0,82 a 0,98 para os observadores 1 e 2 respectivamente utilizando a TCMS e de 0,84 a 0,98 e 0,80 a 0,98 utilizando a TCFC. A análise inter-observadores variou de 0,85 a 0,98 para a TCMS e de 0,80 a 0,99 para a TCFC. A análise intra-observador utilizando os diferentes programas de imagem na TCFC apresentou variações de 0,90 a 0,97 (Vítrea), 0,65 a 0,97 (OsiriX) e 0,51 a 0,94 (Dolphin). Na análise inter-obsevador obtivemos valores de 0,92 a 0,99 e 0,88 a 0,98 para os observadores 1 e 2 respectivamente utilizando o Vítrea, 0,58 a 0,90 e 0,48 a 0,85 para o programa OsiriX e de 0,80 a 0,96 e 0,57 a 0,92 com o programa Dolphin. O programa Vítrea não apresentou diferenças estatisticamente significante nas análises intra e inter-observador e medidas físicas utilizando a TCMS e TCFC. Em relação à análise dos programas, diferenças estatisticamente foram constatadas com o programa OsiriX e Dolphin em relação ao padrão ouro. / The success of orthognathic surgery depends on many factors as precise and accurate facial analysis and high quality imaging exams. Nowadays a lot of commercial and open-source three-dimensional software programs currently available to assist diagnosis, elaboration of treatment planning, and to predict outcomes related to orthognathic surgery. The aim of this study was to establish: a) the precision and accuracy of three-dimensional linear measurements for Le Fort I osteotomy, obtained from multislice computed tomography (MSCT) and cone-beam computed tomography (CBCT) scans and b) compare the precision and accuracy of linear measurements for Le Fort I osteotomy performed by three different imaging software programs and obtained from 3D-CBCT images. The study population consisted of 11 dried skulls submitted to 64-row MSCT and CBCT scans. Three-dimensional reconstructed images (3D-CT) were generated, and linear measurements (n = 11) based on anatomical structures and landmarks of interest for Le Fort I osteotomy were performed independently by 2 oral and maxillofacial radiologists, twice each, using Vítrea 3.8.1 software for 3D-MSCT and 3D-CBCT and OsiriX 1.2 64-bit and Dolphin Imaging version 11.5.04.35 from 3D-CBCT. Subsequently, a third examiner expert in anatomical analysis and calibrated, who did not evaluate the images, performed measurements on dry skulls using a digital caliper (gold standard) with which the measurements were compared. The analyses of intra- and inter-observer as well as the individual correlations of each measurement were performed using the coefficient of intra-class correlation (ICC), with a confidence interval of 95 %. The intra-observer results showed that using the Vitrea program, excellent correlation for all measurements were reached with ICC values ranging from 0.87 to 0.96 and 0.82 0.98 for observers 1 and 2 respectively using the MSCT and 0.84 to 0.98 and 0.80 to 0.98 using CBCT. Inter-observer analysis ranged from 0.85 to 0.98 for MSCT and 0.80 to 0.99 for CBCT. The intra-observer analysis using the different programs using CBCT images varied from 0.90 to 0.97 for Vitrea, 0.65 to 0.97 for OsiriX and 0.51 to 0.94 using Dolphin. Inter-observer analysis demonstrated values ranging from 0.92 to 0.99 and 0.88 0.98 for observers 1 and 2 respectively using the Vitrea; 0.58 to 0.90 and 0.48 to 0.85 for OsiriX, and 0.80 to 0.96 and 0.57 to 0.92 using Dolphin. Vítrea software showed no statistically significant differences for intra-and inter-observer analysis and physical measurements using MSCT and CBCT. Regarding the analysis of softwares, statistical differences were found with the program OsiriX and Dolphin in comparison to gold standard.

Os dentes incisivos inferiores apresentam, em sua maioria, canal radicular único, que pode ter conformações distintas. De acordo com a literatura científica, a presença de um segundo canal radicular pode ser constatada em 10 a 40% dos casos. A não-detecção do segundo canal é um importante fator para o insucesso do tratamento endodôntico. Esta pesquisa foi realizada com os seguintes objetivos: 1) comparar a eficácia na identificação de padrões anatômicos internos em incisivos inferiores permanentes extraídos com uso de imagem radiográfica periapical digital e de tomografia computadorizada de feixe cônico (TCFC); e 2) determinar a prevalência de 2 canais radiculares em incisivos inferiores em imagens de TCFC de um banco de dados de exames previamente realizados, associando com localização do dente, gênero e idade do paciente. Na primeira etapa da pesquisa, 40 dentes incisivos inferiores foram submetidos a escaneamento em microtomógrafo computadorizado da FOB-USP (Skyscan 1074) para estabelecer o padrão ouro do tipo anatômico interno de cada dente. Os dentes foram então classificados em: Tipo I (1 canal radicular regular, n=12), Tipo Ia (1 canal radicular oval, n=12) e Tipo III (2 canais radiculares, n=16). Em seguida, os dentes foram divididos em 10 grupos de 4 dentes e posicionados em alvéolos de uma mandíbula humana para exposição radiográfica periapical digital direta com duas tomadas variando o ângulo horizontal de incidência (Schick CDR) e para escaneamento em 3 tomógrafos (Kodak 9000 3D, Veraviewepocs 3De e NewTom 5G) da Universidade de Loma Linda, CA, EUA. Dois examinadores treinados classificaram o tipo anatômico de cada dente e suas respostas foram comparadas ao padrão ouro estabelecido por microtomografia. Para descrição dos resultados, utilizou-se a porcentagem (%) de respostas certas / erradas. Aplicou-se o teste do qui-quadrado (X2), com nível de significância estatística de 5%, para verificação da associação entre variáveis. As concordâncias inter e intraexaminador foram determinadas por teste de kappa. Na segunda etapa da pesquisa, foram interpretadas imagens de incisivos inferiores de 100 pacientes, cujos exames estavam disponíveis no banco de dados do tomógrafo i-CAT Classic da FOB-USP. Dois examinadores avaliaram a anatomia interna de incisivos inferiores, em reconstruções axiais, sagitais e coronais, classificando-a de acordo com o número de canais radiculares. A prevalência de 2 canais radiculares foi relacionada à localização do dente e ao gênero e idade do paciente. Para descrição dos dados coletados, utilizou-se a porcentagem (%). Para verificar a associação entre variáveis, utilizou-se o teste do qui-quadrado (X2), com nível de significância estatística de 5%. Para a concordância intra e interexaminador, utilizou-se o teste de kappa. Como resultado da primeira etapa da pesquisa, obteve-se alto índice de detecção de tipos anatômicos para todos os métodos avaliados (p <0,05). Para dentes com Tipo I (1 canal radicular regular), as imagens de TCFC foram superiores em comparação à radiografia periapical digital com dupla exposição (RP= 67% de acerto; TCFC= 98% de acerto, p <0,05). Considerando os 3 aparelhos de TCFC, não houve diferença estatística significante entre eles para identificação do Tipo I. Já para dentes com Tipo Ia (1 canal radicular oval), houve diferença estatística significante somente entre radiografia periapical digital com dupla exposição e o tomógrafo NewTom (RP= 44% de acerto; TCFC NewTom= 88% de acerto). Não houve diferença significante entre os outros 2 tomógrafos e radiografia periapical ou entre os 3 tomógrafos. Considerando dentes com Tipo III (2 canais radiculares), não houve diferença estatística significante entre nenhum dos métodos. Todos os métodos apresentaram números de respostas certas semelhantes para o Tipo III, sugerindo que a radiografia periapical com dupla angulação é suficiente para identificação de 2 canais radiculares em incisivos inferiores. A concordância intraexaminador para radiografia periapical foi regular (kappa=0,40 a 0,66) e de boa a excelente para os aparelhos de TCFC (kappa=0,62 a 0,85). A concordância interexaminador para radiografia periapical foi de ruim a regular (kappa=0,25 a 0,32) e de boa a excelente para os aparelhos de TCFC (kappa=0,62 a 0,92). Na segunda etapa da pesquisa, o total de 386 incisivos inferiores foi avaliado, sendo 192 incisivos centrais e 194 incisivos laterais. A prevalência de 2 canais radiculares constatada no total de dentes foi de 16,5%, sendo de 13% em incisivos centrais e de 20% nos incisivos laterais (p >0,05). Não houve diferença estatisticamente significante entre gêneros e idades. A concordância intra e interexaminador foi regular (kappa intra=0,60; kappa inter=0,57). Como conclusão da primeira etapa da pesquisa, observou-se que a identificação do número de canais radiculares foi efetiva em todos os métodos. No entanto, limitações foram encontradas para a diferenciação da forma do canal radicular. Na segunda etapa da pesquisa, concluiuse que a presença de 2 canais radiculares em incisivos inferiores de pacientes da região de Bauru é de aproximadamente 20% e não depende da localização do dente ou de gênero e idade do paciente. / Mandibular incisors most commonly have a single root canal, which can present with different anatomic configurations. According to the literature, the presence of a second root canal can be observed in 10 - 40% of the teeth. Difficulty in detecting the second root canal is an important factor for the endodontic treatment failure. The aim of this research was: 1) to compare the efficacy of digital periapical radiography (PA) with double exposure and cone beam computed tomography (CBCT) in the identification of internal anatomic patterns in mandibular incisors, and 2) to determine the prevalence of 2 root canals in mandibular incisors using cone beam computed tomographic images of a patient database, comparing to tooth position and patients gender and age. In the first part of this research, 40 extracted mandibular incisors underwent microcomputed tomographic (micro-CT) scanning (Skyscan 1074) in order to establish the gold standard for internal anatomic pattern. The teeth were classified according to: Type I (1 regular root canal, n=12), Type Ia (1 oval root canal, n=12), and Type III (2 root canals, n=16). Then, the teeth were divided into 10 groups of 4 teeth and placed in a preserved human mandible for direct digital periapical radiographic double exposure (Schick CDR) and CBCT scans using Kodak 9000 3D, Veraviewepocs 3De and NewTom 5G. Two blinded examiners classified the anatomic pattern of each tooth and their answers were compared to the gold standard (microtomographic images). Percentage (%) of right / wrong answers was used for the statistical analysis of the results. Chi-square test (X2) was used to verify the association between variables (p <.05). Inter and intraexaminer agreements were determined using kappa values. In the second part of this research, CBCT images of a 100 patients database from FOB-USP were examined. Two examiners assessed the internal anatomy of mandibular incisors in axial, sagittal and coronal reconstructions and classified the teeth according to the number of root canals. The prevalence of 2 root canals was related to the tooth location and patients gender and age. Percentage (%) was used to describe the collected data. Chi-square test (X2) was used to verify the association between variables (p <.05). Inter and intraexaminer agreements were determined using kappa values. The results of the first part of the research showed a high level of identification of anatomic patterns for all the methods (p <0.05). Considering Type I (1 regular root canal), CBCT images were better in comparison to PA (PA= 67%; CBCT= 98%, p <0.05). There was no significant difference between the 3 CBCT scanners. For Type Ia (1 oval root canal), there was a significant difference between PA and CBCT imaging using the NewTom unit only (PA= 44%, NewTom CBCT= 88%). No significant differences were found between the other 2 CBCT units and PA or between the 3 CBCT units. Considering Type III (2 root canals), there was no significant difference between the various methods. All the methods presented similar corrected answers index for Type III, which may suggest that PA with double exposure is sufficient for the identification of 2 root canals in mandibular incisors. The intraexaminer agreement was fair for PA (kappa=0.40 to 0.66) and good to very good for the CBCT units (kappa=0.62 to 0.85). The interexaminer agreement was poor to fair for PA (kappa=0.25 to 0.32) and good to very good for CBCT units (kappa=0.62 to 0.92). In the second part of this research, the total amount of 386 mandibular incisors was assessed in CBCT images (192 mandibular central incisors and 194 mandibular lateral incisors). The overall prevalence of 2 root canals was 16.5%, and 13% in mandibular central incisors and 20% in mandibular lateral incisors (p >0.05). There was no significant difference between gender and age. The intra and interexaminer agreement was fair (kappa intra=0.60; kappa inter=0.57). For the first part of this research, it is possible to conclude that the identification of the number of root canals was effective using all the methods. However, limitations were found in differentiating the shape of the root canal. As a conclusion of the second part of this research, the presence of 2 root canals in mandibular incisors of Bauru region patients is approximately 20% and it does not depend on tooth location or patients gender and age.

Computed tomography angiography (CTA) of the brain poses challenges on the imaging system; the contrast between blood vessels and surrounding soft tissue is very low, and to render small intricate vessel structures high spatial resolution is needed. Higher precision angiography would facilitate more accurate diagnosis of pathological conditions. The aim of this work was to analyze the factors which contribute to the image quality in cerebrovascular imaging contexts and make a comparison between state-of-the-art energy-integrating and photon counting CT systems. A geometrical model was devised to mimic the conditions of cerebral angiography. Different parameters and detectors were used to reconstruct images of a spherical head phantom. Compton noise was added to several image acquisitions after a Monte Carlo study was used to estimate the scatter to primary ratio (SPR) with a spherical phantom. The images were evaluated qualitatively and quantitatively. A real phantom was scanned with an experimental photon counting detector and compared with the simulated approach. The work resulted in qualitative reconstructed images, a decrease in SPR when introducing air gaps and improved resolution but worsened contrast as a result of smaller detector sizes. The SPR was shown to be higher in cone-beam geometry than fan-beam geometry. Electronic noise present with energy integrating detectors was shown to degrade image quality significantly in low dose imaging, reducing contrast when imaging vascular-like structures. Photon counting detectors without electronic noise could provide greater image quality and better diagnostic information.

Published Article / Rapid Manufacturing (RM) has emerged over the past few years as a potential technology to successfully produce patient-specific implants for maxilla/facial and cranial reconstructive surgeries. However, in the area of spinal implants, customization has not yet come to the forefront and with growing capabilities in both software and manufacturing technologies, these opportunities need to be investigated and developed wherever possible. The possibility of using Computed Tomography (CT) and Rapid Manufacturing (RM) technologies to design and manufacture a customized, patient-specific intervertebral implant, is investigated. Customized implants could aid in the efforts to reduce the risk of implant subsidence, which is a concern with existing standard implants. This article investigates how accurately the geometry of a customized artificial intervertebral disc (CAID) can represent the inverse geometry of a patient's vertebral endplates. The results indicate that the endplates of a customized disc implant can be manufactured to a calculated average error of 0.01mm within a confidence interval of 0.022mm, with 95% confidence, when using Direct Metal Laser Sintering.

PEPT (positron emission particle tracking) is a technique for tracking a small radioactive tracer in Lagrangian co-ordinates. The technique was used to study the flow patterns of non-Newtonian CMC (Carboxy Methyl Cellulose) solutions inside a vessel agitated by an axial flow impeller. The 'non-intrusive' PEPT technique uses two position-sensitive detectors to track a radioactive particle in space and time. The particle is labelled with a positron emitting isotope. Once emitted from the nucleus a positron annihilates with an electron releasing energy in the form of two 511 keV back-to-back gamma-rays travelling in opposite directions, 180 degrees apart. The tracer particle is introduced into the stirred vessel which is mounted between the two detectors of the positron camera. Three axial flow impellers produced by Lightnin Mixers Ltd were used to carry out the experiments. Results showed that the discharge from the three impellers was radial when agitating non-Newtonian viscous solutions of CMC. Trajectory analysis was used to compare the performance of the impellers using the agitation index and the efficiency of circulation. A limited number of experiments was carried out to compare the effect of baffles on the circulation of the fluids in a mixing tank. The results showed that mixing of these non-Newtonian liquids in an unbaffled tank is better than in a baffled tank when using axial flow impellers. Other experiments were carried out to suspend solid particles in viscous fluids. Results showed that the minimum speed required to suspend large particles is lower than that required to suspend small particles. There are many correlations and models in the literature to determine the minimum speed required to suspend all the particles in a fluid; some of these correlations and models were compared with experimental results from this work. The correlation of Zweitering (1958) agreed with experimental data after modification. The Geisler et al. (1993) model agreed with the data provided that the power consumption is correctly substituted. The last part of this work concerned the flow of non-Newtonian viscous materials through industrial equipment. Yoghurt was chosen as the test fluid as one of the companies sponsoring this project was Eden Vale, a yoghurt manufacturer. A method was proposed using rheological measurements to simulate the flow through the dispensing pipeline and distributing nozzles; this method allows the designer to predict the final properties of yoghurt after passing through the paching head. Measurements were also carried out to determine the final gel structure of yoghurt in the delivery pots. This data of this thesis is useful in designing stirred tanks when non-Newtonian fluid is present, either for agitation or when suspending solids. Also, a method was provided to design yoghurt manufacturing line.