Semi-automatic 3D Segmentation Of Costal Cartilage In CT Data From Pectus Excavatum Patients

One of the current frontiers in the clinical management of Pectus Excavatum (PE) patients is the prediction of the surgical outcome prior to the intervention. This can be done through computerized simulation of the Nuss procedure, which requires an anatomically correct representation of the costal cartilage. To this end, we take advantage of the costal cartilage tubular structure to detect it through multi-scale vesselness filtering. This information is then used in an interactive 2D initialization procedure which uses anatomical maximum intensity projections of 3D vesselness feature images to efficiently initialize the 3D segmentation process. We identify the cartilage tissue centerlines in these projected 2D images using a livewire approach. We finally refine the 3D cartilage surface through region-based sparse field level-sets. We have tested the proposed algorithm in 6 noncontrast CT datasets from PE patients. A good segmentation performance was found against reference manual contouring, with an average Dice coefficient of 0.75±0.04 and an average mean surface distance of 1.69±0.30mm. The proposed method requires roughly 1 minute for the interactive initialization step, which can positively contribute to an extended use of this tool in clinical practice, since current manual delineation of the costal cartilage can take up to an hour.

IDENTIFYING ETHICAL DILEMMAS OF TOC/CHARTERED ACCOUNTANTS

The way professionals deal with ethical dilemmas and the decisions they make may be guided by a personal and individual ideology, but these are also strongly influenced by their professional group and society. The focus in this paper is on situations as experienced by individuals in their day-to-day professional life. The data were collected with opened-end interviews. Respondents were asked to identify the ethical dilemmas they had been faced with during their professional life. Qualitative analysis shows that main dilemmas are about how to deal with “informal economy”, “false invoices” and “tax evasion”. This study aims to contribute to the discussion of ethical issues faced by TOC, thus promoting a large debate about the way TOC can help create a better society and consequently legitimating their existence as a professional organization of public interest.