Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-32	Image registration is a process of correctly aligning images; Shape-Based Segmentation: Many methods parametrize a template shape for a given structure, often relying on control points along the boundary. The entire shape is then deformed to match a new image. Two of the most common shape-based techniques are Active Shape Models and Active Appearance Models; Image-Based Segmentation: Some methods initiate a template and refine its shape according to the image data while minimizing integral error measures, like the Active contour model and its variations; Interactive Segmentation: Interactive methods are useful when clinicians can provide some information, such as a seed region or rough outline of the region to segment. An algorithm can then iteratively refine such a segmentation, with or without guidance from the clinician. Manual segmentation, using tools such as a paint brush to explicitly define the tissue class of each pixel, remains the gold standard for many imaging applications. Recently, principles from feedback control theory have been incorporated into segmentation, which give the user much greater flexibility and allow for the automatic correction of errors; Subjective surface Segmentation: This method is based on the idea of evolution of segmentation function which is governed by an advection-diffusion model. To segment an object, a segmentation seed is needed (that is the starting point that determines the approximate position of the object in the image). Consequently, an initial segmentation function is constructed. With the subjective surface method, the position of the seed is the main factor determining the form of this segmentation function; and Hybrid segmentation which is based on combination of methods. (Search "medical image computing" on Wikipedia.com June 24, 2021. CC-BY-SA 3.0 Modified. Accessed June 24, 2021.)	38	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	As used herein, "medical imaging" refers to a technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging may be used to establish a database of normal anatomy and physiology to make possible identification of abnormalities. Medical imaging in its widest sense, is part of biological imaging and incorporates radiology, which uses the imaging technologies of X-ray radiography, magnetic resonance imaging, ultrasound, endoscopy, elastography, tactile imaging, thermography, medical photography, nuclear medicine functional imaging techniques as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Another form of X-ray radiography includes computerized tomography (CT) scans in which a computer controls the position of the X-ray sources and detectors. Magnetic Resonance Imaging (MRI) is another medical imaging technology. Measurement and recording techniques that are not primarily designed to produce images, such as electroencephalography (EEG), magnetoencephalography (MEG), electrocardiography (ECG), and others, represent other technologies that produce data susceptible to representation as a parameter graph vs. time or maps that contain data about the measurement locations. In certain embodiments bone imaging includes devices that scan and gather bone density anatomic data. These technologies may be considered forms of medical imaging in certain disciplines. (Search "medical imaging" on Wikipedia.com June 16, 2021. CC-BY-SA 3.0 Modified. Accessed June 23, 2021.) Data, including images, text, and other data associated with medical imaging is referred to as patient imaging data. As used herein, "patient imaging data" refers to data identified, used, collected, gathered, and/or generated in connection with medical imaging and/or medical imaging data. Patient imaging data can be shared between users, systems, patients, and professionals using a common data format referred to as Digital Imaging and Communications in Medicine (DICOM) data. DICOM data is a standard format for storing, viewing, retrieving, and sharing medical images.	39	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	As used herein, "medical image computing" or "medical image processing" refers to systems, software, hardware, components, and/or apparatus that involve and combine the fields of computer science, information engineering, electrical engineering, physics, mathematics and medicine. Medical image computing develops computational and mathematical methods for working with medical images and their use for biomedical research and clinical care. One goal for medical image computing is to extract clinically relevant information or knowledge from medical images. While closely related to the field of medical imaging, medical image computing focuses on the computational analysis of the images, not their acquisition. The methods can be grouped into several broad categories: image segmentation, image registration, image-based physiological modeling, and others. (Search "medical image computing" on Wikipedia.com June 24, 2021. CC-BY-SA 3.0 Modified. Accessed June 24, 2021.) Medical image computing may include one or more processors or controllers on one or more computing devices. Such processors or controllers may be referred to herein as medical image processors. Medical imaging and medical image computing together can provide systems and methods to image, quantify and fuse both structural and functional information about a patient in vivo. These two technologies include the transformation of computational models to represent specific subjects/patients, thus paving the way for personalized computational models. Individualization of generic computational models through imaging can be realized in three complementary directions: definition of the subject-specific computational domain (anatomy) and related subdomains (tissue types); definition of boundary and initial conditions from (dynamic and/or functional) imaging; and characterization of structural and functional tissue properties. Medical imaging and medical image computing enable in the translation of models to the clinical setting with both diagnostic and therapeutic applications. (Id.) In certain embodiments, medical image computing can be used to generate a bone model, a patient-specific model, and/or a patent specific instrument from medical imaging and/or medical imaging data.	40	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	As used herein, "model" refers to an informative representation of an object, person or system. Representational models can be broadly divided into the concrete (e.g. physical form) and the abstract (e.g. behavioral patterns, especially as expressed in mathematical form). In abstract form, certain models may be based on data used in a computer system or software program to represent the model. Such models can be referred to as computer models. Computer models can be used to display the model, modify the model, print the model (either on a 2D medium or using a 3D printer or additive manufacturing technology). Computer models can also be used in environments with models of other objects, people, or systems. Computer models can also be used to generate simulations, display in virtual environment systems, display in augmented reality systems, or the like. Computer models can be used in Computer Aided Design (CAD) and/or Computer Aided Manufacturing (CAM) systems. Certain models may be identified with an adjective that identifies the object, person, or system the model represents. For example, a "bone" model is a model of a bone, and a "heart" model is a model of a heart. (Search "model" on Wikipedia.com June 13, 2021. CC-BY-SA 3.0 Modified. Accessed June 23, 2021.) As used herein, “additive manufacturing” refers to a manufacturing process in which materials are joined together in a process that repeatedly builds one layer on top of another to generate a three-dimensional structure or object. Additive manufacturing may also be referred to using different terms including additive processes, additive fabrication, additive techniques, additive layer manufacturing, layer manufacturing, freeform fabrication, ASTM F2792 (American Society for Testing and Materials), and 3D printing. Additive manufacturing can build the three-dimensional structure or object using computer-controlled equipment that applies successive layers of the material(s) based on a three-dimensional model that may be defined using Computer Aided Design (CAD) software. Additive manufacturing can use a variety of materials including polymers, thermoplastics, metals, ceramics, biochemicals, and the like. Additive manufacturing may provide unique benefits, as an implant together with the pores and/or lattices can be directly manufactured (without the need to generate molds, tool paths, perform any milling, and/or other manufacturing steps).	41	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-32	"Repository" refers to any data source or dataset that includes data or content. In one embodiment, a repository resides on a computing device. In another embodiment, a repository resides on a remote computing or remote storage device. A repository may comprise a file, a folder, a directory, a set of files, a set of folders, a set of directories, a database, an application, a software application, content of a text, content of an email, content of a calendar entry, and the like. A repository, in one embodiment, comprises unstructured data. A repository, in one embodiment, comprises structured data such as a table, an array, a queue, a look up table, a hash table, a heap, a stack, or the like. A repository may store data in any format including binary, text, encrypted, unencrypted, a proprietary format, or the like.	42	Added by DJM Jan 2024	1/6/24, 9:48 PM
View Edit Delete	PER-16	FIG. 11E illustrates that the first height 1120 and the second height 1122 are defined such that the trajectory 1124 of the cutter guide 1010 extends substantially perpendicular to the longitudinal axis 1154 of at least one of the bones that is to be resected/dissected using the pivoting resection guide 1002. In one example, the longitudinal axis 1154 may be a long axis of a first metatarsal 208. In certain embodiments, the first height 1120 and second height 1122 may be of the same or substantially the same magnitude. The size of the first height 1120 and/or second height 1122 can vary depending on the contour of a bone surface that contacts the first bone attachment feature 1006 and second bone attachment feature 1008, the first angle 1150, the second angle 1152, an angle of the opening 1116, an angle of the opening 1146, whether the pivoting resection guide 1002 will span a joint and involve two bones, and the like. Advantageously, each of these aspects can be accounted for and accommodated when models of the bones of the patient and/or models of instruments such as the osteotomy system 1000 are reviewed and defined during preoperative planning stages in accordance with the present disclosure.	278	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	In the illustrated embodiment, the first angle 1150 and the second angle 1152 are right angles. Of course, in certain embodiments, the first angle 1150 may not be at a right angle with respect to the distal side 1114 of the first bone attachment feature 1006 and the second angle 1152 may not be at a right angle with respect to the proximal side 1142 of the second bone attachment feature 1008. Alternatively, or in addition, the first height 1120 and/or second height 1122 may be defined such that the trajectory 1124 of the cutter guide 1010 extends at an angle that is not perpendicular to the longitudinal axis 1154 of at least one of the bones that is to be resected/dissected using the pivoting resection guide 1002. Accordingly, in this manner, the angle of the trajectory 1124 can be predetermined and/or can be patient-specific to meet the needs of the patient, the angle needed for a correction, the preferences of a surgeon, or the like.	279	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	FIGs 11A-11H, illustrate an embodiment of an osteotomy system 1000 that includes both a first bone attachment feature 1006 and a second bone attachment feature 1008 with a cutter guide 1010 between them. However, certain embodiments of an osteotomy system may have substantially the same constructs, components, and aspects as those described with respect to embodiments in FIGs 11A-11H with the exception that these embodiments may include either the first bone attachment feature 1006 or the second bone attachment feature 1008. Thus, the present disclosure supports embodiments of a pivoting resection guide that includes one of the first bone attachment feature 1006 or the second bone attachment feature 1008 but not both. Such an embodiment can also include a first bone engagement surface 1022 or second bone engagement surface 1024 depending on which bone attachment feature is included. The first bone engagement surface 1022 or second bone engagement surface 1024 may be determined at least in part based on a model of a bone of a patient’s foot. In certain embodiments, the bone is the bone that the first bone attachment feature 1006 or the second bone attachment feature 1008 will contact during the surgical procedure.	280	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	For example, suppose in one embodiment, the osteotomy system includes a first bone attachment feature 1006, at least one fastener 1012, a cutting tool 1026, and the cutter guide 1010. Accordingly, the first bone attachment feature 1006 includes a first bone engagement surface 1022 that is configured to engage with a bone surface to position the first bone attachment feature 1006 for the surgical procedure. Alternatively, in another embodiment, the osteotomy system includes a second bone attachment feature 1008, at least one fastener 1012, a cutting tool 1026, and the cutter guide 1010. Accordingly, the second bone attachment feature 1008 includes a second bone engagement surface 1024 that is configured to engage with a bone surface to position the second bone attachment feature 1008 for the surgical procedure.	281	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	FIG. 12A is an exploded view of a pivoting resection guide 1002, according to one embodiment, including a handle 1004. The osteotomy system 1000 includes a cutting tool 1026, first bone attachment feature 1006, second bone attachment feature 1008, cutter guide 1010 and the first coupler 1118 and second coupler 1148 describe earlier.	282	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	The cutter guide 1010 is configured to receive a cutting tool 1026 such as a burr, a drill bit, or the like. The cutting tool 1026 can also be referred to as a cutter. The cutting tool 1026 includes a proximal end 1202 and a distal end 1204. The cutting tool 1026 is configured to be deployed within an opening 1206 in the cutter guide 1010. In one embodiment, the opening 1206 in the cutter guide 1010 extends from one end to the other. The opening 1206 extends from a proximal end of the cutter guide 1010 to a distal end of the cutter guide 1010. The opening 1206 of the cutter guide is sized and shaped to accept at least the cutting section 1222 of the cutting tool cutting tool 1026.	283	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	The handle 1004 provides precise and accurate control of the cutting tool 1026 as the pivoting resection guide 1002 is used to guide the cutting tool 1026 is performing an osteotomy. The handle 1004 enables a surgeon to pivot the cutter guide 1010 with fine control within a plane between the first bone attachment feature 1006 and the second bone attachment feature 1008 and without interference from the cutting tool 1026.	284	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	The handle 1004 includes a distal handle end 1208 and a proximal handle end 1210 opposite the distal handle end 1208. The distal handle end 1208 includes a handle coupler 1212. The handle coupler 1212 is configured to couple the handle 1004 to the cutter guide 1010, at least temporarily. The handle 1004 also includes an opening 1214 that extends from the proximal handle end 1210 to the distal handle end 1208. In certain embodiments, the opening 1214 is coaxial with a longitudinal axis 1216 of the handle 1004. The opening 1214 is sized to accept the cutting tool 1026. In particular, the handle 1004 is configured to pass the cutting tool 1026 through the handle 1004. The handle coupler 1212 couples the handle 1004 to the cutter guide 1010. Coupling the handle 1004 to the cutter guide 1010 forms a first-class lever. The first-class lever magnifies a load force applied to a bone in contact with the cutting tool 1026 near the distal end 1204 of the cutting tool 1026 based on an effort force applied by a user toward the proximal handle end 1210.	285	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	The cutting tool 1026 includes a body 1218 that includes a drive section 1220, a cutting section 1222, and a guide section 1224 between the drive section 1220 and the cutting section 1222. In one embodiment, the body 1218 is an elongate body with a round cross section. The drive section 1220 is near the proximal end 1202 and is configured to couple to a driver that rotates the cutting tool 1026. The guide section 1224 engages with the pivoting resection guide 1002 and guides the cutting tool 1026 during the creation of an osteotomy. The cutting section 1222 is near the distal end 1204. The cutting section 1222 is the part that resects/dissects the bone to form an osteotomy. In one embodiment, the cutting section 1222 includes a set of flutes or grooves that include sharp edges configured to cut and resect hard tissue and/or soft tissue.	286	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	In certain embodiments, the cutting section 1222 has a predetermined length. This predetermined length may be patient-specific. Alternatively, or in addition, the predetermined length is configured based on a diameter of the tissue the cutting tool 1026 will resect/dissect. In certain embodiments, the predetermined length is configured to extend from one cortex of a bone to an opposite cortex of the bone when the cutting tool 1026 is used to resect the bone. Alternatively, or in addition, the cutting tool 1026 can be used to form a channel or bone tunnel or recess, in such cases the predetermined length may be set to accommodate that use.	287	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	In the illustrated embodiment, the cutter guide 1010 includes two arms that each extend into an opening 1226, 1228 in each of the first bone attachment feature 1006 and the second bone attachment feature 1008. The arms may be secured in the openings using one or more fasteners 1016 (e.g., set screws, thumbscrews, pins, dowels, or the like). Together the arms, openings, and/or fasteners 1016 may operate as one example of a first coupler 1118 and/or second coupler 1148.	288	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	Referring still to FIG. 12A, in one embodiment, the first coupler 1118 includes a proximal arm 1230, a proximal arm groove 1232, and a proximal arm retainer 1234. The proximal arm 1230 extends from a first side of the cutter guide 1010 at a first arm angle 1236 towards the first bone attachment feature 1006. In the illustrated embodiment, the proximal arm 1230 is a cylindrical structure that extends from the cutter guide 1010. The opening 1226 is also circular which allows the proximal arm 1230 to rotate within the opening 1226.	289	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	The proximal arm groove 1232 may be toward a distal end of the proximal arm 1230. The proximal arm groove 1232 circumscribes the proximal arm 1230 and cooperates with the proximal arm retainer 1234 to retain the proximal arm 1230 within the opening 1226. In the illustrated embodiment, the proximal arm retainer 1234 is a set screw that passes through an opening in the body 1102 of the first bone attachment feature 1006 and extends into the proximal arm groove 1232. The proximal arm retainer 1234 engages the body 1102 of the first bone attachment feature 1006 and the proximal arm groove 1232 to couple the proximal arm 1230 to the first bone attachment feature 1006.	290	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	The proximal arm retainer 1234 provides interference within the proximal arm groove 1232 such that the proximal arm 1230 is retained within the opening 1226. Of course, a set screw is but one example of a suitable proximal arm retainer 1234. In one embodiment, the proximal arm retainer 1234 is a thumbscrew, which may enable a user to readily release a proximal arm 1230 so that the cutter guide 1010 can be swapped with another one. The proximal arm retainer 1234 may also be a pin, a screw, a bolt, or the like. In the illustrated embodiment, the first arm angle 1236 is a right angle such that the longitudinal axis of the cutter guide 1010 is parallel to the distal side 1114 of the first bone attachment feature 1006. Those of skill in the art will appreciate that the first arm angle 1236 can be a variety of angles and can be patient-specific such that the trajectory 1124 of the cutter guide 1010 can be predetermined based, at least in part on the first arm angle 1236.	291	Added by DJM Jan 2024	1/3/24, 4:26 AM
View Edit Delete	PER-16	In the illustrated embodiment, the second coupler 1148 in one embodiment, includes a distal arm 1238, a distal arm groove 1240, and a distal arm retainer 1242. The distal arm 1238 extends from a second side of the cutter guide 1010 at a second arm angle 1244 towards the second bone attachment feature 1008. In the illustrated embodiment, the distal arm 1238 is a cylindrical structure that extends from the cutter guide 1010. The opening 1228 is also circular which allows the distal arm 1238 to rotate within the opening 1228.	292	Added by DJM Jan 2024	1/3/24, 4:26 AM

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