Risk factors for rotator cuff pathology.
\r\n\tThis book will present and discuss the advancement of research on age-associated diseases and their underlying mechanisms, exploring mainly causal relation aspects of the glutathione peroxidase.
",isbn:"978-1-83880-126-7",printIsbn:"978-1-83880-125-0",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"127defed0a50ad5ed92338dc96e1e10e",bookSignature:"Dr. Margarete Bagatini",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9002.jpg",keywords:"Free Radicals, Antioxidants, Health, Glutathione Peroxidase, Superoxide Dismutase, Catalase, Structure, Activity, Infectious Diseases, Coronary Diseases, Neurological Diseases, Protection",numberOfDownloads:54,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 27th 2019",dateEndSecondStepPublish:"September 17th 2019",dateEndThirdStepPublish:"November 16th 2019",dateEndFourthStepPublish:"February 4th 2020",dateEndFifthStepPublish:"April 4th 2020",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,editors:[{id:"217850",title:"Dr.",name:"Margarete",middleName:null,surname:"Bagatini",slug:"margarete-bagatini",fullName:"Margarete Bagatini",profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Margarete Dulce Bagatini has been an Associate Professor at the Federal University of Fronteira Sul (UFFS) since 2011. She has graduated from Federal University of Santa Maria / UFSM (Pharmacy - Clinical Analysis, 2006) and she obtained Ph.D. (2010) in Biological Sciences from the same university. She is a member of the research advisory committee (2013), assistant coordinator of research (2014) and academic coordinator (2015) of Campus Chapecó /UFFS. Also she is a leader of the research group: Biological and Clinical Studies in Human Pathologies, professor of postgraduate programs and member of the Committee UFFS Research Advisor. She has experience in the field of Pharmacy, Clinical Analysis, Microbiology, Immunology and Biochemistry, working mainly in the following subjects: oxidative stress, purinergic system and human pathologies. She has been a reviewer of several international journals and editor of the journals Journal of Immunology Research and Oxidative Medicine and Cellular Longevity.",institutionString:"Universidade Federal da Fronteira Sul",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Universidade Federal da Fronteira Sul",institutionURL:null,country:{name:"Brazil"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"6",title:"Biochemistry, Genetics and Molecular Biology",slug:"biochemistry-genetics-and-molecular-biology"}],chapters:[{id:"69266",title:"Subcellular Localization of Glutathione Peroxidase, Change in Glutathione System during Ageing and Effects on Cardiometabolic Risks and Associated Diseases",slug:"subcellular-localization-of-glutathione-peroxidase-change-in-glutathione-system-during-ageing-and-ef",totalDownloads:54,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"220812",firstName:"Lada",lastName:"Bozic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/220812/images/6021_n.jpg",email:"lada@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6694",title:"New Trends in Ion Exchange Studies",subtitle:null,isOpenForSubmission:!1,hash:"3de8c8b090fd8faa7c11ec5b387c486a",slug:"new-trends-in-ion-exchange-studies",bookSignature:"Selcan Karakuş",coverURL:"https://cdn.intechopen.com/books/images_new/6694.jpg",editedByType:"Edited by",editors:[{id:"206110",title:"Dr.",name:"Selcan",surname:"Karakus",slug:"selcan-karakus",fullName:"Selcan Karakus"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3794",title:"Swarm Intelligence",subtitle:"Focus on Ant and Particle Swarm Optimization",isOpenForSubmission:!1,hash:"5332a71035a274ecbf1c308df633a8ed",slug:"swarm_intelligence_focus_on_ant_and_particle_swarm_optimization",bookSignature:"Felix T.S. Chan and Manoj Kumar Tiwari",coverURL:"https://cdn.intechopen.com/books/images_new/3794.jpg",editedByType:"Edited by",editors:[{id:"252210",title:"Dr.",name:"Felix",surname:"Chan",slug:"felix-chan",fullName:"Felix Chan"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3621",title:"Silver Nanoparticles",subtitle:null,isOpenForSubmission:!1,hash:null,slug:"silver-nanoparticles",bookSignature:"David Pozo Perez",coverURL:"https://cdn.intechopen.com/books/images_new/3621.jpg",editedByType:"Edited by",editors:[{id:"6667",title:"Dr.",name:"David",surname:"Pozo",slug:"david-pozo",fullName:"David Pozo"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"54473",title:"Colonoscopy Image Pre-Processing for the Development of Computer-Aided Diagnostic Tools",doi:"10.5772/67842",slug:"colonoscopy-image-pre-processing-for-the-development-of-computer-aided-diagnostic-tools",body:'\nThe unceasing increase in incidences of colorectal cancer (CRC) in recent decades has led to a rise in the number of medical tests being carried out; in the case at hand, colonoscopies. Specialists consequently have a greater amount of work, and find themselves overwhelmed. As a result of this problem, numerous investigations have been conducted in recent years focussing on developing tools to help with diagnoses, thereby supporting specialists. Development of algorithms for the automatic analysis of colonoscopy imaging requires preliminary pre-processing of the images in order to rectify the multiple factors that detract from their quality.
\nThe objective of this chapter is to shed light on the most common problems encountered in colonoscopic imaging, while also providing the most frequentlys-used solutions among the scientific community. The aim is to thusly supply useful information in order to develop automatic algorithms, which may then be implanted in robots that automate tasks currently requiring manual interaction.
\nA colonoscopy is a method of reference for diagnosing and treating colonic diseases; essential to both colorectal screening and monitoring. This exploration enables the large intestine to be viewed in its entirety, to extract biopsies and to remove tumours.
\nIt has been proven that carrying out this procedure reduces the colon cancer mortality rate. Before undergoing the procedure, it is necessary for the patient to have been through a preparation phase, so that there is no solid waste in the colon. The procedure is performed by inserting a colonoscope—a flexible tube with a camera at the end—into the anus (see \nFigure 1\n). In some cases, a sedative is used so as to carry out the procedure without causing discomfort. It is the best means of detecting CRC since it enables localisation and, in the majority of cases, immediate extraction.
\nColonoscope. Source: goo.gl/6qtSW9.
The principal difficulties in obtaining colonoscopy imaging are described below; which, in many cases, are the result of the equipment used or the environmental difficulties.
\n\nBlack mask: this is due to the fact that the lenses used in the colonoscopy image capturing system have a black frame around the edge. In many cases, the mask is used to convey information, either pertaining to the patient or the test being carried out. This black frame hinders the development of digital image processing algorithms since it creates false borders, as well as covering a larger area for analysis that would not yield useful information. For these reasons, applying different techniques to eliminate its effects becomes necessary. In \nFigure 2\n, the black mask in colonoscopy imaging can be observed.
\nBlack mask.
\nGhost colours: the problem of ghost colours (see \nFigure 3\n) is linked to a lack of synchronisation of the colour channels. Its appearance is due to the fact that most colonoscopy equipment uses monochromatic cameras, in which the components R, G, and B are obtained at different times. This causes a reduction in the quality of the image, making the subsequent development of PDI algorithms difficult.
\nGhost colours.
\nInterlacing: interlacing allows twice the number of frames per second to be taken without consuming additional bandwidth. It is used in standard formats such as the National Television System Committee (NTSC) or phase alternating line (PAL), and shows half of the horizontal lines in each iteration. Each frame is divided into two fields: the first contains odd-numbered lines and the second field the even-numbered lines. Due to the phenomenon of the persistence of the human eye, the brain mixes both iterations of the interlaced frame, identifying it as one image. The effects of interlacing cause the appearance of false outlines in the images (see \nFigure 4\n), which make the development of algorithms more complicated. Therefore, it is necessary to implement techniques to reduce its occurrence.
\nEffects of interlacing.
\nSpecular highlights: specular highlights (see \nFigure 5\n) are points of high intensity in the image due to the illumination of shiny objects. When a source of light is shone directly on an object, the light is reflected and captured by the camera. This process generates heavily saturated areas in the image, which can lead to unwanted outlines, making it subsequently difficult to process the image. This effect is extremely important in the detection of polyps, which are generally rounded and similar to tumours. Due to their shape, they reflect light and generate specular highlights when illuminated, which can lead to a malfunction of the developed algorithms.
\nSpecular highlights.
\nUneven lighting: the variations in the intensity and direction of lighting are decisive in the appearance of objects in digital images. The illumination of the colon in a colonoscopy is variable, which, because of the colon’s three-dimensional shape, causes shadows to appear, accentuating or diminishing certain aspects of the image. Varying degrees of illumination on the same object cause differing representations of the object, rendering said variability of lighting unwanted. In the literature, there are numerous publications that address this problem. In \nFigure 6\n, an example of uneven lighting in colonoscopic imaging is shown in order to facilitate its detection.
\nUneven lighting.
Every image capturing process is affected in some way by factors that reduce the quality of the image to some degree. Colonoscopic imaging is no exception, so it is necessary to implement techniques that help to improve the quality and thereby obtain a better visual representation.
\nAny technique whose objective is to contrast, highlight, accentuate or remove unwanted effects from the image is considered a method of improvement. This is a process of vital importance in medical imaging, in which the limitations of the image capturing system—in the case at hand, colonoscopies—cause unwanted effects which need to be removed. It is crucial to point out that by improving imaging:
\nNo new information is added to the image; the image is only highlighted so as to be used more efficiently by the algorithms that are to be developed.
There is no exact criterion for quantifying the degree of improvement; in many cases, it is based on subjective opinions and/or on the result obtained by the developed algorithms.
Below is an outline of the applicability of pre-processing colonoscopic imagery in robots which may be able to automate tasks that are vital in a colonoscopy.
\nFaced with the growing number of diagnostic tests for colon cancer being carried out, it has become necessary to rely on support tools for medical diagnoses. These tools support the specialist by providing objective data, thereby enabling more accurate diagnoses.
\nThe main functions that endoscopists require are related to the automatic detection of polyps and the evaluation of the quality of the test being carried out.
\nIn the case of detecting polyps, having tools available that enable their automatic detection will mean a reduction in the number of missed tumours, which, in many cases, lead to interval cancers. Interval cancers are those that appear between two scheduled diagnostic tests and, in most cases, are due to a polyp or tumour that was not detected by the specialist during the procedure. In this context, publications such as [1–3] have made important contributions to the scientific community.
\nMoreover, the quality evaluation of the procedure is a necessity, since many of the metrics are currently based on the specialist’s interpretation and are therefore subjective, impeding correct comparison among different health centres with the intention of improving the process. The European Guidelines for Quality Assurance in Colorectal Screening and Diagnosis [4] provide a series of metrics that evaluate different aspects of the colonoscopy. In this regard, publications such as [5–8] make valuable contributions to the scientific community.
\nAll research studies focused on the development of automated tools for the assistance of medical diagnoses share the need for the availability of an image pre-processing system. The availability of tools to improve the quality of the images is a necessity, as can be observed in investigation [9].
\nAll the methods for pre-processing imagery outlined in this chapter will be able to be implanted in robots and colonoscopies in such a way as to enable the development of various automated tools, which allows for significant higher reliability of colonoscopies.
\nHere, we describe the most frequently used techniques in the scientific community for removing the most common discrepancies in colonoscopic imagery. Solutions that have been proposed in the literature are outlined, and the most appropriate focus for each point has also been proposed.
\nIn the literature, there are three tendencies for black border removal: the restoration of the image, the use of thresholding and cropping of the black mask. Following is a brief explanation of each method.
\nRemoval of the black mask through restoring the image: this involves replacing the pixels of the black mask using the median value of the pixels in a certain vicinity. This focus has been used in investigation [9], obtaining satisfactory results.
Removal of the black mask using thresholding: a threshold is set to detect the real frame of the image, removing the black mask. In many occasions, this focus does not manage to completely remove the black mask, leaving residual lines, which makes it necessary to apply techniques such as the Hough transform [10] to remove them. This technique was used in investigation [11].
Removal of the black mask through cropping the image: this is the simplest focus, in which an area of the image is selected and the rest is removed. This method involves obtaining a smaller image but maintaining the maximum amount of information possible from the original image, running the risk of losing valuable information.
In this section, a suggestion for an alternative focus for the removal of black borders is presented. Depending on the model of colonoscope used, the black borders that are generated vary (see \nFigure 7\n), which makes pre-processing difficult. In many cases, the borders are used to provide information about either the patient or the procedure being carried out (see \nFigure 7(b)\n). This frame makes the development of PDI algorithms difficult, since it generates false borders, as well as entailing a greater area to be analysed that does not provide useful information. Due to these reasons, it is necessary to apply different techniques to remove their effects.
\nBlack masks with different characteristics: (a) Black mask in the corners. (b) Circular black mask and with information. (c) Black mask bordering the image.
There are various literary references to methods addressing this problem: reconstructing the borders by restoring them [9], the use of thresholding for their detection [11] and the cropping of the black mask. In this pre-processing design, a method combining the existing solutions was chosen. This technique involves detecting the black mask using thresholding, as well as cropping and reconstructing. \nFigure 8\n shows the process in which this task is carried out.
\nRemoval of black borders.
The following is a description of the steps to remove the black borders using the proposed method:
\n\nConversion to Hue, Saturation, Value: in order to address the automatic detection of the black mask in colonoscopic images, it is necessary to convert them from the RGB colour model (the original colour model for colonoscopic imagery) to the HSV colour model. This is due to the fact that the RGB model makes certain colour specification difficult, whereas this is one of the HSV model’s strengths. Thanks to this, the thresholding described in the next step is made much more simple.
\nChannel V thresholding: once the conversion from the RGB colour model to HSV is complete, the image is ready for thresholding. Thresholding offers a wide range of intensity values from which to choose, allowing us to define among them those objects that we want to be detected automatically. In this chapter, channel V thresholding is proposed, in which values of 0.03 and lower are attributed to the black mask. This method enables the separation of useful content in the colonoscopic image from the black borders. This process can be observed in \nFigure 9\n, in which \nFigure 9(a)\n shows the process of Channel V thresholding and \nFigure 9(b)\n presents the result generated.
Depending on the model of colonoscope used to capture the images, the black borders may be different. This is a problem, since when thresholding is carried out to detect the black borders, the information shown in the borders will remain visible over the image. In order to remove it, an additional step is necessary which involves making a morphological opening by using a size-5 disk structure to the detected black mask. In this way, all the information shown on the black border is removed, leaving it clean. This process can be observed in \nFigure 10\n, in which \nFigure 10(a)\n shows the detected black mask with leftover information and \nFigure 10(b)\n shows the result of the morphological opening for its removal.
Once the thresholding of the image is complete, it is possible to proceed to the removal of the black borders.
\nBlack border removal: the process of black border removal comprises two steps: cropping and reconstructing. The following is a detailed description of both:
\nDetection of the upper central point not belonging to the black mask: starting from the pixel in position (max(X)/2.1) searching southwards, the first pixel does not belong to the black mask.
\nDetection of the lower central point not belonging to the black mask:\n starting from the pixel in position (max(X)/2.max(Y)) searching northwards, the first pixel does not belong to the black mask.
\nDetection of the centre-left point not pertaining to the black mask: starting from the pixel in position (1.max(Y)/2) searching eastwards, the first pixel does not belong to the black mask.
\nDetection of the centre-right point not pertaining to the black mask: starting from the pixel in position (max(X).max(Y)/2) searching westwards, the first pixel does not belong to the black mask.
Once the four positions of the sought pixels have been obtained, a rectangle is generated whi ch contains them and will be what determines the dimensions of the image with the black borders cropped out. \nFigure 11\n shows a visual example of this process. The next step in removing the black borders is the reconstruction of the leftover black borders. This process is addressed in the following section.
\nReconstruction of the remnants of the black mask: in \nFigure 11\n it can be seen that the final area of the image highlighted in orange still contains remnants of the black borders. The final task for their removal is to reconstruct them. In order to do so, a restoration is applied which aims to replace the pixels of the black mask by the median value of the pixels in a certain vicinity. This operation is carried out repeatedly until the difference between the values of the neighbouring pixels used in the reconstruction falls below a predetermined amount.
\nImage without black borders: having performed all the procedures designed for black border removal, we will obtain an image with reduced dimensions and the reconstructed black borders. The result obtained can be seen in \nFigure 12\n, in which \nFigure 12(a)\n shows the original image without editing, and \nFigure 12(b)\n provides the result obtained through this process.
Thresholding for the detection of black borders: (a) Channel V thresholding highlighted in red. (b) Result of thresholding.
Thresholding for the detection of black borders: (a) Black borders with information highlighted in red. (b) Result of the morphological opening.
Process of cropping the black borders.
Result of black border removal: (a) Original image with black borders. (b) Result of black border removal.
There are numerous methods to detect specular highlights. The following is a brief summary of the most important of these:
\nPark et al. [12] propose the detection of specular highlights using a search of saturated areas and small regions with high contrast. The saturated areas are detected by applying adaptive thresholding to the image’s intensity histogram. The value of the threshold is predetermined as the region that surrounds the maximum value of the histogram. The smaller regions with high contrast are detected using the method proposed in Ref. [13], which applies a top-hat filter followed by a reconstruction and erosion operation by a size-5 disk structure.
\nBernal et al. [9] assume that the specular pixel intensity value is greater than that of the non-specular pixels in their vicinity. Furthermore, they indicate that non-specular pixels which neighbour specular pixels will have higher intensity values than non-specular pixels far from the reflective areas. The detection of specular highlights is carried out by the subtraction of the original image and their median. Once this has been done, specular highlights can be detected through the use of thresholding.
\nGross et al. [14] detect specular highlights based on the space of HSV colour. Specular highlights show a high saturation and low brightness, which makes their detection simple.
\nThe method put forward in Ref. [15] for the detection of specular highlights uses two different colour spaces. In the first, it is necessary to observe the borders generated by the changes in texture and specular highlights. In the second, only the borders generated by the textures need to be seen. Subtraction of these two colour spaces enables the detection of specular highlights. This method has been used in investigation [16] with satisfactory results. Therein, the detection of specular highlights based on low saturation of the colour of the highlights is suggested.
\nHaving shown the techniques used in various studies for the removal of specular highlights, the method for their elimination is proposed. \nFigure 13\n shows the steps for a better understanding. A description of each of the modules that comprise them follows.
\nSystem for the removal of specular highlights.
\nConversion to greyscale: in order to commence the process of specular highlight removal, it is necessary to convert the borderless image from the original colour model (RGB) to greyscale. This operation is necessary for subsequent detection of specular highlights, which is described in the next step.
\nDetection of specular highlights: the method used for the detection of specular highlights has been proposed by the authors of the study [9]. To this end, a system comprising four blocks has been designed, which is shown in \nFigure 14\n. In the following steps, there is a detailed description of the process for specular highlight removal proposed for this investigation.
\nCalculation of the threshold value (U): to detect specular highlighting automatically, it is vital to affix a threshold value (U) which distinguishes between normal values in the image and specular highlighting. To this end, the median value of the original image (μ) is calculated on a greyscale, which is then multiplied by a weight (W) which, by default, has a value of 0.3. In this way, the value required for addressing the next phase in the detection of specular highlights is calculated.
\nSubtraction of the original image in greyscale and the threshold value: once the threshold value (U) has been calculated, the subtraction of the original image in greyscale with the threshold value (U) is performed. In this way, a matrix equal in dimensions to that of the image in greyscale is obtained, in which values above 0.75 belong to specular highlighting.
\nThresholding: having calculated the matrix with the values pertaining to the subtraction between the original image in greyscale and the threshold value (U), a binary mask will be generated in which values surpassing the threshold (U) are given a value of 1, and everything else a value of 0, thereby obtaining an image that only shows the positions of the specular highlighting that has been detected.
\nMask with specular highlights: as a result of this process, a mask is obtained which will be used in the next step and will deal with the reconstruction of the highlighting.
\nReconstruction of the image: once the dilation of the specular highlighting mask has been carried out, we can begin to reconstruct the regions of the image indicated by the mask through the following steps:
The damaged section is filled in using information from the rest of the image.
The structure of the area surrounding the deteriorated part is filled in towards its centre, extending the lines that reach the border.
The numerous regions that are generated inside the damaged area from the extension of the contour lines are filled in with the colour of the corresponding bordering region.
Finally, the small details are coloured in to maintain uniformity.
Detection of specular highlights. μ Represents the median value of the image without black borders and W denotes the multiplication factor (0.3 by default).
The algorithm repeatedly carries out steps 2 and 3 until the desired quality is achieved. Having carried out this process, an image free of specular highlights is obtained. The result is highly effective, as shown in \nFigure 15\n.
\nRemoval of specular highlights.
In the scientific literature, there are numerous publications that deal with uneven lighting in imaging. A brief summary of the most relevant works, as well as a proposal for an alternative to normalise lighting in colonoscopic imagery illumination is presented. Investigation [17] presents a contrast operator built by means of two primitives involving Weber’s law, and, in doing so, achieving an improvement in the contrast of the image. On the other hand, study [16] carries out a reduction of the effects of uneven lighting through the local normalisation of the image’s brightness. For this, each pixel is divided by the maximum value of its vicinity. In this publication, vicinity was considered 13 × 13 pixels. Finally, in investigation [14], an equalisation of the background of the image in greyscale was carried out, thereby strengthening the contrast of the different structures, as well as removing the lighting variation in the image.
\nThe following procedure is proposed to solve the issue of homogenous lighting in colonoscopic imagery. The proposed design is shown in \nFigure 16\n, offering a complete description of the blocks comprising it; i.e. obtaining the subtraction value, subtracting the image with the subtraction value and the image with normalised lighting.
\nIllumination normalisation.
\nObtaining the subtraction value: in order to achieve a more uniform illumination in the images, it is a fundamental requirement to calculate a subtraction value for each of the windows into which the image has been divided (20 × 20 pixels). This value is obtained by calculating the median value of each channel inside the said window and multiplying it by a weight (0.3 by default).
\nSubtraction from the window with the subtraction value: once the subtraction values of the different channels have been calculated, these are subtracted from the corresponding channel of the window. In this way, the effects of the peaks of intensity that the uneven lighting causes are mitigated.
\nImage with normalised lighting: as an output of the lighting normalisation module, an image is obtained with a range of much more uniform colour intensities, which aids its subsequent analysis. Following this previous step, the colonoscopic images are ready to be used for quality evaluation algorithms for the preparation of the colon, using the BBPS, and automatic polyp detection. In \nFigure 17\n, it is possible to observe the result obtained through the normalisation of lighting. \nFigure 17(a)\n shows an image without lighting normalisation and \nFigure 17(b)\n shows the result obtained through this process.
Result of lighting normalisation: (a) Image with neither black borders nor specular highlighting. (b) Result of lighting normalisation.
The adverse effects of interlacing are habitual in the use of videos, or in the extraction of images from video frames. The removal of these aspects has been addressed in numerous investigations, which achieve very accurate results. Below, the most relevant publications that propose a solution to this problem are shown.
\nStudies [18–20] address the removal of the effects of interlacing through deinterlacing. The procedure is based on obtaining one in every two horizontal lines, decreasing the vertical size of the image. To maintain the size proportion of the original image, they apply vertical redimensioning by a factor of 0.5.
\n\n\nFigure 18\n shows the results of applying these techniques for removing interlacing effects. As can be observed, the obtained result is very good, achieving high effectiveness.
\nRemoval of the effects of interlacing.
This problem has been addressed in the literature, in study [21], where channel equalisation is proposed, as is carrying out an estimation and compensation of the movements of the camera. Channel equalisation aims to obtain a histogram with a more uniform distribution, i.e. the same number of pixels should exist for each level of grey in the histogram of a monochrome image. The estimation and compensation of the movements of the camera are obtained through the use of the movement vectors from MPEG video standard. These enable an estimate of the deviation affecting each colour channel in obtaining the image, allowing the errors produced to be corrected. This same solution has been addressed in study [22]. The application of this technique corrects the effect very accurately, failing solely in images of very low initial quality. The result obtained using this solution is shown in \nFigure 19\n.
\nRemoval of ghost colours.
The benefits derived from the tools described in the present chapter are in the improvement of colonoscopic images. Specifically:
\nThe scientific community is provided with information about the origin and characteristics of the most prevalent artefacts that corrupt colonoscopic images, thus allowing for their identification, detection and removal.
The techniques that have to be applied to the images in order to increase their quality are described, as well as the methodology that has to be used to apply them.
The scientific community is also given a useful guide to a system of medical diagnosis aid based on colonoscopic images, thus allowing to offer tools better suited to the needs of the patients.
Since the systems to aid diagnosis are constantly on the rise nowadays and are likely to be in the immediate future, we consider the current chapter is undoubtedly necessary to the specialist in the area.
\nRotator cuff tears affect millions worldwide; given their age-dependent increase in prevalence, they pose a significant healthcare burden on today’s aging population [1]. Chronic large to massive rotator cuff tears are often considered “irreparable” secondary to poor tissue quality, tendon retraction, and muscle atrophy and fatty infiltration [2]. Surgical options for treatment of these tears have not demonstrated consistently good outcomes [2, 3, 4]. These include attempts at relieving pain by way of debridement with or without biceps tenotomy; balancing the anterior/posterior force couples by way of partial repair; restoring cuff integrity by way of interpositional grafting; and tendon transfers. Reverse shoulder arthroplasty has been gaining popularity and demonstrates good outcomes as a treatment option for patients with rotator cuff arthropathy, but is typically reserved for the elderly patients. Massive and irreparable rotator cuff tears in younger and more active individuals, especially without significant arthritic changes of the glenohumeral joint, remain a clinical conundrum.
Recently, a new surgical procedure called superior capsular reconstruction (SCR) was described by Mihata et al., who reported promising short-term clinical outcomes in 24 shoulders (23 consecutive patients) with symptomatic irreparable rotator cuff tears [2]. Although the procedure has a strong appeal for physicians treating patients with this difficult problem and has been quickly gaining popularity, caution regarding widespread use is warranted, as large-scale and long-term data is still lacking. This chapter reviews the anatomy and function of the rotator cuff and shoulder capsule; patho-etiology of rotator cuff tears; and rationale, techniques, outcomes, and future direction of superior capsule reconstruction for irreparable tears.
The rotator cuff is composed of the musculotendinous units that bound the glenohumeral joint. Its components are supraspinatus (SS), infraspinatus (IS), teres minor (TM), and subscapularis (SSC) muscles [5, 6] (Figure 1). The supraspinatus, which is most commonly involved in rotator cuff tears, originates on the superior aspect of the scapular body, in the supraspinous fossa, and inserts onto the anterior-superior aspect of the greater tuberosity of the humerus. The infraspinatus originates on the posterior scapular body, from the infraspinous fossa, and inserts on the posterior-superior aspect of the greater tuberosity. The teres minor, which is rarely involved in rotator cuff tears, originates from the lateral lower-half of the scapular body, inferior to the infraspinatus, and inserts on the posterior – inferior aspect of the great tuberosity and humeral head. The subscapularis, which is the largest muscle of the rotator cuff group, originates from the anterior scapular body (the subscapular fossa), runs deep to the coracoid process, and inserts onto the lesser tuberosity of the humerus. Innervation to the rotator cuff comes from the C5-6 nerve roots, with the suprascapular nerve supplying the supraspinatus and infraspinatus, axillary nerve supplying teres minor, and the upper and lower subscapular nerves supplying the subscapularis. The close interplay and confluence of the different parts of the rotator cuff creates several structures important for glenohumeral joint stability and function. These include the rotator interval, crescent, and cable.
Arthroscopic views of the rotator cuff tendons (left shoulder). (A) Intraarticular view from the posterior portal, showing the humeral head (HH), supraspinatus (SS), subscapularis (SSC), the long-head of the biceps tendon (LHBT), the middle glenohumeral ligament (MGHL), and rotator interval (RI). (B) Bursal view of the superior rotator cuff (SS and IS)..
The rotator interval (Figure 1A) is the anterior triangular space between the anterior border of the supraspinatus and superior border of the subscapularis, and contains the anterior glenohumeral joint capsule, the coracohumeral ligament (CHL), and the superior glenohumeral ligament (SGHL). The interval helps maintain the biceps tendon within the bicipital groove, and also contributes to stability of the glenohumeral joint [7, 8]. The rotator interval is also often implicated in the adhesions and contractures that occur in adhesive capsulitis of the shoulder.
The rotator crescent is a thin sheet of rotator cuff tendon, comprising the distal portions of the SS and IS insertions. The crescent is proximally bound by a thick bundle of fibers—the rotator cable—that runs perpendicular to the SS and IS fibers. Burkhart et al. described a biomechanical model of rotator cuff tears using 20 cadaver shoulders, where the rotator cable acts as a stress shield for the crescent, and the two structures form a “suspension bridge.” According to this model, tears in the crescent have minimal effects on shoulder function, while those that involve the cable impair its ability to distribute the load and tension between the anterior and posterior rotator cuff and therefore its role as a dynamic stabilizer of the humeral head [9]. This concept has clinical implications as it helps guide decision making in identifying tears that can be managed non-operatively, versus those that require surgical fixation.
While the rotator cuff is the main dynamic stabilizer of the glenohumeral joint, the glenohumeral joint capsule acts as a static stabilizer. It is a thin membranous structure located deep to the rotator cuff; it originates medially from the glenoid neck and inserts laterally to the anatomical neck of humerus.
The capsule is thicker anteriorly than posteriorly. The anterior capsule contains focal thickened bundles, which are called superior, middle, and anterior-inferior glenohumeral ligaments (GHL). The posterior capsule has an inferior thickening called the posterior-inferior GHL, but does not have separate ligaments further superiorly. Directly inferiorly, between the anterior-inferior and posterior-inferior glenohumeral ligaments, the capsule forms the axillary pouch, which tightens in abduction, and relaxes in adduction [3, 4, 5, 10]. Contracture and loss of normal axillary pouch volume is frequently seen in adhesive capsulitis, whereas a patulous capsule with an enlarged pouch is often seen in multi-directional shoulder instability.
The superior capsule is thin and was previously less well-studied. It originates from the glenoid neck along with its anterior-posterior counterparts, courses directly underneath the SS and anterior part of the IS, and attaches to 30–61% of surface area of the greater tuberosity (GT) [5, 10]. Nimura et al. measured superior capsule attachments in cadaveric shoulders. They reported thicker footprint at the anterior edge of SS and posterior edge of IS (5.6 ± 1.6 mm and 9.1 ± 1.7 mm, respectively), whereas the attachment was thinner at the middle area of the rotator cuff, near the posterior margin of SS (4.4 ± 1.2 mm). The authors concluded that the thinnest point of the capsule could contribute to the etiology of the initiation of degenerative rotator cuff tears [5]. The superior capsule is closely associated with the SS and IS, and typically tears together with complete tears of these tendons [1, 2, 3, 4].
The muscles of the rotator cuff help initiate movement of the shoulder joint, and also serve as the main dynamic stabilizer of this joint. Supraspinatus aids in abduction of the humerus, particularly in the scapular plane; external rotation is provided by infraspinatus (more active in adduction), and teres minor (more active in abduction); and internal rotation is the function of subscapularis. Furthermore, SS prevents abnormal inferior-superior translation of the humeral head, particularly during active arm elevation, by compressing the head into the glenoid fossa. The balancing forces between SSC anteriorly and IS and TM posteriorly provide stability in the sagittal plane, and the upward force of the deltoid is balanced by that of IS, TM, and SSC in the coronal plane [11, 12].
The shoulder capsule provides static stability, serving to prevent excessive translation of the humeral head relative to the glenoid [5, 10]. The anterior capsule prevents anterior translation, while the posterior prevents posterior translation. The function of the superior capsule was previously poorly understood and continues to be studied. Ishihara et al. demonstrated in a biomechanical study that the superior capsule plays an important role in passive stability in all directions, and cutting it significantly increases abnormal translation, especially superiorly [10]. This can lead to a decrease in the acromiohumeral distance—a finding commonly seen in patients with chronic massive superior cuff tears as well as cuff-tear arthropathy [2] (Figure 2).
Anterior-posterior plain radiograph of a left shoulder with rotator cuff arthropathy. Note the “high-riding” humeral head, with a decreased acromiohumeral distance, and interrupted Shenton’s line at the inferior aspect of the glenohumeral joint.
While a significant number of rotator cuff tear cases present to the physician after a traumatic episode, most tears do not occur in a setting of a normal tendon. Preexisting degenerative changes are usually found in the torn tendons, and the injury that leads to clinical presentation is likely the “straw that breaks the camel’s back.” A number of both intrinsic and extrinsic pathways and risk factors are thought to contribute to chronic degeneration and weakening of the cuff tendons, as described below (Table 1).
Strong association | Controversial or weak association |
---|---|
Age (particularly >60) Smoking (dose and time-dependent) Family history Previous history of tear Trauma Hypercholesterolemia Heavy labor and overhead athletes (chronic wear-and-tear) | Peripartum Hormonal changes Dominant side Postural abnormalities |
Risk factors for rotator cuff pathology.
The main intrinsic mechanism pathway is thought to be tenocyte apoptosis and inflammation resulting from chronic microtrauma to the rotator cuff tendons. Advancing age is the most common reason for this mechanism, and age has been found to be the strongest risk factor for rotator cuff disease. This is thought to be due to the combination of age-related degenerative changes and accumulation of microtrauma and macrotrauma over the course of an individual’s lifetime [3, 4]. Older patients are also more likely to develop larger tears; Gumina et al. reported a mean age of 59 years in a group of 586 patients undergoing arthroscopic tear repair, with those older than 60 being twice as likely to develop large and massive tears [13].
Tendon degeneration and poor healing potential are exacerbated by hypovascularity, which is worsened not only with advancing age, but also with smoking, and certain other conditions [4]. Smoking has a strong dose and time-dependent association with both the prevalence and size of tears; it negatively affects the vascularity of tendons, thereby predisposing them to tears and preventing healing [3, 4]. Similarly, hypercholesterolemia has been implicated in rotator cuff disease. The mechanism here is thought to be deposition of cholesterol by-products within the rotator cuff tendons, leading to worsening of biomechanical properties of the tendon and increasing the risk of tearing [14].
Genetic predisposition may also play a role. Patients diagnosed relatively early in life (before age 40) often have a family history of rotator cuff disease [3]. Particularly in irreparable tears, studies have shown expression of genes that favor fatty atrophy and fibrosis and inhibit myogenesis [15].
The most commonly accepted extrinsic mechanism for rotator cuff disease was originally described by Neer in his classic article from 1972, Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: a Preliminary Report, and has guided clinical approach to management of impingement and rotator cuff tears ever since, although validity of some of these concepts has been challenged in the recent years. Neer suggested that repetitive contact between the rotator cuff tendons and the underside of the coracoacromial arch (which includes the anterolateral acromion, coracoacromial ligament, and the coracoid) results in trauma to the tendon, which produces the clinical entities of subacromial or subcoracoid impingement, and, in its more advanced stages, tendon tears [16]. Acromial morphology (hooked versus flat) and presence of subacromial enthesophytes have also been proposed to be contributing factors to symptomatic cuff disease, and surgical approach directed at increasing the space under coracoacromial arch by way of acromioplasty and coracoacromial ligament release has been advocated [17]. However, recent studies have questioned the benefit of these procedures [18], and attention has been directed to position and dynamic function of the scapula, as a contributor to rotator cuff impingement and tears [19]. Therefore, postural abnormalities and peri-scapular muscle strength have received greater recent attention as potentially contributing risk factor that can and should be addressed in management of rotator cuff disease.
Rotator cuff repair was originally performed with open, and subsequently mini-open, techniques, which have produces good results, including restoration of shoulder strength and function. Advent and popularization of arthroscopy have allowed for a less invasive method of rotator cuff repair, contributing to decreased postoperative pain and more rapid return of motion. Other modern advancements, such as improved instrumentation, as well as stronger and more biocompatible suture and anchor materials, have led to new surgical techniques, such as a double-row rotator repair, which may contribute to better healing and possibly improved outcomes, especially for larger tears. Multiple clinical studies of arthroscopic repair have shown good to excellent results in as many as 90% of patients postoperatively, even including those with large and massive tears [20, 21, 22, 23]. A recent systemic review and meta-analysis by McElvany et al. [24] included 108 clinical studies and showed postoperative clinical outcomes scores improved by an average of 103% of the preoperative scores. However, despite the overall good results, this same study found that 26.6% of the repairs failed to heal. Failure to heal may not (and often does not) affect short-term results, but may lead to deterioration of shoulder function after 2 years post-repair. Risk factors for failure of the rotator cuff tear to heal after surgery include preoperative fatty infiltration of the muscle, older age, and increased tear size. As many as 50% of larger (≥3 cm) tears may fail to heal after repair.
One of the most important predictors for failure of rotator cuff repair, along with tear size, is muscle atrophy and fatty infiltration (Figure 3). Most common system used to classify fatty degeneration of rotator cuff muscles was described by Goutallier et al. [25]. Even small and medium tears are at risk for failure after repair with as little as grade 2 muscle degeneration [26]. Shoulders with more severe (grade 3 or 4) degeneration, where more than 50% of muscle volume is replaced by fat, are at a very high risk of poor outcomes, since, even if tendon repair and healing to bone is achieved, dynamic function of the rotator cuff muscle-tendon unit remains compromised.
Fatty atrophy of the superior rotator cuff. (A) Sagittal MRI view of a right shoulder showing severe fatty degeneration (more than 50% of muscle volume replaced by fat) of the supraspinatus (SS), infraspinatus (IS), and subscapularis (SSC) muscles. (B) Arthroscopic view of the supraspinatus (SS), demonstrating severe muscle atrophy (view from a posterolateral subacromial portal in the right shoulder).
Therefore, due to poor healing potential and low likelihood of restoration of good cuff function, chronic large (3–5 cm) and massive (>5 cm) tears, especially those with Goutallier 2 or greater atrophy, may be considered irreparable. Other types of tears that are considered irreparable include tears with significant retraction of the tendon (medial to the glenoid), poor tendon quality for repair, and poor bone quality at the greater tuberosity attachment site (Figure 4). Attempts at repair of tears with these features should be approached with guarded expectations.
Massive tear of the superior rotator cuff, not amenable to repair. (A) Note poor tissue quality of the tendon stump, and retraction medial to the glenoid rim. (B) Despite extensive releases, this tendon stump could not be mobilized even to the medial margin of the greater tuberosity.
Those rotator cuff tears that fail to heal or are irreparable frequently go on to a clinical condition called cuff tear arthropathy (CTA) (Figure 2). This is a specific form of shoulder arthritis resulting from rotator cuff deficiency. Due to the failure and absence of superior restraint, the humeral head typically migrates superiorly, and eventually articulates with the acromion. Over time this leads to wear of the acromion, destruction of the humeral head cartilage, and eventually the glenoid cartilage as well. Patients typically present with significant pain, weakness, and crepitus with range of motion, and sometimes even pseudoparalysis—severe inability to elevate the shoulder. Once advanced CTA develops, the only surgical solution available to treat it (other than fusion of the shoulder joint) is a reverse total shoulder replacement (Figure 5).
Reverse shoulder replacement in a 60 year-old man, performed for symptomatic advanced cuff-tear arthropathy.
The treatment of massive and irreparable rotator cuff tears is challenging. Surgical options include partial repair with marginal convergence, debridement with biceps tenotomy, graft interposition, tendon transfer, reverse total shoulder, and now superior capsular reconstruction. Partial repair of the inferior half of the infraspinatus was originally described by Burkhart et al. in 1994, with the goal restoring a balanced anterior-posterior force couple in the shoulder [27]. Multiple studies which analyzed surgery for massive cuff tears with combinations of partial repair, marginal convergence, debridement, and biceps tenotomy have shown mixed results, typically with good outcomes early on, but persistent strength deficit in elevation, and deterioration of clinical results over time. For example, Shon et al. performed partial repair and marginal convergence techniques in 31 patients and found initial improvement in clinical outcome scores, whereas 2-year follow-up showed a dissatisfaction rate of 50% [28]. Fatty infiltration of the infraspinatus was found to be a negative predictor of outcome in these patients.
Graft interposition techniques to bridge irreparable rotator cuff defects have been described using autograft, allograft, xenograft, and synthetic materials. A systematic review of these techniques found a lack of high quality comparative studies. The limited studies available show improvement in clinical outcomes in all graft types [29], with allograft, xenograft, and synthetic grafts having the appeal of no harvest site morbidity, compared to autograft. On the other hand, significant inflammatory reactions have been reported with the use of xenografts as well as allografts [30], and therefore caution must be used. Just as with other surgeries for massive cuff tear, significant fatty atrophy leads to significantly lower healing rates after graft interposition repairs. Finally, interpositional grafts may need to be placed through an open approach, which runs the increased disk of damage to the deltoid muscle, potentially making subsequent revision surgery more difficult and less successful. In summary, due to lack of high quality comparative studies on the use of graft interposition for cuff repair, the potential benefits of this procedure must be weighed against the cost, risks, and potential future complications of this approach.
Several tendon transfer procedures have been described for the treatment of massive irreparable rotator cuff tears. Tendon transfers are typically performed in younger patients without glenohumeral arthritis and good range of motion. The most common transfers used for posterosuperior tears are latissimus dorsi and lower trapezius transfers. Clinical studies show latissimus dorsi transfer provides significant pain relief after tendon transfer, whereas functional results are more unpredictable [31]. Lower trapezius transfer anatomically provides a more direct line of pull compared to latissimus dorsi transfer; however, limited clinical evidence is available to show improvement in pain and function.
Reverse total shoulder arthroplasty (RTSA) is a semiconstrained reverse ball and socket prosthesis which helps improve the biomechanical efficiency of the deltoid muscle by lengthening its lever arm. The design provides inherent glenohumeral stability and lowers the humeral head to increase deltoid tension, which allows this muscle to elevate the arm without a functional rotator cuff. While elevation is typically restored after RTSA, active rotation of the shoulder is not as easily recovered as it relies on presence of the anterior-posterior components of the cuff. Overall, clinical studies have shown significant improvements in pain, motion, and functional scores in patients treated for cuff-tear arthropathy. However, implant longevity is a concern, as are functional limitations imposed by this surgery. Due to these limitations, reverse shoulder arthroplasty is typically reserved for patients in their 60s, 70s, and older [32].
The main reason to consider superior capsule reconstruction (SCR) is as an alternative to reverse shoulder arthroplasty or tendon transfers in patients with irreparable superior rotator cuff tears, with or without early cuff tear arthropathy. In this procedure a graft tissue is attached to the superior glenoid and the greater tuberosity, thereby spanning the superior aspect of the glenohumeral joint (Figure 6). The biomechanical rationale behind this surgery is debated. One proposed rationale is a tenodesis effect between the glenoid and the humeral head, which helps regain the stabilizing effect to the glenohumeral articulation normally conferred by the superior capsule and the rotator cuff [2]. This has been called the “reverse trampoline” effect. The other proposed mechanism is that the inserted graft acts a spacer between the humeral head and the underside of the acromion, essentially keeping the head depressed by way occupying the space above it. Biomechanical cadaveric studies by Mihata and colleagues have shown that SCR does restore superior translation to physiologic conditions [33]; and also that increased thickness of the graft improves stability [34]. These studies lend credence to both theories regarding biomechanical function of SCR; indeed both factors may be at play.
Schematic drawing, showing a shoulder with a normal superior rotator cuff (A), a large and irreparable defect of the superior cuff (B), and after a SCR (C and D).
Indications for this surgery currently include physiologically young (absolute age has not been determined) and relatively active patients with symptomatic irreparable superior rotator cuff, with intact anterior-posterior force couples, and no or minimal glenohumeral arthritic wear. Young patients with moderate cartilage wear and symptoms primarily related to cuff function may be considered for SCR, in lieu of RTSA, but guarded expectation are warranted with more severe arthritic wear. SCR may also be an attractive option for previous failed cuff repair, in a setting of poor tissue quality, fatty infiltration, and other factors that may result in tear irreparability.
Absolute contraindications include infection, neuropathic disease of the shoulder, and neurologic disorders significantly affecting function of the deltoid muscle. Relative contraindications include advanced arthritis, tears of the anterior/posterior rotator cuff, as well as unwillingness or inability to comply with postoperative immobilization and rehabilitation protocol.
Arthroscopic reconstruction using tensor fascia lata was initially proposed by Mihata et al. [2]. Several other authors have reported SCR using acellular dermal allograft [35, 36, 37, 38, 39]. An arthroscopic technique is typically used for this procedure, but an open technique may be used in cases of difficult arthroscopic exposure or for surgeons less familiar with arthroscopic techniques. We describe our preferred technique for arthroscopic superior capsular reconstruction.
Surgery is typically performed in an ambulatory setting, under combination general and regional anesthesia. After induction of anesthesia, and prior to positioning (with the patient supine on the operating table), the shoulder should be examined for passive motion and stability. Manipulation of the shoulder to regain motion should be performed as needed. We prefer a beach-chair position with the arm supported by a hydraulic arm positioner device, but a lateral decubitus with balanced suspension-traction may also be used.
Standard posterior portal is used to enter the glenohumeral joint, and an anterior portal is established in the rotator interval. A thorough diagnostic arthroscopy of the glenohumeral joint is performed, and pathologic lesions are addressed as needed. Particular attention must be paid to the integrity of the subscapularis tendon, which needs to be repaired if significantly torn. If the biceps tendon is still present in the joint (more often than not there is a chronic tear and absence of the long head), it needs to be removed from the superior glenoid, so that it does not block graft placement; a tenotomy or tenodesis is performed. Any loose bodies should be removed, and synovectomy is performed as needed. Chondroplasty may be performed for frayed and unstable cartilage flaps on the humeral head and glenoid.
The camera is then repositioned into the subacromial space. Subacromial portals are created, typically one anterolaterally and one posterolaterally. A bursectomy is performed, and the rotator cuff tear is then carefully evaluated, characterized and mobilized, ensuring that a repair is not possible or not advisable. A superior capsular reconstruction is considered if there is a massive full-thickness tear of the supraspinatus, without or without infraspinatus tear, that cannot be repaired, and the glenohumeral joint does not show severe degenerative changes (Figure 7).
Massive and irreparable rotator cuff tear in the left shoulder of a 70 year old active male (view from posterolateral portal). (A) Note severely retracted massive tear of the superior cuff (SS and IS), with relatively normal articular cartilage both on the glenoid and the humeral head. (B) Even after extensive releases, the tendon stump is not adequately mobile for primary repair (HH—humeral head; G—glenoid).
Once a decision is made to perform a SCR, an acromioplasty should be performed, to increase working space for graft placement and fixation, and also to decrease the risk of graft tissue abrasion postoperatively [40]. Any osteophytes off the inferior aspect of the AC joint need to be resected as well (Figure 8). We always attempt to preserve the CA ligament, if possible, so as not to disrupt the coracoacromial arch.
An inferior osteophyte (OP) is being resected off the distal clavicle (DC), to avoid impingement and abrasion of the graft postoperatively.
We also prefer at this time to place #2 braided sutures into the upper borders of the intact cuff posteriorly (teres minor or infraspinatus) and anteriorly (subscapularis or intact anterior fibers of the supraspinatus); these are used, after graft fixation, to repair the native cuff to the patch, side to side. Additionally, if there is any significant cuff tissue remaining medially, overlying the glenoid rim, it can be tagged with a #2 suture through a Neviaser portal, and pulled up for better visualization of the superior glenoid (Figure 9).
(A) A penetrating suture passer is inserted through the Neviaser portal and is used to pass a tagging suture through the rotator cuff tendon stump. (B) The rotator cuff can then be pulled up, to allow better visualization of and instrumentation on the glenoid neck.
Any residual soft tissue on the superior glenoid neck and greater tuberosity is removed using a motorized shaver and/or electrocautery wand. To maximize healing potential, the superior glenoid neck and greater tuberosity are burred down to bleeding bone.
Medial anchors are placed on the superior glenoid, approximately 2–4 mm medial to the rim, taking care to ensure good bone purchase and avoid intraarticular penetration. Anchors are placed as far anterior and posterior as possible to provide adequate spread and coverage for the medial graft fixation on the glenoid. Typically two anchors, each double loaded with a #2 braided suture, are placed, in the region between the 10 and 2 o’clock positions (Figure 10A and B), but a third anchor may need to be added for very large defects (Figure 10C). Appropriate trajectory for anchor placement should be confirmed prior to drilling, and can typically be achieved from the anterior, posterior and Neviaser portals.
Glenoid anchors. Each one is double-loaded with a #2 braided suture. Note the anchor position approximately 2–4 mm medial to the rim, and the trajectory of insertion (away from the articular cartilage). The spread between the anchors can be narrow (A) for smaller defects, or wide (B) for larger ones. Sometimes three anchors may need to be placed (C), for massive tears involving both the SS and IS. In this case, a Neviaser portal helps with proper trajectory for the middle anchor, as shown by the spinal needle.
On the humeral head, graft fixation is accomplished using a double row transosseous equivalent technique. Prior to graft passage, medial row greater tuberosity anchors placed, just lateral to the articular margin (Figure 11). We prefer to use anchors preloaded with #2 suture-tape, non-sliding. As on the glenoid, two anchors are typically used, but a third one may be needed in large shoulders with large defects.
Medial row greater tuberosity (GT) anchors are inserted. The anterior anchor is placed just posterior to the bicipital groove, and the posterior anchor is at the posterior-most extent of the exposed tuberosity. Both are pre-loaded with a suture-tape, and placed adjacent to the articular margin of the humeral head. Note how the surface of the GT has been decorticated down to bleeding bone.
Once all the anchors are placed, distances between them are measured. First the anterior-posterior distance is measured for the glenoid anchors and tuberosity anchors. Then the medial-lateral distance is measured between the glenoid and tuberosity anchors, obtaining one measurement anteriorly, and one posteriorly. A calibrated probe is used to make these measurements (Figure 12). In our opinion, in order to obtain the graft size that will provide appropriate stabilizing affect without overtightening the glenohumeral articulation, the shoulder should be positioned in neutral rotation and approximately 20–30° of abduction for the measurement, and during subsequent graft fixation.
Measuring distances between the anchors using a calibrated probe. (A) Distance between the glenoid anchors. (B) Distance between the medial GT anchors. (C) Distance between the glenoid and GT anchors (posterior, viewing from the anterolateral portal).
Next the graft if prepared. We use an acellular human dermal graft (Arthroflex by Arthex, Inc., Naples, FL), but an autograft, such as tensior fascia lata, may also be harvested and used. Whichever graft is used, it is now sized and prepared on the back table. The graft is cut to allow a 5 mm margin medially, anteriorly and posteriorly and a 10 mm margin laterally. The dimensions of the anchor configuration are then carefully marked on the graft using a marking pen (Figure 13).
Graft measurement. It is important not to cut the graft too short. 5 mm extra is left on the medial, anterior, and posterior edges, whereas laterally 10 mm extra distance is left to allow coverage over the GT footprint.
At this point, all the sutures must be brought out through one of the subacromial portals in preparation for graft passage. We prefer to view from the posterior or posterolateral portal, and use the anterolateral portal for graft passage. Sometimes this portal must be slightly increased in size, and a flexible cannula, which can be cut along one of its sides (such as the Arthex Passport) can be helpful.
The graft is brought close to the shoulder, carefully supported on a sterile Mayo stand. The sutures from the glenoid anchors are passed through the medial edge of the graft. Simple configuration can be used, but we prefer to place each sets of sutures in a criss-crossing mattress configuration (one vertically and one horizontally), creating a Mason-Allen type configuration. One limb from each suture set is tied to a limb from another suture set (off a different color), and the knot tails are cut. This leaves two suture limbs (one of each color) on the anterior-medial and posterior-medial edges of the graft, which, when tensioned, create a pulley effect on the graft, allowing it to be drawn into the joint (Figures 14 and 15).
Suture placement into the graft prior to shuttling. Glenoid sutures are placed in a horizontal and vertical mattress configurations, perpendicular to each other. Laterally, we prefer to place a suture-loop (Arthrex Fiberlink), for subsequent shuttling of suture-tapes from the GT medial row anchors.
Model demonstration of the step-by-step process of glenoid suture placement and tying. (A) All suture limbs from each anchor are placed in a mattress configuration, perpendicular to each other. (B) One limb from each suture is tied to a limb from the other suture (different color), and this creates a double-pulley system, which helps shuttle the graft to its attachment points on the glenoid. (C) Final construct, with all glenoid sutures tied.
At this time it is possible to either place the tuberosity medial row sutures through the graft, or instead place a suture loop (such as Arthrex Fiberlink) which would aide with the passage of those sutures later. The advantage of the latter approach is minimizing suture traffic in the lateral subacromial portal, and avoiding suture entanglement. We prefer this technique (Figure 14), and temporarily park the medial row tuberosity sutures in the anterior and posterior portals, while the graft is being passed.
The suture pulley system previously created on the medial side of the graft with the glenoid sutures is now tensioned. The graft may need to be partially folded to allow it to pass through the cannula, or the cannula may be removed (if it was pre-cut). Also, a blunt tissue grasper can be used to pinch the graft medially to ease the delivery and transport of the graft through the cannula. The graft is visualized entering the joint, and moving medially until it sits flush on the superior glenoid neck, covering the rim (Figure 16A and B). It may be necessary to help unfold the anterior and posterior edges of the graft once its fully inside, in case they get folded in.
Arthroscopic view of graft fixation to the glenoid. (A) The graft is pulled in using the double-pulley system, which is created by tying one limb of each suture to the other one from the same anchor (white arrows); the remaining limbs act as pulley sutures (black arrows), to cinch the graft onto the superior glenoid rim. (B) Note the ability to pull up the remnant of the superior cuff, with a previously placed free suture, via the Neviaser portal, for improved visualization. (C) After the sutures from the glenoid anchors are tied, securing the graft to the glenoid, the remnant cuff tissue can be tied down to the graft, using those suture tails. This creates a nice biologic seal over the medial part of the SCR construct.
The sutures from the glenoid anchors are then tied arthroscopically to secure the graft to the glenoid neck. The tails of those sutures may be passed up through the remnant of the native cuff, to bring it down to the medial edge of the graft, helping create a biologic seal over this area (Figure 16C).
Then the tuberosity medial row sutures are passed through the graft using the previously pre-loaded suture-loop, if they haven’t been already placed outside the shoulder. Both limbs of the sutures from the medial GT anchors are passed through the graft, from inferior to superior, one at the anterior and one at the posterior pre-determined spots (Figure 17A). Finally, these suture-tapes are brought over the lateral-most extent of the graft in a criss-cross fashion, and secured just past the lateral margin of the tuberosity with knotless anchors (Figure 17B–D). Prior to setting final tension and fixating the graft laterally, proper shoulder position of neutral rotation and slight abduction (20–30°) needs to be ensured.
Graft fixation to the humeral head. (A) Suture-tapes from the medial row greater tuberosity anchors are passed up through the graft, using the previously placed suture-loop (left shoulder, view from the anterolateral portal; AA—anterior anchor, PA—posterior anchor, GT—greater tuberosity); (B) Suture tapes are criss-crossed and secured just past the lateral margin of the tuberosity with knotless anchors, providing excellent compression of the graft over the tuberosity footprint. (C) If a small “dog-ear” is noted after lateral graft fixation, a suture preloaded into the lateral-row anchor can be used to tie it down. (D) Model demonstration of graft fixation to the humeral head.
Once the graft is secured medially and laterally, side-to-side margin convergence sutures are placed to secure the graft to the intact cuff (Figure 18A and B ). Pre-placed sutures are helpful for this, as discussed above. Typically two side-to-side sutures are used posteriorly, to connect the graft to the intact part of the infraspinatus or to the teres minor. Anteriorly, if the fixation is to the intact remaining supraspinatus, two sutures may be used as well (Figure 18C); however, if there is no supraspinatus left, and fixation is to the upper border of the subscapularis, no more than one suture should be used, as laterally as possible, to avoid over-constricting the rotator interval. If the distance between the anterior edge of the graft and the upper border of the subscapularis is too great, no margin convergence sutures are placed here.
Side-to-side repair to the intact cuff and completion of the SCR. (A) Sutures are passed through the graft and adjacent intact cuff. (B) Sutures are then tied, providing close approximation between the graft and native tissue. (C) Superior view from the Neviaser portal, showing a completed SCR, with excellent coverage of the joint by the graft and native cuff, repaired to the graft.
The shoulder is then taken through a full range of motion to ensure no signs of impingement. And residual spurs on the acromion, or osteophytes off the inferior distal clavicle should be resected (Figure 8).
We follow the same protocol for our SCR cases as for our large rotator cuff repair cases. A shoulder immobilizer sling is worn for 6 weeks, with or without an abduction pillow. Passive range of motion exercises are started at 4–6 weeks postoperatively, active-assisted motion is allowed at 6–8 weeks, and full active motion is allowed after 8 weeks. Strengthening progresses after 12 weeks, and return to activities which require overhead lifting is allowed no earlier than 16 weeks. Typical full return to activities is allowed 6 months postoperatively.
Published reports of clinical outcomes following superior capsular reconstruction thus far have been limited to one study, but more such studies are currently either in data collection or already in preparations to report outcomes. In 2013, Mihata et al. reported a case series of 24 shoulders (23 consecutive patients), treated with SCR using fascia lata autograft, with minimum 2-year follow-up [2]. At an average follow-up of 34 months (24–51 months), mean active elevation increased from 84 to 148° and mean external rotation increased from 26 to 40°. All clinical outcomes scores improved significantly, with American Shoulder and Elbow Surgeons score (ASES) score going up from an average of 23.5 to 92.9. Furthermore, imaging showed acromiohumeral distance increased from 4.6 to 8.7 mm, on average. No procedure-related complications were reported [2].
In the United States, most surgeons prefer to use a dermal allograft (Arthrex Arthroflex), which is a thick (3 mm) and durable patch, which requires minimal preparation time and is relatively easy to handle. Several technical reports using this graft have been published, including those by Hirahara and Adams, Petri et al., Tokish and Beicker, and Burkhart et al. [36, 37, 38, 39], but clinical data on the outcomes of this approach is lacking in the published literature. However, personal communication with a number of surgeons currently performing SCR using the dermal allograft patch produced reports of high patient satisfaction rates, excellent improvement in function and pain levels in the short term, and low risk of complications. One of our personal communications has been with a surgeon who now has data on 20 SCR procedures, with a minimum follow-up of 3 months and up to 1.5 years, and reports that Visual Analogue Scale (VAS) scores decreased on average from 6–9 to 0–3 range, while ASES scores went up from the 20–30 range to the 70–90 range. No complications were reported in this patient group (personal communication with Dr. Kevin Kaplan, Jacksonville Orthopedic Institute, Jacksonville, FL).
Large irreparable rotator cuff tears in younger and active patients continue to pose a significant clinical challenge to orthopedic surgeons. Arthroplasty treatment option with a reverse shoulder replacement is not ideal in this patient population. Mihata et al. [33] have shown in biomechanical cadaveric studies that a graft reconstruction can restore superior glenohumeral translation when the graft is attached to the glenoid medially and humeral head laterally. However, many technical aspects of this procedure have not been well studied, such as ideal suture and anchor configuration medially or laterally, ideal graft tissue (allograft versus autograft), ideal graft thickness, or ideal tensioning technique.
In the immediate future, we will need larger clinical studies with short, medium, and long-term outcome data demonstrating the effectiveness of superior capsular reconstruction. Radiographic follow-up studies are needed to document graft incorporation or deterioration after this surgery, as well as to monitor the acromiohumeral distance in this patient population. Clinical indications and contraindications, as well as the ideal patient population, for this procedure need be better defined.
Superior capsular reconstruction is a novel technique that may provide a potentially promising solution to a tough problem in the shoulder region. The procedure should be considered for active and physiologically young patients with high functional demand on their upper extremity, and an irreparable rotator cuff tear, and should be performed by surgeons experienced in treating shoulder pathology. More clinical studies are needed before we can advocate widespread use of this procedure in general orthopedic practice.
The Edited Volume, also known as the IntechOpen Book, is an IntechOpen pioneered publishing product. Edited Volumes make up the core of our business - and as pioneers and developers of this Open Access book publishing format, we have helped change the way scholars and scientists publish their scientific papers - as scientific chapters.
",metaTitle:"Edited Volumes",metaDescription:"The Edited Volume, also known as the InTechOpen Book, is an InTechOpen pioneered publishing product. Edited Volumes make up the core of our business - and as pioneers and developers of this Open Access book publishing format, we have helped change the way scholars and scientists publish their scientific papers - as scientific chapters. ",metaKeywords:null,canonicalURL:"/pages/edited-volumes",contentRaw:'[{"type":"htmlEditorComponent","content":"WHY PUBLISH IN AN INTECHOPEN EDITED VOLUME?
\\n\\nOut of all of the publishing options available to researchers, why choose to contribute your research to an IntechOpen Edited Volume? The reasons are simple. IntechOpen has worked exceptionally hard over the past years to fine tune the Open Access book publishing process and we continue to work hard to deliver the best for all of our contributors. The quality of published content is of utmost importance to us, followed closely by speed, and of course, availability and accessibility. To view current Open Access book projects that are Open for Submissions visit us here.
\\n\\nQUALITY CONTENT
\\n\\nOver the years we have learned what is important. What makes a difference to the researchers that work with us, what they value. Something that is very high not only on their lists, but our own, is the quality of the published content.
\\n\\nOur books contain scientific content written by two Nobel Prize winners, two Breakthrough Prize winners and 73 authors who are in the top 1% Most Cited.
\\n\\nWith regular submission for coverage in the single most important database, the Book Citation Index in the Web of Science™ Core Collection (BKCI), and no rejected submissions to date, over 43% of all Open Access books indexed in the BKCI are IntechOpen published books.
\\n\\nIn addition to BKCI, IntechOpen covers a number of important discipline specific databases as well, such as Thomson Reuters’ BIOSIS Previews.
\\n\\nACCESS
\\n\\nThe need for up to date information available at the click of a mouse is one thing that sets IntechOpen apart. By developing our own technologies in order to streamline the publishing process, we are able to minimize the amount of time from initial submission of a manuscript to its final publication date, without compromising the rigor of the editorial and peer review process. This means that the research published stays relevant, and in this fast paced world, this is very important.
\\n\\nYOUR WORK, YOUR COPYRIGHT
\\n\\nThe utilization of CC licenses allow researchers to retain copyright to their work. Researchers are free to use, adapt and share all content they publish with us. You will never have to pay permission fees to reuse a part of an experiment that you worked so hard to complete and are free to build upon your own research and the research of others. The Edited Volume helps bring together research from all over the world and compiles that research into one book - accessible for all. The research presented in chapter one can inspire the author of chapter three to take his or her research to the next level. It is about sharing ideas, insights and knowledge.
\\n\\nCan collaboration be inspired by a publishing format? At IntechOpen, the answer is yes. The way the research is published, the way it is accessed, it’s all part of our mission to help academics make a greater impact by giving readers free access to all published work.
\\n\\nOur Open Access book collection includes:
\\n\\n3,332 OPEN ACCESS BOOKS
\\n\\n107,564 INTERNATIONAL AUTHORS AND ACADEMIC EDITORS
\\n\\n113+ MILLION DOWNLOADS
\\n\\nPUBLISHING PROCESS STEPS
\\n\\nSee a complete overview of all publishing process steps and descriptions here.
\\n\\nCURRENT PROJECTS
\\n\\nTo view current Open Access book projects that are Open for Submissions visit us here.
\\n\\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'WHY PUBLISH IN AN INTECHOPEN EDITED VOLUME?
\n\nOut of all of the publishing options available to researchers, why choose to contribute your research to an IntechOpen Edited Volume? The reasons are simple. IntechOpen has worked exceptionally hard over the past years to fine tune the Open Access book publishing process and we continue to work hard to deliver the best for all of our contributors. The quality of published content is of utmost importance to us, followed closely by speed, and of course, availability and accessibility. To view current Open Access book projects that are Open for Submissions visit us here.
\n\nQUALITY CONTENT
\n\nOver the years we have learned what is important. What makes a difference to the researchers that work with us, what they value. Something that is very high not only on their lists, but our own, is the quality of the published content.
\n\nOur books contain scientific content written by two Nobel Prize winners, two Breakthrough Prize winners and 73 authors who are in the top 1% Most Cited.
\n\nWith regular submission for coverage in the single most important database, the Book Citation Index in the Web of Science™ Core Collection (BKCI), and no rejected submissions to date, over 43% of all Open Access books indexed in the BKCI are IntechOpen published books.
\n\nIn addition to BKCI, IntechOpen covers a number of important discipline specific databases as well, such as Thomson Reuters’ BIOSIS Previews.
\n\nACCESS
\n\nThe need for up to date information available at the click of a mouse is one thing that sets IntechOpen apart. By developing our own technologies in order to streamline the publishing process, we are able to minimize the amount of time from initial submission of a manuscript to its final publication date, without compromising the rigor of the editorial and peer review process. This means that the research published stays relevant, and in this fast paced world, this is very important.
\n\nYOUR WORK, YOUR COPYRIGHT
\n\nThe utilization of CC licenses allow researchers to retain copyright to their work. Researchers are free to use, adapt and share all content they publish with us. You will never have to pay permission fees to reuse a part of an experiment that you worked so hard to complete and are free to build upon your own research and the research of others. The Edited Volume helps bring together research from all over the world and compiles that research into one book - accessible for all. The research presented in chapter one can inspire the author of chapter three to take his or her research to the next level. It is about sharing ideas, insights and knowledge.
\n\nCan collaboration be inspired by a publishing format? At IntechOpen, the answer is yes. The way the research is published, the way it is accessed, it’s all part of our mission to help academics make a greater impact by giving readers free access to all published work.
\n\nOur Open Access book collection includes:
\n\n3,332 OPEN ACCESS BOOKS
\n\n107,564 INTERNATIONAL AUTHORS AND ACADEMIC EDITORS
\n\n113+ MILLION DOWNLOADS
\n\nPUBLISHING PROCESS STEPS
\n\nSee a complete overview of all publishing process steps and descriptions here.
\n\nCURRENT PROJECTS
\n\nTo view current Open Access book projects that are Open for Submissions visit us here.
\n\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"6700",title:"Dr.",name:"Abbass A.",middleName:null,surname:"Hashim",slug:"abbass-a.-hashim",fullName:"Abbass A. Hashim",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/6700/images/1864_n.jpg",biography:"Currently I am carrying out research in several areas of interest, mainly covering work on chemical and bio-sensors, semiconductor thin film device fabrication and characterisation.\nAt the moment I have very strong interest in radiation environmental pollution and bacteriology treatment. The teams of researchers are working very hard to bring novel results in this field. I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. I have served as the editor for many books, been a member of the editorial board in science journals, have published many papers and hold many patents.",institutionString:null,institution:{name:"Sheffield Hallam University",country:{name:"United Kingdom"}}},{id:"54525",title:"Prof.",name:"Abdul Latif",middleName:null,surname:"Ahmad",slug:"abdul-latif-ahmad",fullName:"Abdul Latif Ahmad",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"20567",title:"Prof.",name:"Ado",middleName:null,surname:"Jorio",slug:"ado-jorio",fullName:"Ado Jorio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidade Federal de Minas Gerais",country:{name:"Brazil"}}},{id:"47940",title:"Dr.",name:"Alberto",middleName:null,surname:"Mantovani",slug:"alberto-mantovani",fullName:"Alberto Mantovani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"12392",title:"Mr.",name:"Alex",middleName:null,surname:"Lazinica",slug:"alex-lazinica",fullName:"Alex Lazinica",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/12392/images/7282_n.png",biography:"Alex Lazinica is the founder and CEO of IntechOpen. After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:null},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). I am a Reviewer for several refereed journals and international conferences, such as IEEE Transactions on Biomedical Engineering, IEEE Transactions on Industrial Electronics, Optic Letters, Measurement Science Review, and also a member of the International Advisory Committee for 2012 IEEE Business Engineering and Industrial Applications and 2012 IEEE Symposium on Business, Engineering and Industrial Applications.",institutionString:null,institution:{name:"Joseph Fourier University",country:{name:"France"}}},{id:"55578",title:"Dr.",name:"Antonio",middleName:null,surname:"Jurado-Navas",slug:"antonio-jurado-navas",fullName:"Antonio Jurado-Navas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/55578/images/4574_n.png",biography:"Antonio Jurado-Navas received the M.S. degree (2002) and the Ph.D. degree (2009) in Telecommunication Engineering, both from the University of Málaga (Spain). He first worked as a consultant at Vodafone-Spain. From 2004 to 2011, he was a Research Assistant with the Communications Engineering Department at the University of Málaga. In 2011, he became an Assistant Professor in the same department. From 2012 to 2015, he was with Ericsson Spain, where he was working on geo-location\ntools for third generation mobile networks. Since 2015, he is a Marie-Curie fellow at the Denmark Technical University. His current research interests include the areas of mobile communication systems and channel modeling in addition to atmospheric optical communications, adaptive optics and statistics",institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}}],filtersByRegion:[{group:"region",caption:"North America",value:1,count:5319},{group:"region",caption:"Middle and South America",value:2,count:4830},{group:"region",caption:"Africa",value:3,count:1469},{group:"region",caption:"Asia",value:4,count:9372},{group:"region",caption:"Australia and Oceania",value:5,count:837},{group:"region",caption:"Europe",value:6,count:14789}],offset:12,limit:12,total:108347},chapterEmbeded:{data:{}},editorApplication:{success:null,errors:{}},ofsBooks:{filterParams:{hasNoEditors:"0",sort:"dateEndThirdStepPublish"},books:[{type:"book",id:"8968",title:"Molecular and Metabolic Alterations in Tumorigenesis",subtitle:null,isOpenForSubmission:!0,hash:"e3c27ac25ffa58c82beeb2b70147b9bf",slug:null,bookSignature:"Dr. Yasemin Basbinar and Dr. Gizem Calibasi Kocal",coverURL:"https://cdn.intechopen.com/books/images_new/8968.jpg",editedByType:null,editors:[{id:"242097",title:"Dr.",name:"Yasemin",surname:"Basbinar",slug:"yasemin-basbinar",fullName:"Yasemin Basbinar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8976",title:"Aquifers",subtitle:null,isOpenForSubmission:!0,hash:"5b13aa76c9209e22274018bd78cab538",slug:null,bookSignature:"Dr. Muhammad Salik Javaid and Dr. Aftab Sadiq",coverURL:"https://cdn.intechopen.com/books/images_new/8976.jpg",editedByType:null,editors:[{id:"98883",title:"Dr.",name:"Muhammad Salik",surname:"Javaid",slug:"muhammad-salik-javaid",fullName:"Muhammad Salik Javaid"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9010",title:"Ion Channel Dysfunction in Disease",subtitle:null,isOpenForSubmission:!0,hash:"2bc87751cc961a9d348958e2ebb8b3a7",slug:null,bookSignature:"Dr. Saverio Gentile",coverURL:"https://cdn.intechopen.com/books/images_new/9010.jpg",editedByType:null,editors:[{id:"181463",title:"Dr.",name:"Saverio",surname:"Gentile",slug:"saverio-gentile",fullName:"Saverio Gentile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7997",title:"Autophagy in Injury, Infection and Cancer Diseases",subtitle:null,isOpenForSubmission:!0,hash:"3daed6048bc8ff8368c4279558f109d7",slug:null,bookSignature:"Dr. Nikolai Gorbunov",coverURL:"https://cdn.intechopen.com/books/images_new/7997.jpg",editedByType:null,editors:[{id:"180960",title:"Dr.",name:"Nikolai",surname:"Gorbunov",slug:"nikolai-gorbunov",fullName:"Nikolai Gorbunov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8773",title:"Magnetic Materials",subtitle:null,isOpenForSubmission:!0,hash:"2342b6038c029039a1a852caa1fecb9f",slug:null,bookSignature:"Prof. Dipti Ranjan Sahu",coverURL:"https://cdn.intechopen.com/books/images_new/8773.jpg",editedByType:null,editors:[{id:"251855",title:"Prof.",name:"Dipti Ranjan",surname:"Sahu",slug:"dipti-ranjan-sahu",fullName:"Dipti Ranjan Sahu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8031",title:"Pavement Engineering",subtitle:null,isOpenForSubmission:!0,hash:"1d8ae1b3b3a208c2b16c1ff852e14207",slug:null,bookSignature:"Dr. Sameh Zaghloul",coverURL:"https://cdn.intechopen.com/books/images_new/8031.jpg",editedByType:null,editors:[{id:"269407",title:"Dr.",name:"Sameh",surname:"Zaghloul",slug:"sameh-zaghloul",fullName:"Sameh Zaghloul"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9069",title:"Zinc and Human Health",subtitle:null,isOpenForSubmission:!0,hash:"b40ada91c760e960017f31af036f60e0",slug:null,bookSignature:"Dr. Andreas Grabrucker",coverURL:"https://cdn.intechopen.com/books/images_new/9069.jpg",editedByType:null,editors:[{id:"178792",title:"Dr.",name:"Andreas",surname:"Grabrucker",slug:"andreas-grabrucker",fullName:"Andreas Grabrucker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8942",title:"Hippocampus",subtitle:null,isOpenForSubmission:!0,hash:"e3b98380a5f3940fec680ae0d35f7664",slug:null,bookSignature:"Dr. Marco Cascella",coverURL:"https://cdn.intechopen.com/books/images_new/8942.jpg",editedByType:null,editors:[{id:"199335",title:"Dr.",name:"Marco",surname:"Cascella",slug:"marco-cascella",fullName:"Marco Cascella"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8445",title:"Dam Engineering",subtitle:null,isOpenForSubmission:!0,hash:"a7e4d2ecbc65d78fa7582e0d2e143906",slug:null,bookSignature:"Dr. Zhongzhi Fu and Dr. Erich Bauer",coverURL:"https://cdn.intechopen.com/books/images_new/8445.jpg",editedByType:null,editors:[{id:"249577",title:"Dr.",name:"Zhongzhi",surname:"Fu",slug:"zhongzhi-fu",fullName:"Zhongzhi Fu"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9224",title:"Distributed Computing - Principles and Practices",subtitle:null,isOpenForSubmission:!0,hash:"19d48e221488c1a086945120776441f3",slug:null,bookSignature:"Dr. Thummuru Gunasekhar and Dr. Komati Thirupathi Rao",coverURL:"https://cdn.intechopen.com/books/images_new/9224.jpg",editedByType:null,editors:[{id:"298899",title:"Dr.",name:"Thummuru",surname:"Gunasekhar",slug:"thummuru-gunasekhar",fullName:"Thummuru Gunasekhar"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7996",title:"Wildfire in the Wildland Urban Interface",subtitle:null,isOpenForSubmission:!0,hash:"caac4a94c451c97cf8b52a6dcbac746b",slug:null,bookSignature:"Dr. Jason Gordon",coverURL:"https://cdn.intechopen.com/books/images_new/7996.jpg",editedByType:null,editors:[{id:"264298",title:"Dr.",name:"Jason",surname:"Gordon",slug:"jason-gordon",fullName:"Jason Gordon"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9297",title:"Smart Materials",subtitle:null,isOpenForSubmission:!0,hash:"139621c1c59461cc2dd2fa3632449513",slug:null,bookSignature:"Dr. Prasanta Ghosh, Dr. Arti Rushi and Dr. Kunal Datta",coverURL:"https://cdn.intechopen.com/books/images_new/9297.jpg",editedByType:null,editors:[{id:"294687",title:"Dr.",name:"Prasanta",surname:"Ghosh",slug:"prasanta-ghosh",fullName:"Prasanta Ghosh"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],filtersByTopic:[{group:"topic",caption:"Agricultural and Biological Sciences",value:5,count:35},{group:"topic",caption:"Biochemistry, Genetics and Molecular Biology",value:6,count:36},{group:"topic",caption:"Business, Management and Economics",value:7,count:10},{group:"topic",caption:"Chemistry",value:8,count:30},{group:"topic",caption:"Computer and Information Science",value:9,count:25},{group:"topic",caption:"Earth and Planetary Sciences",value:10,count:15},{group:"topic",caption:"Engineering",value:11,count:70},{group:"topic",caption:"Environmental Sciences",value:12,count:13},{group:"topic",caption:"Immunology and Microbiology",value:13,count:3},{group:"topic",caption:"Materials Science",value:14,count:38},{group:"topic",caption:"Mathematics",value:15,count:14},{group:"topic",caption:"Medicine",value:16,count:137},{group:"topic",caption:"Nanotechnology and Nanomaterials",value:17,count:6},{group:"topic",caption:"Neuroscience",value:18,count:7},{group:"topic",caption:"Pharmacology, Toxicology and Pharmaceutical Science",value:19,count:8},{group:"topic",caption:"Physics",value:20,count:20},{group:"topic",caption:"Psychology",value:21,count:2},{group:"topic",caption:"Robotics",value:22,count:6},{group:"topic",caption:"Social Sciences",value:23,count:13},{group:"topic",caption:"Technology",value:24,count:9},{group:"topic",caption:"Veterinary Medicine and Science",value:25,count:4},{group:"topic",caption:"Insectology",value:39,count:1},{group:"topic",caption:"Genesiology",value:300,count:1},{group:"topic",caption:"Machine Learning and Data Mining",value:521,count:1},{group:"topic",caption:"Intelligent System",value:535,count:1}],offset:12,limit:12,total:507},popularBooks:{featuredBooks:[{type:"book",id:"7640",title:"Perspective of Carbon Nanotubes",subtitle:null,isOpenForSubmission:!1,hash:"8b85a9957fad5206369eadf0c1ffa27d",slug:"perspective-of-carbon-nanotubes",bookSignature:"Hosam El-Din Saleh and Said Moawad Mohamed El-Sheikh",coverURL:"https://cdn.intechopen.com/books/images_new/7640.jpg",editors:[{id:"144691",title:"Prof.",name:"Hosam El-Din",middleName:"M.",surname:"Saleh",slug:"hosam-el-din-saleh",fullName:"Hosam El-Din Saleh"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7583",title:"Advanced Computational Fluid Dynamics for Emerging Engineering Processes",subtitle:"Eulerian vs. Lagrangian",isOpenForSubmission:!1,hash:"896509fa2e7e659811bffd0f9779ca9d",slug:"advanced-computational-fluid-dynamics-for-emerging-engineering-processes-eulerian-vs-lagrangian",bookSignature:"Albert S. Kim",coverURL:"https://cdn.intechopen.com/books/images_new/7583.jpg",editors:[{id:"21045",title:"Prof.",name:"Albert S.",middleName:null,surname:"Kim",slug:"albert-s.-kim",fullName:"Albert S. Kim"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7839",title:"Malaria",subtitle:null,isOpenForSubmission:!1,hash:"91cde4582ead884cb0f355a19b67cd56",slug:"malaria",bookSignature:"Fyson H. Kasenga",coverURL:"https://cdn.intechopen.com/books/images_new/7839.jpg",editors:[{id:"86725",title:"Dr.",name:"Fyson",middleName:"Hanania",surname:"Kasenga",slug:"fyson-kasenga",fullName:"Fyson Kasenga"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7698",title:"Educational Psychology",subtitle:"Between Certitudes and Uncertainties",isOpenForSubmission:!1,hash:"740943e2d029253e777150e98ebe2f0d",slug:"educational-psychology-between-certitudes-and-uncertainties",bookSignature:"Victori?a Trif",coverURL:"https://cdn.intechopen.com/books/images_new/7698.jpg",editors:[{id:"201656",title:"Ph.D.",name:"Victorița",middleName:null,surname:"Trif",slug:"victorita-trif",fullName:"Victorița Trif"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7000",title:"Legume Crops",subtitle:"Characterization and Breeding for Improved Food Security",isOpenForSubmission:!1,hash:"4d0f73bf883bbb984cc2feef1259a9a7",slug:"legume-crops-characterization-and-breeding-for-improved-food-security",bookSignature:"Mohamed Ahmed El-Esawi",coverURL:"https://cdn.intechopen.com/books/images_new/7000.jpg",editors:[{id:"191770",title:"Dr.",name:"Mohamed A.",middleName:null,surname:"El-Esawi",slug:"mohamed-a.-el-esawi",fullName:"Mohamed A. El-Esawi"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7093",title:"Pneumothorax",subtitle:null,isOpenForSubmission:!1,hash:"0b1fdb8bb0448f48c2f234753898f3f8",slug:"pneumothorax",bookSignature:"Khalid Amer",coverURL:"https://cdn.intechopen.com/books/images_new/7093.jpg",editors:[{id:"63412",title:"Dr.",name:"Khalid",middleName:null,surname:"Amer",slug:"khalid-amer",fullName:"Khalid Amer"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7612",title:"Electrospinning and Electrospraying",subtitle:"Techniques and Applications",isOpenForSubmission:!1,hash:"77e9708250507395a4bea2c17d012982",slug:"electrospinning-and-electrospraying-techniques-and-applications",bookSignature:"Sajjad Haider and Adnan Haider",coverURL:"https://cdn.intechopen.com/books/images_new/7612.jpg",editors:[{id:"110708",title:"Dr.",name:"Sajjad",middleName:null,surname:"Haider",slug:"sajjad-haider",fullName:"Sajjad Haider"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8323",title:"Traditional and Complementary Medicine",subtitle:null,isOpenForSubmission:!1,hash:"60eadb1783d9bba245687adf284d4871",slug:"traditional-and-complementary-medicine",bookSignature:"Cengiz Mordeniz",coverURL:"https://cdn.intechopen.com/books/images_new/8323.jpg",editors:[{id:"214664",title:"Associate Prof.",name:"Cengiz",middleName:null,surname:"Mordeniz",slug:"cengiz-mordeniz",fullName:"Cengiz Mordeniz"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7646",title:"Scientometrics Recent Advances",subtitle:null,isOpenForSubmission:!1,hash:"86bbdd04d7e80be14283d44969d1cc32",slug:"scientometrics-recent-advances",bookSignature:"Suad Kunosic and Enver Zerem",coverURL:"https://cdn.intechopen.com/books/images_new/7646.jpg",editors:[{id:"88678",title:"Prof.",name:"Suad",middleName:null,surname:"Kunosic",slug:"suad-kunosic",fullName:"Suad Kunosic"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8516",title:"Metacognition in Learning",subtitle:null,isOpenForSubmission:!1,hash:"5fa6eaad7b509b8b7ec5124d79e5f605",slug:"metacognition-in-learning",bookSignature:"Nosisi Feza",coverURL:"https://cdn.intechopen.com/books/images_new/8516.jpg",editors:[{id:"261665",title:"Prof.",name:"Nosisi",middleName:"N.",surname:"Feza",slug:"nosisi-feza",fullName:"Nosisi Feza"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7404",title:"Hysteresis of Composites",subtitle:null,isOpenForSubmission:!1,hash:"8540fa2378dbb92e50411cfebfb853a6",slug:"hysteresis-of-composites",bookSignature:"Li Longbiao",coverURL:"https://cdn.intechopen.com/books/images_new/7404.jpg",editors:[{id:"260011",title:"Dr.",name:"Li",middleName:null,surname:"Longbiao",slug:"li-longbiao",fullName:"Li Longbiao"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7878",title:"Advances in Extracorporeal Membrane Oxygenation",subtitle:"Volume 3",isOpenForSubmission:!1,hash:"f95bf990273d08098a00f9a1c2403cbe",slug:"advances-in-extracorporeal-membrane-oxygenation-volume-3",bookSignature:"Michael S. Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/7878.jpg",editors:[{id:"64343",title:null,name:"Michael S.",middleName:"S",surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],productType:{id:"1",chapterContentType:"chapter"}}],offset:12,limit:12,total:4407},hotBookTopics:{hotBooks:[],offset:0,limit:12,total:null},publish:{},publishingProposal:{success:null,errors:{}},books:{featuredBooks:[{type:"book",id:"7640",title:"Perspective of Carbon Nanotubes",subtitle:null,isOpenForSubmission:!1,hash:"8b85a9957fad5206369eadf0c1ffa27d",slug:"perspective-of-carbon-nanotubes",bookSignature:"Hosam El-Din Saleh and Said Moawad Mohamed El-Sheikh",coverURL:"https://cdn.intechopen.com/books/images_new/7640.jpg",editors:[{id:"144691",title:"Prof.",name:"Hosam El-Din",middleName:"M.",surname:"Saleh",slug:"hosam-el-din-saleh",fullName:"Hosam El-Din Saleh"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7583",title:"Advanced Computational Fluid Dynamics for Emerging Engineering Processes",subtitle:"Eulerian vs. Lagrangian",isOpenForSubmission:!1,hash:"896509fa2e7e659811bffd0f9779ca9d",slug:"advanced-computational-fluid-dynamics-for-emerging-engineering-processes-eulerian-vs-lagrangian",bookSignature:"Albert S. Kim",coverURL:"https://cdn.intechopen.com/books/images_new/7583.jpg",editors:[{id:"21045",title:"Prof.",name:"Albert S.",middleName:null,surname:"Kim",slug:"albert-s.-kim",fullName:"Albert S. Kim"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7839",title:"Malaria",subtitle:null,isOpenForSubmission:!1,hash:"91cde4582ead884cb0f355a19b67cd56",slug:"malaria",bookSignature:"Fyson H. Kasenga",coverURL:"https://cdn.intechopen.com/books/images_new/7839.jpg",editors:[{id:"86725",title:"Dr.",name:"Fyson",middleName:"Hanania",surname:"Kasenga",slug:"fyson-kasenga",fullName:"Fyson Kasenga"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7698",title:"Educational Psychology",subtitle:"Between Certitudes and Uncertainties",isOpenForSubmission:!1,hash:"740943e2d029253e777150e98ebe2f0d",slug:"educational-psychology-between-certitudes-and-uncertainties",bookSignature:"Victori?a Trif",coverURL:"https://cdn.intechopen.com/books/images_new/7698.jpg",editors:[{id:"201656",title:"Ph.D.",name:"Victorița",middleName:null,surname:"Trif",slug:"victorita-trif",fullName:"Victorița Trif"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7000",title:"Legume Crops",subtitle:"Characterization and Breeding for Improved Food Security",isOpenForSubmission:!1,hash:"4d0f73bf883bbb984cc2feef1259a9a7",slug:"legume-crops-characterization-and-breeding-for-improved-food-security",bookSignature:"Mohamed Ahmed El-Esawi",coverURL:"https://cdn.intechopen.com/books/images_new/7000.jpg",editors:[{id:"191770",title:"Dr.",name:"Mohamed A.",middleName:null,surname:"El-Esawi",slug:"mohamed-a.-el-esawi",fullName:"Mohamed A. El-Esawi"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7093",title:"Pneumothorax",subtitle:null,isOpenForSubmission:!1,hash:"0b1fdb8bb0448f48c2f234753898f3f8",slug:"pneumothorax",bookSignature:"Khalid Amer",coverURL:"https://cdn.intechopen.com/books/images_new/7093.jpg",editors:[{id:"63412",title:"Dr.",name:"Khalid",middleName:null,surname:"Amer",slug:"khalid-amer",fullName:"Khalid Amer"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7612",title:"Electrospinning and Electrospraying",subtitle:"Techniques and Applications",isOpenForSubmission:!1,hash:"77e9708250507395a4bea2c17d012982",slug:"electrospinning-and-electrospraying-techniques-and-applications",bookSignature:"Sajjad Haider and Adnan Haider",coverURL:"https://cdn.intechopen.com/books/images_new/7612.jpg",editors:[{id:"110708",title:"Dr.",name:"Sajjad",middleName:null,surname:"Haider",slug:"sajjad-haider",fullName:"Sajjad Haider"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8323",title:"Traditional and Complementary Medicine",subtitle:null,isOpenForSubmission:!1,hash:"60eadb1783d9bba245687adf284d4871",slug:"traditional-and-complementary-medicine",bookSignature:"Cengiz Mordeniz",coverURL:"https://cdn.intechopen.com/books/images_new/8323.jpg",editors:[{id:"214664",title:"Associate Prof.",name:"Cengiz",middleName:null,surname:"Mordeniz",slug:"cengiz-mordeniz",fullName:"Cengiz Mordeniz"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"7646",title:"Scientometrics Recent Advances",subtitle:null,isOpenForSubmission:!1,hash:"86bbdd04d7e80be14283d44969d1cc32",slug:"scientometrics-recent-advances",bookSignature:"Suad Kunosic and Enver Zerem",coverURL:"https://cdn.intechopen.com/books/images_new/7646.jpg",editors:[{id:"88678",title:"Prof.",name:"Suad",middleName:null,surname:"Kunosic",slug:"suad-kunosic",fullName:"Suad Kunosic"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8516",title:"Metacognition in Learning",subtitle:null,isOpenForSubmission:!1,hash:"5fa6eaad7b509b8b7ec5124d79e5f605",slug:"metacognition-in-learning",bookSignature:"Nosisi Feza",coverURL:"https://cdn.intechopen.com/books/images_new/8516.jpg",editors:[{id:"261665",title:"Prof.",name:"Nosisi",middleName:"N.",surname:"Feza",slug:"nosisi-feza",fullName:"Nosisi Feza"}],productType:{id:"1",chapterContentType:"chapter"}}],latestBooks:[{type:"book",id:"7698",title:"Educational Psychology",subtitle:"Between Certitudes and Uncertainties",isOpenForSubmission:!1,hash:"740943e2d029253e777150e98ebe2f0d",slug:"educational-psychology-between-certitudes-and-uncertainties",bookSignature:"Victori?a Trif",coverURL:"https://cdn.intechopen.com/books/images_new/7698.jpg",editedByType:"Edited by",editors:[{id:"201656",title:"Ph.D.",name:"Victorița",middleName:null,surname:"Trif",slug:"victorita-trif",fullName:"Victorița Trif"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8747",title:"Asphalt and Asphalt Mixtures",subtitle:null,isOpenForSubmission:!1,hash:"6083f7c9881029f1e033a1e512af7e20",slug:"asphalt-and-asphalt-mixtures",bookSignature:"Haitao Zhang",coverURL:"https://cdn.intechopen.com/books/images_new/8747.jpg",editedByType:"Edited by",editors:[{id:"260604",title:"Prof.",name:"Haitao",middleName:null,surname:"Zhang",slug:"haitao-zhang",fullName:"Haitao Zhang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8516",title:"Metacognition in Learning",subtitle:null,isOpenForSubmission:!1,hash:"5fa6eaad7b509b8b7ec5124d79e5f605",slug:"metacognition-in-learning",bookSignature:"Nosisi Feza",coverURL:"https://cdn.intechopen.com/books/images_new/8516.jpg",editedByType:"Edited by",editors:[{id:"261665",title:"Prof.",name:"Nosisi",middleName:"N.",surname:"Feza",slug:"nosisi-feza",fullName:"Nosisi Feza"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7000",title:"Legume Crops",subtitle:"Characterization and Breeding for Improved Food Security",isOpenForSubmission:!1,hash:"4d0f73bf883bbb984cc2feef1259a9a7",slug:"legume-crops-characterization-and-breeding-for-improved-food-security",bookSignature:"Mohamed Ahmed El-Esawi",coverURL:"https://cdn.intechopen.com/books/images_new/7000.jpg",editedByType:"Edited by",editors:[{id:"191770",title:"Dr.",name:"Mohamed A.",middleName:null,surname:"El-Esawi",slug:"mohamed-a.-el-esawi",fullName:"Mohamed A. El-Esawi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8292",title:"Oral Health by Using Probiotic Products",subtitle:null,isOpenForSubmission:!1,hash:"327e750e83634800ace02fe62607c21e",slug:"oral-health-by-using-probiotic-products",bookSignature:"Razzagh Mahmoudi",coverURL:"https://cdn.intechopen.com/books/images_new/8292.jpg",editedByType:"Edited by",editors:[{id:"245925",title:"Dr.",name:"Razzagh",middleName:null,surname:"Mahmoudi",slug:"razzagh-mahmoudi",fullName:"Razzagh Mahmoudi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8323",title:"Traditional and Complementary Medicine",subtitle:null,isOpenForSubmission:!1,hash:"60eadb1783d9bba245687adf284d4871",slug:"traditional-and-complementary-medicine",bookSignature:"Cengiz Mordeniz",coverURL:"https://cdn.intechopen.com/books/images_new/8323.jpg",editedByType:"Edited by",editors:[{id:"214664",title:"Associate Prof.",name:"Cengiz",middleName:null,surname:"Mordeniz",slug:"cengiz-mordeniz",fullName:"Cengiz Mordeniz"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8347",title:"Computer Architecture in Industrial, Biomechanical and Biomedical Engineering",subtitle:null,isOpenForSubmission:!1,hash:"3d7024a8d7d8afed093c9c79ec31f15a",slug:"computer-architecture-in-industrial-biomechanical-and-biomedical-engineering",bookSignature:"Lulu Wang and Liandong Yu",coverURL:"https://cdn.intechopen.com/books/images_new/8347.jpg",editedByType:"Edited by",editors:[{id:"257388",title:"Dr.",name:"Lulu",middleName:null,surname:"Wang",slug:"lulu-wang",fullName:"Lulu Wang"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7583",title:"Advanced Computational Fluid Dynamics for Emerging Engineering Processes",subtitle:"Eulerian vs. Lagrangian",isOpenForSubmission:!1,hash:"896509fa2e7e659811bffd0f9779ca9d",slug:"advanced-computational-fluid-dynamics-for-emerging-engineering-processes-eulerian-vs-lagrangian",bookSignature:"Albert S. Kim",coverURL:"https://cdn.intechopen.com/books/images_new/7583.jpg",editedByType:"Edited by",editors:[{id:"21045",title:"Prof.",name:"Albert S.",middleName:null,surname:"Kim",slug:"albert-s.-kim",fullName:"Albert S. Kim"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7839",title:"Malaria",subtitle:null,isOpenForSubmission:!1,hash:"91cde4582ead884cb0f355a19b67cd56",slug:"malaria",bookSignature:"Fyson H. Kasenga",coverURL:"https://cdn.intechopen.com/books/images_new/7839.jpg",editedByType:"Edited by",editors:[{id:"86725",title:"Dr.",name:"Fyson",middleName:"Hanania",surname:"Kasenga",slug:"fyson-kasenga",fullName:"Fyson Kasenga"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7093",title:"Pneumothorax",subtitle:null,isOpenForSubmission:!1,hash:"0b1fdb8bb0448f48c2f234753898f3f8",slug:"pneumothorax",bookSignature:"Khalid Amer",coverURL:"https://cdn.intechopen.com/books/images_new/7093.jpg",editedByType:"Edited by",editors:[{id:"63412",title:"Dr.",name:"Khalid",middleName:null,surname:"Amer",slug:"khalid-amer",fullName:"Khalid Amer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"1213",title:"Radiobiology",slug:"radiobiology",parent:{title:"Biophysics",slug:"physics-biophysics"},numberOfBooks:3,numberOfAuthorsAndEditors:132,numberOfWosCitations:65,numberOfCrossrefCitations:40,numberOfDimensionsCitations:97,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicSlug:"radiobiology",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"7373",title:"Nuclear Medicine Physics",subtitle:null,isOpenForSubmission:!1,hash:"4aaee2e9fd29a290d04e9041b003462b",slug:"nuclear-medicine-physics",bookSignature:"Aamir Shahzad and Sajid Bashir",coverURL:"https://cdn.intechopen.com/books/images_new/7373.jpg",editedByType:"Edited by",editors:[{id:"288354",title:"Dr.",name:"Aamir",middleName:null,surname:"Shahzad",slug:"aamir-shahzad",fullName:"Aamir Shahzad"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4604",title:"Evolution of Ionizing Radiation Research",subtitle:null,isOpenForSubmission:!1,hash:"eba92f773b60df7b8d34361670fad600",slug:"evolution-of-ionizing-radiation-research",bookSignature:"Mitsuru Nenoi",coverURL:"https://cdn.intechopen.com/books/images_new/4604.jpg",editedByType:"Edited by",editors:[{id:"35416",title:"Dr.",name:"Mitsuru",middleName:null,surname:"Nenoi",slug:"mitsuru-nenoi",fullName:"Mitsuru Nenoi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1562",title:"Current Topics in Ionizing Radiation Research",subtitle:null,isOpenForSubmission:!1,hash:"b1443bb4589a4088326076be6ff30f13",slug:"current-topics-in-ionizing-radiation-research",bookSignature:"Mitsuru Nenoi",coverURL:"https://cdn.intechopen.com/books/images_new/1562.jpg",editedByType:"Edited by",editors:[{id:"35416",title:"Dr.",name:"Mitsuru",middleName:null,surname:"Nenoi",slug:"mitsuru-nenoi",fullName:"Mitsuru Nenoi"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:3,mostCitedChapters:[{id:"32114",doi:"10.5772/32664",title:"Atmospheric Ionizing Radiation from Galactic and Solar Cosmic Rays",slug:"atmospheric-ionizing-radiation-from-galactic-and-solar-cosmic-rays",totalDownloads:3322,totalCrossrefCites:2,totalDimensionsCites:13,book:{slug:"current-topics-in-ionizing-radiation-research",title:"Current Topics in Ionizing Radiation Research",fullTitle:"Current Topics in Ionizing Radiation Research"},signatures:"Christopher J. Mertens, Brian T. Kress, Michael Wiltberger, W. Kent Tobiska, Barbara Grajewski and Xiaojing Xu",authors:[{id:"92275",title:"Dr.",name:"Christopher",middleName:null,surname:"Mertens",slug:"christopher-mertens",fullName:"Christopher Mertens"}]},{id:"32084",doi:"10.5772/33257",title:"Measurement of H2AX Phosphorylation as a Marker of Ionizing Radiation Induced Cell Damage",slug:"measurement-of-h2ax-phosphorylation-as-a-marker-of-ionizing-radiation-induced-cell-damage",totalDownloads:7990,totalCrossrefCites:3,totalDimensionsCites:8,book:{slug:"current-topics-in-ionizing-radiation-research",title:"Current Topics in Ionizing Radiation Research",fullTitle:"Current Topics in Ionizing Radiation Research"},signatures:"Aida Muslimovic, Pegah Johansson and Ola Hammarsten",authors:[{id:"94660",title:"Dr.",name:"Ola",middleName:null,surname:"Hammarsten",slug:"ola-hammarsten",fullName:"Ola Hammarsten"},{id:"106943",title:"Dr.",name:"Aida",middleName:null,surname:"Muslimovic",slug:"aida-muslimovic",fullName:"Aida Muslimovic"},{id:"108167",title:"Dr.",name:"Pegah",middleName:null,surname:"Johansson",slug:"pegah-johansson",fullName:"Pegah Johansson"}]},{id:"32116",doi:"10.5772/39263",title:"Influence of Ionizing Radiation and Hot Carrier Injection on Metal-Oxide-Semiconductor Transistors",slug:"influence-of-ionizing-radiation-and-hot-carrier-injection-on-metal-oxide-semiconductor-transistors",totalDownloads:1861,totalCrossrefCites:4,totalDimensionsCites:6,book:{slug:"current-topics-in-ionizing-radiation-research",title:"Current Topics in Ionizing Radiation Research",fullTitle:"Current Topics in Ionizing Radiation Research"},signatures:"Momčilo Pejović, Predrag Osmokrović, Milica Pejović and Koviljka Stanković",authors:[{id:"147994",title:"Dr.",name:"Momčilo",middleName:"M.",surname:"Pejović",slug:"momcilo-pejovic",fullName:"Momčilo Pejović"}]}],mostDownloadedChaptersLast30Days:[{id:"32100",title:"Ionizing Radiation in Medical Imaging and Efforts in Dose Optimization",slug:"ionizing-radiation-in-medical-imaging-and-efforts-in-dose-optimization",totalDownloads:4271,totalCrossrefCites:1,totalDimensionsCites:1,book:{slug:"current-topics-in-ionizing-radiation-research",title:"Current Topics in Ionizing Radiation Research",fullTitle:"Current Topics in Ionizing Radiation Research"},signatures:"Varut Vardhanabhuti and Carl A. Roobottom",authors:[{id:"95548",title:"Prof.",name:"Carl",middleName:null,surname:"Roobottom",slug:"carl-roobottom",fullName:"Carl Roobottom"},{id:"102622",title:"Dr.",name:"Varut",middleName:null,surname:"Vardhanabhuti",slug:"varut-vardhanabhuti",fullName:"Varut Vardhanabhuti"}]},{id:"62269",title:"An Overview of PET Radiopharmaceuticals in Clinical Use: Regulatory, Quality and Pharmacopeia Monographs of the United States and Europe",slug:"an-overview-of-pet-radiopharmaceuticals-in-clinical-use-regulatory-quality-and-pharmacopeia-monograp",totalDownloads:867,totalCrossrefCites:2,totalDimensionsCites:1,book:{slug:"nuclear-medicine-physics",title:"Nuclear Medicine Physics",fullTitle:"Nuclear Medicine Physics"},signatures:"Ya-Yao Huang",authors:[{id:"247754",title:"Prof.",name:"Ya-Yao",middleName:null,surname:"Huang",slug:"ya-yao-huang",fullName:"Ya-Yao Huang"}]},{id:"49039",title:"Physical and Radiobiological Evaluation of Radiotherapy Treatment Plan",slug:"physical-and-radiobiological-evaluation-of-radiotherapy-treatment-plan",totalDownloads:2533,totalCrossrefCites:4,totalDimensionsCites:4,book:{slug:"evolution-of-ionizing-radiation-research",title:"Evolution of Ionizing Radiation Research",fullTitle:"Evolution of Ionizing Radiation Research"},signatures:"Suk Lee, Yuan Jie Cao and Chul Yong Kim",authors:[{id:"96630",title:"Prof.",name:"Suk",middleName:null,surname:"Lee",slug:"suk-lee",fullName:"Suk Lee"},{id:"175104",title:"Prof.",name:"Chul Yong",middleName:null,surname:"Kim",slug:"chul-yong-kim",fullName:"Chul Yong Kim"},{id:"175234",title:"Dr.",name:"Yuan Jie",middleName:null,surname:"Cao",slug:"yuan-jie-cao",fullName:"Yuan Jie Cao"}]},{id:"48796",title:"Ionizing Radiation Detectors",slug:"ionizing-radiation-detectors",totalDownloads:2257,totalCrossrefCites:0,totalDimensionsCites:1,book:{slug:"evolution-of-ionizing-radiation-research",title:"Evolution of Ionizing Radiation Research",fullTitle:"Evolution of Ionizing Radiation Research"},signatures:"Marcia Dutra R. Silva",authors:[{id:"173533",title:"Dr.",name:"Marcia",middleName:"Dutra",surname:"Silva",slug:"marcia-silva",fullName:"Marcia Silva"}]},{id:"66165",title:"Environmental Radiation: Natural Radioactivity Monitoring",slug:"environmental-radiation-natural-radioactivity-monitoring",totalDownloads:415,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:null,title:"Ionizing and Non-ionizing Radiation",fullTitle:"Ionizing and Non-ionizing Radiation"},signatures:"Isam Salih Mohamed Musa",authors:null},{id:"32084",title:"Measurement of H2AX Phosphorylation as a Marker of Ionizing Radiation Induced Cell Damage",slug:"measurement-of-h2ax-phosphorylation-as-a-marker-of-ionizing-radiation-induced-cell-damage",totalDownloads:7990,totalCrossrefCites:3,totalDimensionsCites:8,book:{slug:"current-topics-in-ionizing-radiation-research",title:"Current Topics in Ionizing Radiation Research",fullTitle:"Current Topics in Ionizing Radiation Research"},signatures:"Aida Muslimovic, Pegah Johansson and Ola Hammarsten",authors:[{id:"94660",title:"Dr.",name:"Ola",middleName:null,surname:"Hammarsten",slug:"ola-hammarsten",fullName:"Ola Hammarsten"},{id:"106943",title:"Dr.",name:"Aida",middleName:null,surname:"Muslimovic",slug:"aida-muslimovic",fullName:"Aida Muslimovic"},{id:"108167",title:"Dr.",name:"Pegah",middleName:null,surname:"Johansson",slug:"pegah-johansson",fullName:"Pegah Johansson"}]},{id:"62645",title:"Applied Radiation Protection Physics",slug:"applied-radiation-protection-physics",totalDownloads:325,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"nuclear-medicine-physics",title:"Nuclear Medicine Physics",fullTitle:"Nuclear Medicine Physics"},signatures:"Khaled Soliman, Ahmed Alenezi, Abdullah Alrushoud, Salman Altimyat, Hasna Albander and Turki Alruwaili",authors:[{id:"200866",title:"Dr.",name:"Khaled",middleName:null,surname:"Soliman",slug:"khaled-soliman",fullName:"Khaled Soliman"},{id:"248341",title:"Dr.",name:"Ahmed",middleName:null,surname:"Alenezi",slug:"ahmed-alenezi",fullName:"Ahmed Alenezi"},{id:"257768",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alrushoud",slug:"abdullah-alrushoud",fullName:"Abdullah Alrushoud"},{id:"257769",title:"Mr.",name:"Salman",middleName:null,surname:"Altimyat",slug:"salman-altimyat",fullName:"Salman Altimyat"},{id:"257770",title:"Mrs.",name:"Hasna",middleName:null,surname:"Albander",slug:"hasna-albander",fullName:"Hasna Albander"},{id:"257771",title:"Mr.",name:"Turki",middleName:null,surname:"Alruwaili",slug:"turki-alruwaili",fullName:"Turki Alruwaili"}]},{id:"68051",title:"Applications of Diagnostic Reference Levels of Standard Doses in Nuclear Medicine",slug:"applications-of-diagnostic-reference-levels-of-standard-doses-in-nuclear-medicine",totalDownloads:278,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:"nuclear-medicine-physics",title:"Nuclear Medicine Physics",fullTitle:"Nuclear Medicine Physics"},signatures:"Aamir Shahzad and Sajid Bashir",authors:[{id:"253083",title:"Dr.",name:"Sajad",middleName:null,surname:"Bashir",slug:"sajad-bashir",fullName:"Sajad Bashir"},{id:"288354",title:"Dr.",name:"Aamir",middleName:null,surname:"Shahzad",slug:"aamir-shahzad",fullName:"Aamir Shahzad"}]},{id:"65118",title:"Spinal Stereotactic Body Radiotherapy (SBRT) Planning Techniques",slug:"spinal-stereotactic-body-radiotherapy-sbrt-planning-techniques",totalDownloads:447,totalCrossrefCites:0,totalDimensionsCites:0,book:{slug:null,title:"Ionizing and Non-ionizing Radiation",fullTitle:"Ionizing and Non-ionizing Radiation"},signatures:"Jina Kim, Yunji Seol, Hong Seok Jang and Young-Nam Kang",authors:null},{id:"32114",title:"Atmospheric Ionizing Radiation from Galactic and Solar Cosmic Rays",slug:"atmospheric-ionizing-radiation-from-galactic-and-solar-cosmic-rays",totalDownloads:3322,totalCrossrefCites:2,totalDimensionsCites:13,book:{slug:"current-topics-in-ionizing-radiation-research",title:"Current Topics in Ionizing Radiation Research",fullTitle:"Current Topics in Ionizing Radiation Research"},signatures:"Christopher J. Mertens, Brian T. Kress, Michael Wiltberger, W. Kent Tobiska, Barbara Grajewski and Xiaojing Xu",authors:[{id:"92275",title:"Dr.",name:"Christopher",middleName:null,surname:"Mertens",slug:"christopher-mertens",fullName:"Christopher Mertens"}]}],onlineFirstChaptersFilter:{topicSlug:"radiobiology",limit:3,offset:0},onlineFirstChaptersCollection:[{id:"70114",title:"Monitoring of Natural Radioactivity in Drinking Water and Food with Emphasis on Alpha-Emitting Radionuclides",slug:"monitoring-of-natural-radioactivity-in-drinking-water-and-food-with-emphasis-on-alpha-emitting-radio",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.90166",book:{title:"Ionizing and Non-ionizing Radiation"},signatures:"Markus Zehringer"},{id:"69519",title:"The Effect of Repeated Electromagnetic Fields Stimulation in Biological Systems",slug:"the-effect-of-repeated-electromagnetic-fields-stimulation-in-biological-systems",totalDownloads:89,totalDimensionsCites:0,doi:"10.5772/intechopen.89668",book:{title:"Ionizing and Non-ionizing Radiation"},signatures:"Felipe P. Perez, James Rizkalla, Matthew Jeffers, Paul Salama, Cristina N. Perez Chumbiauca and Maher Rizkalla"},{id:"67590",title:"Study of Non-predictive Patterns of Non-Ionizing Radiation in the City of Salta in Argentine",slug:"study-of-non-predictive-patterns-of-non-ionizing-radiation-in-the-city-of-salta-in-argentine",totalDownloads:126,totalDimensionsCites:0,doi:"10.5772/intechopen.84717",book:{title:"Ionizing and Non-ionizing Radiation"},signatures:"Mario Marcelo Figueroa de la Cruz and Roberto Daniel Breslin"}],onlineFirstChaptersTotal:8},preDownload:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[{type:"book",id:"10080",title:"Vortex Dynamics",subtitle:null,isOpenForSubmission:!0,hash:"ea97962e99b3e0ebc9b46b48ba5bea14",slug:null,bookSignature:"Dr. Zambri Harun",coverURL:"https://cdn.intechopen.com/books/images_new/10080.jpg",editedByType:null,editors:[{id:"243152",title:"Dr.",name:"Zambri",middleName:null,surname:"Harun",slug:"zambri-harun",fullName:"Zambri Harun"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8903",title:"Carbon Based Material for Environmental Protection and Remediation",subtitle:null,isOpenForSubmission:!0,hash:"19da699b370f320eca63ef2ba02f745d",slug:null,bookSignature:"Dr. Mattia Bartoli and Dr. Marco Frediani",coverURL:"https://cdn.intechopen.com/books/images_new/8903.jpg",editedByType:null,editors:[{id:"188999",title:"Dr.",name:"Mattia",middleName:null,surname:"Bartoli",slug:"mattia-bartoli",fullName:"Mattia Bartoli"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"8771",title:"Raman Scattering",subtitle:null,isOpenForSubmission:!0,hash:"1354b3097eaa5b27d9d4bd29d3150b27",slug:null,bookSignature:"Dr. Samir Kumar and Dr. Prabhat Kumar",coverURL:"https://cdn.intechopen.com/books/images_new/8771.jpg",editedByType:null,editors:[{id:"296661",title:"Dr.",name:"Samir",middleName:null,surname:"Kumar",slug:"samir-kumar",fullName:"Samir Kumar"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10073",title:"Recent Advances in Nanophotonics-Fundamentals and Applications",subtitle:null,isOpenForSubmission:!0,hash:"aceca7dfc807140870a89d42c5537d7c",slug:null,bookSignature:"Dr. Mojtaba Kahrizi and Ms. Parsoua Abedini Sohi",coverURL:"https://cdn.intechopen.com/books/images_new/10073.jpg",editedByType:null,editors:[{id:"113045",title:"Dr.",name:"Mojtaba",middleName:null,surname:"Kahrizi",slug:"mojtaba-kahrizi",fullName:"Mojtaba Kahrizi"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10132",title:"Applied Computational Near-surface Geophysics - From Integral and Derivative Formulas to MATLAB Codes",subtitle:null,isOpenForSubmission:!0,hash:"38cdbbb671df620b36ee96af1d9a3a90",slug:null,bookSignature:"Dr. Afshin Aghayan",coverURL:"https://cdn.intechopen.com/books/images_new/10132.jpg",editedByType:null,editors:[{id:"311030",title:"Dr.",name:"Afshin",middleName:null,surname:"Aghayan",slug:"afshin-aghayan",fullName:"Afshin Aghayan"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10110",title:"Advances and Technologies in Building Construction and Structural Analysis",subtitle:null,isOpenForSubmission:!0,hash:"df2ad14bc5588577e8bf0b7ebcdafd9d",slug:null,bookSignature:"Dr. Ali Kaboli and Dr. Sara Shirowzhan",coverURL:"https://cdn.intechopen.com/books/images_new/10110.jpg",editedByType:null,editors:[{id:"309192",title:"Dr.",name:"Ali",middleName:null,surname:"Kaboli",slug:"ali-kaboli",fullName:"Ali Kaboli"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"10175",title:"Ethics in Emerging Technologies",subtitle:null,isOpenForSubmission:!0,hash:"9c92da249676e35e2f7476182aa94e84",slug:null,bookSignature:"Prof. Ali Hessami",coverURL:"https://cdn.intechopen.com/books/images_new/10175.jpg",editedByType:null,editors:[{id:"108303",title:"Prof.",name:"Ali",middleName:null,surname:"Hessami",slug:"ali-hessami",fullName:"Ali Hessami"}],productType:{id:"1",chapterContentType:"chapter"}},{type:"book",id:"9284",title:"Computational Aeroacoustics",subtitle:null,isOpenForSubmission:!0,hash:"7019c5e5985faef7dc384c87dca5c8ef",slug:null,bookSignature:"Prof. Ramesh K. Agarwal",coverURL:"https://cdn.intechopen.com/books/images_new/9284.jpg",editedByType:null,editors:[{id:"38519",title:"Prof.",name:"Ramesh K.",middleName:null,surname:"Agarwal",slug:"ramesh-k.-agarwal",fullName:"Ramesh K. Agarwal"}],productType:{id:"1",chapterContentType:"chapter"}}],offset:8,limit:8,total:16},humansInSpaceProgram:{},teamHumansInSpaceProgram:{},route:{name:"profile.detail",path:"/profiles/84428/miguel-urrestarazu",hash:"",query:{},params:{id:"84428",slug:"miguel-urrestarazu"},fullPath:"/profiles/84428/miguel-urrestarazu",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()