Papers by Dr. Summer J . Decker
Forensic Science, Medicine and Pathology, 2020
The use of postmortem computed tomography in forensic medicine, in addition to conventional autop... more The use of postmortem computed tomography in forensic medicine, in addition to conventional autopsy, is now a standard procedure in several countries. However, the large number of cases, the large amount of data, and the lack of postmortem radiology experts have pushed researchers to develop solutions that are able to automate diagnosis by applying deep learning techniques to postmortem computed tomography images. While deep learning techniques require a good understanding of image analysis and mathematical optimization, the goal of this review was to provide to the community of postmortem radiology experts the key concepts needed to assess the potential of such techniques and how they could impact their work.
Forensic anthropology, Jan 18, 2022
Fractography has been shown to be applicable to forensic assessments of skeletal trauma by observ... more Fractography has been shown to be applicable to forensic assessments of skeletal trauma by observing the presence and orientation of fracture surface features, which reveal information about the direction of crack propagation. Previous studies have examined dry or processed bone surfaces, often fractured under controlled experimental conditions. Here we assess a series of clinical computed tomography scans involving lower extremity injuries and find that a number of fracture surface features can be seen on three-dimensional computational models (surface and volumetric). These findings indicate that bone fractography can be used in skeletal trauma analyses without processing the remains and may also have clinical as well as forensic applications.
Springer eBooks, 2019
The nature of forensic anthropology presents a number of ethical challenges to its practitioners.... more The nature of forensic anthropology presents a number of ethical challenges to its practitioners. Some of these issues are similar to those encountered in bioarchaeology or biological anthropology, but a number of dilemmas are unique to the discipline. These ethical challenges are continually growing and becoming more significant as forensic anthropologists practice in a number of different casework scenarios, both domestically and internationally. These include cases ranging from law enforcement or coroner investigations dealing with one individual to mass fatalities. Moreover, forensic anthropologists may be involved in cases requiring the analysis of living individuals, which brings its own unique ethical issues. As technology develops, and the contributions that forensic anthropology makes to various forensic investigations increases worldwide, the need to confront the multitude of ethical issues as well as ensuring forensic anthropologists are qualified and competent, rises exponentially. This chapter highlights a number of areas, including: codes of ethics, field and laboratory analysis, age estimation in the living, education and teaching, research, and dealing with families within a forensic anthropological context. It is hoped that these topics will increase awareness of the need for ethical practice in forensic anthropology and some of the many professional challenges forensic anthropologists routinely face.
World Neurosurgery, Apr 1, 2019
BACKGROUND: Little published data exist regarding normal values of disc height. Current literatur... more BACKGROUND: Little published data exist regarding normal values of disc height. Current literature relies on plain radiographs making accurate measurements of individual lumbar disc height difficult.-OBJECTIVE: We seek to establish normal values for lumbar intervertebral discs in different age groups using computed tomography scans in healthy individuals.-METHODS: Two hundred forty anonymized abdominal computed tomography scans (131 women) were prospectively collected once institutional review board approval was obtained. Individuals with spinal pathologies were excluded. Disc height measurements were obtained at the anterior edge, center, and posterior edge of each vertebra in the midsagittal plane, averaged, and compared against age and sex.-RESULTS: Average age was 45 (14e83) years for women and 48 (14e89) years for men. Average lumbar disc height was 5.6 AE 1.1 mm for men and 4.8 AE 0.8 mm for women at T12/L1, 6.9 AE 1.3 mm for men and 5.8 AE 0.9 mm for women at L1/2, 8.1 AE 1.4 mm for men and 6.9 AE 1.1 mm for women at L2/ 3, 8.7 AE 1.5 mm for men and 7.6 AE 1.2 mm for women at L3/4, 9.2 AE 1.6 mm for men and 8.5 AE 1.6 mm for women at L4/5, and 8.8 AE 1.6 mm for men and 8.6 AE 1.8 mm for women at L5/ S1. Disc height was significantly smaller for women than men (P < 0.001), except at L5/S1.-CONCLUSIONS: Variation in disc height is determined much more by sex than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9 AE 1.7 mm [men], 8.6 AE 1.8 mm [women]). Based on our findings, >10 mm cage height will result in supraphysiologic interbody space restoration and potentially predispose to complications.
Journal of Forensic Sciences, Sep 21, 2011
Zoomorphology, Feb 8, 2023
Ectoparasitic cookiecutter sharks (Chondrichthyes: Squaliformes: Dalatiidae; Isistius) share comm... more Ectoparasitic cookiecutter sharks (Chondrichthyes: Squaliformes: Dalatiidae; Isistius) share common features for jaw and teeth structure, in particular, robust lower jaws and dignathic heterodonty (upper teeth crowns are more slender and shorter than the broader and longer lower teeth crowns). The jaws and teeth are well suited for feeding by excising a nearly symmetrical oval-flesh bite plug from a variety of prey species including marine mammals, fishes, and squids. There is considerable speculation regarding cookiecutter shark bite dynamics given that natural feeding behavior has not been observed. To elucidate cookiecutter shark bite dynamics, bites were experimentally simulated for the two cookiecutter shark species; the Cookiecutter Shark, Isistius brasiliensis (Quoy JRC, Gaimard, P (1824) Zoologie (3) Imprimerie royale) and the Largetooth Cookiecutter Shark, Isistius plutodus (Garrick JAF, Springer S (1964) Isistius plutodus, a new squaloid shark from the Gulf of Mexico. Copeia 678-682), using three-dimensional printed models of jaws with teeth. Bite simulations were conducted at standardized jaw bite-gape angles and ballistic gelatin was used to approximate prey flesh, from which aspect ratio analysis of bite wound geometrics was used to determine bite wound morphometrics for each species. The simulated bite experiment also was useful for assessing factors that potentially affect cookiecutter shark total length estimates when based on natural bite geometrics. In addition, the mechanics of producing experimental bites provide new insights related to the necessity for cookiecutter sharks to rotate their body to create nearly symmetrical oval bite wounds.
Forensic Anthropology, 2022
Fractography has been shown to be applicable to forensic assessments of skeletal trauma by observ... more Fractography has been shown to be applicable to forensic assessments of skeletal trauma by observing the presence and orientation of fracture surface features, which reveal information about the direction of crack propagation. Previous studies have examined dry or processed bone surfaces, often fractured under controlled experimental conditions. Here we assess a series of clinical computed tomography scans involving lower extremity injuries and find that a number of fracture surface features can be seen on three-dimensional computational models (surface and volumetric). These findings indicate that bone fractography can be used in skeletal trauma analyses without processing the remains and may also have clinical as well as forensic applications.
World Neurosurgery, 2021
BACKGROUND Surgical strategy in vestibular schwannomas may require subtotal resection to preserve... more BACKGROUND Surgical strategy in vestibular schwannomas may require subtotal resection to preserve neurological function. Residual tumor growth pattern and contrast enhancement in the immediate post-resection period remains uncertain. We sought to evaluate changes in the enhancement pattern and volume of vestibular schwannomas after subtotal resection in the immediate post-operative period. METHODS Volumetric analysis of tumor size and enhancement patterns of vestibular schwannomas were measured on MRIs obtained within three days of surgery, three months after surgery, and one year after surgery. RESULTS Nineteen patients were eligible for inclusion in the study (nine males and ten females) with an average age of 47 years. Contrast enhancement was absent in 6/19 (32%) of cases on the immediate post-resection MRI with return of expected enhancement on subsequent studies. Volumetric analysis identified that tumors decreased in size by an average of 35% in the first three months (p = 0.025) after resection and 46% in the first year after resection (p<0.01). CONCLUSION Vestibular schwannomas that undergo subtotal resection tend to decrease in size over the first 3 months after resection. Residual tumor volume may fail to enhance on the immediate post-resection MRI. Both of these findings could lead surgeons to misinterpret degree of resection after surgery and have implications for clinical decision making and research reporting in the scientific literature for vestibular schwannomas after subtotal resection.
IGI Global eBooks, Oct 4, 2011
... Stephanie L. Davy-Jow (Liverpool John Moores University, UK), Summer J. Decker (University of... more ... Stephanie L. Davy-Jow (Liverpool John Moores University, UK), Summer J. Decker (University of South Florida, USA) and Damian Schofield (State University of New York at Oswego, USA). Copyright © 2012. ... Davy-Jow, Stephanie L., Summer J. Decker and Damian Schofield. ...
The Cleft Palate-Craniofacial Journal, Jan 12, 2023
Objective To assess the ability of current 3D printing technology to generate a craniofacial bony... more Objective To assess the ability of current 3D printing technology to generate a craniofacial bony and soft tissue anatomical model for use in simulating the performance of a fronto-orbital advancement (FOA) osteotomy and then to further assess the value of the model as an educational tool. Design Anatomic models were designed with a process of serial anatomic segmentation/design, 3D printing, dissection, and device refinement. A validation study was conducted with 5 junior and 5 senior plastic surgery residents. The validation study incorporated a multiple-choice Knowledge Assessment test (KA), an Objective Structured Assessment of Technical skills (OSATs), a Global Rating Scale (GRS) and a Michigan Standard Simulation Experience Scale (MiSSES). We compared the scores of both the junior and senior residents and compared junior resident scores, before and after viewing a lecture/demonstration. Results MiSSES showed high face validity with a score of 85.1/90, signifying high satisfaction with the simulator learning experience. Simulation and the lecture/demonstration improved the junior resident average KA score from 5.6/10 to 9.6/10 ( P = .02), OSATs score from 32.4/66 to 64.4/66 ( P &lt; .001) and GRS score from 13.9/35 to 27.5/35 ( P &lt; .001). The senior residents OSATs score of 56.3/66 was higher than the pre-lecture juniors (32.4/66) ( P &lt; .001), but lower than the post-lecture juniors (64.4/66) ( P &lt; .001). Conclusion We have successfully fabricated a 3D printed craniofacial simulator capable of being used as an educational tool alongside traditional surgical training. Next steps would be improving soft tissue realism, inclusion of patient and disease specific anatomy and creation of models for other surgical specialties.
IGI Global eBooks, Jun 17, 2013
Chapter 42 INTRODUCTION Forensic anthropology is a very broad discipline, and can therefore be de... more Chapter 42 INTRODUCTION Forensic anthropology is a very broad discipline, and can therefore be defined in a number of ways. Dirkmaat et al (2008) describe it as "...the scientific discipline that focuses on the life, the death, and the post-life history of a specific individual, as reflected primarily in their skeletal remains and the physical and forensic context in which they are emplaced". Anthropologists are often employed in scenarios involving severely decomposed and/or unidentified human remains. The varied nature of such circumstances dictates that the remit of the anthropologist is
3D printing in medicine, Aug 15, 2020
The nasopharyngeal swab is a critical component of the COVID-19 testing kit. Supply chain remains... more The nasopharyngeal swab is a critical component of the COVID-19 testing kit. Supply chain remains greatly impacted by the pandemic. Teams from USF Health Radiology and Northwell Health System developed a 3Dprinted stopgap alternative. This descriptive study details the workflow and provides guidance for hospital-based 3D printing labs to leverage the design to make a positive impact on the pandemic. Swab use is also outlined, and the early information regarding clinical use is described, including an ongoing multicenter trial methodology.
Clinical Anatomy, Oct 18, 2019
The success of a total hip arthroplasty is directly related to the ability of the implant to matc... more The success of a total hip arthroplasty is directly related to the ability of the implant to match original femoral morphology. Given this critical relationship, we characterized normal proximal femoral morphology as it relates to sex, age, and symmetry. Sixty abdominopelvic computed tomography (CT) scans (30 male and 30 female, ages 20-85 years old) from patients without any osseous pathology or implants were utilized. Three-dimensional models were constructed from the CT scans using Mimics v19 (Materialize). Thirteen landmarks were placed on each femur model and yielded eight morphological measurements for each femur. Medullary cavity measurements were taken superior to, at the center of, and inferior to the lesser trochanter. Morphological measurements were analyzed by sex, age group, and left versus right. A significant difference was identified between males and females for femoral head height, inferior neck length, minimum neck diameter, neck shaft angle, mediolateral medullary cavity measurement superior to the lesser trochanter and the anteroposterior at the lesser trochanter (P < 0.05). Age was found to correlate with medullary cavity measurements. As previously identified in the literature, differences with respect to the right and left femur were not of practical significance. The results show that sex is critical in determining prosthesis fit with the examined morphological measurements of the proximal femur while age is more important with respect to the medullary cavity. It is also evident that the current practice of using one femur to approximate the opposite is a viable clinical assumption. Clin.
Forensic Science International, 2019
The objective of this project was to document the efficacy of part-to-part comparison of computed... more The objective of this project was to document the efficacy of part-to-part comparison of computed tomography (CT)-derived three-dimensional (3D) models of the lumbar spine in forensic personal identification. By testing the methodology, this study aimed to provide a new technique of quantifiable (through a percent match) positive identification that meets the explicit requirements of the Daubert ruling and the challenges set forth in the 2009 NAS report. Ante-mortem (AM) and simulated postmortem (PM) models of the lumbar vertebrae (L1-L5) for 30 unique individuals were compared via part comparison analyses. The threshold of AE0.5 mm with at least a 90% match was considered a positive identification. Using this threshold, the part comparison results had a perfect identification rate with no false positives and no false negative matches. A ROC curve was generated with a score of 1, signifying a "perfect" sensitivity and specificity, at a cutoff value of 65.5%. On average positive IDs had a 94.7% percent match within the established threshold, while negative IDs had an average of 21.4%. In looking at the impact of different components of the biological profile, age and sex of the unknown individual played a minimal role in the percent match for both a positive and a negative ID. Lumbar level also played a minor role in in both the positive and negative percent match. The real-world application of 3D part-topart comparison on AM and simulated PM scans demonstrate the potential usefulness of this technology in forensic identification.
Forensic Science International, 2012
Despite numerous papers relating to the prediction of nose projection for the purposes of facial ... more Despite numerous papers relating to the prediction of nose projection for the purposes of facial approximation, there is little guidance for nose tip shape that has been evaluated on a known data set. This study presents a novel, simple technique for validation of the reconstructed nose tip shape based on methods used in actual approximation practice. The data set was comprised of 25 full-head computed tomography (CT) patient scans. In 22 of the 25 patients across all age and sex groups, when the head is tilted so that soft tissue pronasale is superimposed on hard tissue rhinion, the curvature of the nose tip was found to mimic the curvature of the superior portion of the nasal aperture. This occurs when the head is tilted dorsally by approximately 60° (55.87±5.91). Individuals with snub noses presented a much wider tip curvature. The method was highly repeatable and was evaluated through inter- and intra-observer studies (error=3.15%).
Clinical Infectious Diseases, Sep 10, 2020
See the Editorial commentary by Rybicki on pages e3033-5.) Background. Severe acute respiratory s... more See the Editorial commentary by Rybicki on pages e3033-5.) Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can be detected in respiratory samples by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or other molecular methods. Accessibility of diagnostic testing for COVID-19 has been limited by intermittent shortages of supplies required for testing, including flocked nasopharyngeal (FLNP) swabs. Methods. We developed a 3-dimensional printed nasopharyngeal (3DP) swab as a replacement of the FLNP swab. The performance of 3DP and FLNP swabs were compared in a clinical trial of symptomatic patients at 3 clinical sites (n = 291) using 3 SARS-CoV-2 emergency use authorization tests: a modified version of the Centers for Disease Control and Prevention (CDC) RT-PCR Diagnostic Panel and 2 commercial automated formats, Roche Cobas and NeuMoDx. Results. The cycle threshold-C(t)-values from the gene targets and the RNase P gene control in the CDC assay showed no significant differences between swabs for both gene targets (P = .152 and P = .092), with the RNase P target performing significantly better in the 3DP swabs (P < .001). The C(t) values showed no significant differences between swabs for both viral gene targets in the Roche cobas assay (P = .05 and P = .05) as well as the NeuMoDx assay (P = .401 and P = .484). The overall clinical correlation of COVID-19 diagnosis between all methods was 95.88% (Kappa 0.901). Conclusions. The 3DP swabs were equivalent to standard FLNP in 3 testing platforms for SARS-CoV-2. Given the need for widespread testing, 3DP swabs printed onsite are an alternate to FLNP that can rapidly scale in response to acute needs when supply chain disruptions affect availability of collection kits.
Journal of Forensic Sciences, May 19, 2011
Examination of the adult os coxae and sacrum is one of the most common methods of sex estimation ... more Examination of the adult os coxae and sacrum is one of the most common methods of sex estimation from bone. Medical imaging, such as computed tomography (CT), provides the opportunity for three-dimensional (3D) imaging of the skeleton from clinical scans of known individuals in situ. In this study, a randomly selected subset of abdominopelvic CT-derived models were used to evaluate simple, repeatable metric methods of sex estimation based on a combination of obstetric measurements and the traditionally nonmetric Phenice-derived traits. A four-variable discriminant function for sex estimation was developed based on statistical analyses. Overall, the cross-validated accuracy of this method was 100%, with inter-observer error showing an average of only 2.2%. Comparative analysis was run on the data set using FORDISC 3.0. This study shows that current sex determination standards from the pelvis should be updated to include more in vivo data to increase the accuracy of identification.
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Papers by Dr. Summer J . Decker
Virtual Reality (VR) is being applied to forensic anthropology in a multitude of ways to benefit research and teaching. Several large-scale projects have been launched to digitize, reconstruct and disseminate specimens (for example, http://www.virtual-anthropology.com). This chapter will begin with an overview of the discipline of forensic anthropology and discuss a number of representative applications of VR technology in this field that are changing the way in which case work may be handled in the future.