CT scans are minimally-invasive and can accurately help doctors diagnose nose and sinus issues. Head and Neck Imaging - 2 Volume Set. Vreugdenburg TD, et al. Soft tissue, such as the heart or liver, shows up in shades of gray. 0000011190 00000 n Speed is especially beneficial for children, the elderly, and critically ill anyone who finds it difficult to stay still, even for the brief time necessary to obtain images. 0000014497 00000 n 0000001941 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ kBqe|$L0et76+W&7 ]&lc6Mc@i2Y5i*QXGbE:jC9_S|M0-u?0skO'33Lk\e\e!}i! After the ostiomeatal complex is accessed through the nostril with a rigid endoscope, the ostia and recesses are targeted, depending on the location and pattern of disease. Scopis is a next-generation solution for navigating functional endoscopic sinus surgery (FESS) offering surgeons highly advanced image guidance and visualization capabilities in a single system. 0000051629 00000 n Weight 75-90kg: 120cc. Your doctor can review these images on a computer monitor, print them on film or via a 3D printer, or transfer them to a CD or DVD. 150 to 400 HU). Nearly all CT scanners can obtain multiple slices in a single rotation. A special computer program processes this large volume of data to create two-dimensional cross-sectional images of your body. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ It is usually performed as a non-contrast study. 0000111478 00000 n Citardi MJ, et al. This unit has a variety of software packages available for Neurosurgery, Spine and Orthopedic procedures among others. Including: CT of the brain (or spine) with stealth protocol. 0000002164 00000 n The radiological protocol is the 'type' of CT exam that will best suit the clinical question and patient presentation. The paranasal sinuses are hollow, air-filled spaces located within the bones of the face and surrounding the nasal cavity, a system of air channels connecting the nose with the back of the throat. Face/Sinus. provide additional information about tumors of the nasal cavity and sinuses. CT images of internal organs, bones, soft tissue, and blood vessels provide greater detail than traditional x-rays. At the time the article was last revised Andrew Murphy had Scopis is a next-generation solution for navigating functional endoscopic sinus surgery (FESS) offering surgeons highly advanced image guidance and visualization capabilities in a single system. }d'z Yxs`;Zh_yl6b However, the technologist will always be able to see, hear and speak with you through a built-in intercom system. 0000107765 00000 n Because children are more sensitive to radiation, they should have a CT exam only if it is essential for making a diagnosis. 0000136210 00000 n It might be combined or simultaneously acquired with a CT abdomen. The paranasal sinusesare hollow, air-filled spaces located within the bones of the face and surrounding the nasal cavity, a system of air channels connecting the nose with the back of the throat. 0000001928 00000 n Healthcare Professionals If you have a known allergy to contrast material, your doctor may prescribe medications to reduce the risk of an allergic reaction. `gG>XZz8%K8Z[o_-::@vIABb"snk(Blm:N^L|9jmT` -Y endstream endobj 355 0 obj <>stream Siemens Definition AS 20 Protocols. These lines help ensure that you are in the correct position on the exam table. Unable to process the form. The radiologist will send an official report to the doctor who ordered the exam. 4000 HU), soft tissue kernel (e.g. Acute cerebral venous sinus thrombosis (VST) is a rare form of stroke, and establishing a correct diagnosis can be challenging due to its diverse and typically delayed clinical presentation [1,2].VST is most common in young women and is associated with pregnancy/puerperium, use of hormonal contraceptives, hypercoagulable states, and malignancy [3,4]. Intra-Operative Use of Computer Aided Surgery. CT scanning is painless, noninvasive and accurate. There are four pairs of sinuses, each connected to the nasal cavity by small openings. 0000013731 00000 n 0000009151 00000 n Thus, it should be utilized as the adjunct and should not be viewed as a substitute for surgical knowledge and anatomical familiarity with the surgical region. CT of the brain with Lorenz protocol. Phone: (860) 969-6400 Fax: (860) 969-6392www.rahxray.com *These CPT codes represent the most commonly ordered CT exams. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ x] xE endobj Note: we are unable to answer specific questions or offer individual medical advice or opinions. 2019; 46(4): 520-525. Guidance of endoscopic instruments may help you to perform a minimally invasive, accurate and selective surgery. A radiologist, a doctor specially trained to supervise and interpret radiology exams, will analyze the images. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Trade mark is and ctsinus stryker protocol was required for this solution to the anatomic compartments. 0000051941 00000 n You may feel warm or flushed as the contrast is injected. 2017;50(3):617-632. The optical capability refers to the infrared light based camera that monitors reflections from the spheres placed on the surgical instrumentation. 0000013608 00000 n hbb2a`b``3 n 9 This results in more detail. The endoscopic view obtained of the surgical field and positioned instrumentation should be the primary focus while performing the surgery. 0000014919 00000 n Reduced surgical bleeding 5,8 and improved visibility 5,6. 0000111824 00000 n CT imaging provides real-time imaging, making it a good tool for guiding. startxref You may need to change into a gown for the procedure. 0000007874 00000 n 0000003434 00000 n see full revision history and disclosures, iodinated contrast-induced thyrotoxicosis, saline flush during contrast administration, CT NCAP (neck, chest, abdomen and pelvis), CT angiography of the cerebral arteries (protocol), CT angiography of the circle of Willis (protocol), cardiac CT (prospective high-pitch acquisition), CT transcatheter aortic valve implantation planning (protocol), CT colonography reporting and data system, CT kidneys, ureters and bladder (protocol), CT angiography of the splanchnic vessels (protocol), 1. 0000010842 00000 n 0000004568 00000 n 2013;3(3):236-241. 0000006544 00000 n CT is usually the first test ordered when a sinus tumor is suspected. StealthStation ENT navigation system offers electromagnetic technology that expands what was previously possible with image-guided surgery so you can see more, do more. They should not have repeated CT exams unless necessary. 0000052054 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ 0000051668 00000 n You can return to your normal activities immediately. With pediatric patients, a parent may be allowed in the room but may need to wear a lead apron to minimize radiation exposure. All Rights Reserved. Some imaging tests and treatments have special pediatric considerations. trailer <<8C6E674339FF4166ABD801C45B1E2FA5>]/Prev 472851/XRefStm 1746>> startxref 0 %%EOF 402 0 obj <>stream `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Recognition and utilization of surgical landmarks is imperative for the surgeon. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ 0000002669 00000 n 0000327514 00000 n Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical imaging test. Medtronic and Stryker Sinuses Scan range should begin below the upper teeth and extend through the top of the skull DFOV 25-30 cm DFOV is used for the CD Data set. Though the scanning itself causes no pain, there may be some discomfort from having to remain still for several minutes. 0000009758 00000 n 0000014590 00000 n 0000111556 00000 n Surgeon and OR staff ensure the appropriate equipment are available and present in or near the OR room prior to transport of the patient to the OR. Q Recommended protocol for medical CBCT scanners Scan time Longest available Voxel size 0.3 - 0.5mm Field of view Largest available File type CT (one file per slice) Reconstruction Axial Compression Uncompressed Thank you for taking a moment to read this protocol. 0000010968 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Masterson L, et al. 8t4c-mc\XrZkM_L-*p|EbizJ::E;iH82RgU9'Xi) "u$u/LYLfl7mn!. What is CT (Computed Tomography) of the Sinuses? `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ implants, specific indications. Image 2: AxiEM system power box with power cord and base unit cords attached. Only one CT contrast study should be scheduled within a 48 hour period. 0000013974 00000 n Modern CT scanners can image large sections of the body in just a few seconds, and even faster in small children. In addition, in the case of planned surgery, imaging can provide the surgeon with necessary information regarding any anatomical variants and allow the diagnosis of clinically silent diseases, e.g. After a CT exam, the technologist will remove your intravenous line. 0000003480 00000 n Guidance of endoscopic instruments may help you to perform a minimally invasive, accurate and selective surgery. Keep reading to know what we look for in a CT scan of the sinuses. 0000013851 00000 n CT has become a useful diagnostic modality in the evaluation of the paranasal sinuses and an integral part of surgical planning. endstream Treon Plus: Infrared light based unit currently utilized at the VA in Iowa City. ENT Navigation Solutions CT is the most reliable imaging technique for determining if the sinuses are obstructed. Become a Gold Supporter and see no third-party ads. 0000014012 00000 n 0000008479 00000 n Safety in X-ray, Interventional Radiology and Nuclear Medicine Procedures, Radiation Therapy for Head and Neck Cancer, evaluate sinuses that are filled with fluid or thickened sinus. Ahn S, et al. 0000127121 00000 n 0000010404 00000 n Stealth 7 (S7): Utilized in the main OR at UIHC. In emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives. It can even generate three-dimensional images. However, these are only side effects of the contrast injection, and they subside quickly. The CT lumbar spine or L-spine protocol serves as an examination for the assessment of the lumbar spine. 0000008617 00000 n An advanced navigation protocol for endoscopic transsphenoidal surgery. If a Stealth protocol CT cannot be obtained, a normal sinus CT can be utilized but may not provide the same level of accuracy. 0000107831 00000 n 0000007230 00000 n If so, your doctor will explain why. ! ?,8!o?:g,96Z9v-:fJ4)0<9(/dJJ_aYKoP;H,Abtx+Sg{tm&.,+d[w9qkM|]"O)s5q>BSM&U[~Y:FR4~ c endstream endobj 356 0 obj <> endobj 357 0 obj <>stream 0000014366 00000 n To the left of the picture are inputs for the EGM cords (shown in figure 4). Home We offer routine ENT MRI and CT sequences and protocols with and without contrast. Iowa City, IA 52242-1089, Editor: Henry Hoffman, MD The technologist may ask you to hold your breath during the scanning. CTDI: ~10-20 mGy Place skin marker on the patient's right cheek prior to scanning Setup: Head first supine , lateral scout from below the chin through the top of the skull Patient positioned so that the IOML is perpendicular to the table top Only use the flat sponge , NO LENS SHIELD TO BE USED Intra-Operative Use of Computer Aided Surgery, Sinus Surgery and Transnasal Skull Base Surgery, Otology, Neurotology, and Lateral Skull Base Surgery, Electromagnetic Compatibility for Cardiac Devices, California Transparency in Supply Chains Act, Information About Proposition 65 for California Customers, Digital Millennium Copyright Act (DMCA) Notification, Distorted sinus anatomy of development, postoperative, or traumatic origin, Pathology involving the frontal, posterior ethmoid and sphenoid sinuses, Disease abutting the skull base, orbit, optic nerve, or carotid artery, Cerebrospinal fluid rhinorrhea or conditions where there is a skull base defect, Benign and malignant sino-nasal neoplasms, Scanning and registration protocols that enable accuracy, StealthMerge ENT software that fuses different imaging modalities (CT, MRI) togetherfor improved visualization, Instruments that are designed and calibrated for use in image-guided surgery. What will I experience during and after the procedure? It is also used to create intraoperative road maps. 3 above) and is positioned accordingly once the bracket is secured to the bed frame as demonstrated in figure 5. 0000014682 00000 n <> stream 3 0 obj A CT scan of the face produces images that also show a patient's paranasal sinus cavities. Doctors do not generally recommend CT scanning for pregnant women unless medically necessary because of potential risk to the unborn baby. 0000111362 00000 n CT scans in children should always be done with low-dose technique. 0000014677 00000 n Dalgorf M, et al. <> hbbe`b``3 ` endstream endobj 349 0 obj <>/Metadata 49 0 R/OpenAction 350 0 R/Pages 48 0 R/StructTreeRoot 51 0 R/Type/Catalog/ViewerPreferences<>>> endobj 350 0 obj <> endobj 351 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 352 0 obj <> endobj 353 0 obj <> endobj 354 0 obj <>stream To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database. 0000002620 00000 n Surgical Navigation can be utilized for a number of different surgical procedures. Rad Director will be notified if this occurs without prior approval. Image-guided surgery influences perioperative morbidity from endoscopic sinus surgery: a systematic review and meta-analysis. 0000108025 00000 n The quality of the CT or CBCT scan is the most important aspect of creating To help ensure current and accurate information, we do not permit copying but encourage linking to this site. Some patients require an injection of a contrast materialto enhance the visibility of certain tissues or blood vessels. Fusion: Standalone, electromagnetic based ENT image guidance system. 0000003850 00000 n The technologist or nurse, under the direction of a physician, may offer you some medication to help you tolerate the CT scanning procedure. Keep in mind that the images provided are based on the anatomy at the time of CT scan and the surgical anatomy may have changed prior to the start of the procedure (resolution/progression of infection, change in size of masses, etc). Any of these conditions may increase the risk of an adverse effect. CT scanning is painless, noninvasive, and accurate. Peter M. Som, Hugh D. Curtin. 0000002899 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Your doctor may instruct you to not eat or drink anything for a few hours before your exam if it will use contrast material. % You may feel a need to urinate. Return toParanasal Sinus Surgery Protocols. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Tell your doctor if there's a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking, and allergies. Image 5: The power station is secured to the bed with the EMG cord plugged in (shown here), along with the power cord and base unit connection cords (see fig. The CT scanner is typically a large, donut-shaped machine with a short tunnel in the center. Also tell your doctor about any recent illnesses or other medical conditions and whether you have a history of heart disease, asthma, diabetes, kidney disease, or thyroid problems. The goal of sinus surgery is to restore ventilation and drainage while preserving mucosa. 7 0 obj Straps and pillows may be used to help the patient maintain the correct position and to hold still during the exam. During surgery, the planned pathways are overlaid in real-time onto the endoscopic image, providing you with unique Scopis augmented reality technology. If you have a hard time staying still, are claustrophobic, or have chronic pain, you may find a CT exam to be stressful. HdAo1+rxccR{@\J](. Introduction. 0000006850 00000 n 0000123602 00000 n hb``Pa``c`a` Bl@q c?td$3V0D)))e`s@HXDh[i C?&j]`fhTt The traditional frame-based study demands a compatible head-containing stereotactic system (frame and skull screws) that should be well visualized on images and must be artifact-free. Learn more about our additional products for FESS and their potential benefits for you and your patients. Preoperative computed tomography (CT) affords radiologists the opportunity to prospectively identify anatomic variants that predispose patients to major surgical complications; however, these critical variants are not consistently evaluated or documented on preoperative imaging reports. 0000006140 00000 n However, the risk from any one scan is very small. NB: This article aims to frame a general concept of a CT protocol for the assessment of the paranasal sinuses. Image-guided sinus surgery: practical and financial experiences from a UK centre 2001-2009. CPT CODE AND GUIDELINES FOR CT SCANS SCHEDULE 203-878-2341 FAX 203-878-3429. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ University of Iowa Polyps in the sinuses; Sinus infection (sinusitis) Risks. Unlike MRI, an implanted medical device of any kind will not prevent you from having a CT scan. 0000004204 00000 n The American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) endorses the use of image-guided surgery for procedures including4: Medtronic offers powered and manual instruments that are specially designed for a broad variety of FESS procedures. ADVERTISEMENT: Supporters see fewer/no ads, from the hard palate to above the end of the frontal sinuses, bone kernel (e.g. Such speed is beneficial for all patients. endobj Avon 35 Nod Road Bloomfield 673 Cottage Grove Road Enfield 9 Cranbrook Blvd Glastonbury 31 Sycamore Street 2021 MRI Scan Exam CPT Codes* Brain / MRA Brain The technologist will be able to hear and talk to you using a speaker and microphone. Leave jewelry at home and wear loose, comfortable clothing. It may also see if there has been any change in an issue over time. If you choose to logout it will log you out from all the applications. Image-guided navigation systems used in endoscopic sinus surgery have shown a reduction in the need for revision surgeries. Strauss G, et al. 2012;126(12):1224-1230. 0000051505 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Accessed November 17, 2009. The computer workstation that processes the imaging information is in a separate control room. Total amount of contrast. /Matrix [1 0 0 -1 0 792] With CT scanning, several x-ray beams and electronic x-ray detectors rotate around you. CT of the sinuses can help plan the safest and most effective surgery. The University of Iowa does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on this web site. H\n0yC$ian@tH#@!(/k'$+WNYx+ae' 0000051863 00000 n NB: This article aims to frame a general concept of a CT protocol for the assessment of the paranasal sinuses. This will be determined by the ordering physician and/or the imaging physician. 0000014431 00000 n 0000015162 00000 n ]$"D o]\\o:w2qP?O^aAvv]{@o#F 0000014254 00000 n CT scanning protocol 3D SYSTEMS CT scanning protocol A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Yao WC, et al. The contrast material will be injected through this line. Brain (CTA) Brain (helical adult) CTA Carotid and Brain. Slope foreducational and safe navigation, and ct of the different sinuses. 348 0 obj <> endobj xref 348 55 0000000016 00000 n The patient should be positioned in the bed, head generally positioned to the right for FESS. All Rights Reserved Protocol specifics will vary depending . The StealthStation ENT is a navigation system for your most basic to your most complex cases. Illustrated by: Timothy McCulloch, MD, Copyright The University of Iowa. Web Privacy Policy | Nondiscrimination Statement. At UIHC, this is equipment is kept in a mobile storage unit that can be positioned outside the room prior to the start of the case. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ 1`,n::&a?k4zeCn7|Q6qInl|@@@@@?}6}'7n5~e&>'Sj&1 ;jo/Nv$[fo|wPt&Gspl?So.rE%?;~ > N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Air appears black. Like traditional x-rays, it produces multiple images or pictures of the inside of the body. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ 612 0 0 -792 0 792 cm (2021). 0000051976 00000 n 0000119634 00000 n For a CT scan of the sinuses, the patient is most commonly positioned lying flat on the back. 0000052173 00000 n Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Lower Lip Bump - Mucocele verus Mucus Retention Cyst, The AAO-HNS currently maintains surgical navigation systems are deemed appropriate in "select cases to assist the surgeon in clarifying complex anatomy during sinus and skull base surgery.". It is usually performed as a non-contrast study.NB: This article aims to frame an gen concept o. 5 0 obj This loss of image quality can resemble the blurring seen on a photograph taken of a moving object. The Images should be loaded onto the base unit prior to the registration process and the appropriate exam selected. Wear comfortable, loose-fitting clothing to your exam. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ It also forms a part of a polytrauma CT or might rarely be done as a CT myelogram in situations . (New protocols can be added as requested) ENT CT Protocols* CT Maxillofacial; CT Parathyroid 4D; CT Sinus; CT Surgical Sinus (Fiagon, Medtronic, Stealth, Stryker) CT Soft Tissue Neck; CT Temporal Bone and/or IAC; CTA Brain & Neck; ENT MRI Sequence* MR . Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study. <> stream 0000009630 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ A 501(c)(3) nonprofit organization, Adler/Nail and Cedars-Sinai Research for Women's Cancers P.E.T. 0000003862 00000 n 0000002736 00000 n CT is less sensitive to patient movement than MRI. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ As a separate examination, it is most often performed as a non-contrast study. A CT scan of the face produces images that also show a patient's paranasal sinus cavities. Having many x-rays or CT scans over time may increase your risk for cancer. o7uFaaL6mlH1$Y{ [) Zz_Ea\[)dZSc;/MmtK}($^E0wbj V-/6&U0AO)&UKl sZX'&V!$Z07d]&O+|^xp9&_o*s+4[[oSqmNuVKmEY~0D_l|hdI$uwC)p/h! <]/Prev 546335/XRefStm 1759>> Sinuses - Limited Indications o Anosmia, allergic sinusitis Sequences o Coronal sections without contrast Comments o Scans should be perpendicular to the hard palate. endobj 0000051427 00000 n NB: This article aims to frame a general concept of a CT protocol for the assessment of the paranasal sinuses. Stryker ENT navigation system powered by Scopis software allows the analysis and identification of sinus cells in the complex patient anatomy and planning of the natural drainage pathways through the sinus cavity. American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). However, the most recent American College of Radiology (ACR) Manual on Contrast Media reports that studies show the amount of contrast absorbed by the infant during breastfeeding is extremely low. Metal objects, including jewelry, eyeglasses, dentures, and hairpins, may affect the CT images. %PDF-1.4 Patient undergoing computed tomography (CT) scan. This is where the technologist operates the scanner and monitors your exam in direct visual contact. When you enter the CT scanner, you may see special light lines projected onto your body. Sometimes, the exam table will move during the scan. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Powered sinus surgery with a microdebrider has several benefits compared to surgery with manual instruments alone: Minimized mucosal damage 5-8. 0000052208 00000 n `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Multidetector CT reduces the amount of time that the patient needs to lie still. Some CT exams will require you to remove hearing aids and removable dental work. This unit has both electromagnetic and optical capabilities. For children, the radiologist will adjust the CT scanner technique to their size and the area of interest to reduce the radiation dose. endstream A special electronic image recording plate captures the image. The aim of FESS is to preserve mucosa while restoring drainage and ventilation of the sinuses. The surgeon should ensure the desired patient, date of study, and anatomical location are obtained. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{
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