Ethiopian Journal of Science and Sustainable Development

e-ISSN 2663-3205 Volume 10 (1), 2023

Journal Home Page: www.ejssd.astu.edu.et ASTU

Research Paper

Investigation of a Lodged Bullet inside a Human Brain using Computed Tomographic

(CT) Imaging

Wubante Mehari Wollelaw1, Getasew Admasu Wubetu2,3 , Getnet Yitayew Tessema4

1Department of Physics, College of Natural Science and Computational, Debre Markos University, Debre Markos, Ethiopia

2Department of Physics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia

3Department of Physics, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia

4Department of Radiology and Imaging, College of Medicine and Health Science, Bahir-Dar University, Bahir Dar, Ethiopia

Article Info Abstract

Article History:

Received 02 August 2022

Received in revised form

09 December 2022

Accepted 12 December

2022

We reported the location of a lodged bullet inside a human brain from the 2D and 3D images

using Computed Tomography (CT). It is based on the scanning of the hard and the soft tissues

of the brain as well as a bullet by X-ray photons on the circular 3600 CCD detectors. The

absorption on the target brain and the bullet had significant differences in the measured current

(mA) and the mapped Hounsfield Unit (HU) as a function of the number of slices. The 2D and

the reconstructed 3D images displayed the brain soft tissue, which was dark with low HU

compared to the white in the bullet part with a higher HU. The attenuation coefficients of a

bullet with Copper (Cu) and the skull of the brain with Calcium (Ca) were higher than that of

the brain soft tissues with Hydrogen (H) and Oxygen (O). A typical example is the observation

of the image at the center of the slices displayed brighter at 3071 HU. 3D structures of brain

images were generated and visualized in different viewing positions. The measured value for

a lodged bullet was 11.28 cm away from its entry (Frontal), 7.92 cm from the back, and 6.96

cm deep, down from the upper part of the brain. Based on our analysis, the bullet is located in

the left hemisphere, which is part of the hypothalamus and parity.

Keywords:

Lodged Bullet Investigation,

Computer Tomography,

Attenuation Coefficient,

Hounsfield Value,

X-ray Tomography,

CT Brain Imaging

1. Introduction
Computed Tomography (CT) scan is one of the

diagnostic tools used to diagnose a patient with a foreign

metallic body inserted in the brain. It can image cross-

sections with a series of X-ray projections taken from

different angles around the patient and captured by the

detectors (Landis and Keane et al., 2010). The new

design of CT has a revolutionary impact on clinical

practice and investigation in forensic medicine for the

observation of foreign bodies embedded in a person (De

Beer et al., 2008). CT imaging is a highly acceptable

method of investigating a lodged bullet inside the

Corresponding author, e-mail: getasew.wubetu2@mail.dcu.ie or getasew.admasu@bdu.edu.et

https://doi.org/10.20372/ejssdastu:v10.i1.2023.531

human brain (Gascho, 2021; Bolliger, 2021; Thali,

2021a). The CT has high spatial resolution and

detections at different angles for taking the capture of

different slices of 2D images and later building them up

to the reconstructed 3D images (Liu, 2022; Gascho et

al.,2020). Previous studies have shown that CT allows

accurate detection and classification of foreign metals

such as cardiac pacemakers, ferromagnetic vascular

clips, and nerve simulators (Nguyen et al., 2017). The

detection of a bullet inside the brain has been studied by

different authors such as Gascho et al., (2020). X-ray

http://www.ejssd.astu.edu/
mailto:getasew.wubetu2@mail.dcu.ie
mailto:getasew.admasu@bdu.edu.et

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

radiation can cause permanent damage to a brain during

scanning so proper dose and careful detection are

needed (Gascho, 2020b; Bolliger, 2021b and Thali,

2021b). Such detection can help to look at the hidden

part of the brain with inserted metal as the attenuations

of the metals; these attenuations of metals are different:

the hard and soft tissues of the brain (Bolliger and Thali,

2021b). It has been observed from the 2D and the

reconstructed 3D images that the attenuation coefficient

of Cu is greater than that of Ca and soft tissues (Seletchi

and Duliu, 2007).

In this work, we investigated a lodged bullet inside

the dead body of a 25-year-old man using CT imaging.

The 2D images were taken from Felege Hiwot Referral

Hospital and the reconstructed 3D images from the 2D

images by radiant viewer software. Then, the location of

the bullet in the brain was determined quantitatively and

qualitatively from the measured current values. It is

derived from the attenuation of the incident X-ray

source detection on both the hard and soft tissues of the

brain as well as the bullet in the form of the measured

current and the mapped HU.

2. Materials and Methods

2.1.Instrumentation

Figure 1 displays the Optima CT-540 scan machine at

Felege Hiwot Specialized Hospital in Bahir Dar,

Ethiopia. This machine has three main parts: an X-ray

source, detectors, and a circular sample stage. The X-ray

source was rotated through the gantry and equipped with

3600 detectors in a circular ring-like structure. Standard

imaging protocols were used to image the bullet

embedded in the brain of the dead body of a 25-year-old

man who died by a gunshot. The key input parameters

were set for the CT scan with a peak voltage of 120 kV,

current scout image of 10 mA, slice thickness of 0.625

mm, scanning time of 2s, and the helical acquisition

protocol. The data acquisitions were taken step-by-step

for measuring the 2D images at different projections.

2.2.Imaging Procedure

In the imaging process, the first thing is to keep the

patient inside the Gantry on the CT scan and lay him

down on the examination table in the appropriate

position. The X-ray beam was focused onto the brain of

the dead body of a man that follows a spiral path of

rotation to be imaged by each 3600 CCD detector in the

circular directions. The input parameters were set with

a low radiation dose to produce quality images.

Normally, there is a standard procedure for taking the

patient’s 2D images by setting the noise management

that should be pre-set to filter out unnecessary data to be

shielded and set at lower peak voltage settings to

accomplish the lowest possible dose necessary. Then,

the CT scan was set to measure the cross-sectional

images of 2D slices and further constructed the 3D

image (Gruetzemacher et al., 2018). Generally, the

technologist took the order to the patient to avoid any

movement during the scan; hence, this will be important

in taking quality images of the examination (Fahrni et

al., 2017). The CT computer program process had a

large volume of data to create two-dimensional cross-

sectional images of a patient’s head part which were

then displayed on a monitor. Then, the image processing

was completed using radiant viewer software. The scout

and slices were generated from the CT images taken.

2.3.The Physics of x-ray Computed Tomography

The X-ray radiation depends on parameters such as

intensity, attenuation, wavelength, and microstructural

parameters of the human brain (Sagsoz et al., 2010). X-ray

tomography was used to visualize the hard and soft tissues

alternatively (Said, Noor, and Yueniwati, 2014).

Appropriate software is used for better efficiency, higher

sensitivity, faster exposure, and dynamic imaging (Cong.,

et al 2011). Figure 2 shows the basic principle that governs

the interaction of the X-ray with the sample to give a 2D

image projection constructed to the 3D image. Assuming

that the X-rays are a single energetic source, the intensity

I1 of an X-ray beam of incident intensity I0 transmitted

beam through a small volume of tissue having thickness x

and attenuation coefficient µ1 (Turbell et al., 2001).can be

written based on Beer-Lambert law as:
x

eII 1
01




(1)

The scanning of the X-rays passes from one side to the

other with the Charge Coupled Device (CCD) detection

recording the attenuated coefficient for both the bullet and

the brain's soft and hard tissues. The intensity of the

attenuated X-ray source is given by (Chamard et al., 2010):





n

ii x

eII 1
0



(2)

where μi and xi are the linear attenuation coefficient of, and

path length through, the material, i.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

Figure 1: The CT machine is displayed in two separate rooms for medical imaging in Felege Hiwot

Specialized Hospital

Figure 2: Basic principle of CT imaging procedure to construct the 3D image from 2D slices.

3.Results and Discussion

The CT data are manipulated sequentially in the 2D

slices and computationally reconstructed by adding each

slice to 3D images. The radiant viewer software is a

powerful tool for manipulating the HU values for each

slice of the brain with a bullet inside. Three modes of

assessment have been used to study the embedded bullet

(Xue et al., 2012). These include imaging based on

scout images, current properties, and HU values of the

slices respectively.

3.1.Scout Images

Figure 3 illustrates the scout image of a head. The

frontal and lateral scout images show in A and C

respectively with a question mark to identify the

location of the bullet from different directions. As

mentioned earlier, the introduction part of the 2D and

reconstructed 3D imaging is helpful to extract the

measured current in mA and HU as a function of the

number of slices from the differences in the intensity (I)

the attenuation coefficients of the hard and soft brain

tissues and a bullet.

3.2.Image Slices

Figure 4 displays the multiple discrete slices

produced using the scout CT scan to define the starting

and ending locations of the head. The 255 slice

thicknesses were measured to be 0.625 mm generated

from the diagnosis of the lodged bullet inside the skull.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

Figure 3: The scout images of a head.

Figure 4: The 2D view of a slice image of the brain with different profiles.

The 2D slices correspond to the gray levels of the

images of the head due to X-ray source attenuation,

reflection, scattering, and absorption. Typically, the X-

ray attenuation primarily is a function of X-ray energy

and the density and composition of the brain tissues and

the bullet. From the measured HU and current values,

it is indicated that the gray level observed by the blue

arrows on the 2D slice image of a brain with a different

profile of CT imaging for a variation of a slice thickness

in a range of 3 to 5 mm (Osborne et al., 2016) and the

interpretation based on Michael et al., (2001). The

assignment of each pixel based on the attenuation of

water value on the scale reading is named Hounsfield

Units (HU), after Sir Godfrey Hounsfield (Osborne et

al., 2016).

The different tissues are represented by arrows as

displayed in Figure 4. Blue arrows indicate air, fat, fluid,

and soft tissue of the brain described as the red dot lines

(beam hardening artifact from the metal alloy in a

lodged bullet). Besides, the red arrows around the brain

(bone of the skull around the brain) display the bright

area indicated at the center of the slices by the green

arrow that shows the expected location of the bullet in

the brain. The CT helical slice above highlights the

common anatomical structures which may help interpret

the CT image of a shot brain. The HU value ranges of

each area indicated using different arrows are labeled in

Table 1 based on the following equation:

100
tissue

WaterH




(3)

where μwater and μtissue are the linear attenuation

coefficient of water and the linear attenuation

coefficient of tissue, respectively.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

Table 1: HU values of areas indicated by different arrows and their profiles in Figure 4

Areas indicated by arrows HU values in (HU) Remarks

Area indicated by red arrows 768 up to 1434 Skull bone

Area indicated by blue arrows -15 up to 43 Fluid and Soft tissues

Area indicated by green arrow at the center 3071 Bullet

The amount of X-rays absorbed by the brain and the

bullet was mapped as HU. The denser the tissue, the

more X-rays were attenuated, and the higher the number

of HU. Water was always set to be 0 HU, while the air

was −1000HU, and bones had values between several

hundred to thousands of HU (Bolliger et al., 2021).

Brain profiles were thus separated (air, soft tissues,

fluids, bone, and bullets). The HU mapping was in the

range of -1024 to +3071 for the CT scan. Therefore, the

maximum HU value was determined to be the bullet.

The penetration level of the bullet was determined

individually from the measured slice variation in both

brightness and darkness, as shown in Figure 5. It can be

observed that the bright image with a higher density of

the bullet has attenuation that only allows a small

amount of radiation to pass through it.

Typically, the 108th and 124th slices with a dark area

at the center of the 2D slice images have been observed

in Figure 5. However, the slices of the 109th to 123rd

images have brighter areas at the center that indicates a

lodged bullet in these slice numbers. Therefore, the scan

of the X-rays onto the metal bullet highly attenuated the

incident source due to the heavier metallic atoms Cu in

the bullet. Besides, the observation of a brain with a

higher elemental combination of water of H and O

atoms is observed as dark, there are heavy elements Ca

for the hard tissue and Cu for a bullet with brighter

figure print in the 2D slices each slice as a brighter area.

3.2.1. The current (in mA) through the slices

Figure 6 (a) displays the variation of the measured

current vs. the number of slices set in the brain. The

incident current was set at 10 mA and it produces 100 to

306 mA for each slice. It has been observed that the

maximum current was recorded in the range of 300 to

306 mA for the slice numbers ranging from 100-120. It

has been observed that such a high current for these

slices is due to the presence of a bullet in the scanned

slices that increases the conductivity of the measured

slice and in turn, increases the current in these ranges of

the measured slices. The variation of 255 slices with

constant readings of the current was assessed on the

slices between the 105th and 123rd. The brain profiles are

composed of different materials. So Cu in a bullet is a

conductor with low resistivity. So, slices that had a

bullet read the high current value. The current readings

on the other slices were controlled by a high resistance

of the brain profiles. The current readings from slices

105th up to 123rd were constant as a result of the presence

of the bullet. A maximum of 306 mA current was

measured from the 2D images of slices as the result of

the higher conductivity of Cu in a bullet However, the

currents were normal for the 2D l slices that varied from

112 mA up to 304 mA.

3.2.2. The Hounsfield value profiles of the slices

Studies prove that metal artifacts degrade the image

qualities of bullets (Makris et al., 2008). In contrast, the

results of 2D image slices measured as HU were

displayed in Figures 6 (b) as the results of the different

densities in a head such as air, water, soft tissue bone,

hard tissue, and a bullet in terms of different HU values.

Medical scanners typically work in a range of –1024 HU

to +3071 HU (Osborne et al., 2016). It is labeled as the

tissues greater than +100 HU in density appears pure

white. There are standard labels in HU, where fat (-60

HU) and air (-1000HU) respectively form the examined

patients. Therefore, in this work, the HU value reading

includes the maximum range of the medical scanner, the

same +3071 HU (pure white), where a lodged bullet is

identified. Some slice profiles were assessed as

Cerebrospinal fluid (CSF) (0 HU), Skull bone (+100

HU), fat ( -50 HU), the air outside the patient (-1000 HU),

and subdural hematoma (+60 HU) (Gigantesco and

Giuliani, 2011). We discussed the image profiles of the

slices based on the HU values by plotting the graph as

shown in Figure 6(b). This assessment included 22 slices.

The HU numbers were closely spaced at the ranges of the

soft tissue and below the level of water. Spatially, slices

from 111th up to 120th indicated the HU values around the

proposed range.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

Figure 5: Systematic illustrations of slice images of the head (from 108th up to 124th).

Figure 6 (a): The tube current vs. number of slices; (b): The HU values as a function of the number of a slice with

maxima and minima in HS.

The center of the selected slices was evaluated as 3071

HU (pure white) and slices from 111th up to 121th had

closely spaced HU readings below the level of water.

Most of the indicated areas of the slices indicate that the

profile around the location of the proposed area might be

soft tissues and fluid. It has been observed that the 3071

HU was at the center of the measured slices to the 109th

to 123rd. Now, the HU values through the brain images

were compared with previous literature and discussed

accordingly. It is believed that the CSF HU values are in

the range of 0 to 15 (Nguyen et al., 2017). The HU ranges

could vary from -1000 HU (air) up to +1000 HU (metal)

(Makris et al., 2008). The range of CT scan numbers was

at HU value of up to 2000, and each scan represents a

shade of gray with +1000 (white) and -100 (black) at

either end of the spectrum. It has been indicated by

(Gruetzemacher and Paradice, 2018), the metals' HU

values are above 1000HU. However, the image of the

bullet could read 3071 HU. CT scan 2D slices at different

levels can determine the ventricular system with a central

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

image depicting the CSF flows. It has a lateral ventricle

and CSF circulates into the subarachnoid space by exiting

through the medial and lateral apertures (Lind et al.,

2019).

3.2.3. The location of a lodged bullet

The internal structure of the brain around the

location of a lodged bullet is indicated as the lateral

cerebral vein, third ventricle, lateral ventricle, internal

cerebral veins, midbrain, cerebral aqueduct, and

thalamus. We investigated a lodged bullet at the left

side of the third ventricle. The helical slice of the brain

parts around the lodged bullet is shown in Figure 7 (a).

The 3D multiple planar reconstructions (MPR)

technique was preferred to compare 2D and 3D images

of the brain. The 3D MPR images of the brain were

displayed and appropriate positions were adjusted by

locating the x-y coordinate system at the location of the

lodged bullet on slices. In this setup, the frontal and

lateral 3D images and the selected slices were

displayed at the same time. The comparison between

2D and 3D images helped guess and investigate the

location of the lodged bullet inside the brain, as shown

in Figure 7 (b).

We compared the lateral and frontal 3D images with

2D slices to gain evidence about the location of the

bullet. The slices and the frontal 3D images indicated

as the bullet was located in the left hemisphere of the

brain. The lateral 3D image of the brain demonstrated

how much the location was deep and how far the bullet

was from the entry part at the frontal.

The lengths were 11.28cm from the frontal, 79.2cm

from the back, 6.96cm from the upper part of the brain,

and as far as possible from the area of the mouth to the

location of the lodged bullet respectively, as shown in

Figure 8 (a). The bullet is closely located on two major

parts of the brain, namely, the Hypothalamus, which is

the central part of the brain, and the Parietal, which is

part of the Cerebrum.

The use of CSF selection as a reference may serve

as an adjunct for the evaluation of surgical lesions

(Kurihara et al., 2013). The CSF refers to the space

between the dura and the pia mater (Papp et al., 2017).

This space is filled with cerebrospinal fluid, which is a

clear, very low-protein liquid similar to blood plasma

but with a different electrolyte concentration (Nguyen

et al., 2017). This system is divided into two to four

cavities that are connected by a series of holes. Two

ventricles are enclosed in the cerebral hemisphere

called lateral ventricles which could be part of the

location of the bullet. CSF volume is the nearest and

comparable to a lateral ventricle (Osborne et al., 2016).

The CT scan imaging was taken by the CCD to

image the 2D slices, which were later constructed by

the 3D images as shown in Figure 8 (b). CT scan

imaging changes the modern approach to determining

patients’ practical observation of the brain that pre-

determines to acquire 0.5 to 0.625 mm thick

tomographic images (Ro et al., 2015). In this work, we

set the slice thickness at 0.625 mm to include the

region of interest to investigate the location of the

bullet, as shown in the reconstructed 3D image shown

in Figure 8 (b).

3.3. Three-dimensional (3D) images

The 3D images of the head anatomy and the

surrounding structures can be based on the

interpretation of 2D slice summations (Osborne et al.,

2016). It is based on the generation of 2D images using

radiant viewer software. Such visualization can help to

determine the small thickness in the measured multiple

slices. It has been observed that a lodged bullet was on

the 17 slices (ranging from 108th up to 124th) from the

generated 3D image and is found to be 10.625 mm

thick. The gray and dark colors help us to determine

the HU for these measured slices. The upper gray level

is measured at 1450 HU and the lower one at -900 HU.

The darker colors range from -900 to 1450 HU.

However, the upper gray levels are in the range of 1450

to 3071 HU for the brighter part touched by a bullet.

Figure 9 shows the frontal view of the head with an

observation of the point link in the front skull and

observed a lodged bullet from the reconstruction of the

255 slices. The bullet entered the skull at the front of

the head and there was no indication of an exit wound,

so the bullet may remain inside the head. Here, the

image has WW: 287, WL: 332, L-I: 0.00, S-I: 210 HU.

This means that a total range of 287 HU is displayed,

centered on a density of 332 HU. Figure 9 (a) shows a

3D image generated from 255 slices of 2D images. The

original 3D image was rotated at 210 … towards a

vertical … with the best number of selected slices

based on their physical profiles to map the skull.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

Figure 7 (a): Illustration of helical slices of brain parts around the location of a lodged bullet; (b): Comparison

of a lodged bullet location using 2D and 3D images.

Figure 8; (a) Illustration of the location of the bullet from the 3D MPR method; (b) 3D image generated

from 17 slices.

The visualization of the internal parts of the head was

shown from the deeper upper layer to the

hypothalamus by rotating the 3D images at different

directions and angles. This 3D image of the skull

shown in Figure 9 (b) was constructed from the first

200 slices out of 255 that generate a slice thickness of

0.625mm. Our brain has complex structures and

different functions. The images are displayed with the

parameters such as WL at 287, WW at 332, LR at 00,

SI at 63.40, and Roll at 21.80. This means that a total

range of 287 HU is displayed, centered on a density of

332 HU. The 3D image was constructed from 200

slices and rotated at 70.00 towards a vertical circular

trajectory downwards to observe the location of the

lodged bullet inside the 3D image of the brain. This

image could show the location of the bullet in the

internal part of the brain, around the hypothalamic

area. To be sure about the location of the lodged bullet

in the hypothalamic part, the rotated images are shown

in Figure 10.

To further observe the reconstructed 3D images at

different angles upon the rotation of the X-rays, the

source in the Gantry is shown in Figure 9 and Figure

10. The visualization of the 3D images displayed

taking Bo as referenced is anticlockwise rotated by B1

by 700, B2 by 800, and B3 by 850 HU respectively.

The findings of this study show that the bullet has

traveled subcutaneously through the cerebrum passed

through the lateral ventricle, and rested in the

hypothalamus, near the cerebellum.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

Figure 9: Illustration of 3D CT image of skull very well demonstrating entry of the lodged bullet.

Figure 10: Systematic visualizations of the location of the bullet in different viewing positions.

4. Conclusion

The clear observation of an embedded bullet can be

easily identified by taking successive 2D slices by the

CT scan and later reconstructing it into 3D images

using radiant software. The X-ray source is scanning

both the hard and soft tissues of the brain and an

embedded bullet. The attenuation coefficients are

different for these targets. It is based on the differences

in the intensities for the measured values for the air,

water, soft and hard tissue, and a bullet during the 2D

slices images to measure the current in mA for each

slice and mapped to the HU. Typically, the HU value

of the bullet was 3071H. The current readings from the

slices were maximum on the lodged bullet due to the

high density of the bullet made of Cu and low current

flows through normal slices made of H & O (slices

without a bullet). The 3D images were rotated in

different positions to visualize the bullet inside the

brain images. Correspondingly, findings from scout

images, slices, and 3D images indicate that the bullet

entered the frontal skull, and then passed toward the

frontal cerebrum and other complex parts of the left

hemisphere of the brain. Finally, the lodged bullet is

estimated to be in the ventricular system and the

hypothalamus part of the brain image. An experienced

physician could refer to this type of study during

medical and surgical cases. Atypical gunshot wounds,

such as the case under investigation, an implications

for multiple issues including delayed diagnostic tests,

inaccurate radiological readings, and inappropriate

medication management. Ordering full head CT scans

and making quick decisions in surgical and medical

management are critical takeaways in providing

quality care to patients with these injuries.

Acknowledgment

The authors would like to thank Bahir Dar University,

Ethiopia, for providing a scholarship to the first author

to complete his MSc research in Laser Spectroscopy.

Wubante Mehari Wollelaw et al Ethiop.J.Sci.Sustain.Dev., Vol. 10 (1), 2023

We also extend our gratitude to Felege Hiwot

Specialized Hospital, Bahir Dar, Ethiopia, for providing

us with the CT data.

Conflict of Interest

On behalf of all authors, the corresponding author

declares that there is no conflict of interest in this study.

Authors’ Contributions

GAW has proposed the problem and GY has provided

the CT images. WMA and GAW have processed the CT

images to convert the physical parameters and interpret

the data. WMW has drafted the manuscript and GAW

reviewed the manuscript. All of the writers have

approved the manuscript in its current state.

Ethical Statement/Consent

The authors declare that there is no human participant in

the investigation of our paper. The experiment result

was based on the CT imaging of the body of a 25-year-

old person to look at the physics of a lodged bullet inside

the human brain. Therefore, the authors declare that the

work described has been carried out following the

Declaration of Helsinki of the World Medical

Association revised in 2013 for experiments involving

humans as well as following the EU Directive

2010/63/EU for animal experiments.

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