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Sample records for chest-wall impedance algorithms

  1. Algorithm of chest wall keloid treatment

    PubMed Central

    Long, Xiao; Zhang, Mingzi; Wang, Yang; Zhao, Ru; Wang, Youbin; Wang, Xiaojun

    2016-01-01

    Abstract Keloids are common in the Asian population. Multiple or huge keloids can appear on the chest wall because of its tendency to develop acne, sebaceous cyst, etc. It is difficult to find an ideal treatment for keloids in this area due to the limit of local soft tissues and higher recurrence rate. This study aims at establishing an individualized protocol that could be easily applied according to the size and number of chest wall keloids. A total of 445 patients received various methods (4 protocols) of treatment in our department from September 2006 to September 2012 according to the size and number of their chest wall keloids. All of the patients received adjuvant radiotherapy in our hospital. Patient and Observer Scar Assessment Scale (POSAS) was used to assess the treatment effect by both doctors and patients. With mean follow-up time of 13 months (range: 6–18 months), 362 patients participated in the assessment of POSAS with doctors. Both the doctors and the patients themselves used POSAS to evaluate the treatment effect. The recurrence rate was 0.83%. There was an obvious significant difference (P < 0.001) between the before-surgery score and the after-surgery score from both doctors and patients, indicating that both doctors and patients were satisfied with the treatment effect. Our preliminary clinical result indicates that good clinical results could be achieved by choosing the proper method in this algorithm for Chinese patients with chest wall keloids. This algorithm could play a guiding role for surgeons when dealing with chest wall keloid treatment. PMID:27583896

  2. Algorithm of chest wall keloid treatment.

    PubMed

    Long, Xiao; Zhang, Mingzi; Wang, Yang; Zhao, Ru; Wang, Youbin; Wang, Xiaojun

    2016-08-01

    Keloids are common in the Asian population. Multiple or huge keloids can appear on the chest wall because of its tendency to develop acne, sebaceous cyst, etc. It is difficult to find an ideal treatment for keloids in this area due to the limit of local soft tissues and higher recurrence rate. This study aims at establishing an individualized protocol that could be easily applied according to the size and number of chest wall keloids.A total of 445 patients received various methods (4 protocols) of treatment in our department from September 2006 to September 2012 according to the size and number of their chest wall keloids. All of the patients received adjuvant radiotherapy in our hospital. Patient and Observer Scar Assessment Scale (POSAS) was used to assess the treatment effect by both doctors and patients. With mean follow-up time of 13 months (range: 6-18 months), 362 patients participated in the assessment of POSAS with doctors.Both the doctors and the patients themselves used POSAS to evaluate the treatment effect. The recurrence rate was 0.83%. There was an obvious significant difference (P < 0.001) between the before-surgery score and the after-surgery score from both doctors and patients, indicating that both doctors and patients were satisfied with the treatment effect.Our preliminary clinical result indicates that good clinical results could be achieved by choosing the proper method in this algorithm for Chinese patients with chest wall keloids. This algorithm could play a guiding role for surgeons when dealing with chest wall keloid treatment. PMID:27583896

  3. Total and local impedances of the chest wall up to 10 Hz.

    PubMed

    Barnas, G M; Yoshino, K; Fredberg, J; Kikuchi, Y; Loring, S H; Mead, J

    1990-04-01

    To understand how bical mechanical chest wall (CW) properties are related to those of the CW as a whole, we measured esophageal and gastric pressures, CW volume changes (measured with a head-out body plethysmograph), and anteroposterior and transverse CW diameter changes (measured with magnetometers attached to the surface) during sinusoidal forcing at the mouth (2.5% vital capacity, 0.5-10 Hz) in four healthy subjects. Total CW resistance decreased sharply as frequency rose to 3-4 Hz and remained relatively constant at higher frequencies. Total CW reactance became less negative with increasing frequency but showed no tendency to change sign. Above 2 Hz, diameters measured at different locations changed asynchronously between and within the rib cage and abdomen. "Local pathway impedances" (ratios of esophageal or gastric pressure to a rate of diameter change) showed frequency dependence similar to that of the total CW less than 3 Hz. Local pathway impedances increased during contraction of respiratory muscles acting on the pathway. We conclude that 1) total CW behavior is mainly a reflection of its individual local properties at less than or equal to 3 Hz, 2) local impedances within the rib cage or within the abdomen can change independently in some situations, and 3) asynchronies that develop within the CW during forcing greater than 3 Hz suggest that two compartments may be insufficient to describe CW properties from impedance measurements. PMID:2140827

  4. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

  5. [Chest wall reconstruction after resection of malignant chest wall tumors].

    PubMed

    Ayabe, H; Oka, T; Akamine, S; Takahashi, T; Nagayasu, T

    1998-05-01

    Full-thickness chest wall resection is performed for complete removal of primary and secondary malignant chest wall tumors. Large defects of the chest wall after resection must be repaired to maintain adequate ventilation, to protect important intrathoracic structures, and to preserve cosmetic integrity. Various materials have been utilized over the years to replace the rigid chest wall. At present, Marlex mesh and a composite of Marlex mesh and methylmethacrylate are frequently used to reconstruct rigid chest wall defects. On the other hand, to replace the soft part of the chest wall and cover the rigid materials, pedicled muscle flaps, myocutaneous flaps, or omentum are used. Major pedicled flaps include the pectoralis major, rectus abdominis and latissimus dorsi muscular, and musculocutaneous flaps. Techniques are now available to repair any chest wall site, and to restore chest continuity in patients whose tumors are curatively resected. PMID:9656244

  6. Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?

    PubMed

    Kaplan, Tevfik; Gunal, Nesimi; Gulbahar, Gultekin; Kocer, Bulent; Han, Serdar; Eryazgan, Mehmet Ali; Ozsoy, Arzu; Naldoken, Seniha; Alhan, Aslıhan; Sakinci, Unal

    2016-04-01

    Background Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. Methods This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 ± 3.2 years) of TS. Results In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 ± 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). Conclusion Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered. PMID:25742551

  7. Chest wall resection for extrapulmonary tumor.

    PubMed

    Long, W P; Kline, R; Levine, E A

    1997-09-01

    Despite progress in early detection of breast cancer, a minority of women continue to present with extensive disease which may necessitate chest wall resection. Between 1992 and 1996, 14 patients were treated by surgical resection of the chest wall and reconstruction by the LSU Sections of Surgical Oncology and Plastic Surgery. Indications included resection of primary tumor, resection of recurrent tumor, and resection of radiation therapy induced damage to the chest wall. We report chest wall excision and reconstruction with no operative mortality and minor surgical morbidity in 21% of cases. Local control was achieved in 13 of 14 cases. Additionally we report uniform success in the palliation of ulcerating, painful, or infected chest wall lesions. Approximately 25% of patients treated for breast cancer and followed up for more than 6 months have remained free of disease. Chest wall resection is a useful modality in selected patients with extensive disease. PMID:9316348

  8. Classification of chest wall diseases.

    PubMed

    Pozzi, E; Gulotta, C

    1993-01-01

    Several disorders of the thoracic cage are known to cause respiratory failure, by means of relatively simple mechanisms, such as the increased work of breathing, which results in alveolar hypoventilation. A variety of pathogenic mechanisms may be considered, as functions of the types of thoracic disorders present. As causes of these additional potential mechanisms, we considered the following: 1) ventilation-perfusion (V/Q) inhomogeneity; 2) inability to cough; 3) malformation or acquired defect of the respiratory centres; and 4) excess blood volume and fluid retention, which aggravate work of breathing and V/Q inhomogeneity. All of these disorders can be grouped into two major categories (which nevertheless have some of the pathophysiology in common): the mechanical syndrome and the neuromuscular or paralytic syndrome. In this paper we discuss chest wall diseases falling into the first category; namely, kyphoscoliosis, fibrothorax, thoracoplasty, ankylosing spondylitis and obesity-hypoventilation. Congenital deformities of the thoracic cage, which do not have important effects on ventilatory apparatus (e.g. pectus excavatum and pectus carinatum), were also considered. PMID:8472068

  9. Intercostal hemangioma of the chest wall

    PubMed Central

    Hamzík, Julian

    2016-01-01

    The authors describe a case of a 36-year-old patient who had six months’ pain of the thoracic spine and left chest. A soft slowly growing resistance was present on the dorso-lateral side of the left chest wall, in the range of the seventh to ninth rib. According to the medical history, the patient did not have any prior trauma and malignancy. A well-defined tumor of the left chest wall with calcifications, which grew to the seventh and eighth intercostal space, was present on computed tomography (CT) and magnetic resonance (MR) scans. The patient underwent resection of the tumor with the chest wall and reconstruction with polypropylene mesh. Histologically, it was a venous hemangioma, one of very rare tumors of the chest wall. PMID:27212983

  10. Chest wall reconstruction after resection using hernia repair piece

    PubMed Central

    Wu, Yimin; Zhang, Guofei; Zhu, Zhouyu

    2016-01-01

    Reconstruction of chest wall tumor is very important link of chest wall tumor resection. Many implants have been reported to be used to reconstruct the chest wall, such as steelwire, titanium mesh and polypropylene mesh. It is really hard for clinicians to decide which implant is the best one to replace the chest wall. We herein report a 68-year-old man who had underwent a chest wall reconstruction with a hernia repair piece and a Dacron hernia repair piece. The patient has maintained an excellent cosmetic and functional outcome since surgery, which proves that the hernia piece still has its place in reconstruction of chest wall. PMID:27293859

  11. Effect of gravity on chest wall mechanics.

    PubMed

    Bettinelli, D; Kays, C; Bailliart, O; Capderou, A; Techoueyres, P; Lachaud, J L; Vaïda, P; Miserocchi, G

    2002-02-01

    Chest wall mechanics was studied in four subjects on changing gravity in the craniocaudal direction (G(z)) during parabolic flights. The thorax appears very compliant at 0 G(z): its recoil changes only from -2 to 2 cmH(2)O in the volume range of 30-70% vital capacity (VC). Increasing G(z) from 0 to 1 and 1.8 G(z) progressively shifted the volume-pressure curve of the chest wall to the left and also caused a fivefold exponential decrease in compliance. For lung volume <30% VC, gravity has an inspiratory effect, but this effect is much larger going from 0 to 1 G(z) than from 1 to 1.8 G(z). For a volume from 30 to 70% VC, the effect is inspiratory going from 0 to 1 G(z) but expiratory from 1 to 1.8 G(z). For a volume greater than approximately 70% VC, gravity always has an expiratory effect. The data suggest that the chest wall does not behave as a linear system when exposed to changing gravity, as the effect depends on both chest wall volume and magnitude of G(z). PMID:11796685

  12. Salmonella typhimurium abscess of the chest wall

    PubMed Central

    Tonziello, Gilda; Valentinotti, Romina; Arbore, Enrico; Cassetti, Paolo; Luzzati, Roberto

    2013-01-01

    Patient: Male, 73 Final Diagnosis: Salmonella typhimurium abscess of the chest wall Symptoms: — Medication: Ciprofloxacin Clinical Procedure:— Specialty: Infectious Diseases Objective: Unusual clinical course Background: Non-typhoid Salmonella extra-intestinal infections usually develop in infants and in adult patients with pre-existing predisposing conditions. Blood stream infections and urinary tract infections are the most common clinical presentations, but other sites of infection may be involved as well. Case Report: We describe a case of invasive salmonellosis caused by Salmonella typhimurium involving the chest wall in a 73-year-old man. The patient had suffered from gastroenteritis followed by left basal pneumonia with pleural effusion 7 weeks before. The CT scan of the chest wall showed a pericostal abscess with shirt-stud morphology near the left last cartilaginous arch. The abscess was surgically drained and patient was cured after a 40-day ciprofloxacin treatment. Conclusions: A review of the literature on extra-intestinal non-typhoid salmonellosis shows that pleuropulmonary and soft-tissue infections are uncommon. We argue that non-typhoid Salmonella might be considered as a possible cause of chest wall abscess in individuals with recent history of gastroenteritis complicated by pneumonia and pleural effusion. PMID:24298305

  13. Uncommon Flaps for Chest Wall Reconstruction

    PubMed Central

    Matros, Evan; Disa, Joseph J.

    2011-01-01

    The omentum, external oblique musculocutaneous, and thoracoepigastric flaps are uncommonly used for chest wall reconstruction. Nevertheless, awareness and knowledge of these flaps is essential for reconstructive surgeons because they fill specific niche indications or serve as lifeboats when workhorse flaps are unavailable. The current report describes the anatomic basis, technical aspects of flap elevation, and indications for these unusual flaps. PMID:22294943

  14. [Chest Wall Reconstruction Using Titanium Plates Sandwiched Between Sheets after Resection of Chest Wall Chondrosarcoma].

    PubMed

    Endoh, Makoto; Oizumi, Hiroyuki; Kato, Hirohisa; Suzuki, Jun; Watarai, Hikaru; Hamada, Akira; Suzuki, Katsuyuki; Takahashi, Ai; Nakahashi, Kenta; Sugawara, Masato; Tsuchiya, Takashi; Sadahiro, Mitsuaki

    2016-07-01

    Extensive chest wall resection carries the risk of difficult reconstruction and surgical complications. We report our experience on chest wall reconstruction using titanium plates for a wide thoracic defect after tumor resection. A 74-year-old man was diagnosed with chondrosarcoma of the 6th rib on the right. He needed extensive chest wall resection because of skip lesions on 4th rib noted on operative inspection, leaving a defect measuring 33 × 20 cm. Reconstruction using 5 transverse titanium plates sandwiched between an expanded polytetrafluoroethylene patch and a polypropylene mesh sheet stabilized the chest wall. This reconstruction allowed successful separation from ventilatory support after operation. The postoperative course was uneventful, and he was discharged on postoperative day 20. The advantages of this form of reconstruction over conventional prostheses are rigidity, and stability and usability. PMID:27365062

  15. Normalized mean shapes and reference index values for computerized quantitative assessment indices of chest wall deformities

    NASA Astrophysics Data System (ADS)

    Kim, Ho Chul; Park, Man Sik; Lee, Seong Keon; Nam, Ki Chang; Park, Hyung Joo; Kim, Min Gi; Song, Jae-Jun; Choi, Hyuk

    2015-11-01

    We previously proposed a computerized index (eccentricity index [EI]) for chest-wall deformity measurements, such as pectus excavatum. We sought to define mean shapes based on normal chest walls and to propose for computerized index reference values of that are used in the quantitative analysis of the severity of chest-wall deformities. A total of 584 patients were classified into 18 groups, and a database of their chest-wall computed tomography (CT) scan images was constructed. The boundaries of the chest wall were extracted by using a segmentation algorithm, and the mean shapes were subsequently developed. The reference index values were calculated from the developed mean shapes. Reference index values for the EI were compared with a conventional index, the Haller index (HI). A close association has been shown between the two indices in multiple subjects (r = 0.974, P < 0.001). The newly developed mean shapes and reference index values supply both reliability and objectivity to the diagnosis, analysis, and treatment of chest-wall deformities. They promise to be highly useful in clinical settings.

  16. [Chest wall tuberculosis: report of 3 cases].

    PubMed

    Zidane, A; Bakzaza, O; Afandi, O; Baiz, Y; Chafik, A

    2015-10-01

    Despite the dramatic decline in the incidence of tuberculosis during the last decades, the disease remains a significant public health problem especially in developing countries. Chest wall tuberculosis is a very rare location. Clinically, it can present as a pyogenic abscess or soft tumor, making diagnosis difficult, particularly in the absence of warning signs. Optimal therapeutic management is controversial. Medical treatment alone in often insufficient and must be associated with a surgical excision or debridement. PMID:25725600

  17. Reconstruction of full thickness chest wall defects.

    PubMed

    Morgan, R F; Edgerton, M T; Wanebo, H J; Daniel, T M; Spotnitz, W D; Kron, I L

    1988-06-01

    Over the last 5 years, 14 patients were treated by wide en bloc resection of chest wall tumors with primary reconstruction. There were nine females and five male patients with an age range of 31-77 years. All patients had a skeletal resection of the chest wall. An average of 3.9 ribs were resected in the patients treated. In three patients a partial sternectomy was carried out in conjunction with the rib resections. Chest wall skeletal defects were reconstructed with Prolene mesh, which was placed under tension. Soft tissue reconstruction utilized selected portions of the latissimus dorsi musculocutaneous territory with fasciocutaneous extensions beyond the muscle itself. Primary healing was obtained in all patients and secondary procedures were not required. The average hospitalization was 23 days. All patients survived the resection and reconstruction and were alive 30 days after operation. In selected patients the preservation of a portion of the innervated muscle in situ or the transfer of the muscle with the preservation of its resting length has maintained the majority of the muscle function. PMID:3389939

  18. Reconstruction of full thickness chest wall defects.

    PubMed Central

    Morgan, R F; Edgerton, M T; Wanebo, H J; Daniel, T M; Spotnitz, W D; Kron, I L

    1988-01-01

    Over the last 5 years, 14 patients were treated by wide en bloc resection of chest wall tumors with primary reconstruction. There were nine females and five male patients with an age range of 31-77 years. All patients had a skeletal resection of the chest wall. An average of 3.9 ribs were resected in the patients treated. In three patients a partial sternectomy was carried out in conjunction with the rib resections. Chest wall skeletal defects were reconstructed with Prolene mesh, which was placed under tension. Soft tissue reconstruction utilized selected portions of the latissimus dorsi musculocutaneous territory with fasciocutaneous extensions beyond the muscle itself. Primary healing was obtained in all patients and secondary procedures were not required. The average hospitalization was 23 days. All patients survived the resection and reconstruction and were alive 30 days after operation. In selected patients the preservation of a portion of the innervated muscle in situ or the transfer of the muscle with the preservation of its resting length has maintained the majority of the muscle function. Images Fig. 3A. Fig. 3C. Fig. 3D. Fig. 4A. Fig. 4C. Fig. 4D. Fig. 4E. Fig. 5A. Fig. 5B. Fig. 5D. Fig. 6A. Fig. 6C. Fig. 6D. Fig. 6E. Fig. 6F. Fig. 6G. Fig. 6H. PMID:3389939

  19. Solitary fibrous tumour of the chest wall.

    PubMed

    Mohtarrudin, N; Nor Hanipah, Z; Mohd Dusa, N

    2016-04-01

    Extrapleural solitary fibrous tumours (SFTs) are rare tumours characterized by patternless spindle cells with haemangiopericytoma-like vascular spaces. Previously the tumours have been classified as haemangiopericytoma, an entity that is now considered obsolete. We report a case of extrapleural SFT arising in the soft tissue of the chest wall. The patient was a 31-year-old Malay lady presenting with a mobile swelling of the right chest wall for more than five years. During excision the tumour was noted to be well-circumscribed and yellowish in colour, giving an impression of lipoma. Microscopically, the tumour had patternless architecture, characterized by hypocellular and hypercellular areas. It was composed of uniform, spindle-shaped cells displaying oval nuclei, inconspicuous nucleoli, pale cytoplasm and indistinct cell borders. The mitotic count was 2 per 10 HPF. Branching, medium-sized thin-walled blood vessels in a haemangiopericytomatous growth pattern, some with hyalinised wall were identified. The neoplastic cells were immunoreactive to CD99 and CD34 and were non-immunoreactive to Desmin, Smooth Muscle Actin, S100 protein and EMA. We elucidate the challenges in diagnosing this tumour in this unusual location. PMID:27126667

  20. [Functional Outcome after Chest Wall Stabilisation].

    PubMed

    Kyriss, T; Lenz, U; Friedel, G

    2016-09-01

    This overview reviews the current literature to compare the functional results after surgical and conservative treatment of patients with flail chest and multiple rib fractures. Regarding functional aspects, patients in the early phase after a thoracic trauma are those that benefit most from the stabilisation of the chest wall by internal fixation of the ribs. Patients recover faster from restrictive respiratory disorders, have less pain and return to the workplace earlier after an operation compared with those that receive conservative treatment. In the medium term, however, patients that are treated conservatively also achieve normal pulmonary function values and become free of pain. The period of convalescence after blunt thoracic trauma is generally underestimated. Future studies of the functional outcome after severe chest injuries should take this into account and the development of functional parameters should be monitored for at least 24 months. A prospective data collection of early and long-term surgical results in registries would be suitable to evaluate benefits and indications of chest wall stabilisation. PMID:27607891

  1. Chest wall tumour following iodized talc pleurodesis

    PubMed Central

    Jackson, John W.; Bennett, M. H.

    1973-01-01

    Jackson, J. W., and Bennett, M. H. (1973).Thorax, 28, 788-793. Chest wall tumour following iodized talc pleurodesis. A man of 37 had an iodized talc pleurodesis carried out for recurrent spontaneous pneumothorax. There was no history of industrial exposure to asbestos. Two years later he presented with pain in the right chest and radiographs at that time showed some localized pleural thickening at the site of the thoracoscopy cannulation for introduction of talc. A provisional diagnosis of talc granuloma, chemical abscess or tumour was made and exploratory thoracotomy revealed a tumour involving the chest wall, lung, and pleura which, on histological examination, showed adenocarcinoma of varying degrees of differentiation and in some parts also presenting a more squamoid appearance. Numerous doubly refractile talc particles were intimately associated with the tumour and fibrous tissue. Shortly after excision the patient developed evidence of systemic dissemination of the disease and died four months later. The possibility of this tumour being induced by the talc is discussed. A brief review is made of the various forms of talc used in surgery over the past 40 years and attention is drawn to the significance of the proportion of asbestos mineral which is present in talc as mined in various parts of the world. We do not consider that this is a case of mesothelioma of the pleura. Images PMID:4787992

  2. Results of chest wall resection and reconstruction in 162 patients with benign and malignant chest wall disease

    PubMed Central

    Aghajanzadeh, Manoucheher; Alavy, Ali; Taskindost, Mehrdad; Pourrasouly, Zahra; Aghajanzadeh, Gilda; massahnia, Sara

    2010-01-01

    Background Chest wall resection is a complicated treatment modality with significant morbidity. The purpose of this study is to report our experience with chest wall resections and reconstructions. Methods The records of all patients undergoing chest wall resection and reconstruction were reviewed. Diagnostic procedures, surgical indications, the location and size of the chest wall defect, performance of lung resection, the type of prosthesis, and postoperative complications were recorded. Results From 1997 to 2008, 162 patients underwent chest wall resection.113 (70%) of patients were male. Age of patients was 14 to 69 years. The most common indications for surgery were primary chest wall tumors. The most common localized chest wall mass has been seen in the anterior chest wall. Sternal resection was required in 22 patients, Lung resection in 15 patients, Rigid prosthetic reconstruction has been used in 20 patients and nonrigid prolene mesh and Marlex mesh in 40 patients. Mean intensive care unit stay was 8 days. In-hospital mortality was 3.7 % (six patients). Conclusions Chest wall resection and reconstruction with Bone cement sandwich with mesh can be performed as a safe and effective surgical procedure for major chest wall defects and respiratory failure is lower in prosthetic reconstruction patients than previously reported (6). PMID:22263024

  3. Mechanical properties of lungs and chest wall during spontaneous breathing.

    PubMed

    Nagels, J; Làndsér, F J; van der Linden, L; Clément, J; Van de Woestijne, K P

    1980-09-01

    Using a forced oscillation technique, we measured the resistance (Rrs) and reactance (Xrs) of the respiratory system between 2 and 32 Hz at three different lung volumes in 15 healthy subjects and 7 patients with chronic obstructive pulmonary disease. Rrs and Xrs were partitioned, by means of a pressure recording in the esophagus, into the resistance and reactance of lung and airways (L) and the chest wall. The measurements were validated by checking the adequacy of the frequency response of the esophagus, by the lack of difference between thoracic and mouth flow, by an estimation of the error introduced by the shunt impedance of the cheeks, and by comparisons with the values of pulmonary compliance and resistance determined in the same subjects with classical techniques. In both healthy subjects and patients, the chest wall has a low resistance that increases somewhat at low lung volumes and behaves functionally as a two-compartment system, with low capacitance at frequencies exceeding 4 Hz. Rrs varies with lung volume and is markedly frequency dependent in patients; both phenomena are due primarily to corresponding variations of RL. In healthy subjects, at and above functional residual capacity (FRC) level, the lungs behave as a one-compartment system, the reactance of which is mainly determined by the gaseous inertance, at least beyond 2 Hz. In patients and in healthy subjects breathing below FRC, the observed frequency dependence of resistance and the simultaneous increase in resonant frequency can be simulated satisfactorily by Mead's two-compartment model, assuming a large increase in peripheral airways resistance. PMID:7204163

  4. [NECROTIZING FASCIITIS OF THE CHEST WALL].

    PubMed

    Farah, Raymond; Asla, Husam

    2016-04-01

    Necrotizing fasciitis (NF) is a bacterial dermo-hypodermitis affecting the soft tissue and muscular fascia. It is an uncommon and severe infection caused by microorganisms called 'flesh eating bacteria', mainly represented by group A beta-haemolytic streptococcus. NF remains a life-threatening condition associated with a high mortality rate. Its location on the chest wall is extremely rare. The few reported cases are subsequent to thoracic drainage, lung surgery or esophageal resection. This is a case report of an 80-year old female with comorbidity of heart disease, a past history of coronary artery by-pass and diabetes. She was admitted to the emergency room with acute NF of the chest and shortly after diagnosis, the patient died. Due to the fast decline observed in this disease, we would like to emphasize the importance of early recognition and diagnosis. PMID:27323534

  5. [Dedifferentiated Chondrosarcoma of the Chest Wall].

    PubMed

    Saitoh, Genkichi; Yoneshima, Yasuto; Nakamura, Toshihiko; Kitagawa, Dai; Kinjo, Nao; Ohgaki, Kippei; Maehara, Shinichiro; Teramoto, Seiichi; Adachi, Eisuke; Ikeda, Yoichi; Mine, Mari

    2016-08-01

    A 79-year-old man complaining of an anterior chest mass with pain had an abnormal shadow on chest X-ray. A mass, 7 cm in size, with destruction of the right 4th rib was found on chest computed tomography. A F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) corresponding to the lesion showed an abnormal accumulation of FDG with the standardized uptake value(SUV) max=16.19. A malignant tumor of the chest wall origin was suspected and the tumor was resected with the 3th, 4th, and 5th ribs. Histologically, the tumor was diagnosed as dedifferentiated chondrosarcoma. He died of local recurrence about 5 months after the operation. PMID:27476566

  6. Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant Chest Wall Tumors

    PubMed Central

    Malahias, Marco N.; Balasubramanian, Balapathiran; Djearaman, Madava G.; Naidu, Babu; Grainger, Melvin F.; Kalkat, Maninder

    2016-01-01

    Background: Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes. Methods: Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009–2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning. Results: Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm2 (mean, 154 cm2). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%). Conclusions: Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction. PMID:27536488

  7. An optical tomography method that accounts for a titled chest-wall in breast imaging

    NASA Astrophysics Data System (ADS)

    Ardeshirpour, Yasaman; Huang, Minming; Zhu, Quing

    2009-02-01

    The chest-wall underneath the breast tissue distorts the diffused near infra-red light measured at distant source-detector pairs. Common image reconstruction method consider the media as homogeneous and applying the semi-infinite model. In this paper, we have compared the performance of our two-layer model with semi-infinite model by simulation and a clinical case. The results show that when the chest wall has significant effect on the measurement data, a benign lesion with low absorption can be misled as a malignant case with high absorption by using semi-infinite model. We have also shown the influence of mismatch geometry of breast tissue and chest-wall at lesion and reference sides on the reconstructed image and a correction method has been introduced to reduce these effects. With the assistance of two orthogonal co-registered ultrasounds, the geometry of the breast tissue and chest wall interface can be determined and modeled as a two-layer medium with 3D finite element mesh. Since numerical algorithms based on finite element methods (FEM) are suitable for complex geometry and boundary conditions, this method is adapted to model the chestwall. Four parameters of bulk absorption and reduced scattering coefficients of the first and second layers are estimated and used to characterize the optical properties of the medium. We used a finite element model based on modified born approximation for image reconstruction. A mismatch correction algorithm has been applied to compensate the mismatch geometry of the breast tissue and chest-wall interface at the reference and the lesion side.

  8. Chest wall mechanics in sustained microgravity.

    PubMed

    Wantier, M; Estenne, M; Verbanck, S; Prisk, G K; Paiva, M

    1998-06-01

    We assessed the effects of sustained weightlessness on chest wall mechanics in five astronauts who were studied before, during, and after the 10-day Spacelab D-2 mission (n = 3) and the 180-day Euromir-95 mission (n = 2). We measured flow and pressure at the mouth and rib cage and abdominal volumes during resting breathing and during a relaxation maneuver from midinspiratory capacity to functional residual capacity. Microgravity produced marked and consistent changes (Delta) in the contribution of the abdomen to tidal volume [DeltaVab/(DeltaVab + DeltaVrc), where Vab is abdominal volume and Vrc is rib cage volume], which increased from 30.7 +/- 3. 5 (SE)% at 1 G head-to-foot acceleration to 58.3 +/- 5.7% at 0 G head-to-foot acceleration (P < 0.005). Values of DeltaVab/(DeltaVab + DeltaVrc) did not change significantly during the 180 days of the Euromir mission, but in the two subjects DeltaVab/(DeltaVab + DeltaVrc) was greater on postflight day 1 than on subsequent postflight days or preflight. In the two subjects who produced satisfactory relaxation maneuvers, the slope of the Konno-Mead plot decreased in microgravity; this decrease was entirely accounted for by an increase in abdominal compliance because rib cage compliance did not change. These alterations are similar to those previously reported during short periods of weightlessness inside aircrafts flying parabolic trajectories. They are also qualitatively similar to those observed on going from upright to supine posture; however, in contrast to microgravity, such postural change reduces rib cage compliance. PMID:9609801

  9. Lung and chest wall mechanics in microgravity.

    PubMed

    Edyvean, J; Estenne, M; Paiva, M; Engel, L A

    1991-11-01

    We studied the effect of 15-20 s of weightlessness on lung, chest wall, and abdominal mechanics in five normal subjects inside an aircraft flying repeated parabolic trajectories. We measured flow at the mouth, thoracoabdominal and compartmental volume changes, and gastric pressure (Pga). In two subjects, esophageal pressures were measured as well, allowing for estimates of transdiaphragmatic pressure (Pdi). In all subjects functional residual capacity at 0 Gz decreased by 244 +/- 31 ml as a result of the inward displacement of the abdomen. End-expiratory Pga decreased from 6.8 +/- 0.8 cmH2O at 1 Gz to 2.5 +/- 0.3 cmH2O at Gz (P less than 0.005). Abdominal contribution to tidal volume increased from 0.33 +/- 0.05 to 0.51 +/- 0.04 at 0 Gz (P less than 0.001) but delta Pga showed no consistent change. Hence abdominal compliance increased from 43 +/- 9 to 70 +/- 10 ml/cmH2O (P less than 0.05). There was no consistent effect of Gz on tidal swings of Pdi, on pulmonary resistance and dynamic compliance, or on any of the timing parameters determining the temporal pattern of breathing. The results indicate that at 0 G respiratory mechanics are intermediate between those in the upright and supine postures at 1 G. In addition, analysis of end-expiratory pressures suggests that during weightlessness intra-abdominal pressure is zero, the diaphragm is passively tensed, and a residual small pleural pressure gradient may be present. PMID:1761497

  10. Chest wall mechanics in sustained microgravity

    NASA Technical Reports Server (NTRS)

    Wantier, M.; Estenne, M.; Verbanck, S.; Prisk, G. K.; Paiva, M.; West, J. B. (Principal Investigator)

    1998-01-01

    We assessed the effects of sustained weightlessness on chest wall mechanics in five astronauts who were studied before, during, and after the 10-day Spacelab D-2 mission (n = 3) and the 180-day Euromir-95 mission (n = 2). We measured flow and pressure at the mouth and rib cage and abdominal volumes during resting breathing and during a relaxation maneuver from midinspiratory capacity to functional residual capacity. Microgravity produced marked and consistent changes (Delta) in the contribution of the abdomen to tidal volume [DeltaVab/(DeltaVab + DeltaVrc), where Vab is abdominal volume and Vrc is rib cage volume], which increased from 30.7 +/- 3. 5 (SE)% at 1 G head-to-foot acceleration to 58.3 +/- 5.7% at 0 G head-to-foot acceleration (P < 0.005). Values of DeltaVab/(DeltaVab + DeltaVrc) did not change significantly during the 180 days of the Euromir mission, but in the two subjects DeltaVab/(DeltaVab + DeltaVrc) was greater on postflight day 1 than on subsequent postflight days or preflight. In the two subjects who produced satisfactory relaxation maneuvers, the slope of the Konno-Mead plot decreased in microgravity; this decrease was entirely accounted for by an increase in abdominal compliance because rib cage compliance did not change. These alterations are similar to those previously reported during short periods of weightlessness inside aircrafts flying parabolic trajectories. They are also qualitatively similar to those observed on going from upright to supine posture; however, in contrast to microgravity, such postural change reduces rib cage compliance.

  11. Chest Wall Dissemination of Nocardiosis after Percutaneous Transthoracic Needle Biopsy

    SciTech Connect

    Shimamoto, Hiroshi Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kamiya, Mika; Miyazaki, Masaya; Arai, Yasuaki; Horio, Yoshitsugu

    2007-07-15

    We described a case of chest wall dissemination after percutaneous transthoracic needle biopsy. A 65-year-old man had a lung nodule which was suspected to be lung carcinoma. He underwent percutaneous transthoracic needle biopsy using an 18G semiautomated biopsy needle and pathologic diagnosis showed organizing pneumonia. Two months after the biopsy, chest wall dissemination occurred. Implantation of carcinoma along the biopsy route was suspected, but the mass was actually due to pulmonary nocardiosis.

  12. Chest wall segmentation in automated 3D breast ultrasound scans.

    PubMed

    Tan, Tao; Platel, Bram; Mann, Ritse M; Huisman, Henkjan; Karssemeijer, Nico

    2013-12-01

    In this paper, we present an automatic method to segment the chest wall in automated 3D breast ultrasound images. Determining the location of the chest wall in automated 3D breast ultrasound images is necessary in computer-aided detection systems to remove automatically detected cancer candidates beyond the chest wall and it can be of great help for inter- and intra-modal image registration. We show that the visible part of the chest wall in an automated 3D breast ultrasound image can be accurately modeled by a cylinder. We fit the surface of our cylinder model to a set of automatically detected rib-surface points. The detection of the rib-surface points is done by a classifier using features representing local image intensity patterns and presence of rib shadows. Due to attenuation of the ultrasound signal, a clear shadow is visible behind the ribs. Evaluation of our segmentation method is done by computing the distance of manually annotated rib points to the surface of the automatically detected chest wall. We examined the performance on images obtained with the two most common 3D breast ultrasound devices in the market. In a dataset of 142 images, the average mean distance of the annotated points to the segmented chest wall was 5.59 ± 3.08 mm. PMID:23273891

  13. Measurement of chest wall displacement based on terahertz wave

    NASA Astrophysics Data System (ADS)

    Li, Hui; Lv, Hao; Jiao, Teng; Lu, Guohua; Li, Sheng; Li, Zhao; Liu, Miao; Jing, Xijing; Wang, Jianqi

    2015-02-01

    Measurement of chest wall displacement is an important approach for measuring mechanics of chest wall, which has considerable significance for assessing respiratory system and diagnosing pulmonary diseases. However, existing optical methods for measuring chest wall displacement are inconvenient for some specific patients such as the female patients and the patients with bandaged chest. In this letter, we proposed a method for measuring chest wall displacement based on terahertz wave and established corresponding mathematic model and set up a terahertz measurement system. The main advantages of this method are that it can measure the chest wall displacement of the subjects without taking off clothes or arranging any markers. To validate this method and assess the performance of the terahertz system, in vitro, the displacement of a water module driven by a linear guide rail was measured by the terahertz system and compared with the actual displacement of the water module. The results showed that the waveforms measured with two methods have a good agreement, and the relative error is less than 5% and sufficiently good for measurement demands. In vivo, the synchronous experiment was performed on five human volunteers with the terahertz system and a respiratory belt transducer. The results demonstrate that this method has good performance and promising prospects for measuring chest wall displacement.

  14. Massive chest wall resection and reconstruction for malignant disease

    PubMed Central

    Foroulis, Christophoros N; Kleontas, Athanassios D; Tagarakis, George; Nana, Chryssoula; Alexiou, Ioannis; Grosomanidis, Vasilis; Tossios, Paschalis; Papadaki, Elena; Kioumis, Ioannis; Baka, Sofia; Zarogoulidis, Paul; Anastasiadis, Kyriakos

    2016-01-01

    Objective Malignant chest wall tumors are rare neoplasms. Resection with wide-free margins is an important prognostic factor, and massive chest wall resection and reconstruction are often necessary. A recent case series of 20 consecutive patients is reported in order to find any possible correlation between tumor histology, extent of resection, type of reconstruction, and adjuvant treatment with short- and long-term outcomes. Methods Twenty patients were submitted to chest wall resection and reconstruction for malignant chest wall neoplasms between 2006 and 2014. The mean age (ten males) was 59±4 years. The size and histology of the tumor, the technique of reconstruction, and the short- and long-term follow-up records were noted. Results The median maximum diameter of tumors was 10 cm (5.4–32 cm). Subtotal sternal resection was performed in nine cases, and the resection of multiple ribs was performed in eleven cases. The median area of chest wall defect was 108 cm2 (60–340 cm2). Histology revealed soft tissue, bone, and cartilage sarcomas in 16 cases (80%), most of them chondrosarcomas. The rest of the tumors was metastatic tumors in two cases and localized malignant pleural mesothelioma and non-Hodgkin lymphoma in one case. The chest wall defect was reconstructed by using the “sandwich technique” (propylene mesh/methyl methacrylate/propylene mesh) in nine cases of large anterior defects or by using a 2 mm polytetrafluoroethylene (e-PTFE) mesh in nine cases of lateral or posterior defects. Support from a plastic surgeon was necessary to cover the full-thickness chest wall defects in seven cases. Adjuvant oncologic treatment was administered in 13 patients. Local recurrences were observed in five cases where surgical reintervention was finally necessary in two cases. Recurrences were associated with larger tumors, histology of malignant fibrous histiocytoma, and initial incomplete resection or misdiagnosis made by nonthoracic surgeons. Three patients died

  15. Effect of the chest wall on breast lesion reconstruction

    NASA Astrophysics Data System (ADS)

    Ardeshirpour, Yasaman; Huang, Minming; Zhu, Quing

    2009-07-01

    The chest wall underneath the breast tissue affects near-infrared (NIR) diffusive waves measured with reflection geometry. With the assistance of a co-registered ultrasound, the depth and the tilting angle of the chest wall can be determined and are used to model the breast as a two-layer medium. Finite element method (FEM) is suitable for modeling complex boundary conditions and is adapted to model the breast tissue and chest wall. Four parameters of bulk absorption and reduced scattering coefficients of these two layers are estimated and used for imaging reconstruction. Using a two-layer model, we have systematically investigated the effect of the chest wall on breast lesion reconstruction. Results have shown that chest-wall depth, titling angle, and difference between optical properties of two layers of lesion and reference sites affect the lesion reconstruction differently. Our analysis will be valuable and informative to researchers who are using reflectance geometry for breast imaging. The analysis can also provide guidelines for imaging operators to minimize image artifacts and to produce the best reconstruction results.

  16. Ventilation distribution and chest wall mechanics in microgravity

    NASA Technical Reports Server (NTRS)

    Paiva, M.; Wantier, M.; Verbanck, S.; Engel, L. A.; Prisk, G. K.; Guy, H. J. B.; West, J. B.

    1997-01-01

    The effect of gravity on lung ventilation distribution and the mechanisms of the chest wall were investigated. The following tests were performed with the respiratory monitoring system of the Anthorack, flown onboard Spacelab D2 mission: single breath washout (SBW), multiple breath washout (MBW) and argon rebreathing (ARB). In order to study chest wall mechanisms in microgravity, a respiratory inductive plethysmograph was used. The SBW tests did not reach statistical significance, while the ARB tests showed that gravity independent inhomogeneity of specific ventilation is larger than gravity dependent inhomogeneity. In which concerns the chest wall mechanisms, the analysis on the four astronauts during the normal respirations of the relaxation maneuver showed a 40 percent increase on the abdominal contribution to respiration.

  17. Stabilization of the Chest Wall: Autologous and Alloplastic Reconstructions

    PubMed Central

    Mahabir, Raman Chaos; Butler, Charles E.

    2011-01-01

    The goals of chest wall stabilization include maintenance of a rigid airtight cavity, protection of the thoracic and abdominal contents, optimization of respiration, and, whenever possible, an aesthetic reconstruction. Evidence suggests that bony fixation results in reduced ventilator dependence, a shorter overall hospital stay, and improved upper extremity function. We prefer to accomplish this with autologous tissue alone (such as the pectoralis major, latissimus dorsi, or rectus abdominus muscle flaps) for small to moderate defects. En bloc resection of defects larger than 5 cm or containing four or more ribs will likely benefit from chest wall stabilization. For patients previously treated with radiation, even larger defects may be tolerated owing to fibrosis. For these larger defects, methyl methacrylate composite meshes are used and covered with vascularized tissue. Contaminated wounds are generally reconstructed with bioprosthetic mesh rather than synthetic mesh. Using these principles, the reconstructive plastic surgeon can devise a comprehensive and safe plan to repair tremendous defects of the chest wall. PMID:22294941

  18. Epithelioid hemangioendothelioma originating from the chest wall with rib metastases.

    PubMed

    Shimamura, Junichi; Kiyoshima, Moriyuki; Suzuki, Hisashi; Kitahara, Miyuki; Asato, Yuji; Iijima, Tatsuo; Amemiya, Ryuta

    2015-11-01

    An asymptomatic 39-year-old woman was referred to us for an abnormal nodular opacity detected on the chest X-ray. Histopathological and further examinations revealed findings consistent with epithelioid hemangioendothelioma (EHE) originating from the chest wall with metastases to the ribs. Complete excision was performed; however, adjuvant chemotherapy was not administered because of the patient's mental disorder. There are very few reports of EHE arising from the chest wall; therefore, we present this case report with the clinicopathological features of EHE and discuss the therapeutic aspects. PMID:24399489

  19. Chest wall reconstruction. Experience with 100 consecutive patients.

    PubMed Central

    Arnold, P G; Pairolero, P C

    1984-01-01

    Experience with 100 consecutive chest wall reconstructions during the past 7 years was reviewed. There were 52 female and 48 male patients with ages ranging from 13 to 78 years (average 53). Of the 100 patients, 42 had tumors of the chest wall, 19 had radiation necrosis, 24 had infected median sternotomies , and 15 had combinations of the three. Seventy-six patients underwent skeletal resection of the chest wall. An average of 5.7 ribs were resected in 63 patients. Total or partial sternectomies were performed in 29. Ninety-two patients underwent 142 muscle flaps: 77 pectoralis major, 29 latissimus dorsi, and 36 other muscles, including serratus anterior, rectus abdominis, and external oblique muscles. The omentum was transposed in ten patients. Chest wall skeletal defects were closed with Prolene mesh in 29 patients and with autogenous ribs in 11. Eighty-nine patients underwent primary closure of the skin. The 100 patients underwent an average of 2.1 operations. Hospitalization averaged 17.5 days. There was one perioperative death (29 days). Two patients required tracheostomy. Follow-up averaged 21.6 months. There were 24 late deaths. All 99 patients who were alive 30 days after operation had excellent results at the time of death or last follow-up. Images Figs. 2A-D. Figs. 3A-F. Figs. 4A-D. Figs. 4A-D. Fig. 5. Fig. 5. PMID:6732314

  20. Electron arc therapy: chest wall irradiation of breast cancer patients.

    PubMed

    McNeely, L K; Jacobson, G M; Leavitt, D D; Stewart, J R

    1988-06-01

    From 1980 to October 1985 we treated 45 breast cancer patients with electron arc therapy. This technique was used in situations where optimal treatment with fixed photon or electron beams was technically difficult: long scars, recurrent tumor extending across midline or to the posterior thorax, or marked variation in depth of target tissue. Forty-four patients were treated following mastectomy: 35 electively because of high risk of local failure, and 9 following local recurrence. One patient with advanced local regional disease was treated primarily. The target volume boundaries on the chest wall were defined by a foam lined cerrobend cast which rested on the patient during treatment, functioning as a tertiary collimator. A variable width secondary collimator was used to account for changes in the radius of the thorax from superior to inferior border. All patients had computerized tomography performed to determine Internal Mammary Chain depth and chest wall thickness. Electron energies were selected based on these thicknesses and often variable energies over different segments of the arc were used. The chest wall and regional node areas were irradiated to 45 Gy-50 Gy in 5-6 weeks by this technique. The supraclavicular and upper axillary nodes were treated by a direct anterior photon field abutted to the superior edge of the electron arc field. Follow-up is from 10-73 months with a median of 50 months. No major complications were observed. Acute and late effects and local control are comparable to standard chest wall irradiation. The disadvantages of this technique are that the preparation of the tertiary field defining cast and CT treatment planning are labor intensive and expensive. The advantage is that for specific clinical situations large areas of chest wall with marked topographical variation can be optimally, homogeneously irradiated while sparing normal uninvolved tissues. PMID:3384727

  1. Electron arc therapy: chest wall irradiation of breast cancer patients

    SciTech Connect

    McNeely, L.K.; Jacobson, G.M.; Leavitt, D.D.; Stewart, J.R.

    1988-06-01

    From 1980 to October 1985 we treated 45 breast cancer patients with electron arc therapy. This technique was used in situations where optimal treatment with fixed photon or electron beams was technically difficult: long scars, recurrent tumor extending across midline or to the posterior thorax, or marked variation in depth of target tissue. Forty-four patients were treated following mastectomy: 35 electively because of high risk of local failure, and 9 following local recurrence. One patient with advanced local regional disease was treated primarily. The target volume boundaries on the chest wall were defined by a foam lined cerrobend cast which rested on the patient during treatment, functioning as a tertiary collimator. A variable width secondary collimator was used to account for changes in the radius of the thorax from superior to inferior border. All patients had computerized tomography performed to determine Internal Mammary Chain depth and chest wall thickness. Electron energies were selected based on these thicknesses and often variable energies over different segments of the arc were used. The chest wall and regional node areas were irradiated to 45 Gy-50 Gy in 5-6 weeks by this technique. The supraclavicular and upper axillary nodes were treated by a direct anterior photon field abutted to the superior edge of the electron arc field. Follow-up is from 10-73 months with a median of 50 months. No major complications were observed. Acute and late effects and local control are comparable to standard chest wall irradiation. The disadvantages of this technique are that the preparation of the tertiary field defining cast and CT treatment planning are labor intensive and expensive. The advantage is that for specific clinical situations large areas of chest wall with marked topographical variation can be optimally, homogeneously irradiated while sparing normal uninvolved tissues.

  2. Mechanically induced sudden death in chest wall impact (commotio cordis).

    PubMed

    Link, Mark S

    2003-01-01

    Sudden death due to nonpenetrating chest wall impact in the absence of injury to the ribs, sternum and heart is known as commotio cordis. Although once thought rare, an increasing number of these events have been reported. Indeed, a significant percentage of deaths on the athletic field are due to chest wall impact. Commotio cordis is most frequently observed in young individuals (age 4-18 years), but may also occur in adults. Sudden death is instantaneous or preceded by several seconds of lightheadedness after the chest wall blow. Victims are most often found in ventricular fibrillation, and successful resuscitation is more difficult than expected given the young age, excellent health of the victims, and the absence of structural heart disease. Autopsy examination is notable for the lack of any significant cardiac or thoracic abnormalities. In an experimental model of commotio cordis utilizing anesthetized juvenile swine, ventricular fibrillation can be produced by a 30 mph baseball strike if the strike occurred during the vulnerable period of repolarization, on the upslope of the T-wave. Energy of the impact object was also found to be a critical variable with 40 mph baseballs more likely to cause ventricular fibrillation than velocities less or greater than 40 mph. In addition, more rigid impact objects and blows directly over the center of the chest were more likely to cause ventricular fibrillation. Peak left ventricular pressure generated by the chest wall blow correlated with the risk of ventricular fibrillation. Activation of the K(+)(ATP) channel is a likely cause of the ventricular fibrillation produced by chest wall blows. Successful resuscitation is attainable with early defibrillation. PMID:12732277

  3. High-frequency oscillation of the airway and chest wall.

    PubMed

    Fink, James B; Mahlmeister, Michael J

    2002-07-01

    High-frequency oscillation (HFO), applied to either the airway or chest wall, has been associated with changes in sputum attributes and clearance. The evolution of evidence, both in vitro and in vivo, supporting the use of HFO is reviewed. Devices that apply HFO to the airway range from the relatively simple mechanical Flutter and Acapella devices to the more complex Percussionaire Intrapercussive Ventilators. and the Hayek Oscillator are designed to provide high-frequency chest wall compression. Operation and use of these devices are described with examples of differentiation of device types by characterization of flows, and airway and esophageal pressures. Although HFO devices span a broad range of costs, they provide a reasonable therapeutic option to support secretion clearance for patients with cystic fibrosis. PMID:12088550

  4. Chest wall reconstruction with methacrylate prosthesis in Poland syndrome.

    PubMed

    Arango Tomás, Elisabet; Baamonde Laborda, Carlos; Algar Algar, Javier; Salvatierra Velázquez, Angel

    2013-10-01

    Poland syndrome is a rare congenital malformation. This syndrome was described in 1841 by Alfred Poland at Guy's Hospital in London. It is characterized by hypoplasia of the breast and nipple, subcutaneous tissue shortages, lack of the costosternal portion of the pectoralis major muscle and associated alterations of the fingers on the same side. Corrective treatment of the chest and soft tissue abnormalities in Poland syndrome varies according to different authors. We report the case of a 17-year-old adolescent who underwent chest wall reconstruction with a methyl methacrylate prosthesis. This surgical procedure is recommended for large anterior chest wall defects, and it prevents paradoxical movement. Moreover it provides for individual remodeling of the defect depending on the shape of the patient's chest. PMID:23453291

  5. Chest wall syndrome among primary care patients: a cohort study

    PubMed Central

    Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

    2007-01-01

    Background The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS). Methods Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6%) patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration. PMID:17850647

  6. Microvascular Reconstructions of Full-Thickness Oncological Chest Wall Defects

    PubMed Central

    Tukiainen, Erkki; Popov, Pentscho; Asko-Seljavaara, Sirpa

    2003-01-01

    Objective: To evaluate the suitability of microvascular flaps for the reconstruction of extensive full-thickness defects of the chest wall. Summary Background Data: Chest wall defects are conventionally reconstructed with pedicular musculocutaneous flaps or the omentum. Sometimes, however, these flaps have already been used, are not reliable due to previous operations or radiotherapy, or are of inadequate size. In such cases, microvascular flaps offer the only option for reconstruction. Methods: From 1988 to 2001, 26 patients with full-thickness resections of the chest wall underwent reconstruction with microvascular flaps. There were 8 soft tissue sarcomas, 8 recurrent breast cancers, 5 chondrosarcomas, 2 desmoid tumors, 1 large cell pulmonary cancer metastasis, 1 renal cancer metastasis, and 1 bronchopleural fistula. The surgery comprised 5 extended forequarter amputations, 5 lateral resections, 8 thoracoabdominal resections, and 8 sternal resections. The mean diameter of a resection was 28 cm. The soft tissue defect was reconstructed with 16 tensor fasciae latae, 5 tensor fascia latae combined with rectus femoris, and 3 transversus rectus abdominis myocutaneous flaps. In 2 patients with a forequarter amputation, the remnant forearm was used as the osteomusculocutaneous free flap. Results: There were no flap losses or perioperative mortality. Four patients needed tracheostomy owing to prolonged respiratory difficulties. The mean survival time for patients with sarcomas was 39 months and for those with recurrent breast cancer 18 months. Conclusions: Extensive chest wall resections are possible with acceptable results. In patients with breast cancer, the surgery may offer valuable palliation and in those with sarcomas it can be curative. PMID:14631216

  7. A magnetostrictive acceleration sensor for registration of chest wall displacements

    NASA Astrophysics Data System (ADS)

    Kaniusas, E.; Mehnen, L.; Krell, C.; Pfützner, H.

    2000-06-01

    The present study concerns a novel acceleration sensor built up using a bimetallic strip with one freely oscillating end. The strip consists of a magnetostrictive amorphous ribbon glued on a nonmagnetic metal ribbon. The sensor's effectiveness is demonstrated for the case of chest wall displacements as resulting from cardiorespiratory activity. The cheap and easy-to-handle novel sensor offers multiple information on the so-called sleep apnea syndrome.

  8. Radiation-induced sarcomas of the chest wall

    SciTech Connect

    Souba, W.W.; McKenna, R.J. Jr.; Meis, J.; Benjamin, R.; Raymond, A.K.; Mountain, C.F.

    1986-02-01

    Sixteen patients are presented who had sarcomas of the chest wall at a site where a prior malignancy had been irradiated. The first malignancies included breast cancer (ten cases), Hodgkin's disease (four cases), and others (two cases). Radiation doses varied from 4200 to 5500 R (mean, 4900 R). The latency period ranged from 5 to 28 years (mean, 13 years). The histologic types of the radiation-induced sarcomas were as follows: malignant fibrous histiocytoma, nine cases; osteosarcoma, six cases; and malignant mesenchymoma, one case. The only long-term survivor is alive and well 12 years after resection of a clavicular chondroblastic osteosarcoma. Three cases were recently diagnosed. Despite aggressive multimodality treatment, the remaining 13 patients have all died from their sarcomas (mean survival, 13.5 months). All patients have apparently been cured of their first malignancies. Chemotherapy was ineffective. No treatment, including forequarter amputation, appeared to palliate the patients with supraclavicular soft tissue sarcomas. Major chest wall resection offered good palliation for seven of eight patients with sarcomas arising in the sternum or lateral chest wall. Close follow-up is needed to detect signs of these sarcomas in the ever-increasing number of patients receiving therapeutic irradiation.

  9. Tracheal mucus clearance in high-frequency oscillation. II: Chest wall versus mouth oscillation.

    PubMed

    King, M; Phillips, D M; Zidulka, A; Chang, H K

    1984-11-01

    We compared the tracheal mucus clearance rate (TMCR) in anesthetized dogs during spontaneous breathing (SB), ventilation by high-frequency oscillation at the airway opening (HFO/AO), and ventilation by high-frequency oscillation of the chest wall (HFO/CW). The HFO/AO was carried out by using a piston pump with a high impedance transverse flow at the proximal end of the endotracheal tube; HFO/CW was effected by creating rapid pressure oscillations in an air-filled cuff wrapped around the lower thorax of the animal, causing small tidal volumes at the mouth. The TMCR was measured by observing the rate of displacement of a charcoal marker in the lower trachea; a fiberoptic bronchoscope was used to deposit the marker before each experiment and to relocate it after a 5-min run. In 7 dogs, mean TMCR during control (SB) was 8.9 +/- 3.5 mm/min. At 13 Hz with an oscillatory tidal volume (VTO) of 1.5 ml/kg, mean TMCR was 240% of control with HFO/CW (p less than 0.001) and 76% of control with HFO/AO (NS). During HFO/AO at 20 Hz and a VTO of 3 ml/kg, mean TMCR was 97% of control. We conclude that high-frequency ventilation by rapid chest wall compression enhances tracheal mucus clearance when compared with spontaneous breathing, whereas high-frequency oscillation at the mouth does not. PMID:6497152

  10. Algorithmic Error Correction of Impedance Measuring Sensors

    PubMed Central

    Starostenko, Oleg; Alarcon-Aquino, Vicente; Hernandez, Wilmar; Sergiyenko, Oleg; Tyrsa, Vira

    2009-01-01

    This paper describes novel design concepts and some advanced techniques proposed for increasing the accuracy of low cost impedance measuring devices without reduction of operational speed. The proposed structural method for algorithmic error correction and iterating correction method provide linearization of transfer functions of the measuring sensor and signal conditioning converter, which contribute the principal additive and relative measurement errors. Some measuring systems have been implemented in order to estimate in practice the performance of the proposed methods. Particularly, a measuring system for analysis of C-V, G-V characteristics has been designed and constructed. It has been tested during technological process control of charge-coupled device CCD manufacturing. The obtained results are discussed in order to define a reasonable range of applied methods, their utility, and performance. PMID:22303177

  11. Chest wall motion in preterm infants using respiratory inductive plethysmography.

    PubMed

    Warren, R H; Horan, S M; Robertson, P K

    1997-10-01

    Preterm infant tidal breathing may be different from that of healthy full-term infants because of various features of the premature thorax. The purpose of this project was to describe chest wall motion in the preterm infant (gestational age <37 weeks) and compare it with chest wall motion data in a group of healthy, full-term infants. We wanted to use an objective bedside method for assessment with minimal disruption to the infant. The study population consisted of 61 preterm human infants whose mean(+/-sD) postconceptional age at time of study was 35.3+/-2.1 weeks. During the study, the infants were quietly awake in a prone position. Preterm infants had initially been admitted to a level III neonatal intensive care unit for acute management and had been transferred to a step-down area, where they were in stable condition for study. Data were collected with a semiquantitatively calibrated, noninvasive respiratory inductive plethysmograph. Mean(+/-SD) phase angle was significantly greater in preterm infants than in full-term infants (60.6+/-39.8 degrees versus 12.5+/-5.0 degrees, respectively, p < or = 0.0001). The laboured breathing index was significantly greater in preterm infants than in full-term infants (1.35+/-0.35 versus 1.01+/-0.01, respectively, p = 0.001). The ribcage contribution to breathing did not differ significantly between preterm and full-term infants (25.5+/-17.7% versus 36.3+/-14.4%, respectively, p = 0.11). These results indicate a significant increase in the degree of ribcage and abdomen asynchrony in the preterm subjects compared to the full-term infants. Plethysmography provided a time-efficient and objective method of assessing chest wall motion in this fragile population. PMID:9387956

  12. Primary malignant chest wall tumors: analysis of 40 patients

    PubMed Central

    2014-01-01

    Background Primary chest wall tumors originate from different constructions of thoracic wall. We report our multidisciplinary experience on primary thoracic tumor resection and thoracic reconstruction, the need to additional therapy and evaluating prognostic factors affecting survival. Methods We performed a retrospective review of our prospectively maintained database of 40 patients treated for malignant primary chest wall tumor from 1989 to 2009. Patients were evaluated in terms of age, sex, clinical presentation, type of imaging, tissue diagnosis methods, pathology, surgical technique, early complications, hospital mortality, prevalence of recurrence and distant metastases, additional treatment, 3 years survival and factors affecting survival. Results Male/Female (F/M) = 1, with median age of 43.72 years. Mass was the most common symptoms and the soft tissue sarcoma was the most common pathology. Resection without reconstruction was performed in 5 patients and Thirty-five patients (87.5%) had extensive resection and reconstruction with rotatory muscular flap, prosthetic mesh and/or cement. Overall, 12.5% (5/40) of patients received neoadjuvant therapy and 75% (30/40) of patients were treated with adjuvant therapy. The 3-year survival rate was 65%. Recurrences occurred in 24 patients (60%), 14 developed local recurrences, and 10 developed distant metastases. The primary treatment modality for both local and distant recurrences was surgical resection; among them, 10 underwent repeated resection, 9 adjuvant therapy and 5 were treated with lung metastasectomy. The most common site of distant metastasis was lung (n = 7). Factors that affected survival were type of pathology and evidence of distant metastasis. Conclusion Surgery with wide margin is the safe and good technique for treatment of primary chest wall tumors with acceptable morbidity and mortality. PMID:24947314

  13. Using "Rebar" to Stabilize Rigid Chest Wall Reconstruction.

    PubMed

    Robinson, Lary A; Grubbs, Deanna M

    2016-04-01

    After major chest wall resection, reconstruction of the bony defect with a rigid prosthesis is mandatory to protect the underlying thoracic organs, and to prevent flail chest physiology. Although many methods have been described for chest wall reconstruction, a commonly used technique employs a composite Marlex (polypropylene) mesh with methyl-methacrylate cement sandwiched between two layers of mesh (MMS), which is tailored to the defect size and shape. In building construction, steel "rebar" is used to strengthen and reinforce masonry structures. To avoid the initial residual motion of the rigid prosthesis used to reconstruct very large defects, particularly the sternum, we devised a simple technique of adding one or more Steinmann steel pins as "rebar" to strengthen and immediately stabilize the prosthesis to the surrounding ribs and sternum. For the very large defects, particularly over the heart and great vessels, titanium mesh may also be readily added into the sandwich construction for increased strength and to prevent late prosthetic fractures. Short- and long-term results of this inexpensive modification of the MMS reconstruction technique are excellent. This modified MMS tailor-made prosthesis is only one-third the cost of the recently popular prosthetic titanium systems, takes much less operative time to create and implant, and avoids the well-described complications of late titanium bar fracture and erosion/infection as well as loosening of screws and/or titanium bars. PMID:25602843

  14. Predicting Chest Wall Pain From Lung Stereotactic Body Radiotherapy for Different Fractionation Schemes

    SciTech Connect

    Woody, Neil M.; Videtic, Gregory M.M.; Stephans, Kevin L.; Djemil, Toufik; Kim, Yongbok; Xia Ping

    2012-05-01

    Purpose: Recent studies with two fractionation schemes predicted that the volume of chest wall receiving >30 Gy (V30) correlated with chest wall pain after stereotactic body radiation therapy (SBRT) to the lung. This study developed a predictive model of chest wall pain incorporating radiobiologic effects, using clinical data from four distinct SBRT fractionation schemes. Methods and Materials: 102 SBRT patients were treated with four different fractionations: 60 Gy in three fractions, 50 Gy in five fractions, 48 Gy in four fractions, and 50 Gy in 10 fractions. To account for radiobiologic effects, a modified equivalent uniform dose (mEUD) model calculated the dose to the chest wall with volume weighting. For comparison, V30 and maximum point dose were also reported. Using univariable logistic regression, the association of radiation dose and clinical variables with chest wall pain was assessed by uncertainty coefficient (U) and C statistic (C) of receiver operator curve. The significant associations from the univariable model were verified with a multivariable model. Results: 106 lesions in 102 patients with a mean age of 72 were included, with a mean of 25.5 (range, 12-55) months of follow-up. Twenty patients reported chest wall pain at a mean time of 8.1 (95% confidence interval, 6.3-9.8) months after treatment. The mEUD models, V30, and maximum point dose were significant predictors of chest wall pain (p < 0.0005). mEUD improved prediction of chest wall pain compared with V30 (C = 0.79 vs. 0.77 and U = 0.16 vs. 0.11). The mEUD with moderate weighting (a = 5) better predicted chest wall pain than did mEUD without weighting (a = 1) (C = 0.79 vs. 0.77 and U = 0.16 vs. 0.14). Body mass index (BMI) was significantly associated with chest wall pain (p = 0.008). On multivariable analysis, mEUD and BMI remained significant predictors of chest wall pain (p = 0.0003 and 0.03, respectively). Conclusion: mEUD with moderate weighting better predicted chest wall pain than

  15. Clinical image: Hydatid disease of the chest wall

    SciTech Connect

    Graham, R.J.; Berlin, J.W.; Ghahremani, G.G.

    1996-05-01

    Hydatid disease is rarely encountered among the population of the United States, but it affects several million people in sheep-raising regions of the world. Human infestation with Echinococcus granulosus begins following ingestion of its ova, which are excreted into the contaminated water during the usual dog-sheep cycle. Hydatid cysts will then develop most frequently in the liver (75% of cases) and lungs (15%) of the human host. Skeletal involvement has been reported to occur in only 0.5-4.0% of patients in the endemic areas. Because of the rarity and perplexing imaging features of hydatid disease involving the chest wall, we wish herein to present a case evaluated recently at our institution. 5 refs., 1 fig.

  16. CT after reconstructive repair of the sternum and chest wall.

    PubMed

    Maddern, I R; Goodman, L R; Almassi, G H; Haasler, G B; McManus, R P; Olinger, G N

    1993-03-01

    Acute mediastinitis and sternal infection after sternotomy are potentially devastating complications, but considerable advances in treatment have been made during the past decade. Sternectomy followed by reconstruction with use of either an omental transposition or a muscle flap has markedly decreased mortality and morbidity. After extensive rib resection, various reconstructive repairs, including the use of polytetrafluoroethylene mesh, have proved successful. The authors retrospectively reviewed 27 postoperative computed tomographic (CT) scans obtained in 19 patients. Twelve of these patients had sternal wounds repaired with either omental or muscle flap procedures. Seven patients had chest wall reconstructions with polytetrafluoroethylene patches, muscle transpositions, or both. The authors found no cases of unexpected or unexplained fluid collections on CT scans obtained beyond the 1st month. Any persistent or recurrent collection is suggestive of infection. If clinical and imaging findings are at odds, imaging-directed needle aspiration can help determine whether a fluid collection is infected and in need of further treatment. PMID:8430171

  17. Chest wall reconstruction using iliac bone allografts and muscle flaps.

    PubMed

    Garcia-Tutor, Emilio; Yeste, Luis; Murillo, Julio; Aubá, Cristina; Sanjulian, Mikel; Torre, Wenceslao

    2004-01-01

    Technically we can divide full-thickness thoracic reconstruction into 2 parts: providing a rigid support and ensuring well-vascularized coverage. Since 1986, the authors' center has had ample experience with bone banks and the use of cryopreserved bone grafts, which led them to consider the possibility of using these grafts for full-thickness chest wall reconstruction. They describe 3 patients in whom resection of the tumor and reconstruction of the thorax were carried out using iliac bone allografts covered with muscle flaps (1 pectoralis major and 2 rectus abdominis). None of the patients experienced breathing difficulties, pain, or instability after 14 months, 18 months, and 11 years of follow-up. The result of the reconstruction was excellent in all 3 patients in terms of function and aesthetics. The advantage of allografts compared with synthetic materials is their potential integration; they can become part of the host patient's living tissue. PMID:14676700

  18. RLC model of visco-elastic properties of the chest wall

    NASA Astrophysics Data System (ADS)

    Aliverti, Andrea; Ferrigno, Giancarlo

    1996-04-01

    The quantification of the visco-elastic properties (resistance (R), inertia (L) and compliance (C)) of the different chest wall compartments (pulmonary rib cage,diaphragmatic rib cage and abdomen) is important to study the status of the passive components of the respiratory system, particularly in selected pathologies. Applying the viscoelastic-electrical analogy to the chest wall, we used an identification method in order to estimate the R, L and C parameters of the different parts of the chest, basing on different models; the input and output measured data were constituted by the volume variations of the different chest wall compartments and by the nasal pressure during controlled intermittent positive pressure ventilation by nasal mask, while the parameters of the system (R, L and C of the different compartments) were to be estimated. Volumes were measured with a new method, recently validated, based on an opto-electronic motion analyzer, able to compute with high accuracy and null invasivity the absolute values and the time variations of the volumes of each of the three compartments. The estimation of the R, L and C parameters has been based on a least-squared criterion, and the minimization has been based on a robustified iterative Gauss-Newton algorithm. The validation of the estimation procedure (fitting) has ben performed computing the percentage root mean square value of the error between the output real data and the output estimated data. The method has been applied to 2 healthy subjects. Also preliminary results have been obtained from 20 subjects affected by neuromuscular diseases (Duchenne Muscular Dystrophy (DMD) and Spinal Muscle Atrophy (SMA)). The results show that: (a) the best-fitting electrical models of the respiratory system are made up by one or three parallel RLC branches supplied by a voltage generator (so considering inertial properties, particularly in the abdominal compartment, and not considering patient/machine connection); (b) there

  19. Chest Wall Motion during Speech Production in Patients with Advanced Ankylosing Spondylitis

    ERIC Educational Resources Information Center

    Kalliakosta, Georgia; Mandros, Charalampos; Tzelepis, George E.

    2007-01-01

    Purpose: To test the hypothesis that ankylosing spondylitis (AS) alters the pattern of chest wall motion during speech production. Method: The pattern of chest wall motion during speech was measured with respiratory inductive plethysmography in 6 participants with advanced AS (5 men, 1 woman, age 45 plus or minus 8 years, Schober test 1.45 plus or…

  20. The development of algorithms in electrical impedance computerized tomography.

    PubMed

    Shie, J R; Li, C J; Lin, J T

    2000-01-01

    Electrical Impedance Computerized Tomography (EICT) is an imaging method to reconstruct the impedance distribution inside of domain through the boundary injected current and display the impedance contrast ratio as an image. This paper concentrates on developing two algorithms to enhance the quality of the conductivity image. The two algorithms are "Fine-Mesh Conversion Method" and "Sub-Domain EICT Method". "Fine-Mesh Conversion Method" is a numerical calibration process to find a coarse mesh impedance network that behaves like a fine mesh network in terms of giving similar voltages under the same current excitations. "Sub-Domain EICT" solves a higher resolution EICT with the cost of a lower resolution EICT by combining "Fine-Mesh Conversion Method", and a Fuzzy Logic Inference Systems (FLIS) classifier. PMID:10834231

  1. A triceps musculocutaneous flap for chest-wall defects

    SciTech Connect

    Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. )

    1990-09-01

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.

  2. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

    PubMed Central

    Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2014-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

  3. A single plan solution to chest wall radiotherapy with bolus?

    PubMed Central

    Ordonez-Sanz, C; Bowles, S; Hirst, A

    2014-01-01

    Objective: Radiotherapy treatments of post-mastectomy chest walls are complex, requiring treatment close to skin, necessitating bolus use. Commonly used 5- and 10-mm-thick boluses develop full skin dose, needing removal for the latter half of treatment and requiring two treatment plans to be generated. Can a thinner bolus be used for all treatment fractions, requiring only one plan? Methods: Investigation of doses received using (A) a half-time 10-mm-thick Vaseline® bolus (current situation); (B) a brass mesh (Whiting & Davis, Attleboro Falls, MA) and (C) 3- and 5-mm Superflab™ (Mick Radio-Nuclear Instruments, Mount Vernon, NY) for 6 and 15 MV. Dosimetric measurements in Barts WT1 solid water and an anthropomorphic phantom, using ionization chambers and thermoluminescent dosemeters, were used to study the effect of different bolus regimes on the photon depth–dose curves (DDCs) and skin doses. Results: Measured skin doses for the current 10-mm-thick Vaseline bolus, brass mesh and 3-mm bolus were compared (5 mm bolus has been rejected). The brass mesh has the least effect on the DDC, with changes <0.7% for depths greater than dmax. Brass mesh conforms superiorly to skin surfaces. Measurements on an anthropomorphic phantom demonstrate an increased skin dose compared with our current treatment protocol. Conclusion: Brass mesh has the smallest effect on the DDC, whilst sufficiently increasing surface dose. It can be removed at any fraction, based on a clinical decision, without the need for generating a new plan. Treating with one plan significantly reduces planning times. Advances in knowledge: Quantification of skin doses required and achieved from wax-on/wax-off treatment compared with alternative available breast boluses. PMID:24646288

  4. CONSTANT-PHASE DESCRIPTIONS OF CANINE LUNG, CHEST WALL, AND TOTAL RESPIRATORY SYSTEM VISCOELASTICITY: EFFECTS OF DISTENDING PRESSURE

    PubMed Central

    Kaczka, David W.; Smallwood, Jennifer L.

    2012-01-01

    The dynamic mechanical properties of the respiratory system reflect the ensemble behavior of its constituent structural elements. This study assessed the appropriateness of constant-phase descriptions of respiratory tissue viscoelasticity at various distending pressures. We measured the mechanical input impedance (Z) of the lungs, chest wall and total respiratory system in twelve dogs at mean airway pressures from 5 to 30 cmH2O. Each Z was fitted with a constant-phase model which provided estimates tissue damping (G), elastance (H), and hysteresivity (η = G/H). Both G and H sharply increased with increasing distending pressure for the lungs and chest wall, while η attained a minimum near 15-20 cm H2O. Model fitting errors for the lungs and total respiratory system increased for distending pressures greater than 20 cm H2O, indicating that constant-phase descriptions of parenchymal and respiratory system viscoelasticty may be inappropriate at volumes closer to total lung capacity. Such behavior may reflect alterations in load distribution across various parenchymal stress-bearing elements. PMID:22691447

  5. Arena Roof Technique for Complex Reconstruction After Extensive Chest Wall Resection.

    PubMed

    Rocco, Gaetano; La Rocca, Antonello; La Manna, Carmine; Martucci, Nicola; De Luca, Giuseppe; Accardo, Rosanna

    2015-10-01

    Extensive primary resections or redos may produce significant chest wall defects requiring creative reconstructions in order to avoid reduction of the intrathoracic volume. We describe the successful use of an innovative technique for chest wall reconstruction based on the concept of roof coverage of sport arenas. In fact, titanium plates are anchored to the residual rib stumps along the parasternal and paravertebral lines. The acellular collagen matrix prosthesis was sutured to the free edges of the same titanium plates to create a roof, reproducing the chest wall dome geometric configuration. A 36-year-old female patient was diagnosed with an extensive desmoid tumor involving the lateral segments of second to fifth ribs on the right side. The arena roof technique allowed for adequate expansion of the uninvolved lung and optimal chest wall functional recovery. PMID:26434458

  6. Prediction of Chest Wall Toxicity From Lung Stereotactic Body Radiotherapy (SBRT)

    SciTech Connect

    Stephans, Kevin L.; Djemil, Toufik; Tendulkar, Rahul D.; Robinson, Cliff G.; Reddy, Chandana A.; Videtic, Gregory M.M.

    2012-02-01

    Purpose: To determine patient, tumor, and treatment factors related to the development of late chest wall toxicity after lung stereotactic body radiotherapy (SBRT). Methods and Materials: We reviewed a registry of 134 patients treated with lung SBRT to 60 Gy in 3 fractions who had greater than 1 year of clinical follow-up and no history of multiple treatments to the same lobe (n = 48). Patients were treated as per Radiation Therapy Oncology Group Protocol 0236 without specific chest wall avoidance criteria. The chest wall was retrospectively contoured. Thirty-two lesions measured less than 3 cm, and sixteen measured 3 to 5 cm. The median planning target volume was 29 cm{sup 3}. Results: With a median follow-up of 18.8 months, 10 patients had late symptomatic chest wall toxicity (4 Grade 1 and 6 Grade 2) at a median of 8.8 months after SBRT. No patient characteristics (age, diabetes, hypertension, peripheral vascular disease, or body mass index) were predictive for toxicity, whereas there was a trend for continued smoking (p = 0.066; odds ratio [OR], 4.4). Greatest single tumor dimension (p = 0.047; OR, 2.63) and planning target volume (p = 0.040; OR, 1.04) were correlated with toxicity, whereas distance from tumor edge to chest wall and gross tumor volume did not reach statistical significance. Volumes of chest wall receiving 30 Gy (V30) through 70 Gy (V70) were all highly significant, although this correlation weakened for V65 and V70 and maximum chest wall point dose only trended to significance (p = 0.06). On multivariate analysis, tumor volume was no longer correlated with toxicity and only V30 through V60 remained statistically significant. Conclusions: Tumor size and chest wall dosimetry are correlated to late chest wall toxicity. Only chest wall V30 through V60 remained significant on multivariate analysis. Restricting V30 to 30 cm{sup 3} or less and V60 to 3 cm{sup 3} or less should result in a 10% to 15% risk of late chest wall toxicity or lower.

  7. Extrathoracic chronic heamatoma presenting as a chest wall tumor 2 years after a blunt thoracic injury.

    PubMed

    Kouritas, Vasileios K; Roussakis, Antonios G; Soultanis, Konstantinos; Bellenis, Ion

    2011-01-01

    Chronic expanding heamatomas may present as masses mimicking chest wall tumors. We report the case of a patient who was presented with a giant posterior extrathoracic chest wall tumor. The mass was proven to be a chronic heamatoma possibly developed after a blunt thoracic injury which took place 2 years before presentation and was growing thereafter. Clinicians should have high suspicion of rare entities which mimic tumors and consider any information reported by the patient's history in their diagnostic process. PMID:22112630

  8. Extrathoracic chronic heamatoma presenting as a chest wall tumor 2 years after a blunt thoracic injury

    PubMed Central

    2011-01-01

    Chronic expanding heamatomas may present as masses mimicking chest wall tumors. We report the case of a patient who was presented with a giant posterior extrathoracic chest wall tumor. The mass was proven to be a chronic heamatoma possibly developed after a blunt thoracic injury which took place 2 years before presentation and was growing thereafter. Clinicians should have high suspicion of rare entities which mimic tumors and consider any information reported by the patient's history in their diagnostic process. PMID:22112630

  9. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    SciTech Connect

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-09-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within <2.5 cm of the chest wall; 104 (39%) developed skin toxicity (any grade); 14 (5%) developed acute pain (any grade), and 45 (17%) developed chronic pain (Grade 1 in 22 cases [49%] and Grade 2 or 3 in 23 cases [51%]). Both skin toxicity and chest wall pain were associated with the V{sub 30}, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI {>=}29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  10. Assessment of the chest wall thickness of the lawrence livermore torso phantom using a voxel image.

    PubMed

    Ahmed, A S M Sabbir; Capello, Kevin; Kramer, Gary H

    2011-06-01

    This paper describes the methodology of measuring the chest wall thickness using the voxel image of the Lawrence Livermore National Lab (LLNL) torso phantom. The LLNL phantom is used as a standard to calibrate a lung counter consisting of a 2 × 2 array of germanium detectors. In general, an average thickness estimated from four counting positions is used as the chest wall thickness for a given overlay plate. For a given overlay, the outer chest surface differs from that of inner one, and the chest wall thickness varies from one position to other. The LLNL phantom with chest plate and C4 overlay plate installed was scanned with a CT (computed tomography) scanner. The image data, collected in DICOM (Digital Imaging and Communication) format, were converted to the MCNP input file by using the Scan2Mcnp program. The MCNP file was visualized and analyzed with the Moritz visual editor. An analytic expression was formulated and solved to calculate the chest wall thickness by using the point detector responses (F 5 tally of MCNP). To map the chest thickness, the entire chest wall was meshed into virtual grids of 1 cm width. A source and detector pair was moved along the inner and outer surface of the chest wall from right to left at different heights from neck to abdomen. For each height (z(k)), (x(i), y(j)) coordinates for the detector source pair were calculated from the visual editor and were scaled on-screen. For each (x(i), y(j), z(k)) position, a mesh thickness was measured from on-screen measurement and by solving the detector responses. The chest wall thicknesses at different positions on the outer surface of the chest were compared and verified using two methods. PMID:22004927

  11. Dose-Response Model for Chest Wall Tolerance of Stereotactic Body Radiation Therapy.

    PubMed

    Kimsey, Frank; McKay, Jesse; Gefter, Jeffrey; Milano, Michael T; Moiseenko, Vitali; Grimm, Jimm; Berg, Ronald

    2016-04-01

    Many recent studies have described rib fractures and chest wall pain following stereotactic body radiation therapy (SBRT). Although these toxicities generally are not life-threatening, the chest wall and ribs are considered dose-limiting tissues because of the potential effect on patients׳ quality of life. Few studies have reported dose-response models that can provide quantitative estimates of risk as a function of dose and volume. Notably, Memorial Sloan Kettering Cancer Center (Mutter et al(8)) analyzed grade 2 or higher chest wall toxicity in a cohort of 126 patients treated with linear accelerator-based SBRT; the authors provided detailed dose-volume histogram (DVH) data to allow for pooled analyses. We pooled these 126 patients with an additional 44 patients treated with CyberKnife at the Erlanger Medical Center to create an updated dose-response model for chest wall tolerance. In the aggregate analysis, the 10% risk level for grade 2 or higher complications for D70cc was 16.2Gy in 4 fractions, and the 50% risk level was D70cc = 65.1Gy in 4 fractions. For D2cc, the 10% and 50% risk levels in 4 fractions were 43.0Gy and 87.9Gy, respectively. These dose-tolerance limits may help quantify chest wall toxicity risks. Further research continues to determine more accurate estimates of grade 3 risk levels. PMID:27000509

  12. Some Nonlinear Reconstruction Algorithms for Electrical Impedance Tomography

    SciTech Connect

    Berryman, J G

    2001-03-09

    An impedance camera [Henderson and Webster, 1978; Dines and Lytle, 1981]--or what is now more commonly called electrical impedance tomography--attempts to image the electrical impedance (or just the conductivity) distribution inside a body using electrical measurements on its boundary. The method has been used successfully in both biomedical [Brown, 1983; Barber and Brown, 1986; J. C. Newell, D. G. Gisser, and D. Isaacson, 1988; Webster, 1990] and geophysical applications [Wexler, Fry, and Neurnan, 1985; Daily, Lin, and Buscheck, 1987], but the analysis of optimal reconstruction algorithms is still progressing [Murai and Kagawa, 1985; Wexler, Fry, and Neurnan, 1985; Kohn and Vogelius, 1987; Yorkey and Webster, 1987; Yorkey, Webster, and Tompkins, 1987; Berryman and Kohn, 1990; Kohn and McKenney, 1990; Santosa and Vogelius, 1990; Yorkey, 1990]. The most common application is monitoring the influx or efflux of a highly conducting fluid (such as brine in a porous rock or blood in the human body) through the volume being imaged. For biomedical applications, this met hod does not have the resolution of radiological methods, but it is comparatively safe and inexpensive and therefore provides a valuable alternative when continuous monitoring of a patient or process is desired. The following discussion is intended first t o summarize the physics of electrical impedance tomography, then to provide a few details of the data analysis and forward modeling requirements, and finally to outline some of the reconstruction algorithms that have proven to be most useful in practice. Pointers to the literature are provided throughout this brief narrative and the reader is encouraged to explore the references for more complete discussions of the various issues raised here.

  13. Rhabdomyosarcoma of the posterior chest wall in a newborn: a case report

    PubMed Central

    Gupta, Shilpi Singh; Upadhyaya, Vijay; Sharma, Shashi Shankar; Lahoti, Brijesh Kumar; Mathur, K Raj

    2009-01-01

    Rhabdomyosarcoma is the most common soft tissue malignancy of childhood, but may occur extremely rarely in the neonatal period. There are only a few reports of rhabdomyosarcoma in neonates. Although, it may arise anywhere in the body, the head and neck, and genitourinary regions are the most frequent sites. Truncal and chest wall rhabdomyosarcoma is relatively rare occurrence. We report a neonate with embryonal rhabdomyosarcoma arising from the posterior chest wall muscles at birth. Computer Tomography scan raised the possibility of rhabdomyosarcoma or neurofibroma, fine-needle aspiration cytology was inconclusive. Total excision was done and chemotherapy given. At 6 months child is without recurrence. PMID:19829867

  14. [POSSIBILITIES FOR THE SURGICAL TREATMENT OF PATIENTS WITH EXTENSIVE MALIGNANT CHEST WALL NEOPLASMS].

    PubMed

    Larin, I A; Tarasov, V A; Khubulava, G G; Gavrilov, E K

    2015-01-01

    The authors consider possibilities for the surgical treatment of patients with extensive malignant chest wall neoplasms. It is argued that combinedsugical interventions and resection of the affected parts of the chest wall together with the tumour and the use of plastic procedures allow to arrest further development of severe complications in the majority of patients and create conditions for the continuation of the anti-tumour treatment. Plastic and reconstructive surgery permits to extend operability limits and thereby improve the quality of the treatment and increase life expectancy of the patients with extensive tumorigenic process. PMID:26596058

  15. Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis.

    PubMed

    Fournié, B; Boutes, A; Dromer, C; Sixou, L; Le Guennec, P; Granel, J; Railhac, J J

    1997-01-01

    A prospective study of anterior chest wall involvement was conducted in 50 ankylosing spondylitis patients and 50 psoriatic arthritis patients in the absence of palmoplantar pustulosis. All patients underwent a physical examination, tomograms, and a radionuclide bone scan. Magnetic resonance imaging with gadolinium was done in some cases. Half the patients in both groups had anterior chest wall involvement. Enthesitis was the mechanism of the lesions. The manubriosternal symphysis and sternocostoclavicular joints were the most common sites of involvement, although other entheses in the region were affected in some patients. PMID:9051856

  16. Evaluation of a Thermoplastic Immobilization System for Breast and Chest Wall Radiation Therapy

    SciTech Connect

    Strydhorst, Jared H.; Caudrelier, Jean-Michel; Clark, Brenda G.; Montgomery, Lynn A.; Fox, Greg; MacPherson, Miller S.

    2011-04-01

    We report on the impact of a thermoplastic immobilization system on intra- and interfraction motion for patients undergoing breast or chest wall radiation therapy. Patients for this study were treated using helical tomotherapy. All patients were immobilized using a thermoplastic shell extending from the shoulders to the ribcage. Intrafraction motion was assessed by measuring maximum displacement of the skin, heart, and chest wall on a pretreatment 4D computed tomography, while inter-fraction motion was inferred from patient shift data arising from daily image guidance procedures on tomotherapy. Using thermoplastic immobilization, the average maximum motion of the external contour was 1.3 {+-} 1.6 mm, whereas the chest wall was found to be 1.6 {+-} 1.9 mm. The day-to-day setup variation was found to be large, with random errors of 4.0, 12.0, and 4.5 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively, and the standard deviations of the systematic errors were found to be 2.7, 9.8, and 4.1 mm. These errors would be expected to dominate any respiratory motion but can be mitigated by daily online image guidance. Using thermoplastic immobilization can effectively reduce respiratory motion of the chest wall and external contour, but these gains can only be realized if daily image guidance is used.

  17. Effect of shape and size of lung and chest wall on stresses in the lung

    NASA Technical Reports Server (NTRS)

    Vawter, D. L.; Matthews, F. L.; West, J. B.

    1975-01-01

    To understand better the effect of shape and size of lung and chest wall on the distribution of stresses, strains, and surface pressures, we analyzed a theoretical model using the technique of finite elements. First we investigated the effects of changing the chest wall shape during expansion, and second we studied lungs of a variety of inherent shapes and sizes. We found that, in general, the distributions of alveolar size, mechanical stresses, and surface pressures in the lungs were dominated by the weight of the lung and that changing the shape of the lung or chest wall had relatively little effect. Only at high states of expansion where the lung was very stiff did changing the shape of the chest wall cause substantial changes. Altering the inherent shape of the lung generally had little effect but the topographical differences in stresses and surface pressures were approximately proportional to lung height. The results are generally consistent with those found in the dog by Hoppin et al (1969).

  18. Use of Lumbar Perforator Recipient Vessels for Salvage Chest Wall Reconstruction: A Case Report

    PubMed Central

    Sillah, Nyama M.; Shah, Jinesh; Fukudome, Eugene

    2016-01-01

    Summary: Abdominal-based free flaps are commonly used for breast reconstruction, and the internal mammary or thoracodorsal vessels are typically used as recipient sites. Conversely, free tissue transfer is less commonly used for chest wall reconstruction in the setting of chest wall recurrence, in part, because of a paucity of recipient vessels. Here, we describe a case of a 68-year-old female smoker with metastatic breast cancer, who presented with a chest wall recurrence. There was a large area of chronic ulceration with foul smelling drainage, in addition to radiation-induced tissue injury, and palliative resection was performed. The area was reconstructed with a free transverse rectus abdominis myocutaneous flap using lumbar perforators as recipient vessels, because conventional recipient sites were unavailable because of scarring from radiation and residual tumor. This case demonstrates that uncommon recipient vessels such as lumbar perforators may allow for successful palliative chest wall reconstruction. We hypothesize that the tumor burden, previous surgeries, and radiation may have rendered the recipient field relatively ischemic, thereby inducing hypertrophy of the lumbar perforators, similar to a delay phenomenon. PMID:27257572

  19. Severe Chest Wall Toxicity From Cryoablation in the Setting of Prior Stereotactic Ablative Radiotherapy.

    PubMed

    Chaudhuri, Aadel A; Binkley, Michael S; Aggarwal, Sonya; Qian, Yushen; Carter, Justin N; Shah, Rajesh; Loo, Billy W

    2016-01-01

    We present the case of a 42-year-old woman with metastatic synovial sarcoma of parotid origin, treated definitively with chemoradiation, who subsequently developed oligometastatic disease limited to the lungs. She underwent multiple left and right lung wedge resections and left lower lobectomy, followed by right lower lobe stereotactic ablative radiotherapy (SABR), 54 Gy in three fractions to a right lower lobe lesion abutting the chest wall. Two years later, she was treated with cryoablation for a separate right upper lobe nodule abutting the chest wall. Two months later, she presented with acute shortness of breath, pleuritic chest pain, decreased peripheral blood O2 saturation, and productive cough. A computed tomography (CT) scan demonstrated severe chest wall necrosis in the area of recent cryoablation that, in retrospect, also received a significant radiation dose from her prior SABR. This case demonstrates that clinicians should exercise caution in using cryoablation when treating lung tumors abutting a previously irradiated chest wall. Note: Drs. Loo and Shah contributed equally as co-senior authors. PMID:27004154

  20. Severe Chest Wall Toxicity From Cryoablation in the Setting of Prior Stereotactic Ablative Radiotherapy

    PubMed Central

    Chaudhuri, Aadel A; Binkley, Michael S; Aggarwal, Sonya; Qian, Yushen; Carter, Justin N; Shah, Rajesh

    2016-01-01

    We present the case of a 42-year-old woman with metastatic synovial sarcoma of parotid origin, treated definitively with chemoradiation, who subsequently developed oligometastatic disease limited to the lungs. She underwent multiple left and right lung wedge resections and left lower lobectomy, followed by right lower lobe stereotactic ablative radiotherapy (SABR), 54 Gy in three fractions to a right lower lobe lesion abutting the chest wall. Two years later, she was treated with cryoablation for a separate right upper lobe nodule abutting the chest wall. Two months later, she presented with acute shortness of breath, pleuritic chest pain, decreased peripheral blood O2 saturation, and productive cough. A computed tomography (CT) scan demonstrated severe chest wall necrosis in the area of recent cryoablation that, in retrospect, also received a significant radiation dose from her prior SABR. This case demonstrates that clinicians should exercise caution in using cryoablation when treating lung tumors abutting a previously irradiated chest wall. Note: Drs. Loo and Shah contributed equally as co-senior authors. PMID:27004154

  1. The expanded role of extracellular matrix patch in malignant and non-malignant chest wall reconstruction in thoracic surgery†

    PubMed Central

    George, Robert S.; Kostopanagiotou, Kostas; Papagiannopoulos, Kostas

    2014-01-01

    OBJECTIVES The extracellular matrix (XCM Biologic Tissue Matrix) is a non-cross-linked 3D patch derived from porcine dermis. Once implanted, it is infiltrated by recipient's cells and becomes incorporated in the repair. Here, we report the first series of using this device for chest wall reconstruction. METHODS The XCM Biologic Tissue Matrix was utilized to provide the restoration of chest wall defects. It was used either alone or in conjunction with the Synthes titanium system to provide additional support. The decision was made intraoperatively. RESULTS Since April 2010, 21 (12 females) patients received the device. Average age at operation was 47 ± 17 years. Eleven (52%) patients had the patch inserted alone, while the remaining 10 received it in combination with another implantable medical device. The biological tissue matrix was used to reconstruct chest wall defects in cancer involving chest wall (n = 9), chest wall deformity (n = 6), chest wall hernia (n = 5) and chest wall repair following empyema drainage (n = 1). Complications were witnessed in 3 patients receiving the combined XCM and Synthes bar mechanisms; infection (n = 2) and bar displacement and infection (n = 1). CONCLUSIONS The XCM patch can be safely used to provide the strength required for chest wall reconstruction and to replace previously infected reconstructions. PMID:24263580

  2. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

    PubMed Central

    2013-01-01

    Background Conventional post-mastectomy radiation therapy is delivered with tangential fields for chest wall and separate fields for regional nodes. Although chest wall and regional nodes delineation has been discussed with RTOG contouring atlas, CT-based planning to treat chest wall and regional nodes as a whole target has not been widely accepted. We herein discuss the dosimetric characteristics of a linac IMRT technique for treating chest wall and regional nodes as a whole PTV after modified radical mastectomy, and observe acute toxicities following irradiation. Methods Patients indicated for PMRT were eligible. Chest wall and supra/infraclavicular region +/−internal mammary nodes were contoured as a whole PTV on planning CT. A simplified linac IMRT plan was designed using either integrated full beams or two segments of half beams split at caudal edge of clavicle head. DVHs were used to evaluate plans. The acute toxicities were followed up regularly. Results Totally, 85 patients were enrolled. Of these, 45 had left-sided lesions, and 35 received IMN irradiation. Planning designs yielded 55 integrated and 30 segmented plans, with median number of beams of 8 (6–12). The integrated and segmented plans had similar conformity (1.41±0.14 vs. 1.47±0.15, p=0.053) and homogeneity indexes (0.13±0.01 vs. 0.14±0.02, p=0.069). The percent volume of PTV receiving >110% prescription dose was <5%. As compared to segmented plans, integrated plans typically increased V5 of ipsilateral lung (p=0.005), and heart (p=0.001) in patients with left-sided lesions. Similarly, integrated plans had higher spinal cord Dmax (p=0.009), ipsilateral humeral head (p<0.001), and contralateral lung Dmean (p=0.019). During follow-up, 36 (42%) were identified to have ≥ grade 2 radiation dermatitis (RD). Of these, 35 developed moist desquamation. The median time to onset of moist desquamation was 6 (4–7) weeks from start of RT. The sites of moist desquamation were most frequently occurred

  3. Respiratory kinematics by optoelectronic analysis of chest-wall motion and ultrasonic imaging of the diaphragm

    NASA Astrophysics Data System (ADS)

    Aliverti, Andrea; Pedotti, Antonio; Ferrigno, Giancarlo; Macklem, P. T.

    1998-07-01

    Although from a respiratory point of view, compartmental volume change or lack of it is the most crucial variable, it has not been possible to measure the volume of chest wall compartments directly. Recently we developed a new method based on a optoelectronic motion analyzer that can give the three-dimensional location of many markers with the temporal and spatial accuracy required for respiratory measurements. Marker's configuration has been designed specifically to measure the volume of three chest wall compartments, the pulmonary and abdominal rib cage compartments and the abdomen, directly. However, it can not track the exact border between the two rib cage compartments (pulmonary and abdominal) which is determined by the cephalic extremity of the area of apposition of the diaphragm to the inner surface of the rib cage, and which can change systematically as a result of disease processes. The diaphragm displacement can be detected by ultrasonography. In the present study, we propose an integrated system able to investigate the relationships between external (chest wall) and internal (diaphragm) movements of the different respiratory structures by simultaneous external imaging with the optoelectronic system combined with internal kinematic imaging using ultrasounds. 2D digitized points belonging to the lower lung margin, taken from ultrasonographic views, are mapped into the 3D space, where chest wall markers are acquired. Results are shown in terms of accuracy of 3D probe location, relative movement between the probe and the body landmarks, dynamic relationships between chest wall volume and position of the diaphragm during quiet breathing, slow inspirations, relaxations and exercise.

  4. Comparison of total variation algorithms for electrical impedance tomography.

    PubMed

    Zhou, Zhou; Sato dos Santos, Gustavo; Dowrick, Thomas; Avery, James; Sun, Zhaolin; Xu, Hui; Holder, David S

    2015-06-01

    The applications of total variation (TV) algorithms for electrical impedance tomography (EIT) have been investigated. The use of the TV regularisation technique helps to preserve discontinuities in reconstruction, such as the boundaries of perturbations and sharp changes in conductivity, which are unintentionally smoothed by traditional l2 norm regularisation. However, the non-differentiability of TV regularisation has led to the use of different algorithms. Recent advances in TV algorithms such as the primal dual interior point method (PDIPM), the linearised alternating direction method of multipliers (LADMM) and the spilt Bregman (SB) method have all been demonstrated successful EIT applications, but no direct comparison of the techniques has been made. Their noise performance, spatial resolution and convergence rate applied to time difference EIT were studied in simulations on 2D cylindrical meshes with different noise levels, 2D cylindrical tank and 3D anatomically head-shaped phantoms containing vegetable material with complex conductivity. LADMM had the fastest calculation speed but worst resolution due to the exclusion of the second-derivative; PDIPM reconstructed the sharpest change in conductivity but with lower contrast than SB; SB had a faster convergence rate than PDIPM and the lowest image errors. PMID:26008768

  5. Chronic cutaneous chest wall fistula and gallstone empyema due to retained gallstones

    PubMed Central

    Gaster, Richard S; Berger, Aaron J; Ahmadi-Kashani, Mastaneh; Shrager, Joseph B; Lee, Gordon K

    2014-01-01

    We report a case of a 72-year-old man who presented with a persistent pleural effusion and painful abscess in the right lower chest wall 6 months following a laparoscopic cholecystectomy. The patient subsequently developed a chronic cutaneous chest wall fistula requiring a large resection and complex closure. The complication was likely secondary to intraoperative spillage of gallstones. While previous reports describe gallstone spillage in the abdominal cavity as benign, this case illustrates that stones left in the abdominal cavity can potentially lead to significant morbidity. Therefore, stones should be diligently removed from the abdominal cavity when spillage occurs. In addition, it is important that operative notes reflect the occurrence of stone spillage so stones may be suspected when a patient presents with an abdominal or thoracic infection following a cholecystectomy. PMID:25123567

  6. Cavernous hemangioma with hematoma in the chest wall due to penetration from the anterior mediastinum.

    PubMed

    Nakamura, Hiroshige; Miwa, Ken; Miyoshi, Kenichirou; Adachi, Yoshin; Fujioka, Shinji; Taniguchi, Yuji; Yaniguchi, Yuji

    2007-04-01

    The patient was a 51-year-old man who visited the hospital with swelling of the anterior chest. Chest computed tomography detected a tumor developing from the anterior mediastinum to the anterior chest wall. There was weak contrast enhancement inside the tumor, and calcification was observed in the central region. A soft tumor with an obscure border and that adhered to the back of the left sternum was surgically removed with thymic fat including the region of the chest wall that had been penetrated by the tumor. The tumor measured 30 x 25 mm, and a phlebolith was observed in the center. The pathological tissue was diagnosed to be a cavernous hemangioma, and there were no malignant findings in the endothelial cells. Mediastinal hemangioma should therefore be kept in mind during an evaluation of mediastinal tumors, and one must also take into account the effect on the surrounding organs. PMID:17491358

  7. Review of Chest Wall Tumors: A Diagnostic, Therapeutic, and Reconstructive Challenge

    PubMed Central

    David, Elizabeth A.; Marshall, M. Blair

    2011-01-01

    Chest wall tumors are a heterogeneous group of lesions that provide an interesting diagnostic and therapeutic challenge for surgeons. They make up less than 5% of thoracic malignancies and vary widely in pathology as they arise from all anatomic structures of the chest wall. In general, treatment is wide local excision, the margins for malignant disease are necessarily wider, and adjuvant radiation is typically given for those with positive margins. Chemotherapy is rarely effective. Local control is the most important prognostic factor. Disease-free survival for malignant disease is limited by positive margins; therefore full oncologic resection with 4-cm margins should be attempted. For small lesions, the resection and reconstruction is usually straightforward. For more advanced disease or those lesions that require significant functional loss, preoperative planning using a multidisciplinary approach, incorporating thoracic surgery, plastic surgery, neurosurgery, radiation medicine, oncology, and physical medicine and rehabilitation, may be essential. PMID:22294939

  8. Reconstruction of full-thickness chest wall defects using rectus abdominis musculocutaneous flap: A report of fifteen cases

    SciTech Connect

    Miyamoto, Y.; Hattori, T.; Niimoto, M.; Toge, T. )

    1986-02-01

    In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe flail chest, and we had successful results in all our cases. These results show that the rectus abdominis musculocutaneous flap is quite effective and safe to use in the reconstruction of chest wall defects.

  9. Multidisciplinary approach to treatment of radiation-induced chest wall sarcoma.

    PubMed

    Kara, H Volkan; Gandolfi, Brad M; Williams, Judson B; D'Amico, Thomas A; Zenn, Michael R

    2016-08-01

    Radiation-induced sarcoma (RIS) is a rare complication following therapeutic external irradiation for lung cancer patients. Patients with RIS may develop recurrence or metastasis of the previous disease and also at high risk for early chest wall complications following operation, which requires close follow-up and multidisciplinary approach. We present a challenging case of RIS with a multidisciplinary teamwork in the decision-making and successful management. PMID:25663293

  10. Case of chest-wall rigidity in a preterm infant caused by prenatal fentanyl administration

    PubMed Central

    Eventov-Friedman, S; Rozin, I; Shinwell, E S

    2010-01-01

    The inability to appropriately ventilate neonates shortly after their birth could be related in rare cases to chest-wall rigidity caused by the placental transfer of fentanyl. Although this adverse effect is recognized when fentanyl is administered to neonates after their birth, the prenatal phenomenon is less known. Treatment with either naloxone or muscle relaxants reverses the fentanyl effect and may prevent unnecessary excessive ventilatory settings. PMID:20118943

  11. SU-E-T-437: Dosimetric Assessment of Brass Mesh Bolus for Postmastectomy Chest Wall Irradiation

    SciTech Connect

    Manger, R; Paxton, A; Cervino, L

    2014-06-01

    Purpose: It has been suggested that the use of a brass mesh bolus for chest wall irradiation sufficiently increases surface dose while having little effect on the dose at depth. This work quantified the increase in surface dose when using a brass mesh bolus in postmastectomy chest wall radiotherapy compared to tissue-equivalent bolus and assessed its effect on dose at depth. Methods: Percent depth doses with brass bolus, 5mm tissue-equivalent bolus, and no bolus were determined for a 6 MV photon beam in a solid water phantom using a parallel plate ionization chamber. Gafchromic film was used to determine the surface dose for the same three experimental setups. For comparison to a realistic treatment setup, gafchromic film and OSLDs were used to determine the surface dose over the irradiated area of a 6 MV chest wall plan with tangential beams delivered to a heterogeneous thorax phantom. The plan was generated using a CT of the phantom and delivered using brass mesh bolus, 5mm tissue-equivalent bolus, and no bolus. Results: For the en face beam, the central surface dose increased to 90% of maximum with the tissue-equivalent bolus, but to only 62% of maximum with the brass mesh. Using tangential beams on the thorax phantom, the surface dose increased from 40–72% to 75–110% of prescribed dose, with the brass mesh, and to 85–109% with the tissue-equivalent bolus. At depths beyond dmax in the plastic water phantom, the dose with and without brass mesh bolus differed by less than 0.5%. Conclusion: A brass mesh may be considered as a substitute for tissue-equivalent bolus to increase the superficial dose of 6 MV chest wall tangent plans. The brass mesh does not significantly change the dose at depth, so a non-bolus plan could be used for bolus and non-bolus treatments.

  12. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher.

    PubMed

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-Ichi; Watanabe, Kazuyuki; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

    2016-06-01

    Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes. PMID:26983590

  13. Long-term survival after chest-wall reconstruction with musculocutaneous flaps

    SciTech Connect

    Kroll, S.S.; Schusterman, M.A.; Larson, D.L.; Fender, A. )

    1990-10-01

    Reconstruction of chest-wall defects with musculocutaneous flaps permits resection of advanced chest-wall tumors and of tissues severely damaged by radiotherapy in patients who in a previous era were not surgically treatable. To determine the long-term outcome from this surgery, the records of 96 patients who had undergone chest-wall resection with musculocutaneous flap reconstruction were reviewed. Median survival for the entire group was 20.5 months, but a more accurate prediction of outcome could be obtained by dividing the patients into three groups. In group I, patients free of known malignancy and undergoing resection of radionecrotic tissues, median survival was 60.0 months. In group II, patients with resectable disease and free of tumor following surgery, median survival was 31.1 months. In group III, patients incompletely resected or known to have metastatic disease following surgery, median survival was only 12.5 months. Even in group III, however, some individuals achieved prolonged survival and lasting benefits from the surgery, so these data should not be used to exclude patients from undergoing necessary palliative procedures.

  14. Surgical treatment of 125 patients with non-small cell lung cancer and chest wall involvement.

    PubMed Central

    Pitz, C. C.; Brutel de la Rivière, A.; Elbers, H. R.; Westermann, C. J.; van den Bosch, J. M.

    1996-01-01

    BACKGROUND: The optimum operative procedure for lung cancer with chest wall invasion (T3) remains controversial. In this study results of en bloc resection and extrapleural dissection are reviewed to determine survival characteristics. METHODS: Between 1977 and 1993 125 patients underwent surgery for primary non-small cell lung cancer with chest wall invasion. Patients with superior sulcus tumours, metastatic carcinomas, synchronous tumours, or recurrences were excluded. Extrapleural dissection was performed in 73 patients and en bloc resection (range 1-4 ribs) in 52. Resection was regarded as complete in 86 and incomplete in 39 patients. Actuarial survival time was estimated and risk factors for late death were identified. RESULTS: Hospital mortality was 3.2%. (n = 4). Estimated mean five year survival was 24% for all hospital survivors (n = 121), 11% for patients with incomplete resection, and 29% for patients having a complete resection. In patients who underwent complete resection mediastinal lymph node involvement and intrapleural tumour spill worsened the prognosis. Patients with adenocarcinoma had a better chance of long term survival. No relationship was found between survival and age, type of operative procedure, depth of chest wall invasion, and postoperative radiotherapy. CONCLUSIONS: Both operative procedures show reasonable survival results. Incomplete resection, mediastinal lymph node involvement, and intrapleural tumour spill adversely influence survival. PMID:8795676

  15. Reconstruction of the sternum and chest wall with methyl methacrylate: CT and MRI appearance.

    PubMed

    Gayer, G; Yellin, A; Apter, S; Rozenman, Y

    1998-01-01

    The aim of our study was to define the appearance of methyl methacrylate grafts replacing resected sternum and ribs on CT and MRI and how the sternal graft may mimic an abnormally sclerotic sternum on CT images. We reviewed the CT scans of nine patients who had undergone chest wall resection (eight with malignant and one with benign disease) and reconstruction with a composite of methyl methacrylate and Marlex mesh graft. One of them had an MRI study as well. The size, shape and CT attenuation were assessed on mediastinal and bone window settings. The sternal graft was seen on mediastinal and even better on bone windows as an abnormally wide, irregularly shaped structure, somewhat denser than the normal sternum. The chest wall prosthesis replacing resected ribs was seen as a continuous dense structure and of similar attenuation as that of the sternal graft. On MRI the prosthesis appeared as a well-defined structure with no signal. Reconstruction of the chest wall with methyl methacrylate appears on CT as a diffusely dense sclerotic bone lesion not unlike a malignant lesion. The possibility of a graft has to be included in the differential diagnosis in these cases. PMID:9477274

  16. Color structured light system of chest wall motion measurement for respiratory volume evaluation

    NASA Astrophysics Data System (ADS)

    Chen, Huijun; Cheng, Yuan; Liu, Dongdong; Zhang, Xiaodong; Zhang, Jue; Que, Chengli; Wang, Guangfa; Fang, Jing

    2010-03-01

    We present a structured light system to dynamically measure human chest wall motion for respiratory volume estimation. Based on a projection of an encoded color pattern and a few active markers attached to the trunk, respiratory volumes are obtained by evaluating the 3-D topographic changes of the chest wall in an anatomically consistent measuring region during respiration. Three measuring setups are established: a single-sided illuminating-recording setup for standing posture, an inclined single-sided setup for supine posture, and a double-sided setup for standing posture. Results are compared with the pneumotachography and show good agreement in volume estimations [correlation coefficient: R>0.99 (P<0.001) for all setups]. The isovolume tests present small variations of the obtained volume during the isovolume maneuver (standard deviation<0.085 L for all setups). After validation by the isovolume test, an investigation of a patient with pleural effusion using the proposed method shows pulmonary functional differences between the diseased and the contralateral sides of the thorax, and subsequent improvement of this imbalance after drainage. These results demonstrate the proposed optical method is capable of not only whole respiratory volume evaluation with high accuracy, but also regional pulmonary function assessment in different chest wall behaviors, with the advantage of whole-field measurement.

  17. Estimating adipose tissue in the chest wall using ultrasonic and alternate /sup 40/K and biometric measurements

    SciTech Connect

    Anderson, A.L.; Campbell, G.W.

    1982-01-22

    The percentage of adipose (fat) tissue in the chest wall must be known to accurately measure Pu in the human lung. Correction factors of 100% or more in x-ray detection efficiency are common. Methods using simple /sup 40/K and biometric measurement techniques were investigated to determine the adipose content in the human chest wall. These methods predict adipose content to within 15% of the absolute ultrasonic value. These new methods are discussed and compared with conventional ultrasonic measurement techniques. (ERB)

  18. Transcatheter Arterial Embolization for Tumor Seeding in the Chest Wall After Radiofrequency Ablation for Hepatocellular Carcinoma

    SciTech Connect

    Shibata, Toshiya Shibata, Toyomichi; Maetani, Yoji; Kubo, Takeshi; Nishida, Naoshi; Itoh, Kyo

    2006-06-15

    Tumor seeding in the chest wall was depicted at follow-up CT obtained 9 months after radiofrequency ablation for hepatocellular carcinoma. Transcatheter arterial embolization was successfully performed, injecting emulsion of 10 mg of epirubicin and 1 ml of iodized oil followed by gelatin sponge particles via the microcatheter placed in the right eleventh intercostal artery. The patient died of tumor growth in the liver one year after the embolization, but no progression of the tumor seeding was noted during the follow-up period. We conclude that transcatheter arterial embolization was effective for the control of tumor seeding after radiofrequency ablation for hepatocellular carcinoma.

  19. [Castleman's Disease of the Chest Wall Successfully Resected by Thoracoscopic Surgery;Report of a Case].

    PubMed

    Naomi, Akira; Kuroda, Hiroaki; Seto, Katsutoshi; Iiduka, Shuhei; Dejima, Hitoshi; Mizuno, Tetsuya; Sakakura, Noriaki; Sakao, Yukinori

    2015-12-01

    A 61-year-old woman without a significant past medical history was pointed out the abnormal shadow on the annual medical checkup. Chest computed tomography (CT) revealed a well-defined paravertebral chest wall tumor of 20 mm in maxmum size. Furthermore, diffusion weighted image on magnetic resonance imaging (MRI) showed high intensity, and standardized uptake value (SUV) max on positron emission tomography/computed tomography (PET/CT) was 13.4. Schwanoma, solitary fibrous tumor (SFT) or malignant lymphoma was suggested. Complete resection was performed with thoracoscopic surgery. The histological diagnosis was Castleman's disease with hyalineized type. PMID:26759958

  20. Fireworks-induced chest wall granulomatous disease: 18F-FDG PET/CT imaging.

    PubMed

    Le, Stephanie T; Nguyen, Ba Duong

    2014-04-01

    The authors present a case of 18F-FDG-avid granulomatous reaction induced by fireworks injury of the chest wall in a patient with esophageal adenocarcinoma. This hypermetabolic lesion, involving the right pectoralis muscles, appeared slightly more prominent on restaging PET/CT imaging following chemotherapy and radiation therapy. Excisional biopsy of the lesion established the diagnosis of foreign-body granulomatous-type inflammation with surrounding foci of non-polarizable black foreign material and ruled out malignancy. The patient recalled accidentally shooting himself in the chest with a Roman candle at the age of 3. PMID:23877517

  1. The Etiologies of Chest Wall and Breast Asymmetry and Improvement in Breast Augmentation.

    PubMed

    Glicksman, Caroline A; Ferenz, Sarah E

    2015-10-01

    Patients presenting for correction of breast and chest wall asymmetries may have undergone numerous thoracic procedures in early childhood and may have suffered profound psychosocial effects. Complex congenital syndromes as well as mild breast asymmetries should be carefully documented using objective measurements, photography, and 3-dimensional simulations when available. Shaped highly cohesive breast implants offer plastic surgeons more possibilities and precision by fine-tuning the gel distribution and specific volumes required to correct the hypoplastic elements. Long-lasting correction of asymmetry can be obtained when patients are not oversized, and care is taken to avoid visibility, palpability, and malposition problems. PMID:26408441

  2. Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

    SciTech Connect

    Yang, Bo; Wei, Xian-ding; Zhao, Yu-tian; Ma, Chang-Ming

    2014-07-01

    To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16 Gy) and 9-MeV electrons (34 Gy) for the upper supraclavicular region. The common prescription dose was 50 Gy/25 Fx/5 W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V{sub 30} of the ipsilateral lung and V{sub 10}, V{sub 30}, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V{sub 5} and V{sub 10} of the ipsilateral lung and V{sub 5} of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.

  3. Factors Associated With Chest Wall Toxicity After Accelerated Partial Breast Irradiation Using High-Dose-Rate Brachytherapy

    SciTech Connect

    Brown, Sheree; Vicini, Frank; Vanapalli, Jyotsna R.; Whitaker, Thomas J.; Pope, D. Keith; Lyden, Maureen; Bruggeman, Lisa; Haile, Kenneth L.; McLaughlin, Mark P.

    2012-07-01

    Purpose: The purpose of this analysis was to evaluate dose-volume relationships associated with a higher probability for developing chest wall toxicity (pain) after accelerated partial breast irradiation (APBI) by using both single-lumen and multilumen brachytherapy. Methods and Materials: Rib dose data were available for 89 patients treated with APBI and were correlated with the development of chest wall/rib pain at any point after treatment. Ribs were contoured on computed tomography planning scans, and rib dose-volume histograms (DVH) along with histograms for other structures were constructed. Rib DVH data for all patients were sampled at all volumes {>=}0.008 cubic centimeter (cc) (for maximum dose related to pain) and at volumes of 0.5, 1, 2, and 3 cc for analysis. Rib pain was evaluated at each follow-up visit. Patient responses were marked as yes or no. No attempt was made to grade responses. Eighty-nine responses were available for this analysis. Results: Nineteen patients (21.3%) complained of transient chest wall/rib pain at any point in follow-up. Analysis showed a direct correlation between total dose received and volume of rib irradiated with the probability of developing rib/chest wall pain at any point after follow-up. The median maximum dose at volumes {>=}0.008 cc of rib in patients who experienced chest wall pain was 132% of the prescribed dose versus 95% of the prescribed dose in those patients who did not experience pain (p = 0.0035). Conclusions: Although the incidence of chest wall/rib pain is quite low with APBI brachytherapy, attempts should be made to keep the volume of rib irradiated at a minimum and the maximum dose received by the chest wall as low as reasonably achievable.

  4. Chest wall deformities and thoracic scoliosis after costal cartilage graft harvesting.

    PubMed

    Ohara, K; Nakamura, K; Ohta, E

    1997-04-01

    Donor-site complications, specifically chest wall deformities and thoracic scoliosis, occurring after harvest of costal cartilage grafts are presented and discussed. The cases of 18 patients (12 male and 6 female), who underwent costal cartilage grafts for microtia reconstruction from 1975 to 1993, were reviewed for donor-site complications using radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 16 of 32 donor sites. The frequency of rib deformity in donor sites was 20.0 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 63.6 percent in patients younger than 10 years old. This difference was statistically significant (p = 0.027, Fisher's exact test), although only 32 grafts were performed in 18 cases. The upper ribs demonstrate a higher incidence of deformity than lower ribs. Thoracic scoliosis was found in 4 of 16 cases. The biomechanical impact of these deformities was considered because of respiratory movement of the thorax and injury to the germinal growth center of the ribs. We recommend delaying costal cartilage grafts for as long as possible, leaving the costochondral junction intact to minimize chest wall deformity and thoracic scoliosis. PMID:9091899

  5. Compartmental chest wall volume changes during volitional hyperpnoea with constant tidal volume in healthy individuals.

    PubMed

    Illi, Sabine K; Hostettler, Stefanie; Aliverti, Andrea; Spengler, Christina M

    2013-01-15

    Prolonged high-intensity ventilation is associated with the development of rapid shallow breathing with decreased end-inspiratory volumes of all chest wall compartments. During respiratory muscle endurance training using normocapnic hyperpnoea, tidal volume (V(T)) is normally kept constant. The aim of this study was to investigate possible changes in muscle recruitment during constant-V(T) hyperpnoea, to assess potential mechanisms related to rapid shallow breathing. Ten healthy subjects performed 1h of normocapnic hyperpnoea at 70% of maximal voluntary ventilation. Chest wall volume changes were assessed by optoelectronic plethysmography. End-inspiratory (1.08 ± 0.18 versus 0.96 ± 0.27 l, p=0.017) and end-expiratory volumes (-0.13 ± 0.15 versus -0.31 ± 0.19 l, p=0.007) of the pulmonary ribcage decreased significantly and lung function and respiratory muscle strength were reduced (all p<0.05). Since with forced, constant V(T) only the inspiratory rib cage muscles were unable to sustain end-inspiratory volume of their compartment, inspiratory rib cage muscles are the most likely candidate responsible for the development of rapid shallow breathing. PMID:22959999

  6. Assessment of skin dose for breast chest wall radiotherapy as a function of bolus material

    NASA Astrophysics Data System (ADS)

    Hsu, Shu-Hui; Roberson, Peter L.; Chen, Yu; Marsh, Robin B.; Pierce, Lori J.; Moran, Jean M.

    2008-05-01

    Skin dose assessment for chest wall radiotherapy is important to ensure sufficient dose to the surface target volume without excessive skin reaction. This study quantified changes to the surface doses as a function of bolus material for conventional and intensity modulated radiation therapy (IMRT) tangential fields. Three types of bolus materials (2 mm solid, 2 mm fine mesh and 3.2 mm large mesh Aquaplast) were compared with Superflab. Surface dose measurements were performed using an Attix parallel plate chamber in a flat solid water phantom at 0°, 45° and 70° incident angles. Over-response correction factors were applied to the Attix chamber results for different incident angles. Surface dose measurements on an anthropomorphic phantom were done using a thermoluminescent dosimeter extrapolation method. Dose characteristics of Superflab and solid Aquaplast were within 2% of solid water material. No significant differences (within 3%) in the surface dose were found between conventional and IMRT tangential techniques. The bolus effect was large for chest wall tangential radiotherapy, with up to an 82% increase using 2 mm fine mesh Aquaplast. The dosimetric effect of different Aquaplast materials has been quantified in this work. These materials can be used to create a custom bolus with potentially better reproducibility of placement.

  7. Chest wall hernia induced by high intensity focused ultrasound treatment of unresectable massive hepatocellular carcinoma: A case report

    PubMed Central

    CHEN, QI-WEN; TENG, WEN-JING; CHEN, QIAN

    2016-01-01

    In the present study, a case of unresectable massive hepatocellular carcinoma (HCC) treated with high intensity focused ultrasound (HIFU) alone is reported. Although the treatment induced chest wall hernia, its efficacy in treating the HCC was demonstrated. The medical records of a patient with an unresectable massive tumor that was effectively treated with serial HIFU ablation were retrospectively studied. Chest wall hernia was detected as a complication of the HIFU treatment, which has not been reported thus far in the literature. The patient has survived for 44 months since the first diagnosis in September 2010. Treatment resulted in partial remission of the tumor, pain relief, decreased levels of alpha-fetoprotein and chest wall hernia, as a complication. Therefore, HIFU may be an effective approach for the treatment of unresectable HCC, although it may occasionally cause complications. PMID:27347191

  8. Chest wall thickness in military personnel: implications for needle thoracentesis in tension pneumothorax.

    PubMed

    Harcke, H Theodore; Pearse, Lisa A; Levy, Angela D; Getz, John M; Robinson, Stephen R

    2007-12-01

    Needle thoracentesis is an emergency procedure to relieve tension pneumothorax. Published recommendations suggest use of angiocatheters or needles in the 5-cm range for emergency treatment. Multidetector computed tomography scans from 100 virtual autopsy cases were used to determine chest wall thickness in deployed male military personnel. Measurement was made in the second right intercostal space at the midclavicular line. The mean horizontal thickness was 5.36 cm (SD = 1.19 cm) with angled (perpendicular) thickness slightly less with a mean of 4.86 cm (SD 1.10 cm). Thickness was generally greater than previously reported. An 8-cm angiocatheter would have reached the pleural space in 99% of subjects in this series. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length. PMID:18274025

  9. [Sudden death caused by a less lethal weapon chest-wall injury (Commotio cordis)].

    PubMed

    Contargyris, C; Peytel, E

    2012-05-01

    Less lethal weapons, like Flashball, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries. PMID:22487658

  10. Malignant triton tumor of the chest wall invading the lung. A case report and literature review

    PubMed Central

    Kamperis, E; Barbetakis, N; Asteriou, C; Kleontas, A; Christoforidou, V

    2013-01-01

    Background: Malignant triton tumor (MTT) is an histological deviation of malignant peripheral nerve sheath tumor with additional rhabdomyosarcomatous elements. It is very rare, profoundly aggressive, with a tendency to recur locally and metastasize early. If manifests itself more often in individuals with neurofibromatosis type I (NF-1) disease but also sporadically or post radiotherapy. Description of case: A 57-year-old male was admitted with a history of malignant triton tumor of the chest wall. Despite prior aggressive locoregional treatment including wide excision and adjuvant consolidating radiotherapy, the tumor recurred. The patient underwent a new operation and systemic chemotherapy, but expired a few months later due to disease progression. Conclusion: MTT is exceedingly malignant requiring multimodality treatment. The cornerstone of management is radical surgical resection with clear margins. Nevertheless, the overall prognosis remains dismal. PMID:24470743

  11. Validation of an Objective Assessment Instrument for Non-Surgical Treatments of Chest Wall Deformities.

    PubMed

    Obeid, Mohammad F; Kidane, Nahom; Rechowicz, Krzysztof J; Chemlal, Salim; Kelly, Robert E; Mckenzie, Frederic D

    2016-01-01

    Depending on the severity of the condition and associated risk, surgical intervention may not always be the first choice. This is true for treating chest wall deformities such as pectus excavatum and pectus carinatum. For both conditions, novel non-surgical treatments have been developed to gradually alleviate the malformation making use of the elastic nature of the costal cartilages at an early age of the patient. To quantify the performance of such treatments, this paper introduces and discusses the development of a software-based instrument that utilizes 3D chest optical images (surface scans) as input and uses registration techniques to produce an objective gauge of a patient's physical improvement after undergoing treatments. Further discussed is an experiment designed to investigate the construct validity of the developed instrument. PMID:27046591

  12. High-Frequency Chest Wall Oscillation Successful in Controlling Refractory Asthma

    PubMed Central

    BOSE, SONALI; JUN, JONATHAN; DIETTE, GREGORY B.

    2016-01-01

    Introduction High-frequency chest wall oscillation (HFCWO) has been traditionally implemented for airway secretion clearance in conditions such as cystic fibrosis (CF) and bronchiectasis. There have been few reports of its use in refractory asthma. Case report A 36-year-old, non-smoker male presented with a lifelong history of poorly controlled asthma. Despite multiple controller medications, he reported daily chest congestion, copious phlegm, and frequent exacerbations. Imaging, blood work, and bronchoscopy ruled out atypical infections, immunodeficiency, CF, and other chronic conditions. Pulmonary function tests supported a diagnosis of asthma. Results We initiated HFCWO therapy twice daily in addition to standard inhaled pharmacological therapy. After 2 months, the patient noted resolution of respiratory symptoms as well as improvement in lung function. He remained symptom-free at his 2-year follow-up. Conclusion High-frequency chest oscillation may be useful in phenotypes of asthma characterized by prominent mucus hypersecretion. PMID:23394251

  13. Plasma Cell Leukemia Presenting as a Chest Wall Mass: A Case Report

    PubMed Central

    Ali, Ahmed; Paul, Yonette; Nwabudike, Stanley Madu; Ogbonna, Onyekachi; Grantham, Mica; Taddesse-Heath, Lekidelu

    2016-01-01

    Plasma cell leukemia (PCL) is an uncommon neoplasm of plasma cells, with an aggressive clinical course and poor outcome, even with current standard of care. It can occur either de novo (primary PCL) or as a progression of multiple myeloma (MM). This disease has unique diagnostic criteria but certain genetic markers and clinical features may overlap with MM. Due to the low prevalence of PCL, guidelines on its management are extrapolated from the management of MM and based on small retrospective studies and cases reports/series. We present an interesting case of PCL in a middle-aged African-American male, who was diagnosed incidentally after chest wall imaging for an unrelated complaint. The diagnostic approach, management and outcomes of PCL are discussed. PMID:27462235

  14. Carcinoma originating from aberrant breast tissue of the right upper anterior chest wall : a case report.

    PubMed Central

    Rho, J. Y.; Juhng, S. K.; Yoon, K. J.

    2001-01-01

    Aberrant breast tissue is usually found in proximity to the normal breast, that is, in the axillary, sternal or clavicular regions. Carcinoma occurs more frequently in the aberrant tissue of the axilla than the extra-axillary site though the overall incidence of tumors of aberrant breast tissue is low. To our knowledge, studies regarding the carcinoma of aberrant breast tissue of the extra-axillary site have been reported rarely. Here we report a recent case of carcinoma originating from the extra-axillary aberrant breast tissue, presenting as a subcutaneous nodule on the right upper anterior chest wall. It is suggested that subcutaneous nodules of uncertain origin around the periphery of the breast should be suspected for breast carcinoma as a differential diagnosis and treated properly. PMID:11511802

  15. Laser based method for real-time three-dimensional monitoring of chest wall movement

    NASA Astrophysics Data System (ADS)

    Jezeršek, Matija; Povšič, Klemen; Topole, Eva; Fležar, Matjaž; Možina, Janez

    2010-05-01

    Novel method for monitoring the entire three-dimensional shape of the chest wall in real time is presented. The system is based on the multiple-line laser triangulation principle. The laser projector generates a light pattern of 33 equally inclined light planes directed toward the measured surface. The camera records the illuminated surface from a different viewpoint, and consequently, the light pattern is distorted by the shape of the surface. The acquired images are transferred in the personal computer, where contour detection, three-dimensional surface reconstruction, shape analysis, and displaying are performed in real time. Surface displacements are calculated by subtraction of the current measured surface from the reference one. Differences are displayed with color palette, where the blue represent the inward (negative) and the red represent the outward (positive) movement. The accuracy of the calibrated apparatus is +/-0.5 mm, which is calculated as a standard deviation between points of the measured and nominal reference surface. The measuring range is approximately 400×600×500 mm in width, height and depth. The intention of this study was to evaluate the system by means of its ability to distinguish between different breathing patterns and to verify the accuracy of measuring chest wall deformation volumes during breathing. The results demonstrate that the presented 3-d measuring system has a great potential as a diagnostic and training tool in case of monitoring the breathing pattern. We believe that exact graphical communication with the patient is much more simple and easy to understand than verbal and/or numerical.

  16. Chest Wall Ewing Sarcoma Family of Tumors: Long-Term Outcomes

    SciTech Connect

    Indelicato, Daniel J.; Keole, Sameer R.; Lagmay, Joanne P.; Morris, Christopher G.; Gibbs, C. Parker; Scarborough, Mark T.; Islam, Saleem; Marcus, Robert B.

    2011-09-01

    Purpose: To review the 40-year University of Florida experience treating Ewing sarcoma family of tumors of the chest wall. Methods and Materials: Thirty-nine patients were treated from 1966 to 2006. Of the patients, 22 were treated with radiotherapy (RT) alone, and 17 patients were treated with surgery with or without RT. Of 9 patients with metastatic disease, 8 were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 16.6 years, and the most frequent primary site was the rib (n = 17). The median potential follow-up was 19.2 years. Results: The 5-year actuarial overall survival (OS), cause-specific survival (CSS), and local control (LC) rates were 34%, 34%, and 72%, respectively. For the nonmetastatic subset (n = 30), the 5-year OS, CSS, and LC rates were 44%, 44%, and 79%, respectively. LC was not statistically significantly different between patients treated with RT alone (61%) vs. surgery + RT (75%). None of the 4 patients treated with surgery alone experienced local failure. No patient or treatment variable was significantly associated with local failure. Of the patients, 26% experienced Common Toxicity Criteria (CTC) Grade 3+ toxicity, including 2 pulmonary deaths. Modern intensive systemic therapy helped increase the 5-year CSS from 7% to 49% in patients treated after 1984 (p = 0.03). Conclusions: This is the largest single-institution series describing the treatment of chest wall Ewing tumors. Despite improvements in survival, obtaining local control is challenging and often accompanied by morbidity. Effort should be focused on identifying tumors amenable to combined-modality local therapy and to improving RT techniques.

  17. Biometric estimation of chest wall thickness of female radiation workers as an aid in in-vivo detection of the actinides

    SciTech Connect

    Lane, B.H.; Berger, C.D.

    1983-01-01

    An equation was derived to estimate female chest wall thickness from a series of biometric measurements. This technique will result in improved performance for actinide detection in females by accounting for variations in chest wall thickness in derivation of calibration factors.

  18. Effects of chest wall compression on expiratory flow rates in patients with chronic obstructive pulmonary disease

    PubMed Central

    Nozoe, Masafumi; Mase, Kyoshi; Ogino, Tomoyuki; Murakami, Shigefumi; Takashima, Sachie; Domen, Kazuhisa

    2016-01-01

    Background: Manual chest wall compression (CWC) during expiration is a technique for removing airway secretions in patients with respiratory disorders. However, there have been no reports about the physiological effects of CWC in patients with chronic obstructive pulmonary disease (COPD). Objective: To compare the effects of CWC on expiratory flow rates in patients with COPD and asymptomatic controls. Method: Fourteen subjects were recruited from among patients with COPD who were receiving pulmonary rehabilitation at the University Hospital (COPD group). Fourteen age-matched healthy subjects were also consecutively recruited from the local community (Healthy control group). Airflow and lung volume changes were measured continuously with the subjects lying in supine position during 1 minute of quiet breathing (QB) and during 1 minute of CWC by a physical therapist. Results: During CWC, both the COPD group and the healthy control group showed significantly higher peak expiratory flow rates (PEFRs) than during QB (mean difference for COPD group 0.14 L/sec, 95% confidence interval (CI) 0.04 to 0.24, p<0.01, mean difference for healthy control group 0.39 L/sec, 95% CI 0.25 to 0.57, p<0.01). In the between-group comparisons, PEFR was significantly higher in the healthy control group than in the COPD group (-0.25 L/sec, 95% CI -0.43 to -0.07, p<0.01). However, the expiratory flow rates at the lung volume at the PEFR during QB and at 50% and 25% of tidal volume during QB increased in the healthy control group (mean difference for healthy control group 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.27 L/sec, 95% CI 0.13 to 0.41, p<0.01, respectively) but not in the COPD group (0.05 L/sec, 95% CI -0.01 to 0.12: -0.01 L/sec, 95% CI -0.11 to 0.08: 0.02 L/sec, 95% CI -0.05 to 0.90) with the application of CWC. Conclusion: The effects of chest wall compression on expiratory flow rates was different between COPD patients and asymptomatic

  19. Measurement of radiotherapy x-ray skin dose on a chest wall phantom.

    PubMed

    Quach, K Y; Morales, J; Butson, M J; Rosenfeld, A B; Metcalfe, P E

    2000-07-01

    Sufficient skin dose needs to be delivered by a radiotherapy chest wall treatment regimen to ensure the probability of a near surface tumor recurrence is minimized. To simulate a chest wall treatment a hemicylindrical solid water phantom of 7.5 cm radius was irradiated with 6 MV x-rays using 20x20 cm2 and 10x20 cm2 fields at 100 cm source surface distance (SSD) to the base of the phantom. A surface dose profile was obtained from 0 to 180 degrees, in 10 degrees increments around the circumference of the phantom. Dosimetry results obtained from radiochromic film (effective depth of 0.17 mm) were used in the investigation, the superficial doses were found to be 28% (of Dmax) at the 0 degrees beam entry position and 58% at the 90 degrees oblique beam position. Superficial dose results were also obtained using extra thin thermoluminescent dosimeters (TLD) (effective depth 0.14 mm) of 30% at 0 degrees, 57% at 90 degrees, and a metal oxide semiconductor field effect transistor (MOSFET) detector (effective depth 0.5 mm) of 43% at 0 degrees, 62% at 90 degrees. Because the differences in measured superficial doses were significant and beyond those related to experimental error, these differences are assumed to be mostly attributable to the effective depth of measurement of each detector. We numerically simulated a bolus on/bolus off technique and found we could increase the coverage to the skin. Using an alternate "bolus on," "bolus off" regimen, the skin would receive 36.8 Gy at 0 degrees incidence and 46.4 Gy at 90 degrees incidence for a prescribed midpoint dose of 50 Gy. From this work it is evident that, as the circumference of the phantom is traversed the SSD increases and hence there is an inverse square fluence fall-off, this is more than offset by the increase in skin dose due to surface curvature to a plateau at about 90 degrees. Beyond this angle it is assumed that beam attenuation through the phantom and inverse square fall-off is causing the surface dose to

  20. Impedance learning for robotic contact tasks using natural actor-critic algorithm.

    PubMed

    Kim, Byungchan; Park, Jooyoung; Park, Shinsuk; Kang, Sungchul

    2010-04-01

    Compared with their robotic counterparts, humans excel at various tasks by using their ability to adaptively modulate arm impedance parameters. This ability allows us to successfully perform contact tasks even in uncertain environments. This paper considers a learning strategy of motor skill for robotic contact tasks based on a human motor control theory and machine learning schemes. Our robot learning method employs impedance control based on the equilibrium point control theory and reinforcement learning to determine the impedance parameters for contact tasks. A recursive least-square filter-based episodic natural actor-critic algorithm is used to find the optimal impedance parameters. The effectiveness of the proposed method was tested through dynamic simulations of various contact tasks. The simulation results demonstrated that the proposed method optimizes the performance of the contact tasks in uncertain conditions of the environment. PMID:19696001

  1. A Simple and Robust Event-Detection Algorithm for Single-Cell Impedance Cytometry.

    PubMed

    Caselli, Federica; Bisegna, Paolo

    2016-02-01

    Microfluidic impedance cytometry is emerging as a powerful label-free technique for the characterization of single biological cells. In order to increase the sensitivity and the specificity of the technique, suited digital signal processing methods are required to extract meaningful information from measured impedance data. In this study, a simple and robust event-detection algorithm for impedance cytometry is presented. Since a differential measuring scheme is generally adopted, the signal recorded when a cell passes through the sensing region of the device exhibits a typical odd-symmetric pattern. This feature is exploited twice by the proposed algorithm: first, a preliminary segmentation, based on the correlation of the data stream with the simplest odd-symmetric template, is performed; then, the quality of detected events is established by evaluating their E2O index, that is, a measure of the ratio between their even and odd parts. A thorough performance analysis is reported, showing the robustness of the algorithm with respect to parameter choice and noise level. In terms of sensitivity and positive predictive value, an overall performance of 94.9% and 98.5%, respectively, was achieved on two datasets relevant to microfluidic chips with very different characteristics, considering three noise levels. The present algorithm can foster the role of impedance cytometry in single-cell analysis, which is the new frontier in "Omics." PMID:26241968

  2. Surgical treatment of T3 lung cancer invading the chest wall.

    PubMed

    Beltrami, V; Bezzi, M; Illuminati, G; Forte, A; Angelici, A; Bertagni, A; Ciulli, A; Gallinaro, L; Lorenzotti, A; Montesano, G; Palumbo, P G; Prece, V

    1999-01-01

    Lung tumors invading the chest wall are classed as belonging to the T3 group and are considered potentially resectable. Their management, however, is controversial, and extrapleural resection, when possible, is preferred to en bloc resection which is regarded as a far more invasive and dangerous operation. Five year survival rates for completely resected cases range in the literature from 25 to 35%, but survival rates are much worse if lymph node metastases are present. These poor outcomes have prompted the development of combined surgical approaches: preoperative radiation therapy, with or without chemotherapy, has been used with an improvement in resectability rates, but only modest results in terms of median survival; in a number of case series, increased operative morbidity and mortality have been reported with this approach. The present report relates to 122 patients treated by en bloc (20 cases) or extrapleural (102 cases) resection, 31 of whom also received neoadjuvant treatment. The operative mortality was 4.6%. Median survival was 17 months after en bloc resection and 19 months after extrapleural resection. Though no statistically significant difference was found, extrapleural resection would appear to yield better results than the en bloc procedure. PMID:10742890

  3. Lung volumes, chest wall configuration, and pattern of breathing in microgravity.

    PubMed

    Paiva, M; Estenne, M; Engel, L A

    1989-10-01

    We studied the changes in functional residual capacity (FRC), thoracoabdominal volume (Vw), and chest wall configuration in five normal subjects seated in an aircraft flying parabolic trajectories resulting in 20-s periods of microgravity. We measured vital capacity (VC), inspiratory capacity, and tidal volume by integrating airflow at the mouth and changes in rib cage and abdominal volume (delta Vrc and delta Vab, respectively, where delta Vrc + delta Vab = delta Vw) using induction plethysmography. During microgravity (0 Gz) FRC decreased by 413 +/- 70 (SE) ml and VC by 0.37 liter. The decrease in Vw did not differ from that in FRC and was entirely the result of reduction of Vab, the Vrc showing no significant change. During tidal breathing the abdominal contribution (delta Vab/delta Vw) increased from 0.39 +/- 0.08 at 1 Gz to 0.57 +/- 0.08 at 0 Gz. During brief periods of hypergravity (approximately 1.8 Gz) all changes were opposite in sign and relatively smaller. Limited data during "roller coaster" flight patterns suggested that, in contrast to configurational changes, the temporal pattern of breathing was uninfluenced by changes in Gz. We conclude that at the onset of weightlessness there are substantial changes in lung volume and thoracoabdominal configuration. Abdominal contribution to tidal excursions increases but the temporal pattern of breathing is unchanged. PMID:2793756

  4. Sonic phase delay from trachea to chest wall: spatial and inhaled gas dependency.

    PubMed

    Patel, S; Lu, S; Doerschuk, P C; Wodicka, G R

    1995-07-01

    A parametric phase delay estimation technique is used to determine the spatial and inhaled gas composition dependencies of sound propagation time through an intact human lung at frequencies of 150-1200 Hz. Noise transmission measurements from the mouth to the extrathoracic trachea and six sites on the posterior chest wall are performed in 11 healthy adult subjects at resting lung volume after equilibration with air, an 80% helium-20% oxygen mixture, and an 80% sulfurhexafluoride-20% oxygen mixture. The phase delay, tau(f), exhibits a bilateral asymmetry with relatively decreased delays to the left posterior chest as compared with the right. The phase delay to lower lung sites is greater than to upper sites at frequencies below 300 Hz; yet the opposite is found at higher frequencies, indicating changing propagation pathways with frequency. There is no measurable effect of inhaled gas composition on tau(f) below 300 Hz. At higher frequencies, changes in tau(f) that reflect the relative sound speed of the particular inhaled gas are observed. These findings support and extend previous measurements and hypotheses concerning the strong frequency dependence of the acoustical properties of the intact respiratory system. PMID:7475389

  5. Actinomycetoma of the chest wall attributed to Nocardia nova after reconstructive surgery.

    PubMed

    Antunes, Joana; Pacheco, David; Travassos, Rita; Sequeira, Hortênsia; Filipe, Paulo; Marques, Manuel Sacramento

    2012-01-01

    A 29-year-old man, presented with multiple ulcers, nodules, abscesses, fistulae, and atrophic scars, over the right chest wall. Six years prior, the patient had a car accident, which resulted in skin loss of the right arm, shoulder, thoracic wall. In addition, he suffered a supracondylar fracture; orthopedic surgery and skin grafts were required. Material discharging from sinus tracts was obtained for mycological and bacteriological studies. Direct microscopic examination revealed small white grains. Cultures on Sabouraud and Lowenstein-Jensen media isolated orange-white colonies suggestive of Nocardia. PCR assay identified Nocardia nova. Thoracic and right upper limb CT showed signs of chronic osteomyelitis. Treatment with imipenem/cilastatin for 8 weeks, followed by amoxicillin clavulanate for 6 months, resulted in healing of lesions and improvement in the patient's general health. Primary cutaneous nocardiosis remains a diagnostic challenge. Nocardia are soil-borne filamentous gram-positive bacteria. Identification of characteristic granules on examination of discharge smears from discharge or tissue biopsy is essential for diagnosing mycetoma. Because grain discharge is discontinuous, multiple clinical specimens should be submitted for microscopic examination and culture. Sulfonamides have been the mainstay of Nocardia actinomycetoma treatment. However, our patient's strain was resistant to Co-trimoxazole. Therefore, treatment with imipenem followed by amoxicillin clavulanate was favored, with good clinical and analytical response. PMID:22301041

  6. Mesenchymal Hamartoma of Chest Wall in an Infant: Mimicking Persistent Pneumonia

    PubMed Central

    Singh, Amitabh; Pai, Gautham; Dawman, Lesa; Satapathy, Amit

    2015-01-01

    Mesenchymal Hamartoma of the chest wall (MHCW) is a very rare benign tumour. They are usually discovered in infancy. Spontaneous regression is known to occur in this benign condition. Management is surgical removal of mass if respiratory compromise is present. Conservative management is preferred modality in asymptomatic children as malignant transformation is not reported. Herein, we present a case of MHCW in a 5 month old infant presenting with acute respiratory distress with history of respiratory problem at 3 months of age. Child was suspected to have persistent pneumonia in view of radiological findings. Child’s respiratory distress improved with antibiotics and bronchodilators. Respiratory symptoms in MHCW are due to extrinsic compression of lung parenchyma. Present case had respiratory symptoms with persistent radiological findings leading to suspicion of persistent pneumonia. His respiratory symptoms and exacerbation on follow up was attributed to hyper reactive airway disease and MHCW was managed conservatively. The non-neoplastic nature, characteristic presentation, histopathology, imaging modality and management options of MHCW are discussed. PMID:26500976

  7. Chest-wall segmentation in automated 3D breast ultrasound images using thoracic volume classification

    NASA Astrophysics Data System (ADS)

    Tan, Tao; van Zelst, Jan; Zhang, Wei; Mann, Ritse M.; Platel, Bram; Karssemeijer, Nico

    2014-03-01

    Computer-aided detection (CAD) systems are expected to improve effectiveness and efficiency of radiologists in reading automated 3D breast ultrasound (ABUS) images. One challenging task on developing CAD is to reduce a large number of false positives. A large amount of false positives originate from acoustic shadowing caused by ribs. Therefore determining the location of the chestwall in ABUS is necessary in CAD systems to remove these false positives. Additionally it can be used as an anatomical landmark for inter- and intra-modal image registration. In this work, we extended our previous developed chestwall segmentation method that fits a cylinder to automated detected rib-surface points and we fit the cylinder model by minimizing a cost function which adopted a term of region cost computed from a thoracic volume classifier to improve segmentation accuracy. We examined the performance on a dataset of 52 images where our previous developed method fails. Using region-based cost, the average mean distance of the annotated points to the segmented chest wall decreased from 7.57±2.76 mm to 6.22±2.86 mm.art.

  8. Dynamic 3D printed titanium copy prosthesis: a novel design for large chest wall resection and reconstruction

    PubMed Central

    Pérez Méndez, Itzell

    2016-01-01

    Due to high rates of complications, chest wall resection and reconstruction is a high risk procedure when large size of resection is required. Many different prosthetic materials have been used with similar results. Recently, thanks to the new advances in technology, personalized reconstruction have been possible with specific custom-made prosthesis. Nevertheless, they all generate certain amount of stiffness in thoracic motion because of his rigidity. In this report, we present a forward step in prosthesis design based on tridimensional titanium-printed technology. An exact copy of the resected chest wall was made, even endowing simulated sternochondral articulations, to achieve the most exact adaptation and best functional results, with a view to minimize postoperative complications. This novel design, may constitute an important step towards the improvement of the functional postoperative outcomes compared to the other prosthesis, on the hope, to reduce postoperative complications. PMID:27293863

  9. Dynamic 3D printed titanium copy prosthesis: a novel design for large chest wall resection and reconstruction.

    PubMed

    Aragón, Javier; Pérez Méndez, Itzell

    2016-06-01

    Due to high rates of complications, chest wall resection and reconstruction is a high risk procedure when large size of resection is required. Many different prosthetic materials have been used with similar results. Recently, thanks to the new advances in technology, personalized reconstruction have been possible with specific custom-made prosthesis. Nevertheless, they all generate certain amount of stiffness in thoracic motion because of his rigidity. In this report, we present a forward step in prosthesis design based on tridimensional titanium-printed technology. An exact copy of the resected chest wall was made, even endowing simulated sternochondral articulations, to achieve the most exact adaptation and best functional results, with a view to minimize postoperative complications. This novel design, may constitute an important step towards the improvement of the functional postoperative outcomes compared to the other prosthesis, on the hope, to reduce postoperative complications. PMID:27293863

  10. Primary chest wall abscess mimicking a breast tumor that occurred after blunt chest trauma: a case report.

    PubMed

    Yamaoka, Yusuke; Yamamura, Jun; Masuda, Norikazu; Yasojima, Hiroyuki; Mizutani, Makiko; Nakamori, Shoji; Kanazawa, Toru; Kuriyama, Keiko; Mano, Masayuki; Sekimoto, Mitsugu

    2014-01-01

    Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient's chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery. PMID:24660001

  11. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic trauma patients

    PubMed Central

    Anderson, Casandra A; Palmer, Cassandra A; Ney, Arthur L; Becker, Brian; Schaffel, Steven D; Quickel, Robert R

    2008-01-01

    Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN), was safe and well tolerated by these patients. Methods Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN). The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit). Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusion This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment. PMID:18837992

  12. Concomitant surgical treatment of a chondrosarcoma of the chest wall and a desmoid tumor of the gastrointestinal tract

    PubMed Central

    Sadowski, Andrzej; Chruścicka, Iwona; Rak, Piotr; Ptach, Anna; Maliszewski, Daniel; Pęksa, Rafał; Haponiuk, Ireneusz

    2015-01-01

    The co-existence of a chondrosarcoma of the chest wall and a desmoid tumor in the gastrointestinal tract is rare. In both Polish and global literature, cases of chest wall chondrosarcomas are presented in the form of case reports. Desmoids of the gastrointestinal tract are more common; notwithstanding, their incidence in Europe is estimated at approximately 2 cases per 1 million inhabitants per year. We present the case of a 62-year-old female patient who suffered from both a chest wall chondrosarcoma and a desmoid tumor of the intestine; both neoplasms were operated on simultaneously. The former tumor was located in the region of the right costal margin, whereas the latter was located in the mesojejunum. The surgery was performed with two independent surgical incisions. The postoperative period was uneventful. The case is noteworthy in view of the extremely rare synchronous occurrence of the described tumors and due to the fact that any such operation requires an individualized surgical approach. PMID:26336503

  13. Chest wall reconstruction in a canine model using polydioxanone mesh, demineralized bone matrix and bone marrow stromal cells.

    PubMed

    Tang, Hua; Xu, Zhifei; Qin, Xiong; Wu, Bin; Wu, Lihui; Zhao, XueWei; Li, Yulin

    2009-07-01

    Extensive chest wall defect reconstruction remains a challenging problem for surgeons. In the past several years, little progress has been made in this area. In this study, a biodegradable polydioxanone (PDO) mesh and demineralized bone matrix (DBM) seeded with osteogenically induced bone marrow stromal cells (BMSCs) were used to reconstruct a 6 cm x 5.5 cm chest wall defect. Four experimental groups were evaluated (n=6 per group): polydioxanone (PDO) mesh/DBMs/BMSCs group, polydioxanone (PDO) mesh/DBMs group, polydioxanone (PDO) mesh group, and a blank group (no materials) in a canine model. All the animals survived except those in the blank group. In all groups receiving biomaterial implants, the polydioxanone (PDO) mesh completely degraded at 24 weeks and was replaced by fibrous tissue with thickness close to that of the normal intercostal tissue (P>0.05). In the polydioxanone (PDO) mesh/DBMs/BMSCs group, new bone formation and bone-union were observed by radiographic and histological examination. More importantly, the reconstructed rib could maintain its original radian and achieve satisfactory biomechanics close to normal ribs in terms of bending stress (P>0.05). However, in the other two groups, fibrous tissue was observed in the defect and junctions, and the reconstructed ribs were easily distorted under an outer force. Based on these results, a surgical approach utilizing biodegradable polydioxanone (PDO) mesh in combination with DBMs and BMSCs could repair the chest wall defect not only in function but also in structure. PMID:19233465

  14. Ventilation by high-frequency chest wall compression in dogs with normal lungs.

    PubMed

    Zidulka, A; Gross, D; Minami, H; Vartian, V; Chang, H K

    1983-06-01

    In 6 anesthetized and paralyzed supine dogs, ventilation by high-frequency chest wall compression (HFCWC) was accomplished by a piston pump rapidly oscillating the pressure in a modified double blood pressure cuff wrapped around the lower thorax. Testing applied frequencies at 3, 5, 8, and 11 Hz, applied peak cuff pressures ranged from 30 to 230 cmH2O. This produced swings of esophageal pressure as high as 18 cmH2O and peak oscillatory air flow ranging from 0.7 to 1.6 L/s. Oscillatory tidal volume declined with increasing frequency and ranged from a mean of 61 to 45 ml. After 30 min of applied HFCWC, arterial blood gas determinations revealed a mean PaCO2 of 29.3 mmHg at 5 Hz, 35 mmHg at 3 Hz, 36 mmHg at 8 Hz, and 51 mmHg at 11 Hz. Mean PaO2 improved from ventilator control values at 3 Hz, remained unchanged at 5 and 8 Hz, and declined at 11 Hz. In 2 dogs breathing spontaneously, HFCWC applied at 5 and 11 Hz resulted in a reduction in spontaneous minute ventilation, mainly by a reduction in spontaneous tidal volume, whereas arterial blood gas values changed slightly. One dog ceased to breath spontaneously within 5 min of application of HFCWC as the PaCO2 fell below control values. We conclude that in dogs with normal lungs, HFCWC may assist spontaneous ventilation. In paralyzed dogs, HFCWC may be of sufficient magnitude to cause hyperventilation. PMID:6407373

  15. 3D analysis of the chest wall motion for monitoring late-onset Pompe disease patients.

    PubMed

    Meric, Henri; Falaize, Line; Pradon, Didier; Orlikowski, David; Prigent, Hélène; Lofaso, Frédéric

    2016-02-01

    Late-onset Pompe disease, for which enzyme replacement therapy is available, induces progressive diaphragmatic weakness. Monitoring diaphragmatic function is therefore crucial but is hindered by the need to insert esophageal and gastric probes. Vital capacity (VC), inspiratory capacity, maximal inspiratory pressure, and sniff nasal pressure are noninvasive measurements but reflect only global inspiratory-muscle function. Diaphragmatic function may be assessable noninvasively based on abdominal contribution to breathing and abdominal volume change during the VC maneuver (AVC-VC), obtained by 3-dimensional chest-wall analysis. In 11 patients, we assessed the relationships between the above-listed noninvasive variables and the invasively measured Gilbert index reflecting the diaphragmatic contribution to breathing (ratio of gastric pressure over transdiaphragmatic pressure swings during spontaneous breathing). Only abdominal contribution to breathing and AVC-VC correlated significantly with the Gilbert index (R = 0.977, P = 0.0001; and R = 0.944, P = 0.001 respectively). AVC-VC correlated significantly with transdiaphragmatic pressure swing during the sniff maneuver (R = 0.743, P = 0.0009) and with phrenic magnetic stimulation (R = 0.610, P = 0.046). Repeat testing 1 year later in the first 6 patients showed concordant changes in abdominal contribution to breathing, Gilbert index, and VC. Abdominal contribution to breathing and AVC-VC are reliable and noninvasive indices of diaphragmatic function in Pompe disease, and therefore hold promise as clinical monitoring tools. PMID:26711305

  16. Lung and chest wall mechanics in patients with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia.

    PubMed

    D'Angelo, E; Calderini, E; Robatto, F M; Puccio, P; Milic-Emili, J

    1997-10-01

    The aim of this study was to assess the mechanical characteristics of the respiratory system in patients with acquired immune deficiency syndrome (AIDS) and acute respiratory distress syndrome (ARDS) caused by Pneumocystis carinii pneumonia (PCP). In 12 mechanically ventilated patients, total respiratory system mechanics was assessed using the technique of rapid airway occlusion during constant flow inflation, and was partitioned into lung and chest wall components using the oesophageal balloon technique. We measured interrupter resistance (Rint), which mainly reflects airway resistance, additional resistance (deltaR) due to viscoelastic behaviour and time constant inequalities, and static elastance (Est). In addition, the static inflation volume-pressure (V-P) curve was assessed. In eight patients, computed tomography scans were performed within 2 days of the assessment of respiratory mechanics. Compared to values reported in the literature for normal subjects, Est and deltaR were markedly increased in AIDS patients with PCP, whilst Rint exhibited a relatively smaller increase. These changes, which involved only the lung and airways, were mainly due to the reduction of ventilated lung units, but additional factors were involved to cause independent modifications of lung stiffness, airway calibre, and viscoelastic properties. The changes in Rint, deltaR, and Est were similar to those observed in other studies on patients with ARDS of different aetiologies. At variance with common observations in the latter patients, none of the AIDS patients with PCP exhibited an inflection point on the static inflation V-P curve, suggesting little or no alveolar recruitment during lung inflation. This finding could be related to the distinctive histopathology of Pneumocystis carinii pneumonia. Indeed, computed tomography revealed homogeneous diffuse interstitial and alveolar infiltration rather than the dense, dependent opacities observed in other studies on acute respiratory

  17. Chest Wall Toxicity After Stereotactic Body Radiotherapy for Malignant Lesions of the Lung and Liver

    SciTech Connect

    Andolino, David L.; Forquer, Jeffrey A.; Henderson, Mark A.; Barriger, Robert B.; Shapiro, Ronald H.; Brabham, Jeffrey G.; Johnstone, Peter A.S.; Cardenes, Higinia R.; Fakiris, Achilles J.

    2011-07-01

    Purpose: To quantify the frequency of rib fracture and chest wall (CW) pain and identify the dose-volume parameters that predict CW toxicity after stereotactic body radiotherapy (SBRT). Methods and Materials: The records of patients treated with SBRT between 2000 and 2008 were reviewed, and toxicity was scored according to Common Terminology Criteria for Adverse Events v3.0 for pain and rib fracture. Dosimetric data for CW and rib were analyzed and related to the frequency of toxicity. The risks of CW toxicity were then further characterized according to the median effective concentration (EC{sub 50}) dose-response model. Results: A total of 347 lesions were treated with a median follow-up of 19 months. Frequency of Grade I and higher CW pain and/or fracture for CW vs. non-CW lesions was 21% vs. 4%, respectively (p < 0.0001). A dose of 50 Gy was the cutoff for maximum dose (Dmax) to CW and rib above which there was a significant increase in the frequency of any grade pain and fracture (p = 0.03 and p = 0.025, respectively). Volume of CW receiving 15 Gy - 40 Gy was highly predictive of toxicity (R{sup 2} > 0.9). According to the EC{sub 50} model, 5 cc and 15 cc of CW receiving 40 Gy predict a 10% and 30% risk of CW toxicity, respectively. Conclusion: Adequate tumor coverage remains the primary objective when treating lung or liver lesions with SBRT. To minimize toxicity when treating lesions in close proximity to the CW, Dmax of the CW and/or ribs should remain <50 Gy, and <5 cc of CW should receive {>=}40 Gy.

  18. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap

    PubMed Central

    Dionyssiou, Dimitrios; Demiri, Efterpi; Batsis, Georgios; Pavlidis, Leonidas

    2015-01-01

    This study aims to present the case of a female patient with Poland's syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland's syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park's classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland's syndrome female patients with chest wall and breast deformities. PMID:25991894

  19. Recurrent cystosarcoma phylloides of breast: extensive full-thickness excision of chest wall with immediate repair using steel mesh and a latissimus dorsi myocutaneous flap.

    PubMed

    Mindikoğlu, A N; Aktan, K

    1983-10-01

    The case of a young woman with a massive recurrent cystosarcoma phylloides of the breast is presented in whom a full thickness excision of the chest wall was carried out en bloc together with four ribs. The large full-thickness defect of the chest wall was reconstructed with stainless steel mesh and covered by a latissimus dorsi myocutaneous flap. The management of post-operative paradoxical movement is also described. PMID:6313105

  20. The gender-specific chest wall thickness prediction equations for routine measurements of 239Pu and 241Am within the lungs using HPGe detectors.

    PubMed

    Vickers, L R

    1996-03-01

    The current chest wall thickness prediction equation is not applicable to use in routine lung counting measurements for detection of low energy photons (17--60 keV) within the lungs of male and female subjects. The current chest wall thickness prediction equation was derived for the NaI-CsI "phoswich" detection system, which is not the routine detection system in use; the subject position was supine, which is not the routine position; the equation did not account for the intercostal tissue thicknesses of muscle and adipose which significantly attenuate low energy photons (17--60keV); it was derived from male subjects only and is used to predict the chest wall thickness of female subjects for whom it is not applicable. The current chest wall thickness prediction equation yields unacceptable percent errors in the HPGe detection efficiency calibration for 239Pu and 241Am (17- and 59.5-keV photons, respectively) relative to the gender-specific HPGe chest wall thickness prediction equations of this paper (+284% to --73% for 239Pu; (+)42% to --39% for 241Am). As a result, use of the current chest wall thickness prediction equation yields unacceptable percent errors (proportional in magnitude to the percent errors in the detection efficiency calibration) in the calculation of the minimum detectable activity (Bq) or in an initial assessment of a radioactive contamination exposure detected by a routine lung count measurement. PMID:8609026

  1. Evaluating Proton Stereotactic Body Radiotherapy to Reduce Chest Wall Dose in the Treatment of Lung Cancer

    PubMed Central

    Welsh, James; Nguyen, Ngoc; Palmer, Matt; Allen, Pamela K.; Paolini, Michael; Liao, Zhongxing; Bluett, Jaques; Mohan, Radhe; Gomez, Daniel; Cox, James D.; Komaki, Ritsuko; Chang, Joe Y.

    2014-01-01

    Purpose Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40 Gy (V20, V30, or V40) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. Methods We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within <2.5 cm of the CW. We found 260 cases; of these chronic grade ≥2 CW pain was identified in 23 patients. We then selected 10 representative patients from this group and generated proton SBRT treatment plans, using the identical dose of 50 Gy in 4 fractions, and assessed potential differences in CW dose between the two plans. Results The proton SBRT plans reduced the CW doses at all dose levels measured. The median CW V was 364.0 cm320 for photons and 160.0 cm3 for protons (P<0.0001); V30 was 144.6 cm3 for photons vs. 77.0 cm3 for protons (P=0.0012); V was 93.9 cm335 for photons vs. 57.9 cm3 for protons (P=0.005); V40 was 66.5 cm3 for photons vs. 45.4 cm3 for protons (P=0.0112); and mean lung dose was 5.9 Gy for photons vs. 3.8 Gy for protons (P=0.0001). Coverage of the planning target volume was comparable between the two sets of plans (96.4% for photons and 97% for protons). Conclusions From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions close to critical structures. PMID:24200220

  2. Evaluating proton stereotactic body radiotherapy to reduce chest wall dose in the treatment of lung cancer

    SciTech Connect

    Welsh, James; Amini, Arya; Ciura, Katherine; Nguyen, Ngoc; Palmer, Matt; Soh, Hendrick; Allen, Pamela K.; Paolini, Michael; Liao, Zhongxing; Bluett, Jaques; Mohan, Radhe; Gomez, Daniel; Cox, James D.; Komaki, Ritsuko; Chang, Joe Y.

    2013-01-01

    Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40 Gy (V{sub 20}, V{sub 30}, or V{sub 40}) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within < 2.5 cm of the CW. We found 260 cases; of these, chronic grade ≥ 2 CW pain was identified in 23 patients. We then selected 10 representative patients from this group and generated proton SBRT treatment plans, using the identical dose of 50 Gy in 4 fractions, and assessed potential differences in CW dose between the 2 plans. The proton SBRT plans reduced the CW doses at all dose levels measured. The median CW V{sub 20} was 364.0 cm{sup 3} and 160.0 cm{sup 3} (p < 0.0001), V{sub 30} was 144.6 cm{sup 3}vs 77.0 cm{sup 3} (p = 0.0012), V{sub 35} was 93.9 cm{sup 3}vs 57.9 cm{sup 3} (p = 0.005), V{sub 40} was 66.5 cm{sup 3}vs 45.4 cm{sup 3} (p = 0.0112), and mean lung dose was 5.9 Gy vs 3.8 Gy (p = 0.0001) for photons and protons, respectively. Coverage of the planning target volume (PTV) was comparable between the 2 sets of plans (96.4% for photons and 97% for protons). From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures.

  3. Development and validation of a clinical prediction rule for chest wall syndrome in primary care

    PubMed Central

    2012-01-01

    Background Chest wall syndrome (CWS), the main cause of chest pain in primary care practice, is most often an exclusion diagnosis. We developed and evaluated a clinical prediction rule for CWS. Methods Data from a multicenter clinical cohort of consecutive primary care patients with chest pain were used (59 general practitioners, 672 patients). A final diagnosis was determined after 12 months of follow-up. We used the literature and bivariate analyses to identify candidate predictors, and multivariate logistic regression was used to develop a clinical prediction rule for CWS. We used data from a German cohort (n = 1212) for external validation. Results From bivariate analyses, we identified six variables characterizing CWS: thoracic pain (neither retrosternal nor oppressive), stabbing, well localized pain, no history of coronary heart disease, absence of general practitioner’s concern, and pain reproducible by palpation. This last variable accounted for 2 points in the clinical prediction rule, the others for 1 point each; the total score ranged from 0 to 7 points. The area under the receiver operating characteristic (ROC) curve was 0.80 (95% confidence interval 0.76-0.83) in the derivation cohort (specificity: 89%; sensitivity: 45%; cut-off set at 6 points). Among all patients presenting CWS (n = 284), 71% (n = 201) had a pain reproducible by palpation and 45% (n = 127) were correctly diagnosed. For a subset (n = 43) of these correctly classified CWS patients, 65 additional investigations (30 electrocardiograms, 16 thoracic radiographies, 10 laboratory tests, eight specialist referrals, one thoracic computed tomography) had been performed to achieve diagnosis. False positives (n = 41) included three patients with stable angina (1.8% of all positives). External validation revealed the ROC curve to be 0.76 (95% confidence interval 0.73-0.79) with a sensitivity of 22% and a specificity of 93%. Conclusions This CWS score offers a useful

  4. Thermal characteristics of thermobrachytherapy surface applicators for treating chest wall recurrence

    NASA Astrophysics Data System (ADS)

    Arunachalam, K.; Maccarini, P. F.; Craciunescu, O. I.; Schlorff, J. L.; Stauffer, P. R.

    2010-04-01

    The aim of this study was to investigate temperature and thermal dose distributions of thermobrachytherapy surface applicators (TBSAs) developed for concurrent or sequential high dose rate (HDR) brachytherapy and microwave hyperthermia treatment of chest wall recurrence and other superficial diseases. A steady-state thermodynamics model coupled with the fluid dynamics of a water bolus and electromagnetic radiation of the hyperthermia applicator is used to characterize the temperature distributions achievable with TBSAs in an elliptical phantom model of the human torso. Power deposited by 915 MHz conformal microwave array (CMA) applicators is used to assess the specific absorption rate (SAR) distributions of rectangular (500 cm2) and L-shaped (875 cm2) TBSAs. The SAR distribution in tissue and fluid flow distribution inside the dual-input dual-output (DIDO) water bolus are coupled to solve the steady-state temperature and thermal dose distributions of the rectangular TBSA (R-TBSA) for superficial tumor targets extending 10-15 mm beneath the skin surface. Thermal simulations are carried out for a range of bolus inlet temperature (Tb = 38-43 °C), water flow rate (Qb = 2-4 L min-1) and tumor blood perfusion (ωb = 2-5 kg m-3 s-1) to characterize their influence on thermal dosimetry. Steady-state SAR patterns of the R- and L-TBSA demonstrate the ability to produce conformal and localized power deposition inside the tumor target sparing surrounding normal tissues and nearby critical organs. Acceptably low variation in tissue surface cooling and surface temperature homogeneity was observed for the new DIDO bolus at a 2 L min-1 water flow rate. Temperature depth profiles and thermal dose volume histograms indicate bolus inlet temperature (Tb) to be the most influential factor on thermal dosimetry. A 42 °C water bolus was observed to be the optimal choice for superficial tumors extending 10-15 mm from the surface even under significant blood perfusion. Lower bolus

  5. Higher Chest Wall Dose Results in Improved Locoregional Outcome in Patients Receiving Postmastectomy Radiation

    SciTech Connect

    Panoff, Joseph E.; Takita, Cristiane; Hurley, Judith; Reis, Isildinha M.; Zhao, Wei; Rodgers, Steven E.; Gunaseelan, Vijayalakshmi; Wright, Jean L.

    2012-03-01

    Purpose: Randomized trials demonstrating decreased locoregional recurrence (LRR) and improved overall survival (OS) in women receiving postmastectomy radiation therapy (PMRT) used up to 50 Gy to the chest wall (CW), but in practice, many centers boost the CW dose to {>=}60 Gy, despite lack of data supporting this approach. We evaluated the relationship between CW dose and clinical outcome. Methods and Materials: We retrospectively reviewed medical records of 582 consecutively treated patients who received PMRT between January 1999 and December 2009. We collected data on patient, disease, treatment characteristics, and outcomes of LRR, progression-free survival (PFS) and OS. Results: Median follow-up from the date of diagnosis was 44.7 months. The cumulative 5-year incidence of LRR as first site of failure was 6.2%. CW dose for 7% (43 patients) was {<=}50.4 Gy (range, 41.4-50.4 Gy) and 93% received >50.4 Gy (range, 52.4-74.4 Gy). A CW dose of >50.4 Gy vs. {<=}50.4 Gy was associated with lower incidence of LRR, a 60-month rate of 5.7% (95% confidence interval [CI], 3.7-8.2) vs. 12.7% (95% CI, 4.5-25.3; p = 0.054). Multivariate hazard ratio (HR) for LRR controlling for race, receptor status, and stage was 2.62 (95% CI, 1.02-7.13; p = 0.042). All LRR in the low-dose group occurred in patients receiving 50 to 50.4 Gy. Lower CW dose was associated with worse PFS (multivariate HR, 2.73; 95% CI, 1.64-4.56; p < 0.001) and OS (multivariate HR, 3.88; 95% CI, 2.16-6.99; p < 0.001). Conclusions: The addition of a CW boost above 50.4 Gy resulted in improved locoregional control and survival in this cohort patients treated with PMRT for stage II-III breast cancer. The addition of a CW boost to standard-dose PMRT is likely to benefit selected high-risk patients. The optimal technique, target volume, and patient selection criteria are unknown. The use of a CW boost should be studied prospectively, as has been done in the setting of breast conservation.

  6. A Comparison of Skin and Chest Wall Dose Delivered With Multicatheter, Contura Multilumen Balloon, and MammoSite Breast Brachytherapy

    SciTech Connect

    Cuttino, Laurie W.; Todor, Dorin; Rosu, Mihaela; Arthur, Douglas W.

    2011-01-01

    Purpose: Skin and chest wall doses have been correlated with toxicity in patients treated with breast brachytherapy . This investigation compared the ability to control skin and chest wall doses between patients treated with multicatheter (MC), Contura multilumen balloon (CMLB), and MammoSite (MS) brachytherapy. Methods and Materials: 43 patients treated with the MC technique, 45 patients treated with the CMLB, and 83 patients treated with the MS were reviewed. The maximum doses delivered to the skin and chest wall were calculated for all patients. Results: The mean maximum skin doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.2 Gy per fraction (94% of prescription dose), respectively. Although the skin distances were similar (p = 0.23) for the two balloon techniques, the mean skin dose with the CMLB was significantly lower than with the MS (p = 0.05). The mean maximum rib doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.6 Gy per fraction (105% of prescription dose), respectively. Again, the mean rib dose with the CMLB was significantly lower than with the MS (p = 0.002). Conclusion: The MC and CMLB techniques are associated with significantly lower mean skin and rib doses than is the MS. Treatment with the MS was associated with significantly more patients receiving doses to the skin or rib in excess of 125% of the prescription. Treatment with the CMLB may prove to yield less normal tissue toxicity than treatment with the MS.

  7. Conformal Radiotherapy Facilitates the Delivery of Concurrent Chemotherapy and Radiotherapy: A Case of Primitive Neuroectodermal Tumour of the Chest Wall

    PubMed Central

    Twyman, N.; Earl, H. M.; Burnet, N. G.

    2000-01-01

    We illustrate the principle of conformal radiotherapy by discussing the case of a patient with a primitive neuroectodermal tumour of the chest wall. Recent advances in radiotherapy planning enable precise localization of the planning target volume (PTV) and normal organs at risk of irradiation. Customized blocks are subsequently designed to produce a treatment field that ‘conforms’ to the PTV. The use of conformal radiotherapy (CRT) in this case facilitated the delivery of concurrent chemotherapy and radiotherapy by significantly reducing the volume of red marrow irradiated.The lack of acute and late toxicities was attributed to optimal exclusion of normal tissues from the treatment field, made possible by CRT. PMID:18521292

  8. A study of the first heart sound spectra in normal anesthetized cats: possible origins and chest wall influences.

    PubMed

    Fazzalari, N L; Mazumdar, J; Ghista, D N; Allen, D G; de Bruin, H

    1984-01-01

    Heart sound recordings were taken from cats. The heart sounds were recorded directly from the chest wall and through an esophageal tube. The phono transducer and the esophageal tube were both placed over the base of the heart. Ultrasound M-mode, or motion-mode, recordings were taken to study the mitral valve dynamics. After analogue to digital conversion, electrocardiogram gated first heart sounds of each phono record were analyzed by the fast Fourier transform to obtain a frequency spectrum. Relative energies in 15 Hz bandwidths up to 150 Hz were correlated with the mitral valve closing velocity of the anterior mitral leaflet, obtained from the M-mode echocardiograms. The closing velocity correlated best with the energy in the 30-45 Hz bandwidth and 60-75 Hz bandwidth for the externally and internally monitored phonocardiogram respectively. The chest wall acted as a low pass filter, that is, the wall favoured the transmission of low frequencies and the energy transmitted decreased as wall thickness increased. PMID:6713253

  9. Levofloxacin decreased chest wall mechanical inhomogeneities and airway and vascular remodeling in rats with induced hepatopulmonary syndrome.

    PubMed

    Gaio, Eduardo; Amado, Veronica; Rangel, Leonardo; Huang, Wilson; Storck, Rodrigo; Melo-Silva, César Augusto

    2013-12-01

    The administration of antibiotics decreases bacterial translocation, reduces the activity of nitric oxide synthase and improves the gas exchange of hepatopulmonary syndrome (HPS) in rats. We hypothesized that levofloxacin could reduce HPS-induced respiratory mechanical inhomogeneities and airway and pulmonary vascular remodeling. We assessed the respiratory mechanical properties and lung tissue structure in 24 rats assigned to the control, HPS (eHPS) and HPS+levofloxacin (eHPS+L) groups. The administration of levofloxacin reduced the HPS-induced chest wall but not the lung mechanical inhomogeneities. The eHPS airway proportion of elastic fibers increased 20% but was similar between the control and eHPS+L groups. The eHPS vascular collagen increased 25% in eHPS but was similar between the control and eHPS+L groups. Compared to the control group, the vascular proportion of elastic fibers of the eHPS and eHPS+L groups increased by 60% and 16%, respectively. The administration of levofloxacin decreased the HPS-induced chest wall mechanical inhomogeneities and airway and vascular remodeling. PMID:23994178

  10. Retrospective case series analysing the clinical data and treatment options of patients with a tubercular abscess of the chest wall

    PubMed Central

    Tanaka, Satona; Aoki, Minoru; Nakanishi, Takao; Otake, Yosuke; Matsumoto, Masataka; Sakurai, Toshiyasu; Tada, Kimihide; Ikeda, Akihiko

    2012-01-01

    The tubercular abscess of the chest wall remains one of the differential diagnoses of a chest wall tumour, and the management strategy is controversial. We reviewed the medical records of 22 patients treated at our institution. Two patients were managed by antitubercular medications alone; eight patients were managed by medication and open drainage. Five patients underwent open drainage with subsequent radical surgery at a constant interval of time, and the mean duration between open drainage and radical surgery was 9.8 weeks (range, 3–12). Seven patients underwent radical surgery without prior open drainage. Five patients required rib resections, and curettage of infected pleural peel was necessary in 5 patients. Antitubercular drugs were administered basically for more than 6 months regardless of surgical management, including for more than 1 month prior to radical surgery. Postoperative empyema was seen in 1 patient after radical surgery. The mean follow-up duration was 32.8 months (range, 3–100), and there was no recurrence. Complete resection of the tubercular abscess with sufficient antitubercular therapy resulted in a satisfactory outcome. Antitubercular therapy with or without open drainage can be a viable choice. PMID:22184463

  11. Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women.

    PubMed

    Muniz de Souza, Helga; Rocha, Taciano; Campos, Shirley Lima; Brandão, Daniella Cunha; Fink, James B; Aliverti, Andrea; de Andrade, Armele Dornelas

    2016-06-15

    It is not completely described how aging affect ventilatory kinematics and what are the mechanisms adopted by the elderly population to overcome these structural modifications. Given this, the aim was to evaluate the acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Variables assessed included: tidal volume (Vt), total chest wall volume (Vcw), pulmonary rib cage (Vrcp%), abdominal rib cage (Vrca%) and abdominal compartment (Vab%) relative contributions to tidal volume. These variables were assessed during quiet breathing, maximal inspiratory pressure maneuver (MIP), and moderate inspiratory resistance (MIR; i.e., 40% of MIP). 22 young women (age: 23.9±2.5 years) and 22 elderly women (age: 68.2±5.0 years) participated to this study. It was possible to show that during quiet breathing, Vab% was predominant in elderly (p<0.001), in young, however, Vab% was similar to Vrcp% (p=0.095). During MIR, Vrcp% was predominant in young (p<0.001) and comparable to Vab% in elderly (p=0.249). When MIP was imposed, both groups presented a predominance of Vrcp%. In conclusion, there are differences in abdominal kinematics between young and elderly women during different inspiratory efforts. In elderly, during moderate inspiratory resistance, the pattern is beneficial, deep, and slow. Although, during maximal inspiratory resistance, the ventilatory pattern seems to predict imminent muscle fatigue. PMID:26900004

  12. Statistical methods for analysis of coordination of chest wall motion using optical reflectance imaging of multiple markers

    NASA Astrophysics Data System (ADS)

    Kenyon, C. M.; Ghezzo, R. H.; Cala, S. J.; Ferrigno, Giancarlo; Pedotti, Antonio; Macklem, P. T.; Rochester, D. F.

    1994-07-01

    To analyze coordination of chest wall motion we have used principle component analysis (PCA) and multiple regression analysis (MRA) with respect to spirometry on the displacements of 93 optical reflective markers placed upon the chest wall (CW). Each marker is tracked at 10 Hz with an accuracy of 0.2 mm in each spatial dimension using the ELITE system (IEEE Trans. Biomed. Eng. 11:943-949, 1985). PCA enables the degree of linear coordination between all of the markers to be assessed using the eigenvectors and eigenvalues of the covariance of the matrix of marker displacements in each dimension against time. Thus the number of linear degrees of freedom (DOF) which contribute more than a particular amount to the total variance can be determined and analyzed. MRA with respect to spirometrically measured lung volume changes enables identification of the CW points whose movement correlates best with lung volume. We have used this analysis to compare a quiet breathing sequence with one where tidal volume was increased fourfold involuntarily and show that the number of DOF with eigenvalues accounting for >5% of the covariance increased from 2 to 3. Also the point whose movement correlated best with lung volume changed from halfway down the lower costal margin to a more lateral point at the level of the bottom of the sternum. This quantification of CW coordination may be useful in analysis and staging of many respiratory disorders and is applicable to any nonrigid body motion where points can be tracked.

  13. Uncertainty induced by chest wall thickness assessment methods on lung activity estimation for plutonium and americium: a large population-based study.

    PubMed

    Broggio, D; Lechaftois, X; Franck, D

    2015-03-01

    In vivo lung counting aims at assessing the retained activity in the lungs. The calibration factor relating the measured counts to the worker's specific retained lung activity can be obtained by several means and strongly depends on the chest wall thickness. Here we compare, for 374 male nuclear workers, the activity assessed with a reference protocol, where the material equivalent chest wall thickness is known from ultrasound measurements, with two other protocols. The counting system is an array of four germanium detectors.It is found that non site-specific equations for the assessment of the chest wall thickness induce large biases in the assessment of activity. For plutonium isotopes or (241)Am the proportion of workers for whom the retained activity is within ± 10% of the reference one is smaller than 10%.The use of site-specific equations raises this proportion to 20% and 58% for plutonium and (241)Am, respectively.Finally, for the studied population, when site-specific equations are used for the chest wall thickness, the standard uncertainties for the lung activity are 42% and 12.5%, for plutonium and (241)Am, respectively. Due to the relatively large size of the studied population, these values are a relatively robust estimate of the uncertainties due to the assessment of the chest wall thickness for the current practice at this site. PMID:25517347

  14. [Reconstruction of the anterior chest wall by a sandwich-type combination of a synthetic support and a muscle flap from the latissimus dorsi. Apropos of a case].

    PubMed

    Lanfrey, E; Grolleau, J L; Glock, Y; Chavoin, J P; Costagliola, M

    1996-04-01

    Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials. PMID:8761064

  15. Cutaneous reinnervation of the rectus abdominis musculocutaneous flap after chest wall reconstruction: development of herpes zoster in the transplanted musculocutaneous flap.

    PubMed

    Tomita, K; Inoue, K

    1998-08-01

    We report a patient in whom herpes zoster developed in the transplanted rectus abdominis musculocutaneous flap 14 months after a chest wall reconstruction for recurrent breast cancer. Based on the distribution of the varicella zoster virus spreading along the sensory nerve fibers, we concluded that the virus spread along the reinnervated sensory nerves from the dorsal ganglia, through the intercostal nerves, and into the flap skin. It is suggested that this finding demonstrates the pathway of reinnervation into the transferred musculocutaneous flap on the chest wall. PMID:9718154

  16. [The use of high-frequency chest wall oscillation for the combined treatment of the children presenting with mucoviscidosis].

    PubMed

    Khan, M A; Lian, N A; Mikitchenko, N A

    2014-01-01

    Mucoviscidosis is a hereditary disease characterized by the severe clinical course which requires its continuous management by means of appropriate therapeutic and rehabilitative modalities. The objective of the present study was to develop the scientifically grounded rationale for the application of vibration and compression impacts with the use of The Vest clearance system for the clearance of the airways in 30 children at the age varying from 5 to 17 years presenting with mucoviscidosis. The results of the study suggest high effectiveness of high-frequency oscillation of the chest wall in such patients. Moreover, the new data have been obtained illustrating the beneficial influence of this therapeutic modality on the clinical symptoms of the disease, characteristics of the external respiration function, and results of pulseoxymetry. PMID:25087417

  17. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    PubMed Central

    Takara, L.S.; Cunha, T.M.; Barbosa, P.; Rodrigues, M.K.; Oliveira, M.F.; Nery, L.E.; Neder, J.A.

    2012-01-01

    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(VCW) = rib cage (VRC) + abdomen (VAB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) VCW increased in relation to resting values. There was a noticeable heterogeneity in the patterns of VCW regulation as EEVCW increased non-linearly in 17/30 “hyperinflators” and decreased in 13/30 “non-hyperinflators” (P < 0.05). EEVAB decreased slightly in 8 of the “hyperinflators”, thereby reducing and slowing the rate of increase in end-inspiratory (EI) VCW (P < 0.05). In contrast, decreases in EEVCW in the “non-hyperinflators” were due to the combination of stable EEVRC with marked reductions in EEVAB. These patients showed lower EIVCW and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIVCW regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment. PMID:23250012

  18. Magnetic Resonance Imaging Appearances in the Postoperative Breast: The Clinical Target Volume-Tumor and Its Relationship to the Chest Wall

    SciTech Connect

    Whipp, Elisabeth C. Halliwell, Michael

    2008-09-01

    Purpose: To describe and measure the postoperative complexes and their relationship to the chest wall in 100 randomly chosen MRI breast scans, to attempt a better understanding of the changes taking place in the postoperative breast. Methods and Materials: Appearances and measurements of MRI postoperative cavities were analyzed in a cohort of 100 randomly selected patients who underwent a single open MRI scan in the conventional breast radiotherapy treatment position before routine two-dimensional simulation. Results: Magnetic resonance imaging appearances of postoperative cavities seem to differ qualitatively from descriptions of CT and ultrasound cavities in the literature. Rather than being principally homogeneous, heterogeneous cavities were seen in 85%, irregular in 51%. The size of cavity was inversely related to the time elapsed since surgery. Cavities directly touched the chest wall in 53% of cases; 89% lay within 10 mm of the chest wall. Regular, annular concentric rings of differing signal were seen in 32% of cases; such appearances have not been previously described. These patterns suggest that seromas may not shrink entirely as a result of simple serous fluid absorption; instead, new tissue may be being laid down. Because large, regular spheroidal/ellipsoidal cavities with crisp margins may be seromas under pressure, greater target shifts during radiation may need to be anticipated in such cases. Conclusions: Postsurgical cavities in the conserved breast on MRI are commonly heterogeneous, irregular, and lie close to the chest wall. Magnetic resonance imaging studies may help in better understanding the natural history of postoperative cavities.

  19. Protocol for PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention

    PubMed Central

    Bayman, N; Ardron, D; Ashcroft, L; Baldwin, D R; Booton, R; Darlison, L; Edwards, J G; Lang-Lazdunski, L; Lester, J F; Peake, M; Rintoul, R C; Snee, M; Taylor, P; Lunt, C

    2016-01-01

    Introduction Histological diagnosis of malignant mesothelioma requires an invasive procedure such as CT-guided needle biopsy, thoracoscopy, video-assisted thorascopic surgery (VATs) or thoracotomy. These invasive procedures encourage tumour cell seeding at the intervention site and patients can develop tumour nodules within the chest wall. In an effort to prevent nodules developing, it has been widespread practice across Europe to irradiate intervention sites postprocedure—a practice known as prophylactic irradiation of tracts (PIT). To date there has not been a suitably powered randomised trial to determine whether PIT is effective at reducing the risk of chest wall nodule development. Methods and analysis In this multicentre phase III randomised controlled superiority trial, 374 patients who can receive radiotherapy within 42 days of a chest wall intervention will be randomised to receive PIT or no PIT. Patients will be randomised on a 1:1 basis. Radiotherapy in the PIT arm will be 21 Gy in three fractions. Subsequent chemotherapy is given at the clinicians’ discretion. A reduction in the incidence of chest wall nodules from 15% to 5% in favour of radiotherapy 6 months after randomisation would be clinically significant. All patients will be followed up for up to 2 years with monthly telephone contact and at least four outpatient visits in the first year. Ethics and dissemination PIT was approved by NRES Committee North West—Greater Manchester West (REC reference 12/NW/0249) and recruitment is currently on-going, the last patient is expected to be randomised by the end of 2015. The analysis of the primary end point, incidence of chest wall nodules 6 months after randomisation, is expected to be published in 2016 in a peer reviewed journal and results will also be presented at scientific meetings and summary results published online. A follow-up analysis is expected to be published in 2018. Trial registration number ISRCTN04240319; NCT01604005; Pre

  20. Occurrence of Breast Cancer After Chest Wall Irradiation for Pediatric Cancer, as Detected by a Multimodal Screening Program

    SciTech Connect

    Terenziani, Monica; Casalini, Patrizia; Scaperrotta, Gianfranco; Gandola, Lorenza; Trecate, Giovanna; Catania, Serena; Cefalo, Graziella; Conti, Alberto; Massimino, Maura; Meazza, Cristina; Podda, Marta; Spreafico, Filippo; Suman, Laura; Gennaro, Massimiliano

    2013-01-01

    Purpose: To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program. Patients and Methods: We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment. Results: Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%. Conclusions: Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.

  1. Treatment techniques for 3D conformal radiation to breast and chest wall including the internal mammary chain

    SciTech Connect

    Sonnik, Deborah; Selvaraj, Raj N. . E-mail: selvarajrn@upmc.edu; Faul, Clare; Gerszten, Kristina; Heron, Dwight E.; King, Gwendolyn C.

    2007-04-01

    Breast, chest wall, and regional nodal irradiation have been associated with an improved outcome in high-risk breast cancer patients. Complex treatment planning is often utilized to ensure complete coverage of the target volume while minimizing the dose to surrounding normal tissues. The 2 techniques evaluated in this report are the partially wide tangent fields (PWTFs) and the 4-field photon/electron combination (the modified 'Kuske Technique'). These 2 techniques were evaluated in 10 consecutive breast cancer patients. All patients had computerized tomographic (CT) scans for 3D planning supine on a breast board. The breast was defined clinically by the physician and confirmed radiographically with radiopaque bebes. The resulting dose-volume histograms (DVHs) of normal and target tissues were then compared. The deep tangent field with blocks resulted in optimal coverage of the target and the upper internal mammary chain (IMC) while sparing of critical and nontarget tissues. The wide tangent technique required less treatment planning and delivery time. We compared the 2 techniques and their resultant DVHs and feasibility in a busy clinic.

  2. Chest Wall Radiotherapy: Middle Ground for Treatment of Patients With One to Three Positive Lymph Nodes After Mastectomy

    SciTech Connect

    MacDonald, Shannon M.; Abi-Raad, Rita F.; Alm El-Din, Mohamed A.; Niemierko, Andrzej; Kobayashi, Wendy; McGrath, John J.; Goldberg, Saveli I.; Powell, Simon; Smith, Barbara; Taghian, Alphonse G.

    2009-12-01

    Purpose: To evaluate the outcomes for patients with Stage II breast cancer and one to three positive lymph nodes after mastectomy who were treated with observation or adjuvant radiotherapy to the chest wall (CW) with or without the regional lymphatics. Methods and Materials: We retrospectively analyzed 238 patients with Stage II breast cancer (one to three positive lymph nodes) treated with mastectomy at the Massachusetts General Hospital between 1990 and 2004. The estimates of locoregional recurrence (LRR), disease-free survival (DFS), and overall survival were analyzed according to the delivery of radiotherapy and multiple prognostic factors. Results: LRR and DFS were significantly improved by postmastectomy radiotherapy (PMRT), with a 5- and 10-year LRR rate without PMRT of 6% and 11%, respectively and, with PMRT, of 0% at both 5 and 10 years (p = .02). The 5- and 10-year DFS rate without PMRT was 85% and 75%, respectively, and, with PMRT, was 93% at both 5 and 10 years (p = .03). A similar benefit was found for patients treated with RT to the CW alone. The LRR, DFS, and overall survival rate for patients treated to the CW only was 0%, 96%, and 95% at 10 years, respectively. Conclusion: Our data suggest that adjuvant PMRT to the CW alone provides excellent disease control for patients with breast cancer <5 cm with one to three positive lymph nodes.

  3. The MUSIC algorithm for impedance tomography of small inclusions from discrete data

    NASA Astrophysics Data System (ADS)

    Lechleiter, A.

    2015-09-01

    We consider a point-electrode model for electrical impedance tomography and show that current-to-voltage measurements from finitely many electrodes are sufficient to characterize the positions of a finite number of point-like inclusions. More precisely, we consider an asymptotic expansion with respect to the size of the small inclusions of the relative Neumann-to-Dirichlet operator in the framework of the point electrode model. This operator is naturally finite-dimensional and models difference measurements by finitely many small electrodes of the electric potential with and without the small inclusions. Moreover, its leading-order term explicitly characterizes the centers of the small inclusions if the (finite) number of point electrodes is large enough. This characterization is based on finite-dimensional test vectors and leads naturally to a MUSIC algorithm for imaging the inclusion centers. We show both the feasibility and limitations of this imaging technique via two-dimensional numerical experiments, considering in particular the influence of the number of point electrodes on the algorithm’s images.

  4. Chest wall segmentation in automated 3D breast ultrasound using rib shadow enhancement and multi-plane cumulative probability enhanced map

    NASA Astrophysics Data System (ADS)

    Kim, Hyeonjin; Kim, Hannah; Hong, Helen

    2015-03-01

    We propose an automatic segmentation method of chest wall in 3D ABUS images using rib shadow enhancement and multi-planar cumulative probability enhanced map. For the identification of individual dark rib shadows, each rib shadow is enhanced using intensity transfer function and 3D sheet-like enhancement filtering. Then, wrongly enhanced intercostal regions and small fatty tissues are removed using coronal and sagittal cumulative probability enhanced maps. The large fatty tissues with globular and sheet-like shapes at the top of rib shadow are removed using shape and orientation analysis based on moment matrix. Detected chest walls are connected with cubic B-spline interpolation. Experimental results show that the Dice similarity coefficient of proposed method as comparison with two manually outlining results provides over 90% in average.

  5. Inhibitory effect of cervical trachea and chest wall vibrations on cough reflex sensitivity and perception of urge-to-cough in healthy male never-smokers

    PubMed Central

    2013-01-01

    Background Non-pharmacological options for symptomatic management of cough are desired. Although chest wall mechanical vibration is known to ameliorate cough reflex sensitivity, the effect of mechanical vibrations on perceptions of urge-to-cough has not been studied. Therefore, we investigated the effect of mechanical vibration of cervical trachea, chest wall and femoral muscle on cough reflex sensitivity, perceptions of urge-to-cough as well as dyspnea. Methods Twenty-four healthy male never-smokers were investigated for cough reflex sensitivity, perceptions of the urge-to-cough and dyspnea with or without mechanical vibration. Cough reflex sensitivity and urge-to-cough were evaluated by the inhalation of citric acid. The perception of dyspnea was evaluated by Borg scores during applications of external inspiratory resistive loads. Mechanical vibration was applied by placing a vibrating tuning fork on the skin surface of cervical trachea, chest wall and femoral muscle. Results Cervical trachea vibration significantly increased cough reflex threshold, as expressed by the lowest concentration of citric acid that elicited five or more coughs (C5), and urge-to-cough threshold, as expressed by the lowest concentration of citric acid that elicited urge-to-cough (Cu), but did not significantly affect dypnea sensation during inspiratory resistive loading. On the other hand, the chest wall vibration not only significantly increased C5 and Cu but also significantly ameliorated the load-response curve of dyspnea sensation. Conclusions Both cervical and trachea vibrations significantly inhibited cough reflex sensitivity and perception of urge-to-cough. These vibration techniques might be options for symptomatic cough management. PMID:24088411

  6. Management of a Chest-Wall Soft-Tissue Tumor Caused by an Infection with the Larval Tapeworm Pathogen Taenia crassiceps

    PubMed Central

    Roesel, Christian; Welter, Stefan; Stamatis, Georgios; Theegarten, Dirk; Tappe, Dennis

    2014-01-01

    A chest-wall lesion of an immunocompetent patient was initially suspicious for a malignant tumor. Histopathological and polymerase chain reaction examinations revealed an infection with the larval stage of the tapeworm Taenia crassiceps. Curative resection of the tumorous lesion was performed. Treatment options for immunocompromised patients and patients without known immune defect are discussed, because most of the infections occur in immunocompromised individuals. PMID:24914004

  7. Low-dose Photofrin-induced PDT offers excellent clinical response with minimal morbidity in chest wall recurrence of breast cancer

    NASA Astrophysics Data System (ADS)

    Allison, Ron; Mang, Thomas S.

    2000-03-01

    Limited therapeutic options exist when chest wall recurrence form breast cancer progresses despite standard salvage treatment. As photodynamic therapy offers excellent response for cutaneous lesions this may be a possible indication for PDT. A total of 102 treatment fields were illuminated on 9 women with biopsy proven chest wall recurrence of breast cancer which was progressing despite salvage surgery, radiation, and chemi-hormonal therapy. PDT consisted of outpatient IV infusion of Photofrin at 0.8 mg/kg followed 48 hours laser by illumination at 140-170 J/cm2 via a KTP Yag laser coupled to a dye unit. No patient was lost to follow up. At 6 months post PDT; complete response, defined as total lesion elimination was 89 percent, partial response 8 percent, and no response 3 percent. No photosensitivity was seen and no patient developed scarring, fibrosis, or healing difficulties. Low dose Photofrin induced PDT is very active against chest wall lesions. Despite fragile and heavily pre-treated tissues, excellent clinical and cosmetic outcome was obtained. PDT is an underutilized modality for this indication.

  8. Highly sensitive monitoring of chest wall dynamics and acoustics provides diverse valuable information for evaluating ventilation and diagnosing pneumothorax.

    PubMed

    Pesin, Jimy; Faingersh, Anna; Waisman, Dan; Landesberg, Amir

    2014-06-15

    Current practice of monitoring lung ventilation in neonatal intensive care units, utilizing endotracheal tube pressure and flow, end-tidal CO2, arterial O2 saturation from pulse oximetry, and hemodynamic indexes, fails to account for asymmetric pathologies and to allow for early detection of deteriorating ventilation. This study investigated the utility of bilateral measurements of chest wall dynamics and sounds, in providing early detection of changes in the mechanics and distribution of lung ventilation. Nine healthy New Zealand rabbits were ventilated at a constant pressure, while miniature accelerometers were attached to each side of the chest. Slowly progressing pneumothorax was induced by injecting 1 ml/min air into the pleural space on either side of the chest. The end of the experiment (tPTX) was defined when arterial O2 saturation from pulse oximetry dropped <90% or when vigorous spontaneous breathing began, since it represents the time of clinical detection using common methods. Consistent and significant changes were observed in 15 of the chest dynamics parameters. The most meaningful temporal changes were noted for features extracted from subsonic dynamics (<10 Hz), e.g., tidal amplitude, energy, and autoregressive poles. Features from the high-frequency band (10-200 Hz), e.g., energy and entropy, exhibited smaller but significant changes. At 70% tPTX, identification of asymmetric ventilation was attained for all animals. Side identification of the pneumothorax was achieved at 50% tPTX, within a 95% confidence interval. Diagnosis was, on average, 34.1 ± 18.8 min before tPTX. In conclusion, bilateral monitoring of the chest dynamics and acoustics provide novel information that is sensitive to asymmetric changes in ventilation, enabling early detection and localization of pneumothorax. PMID:24790013

  9. DOSE–VOLUME PARAMETERS PREDICT FOR THE DEVELOPMENT OF CHEST WALL PAIN AFTER STEREOTACTIC BODY RADIATION FOR LUNG CANCER

    PubMed Central

    Mutter, Robert W.; Liu, Fan; Abreu, Andres; Yorke, Ellen; Jackson, Andrew; Rosenzweig, Kenneth E.

    2013-01-01

    Purpose Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non–small-cell lung cancer (NSCLC). We developed a dose–volume model to predict the development of this toxicity. Methods and Materials A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40–60 Gy and were prospectively followed. The dose–absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients. Results With a median follow-up of 16 months, the 2-year estimated actuarial incidence of Grade ≥ 2 CW pain was 39%. The median time to onset of Grade ≥ 2 CW pain (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0) was 9 months. There was no predictive advantage for biologically corrected dose over physical dose. Neither fraction number (p = 0.07) nor prescription dose (p = 0.07) were significantly correlated with the development of Grade ≥ 2 CW pain. Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations, with the CW volume receiving 30 Gy (V30) as one of the strongest predictors (p < 0.001). CW2cm consistently enabled better prediction of CW toxicity. When a physical dose of 30 Gy was received by more than 70 cm3 of CW2cm, there was a significant correlation with Grade ≥ 2 CW pain (p = 0.004). Conclusions CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients. A volume of CW ≥ 70 cm3 receiving 30 Gy is significantly correlated with Grade ≥ 2 CW pain. We are currently applying this constraint at our institution for patients receiving thoracic SBRT. An actuarial atlas of our data is provided as an electronic supplement to facilitate data-sharing and meta-analysis relating to CW pain. PMID:21868173

  10. Dose-Volume Parameters Predict for the Development of Chest Wall Pain After Stereotactic Body Radiation for Lung Cancer

    SciTech Connect

    Mutter, Robert W.; Liu Fan; Abreu, Andres; Yorke, Ellen; Jackson, Andrew; Rosenzweig, Kenneth E.

    2012-04-01

    Purpose: Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). We developed a dose-volume model to predict the development of this toxicity. Methods and Materials: A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40-60 Gy and were prospectively followed. The dose-absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients. Results: With a median follow-up of 16 months, the 2-year estimated actuarial incidence of Grade {>=} 2 CW pain was 39%. The median time to onset of Grade {>=} 2 CW pain (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0) was 9 months. There was no predictive advantage for biologically corrected dose over physical dose. Neither fraction number (p = 0.07) nor prescription dose (p = 0.07) were significantly correlated with the development of Grade {>=} 2 CW pain. Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations, with the CW volume receiving 30 Gy (V30) as one of the strongest predictors (p < 0.001). CW2cm consistently enabled better prediction of CW toxicity. When a physical dose of 30 Gy was received by more than 70 cm{sup 3} of CW2cm, there was a significant correlation with Grade {>=} 2 CW pain (p = 0.004). Conclusions: CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients. A volume of CW {>=} 70 cm{sup 3} receiving 30 Gy is significantly correlated with Grade {>=} 2 CW pain. We are currently applying this constraint at our institution for patients receiving thoracic SBRT. An actuarial atlas of our data is provided as an electronic supplement to facilitate data-sharing and meta-analysis relating to CW pain.

  11. Design of a Broadband Electrical Impedance Matching Network for Piezoelectric Ultrasound Transducers Based on a Genetic Algorithm

    PubMed Central

    An, Jianfei; Song, Kezhu; Zhang, Shuangxi; Yang, Junfeng; Cao, Ping

    2014-01-01

    An improved method based on a genetic algorithm (GA) is developed to design a broadband electrical impedance matching network for piezoelectric ultrasound transducer. A key feature of the new method is that it can optimize both the topology of the matching network and perform optimization on the components. The main idea of this method is to find the optimal matching network in a set of candidate topologies. Some successful experiences of classical algorithms are absorbed to limit the size of the set of candidate topologies and greatly simplify the calculation process. Both binary-coded GA and real-coded GA are used for topology optimization and components optimization, respectively. Some calculation strategies, such as elitist strategy and clearing niche method, are adopted to make sure that the algorithm can converge to the global optimal result. Simulation and experimental results prove that matching networks with better performance might be achieved by this improved method. PMID:24743156

  12. Reproducibility of The Abdominal and Chest Wall Position by Voluntary Breath-Hold Technique Using a Laser-Based Monitoring and Visual Feedback System

    SciTech Connect

    Nakamura, Katsumasa . E-mail: nakam@radiol.med.kyushu-u.ac.jp; Shioyama, Yoshiyuki; Nomoto, Satoru; Ohga, Saiji; Toba, Takashi; Yoshitake, Tadamasa; Anai, Shigeo; Terashima, Hiromi; Honda, Hiroshi

    2007-05-01

    Purpose: The voluntary breath-hold (BH) technique is a simple method to control the respiration-related motion of a tumor during irradiation. However, the abdominal and chest wall position may not be accurately reproduced using the BH technique. The purpose of this study was to examine whether visual feedback can reduce the fluctuation in wall motion during BH using a new respiratory monitoring device. Methods and Materials: We developed a laser-based BH monitoring and visual feedback system. For this study, five healthy volunteers were enrolled. The volunteers, practicing abdominal breathing, performed shallow end-expiration BH (SEBH), shallow end-inspiration BH (SIBH), and deep end-inspiration BH (DIBH) with or without visual feedback. The abdominal and chest wall positions were measured at 80-ms intervals during BHs. Results: The fluctuation in the chest wall position was smaller than that of the abdominal wall position. The reproducibility of the wall position was improved by visual feedback. With a monitoring device, visual feedback reduced the mean deviation of the abdominal wall from 2.1 {+-} 1.3 mm to 1.5 {+-} 0.5 mm, 2.5 {+-} 1.9 mm to 1.1 {+-} 0.4 mm, and 6.6 {+-} 2.4 mm to 2.6 {+-} 1.4 mm in SEBH, SIBH, and DIBH, respectively. Conclusions: Volunteers can perform the BH maneuver in a highly reproducible fashion when informed about the position of the wall, although in the case of DIBH, the deviation in the wall position remained substantial.

  13. Should Postmastectomy Radiotherapy to the Chest Wall and Regional Lymph Nodes Be Standard for Patients with 1–3 Positive Lymph Nodes?

    PubMed Central

    Offersen, Birgitte V.; Brodersen, Hans-Jürgen; Nielsen, Mette M.; Overgaard, Jens; Overgaard, Marie

    2011-01-01

    The indication for adjuvant postmastectomy radiotherapy (PMRT) in breast cancer patients with small tumors and 1–3 macrometastases in the axilla remains a controversial issue, despite the recommendation that PMRT should be applied in these patients in the most recent overview by the Early Breast Cancer Trialists’ Collaborative Group. In this report, we discuss the available data on the benefit from PMRT in patients diagnosed with N1 breast cancer. Based on this, we recommend adjuvant PMRT to the chest wall and regional lymph nodes in patients diagnosed with early node-positive breast cancer. PMID:22619643

  14. Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager.

    PubMed

    Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio

    2015-06-01

    Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques. PMID:26046903

  15. [Influences of chest deformation by upper abdominal retractor on respiratory system impedance during abdominal surgery].

    PubMed

    Oka, T; Ozawa, Y; Sato, J

    1999-02-01

    The present study was carried out to clarify the effects of chest deformation by upper abdominal retractor on respiratory system impedance during abdominal surgery. We measured the impedances of respiratory system (RS), lung, and chest wall (CW) in nine anesthetized paralyzed subjects employing a pseudorandom noise forced volume oscillation technique. These measurements were performed before and after the lifting chest wall by upper abdominal retractor. The effects of chest deformation was significant on the impedances of RS, lung, while no discernible effect was found in CW impedance. Lifting chest wall decreased RS resistance which was totally accounted for by the decrease in lung resistance, whereas the lifting did not affect reactance in either RS or lung. The mathematical modeling showed the significant lifting effect on the resistance of the parenchyma. In conclusion, change in RS mechanics produced by chest deformation by upper abdominal retractor is dominated in lung but not in CW. Among the lung mechanical components, parenchyma is the primary site of the lifting effect. PMID:10087819

  16. EM algorithm applied for estimating non-stationary region boundaries using electrical impedance tomography

    NASA Astrophysics Data System (ADS)

    Khambampati, A. K.; Rashid, A.; Kim, B. S.; Liu, Dong; Kim, S.; Kim, K. Y.

    2010-04-01

    EIT has been used for the dynamic estimation of organ boundaries. One specific application in this context is the estimation of lung boundaries during pulmonary circulation. This would help track the size and shape of lungs of the patients suffering from diseases like pulmonary edema and acute respiratory failure (ARF). The dynamic boundary estimation of the lungs can also be utilized to set and control the air volume and pressure delivered to the patients during artificial ventilation. In this paper, the expectation-maximization (EM) algorithm is used as an inverse algorithm to estimate the non-stationary lung boundary. The uncertainties caused in Kalman-type filters due to inaccurate selection of model parameters are overcome using EM algorithm. Numerical experiments using chest shaped geometry are carried out with proposed method and the performance is compared with extended Kalman filter (EKF). Results show superior performance of EM in estimation of the lung boundary.

  17. Optimal design of a standing-wave accelerating tube with a high shunt impedance based on a genetic algorithm

    NASA Astrophysics Data System (ADS)

    Tang, Zhenxing; Pei, Yuanji; Pang, Jian

    2015-08-01

    In this paper, we present an optimal design based on a genetic algorithm for a compact standing-wave (SW) accelerating tube with an operating frequency of 2998 MHz for industrial and medical applications. It consists of bi-periodic structures with a nose cone whose inter-cavity coupling is achieved through electric coupling rather than magnetic coupling. A mathematical model is established to optimize the arc at the cavity wall to reduce the microwave power loss and to optimize the nose cone to increase the electric field along the axis to achieve a high shunt impedance. The simulation results indicate that with the proper nose cone and arc, the shunt impedance of the cavity can be as high as 114 MΩ / m. Afterward, we present the tuning of the tube using SUPERFISH and the calculation of the beam dynamics using ASTRA and Parmela. The total length of the optimal tube is only 30.175 cm. Finally, a coupler is designed with a small-aperture coupling using CST MICROWAVE STUDIO.

  18. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system

    PubMed Central

    Sollitto, Francesco; Loizzi, Domenico; Di Gennaro, Francesco; Scarascia, Daniele; Carlucci, Annalisa; Giudice, Giuseppe; Armenio, Andrea; Ludovico, Rossana; Loizzi, Michele

    2016-01-01

    Background We report short and long-term results with the dedicated Synthes® titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. Methods We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16–83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire]. Results Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115–430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5–129 days). At a median follow-up of 20 months (range: 1–59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. Conclusions An optimal chest wall stabilization and reconstruction was achieved with the Synthes® titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time

  19. [Pleuroperitoneal communication due to diaphragmatic injury as a complication of chest wall resection in a peritoneal dialysis patient; report of a case].

    PubMed

    Kanauchi, Naoki; Oizumi, H; Kato, H; Endo, M; Sadahiro, M

    2009-09-01

    A 78-year-old female undergoing peritoneal dialysis due to chronic renal failure was admitted to our hospital because of a tumor on her right chest wall. The diagnosis was recurrence of hepatocellular carcinoma in the thoracic wall, and a combined resection of the thoracic wall and diaphragm was performed. Peritoneal dialysis was resumed 7 days after surgery, but a right pleural effusion was observed after 6 days of dialysis. Surgery was performed because failure of sutures related to the excised diaphragm was suspected. A thoracotomy revealed a large defect, about 1 cm in size, caused by injury of the diaphragm by an edge of the resected rib at the another site of a previous resection of the diaphragm. This defect was closed with sutures and the diaphragm was reinforced with a polyglycolic acid felt and fibrin glue. Peritoneal dialysis was resumed 7 days after surgery and has continued to date without recurrence. PMID:19764505

  20. Radio-guided occult lesion localisation using iodine 125 Seeds “ROLLIS” to guide surgical removal of an impalpable posterior chest wall melanoma metastasis

    SciTech Connect

    Dissanayake, Shashini; Dissanayake, Deepthi; Taylor, Donna B

    2015-09-15

    Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 ({sup 125}I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

  1. Poster — Thur Eve — 09: Evaluation of electrical impedance and computed tomography fusion algorithms using an anthropomorphic phantom

    SciTech Connect

    Chugh, Brige Paul; Krishnan, Kalpagam; Liu, Jeff; Kohli, Kirpal

    2014-08-15

    Integration of biological conductivity information provided by Electrical Impedance Tomography (EIT) with anatomical information provided by Computed Tomography (CT) imaging could improve the ability to characterize tissues in clinical applications. In this paper, we report results of our study which compared the fusion of EIT with CT using three different image fusion algorithms, namely: weighted averaging, wavelet fusion, and ROI indexing. The ROI indexing method of fusion involves segmenting the regions of interest from the CT image and replacing the pixels with the pixels of the EIT image. The three algorithms were applied to a CT and EIT image of an anthropomorphic phantom, constructed out of five acrylic contrast targets with varying diameter embedded in a base of gelatin bolus. The imaging performance was assessed using Detectability and Structural Similarity Index Measure (SSIM). Wavelet fusion and ROI-indexing resulted in lower Detectability (by 35% and 47%, respectively) yet higher SSIM (by 66% and 73%, respectively) than weighted averaging. Our results suggest that wavelet fusion and ROI-indexing yielded more consistent and optimal fusion performance than weighted averaging.

  2. Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance

    PubMed Central

    Bonomi, Alberto G; Goode, Kevin M; Reiter, Harald; Habetha, Joerg; Amft, Oliver; Cleland, John GF

    2016-01-01

    Background Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines. Conclusions NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation. PMID:26892844

  3. Dystrophic calcinosis with both a huge calcified mass in the cervical spine and calcification in the chest wall in a patient with rheumatoid overlap syndrome.

    PubMed

    Nakamura, Tadashi; Hirakawa, Kei; Takaoka, Hirokazu; Iyama, Ken-Ichi

    2016-05-01

    Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis. PMID:24894107

  4. Salmonella Abscess of the Anterior Chest Wall in a Patient With Type 2 Diabetes and Poor Glycemic Control: A Case Report.

    PubMed

    Chiao, Hao-Yu; Wang, Chi-Yu; Wang, Chih-Hsin

    2016-03-01

    Salmonella can cause extra-intestinal focal infections as well as gastrointestinal problems. A few cases of Salmonella skin and soft tissue infection have been documented in immunocompromised patients such as persons with type 2 diabetes and poor glycemic control. A case study is presented of a 30-year-old man with a 10-year history of poorly controlled (HbA1C 11.7%) diabetes mellitus who presented with a ruptured nodule resulting in a wound with signs of infection over his anterior chest region of 1-month duration. He had been taking amoxycillin/clavulanate for the week previous to presentation at the authors' facility. Following sharp debridement, the ulcerative wound deteriorated and a chest wall abscess developed. Bacterial culture results were positive for Salmonella group D, resistant to ampicillin and susceptible to ceftriaxone and ciprofloxacin. The patient underwent surgical debridement, resulting in a wound 7 cm x 4 cm, and was provided ceftriaxone 2.0 g intravenously daily along with insulin therapy. After surgical debridement, a local rotational flap was created for wound closure and reconstruction. The patient was discharged 1 week later on oral antibiotic therapy for 1 week. His wound was completely healed without recurrence at his 4-month follow-up. For this patient, addressing glycemic issues, identifying the infectious organism, and providing appropriate therapy, radical debridement, and flap surgery helped heal an advanced soft tissue infection. In immunocompromised patients with skin or soft tissue infections, the presence of Salmonella should be considered. PMID:26978859

  5. Development of an imaging-planning program for screen/film and computed radiography mammography for breasts with short chest wall to nipple distance

    PubMed Central

    Dong, S L; Su, J L; Yeh, Y H; Chu, T C; Lin, Y C; Chuang, K S

    2011-01-01

    Objective Imaging breasts with a short chest wall to nipple distance (CWND) using a traditional mammographic X-ray unit is a technical challenge for mammographers. The purpose of this study is the development of an imaging-planning program to assist in determination of imaging parameters of screen/film (SF) and computed radiography (CR) mammography for short CWND breasts. Methods A traditional mammographic X-ray unit (Mammomat 3000, Siemens, Munich, Germany) was employed. The imaging-planning program was developed by combining the compressed breast thickness correction, the equivalent polymethylmethacrylate thickness assessment for breasts and the tube loading (mAs) measurement. Both phantom exposures and a total of 597 exposures were used for examining the imaging-planning program. Results Results of the phantom study show that the tube loading rapidly decreased with the CWND when the automatic exposure control (AEC) detector was not fully covered by the phantom. For patient exposures with the AEC fully covered by breast tissue, the average fractional tube loadings, defined as the ratio of the predicted mAs using the imaging-planning program and mAs of the mammogram, were 1.10 and 1.07 for SF and CR mammograms, respectively. The predicted mAs values were comparable to the mAs values, as determined by the AEC. Conclusion By applying the imaging-planning program in clinical practice, the experiential dependence of the mammographer for determination of the imaging parameters for short CWND breasts is minimised. PMID:21123310

  6. SU-E-T-632: A Dosimetric Comparison of the 3D-CRT Planning of Chest Wall in Post-Mastectomy Breast Cancer Patients, with and Without Breast Board Setup

    SciTech Connect

    Muzaffar, Ambreen; Masood, Asif; Ullah, Haseeb; Mehmood, Kashif; Qasim, Uzma; Afridi, M. Ali; Khan, Salim; Hameed, Abdul

    2014-06-15

    Purpose: Breast boards are used in breast radiation which increases normal lung and heart doses, when supraclavicular field is included. Therefore, in this study through dose volume histogram (DVHs), lung and heart doses comparison was done between two different setups i.e. with and without breast board, for the treatment of left chest wall and supraclavicular fossa in postmastectomy left breast cancer. Methods: In this study, CT-Simulation scans of ten breast cancer patients were done with and without breast board, at Shifa International Hospitals Islamabad, to investigate the differences between the two different setups of the irradiation of left chest wall in terms of lung and heart doses. For immobilization, support under the neck, shoulders and arms was used. Precise PLAN 2.15 treatment planning system (TPS) was used for 3D-CRT planning. The total prescribed dose for both the plans was 5000 cGy/25 fractions. The chest wall was treated with a pair of tangential photon fields and the upper supraclavicular nodal regions were treated with an anterior photon field. A mono-isocentric technique was used to match the tangential fields with the anterior field at the isocentre. The dose volume histogram was used to compare the doses of heart and ipsilateral lung. Results: Both the plans of each patient were generated and compared. DVH results showed that for the same PTV dose coverage, plans without breast board resulted in a reduction of lung and heart doses compared with the plans with breast board. There was significant reductions in V20, V<25 and mean doses for lung and V<9 and mean doses for heart. Conclusion: In comparison of both the plans, setup without breast board significantly reduced the dose-volume of the ipsilateral lung and heart in left chest wall patients. Waived registration request has been submitted.

  7. Efficacy and safety of human fibrinogen-thrombin patch (Tachosil®) in the management of diffuse bleeding after chest wall and spinal surgical resection for aggressive thoracic neoplasms

    PubMed Central

    Guerrera, Francesco; Sandri, Alberto; Zenga, Francesco; Lanza, Giovanni Vittorio; Ruffini, Enrico; Bora, Giulia; Lyberis, Paraskevas; Solidoro, Paolo; Oliaro, Alberto

    2016-01-01

    Diffuse bleeding after chest wall and spine resection represents a major problem in General Thoracic Surgery. Several fibrin sealants (FS) have been developed over the years and their use has been gradually increasing over time, becoming an important aid to the surgeons, justifying their use across numerous fields of surgery due to its valid haemostatic properties. Among the several FS available, TachoSil® (Takeda Austria GmbH, Linz, Austria) stands out for its haemostatic and aerostatic properties, the latter being demonstrated even in high-risk patients after pulmonary resections for primary lung cancers. Several papers available in literature demonstrated TachoSil®’s effectiveness in controlling intraoperative and postoperative bleeding in different surgical branches, including hepatic and pancreatic surgery, as well as cardiac and thoracic surgery. However, the use of TachoSil® to control diffuse bleeding following major resections for advanced lung cancers, with requirement of chest wall and vertebral body resection for oncological radicality, was never published so far. In this paper, we report three cases of pulmonary lobectomy associated to chest wall resection and haemivertebrectomy for primary malignant lung neoplasms and for a recurrence of malignant solitary fibrous tumour of the pleura in which we used TachoSil©, which demonstrated its efficacy in controlling diffuse bleeding following resection. PMID:26904247

  8. SU-E-T-583: Operated Left Breast and Chest Wall Radiotherapy: A Dosimetric Comparison Between 3DCRT, IMRT and VMAT

    SciTech Connect

    Sarkar, B; Roy, S; Munshi, A; Pradhan, A

    2015-06-15

    Purpose: To evaluate the comparative dosimetric efficacy between field and field 3DCRT(FnF), multiple field Intensity modulated radiotherapy (SnS IMRT) and, partial arc volumetric modulated arc therapy (VMAT) in case of post operative left side breast and chest wall irradiation. Methods: CT study set of fifteen post-operative left breast and chest wall patient was tested for a treatment plan of 50Gy in 25 fraction using partial arc VMAT, SnSIMRT and tangential beam 3DCRT . 3DCRT FnF gantry angle was ranging for left medial tangential 290±17{sup 0} and Lt lateral tangential l14°±12{sup 0}. For IMRT four fixed beam at gantry angle G130{sup 0} G110{sup 0} G300{sup 0} and G330{sup 0} was used, in case of insufficient dose another beam G150{sup 0} was added. In case of partial arc VMAT, lateral tangential arc G130{sup 0}-G100{sup 0} and medial tangential arc G280{sup 0}-G310{sup 0}. Inverse optimization was opted to cover at least 95%PTV by 95% prescription dose (RxD) and a strong weightage on reduction of heart and lung dose. PTV coverage was evaluated for it’s clinically acceptability depending on the tumor spatial location and its quadrant. Out of the three plans, any one was used for the actual patient treatment. Results: Dosimetric analysis done for breast PTV, left lung, heart and the opposite breast. PTV mean dose and maximum dose was 5129.8±214.8cGy, 4749.0±329.7cGy, 5024.6±73.4cGy and 5855.2±510.7cGy, 5340.7±146.1cGy, 5347.2±196.8cGy for FnF, VMAT and IMRT respectively. Ipsilateral lung volume receiving 20Gy and 5Gy was 23.6±9.5cGy and 32.7±10.3cGy for FnF, 18.6±8.7cGy and 38.8±15.2cGy for VMAT and 25.7±9.6cGy and 50.7±8.4cGy for IMRT respectively. Heart mean and 2cc dose was 867.9±456.7cGy and 5038.5±184.3cGy for FnF, 532.6±263cGy and 3632.1±990.6 for VMAT, 711±229.9cGy and 4421±463.7cGy for IMRT respectively. VMAT shows minimum contralateral breast dose 168±113.8cGy. Conclusion: VMAT shows a better tumor conformity, minimum heart

  9. Postmastectomy Chest Wall Radiation to a Temporary Tissue Expander or Permanent Breast Implant-Is There a Difference in Complication Rates?

    SciTech Connect

    Anderson, Penny R. Freedman, Gary; Nicolaou, Nicos; Sharma, Navesh; Li Tianyu; Topham, Neal; Morrow, Monica

    2009-05-01

    Purpose: The purpose of this study was to evaluate the likelihood of complications and cosmetic results among breast cancer patients who underwent modified radical mastectomy (MRM) and breast reconstruction followed by radiation therapy (RT) to either a temporary tissue expander (TTE) or permanent breast implant (PI). Methods and Materials: Records were reviewed of 74 patients with breast cancer who underwent MRM followed by breast reconstruction and RT. Reconstruction consisted of a TTE usually followed by exchange to a PI. RT was delivered to the TTE in 62 patients and to the PI in 12 patients. Dose to the reconstructed chest wall was 50 Gy. Median follow-up was 48 months. The primary end point was the incidence of complications involving the reconstruction. Results: There was no significant difference in the rate of major complications in the PI group (0%) vs. 4.8% in the TTE group. No patients lost the reconstruction in the PI group. Three patients lost the reconstruction in the TTE group. There were excellent/good cosmetic scores in 90% of the TTE group and 80% of the PI group (p = 0.22). On multivariate regression models, the type of reconstruction irradiated had no statistically significant impact on complication rates. Conclusions: Patients treated with breast reconstruction and RT can experience low rates of major complications. We demonstrate no significant difference in the overall rate of major or minor complications between the TTE and PI groups. Postmastectomy RT to either the TTE or the PI should be considered as acceptable treatment options in all eligible patients.

  10. Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

    SciTech Connect

    Dunlap, Neal E.; Cai, Jing; Biedermann, Gregory B.; Yang, Wensha; Benedict, Stanley H.; Sheng Ke; Schefter, Tracey E.; Kavanagh, Brian D.; Larner, James M.

    2010-03-01

    Purpose: To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving >=20, >=30, >=40, >=50, and >=60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R{sup 2} = 0.9552). A volume threshold of 30 cm{sup 3} was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm{sup 3} receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm{sup 3}, if possible, to reduce the risk of toxicity without compromising tumor coverage.

  11. SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

    SciTech Connect

    Zellars, Richard; Bravo, Paco E.; Tryggestad, Erik; Hopfer, Kari; Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey; Garrett-Mayer, Elizabeth

    2014-03-15

    Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits.

  12. Is there a standard of care for the radical management of non-small cell lung cancer involving the apical chest wall (Pancoast tumours)?

    PubMed

    Peedell, C; Dunning, J; Bapusamy, A

    2010-06-01

    The term Pancoast tumour encompasses a wide range of tumours that invade the apical chest wall. Although less than 5% of non-small cell lung cancers are Pancoast tumours, they still account for most cases. They often pose a formidable challenge to the multidisciplinary lung cancer team due to their relative rarity, anatomical proximity to vital structures, differing stages of presentation, and their association with smoking-related illnesses. A lack of clinical trials makes comparisons between different treatment modalities very difficult and the management of Pancoast tumours has been largely based on the published retrospective experience of large single institutions. The bimodality approach of induction radiotherapy followed by surgical resection has been the accepted standard of care for the last 50 years, with reported 5-year survival rates of 30% in selected patients. However, two recent prospective multicentre phase II studies using a trimodality approach of induction concurrent chemoradiotherapy followed by surgical resection (followed by two further cycles of adjuvant chemotherapy in one of the studies), have reported 5-year survival rates of 44-56%. This has led to some authorities advocating the trimodality approach as the new standard of care for the management of Pancoast tumours. In this overview, the historical evolution of the management of Pancoast tumours and recent published studies on the trimodality approach are discussed. This is followed by a discussion of whether the trimodality approach should be seen as a new standard of care. Finally, other potential treatment options and the possibilities for future research are deliberated. PMID:20347280

  13. Early Detection of Cervical Intraepitelial Neoplasia in a Heterogeneos Group of Colombian Women Using Electrical Impedance Spectroscopy and the Miranda-López Algorithm

    NASA Astrophysics Data System (ADS)

    Miranda, David A.; Corzo, Sandra P.; González-Correa, Carlos-A.

    2012-12-01

    Electrical Impedance Spectroscopy (EIS) allows the study of the electrical properties of materials and structures such as biological tissues. EIS can be used as a diagnostic tool for the identification of pathological conditions such as cervical cancer. We used EIS in combination with genetic algorithms to characterize cervical epithelial squamous tissue in a heterogeneous sample of 56 Colombian women. All volunteers had a cytology taken for Papanicolau test and biopsy taken for histopathological analysis from those with a positive result (9 subjects). ROC analysis of the results suggest a sensitivity and specificity in the order of 0.73 and 0.86, respectively.

  14. Radiation-induced low-grade fibromyxoid sarcoma of the chest wall nine years subsequent to radiotherapy for breast carcinoma: A case report

    PubMed Central

    SHIBATA, SHINO; SHIRAISHI, KENSHIRO; YAMASHITA, HIDEOMI; KOBAYASHI, REIKO; NAKAGAWA, KEIICHI

    2016-01-01

    The present study reports a case of low-grade fibromyxoid sarcoma that occurred in a 62-year-old woman 9 years subsequent to whole breast irradiation for a carcinoma of the left breast, and 18 years following chemotherapy and radiotherapy (RT) for non-Hodgkin's lymphoma (NHL; diagnosed at the age of 43). The patient was 53 years of age when a cT2N0M0 stage IIA breast tumor was identified and excised. A 2.5 cm diameter nodule with dimpling in the upper-outer region of the left breast was detected. Pathological examination revealed that the tumor was an invasive ductal carcinoma, of a solid tubular type. The patient was treated with post-surgical whole breast RT. The left breast received 46 Gy in 23 fractions (2 Gy per fraction) for 4 weeks and 3 days, followed by a cone down boost of 14 Gy in 7 fractions (2 Gy per fraction); therefore a total dose of 60 Gy in 30 fractions was administered. In total, 9 years subsequent to RT, the patient observed a small lump in the left chest wall. The patient underwent excision of the tumor and pectoralis major fascia. Microscopically, the tumor consisted of atypical spindle cells with myxoid stroma. Pathologists concluded that the tumor was a low-grade fibromyxoid sarcoma. Since the tumor developed from tissue in a previously irradiated region, it was considered to be RT-induced, and was classified using the radiation-induced sarcoma (RIS) criteria as dictated by Cahan. Although the majority of RIS cases are angiosarcomas, a rare, low-grade fibromyxoid sarcoma was observed in the present study. The present study hypothesizes that there may have been an overlap region between the RT for supraclavicular nodes of NHL and the whole breast RT for primary breast cancer, due to the results of a retrospective dose reconstruction undertaken by the present study. The patient remained clinically stable for 4 years thereafter, until 2008 when the patient experienced a local relapse and underwent surgery. On 19 October 2011, the patient

  15. Evaluation of bolus electron conformal therapy compared with conventional techniques for the treatment of left chest wall postmastectomy in patients with breast cancer

    SciTech Connect

    Opp, Dan Forster, Kenneth; Li, Weiqi; Zhang, Geoffrey; Harris, Eleanor E.

    2013-01-01

    Postmastectomy radiation (PMRT) lowers local-regional recurrence risk and improves survival in selected patients with breast cancer. The chest wall and lower axilla are technically challenging areas to treat with homogenous doses and normal tissue sparing. This study compares several techniques for PMRT to provide data to guide selection of optimal treatment techniques. Twenty-five consecutive left-sided patients treated postmastectomy were contoured using Radiation Therapy Oncology Group (RTOG) atlas guidelines then planned using 4 different PMRT techniques: opposed tangents with wedges (3-dimensional [3D] wedges), opposed tangents with field-in-field (FiF) modulation, 8-field intensity modulation radiotherapy (IMRT), and custom bolus electron conformal therapy (BolusECT, .decimal, Inc., Sanford, FL). Required planning target volume (PTV) coverage was held constant, and then dose homogeneity and normal tissue dose parameters were compared among the 4 techniques. BolusECT achieved clincally acceptable PTV coverage for 22 out of 25 cases. Compared with either tangential technique, IMRT and BolusECT provided the lowest heart V{sub 25} doses (3.3% ± 0.9% and 6.6% ± 3.2%, respectively with p < 0.0001). FiF had the lowest mean total lung dose (7.3 ± 1.1 Gy, with p = 0.0013), IMRT had the lowest total lung V{sub 20} (10.3% ± 1.6%, p < 0.0001), and BolusECT had the lowest mean heart dose (7.3 ± 2.0 Gy, p = 0.0002). IMRT provided the optimal dose homogeneity and normal tissue sparing compared with all other techniques for the cases in which BolusECT could not achieve acceptable PTV coverage. IMRT generally exposes contralateral breast and lung to slightly higher doses. Optimal PMRT technique depends upon patient anatomy. Patients whose maximal target volume depth is about 5.7 cm or less can be treated with BolusECT-assisted 12 or 15 MeV electron beams. At these energies, BolusECT has comparable dose-volume statistics as IMRT and lower heart V{sub 25} than opposed

  16. Computer simulation of respiratory impedance and flow transfer functions during high frequency oscillations.

    PubMed

    Peslin, R

    1989-01-01

    The usefulness of measuring respiratory flow in the airway and at the chest wall and of measuring respiratory input impedance (Z) to monitor high frequency ventilation was investigated by computer simulation using a monoalveolar 10-coefficient model. The latter included a central airway with its resistance (Rc) and inertance (lc), a resistive peripheral airway (Rp), a lumped bronchial compliance (Cb), alveolar gas compliance (Cgas), lung tissue with its resistance (RL) and compliance (CL), and chest wall resistance (RW), inertance (lw) and compliance (Cw). Gas flow in the peripheral airway (Vp), shunt flow through Cb (Vb), gas compression flow (Vgas) and rate of volume change of the lung (VL) and of the chest (VW) were computed and expressed as a function of gas flow in the central airway (Vc). For normal values of the coefficients, Vp/Vc was found to decrease moderately with increasing frequency and was still 0.75 at 20 Hz. Peripheral airway obstruction (Rp x 5) considerably decreased Vp/Vc, particularly at high frequency. It did not change the relationship between the two measurable flows, Vc and Vw, but increased the effective resistance at low frequency and shifted the reactance curve to the right. A reduced lung or chest wall compliance produced little change in Vp/Vc and Z except at very low frequencies; however, it decreased the phase lag between Vw and Vc. Finally, an increased airway wall compliance decreased Vp/Vc, but had little effect on Z and Vw/Vc. It is concluded that measuring respiratory impedance may help in detecting some, but not all of the conditions in which peripheral flow convection is decreased during high frequency oscillations. PMID:2611083

  17. Electron Impedances

    SciTech Connect

    P Cameron

    2011-12-31

    It is only recently, and particularly with the quantum Hall effect and the development of nanoelectronics, that impedances on the scale of molecules, atoms and single electrons have gained attention. In what follows the possibility that characteristic impedances might be defined for the photon and the single free electron is explored is some detail, the premise being that the concepts of electrical and mechanical impedances are relevant to the elementary particle. The scale invariant quantum Hall impedance is pivotal in this exploration, as is the two body problem and Mach's principle.

  18. Secondary reconstruction with a transverse colon covered with a pectoralis major muscle flap and split thickness skin grafts for an esophageal defect and wide skin defects of the anterior chest wall.

    PubMed

    Sadanaga, Noriaki; Morinaga, Keigo; Matsuura, Hiroshi

    2015-12-01

    Necrosis of a reconstructed organ after esophagectomy is a rare postoperative complication. However, in case this complication develops, severe infectious complications can occur, and subsequent surgical reconstruction is quite complicated. To treat esophageal conduit necrosis after esophageal reconstruction with the terminal ileum and ascending colon, we reconstructed the esophagus using a transverse colon, which was covered with a pectoralis major muscle flap to reinforce the anastomotic site. In addition, split thickness skin grafts were applied to the wide skin defect to cover the reconstructed organs at the antesternal route. Widely extended split thickness skin grafts can adhere to the reconstructed organs without excessive tension. Therefore, this method enabled successful treatment of an esophageal defect and wide skin defects of the anterior chest wall. PMID:26943390

  19. Diastolic timed Vibro-Percussion at 50 Hz delivered across a chest wall sized meat barrier enhances clot dissolution and remotely administered Streptokinase effectiveness in an in-vitro model of acute coronary thrombosis

    PubMed Central

    2012-01-01

    Background Low Frequency Vibro-Percussion (LFVP) assists clearance of thrombi in catheter systems and when applied to the heart and timed to diastole is known to enhance coronary flow. However LFVP on a clotted coronary like vessel given engagement over a chest wall sized barrier (to resemble non-invasive heart attack therapy) requires study. Methods One hour old clots (n=16) were dispensed within a flexible segment of Soft-Flo catheter (4 mm lumen), weighted, interfaced with Heparinized Saline (HS), secured atop a curved dampening base, and photographed. A ~4 cm meat slab was placed over the segment and randomized to receive intermittent LFVP (engaged, - disengaged at 1 second intervals), or no LFVP for 20 minutes. HS was pulsed (~120/80 mmHg), with the diastolic phase coordinated to match LFVP delivery. The segment was then re-photographed and aspirated of fluid to determine post clot weight. The trial was then repeated with 0.5 mls of Streptokinase (15,000 IU/100 microlitre) delivered ~ 2 cm upstream from the clot. Results LFVP - HS only samples (vs. controls) showed; a) development of clot length fluid channels absent in the control group (p < 0.0002); b) enhanced dissolved clot mixing scores ( 5.0 vs. 0.8, p < 2.8 E – 6); and c) increased percent clot dissolution (23.0% vs. 1.8% respectively, p < 8.5 E-6). LFVP - SK samples had a similar comparative clot disruptive profile, however fluid channels developed faster and percent clot dissolution more than doubled (51.0% vs. 3.0%, p< 9.8 E- 6). Conclusion Diastolic timed LFVP (50 Hz) engaged across a chest wall sized barrier enhances clot disruptive effects to an underlying coronary like system. PMID:23146079

  20. Acute clinical benefits of chest wall-stretching exercise on expired tidal volume, dyspnea and chest expansion in a patient with chronic obstructive pulmonary disease: a single case study.

    PubMed

    Leelarungrayub, Donrawee; Pothongsunun, Prapas; Yankai, Araya; Pratanaphon, Sainatee

    2009-10-01

    Chest physical therapy (CPT) has an important role in a medical team to assist in resolving the critical problems deriving from chronic lung disease. These critical problems include increased secretion volume, difficult breathing or dyspnea, ineffective coughing, inability to be weaned off a ventilator, and physical deterioration resulting from low aerobic capacity and endurance after prolonged bed rest. The inability to be weaned off a ventilator does not only result from secretion production or muscle weakness, but other conditions including chest stiffness or immobility. The procedure to increase chest mobility includes specific chest stretching and mobilization. Chest wall-stretching exercises were composed of thoracic rotation and anterior compression with stretching in sitting position, trunk extension and rib torsion in supine lying, and lateral stretching in side lying. These exercises were given to the patient as a regular daily program along with postural drainage, percussion, breathing exercise and limb exercises. The expired tidal volume, dyspnea level, and chest expansion were evaluated and clinical efficiency was analyzed during CPT, compared to Pre-CPT and Post-CPT with Bloom table. The results showed a significant clinical improvement of expired tidal volume, reduction in dyspnea level, and increase in chest expansion. PMID:19761957

  1. Electromagnetic scattering by impedance structures

    NASA Technical Reports Server (NTRS)

    Balanis, Constantine A.; Griesser, Timothy

    1987-01-01

    The scattering of electromagnetic waves from impedance structures is investigated, and current work on antenna pattern calculation is presented. A general algorithm for determining radiation patterns from antennas mounted near or on polygonal plates is presented. These plates are assumed to be of a material which satisfies the Leontovich (or surface impedance) boundary condition. Calculated patterns including reflection and diffraction terms are presented for numerious geometries, and refinements are included for antennas mounted directly on impedance surfaces. For the case of a monopole mounted on a surface impedance ground plane, computed patterns are compared with experimental measurements. This work in antenna pattern prediction forms the basis of understanding of the complex scattering mechanisms from impedance surfaces. It provides the foundation for the analysis of backscattering patterns which, in general, are more problematic than calculation of antenna patterns. Further proposed study of related topics, including surface waves, corner diffractions, and multiple diffractions, is outlined.

  2. Effect of acceleration on the chest wall.

    PubMed

    Wilson, T A; Liu, S

    1994-03-01

    The gravitational force on the rib cage has been found to be an expiratory force of approximately 8 cmH2O. The gravitational force on the abdomen is an inspiratory force of the same magnitude. Because the compliance of the rib cage is greater than the compliance of the abdomen, it follows that gravity has a net expiratory effect on lung volume and that upward accelerations augmenting the gravitational force would have an additional expiratory effect. This conclusion is contrary to observations that functional residual capacity increases during headward accelerations in centrifuges and during intervals of upward acceleration in airplanes. We report the results of two studies of the effects of accelerations that are smaller in magnitude and of shorter duration than those studied in centrifuges and airplanes. The first was an experimental study of the effect of acceleration in an elevator. In subjects who relaxed against an occluded airway, airway pressure increased during upward accelerations and decreased during downward accelerations. The second was the modeling and analysis of the effects of the accelerations that occur during walking. The analysis predicted an initial expiratory response to the acceleration spike that occurs during footfall. The prediction agreed with data in the literature on the respiratory effect of walking. In both of these studies upward accelerations had an expiratory effect. PMID:8005868

  3. Impedance magnetocardiogram.

    PubMed

    Kandori, A; Miyashita, T; Suzuki, D; Yokosawa, K; Tsukada, K

    2001-02-01

    We have developed an impedance magnetocardiogram (IMCG) system to detect the change of magnetic field corresponding to changes in blood volume in the heart. A low magnetic field from the electrical activity of the human heart--the so-called magnetocardiogram (MCG)--can be simultaneously detected by using this system. Because the mechanical and electrical functions in the heart can be monitored by non-invasive and non-contact measurements, it is easy to observe the cardiovascular functions from an accurate sensor position. This system uses a technique to demodulate induced current in a subject. A flux-locked circuit of a superconducting quantum interference device has a wide frequency range (above 1 MHz) because a constant current (40 kHz) is fed through the subject. It is shown for the first time that the system could measure IMCG signals at the same time as MCG signals. PMID:11229740

  4. Dosimetric comparison for volumetric modulated arc therapy and intensity-modulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

    PubMed Central

    Zhang, Qian; Yu, Xiao Li; Hu, Wei Gang; Chen, Jia Yi; Wang, Jia Zhou; Ye, Jin Song; Guo, Xiao Mao

    2015-01-01

    Background The aim of the study was to evaluate the dosimetric benefit of applying volumetric modulated arc therapy (VMAT) on the post-mastectomy left-sided breast cancer patients, with the involvement of internal mammary nodes (IMN). Patients and methods The prescription dose was 50 Gy delivered in 25 fractions, and the clinical target volume included the left chest wall (CW) and IMN. VMAT plans were created and compared with intensity-modulated radiotherapy (IMRT) plans on Pinnacle treatment planning system. Comparative endpoints were dose homogeneity within planning target volume (PTV), target dose coverage, doses to the critical structures including heart, lungs and the contralateral breast, number of monitor units and treatment delivery time. Results VMAT and IMRT plans showed similar PTV dose homogeneity, but, VMAT provided a better dose coverage for IMN than IMRT (p = 0.017). The mean dose (Gy), V30 (%) and V10 (%) for the heart were 13.5 ± 5.0 Gy, 9.9% ± 5.9% and 50.2% ± 29.0% by VMAT, and 14.0 ± 5.4 Gy, 10.6% ± 5.8% and 55.7% ± 29.6% by IMRT, respectively. The left lung mean dose (Gy), V20 (%), V10 (%) and the right lung V5 (%) were significantly reduced from 14.1 ± 2.3 Gy, 24.2% ± 5.9%, 42.4% ± 11.9% and 41.2% ± 12.3% with IMRT to 12.8 ± 1.9 Gy, 21.0% ± 3.8%, 37.1% ± 8.4% and 32.1% ± 18.2% with VMAT, respectively. The mean dose to the contralateral breast was 1.7 ± 1.2 Gy with VMAT and 2.3 ± 1.6 Gy with IMRT. Finally, VMAT reduced the number of monitor units by 24% and the treatment time by 53%, as compared to IMRT. Conclusions Compared to 5-be am step-and-shot IMRT, VMAT achieves similar or superior target coverage and a better normal tissue sparing, with fewer monitor units and shorter delivery time. PMID:25810708

  5. Adaptive Impedance Control Of Redundant Manipulators

    NASA Technical Reports Server (NTRS)

    Seraji, Homayoun; Colbaugh, Richard D.; Glass, Kristin L.

    1994-01-01

    Improved method of controlling mechanical impedance of end effector of redundant robotic manipulator based on adaptive-control theory. Consists of two subsystems: adaptive impedance controller generating force-control inputs in Cartesian space of end effector to provide desired end-effector-impedance characteristics, and subsystem implementing algorithm that maps force-control inputs into torques applied to joints of manipulator. Accurate control of end effector and effective utilization of redundancy achieved simultaneously by use of method. Potential use to improve performance of such typical impedance-control tasks as deburring edges and accommodating transitions between unconstrained and constrained motions of end effectors.

  6. Total respiratory impedance measurement by forced oscillations: a noninvasive method to assess bronchial response in occupational medicine.

    PubMed

    Wouters, E F

    1990-01-01

    The forced oscillation technique is a noninvasive and effort-independent test to characterize the mechanical impedance of the respiratory system. By applying a complex signal, the frequency-dependent behavior of the respiratory system can be measured over an extended spectrum. For clinical practice, the input impedance is used most frequently; pressure and flow are measured at the same place. The impedance can be partitioned into a real part or resistance and an imaginary part or reactance. At low frequencies, reactance is determined by the capacitance of the system and at high frequencies by the inertial properties of the system. Equipment and impedance data in normal subjects and patients with chronic obstructive pulmonary disease are discussed. The frequency-dependent behavior of the respiratory system is described with the use of an electrical model characterized by partitioning of airway resistance and the presence of shunt compliance represented by the compliance of the intrathoracic airway walls. Influences of peripheral resistance, airway compliance, lung volumes, chest wall and pulmonary resistance, and resistance of the cheeks and upper airways are analyzed. Input impedance can be applied to the detection of bronchoconstriction and bronchodilation, but this technique is suitable for detecting early airway abnormalities caused by smoking or occupational hazards. PMID:2307147

  7. ADVANCES IN IMPEDANCE THEORY

    SciTech Connect

    Stupakov, G.; /SLAC

    2009-06-05

    We review recent progress in the following areas of the impedance theory: calculation of impedance of tapers and small angle collimators; optical approximation and parabolic equation for the high-frequency impedance; impedance due to resistive inserts in a perfectly conducting pipe.

  8. Influence of cheek support on respiratory impedance measured by forced oscillation technique.

    PubMed

    Uchida, Akemi; Ito, Satoru; Suki, Béla; Matsubara, Hiroki; Hasegawa, Yoshinori

    2013-01-01

    The forced oscillation technique (FOT) is a useful tool to assess respiratory resistance and reactance during tidal breathing in patients with respiratory diseases, specifically asthma and chronic obstructive pulmonary disease. Although the FOT has been clinically used, results of respiratory impedance can be affected by various factors such as upper airway artifact. We investigated the effects of cheek support on respiratory resistance and reactance measured by a commercially available FOT equipment MostGraph-01. Respiratory resistance at 20 Hz (R20) with support of the cheeks was significantly higher than those without the cheek support in healthy subjects. Two different cheek support protocols, support of the cheeks by subjects themselves and an operator, were compared in healthy volunteers and patients with respiratory diseases. The cheek support protocols significantly affected respiratory resistance at 5 Hz (R5) and reactance at 5 Hz (X5) in the patient group but not in the healthy subjects. Moreover, for X5, there was a significant interaction between cheek support protocols (by a subject or operator) and groups (healthy or diseased). In conclusion, during impedance measurements using the FOT, application of cheek support either by subjects or the operator is recommended to reduce upper airway artifacts, however, results obtained by two protocols may be different in patients with respiratory diseases. Contribution of the chest wall and position of the arms to the mechanical properties should be carefully considered in physiological studies in which the FOT is attempted. PMID:23961407

  9. Impedance based automatic electrode positioning.

    PubMed

    Miklody, Daniel; Hohne, Johannes

    2015-08-01

    The position of electrodes in electrical imaging and stimulation of the human brain is an important variable with vast influences on the precision in modeling approaches. Nevertheless, the exact position is obscured by many factors. 3-D Digitization devices can measure the distribution over the scalp surface but remain uncomfortable in application and often imprecise. We demonstrate a new approach that uses solely the impedance information between the electrodes to determine the geometric position. The algorithm involves multidimensional scaling to create a 3 dimensional space based on these impedances. The success is demonstrated in a simulation study. An average electrode position error of 1.67cm over all 6 subjects could be achieved. PMID:26736345

  10. Robust impedance shaping telemanipulation

    SciTech Connect

    Colgate, J.E.

    1993-08-01

    When a human operator performs a task via a bilateral manipulator, the feel of the task is embodied in the mechanical impedance of the manipulator. Traditionally, a bilateral manipulator is designed for transparency; i.e., so that the impedance reflected through the manipulator closely approximates that of the task. Impedance shaping bilateral control, introduced here, differs in that it treats the bilateral manipulator as a means of constructively altering the impedance of a task. This concept is particularly valuable if the characteristic dimensions (e.g., force, length, time) of the task impedance are very different from those of the human limb. It is shown that a general form of impedance shaping control consists of a conventional power-scaling bilateral controller augmented with a real-time interactive task simulation (i.e., a virtual environment). An approach to impedance shaping based on kinematic similarity between tasks of different scale is introduced and illustrated with an example. It is shown that an important consideration in impedance shaping controller design is robustness; i.e., guaranteeing the stability of the operator/manipulator/task system. A general condition for the robustness of a bilateral manipulator is derived. This condition is based on the structured singular value ({mu}). An example of robust impedance shaping bilateral control is presented and discussed.

  11. Rotor damage detection by using piezoelectric impedance

    NASA Astrophysics Data System (ADS)

    Qin, Y.; Tao, Y.; Mao, Y. F.

    2016-04-01

    Rotor is a core component of rotary machinery. Once the rotor has the damage, it may lead to a major accident. Thus the quantitative rotor damage detection method based on piezoelectric impedance is studied in this paper. With the governing equation of piezoelectric transducer (PZT) in a cylindrical coordinate, the displacement along the radius direction is derived. The charge of PZT is calculated by the electric displacement. Then, by the use of the obtained displacement and charge, an analytic piezoelectric impedance model of the rotor is built. Given the circular boundary condition of a rotor, annular elements are used as the analyzed objects and spectral element method is used to set up the damage detection model. The Electro-Mechanical (E/M) coupled impedance expression of an undamaged rotor is deduced with the application of a low-cost impedance test circuit. A Taylor expansion method is used to obtain the approximate E/M coupled impedance expression for the damaged rotor. After obtaining the difference between the undamaged and damaged rotor impedance, a rotor damage detection method is proposed. This method can directly calculate the change of bending stiffness of the structural elements, it follows that the rotor damage can be effectively detected. Finally, a preset damage configuration is used for the numerical simulation. The result shows that the quantitative damage detection algorithm based on spectral element method and piezoelectric impedance proposed in this paper can identify the location and the severity of the damaged rotor accurately.

  12. Impedance of a nanoantenna

    SciTech Connect

    Greffet, Jean-Jacques; Laroche, Marine; Marquier, Francois

    2009-10-07

    We introduce a generalized definition of the impedance of a nanoantenna that can be applied to any system. We also introduce a definition of the impedance of a two level system. Using this framework, we establish a link between the electrical engineering and the quantum optics picture of light emission.

  13. Overview Of Impedance Sensors

    NASA Astrophysics Data System (ADS)

    Abele, John E.

    1989-08-01

    Electrical impedance has been one of the many "tools of great promise" that physicians have employed in their quest to measure and/or monitor body function or physiologic events. So far, the expectations for its success have always exceeded its performance. In simplistic terms, physiologic impedance is a measure of the resistance in the volume between electrodes which changes as a function of changes in that volume, the relative impedance of that volume, or a combination of these two. The history and principles of electrical impedance are very nicely reviewed by Geddes and Baker in their textbook "Principles of Applied Biomedical Instrumentation". It is humbling, however, to note that Cremer recorded variations in electrical impedance in frog hearts as early as 1907. The list of potential applications includes the measurement of thyroid function, estrogen activity, galvanic skin reflex, respiration, blood flow by conductivity dilution, nervous activity and eye movement. Commercial devices employing impedance have been and are being used to measure respiration (pneumographs and apneamonitors), pulse volume (impedance phlebographs) and even noninvasive cardiac output.

  14. Microfabricated AC impedance sensor

    DOEpatents

    Krulevitch, Peter; Ackler, Harold D.; Becker, Frederick; Boser, Bernhard E.; Eldredge, Adam B.; Fuller, Christopher K.; Gascoyne, Peter R. C.; Hamilton, Julie K.; Swierkowski, Stefan P.; Wang, Xiao-Bo

    2002-01-01

    A microfabricated instrument for detecting and identifying cells and other particles based on alternating current (AC) impedance measurements. The microfabricated AC impedance sensor includes two critical elements: 1) a microfluidic chip, preferably of glass substrates, having at least one microchannel therein and with electrodes patterned on both substrates, and 2) electrical circuits that connect to the electrodes on the microfluidic chip and detect signals associated with particles traveling down the microchannels. These circuits enable multiple AC impedance measurements of individual particles at high throughput rates with sufficient resolution to identify different particle and cell types as appropriate for environmental detection and clinical diagnostic applications.

  15. Wavelet analysis of the impedance cardiogram waveforms

    NASA Astrophysics Data System (ADS)

    Podtaev, S.; Stepanov, R.; Dumler, A.; Chugainov, S.; Tziberkin, K.

    2012-12-01

    Impedance cardiography has been used for diagnosing atrial and ventricular dysfunctions, valve disorders, aortic stenosis, and vascular diseases. Almost all the applications of impedance cardiography require determination of some of the characteristic points of the ICG waveform. The ICG waveform has a set of characteristic points known as A, B, E ((dZ/dt)max) X, Y, O and Z. These points are related to distinct physiological events in the cardiac cycle. Objective of this work is an approbation of a new method of processing and interpretation of the impedance cardiogram waveforms using wavelet analysis. A method of computer thoracic tetrapolar polyrheocardiography is used for hemodynamic registrations. Use of original wavelet differentiation algorithm allows combining filtration and calculation of the derivatives of rheocardiogram. The proposed approach can be used in clinical practice for early diagnostics of cardiovascular system remodelling in the course of different pathologies.

  16. Impedance of accelerator components

    SciTech Connect

    Corlett, J.N.

    1996-05-01

    As demands for high luminosity and low emittance particle beams increase, an understanding of the electromagnetic interaction of these beams with their vacuum chamber environment becomes more important in order to maintain the quality of the beam. This interaction is described in terms of the wake field in time domain, and the beam impedance in frequency domain. These concepts are introduced, and related quantities such as the loss factor are presented. The broadband Q = 1 resonator impedance model is discussed. Perturbation and coaxial wire methods of measurement of real components are reviewed.

  17. Superconducting active impedance converter

    DOEpatents

    Ginley, D.S.; Hietala, V.M.; Martens, J.S.

    1993-11-16

    A transimpedance amplifier for use with high temperature superconducting, other superconducting, and conventional semiconductors allows for appropriate signal amplification and impedance matching to processing electronics. The amplifier incorporates the superconducting flux flow transistor into a differential amplifier configuration which allows for operation over a wide temperature range, and is characterized by high gain, relatively low noise, and response times less than 200 picoseconds over at least a 10-80 K. temperature range. The invention is particularly useful when a signal derived from either far-IR focal plane detectors or from Josephson junctions is to be processed by higher signal/higher impedance electronics, such as conventional semiconductor technology. 12 figures.

  18. Superconducting active impedance converter

    DOEpatents

    Ginley, David S.; Hietala, Vincent M.; Martens, Jon S.

    1993-01-01

    A transimpedance amplifier for use with high temperature superconducting, other superconducting, and conventional semiconductor allows for appropriate signal amplification and impedance matching to processing electronics. The amplifier incorporates the superconducting flux flow transistor into a differential amplifier configuration which allows for operation over a wide temperature range, and is characterized by high gain, relatively low noise, and response times less than 200 picoseconds over at least a 10-80 K. temperature range. The invention is particularly useful when a signal derived from either far-IR focal plane detectors or from Josephson junctions is to be processed by higher signal/higher impedance electronics, such as conventional semiconductor technology.

  19. Impedances of Tevatron separators

    SciTech Connect

    K. Y. Ng

    2003-05-28

    The impedances of the Tevatron separators are revisited and are found to be negligibly small in the few hundred MHz region, except for resonances at 22.5 MHz. The later are contributions from the power cables which may drive head-tail instabilities if the bunch is long enough.

  20. Longitudinal impedance of RHIC

    SciTech Connect

    Blaskiewicz, M.; Brennan, J. M.; Mernick, K.

    2015-05-03

    The longitudinal impedance of the two RHIC rings has been measured using the effect of potential well distortion on longitudinal Schottky measurements. For the blue RHIC ring Im(Z/n) = 1.5±0.2Ω. For the yellow ring Im(Z/n) = 5.4±1Ω.

  1. Impedance cardiography: recent advancements.

    PubMed

    Cybulski, Gerard; Strasz, Anna; Niewiadomski, Wiktor; Gąsiorowska, Anna

    2012-01-01

    The aim of this paper is the presentation of recent advancements in impedance cardiography regarding methodical approach, applied equipment and clinical or research implementations. The review is limited to the papers which were published over last 17 months (dated 2011 and 2012) in well recognised scientific journals. PMID:23042327

  2. Validation of an Impedance Education Method in Flow

    NASA Technical Reports Server (NTRS)

    Watson, Willie R.; Jones, Michael G.; Parrott, Tony L.

    2004-01-01

    This paper reports results of a research effort to validate a method for educing the normal incidence impedance of a locally reacting liner, located in a grazing incidence, nonprogressive acoustic wave environment with flow. The results presented in this paper test the ability of the method to reproduce the measured normal incidence impedance of a solid steel plate and two soft test liners in a uniform flow. The test liners are known to be locally react- ing and exhibit no measurable amplitude-dependent impedance nonlinearities or flow effects. Baseline impedance spectra for these liners were therefore established from measurements in a conventional normal incidence impedance tube. A key feature of the method is the expansion of the unknown impedance function as a piecewise continuous polynomial with undetermined coefficients. Stewart's adaptation of the Davidon-Fletcher-Powell optimization algorithm is used to educe the normal incidence impedance at each Mach number by optimizing an objective function. The method is shown to reproduce the measured normal incidence impedance spectrum for each of the test liners, thus validating its usefulness for determining the normal incidence impedance of test liners for a broad range of source frequencies and flow Mach numbers. Nomenclature

  3. Recycler short kicker beam impedance

    SciTech Connect

    Crisp, Jim; Fellenz, Brian; /Fermilab

    2009-07-01

    Measured longitudinal and calculated transverse beam impedance is presented for the short kicker magnets being installed in the Fermilab Recycler. Fermi drawing number ME-457159. The longitudinal impedance was measured with a stretched wire and the Panofsky equation was used to estimate the transverse impedance. The impedance of 3319 meters (the Recycler circumference) of stainless vacuum pipe is provided for comparison. Although measurements where done to 3GHz, impedance was negligible above 30MHz. The beam power lost to the kicker impedance is shown for a range of bunch lengths. The measurements are for one kicker assuming a rotation frequency of 90KHz. Seven of these kickers are being installed.

  4. Comparison of commercially available three-dimensional treatment planning algorithms for monitor unit calculations in the presence of heterogeneities.

    PubMed

    Butts, J R; Foster, A E

    2001-01-01

    This study uses an anthropomorphic phantom and its computed tomography (CT) data set to evaluate monitor unit (MU) calculations using the CMS Focus Clarkson, the CMS Focus Multigrid Superposition Model, the CMS Focus FFT Convolution Model, and the ADAC Pinnacle Collapsed Cone Convolution Superposition Algorithms. Using heterogeneity corrections, a treatment plan and corresponding MU calculations were generated for several typical clinical situations. A diode detector, placed in an anthropomorphic phantom, was used to compare the treatment planning algorithms' predicted doses with measured data. Differences between diode measurements and the algorithms' calculations were within reasonable levels of acceptability as recommended by Van Dyk et al. [Int. J. Rad. Onc. Biol. Phys. 26, 261-273 (1993)], except for the CMS Clarkson algorithm, which predicted too few MU for delivery of the intended dose to chest wall fields. PMID:11674836

  5. Staging algorithm for diffuse malignant pleural mesothelioma.

    PubMed

    Zielinski, Marcin; Hauer, Jolanta; Hauer, Lukasz; Pankowski, Juliusz; Nabialek, Tomasz; Szlubowski, Artur

    2010-02-01

    An algorithm of preoperative mediastinal nodal staging with endobronchial/endoesophageal ultrasonography (EBUS/EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) combined with laparoscopy/peritoneal lavage and cytology was analyzed to establish the realistic criteria for radical multimodality treatment of malignant pleural mesothelioma (MPM). The algorithm included computed tomography (CT), thoracoscopy with multiple pleural biopsies and talc pleurodesis, EBUS/EUS and one-stage TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid. Forty-two patients were diagnosed from 1 January 2004 to 31 December 2008. There were 16 women and 26 men in ages ranging from 43 to 77 years (mean 57.8); 31 epithelioid, 2 sarcomatoid and 9 biphasic type MPM. 21/42 patients were considered possible candidates for multimodality treatment. Three patients who received neoadjuvant chemotherapy were excluded from this study. EBUS/EUS was performed to stage the mediastinal nodes. In 3/18 patients metastatic nodes were discovered. In the rest of the 15 patients simultaneous TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid were performed. In three patients TEMLA was positive, in six patients laparoscopy was positive and in two patients both TEMLA and laparoscopy were positive. Finally, 4/42 (9.5%) patients underwent thoracotomy with one exploration (chest wall infiltration) and three pleuropneumonectomies with the subsequent chemo- and radiotherapy. The proposed algorithm of preoperative staging spared the majority of MPM patients from futile surgery. PMID:19843550

  6. Impedance calculation for ferrite inserts

    SciTech Connect

    Breitzmann, S.C.; Lee, S.Y.; Ng, K.Y.; /Fermilab

    2005-01-01

    Passive ferrite inserts were used to compensate the space charge impedance in high intensity space charge dominated accelerators. They study the narrowband longitudinal impedance of these ferrite inserts. they find that the shunt impedance and the quality factor for ferrite inserts are inversely proportional to the imaginary part of the permeability of ferrite materials. They also provide a recipe for attaining a truly passive space charge impedance compensation and avoiding narrowband microwave instabilities.

  7. Impedance Measurement Box

    ScienceCinema

    Christophersen, Jon

    2013-05-28

    Energy storage devices, primarily batteries, are now more important to consumers, industries and the military. With increasing technical complexity and higher user expectations, there is also a demand for highly accurate state-of-health battery assessment techniques. IMB incorporates patented, proprietary, and tested capabilities using control software and hardware that can be part of an embedded monitoring system. IMB directly measures the wideband impedance spectrum in seconds during battery operation with no significant impact on service life. It also can be applied to batteries prior to installation, confirming health before entering active service, as well as during regular maintenance. For more information about this project, visit http://www.inl.gov/rd100/2011/impedance-measurement-box/

  8. Impedance Measurement Box

    Energy Science and Technology Software Center (ESTSC)

    2014-11-20

    The IMB 50V software provides functionality for design of impedance measurement tests or sequences of tests, execution of these tests or sequences, processing measured responses and displaying and saving of the results. The software consists of a Graphical User Interface that allows configuration of measurement parameters and test sequencing, a core engine that controls test sequencing, execution of measurements, processing and storage of results and a hardware/software data acquisition interface with the IMB hardware system.

  9. Gynecologic electrical impedance tomograph

    NASA Astrophysics Data System (ADS)

    Korjenevsky, A.; Cherepenin, V.; Trokhanova, O.; Tuykin, T.

    2010-04-01

    Electrical impedance tomography extends to the new and new areas of the medical diagnostics: lungs, breast, prostate, etc. The feedback from the doctors who use our breast EIT diagnostic system has induced us to develop the 3D electrical impedance imaging device for diagnostics of the cervix of the uterus - gynecologic impedance tomograph (GIT). The device uses the same measuring approach as the breast imaging system: 2D flat array of the electrodes arranged on the probe with handle is placed against the body. Each of the 32 electrodes of the array is connected in turn to the current source while the rest electrodes acquire the potentials on the surface. The current flows through the electrode of the array and returns through the remote electrode placed on the patient's limb. The voltages are measured relative to another remote electrode. The 3D backprojection along equipotential surfaces is used to reconstruct conductivity distribution up to approximately 1 cm in depth. Small number of electrodes enables us to implement real time imaging with a few frames per sec. rate. The device is under initial testing and evaluation of the imaging capabilities and suitability of usage.

  10. Acoustic ground impedance meter

    NASA Technical Reports Server (NTRS)

    Zuckerwar, A. J.

    1981-01-01

    A compact, portable instrument was developed to measure the acoustic impedance of the ground, or other surfaces, by direct pressure-volume velocity measurement. A Helmholz resonator, constructed of heavy-walled stainless steel but open at the bottom, is positioned over the surface having the unknown impedance. The sound source, a cam-driven piston of known stroke and thus known volume velocity, is located in the neck of the resonator. The cam speed is a variable up to a maximum 3600 rpm. The sound pressure at the test surface is measured by means of a microphone flush-mounted in the wall of the chamber. An optical monitor of the piston displacement permits measurement of the phase angle between the volume velocity and the sound pressure, from which the real and imaginary parts of the impedance can be evaluated. Measurements using a 5-lobed cam can be made up to 300 Hz. Detailed design criteria and results on a soil sample are presented.

  11. High input impedance amplifier

    NASA Technical Reports Server (NTRS)

    Kleinberg, Leonard L.

    1995-01-01

    High input impedance amplifiers are provided which reduce the input impedance solely to a capacitive reactance, or, in a somewhat more complex design, provide an extremely high essentially infinite, capacitive reactance. In one embodiment, where the input impedance is reduced in essence, to solely a capacitive reactance, an operational amplifier in a follower configuration is driven at its non-inverting input and a resistor with a predetermined magnitude is connected between the inverting and non-inverting inputs. A second embodiment eliminates the capacitance from the input by adding a second stage to the first embodiment. The second stage is a second operational amplifier in a non-inverting gain-stage configuration where the output of the first follower stage drives the non-inverting input of the second stage and the output of the second stage is fed back to the non-inverting input of the first stage through a capacitor of a predetermined magnitude. These amplifiers, while generally useful, are very useful as sensor buffer amplifiers that may eliminate significant sources of error.

  12. [Synovial cyst of chest wall; report of a case].

    PubMed

    Chujo, Masao; Anami, Kentaro; Miura, Takashi

    2014-12-01

    A 55-year-old male taxi driver visited our hospital because of a left dorsal tumor. The tumor was palpated at the inferior angle of the left scapula with tenderness. Computed tomography (CT) revealed a homogeneous 5-cm mass with capsule between the latissimus dorsi muscle and rib. T2-weighted magnetic resonance imaging( MRI) demonstrated the tumor with high intensity. The latissimus dorsi muscle was divided and separated off from the tumor and the lower layer;then, an applied wound retractor (Alexis) was placed under the lower layer of the latissimus dorsi muscle and the operative field was developed. Next, the anterior serratus and greater rhomboid muscles were separated off from the tumor and the lower layer, the Alexis was placed under the lower layer of those muscles. All muscles were preserved and the tumor was removed. The tumor was 56×32 mm in size. The histological diagnosis was synovial cyst. PMID:25434552

  13. Ionospheric effects to antenna impedance

    NASA Technical Reports Server (NTRS)

    Bethke, K. H.

    1986-01-01

    The reciprocity between high power satellite antennas and the surrounding plasma are examined. The relevant plasma states for antenna impedance calculations are presented and plasma models, and hydrodynamic and kinetic theory, are discussed. A theory from which a variation in antenna impedance with regard to the radiated power can be calculated for a frequency range well above the plasma resonance frequency is give. The theory can include photo and secondary emission effects in antenna impedance calculations.

  14. Optically stimulated differential impedance spectroscopy

    DOEpatents

    Maxey, Lonnie C; Parks, II, James E; Lewis, Sr., Samuel A; Partridge, Jr., William P

    2014-02-18

    Methods and apparatuses for evaluating a material are described. Embodiments typically involve use of an impedance measurement sensor to measure the impedance of a sample of the material under at least two different states of illumination. The states of illumination may include (a) substantially no optical stimulation, (b) substantial optical stimulation, (c) optical stimulation at a first wavelength of light, (d) optical stimulation at a second wavelength of light, (e) a first level of light intensity, and (f) a second level of light intensity. Typically a difference in impedance between the impedance of the sample at the two states of illumination is measured to determine a characteristic of the material.

  15. IMPEDANCE OF FINITE LENGTH RESISTOR

    SciTech Connect

    KRINSKY, S.; PODOBEDOV, B.; GLUCKSTERN, R.L.

    2005-05-15

    We determine the impedance of a cylindrical metal tube (resistor) of radius a, length g, and conductivity {sigma}, attached at each end to perfect conductors of semi-infinite length. Our main interest is in the asymptotic behavior of the impedance at high frequency, k >> 1/a. In the equilibrium regime, , the impedance per unit length is accurately described by the well-known result for an infinite length tube with conductivity {sigma}. In the transient regime, ka{sup 2} >> g, we derive analytic expressions for the impedance and wakefield.

  16. Using ac dipoles to localize sources of beam coupling impedance

    NASA Astrophysics Data System (ADS)

    Biancacci, N.; Tomás, R.

    2016-05-01

    The beam coupling impedance is one of the main sources of beam instabilities and emittance blow up in circular accelerators. A refined machine impedance evaluation is therefore required in order to understand and model intensity dependent effects and instabilities that may limit the machine performance. For this reason, many impedance source localization techniques have been developed. In this work we present the impedance localization technique based on the observation of phase advance versus intensity at the beam position monitors using ac dipoles to force betatron oscillations. We present analytical formulas for the interpretation of measurements together with simulations to benchmark and illustrate the equations. Studies on the method accuracy for different Fourier transform algorithms are presented as well as first exploratory measurements performed in the LHC.

  17. Monolithically compatible impedance measurement

    DOEpatents

    Ericson, Milton Nance; Holcomb, David Eugene

    2002-01-01

    A monolithic sensor includes a reference channel and at least one sensing channel. Each sensing channel has an oscillator and a counter driven by the oscillator. The reference channel and the at least one sensing channel being formed integrally with a substrate and intimately nested with one another on the substrate. Thus, the oscillator and the counter have matched component values and temperature coefficients. A frequency determining component of the sensing oscillator is formed integrally with the substrate and has an impedance parameter which varies with an environmental parameter to be measured by the sensor. A gating control is responsive to an output signal generated by the reference channel, for terminating counting in the at least one sensing channel at an output count, whereby the output count is indicative of the environmental parameter, and successive ones of the output counts are indicative of changes in the environmental parameter.

  18. Bioelectrical impedance analysis revisited.

    PubMed

    Mikes, D M; Cha, B A; Dym, C L; Baumgaertner, J; Hartzog, A G; Tacey, A D; Calabria, M R

    1999-12-01

    Although total limb volume measurements are used to track the progress of lymphedema and its treatment, these measurements can be confounded by changes other than fluid excess namely muscle or fat gain. Bioelectrical impedance analysis (BIA) is a technique that specifically quantifies both total body fluid and extracellular fluid in extremities. Whereas BIA has potential as a quick, inexpensive, and quantitative technique to measure directly fluid gain or loss from lymphedema, it also has certain shortcomings that must be addressed before it can be validated. this paper examines the back-ground that explains why measuring total limb volume is insufficient to quantify the extent of peripheral lymphedema and explores the advantages and drawbacks of using BIA for this purpose. PMID:10652699

  19. Robust recursive impedance estimation for automotive lithium-ion batteries

    NASA Astrophysics Data System (ADS)

    Fridholm, Björn; Wik, Torsten; Nilsson, Magnus

    2016-02-01

    Recursive algorithms, such as recursive least squares (RLS) or Kalman filters, are commonly used in battery management systems to estimate the electrical impedance of the battery cell. However, these algorithms can in some cases run into problems with bias and even divergence of the estimates. This article illuminates problems that can arise in the online estimation using recursive methods, and lists modifications to handle these issues. An algorithm is also proposed that estimates the impedance by separating the problem in two parts; one estimating the ohmic resistance with an RLS approach, and another one where the dynamic effects are estimated using an adaptive Kalman filter (AKF) that is novel in the battery field. The algorithm produces robust estimates of ohmic resistance and time constant of the battery cell in closed loop with SoC estimation, as demonstrated by both in simulations and with experimental data from a lithium-ion battery cell.

  20. Antenna pattern control using impedance surfaces

    NASA Astrophysics Data System (ADS)

    Balanis, Constantine A.; Liu, Kefeng

    1992-09-01

    During this research period, we have effectively transferred existing computer codes from CRAY supercomputer to work station based systems. The work station based version of our code preserved the accuracy of the numerical computations while giving a much better turn-around time than the CRAY supercomputer. Such a task relieved us of the heavy dependence of the supercomputer account budget and made codes developed in this research project more feasible for applications. The analysis of pyramidal horns with impedance surfaces was our major focus during this research period. Three different modeling algorithms in analyzing lossy impedance surfaces were investigated and compared with measured data. Through this investigation, we discovered that a hybrid Fourier transform technique, which uses the eigen mode in the stepped waveguide section and the Fourier transformed field distributions across the stepped discontinuities for lossy impedances coating, gives a better accuracy in analyzing lossy coatings. After a further refinement of the present technique, we will perform an accurate radiation pattern synthesis in the coming reporting period.

  1. Impedance in School Screening Programs.

    ERIC Educational Resources Information Center

    Robarts, John T.

    1985-01-01

    This paper examines the controversy over use of impedance screening in public schools to identify students with hearing problems, including otitis media, a common ear condition in infants and young children. It cites research that questions the value of pure tone screening as a single test and raises critics' objections to the use of impedance,…

  2. Ultra-wideband impedance sensor

    DOEpatents

    McEwan, Thomas E.

    1999-01-01

    The ultra-wideband impedance sensor (UWBZ sensor, or Z-sensor) is implemented in differential and single-ended configurations. The differential UWBZ sensor employs a sub-nanosecond impulse to determine the balance of an impedance bridge. The bridge is configured as a differential sample-and-hold circuit that has a reference impedance side and an unknown impedance side. The unknown impedance side includes a short transmission line whose impedance is a function of the near proximity of objects. The single-ended UWBZ sensor eliminates the reference side of the bridge and is formed of a sample and hold circuit having a transmission line whose impedance is a function of the near proximity of objects. The sensing range of the transmission line is bounded by the two-way travel time of the impulse, thereby eliminating spurious Doppler modes from large distant objects that would occur in a microwave CW impedance bridge. Thus, the UWBZ sensor is a range-gated proximity sensor. The Z-sensor senses the near proximity of various materials such as metal, plastic, wood, petroleum products, and living tissue. It is much like a capacitance sensor, yet it is impervious to moisture. One broad application area is the general replacement of magnetic sensors, particularly where nonferrous materials need to be sensed. Another broad application area is sensing full/empty levels in tanks, vats and silos, e.g., a full/empty switch in water or petroleum tanks.

  3. Ultra-wideband impedance sensor

    DOEpatents

    McEwan, T.E.

    1999-03-16

    The ultra-wideband impedance sensor (UWBZ sensor, or Z-sensor) is implemented in differential and single-ended configurations. The differential UWBZ sensor employs a sub-nanosecond impulse to determine the balance of an impedance bridge. The bridge is configured as a differential sample-and-hold circuit that has a reference impedance side and an unknown impedance side. The unknown impedance side includes a short transmission line whose impedance is a function of the near proximity of objects. The single-ended UWBZ sensor eliminates the reference side of the bridge and is formed of a sample and hold circuit having a transmission line whose impedance is a function of the near proximity of objects. The sensing range of the transmission line is bounded by the two-way travel time of the impulse, thereby eliminating spurious Doppler modes from large distant objects that would occur in a microwave CW impedance bridge. Thus, the UWBZ sensor is a range-gated proximity sensor. The Z-sensor senses the near proximity of various materials such as metal, plastic, wood, petroleum products, and living tissue. It is much like a capacitance sensor, yet it is impervious to moisture. One broad application area is the general replacement of magnetic sensors, particularly where nonferrous materials need to be sensed. Another broad application area is sensing full/empty levels in tanks, vats and silos, e.g., a full/empty switch in water or petroleum tanks. 2 figs.

  4. Electrochemical Impedance Spectroscopy

    NASA Astrophysics Data System (ADS)

    Retter, Utz; Lohse, Heinz

    Non-steady-state measuring techniques are known to be extremely suitable for the investigation of the electrode kinetics of more complex electrochemical systems. Perturbation of the electrochemical system leads to a shift of the steady state. The rate at which it proceeds to a new steady state depends on characteristic parameters (reaction rate constants, diffusion coefficients, charge transfer resistance, double-layer capacity). Due to non-linearities caused by the electron transfer, low-amplitude perturbation signals are necessary. The small perturbation of the electrode state has the advantage that the solutions of relevant mathematical equations used are transformed in limiting forms that are normally linear. Impedance spectroscopy represents a powerful method for investigation of electrical properties of materials and interfaces of conducting electrodes. Relevant fields of application are the kinetics of charges in bulk or interfacial regions, the charge transfer of ionic or mixed ionic-ionic conductors, semiconducting electrodes, the corrosion inhibition of electrode processes, investigation of coatings on metals, characterisation of materials and solid electrolyte as well as solid-state devices.

  5. I/O impedance controller

    DOEpatents

    Ruesch, Rodney; Jenkins, Philip N.; Ma, Nan

    2004-03-09

    There is disclosed apparatus and apparatus for impedance control to provide for controlling the impedance of a communication circuit using an all-digital impedance control circuit wherein one or more control bits are used to tune the output impedance. In one example embodiment, the impedance control circuit is fabricated using circuit components found in a standard macro library of a computer aided design system. According to another example embodiment, there is provided a control for an output driver on an integrated circuit ("IC") device to provide for forming a resistor divider network with the output driver and a resistor off the IC device so that the divider network produces an output voltage, comparing the output voltage of the divider network with a reference voltage, and adjusting the output impedance of the output driver to attempt to match the output voltage of the divider network and the reference voltage. Also disclosed is over-sampling the divider network voltage, storing the results of the over sampling, repeating the over-sampling and storing, averaging the results of multiple over sampling operations, controlling the impedance with a plurality of bits forming a word, and updating the value of the word by only one least significant bit at a time.

  6. Impedance-estimation methods, modeling methods, articles of manufacture, impedance-modeling devices, and estimated-impedance monitoring systems

    DOEpatents

    Richardson, John G.

    2009-11-17

    An impedance estimation method includes measuring three or more impedances of an object having a periphery using three or more probes coupled to the periphery. The three or more impedance measurements are made at a first frequency. Three or more additional impedance measurements of the object are made using the three or more probes. The three or more additional impedance measurements are made at a second frequency different from the first frequency. An impedance of the object at a point within the periphery is estimated based on the impedance measurements and the additional impedance measurements.

  7. Short-term variability in respiratory impedance and effect of deep breath in asthmatic and healthy subjects with airway smooth muscle activation and unloading.

    PubMed

    Gobbi, Alessandro; Pellegrino, Riccardo; Gulotta, Carlo; Antonelli, Andrea; Pompilio, Pasquale; Crimi, Claudia; Torchio, Roberto; Dutto, Luca; Parola, Paolo; Dellacà, Raffaele L; Brusasco, Vito

    2013-09-01

    Inspiratory resistance (RINSP) and reactance (XINSP) were measured for 7 min at 5 Hz in 10 subjects with mild asymptomatic asthma and 9 healthy subjects to assess the effects of airway smooth muscle (ASM) activation by methacholine (MCh) and unloading by chest wall strapping (CWS) on the variability of lung function and the effects of deep inspiration (DI). Subjects were studied at control conditions, after MCh, with CWS, and after MCh with CWS. In all experimental conditions XINSP was significantly more negative in subjects with asthma than in healthy subjects, suggesting greater inhomogeneity in the former. However, the variability in both RINSP and XINSP was increased by either ASM activation or CWS, without significant difference between groups. DI significantly reversed MCh-induced changes in RINSP both in subjects with asthma and healthy subjects, but XINSP in the former only. This effect was impaired by CWS more in subjects with asthma than in healthy subjects. The velocity of RINSP and XINSP recovery after DI was faster in subjects with asthma than healthy subjects. In conclusion, these results support the opinion that the short-term variability in respiratory impedance is related to ASM tone or operating length, rather than to the disease. Nevertheless, ASM in individuals with asthma differs from that in healthy individuals in an increased velocity of shortening and a reduced sensitivity to mechanical stress when strain is reduced. PMID:23766502

  8. Coupling impedance for modern accelerators

    SciTech Connect

    Heifets, S.A.; Kheifets, S.A. )

    1992-03-10

    A systematic review of theoretical results for the longitudinal and transverse impedances obtained by different methods is presented. The paper comprises definitions, general theorems, modal analysis, a diffraction model, and analytical results. Several new results are included. In particular, necessary and sufficient conditions are given for the independence of the impedance from the beam longitudinal direction. The impedances of two basic simple structures---that of a {ital cavity} and that of a {ital step}---are studied in detail. The transition from the regime of a cavity to the regime of a step is explained, an approximate formula describing this transition is given, and the criterion for determining the applicability of each regime is established. The asymptotic behavior of the impedance for a finite number {ital M} of periodically arranged cavities as a function of {ital M} is studied. The different behaviors of the impedance for a single cavity and that for an infinite number of cavities are explained as resulting from the interference of the diffracted waves. A criterion for determining the transition in the impedance behavior from small {ital M} to large {ital M} is presented.

  9. Arts of electrical impedance tomographic sensing

    PubMed Central

    Wang, Mi; Wang, Qiang; Karki, Bishal

    2016-01-01

    This paper reviews governing theorems in electrical impedance sensing for analysing the relationships of boundary voltages obtained from different sensing strategies. It reports that both the boundary voltage values and the associated sensitivity matrix of an alternative sensing strategy can be derived from a set of full independent measurements and sensitivity matrix obtained from other sensing strategy. A new sensing method for regional imaging with limited measurements is reported. It also proves that the sensitivity coefficient back-projection algorithm does not always work for all sensing strategies, unless the diagonal elements of the transformed matrix, ATA, have significant values and can be approximate to a diagonal matrix. Imaging capabilities of few sensing strategies were verified with static set-ups, which suggest the adjacent electrode pair sensing strategy displays better performance compared with the diametrically opposite protocol, with both the back-projection and multi-step image reconstruction methods. An application of electrical impedance tomography for sensing gas in water two-phase flows is demonstrated. This article is part of the themed issue ‘Supersensing through industrial process tomography’. PMID:27185968

  10. Arts of electrical impedance tomographic sensing.

    PubMed

    Wang, Mi; Wang, Qiang; Karki, Bishal

    2016-06-28

    This paper reviews governing theorems in electrical impedance sensing for analysing the relationships of boundary voltages obtained from different sensing strategies. It reports that both the boundary voltage values and the associated sensitivity matrix of an alternative sensing strategy can be derived from a set of full independent measurements and sensitivity matrix obtained from other sensing strategy. A new sensing method for regional imaging with limited measurements is reported. It also proves that the sensitivity coefficient back-projection algorithm does not always work for all sensing strategies, unless the diagonal elements of the transformed matrix, A(T)A, have significant values and can be approximate to a diagonal matrix. Imaging capabilities of few sensing strategies were verified with static set-ups, which suggest the adjacent electrode pair sensing strategy displays better performance compared with the diametrically opposite protocol, with both the back-projection and multi-step image reconstruction methods. An application of electrical impedance tomography for sensing gas in water two-phase flows is demonstrated. This article is part of the themed issue 'Supersensing through industrial process tomography'. PMID:27185968