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Sample records for patients expanding image

  1. Expanding Patient Options: Minilaparotomy for Hysterectomy

    MedlinePLUS

    Expanding Patient Options: Minilaparotomy for Hysterectomy Covidien Energy Based Devices Concord, California May 26, 2010 Welcome to this OR Live program presented by Covidien energy-based devices. Good evening, and thank ...

  2. Tissue Expander versus Tissue Expander and Latissimus Flap in Morbidly Obese Breast Reconstruction Patients

    PubMed Central

    Adams, Robert L.; Chandler, Robert G.; Parks, Joseph

    2015-01-01

    Background: Immediate postmastectomy breast reconstruction in morbidly obese patients represents a challenge because neither prosthetic nor abdominal-based options may be suitable. Methods: This study compared a previously published cohort of immediate prosthetic reconstruction of 346 patients (511 breasts) of whom 49 patients (67 breasts) were morbidly obese (defined as a body mass index > 35) with a morbidly obese patient population whose breasts were reconstructed immediately following postmastectomy with latissimus flap and tissue expander (21 patients and 22 breasts) in the same time period. The preoperative risk factors of mastectomy such as tobacco use, diabetes, and prior radiation and the postoperative complications of mastectomy such as skin necrosis, seroma, and prosthesis loss were examined. The explantation of the tissue expander provided a defined endpoint of reconstruction failure. Results: The average body mass index in the tissue expander/implant group and in the latissimus flap plus tissue expander/implant group was 40.9 and 40.1, respectively. The risk profile of diabetes and tobacco use was similar in both groups. Fifteen of the 67 breasts (22.3%) of the tissue expander/implant group and 15 of the 23 breasts (65.2%) of the latissimus flap group had received prior radiation. The prosthesis loss was 13 of 67 breasts (19.4%) that had tissue-expander–alone reconstruction and 1 of 22 (4.8%) in the latissimus group that had tissue expander reconstruction. Modification of donor-site incision and skin-island location in the latissimus group of patients can minimize scar deformity. Conclusion: The loss rate in immediate postmastectomy reconstruction in morbidly obese patients with latissimus flap plus tissue expander was substantially lower than the loss rate in those with breast reconstructed with tissue expander alone. PMID:25878934

  3. Expanding Perspectives for Comprehending Visual Images in Multimodal Texts

    ERIC Educational Resources Information Center

    Serafini, Frank

    2011-01-01

    The texts that adolescents encounter today are often multimodal, meaning they incorporate a variety of modes, including visual images, hypertext, and graphic design elements along with written text. Expanding the perspectives readers use to make sense of the multimodal texts is an important aspect of comprehension instruction. Moving beyond the…

  4. Expanded beam non-imaging fiber optic connector

    DOEpatents

    Jannson, Tommasz (Redondo Beach, CA); Jannson, Joanna (Redondo Beach, CA); Yeung, Peter (Redondo Beach, CA)

    1990-01-01

    There is disclosed an expanded beam fiber to fiber connector, based on non-imaging optic principles for coupling light beams from one optical fiber to another. The system consists of two identical connector parts, referred to herein as a collimating part and a concentrating part, each having a preferred partially curved reflective boundary surface for minimizing power loss and surrounding either a hollow space or a space filled with a uniform transparent medium. In one embodiment the boundary is metallic while in a second embodiment the boundary is in the form of an interface allowing total internal reflection. In both the hollow and filled case a lens may be located at the expanded end of both the collimater part and the concentrator part forming the connector. The connector is preferably located in a housing in order to protect and preserve the mechanical stability of the coupler.

  5. Expanded beam non-imaging fiber optic connector

    DOEpatents

    Jannson, T.; Jannson, J.; Yeung, P.

    1990-02-06

    There is disclosed an expanded beam fiber to fiber connector, based on non-imaging optic principles for coupling light beams from one optical fiber to another. The system consists of two identical connector parts, referred to herein as a collimating part and a concentrating part, each having a preferred partially curved reflective boundary surface for minimizing power loss and surrounding either a hollow space or a space filled with a uniform transparent medium. In one embodiment the boundary is metallic while in a second embodiment the boundary is in the form of an interface allowing total internal reflection. In both the hollow and filled case a lens may be located at the expanded end of both the collimator part and the concentrator part forming the connector. The connector is preferably located in a housing in order to protect and preserve the mechanical stability of the coupler. 13 figs.

  6. As Patient Navigation Expands and Evolves, Nurses Assume Many Roles

    Cancer.gov

    It can be difficult to access care in our labyrinthine health care system. Oncology nurses are joining the ranks of patient navigators—a diverse group of people who help patients at all stages of cancer care, from screening and diagnosis to treatment and survivorship.

  7. Imaging Pregnant and Lactating Patients.

    PubMed

    Tirada, Nikki; Dreizin, David; Khati, Nadia J; Akin, Esma A; Zeman, Robert K

    2015-10-01

    As use of imaging in the evaluation of pregnant and lactating patients continues to increase, misperceptions of radiation and safety risks have proliferated, which has led to often unwarranted concerns among patients and clinicians. When radiologic examinations are appropriately used, the benefits derived from the information gained usually outweigh the risks. This review describes appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation (ie, radiography, computed tomography, nuclear scintigraphy, and fluoroscopically guided interventional radiology), radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women. Maternal radiation risk must be weighed with the potential consequences of missing a life-threatening diagnosis such as pulmonary embolus. Fetal risks (ie, spontaneous abortion, teratogenesis, or carcinogenesis) vary with gestational age and imaging modality and should be considered in the context of the potential benefit of medically necessary diagnostic imaging. When feasible and medically indicated, modalities that do not use ionizing radiation (eg, magnetic resonance imaging) are preferred in pregnant and lactating patients. Radiologists should strive to minimize risks of radiation to the mother and fetus, counsel patients effectively, and promote a realistic understanding of risks related to imaging during pregnancy and lactation. (©)RSNA, 2015. PMID:26466183

  8. Imaging the expanding shell of SN 2011dh

    NASA Astrophysics Data System (ADS)

    de Witt, A.; Bietenholz, M. F.; Kamble, A.; Soderberg, A. M.; Brunthaler, A.; Zauderer, B.; Bartel, N.; Rupen, M. P.

    2016-01-01

    We report on the third epoch of very long baseline interferometry (VLBI) observations of the radio-bright supernova SN 2011dh, located in the nearby (7.8 Mpc) galaxy M51. The observations took place at t = 453 d after the explosion and at a frequency of 8.4 GHz. We obtained a fairly well-resolved image of the shell of SN 2011dh, making it one of only six recent supernovae for which resolved images of the ejecta are available. SN 2011dh has a relatively clear shell morphology, being almost circular in outline, although there may be some asymmetry in brightness around the ridge. By fitting a spherical shell model directly to the visibility measurements we determine the angular radius of SN 2011dh's radio emission to be 636 ± 29 ?as. At a distance of 7.8 Mpc, this angular radius corresponds to a linear radius of (7.4 ± 0.3) × 1016 cm and an average expansion velocity since the explosion of 19 000^{+2800}_{-2400} km s-1. We combine our VLBI measurements of SN 2011dh's radius with values determined from the radio spectral energy distribution under the assumption of a synchrotron-self-absorbed spectrum, and find all the radii are consistent with a power-law evolution, with R ˜ t0.97±0.01, implying almost free expansion over the period t = 4 d to 453 d.

  9. Autosomal recessive spastic ataxia of Charlevoix Saguenay (ARSACS): expanding the genetic, clinical and imaging spectrum

    PubMed Central

    2013-01-01

    Background Mutations in SACS, leading to autosomal-recessive spastic ataxia of Charlevoix-Saguenay (ARSACS), have been identified as a frequent cause of recessive early-onset ataxia around the world. Here we aimed to enlarge the spectrum of SACS mutations outside Quebec, to establish the pathogenicity of novel variants, and to expand the clinical and imaging phenotype. Methods Sequencing of SACS in 22 patients with unexplained early-onset ataxia, assessment of novel SACS variants in 3.500 European control chromosomes and extensive phenotypic investigations of all SACS carriers. Results We identified 11 index patients harbouring 17 novel SACS variants. 9/11 patients harboured two variants of at least probable pathogenicity which were not observed in controls and, in case of missense mutations, were located in highly conserved domains. These 9 patients accounted for at least 11% (9/83) in our series of unexplained early onset ataxia subjects. While most patients (7/9) showed the classical ARSACS triad, the presenting phenotype reached from pure neuropathy (leading to the initial diagnosis of Charcot-Marie-Tooth disease) in one subject to the absence of any signs of neuropathy in another. In contrast to its name “spastic ataxia”, neither spasticity (absent in 2/9=22%) nor extensor plantar response (absent in 3/9=33%) nor cerebellar ataxia (absent in 1/9=11%) were obligate features. Autonomic features included urine urge incontinence and erectile dysfunction. Apart from the well-established MRI finding of pontine hypointensities, all patients (100%) showed hyperintensities of the lateral pons merging into the (thickened) middle cerebellar peduncles. In addition, 63% exhibited bilateral parietal cerebral atrophy, and 63% a short circumscribed thinning of the posterior midbody of the corpus callosum. In 2 further patients with differences in important clinical features, VUS class 3 variants (c.1373C>T [p.Thr458Ile] and c.2983 G>T [p.Val995Phe]) were identified. These variants were, however, also observed in controls, thus questioning their pathogenic relevance. Conclusions We here demonstrate that each feature of the classical ARSACS triad (cerebellar ataxia, spasticity and peripheral neuropathy) might be missing in ARSACS. Nevertheless, characteristic MRI features – which also extend to supratentorial regions and involve the cerebral cortex – will help to establish the diagnosis in most cases. PMID:23497566

  10. Renal imaging in patients requiring renal replacement therapy.

    PubMed

    Cowie, Alistair

    2002-01-01

    Recent advances in imaging technology and interventional radiologic procedures have resulted in an increased variety of radiological techniques that can be used to assess patients who present with renal failure and require renal replacement therapy. This chapter provides an overview of the relative strengths and weaknesses of the available imaging methods. In particular, it covers the expanding role of the cross-sectional, noninvasive, multiplanar imaging techniques such as gray-scale and Doppler ultrasound, magnetic resonance imaging (MRI) and angiography (MRA), and nonenhanced helical or multislice computed tomography (CT). These imaging methods are increasingly replacing those used in the past, such as the conventional radiographic urogram, which requires a high dose of intravenous contrast media, and digital subtraction arteriography. The chapter also covers the radiologic investigation of complications of acquired renal cystic disease, including renal cell carcinoma, hemorrhage, cyst infection and rupture, and nephrolithiasis. PMID:12191024

  11. Patient attitudes regarding the role of the pharmacist and interest in expanded pharmacist services

    PubMed Central

    Kelly, Deborah V.; Young, Stephanie; Phillips, Leslie; Clark, Deidre

    2014-01-01

    Background: Pharmacists are consistently ranked among the most trusted professionals, and research shows high levels of satisfaction with pharmacist services. Studies have also shown that the public is generally unaware of the full range of roles and responsibilities of a pharmacist. The purpose of this study was to explore the public’s knowledge and attitudes regarding the role of the community pharmacist and to determine their likelihood of using expanded pharmacist services. Methods: Adults across Newfoundland and Labrador were surveyed by telephone. Survey questions addressed how frequently participants visited the pharmacy, understanding of duties undertaken by pharmacists, perceptions and attitudes regarding pharmacists as health care professionals, likelihood of using expanded pharmacist services and participant demographics. Comparisons were made between responses from urban and rural participants and frequent versus nonfrequent pharmacy users, to determine if there were any differences. Results: The majority of participants were generally aware of what pharmacists do when filling prescriptions; those who visited the pharmacy more frequently appeared to be more informed. Participants indicated they would take advantage of the expanded services suggested, with greatest interest in receiving advice for minor ailment management and prescription refills from pharmacists. Results support the prevailing view that pharmacists are trusted health professionals who should have access to patients’ health information to provide best care. Conclusion: The public is aware of aspects of the pharmacist’s role, but opportunities exist to better educate the public on the knowledge, skills and unique professional abilities of pharmacists to support uptake of expanded pharmacist services. PMID:25360150

  12. Phase-preserving beam expander for biomedical X-ray imaging

    PubMed Central

    Martinson, Mercedes; Samadi, Nazanin; Bassey, Bassey; Gomez, Ariel; Chapman, Dean

    2015-01-01

    The BioMedical Imaging and Therapy beamlines at the Canadian Light Source are used by many researchers to capture phase-based imaging data. These experiments have so far been limited by the small vertical beam size, requiring vertical scanning of biological samples in order to image their full vertical extent. Previous work has been carried out to develop a bent Laue beam-expanding monochromator for use at these beamlines. However, the first attempts exhibited significant distortion in the diffraction plane, increasing the beam divergence and eliminating the usefulness of the monochromator for phase-related imaging techniques. Recent work has been carried out to more carefully match the polychromatic and geometric focal lengths in a so-called ‘magic condition’ that preserves the divergence of the beam and enables full-field phase-based imaging techniques. The new experimental parameters, namely asymmetry and Bragg angles, were evaluated by analysing knife-edge and in-line phase images to determine the effect on beam divergence in both vertical and horizontal directions, using the flat Bragg double-crystal monochromator at the beamline as a baseline. The results show that by using the magic condition, the difference between the two monochromator types is less than 10% in the diffraction plane. Phase fringes visible in test images of a biological sample demonstrate that this difference is small enough to enable in-line phase imaging, despite operating at a sub-optimal energy for the wafer and asymmetry angle that was used. PMID:25931100

  13. Expanding spectrum of neurologic manifestations in patients with NLRP3 low-penetrance mutations

    PubMed Central

    Schuh, Elisabeth; Lohse, Peter; Ertl-Wagner, Birgit; Witt, Matthias; Krumbholz, Markus; Frankenberger, Marion; Gerdes, Lisa-Ann; Hohlfeld, Reinhard

    2015-01-01

    Objective: To evaluate the frequency of the cryoporin/NLRP3 low-penetrance mutations V198M and Q703K in patients who reported at least 2 symptoms compatible with cryopyrin-associated periodic syndromes (CAPS) and to characterize the phenotype in mutation-positive patients. Methods: The frequency of the V198M and Q703K mutations was investigated in a selected cohort of 108 patients from our neuroimmunology department. We describe the clinical, neurologic, immunologic, and neuroradiologic features of the mutation carriers. Results: Seventeen patients (16%) tested positive for either of the 2 mutations (V198M: n = 2; Q703K: n = 15). Eleven patients (65%) had severe headache syndromes. Six of these 11 patients were diagnosed with migraine. Nine patients (53%) had a concomitant diagnosis of multiple sclerosis (MS). In 3 patients, we identified additional family members with the respective mutation as well as the diagnosis of MS. Severe recurrent cranial nerve (CN) affection was the hallmark feature in 7 of the 8 (88%) non-MS mutation carriers. Brain MRI showed abnormalities in all but 2 patients (88%) and detected CN inflammation in 4 patients. Interleukin-6 was elevated in the CSF of 2 patients in the non-MS cohort during acute CAPS episodes with severe CNS inflammation. 5 of 9 treated patients (56%) responded to anti–interleukin-1 therapy. Conclusion: CAPS constitute rare but treatable and commonly misdiagnosed autoinflammatory syndromes. Our data expand the spectrum of CAPS-associated neurologic manifestations. They also broaden our concept of autoimmunity and autoinflammation by linking CAPS and MS. PMID:26020059

  14. [The expanding spectrum of LGMD--recently discovered disease genes are important also in Finnish patients].

    PubMed

    Jokela, Manu; Palmio, Johanna; Sandell, Satu; Penttilä, Sini; Suominen, Tiina; Udd, Bjarne

    2013-01-01

    Limb-girdle muscular dystrophies (LGMD) are autosomal disorders with a range of manifestations varying from almost asymptomatic late-onset patients to severe childhood onset forms. Recently identified disease genes explain the majority of LGMD cases in Finland. Prognosis, potential cardiac and respiratory complications and symptomatic treatment options differ in different LGMD subtypes. This means that the gold standard of diagnosis is the molecular genetic definition of the disease in each patient. Despite evolving sequencing techniques, the clinical, pathological, neurophysiological and imaging characterisation of patients will not become obsolete, but rather, even more important during the next years to enable targeted genetic diagnostics. PMID:24218732

  15. Quantitative and qualitative characterization of expanded CD4+ T cell clones in rheumatoid arthritis patients

    PubMed Central

    Ishigaki, Kazuyoshi; Shoda, Hirofumi; Kochi, Yuta; Yasui, Tetsuro; Kadono, Yuho; Tanaka, Sakae; Fujio, Keishi; Yamamoto, Kazuhiko

    2015-01-01

    Rheumatoid arthritis (RA) is an autoimmune destructive arthritis associated with CD4+ T cell-mediated immunity. Although expanded CD4+ T cell clones (ECs) has already been confirmed, the detailed characteristics of ECs have not been elucidated in RA. Using combination of a single-cell analysis and next-generation sequencing (NGS) in TCR repertoire analysis, we here revealed the detailed nature of ECs by examining peripheral blood (PB) from 5 RA patients and synovium from 1 RA patient. When we intensively investigated the single-cell transcriptome of the most expanded clones in memory CD4+ T cells (memory-mECs) in RA-PB, senescence-related transcripts were up-regulated, indicating circulating ECs were constantly stimulated. Tracking of the transcriptome shift within the same memory-mECs between PB and the synovium revealed the augmentations in senescence-related gene expression and the up-regulation of synovium-homing chemokine receptors in the synovium. Our in-depth characterization of ECs in RA successfully demonstrated the presence of the specific immunological selection pressure, which determines the phenotype of ECs. Moreover, transcriptome tracking added novel aspects to the underlying sequential immune processes. Our approach may provide new insights into the pathophysiology of RA. PMID:26245356

  16. The Precision Expandable Radar Calibration Sphere (PERCS) With Applications for Laser Imaging and Ranging

    NASA Astrophysics Data System (ADS)

    Bernhardt, P.; Nicholas, A.; Thomas, L.; Davis, M.; Hoberman, C.; Davis, M.

    The Naval Research Laboratory will provide an orbiting calibration sphere to be used with ground-based laser imaging telescopes and HF radio systems. The Precision Expandable Radar Calibration Sphere (PERCS) is a practical, reliable, high-performance HF calibration sphere and laser imaging target to orbit at about 600 km altitude. The sphere will be made of a spherical wire frame with aspect independent radar cross section in the 3 to 35 MHz frequency range. The necessary launch vehicle to place the PERCS in orbit will be provided by the Department of Defense Space Test Program. The expandable calibration target has a stowed diameter of 1 meter and a fully deployed diameter of 10.2 meters. A separate deployment mechanism is provided for the sphere. After deployment, the Precision Expandable Radar Calibration Sphere (PERCS) with 180 vertices will be in a high inclination orbit to scatter radio pulses from a number of ground systems, including (1) over-the-horizon (OTH) radars operated by the United States and Australia; (2) high power HF facilities such as HAARP in Alaska, EISCAT in Norway, and Arecibo in Puerto Rico; (3) the chain of high latitude SuperDARN radars used for auroral region mapping; and (4) HF direction finding for Navy ships. With the PERCS satellite, the accuracy of HF radars can be periodically checked for range, elevation, and azimuth errors. In addition, each of the 360 vertices on the PERCS sphere will support an optical retro-reflector for operations with ground laser facilities used to track satellites. The ground laser systems will be used to measure the precise location of the sphere within one cm accuracy and will provide the spatial orientation of the sphere as well as the rotation rate. The Department of Defense facilities that can use the corner-cube reflectors on the PERCS include (1) the Air Force Maui Optical Site (AMOS), (2) the Starfire Optical Range (SOR), and (3) the NRL Optical Test Facility (OTF).

  17. Dosimetry around metallic ports in tissue expanders in patients receiving postmastectomy radiation therapy: an ex vivo evaluation

    SciTech Connect

    Moni, Janaki; Graves-Ditman, Maria; Cederna, Paul; Griffith, Kent; Krueger, Editha A.; Fraass, Benedick A.; Pierce, Lori J

    2004-03-31

    Postmastectomy breast reconstruction can be accomplished utilizing tissue expanders and implants. However, in patients who require postoperative radiotherapy, the complication rate with tissue expander/implant reconstruction can exceed 50%. One potential cause of this high complication rate may be the metallic port in the tissue expander producing altered dosimetry in the region of the metallic device. The purpose of this study was to quantify the radiation dose distribution in the vicinity of the metallic port and determine its potential contribution to this extremely high complication rate. The absolute dosimetric effect of the tissue expander's metallic port was quantified using film and thermoluminescent dosimetry (TLD) studies with a single beam incident on a metallic port extracted from an expander. TLD measurements were performed at 11 reproducible positions on an intact expander irradiated with tangential fields. A computed tomography (CT)-based treatment plan without inhomogeneity corrections was used to derive expected doses for all TLD positions. Multiple irradiation experiments were performed for all TLD data. Confidence intervals for the dose at TLD sites with the metallic port in place were compared to the expected dose at the site without the metallic port. Film studies did not reveal a significant component of scatter around the metallic port. TLD studies of the extracted metallic port revealed highest doses within the casing of the metallic port and no consistent increased dose at the surface of the expander. No excess dose due to the metallic port in the expander was noted with the phantom TLD data. Based upon these results, it does not appear that the metallic port in tissue expanders significantly contributes to the high complication rate experienced in patients undergoing tissue expander breast reconstruction and receiving radiation therapy. Strategies designed to reduce the breast reconstruction complication rate in this clinical setting will need to focus on factors other than adjusting the dosimetry around the tissue expander metallic port.

  18. Dosimetry around metallic ports in tissue expanders in patients receiving postmastectomy radiation therapy: an ex vivo evaluation.

    PubMed

    Moni, Janaki; Graves-Ditman, Maria; Cederna, Paul; Griffith, Kent; Krueger, Editha A; Fraass, Benedick A; Pierce, Lori J

    2004-01-01

    Postmastectomy breast reconstruction can be accomplished utilizing tissue expanders and implants. However, in patients who require postoperative radiotherapy, the complication rate with tissue expander/implant reconstruction can exceed 50%. One potential cause of this high complication rate may be the metallic port in the tissue expander producing altered dosimetry in the region of the metallic device. The purpose of this study was to quantify the radiation dose distribution in the vicinity of the metallic port and determine its potential contribution to this extremely high complication rate. The absolute dosimetric effect of the tissue expander's metallic port was quantified using film and thermoluminescent dosimetry (TLD) studies with a single beam incident on a metallic port extracted from an expander. TLD measurements were performed at 11 reproducible positions on an intact expander irradiated with tangential fields. A computed tomography (CT)-based treatment plan without inhomogeneity corrections was used to derive expected doses for all TLD positions. Multiple irradiation experiments were performed for all TLD data. Confidence intervals for the dose at TLD sites with the metallic port in place were compared to the expected dose at the site without the metallic port. Film studies did not reveal a significant component of scatter around the metallic port. TLD studies of the extracted metallic port revealed highest doses within the casing of the metallic port and no consistent increased dose at the surface of the expander. No excess dose due to the metallic port in the expander was noted with the phantom TLD data. Based upon these results, it does not appear that the metallic port in tissue expanders significantly contributes to the high complication rate experienced in patients undergoing tissue expander breast reconstruction and receiving radiation therapy. Strategies designed to reduce the breast reconstruction complication rate in this clinical setting will need to focus on factors other than adjusting the dosimetry around the tissue expander metallic port. PMID:15023393

  19. Expanded image database of pistachio x-ray images and classification by conventional methods

    NASA Astrophysics Data System (ADS)

    Keagy, Pamela M.; Schatzki, Thomas F.; Le, Lan Chau; Casasent, David P.; Weber, David

    1996-12-01

    In order to develop sorting methods for insect damaged pistachio nuts, a large data set of pistachio x-ray images (6,759 nuts) was created. Both film and linescan sensor images were acquired, nuts dissected and internal conditions coded using the U.S. Grade standards and definitions for pistachios. A subset of 1199 good and 686 insect damaged nuts was used to calculate and test discriminant functions. Statistical parameters of image histograms were evaluated for inclusion by forward stepwise discrimination. Using three variables in the discriminant function, 89% of test set nuts were correctly identified. Comparable data for 6 human subjects ranged from 67 to 92%. If the loss of good nuts is held to 1% by requiring a high probability to discard a nut as insect damaged, approximately half of the insect damage present in clean pistachio nuts may be detected and removed by x-ray inspection.

  20. Expanding Imaging Capabilities for Microfluidics: Applicability of Darkfield Internal Reflection Illumination (DIRI) to Observations in Microfluidics

    PubMed Central

    Kawano, Yoshihiro; Otsuka, Chino; Sanzo, James; Higgins, Christopher; Nirei, Tatsuo; Schilling, Tobias; Ishikawa, Takuji

    2015-01-01

    Microfluidics is used increasingly for engineering and biomedical applications due to recent advances in microfabrication technologies. Visualization of bubbles, tracer particles, and cells in a microfluidic device is important for designing a device and analyzing results. However, with conventional methods, it is difficult to observe the channel geometry and such particles simultaneously. To overcome this limitation, we developed a Darkfield Internal Reflection Illumination (DIRI) system that improved the drawbacks of a conventional darkfield illuminator. This study was performed to investigate its utility in the field of microfluidics. The results showed that the developed system could clearly visualize both microbubbles and the channel wall by utilizing brightfield and DIRI illumination simultaneously. The methodology is useful not only for static phenomena, such as clogging, but also for dynamic phenomena, such as the detection of bubbles flowing in a channel. The system was also applied to simultaneous fluorescence and DIRI imaging. Fluorescent tracer beads and channel walls were observed clearly, which may be an advantage for future microparticle image velocimetry (?PIV) analysis, especially near a wall. Two types of cell stained with different colors, and the channel wall, can be recognized using the combined confocal and DIRI system. Whole-slide imaging was also conducted successfully using this system. The tiling function significantly expands the observing area of microfluidics. The developed system will be useful for a wide variety of engineering and biomedical applications for the growing field of microfluidics. PMID:25748425

  1. A seed expanding cluster algorithm for deriving upwelling areas on sea surface temperature images

    NASA Astrophysics Data System (ADS)

    Nascimento, Susana; Casca, Sérgio; Mirkin, Boris

    2015-12-01

    In this paper a novel clustering algorithm is proposed as a version of the seeded region growing (SRG) approach for the automatic recognition of coastal upwelling from sea surface temperature (SST) images. The new algorithm, one seed expanding cluster (SEC), takes advantage of the concept of approximate clustering due to Mirkin (1996, 2013) to derive a homogeneity criterion in the format of a product rather than the conventional difference between a pixel value and the mean of values over the region of interest. It involves a boundary-oriented pixel labeling so that the cluster growing is performed by expanding its boundary iteratively. The starting point is a cluster consisting of just one seed, the pixel with the coldest temperature. The baseline version of the SEC algorithm uses Otsu's thresholding method to fine-tune the homogeneity threshold. Unfortunately, this method does not always lead to a satisfactory solution. Therefore, we introduce a self-tuning version of the algorithm in which the homogeneity threshold is locally derived from the approximation criterion over a window around the pixel under consideration. The window serves as a boundary regularizer. These two unsupervised versions of the algorithm have been applied to a set of 28 SST images of the western coast of mainland Portugal, and compared against a supervised version fine-tuned by maximizing the F-measure with respect to manually labeled ground-truth maps. The areas built by the unsupervised versions of the SEC algorithm are significantly coincident over the ground-truth regions in the cases at which the upwelling areas consist of a single continuous fragment of the SST map.

  2. Local Infiltration of Liposomal Bupivacaine for Pain Control in Patients Undergoing Mastectomy with Immediate Tissue Expander Reconstruction.

    PubMed

    Abdelsattar, Jad M; Degnim, Amy C; Hieken, Tina J; Saint-Cyr, Michel; Boughey, Judy C

    2015-10-01

    Mastectomy with immediate tissue expander reconstruction is associated with postoperative pain, nausea, and vomiting. Various techniques of perioperative and postoperative pain control have been described. Our standard of care for postsurgical pain management in patients undergoing mastectomy with immediate tissue expander reconstruction has been preoperative ultrasound-guided paravertebral block. Recent literature demonstrating the opioid-sparing benefits of liposomal bupivacaine has directed two of our plastic surgeons to pilot its use in immediate tissue expander reconstruction. In the accompanying video, we present our technique of intraoperative local infiltration of liposomal bupivacaine into the base of mastectomy skin flaps, serratus fascia, and periaxillary tissue after completion of the mastectomy and before tissue expander placement into the reconstruction pocket. PMID:26202558

  3. Flow field analysis in expanding healthy and emphysematous alveolar models using particle image velocimetry.

    PubMed

    Oakes, Jessica M; Day, Steven; Weinstein, Steven J; Robinson, Risa J

    2010-02-01

    Particulates that deposit in the acinus region of the lung have the potential to migrate through the alveolar wall and into the blood stream. However, the fluid mechanics governing particle transport to the alveolar wall are not well understood. Many physiological conditions are suspected to influence particle deposition including morphometry of the acinus, expansion and contraction of the alveolar walls, lung heterogeneities, and breathing patterns. Some studies suggest that the recirculation zones trap aerosol particles and enhance particle deposition by increasing their residence time in the region. However, particle trapping could also hinder aerosol particle deposition by moving the aerosol particle further from the wall. Studies that suggest such flow behavior have not been completed on realistic, nonsymmetric, three-dimensional, expanding alveolated geometry using realistic breathing curves. Furthermore, little attention has been paid to emphysemic geometries and how pathophysiological alterations effect deposition. In this study, fluid flow was examined in three-dimensional, expanding, healthy, and emphysemic alveolar sac model geometries using particle image velocimetry under realistic breathing conditions. Penetration depth of the tidal air was determined from the experimental fluid pathlines. Aerosol particle deposition was estimated by simple superposition of Brownian diffusion and sedimentation on the convected particle displacement for particles diameters of 100-750 nm. This study (1) confirmed that recirculation does not exist in the most distal alveolar regions of the lung under normal breathing conditions, (2) concluded that air entering the alveolar sac is convected closer to the alveolar wall in healthy compared with emphysematous lungs, and (3) demonstrated that particle deposition is smaller in emphysematous compared with healthy lungs. PMID:20370245

  4. Patient Portal Preferences: Perspectives on Imaging Information

    PubMed Central

    McNamara, Mary; Arnold, Corey; Sarma, Karthik; Aberle, Denise; Garon, Edward; Bui, Alex A. T.

    2014-01-01

    Patient portals have the potential to provide content that is specifically tailored to a patient's information needs based on diagnoses and other factors. In this work, we conducted a survey of 41 lung cancer patients at an outpatient lung cancer clinic at the medical center of the University of California Los Angeles, to gain insight into these perceived information needs and opinions on the design of a portal to fulfill them. We found that patients requested access to information related to diagnosis and imaging, with more than half of the patients reporting that they did not anticipate an increase in anxiety due to access to medical record information via a portal. We also found that patient educational background did not lead to a significant difference in desires for explanations of reports and definitions of terms. PMID:26191535

  5. Development of a bent Laue beam-expanding double-crystal monochromator for biomedical X-ray imaging.

    PubMed

    Martinson, Mercedes; Samadi, Nazanin; Belev, George; Bassey, Bassey; Lewis, Rob; Aulakh, Gurpreet; Chapman, Dean

    2014-05-01

    The Biomedical Imaging and Therapy (BMIT) beamline at the Canadian Light Source has produced some excellent biological imaging data. However, the disadvantage of a small vertical beam limits its usability in some applications. Micro-computed tomography (micro-CT) imaging requires multiple scans to produce a full projection, and certain dynamic imaging experiments are not possible. A larger vertical beam is desirable. It was cost-prohibitive to build a longer beamline that would have produced a large vertical beam. Instead, it was proposed to develop a beam expander that would create a beam appearing to originate at a source much farther away. This was accomplished using a bent Laue double-crystal monochromator in a non-dispersive divergent geometry. The design and implementation of this beam expander is presented along with results from the micro-CT and dynamic imaging tests conducted with this beam. Flux (photons per unit area per unit time) has been measured and found to be comparable with the existing flat Bragg double-crystal monochromator in use at BMIT. This increase in overall photon count is due to the enhanced bandwidth of the bent Laue configuration. Whilst the expanded beam quality is suitable for dynamic imaging and micro-CT, further work is required to improve its phase and coherence properties. PMID:24763635

  6. Schlemm's Canal Expands After Trabeculectomy in Patients With Primary Angle–Closure Glaucoma

    PubMed Central

    Hong, Jiaxu; Yang, Yujing; Wei, Anji; Deng, Sophie X.; Kong, Xiangmei; Chen, Junyi; Girard, Michaël J. A.; Mari, Jean Martial; Xu, Jianjiang; Sun, Xinghuai

    2014-01-01

    Purpose. To evaluate the in vivo changes in the Schlemm's canal (SC) in patients with primary angle-closure glaucoma (PACG) after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT). Methods. Forty eyes of 40 patients with PACG who underwent trabeculectomy were included. All participants underwent SD-OCT. The diameter and area of SC were examined and measured before and within 1 month after trabeculectomy. All SD-OCT images were processed using adaptive compensation algorithm to improve contrast and image quality. Multivariate linear regression analysis was performed for predictors of percentage change in the mean SC diameter and area. Results. The mean age of participants was 60.5 ± 14.6 years. Adaptive compensation significantly increased the percentage of sections in which SC was observable in the subjects studied from 52.5% (21/40) to 75.0% (30/40), which has acceptable intraobserver and interobserver repeatability. There was a significant increase in the SC diameter and area at the follow-up examination compared with the baseline value (SC diameter: 34.2 ± 6.2 ?m vs. 28.4 ± 6.1 ?m; SC area: 8117 ± 1942 ?m2 vs. 5200 ± 996 ?m2; all P < 0.001). After multivariate analysis, the only variable related to changes in SC was percentage change in IOP (SC diameter, P = 0.002; SC area, P < 0.001). In addition, the magnitude of the change in the SC area also correlated with angle opening distance at 750 ?m from the scleral spur at baseline. Conclusions. Expansion of SC was observed after trabeculectomy in PACG patients. The degree of SC expansion was related to the extent of the IOP decrease. PMID:25118266

  7. Spectroscopic, imaging, and probe diagnostics of laser plasma plumes expanding between confining surfaces

    NASA Astrophysics Data System (ADS)

    Yeates, P.; Kennedy, E. T.

    2010-11-01

    Laser plasma plumes were generated in aluminum rectangular cavities of fixed depth (6 mm) and varying height (2.0, 1.5, and 1.0 mm). Space and time resolved visible emission spectroscopy, gated intensified visible imaging, and Langmuir probe diagnostics were utilized to diagnose the evolution of the confined plasma plumes in comparison to freely expanding plasma plume generated from ablation of a planar target. The constrained plasma behavior displayed a multiphase history. Early stage interactions (t <100 ns) resulted in enhanced continuum and line emission, shockwave formation and plasma plume rebound. Later phase, long duration plasma-surface interactions (t >160 ns) resulted in sustained "decay," i.e., a rapid termination of continuum emission, in concert with decreases in peak electron density (Ne) and plasma temperature (T). This later phase originates from loss mechanisms which bleed the plasma plume of thermal energy and charged particles. These loss mechanisms increase in magnitude as the duration of the plasma-surface interaction increases. The transition from enhancement phase, originating from hydrodynamic containment, and plasma-surface collisions, to decay phase is described and occurs for each cavity at a different point in the space time history.

  8. Spectroscopic, imaging, and probe diagnostics of laser plasma plumes expanding between confining surfaces

    SciTech Connect

    Yeates, P.; Kennedy, E. T.

    2010-11-15

    Laser plasma plumes were generated in aluminum rectangular cavities of fixed depth (6 mm) and varying height (2.0, 1.5, and 1.0 mm). Space and time resolved visible emission spectroscopy, gated intensified visible imaging, and Langmuir probe diagnostics were utilized to diagnose the evolution of the confined plasma plumes in comparison to freely expanding plasma plume generated from ablation of a planar target. The constrained plasma behavior displayed a multiphase history. Early stage interactions (t<100 ns) resulted in enhanced continuum and line emission, shockwave formation and plasma plume rebound. Later phase, long duration plasma-surface interactions (t>160 ns) resulted in sustained 'decay', i.e., a rapid termination of continuum emission, in concert with decreases in peak electron density (N{sub e}) and plasma temperature (T). This later phase originates from loss mechanisms which bleed the plasma plume of thermal energy and charged particles. These loss mechanisms increase in magnitude as the duration of the plasma-surface interaction increases. The transition from enhancement phase, originating from hydrodynamic containment, and plasma-surface collisions, to decay phase is described and occurs for each cavity at a different point in the space time history.

  9. Image navigation as a means to expand the boundaries of fluorescence-guided surgery

    NASA Astrophysics Data System (ADS)

    Brouwer, Oscar R.; Buckle, Tessa; Bunschoten, Anton; Kuil, Joeri; Vahrmeijer, Alexander L.; Wendler, Thomas; Valdés-Olmos, Renato A.; van der Poel, Henk G.; van Leeuwen, Fijs W. B.

    2012-05-01

    Hybrid tracers that are both radioactive and fluorescent help extend the use of fluorescence-guided surgery to deeper structures. Such hybrid tracers facilitate preoperative surgical planning using (3D) scintigraphic images and enable synchronous intraoperative radio- and fluorescence guidance. Nevertheless, we previously found that improved orientation during laparoscopic surgery remains desirable. Here we illustrate how intraoperative navigation based on optical tracking of a fluorescence endoscope may help further improve the accuracy of hybrid surgical guidance. After feeding SPECT/CT images with an optical fiducial as a reference target to the navigation system, optical tracking could be used to position the tip of the fluorescence endoscope relative to the preoperative 3D imaging data. This hybrid navigation approach allowed us to accurately identify marker seeds in a phantom setup. The multispectral nature of the fluorescence endoscope enabled stepwise visualization of the two clinically approved fluorescent dyes, fluorescein and indocyanine green. In addition, the approach was used to navigate toward the prostate in a patient undergoing robot-assisted prostatectomy. Navigation of the tracked fluorescence endoscope toward the target identified on SPECT/CT resulted in real-time gradual visualization of the fluorescent signal in the prostate, thus providing an intraoperative confirmation of the navigation accuracy.

  10. Image navigation as a means to expand the boundaries of fluorescence-guided surgery.

    PubMed

    Brouwer, Oscar R; Buckle, Tessa; Bunschoten, Anton; Kuil, Joeri; Vahrmeijer, Alexander L; Wendler, Thomas; Valdés-Olmos, Renato A; van der Poel, Henk G; van Leeuwen, Fijs W B

    2012-05-21

    Hybrid tracers that are both radioactive and fluorescent help extend the use of fluorescence-guided surgery to deeper structures. Such hybrid tracers facilitate preoperative surgical planning using (3D) scintigraphic images and enable synchronous intraoperative radio- and fluorescence guidance. Nevertheless, we previously found that improved orientation during laparoscopic surgery remains desirable. Here we illustrate how intraoperative navigation based on optical tracking of a fluorescence endoscope may help further improve the accuracy of hybrid surgical guidance. After feeding SPECT/CT images with an optical fiducial as a reference target to the navigation system, optical tracking could be used to position the tip of the fluorescence endoscope relative to the preoperative 3D imaging data. This hybrid navigation approach allowed us to accurately identify marker seeds in a phantom setup. The multispectral nature of the fluorescence endoscope enabled stepwise visualization of the two clinically approved fluorescent dyes, fluorescein and indocyanine green. In addition, the approach was used to navigate toward the prostate in a patient undergoing robot-assisted prostatectomy. Navigation of the tracked fluorescence endoscope toward the target identified on SPECT/CT resulted in real-time gradual visualization of the fluorescent signal in the prostate, thus providing an intraoperative confirmation of the navigation accuracy. PMID:22547491

  11. Isolation and characterization of ex vivo expanded mesenchymal stem cells obtained from a surgical patient

    PubMed Central

    HUANG, JIA; SHA, HUIFAN; WANG, GUAN; BAO, GUOLIANG; LU, SHUN; LUO, QINGQUAN; TAN, QIANG

    2015-01-01

    The aim of the present study was to investigate the morphological characteristics and pluripotent differentiation potential of human bone marrow mesenchymal stem cells (hBMMSCs) in vitro and in vivo. Bone marrow cells were isolated from a rib fragment of an adult surgical patient, hBMMSCs were isolated based on plastic adherence and expanded ex vivo and phenotyping was performed. Pluripotent differentiation assays for adipogenesis, myogenesis and osteogenesis were conducted. Hematopoietic reconstruction of sublethally irradiated nude mice was performed by infusion of hBMMSCs. The gene expression profiles of early and late hBMMSCs were examined. The rate of CD31-positive cells was 31.1% in passage (P)4 hBMMSCs and 18.6% in P10 hBMMSCs. CD105 and CD106 were expressed in 99 and 95% of P25 hBMMSCs, respectively. Lipid droplets appeared at day 18 post induction. For osteogenesis, palpable masses were grossly observed from day 35 post inoculation of hBMMSCs. Hematoxylin and eosin staining further revealed chondrocytes and bone tissues. For myogenesis, at day six post subcutaneous inoculation, hBMMSCs differentiated into myocytes and were positive for myoglobin and MyoD1. In irradiated nude mice reconstituted by hBMMSCs, the white blood cell count briefly decreased following irradiation; however, it gradually recovered. In the irradiated nude mice reconstituted with hBMMSCs, CD45- and CD34-positive cells were detected 72 h post induction. Gene microarray analysis of P7 and P57 hBMMSCs demonstrated that 20 genes were upregulated >2 fold and 40 genes were downregulated >2 fold in P57 hBMMSCs. In conclusion, the isolated HBMMSCs possessed pluripotent differentiation potential and it was feasible and safe to use hBMMSCs within 30 passages. PMID:25376882

  12. Towards online patient imaging during helical radiotherapy.

    PubMed

    Yu, L; Poole, C M; Lancaster, C M; Sylvander, S R

    2015-03-01

    Exit-detector data from helical radiation therapy have been studied extensively for delivery verification and dose reconstruction. Since the same radiation source is used for both imaging and treatment, this work investigates the possibility of utilising exit-detector raw data for imaging purposes. This gives rise to potential clinical applications such as retrospective daily setup verification and inter-fractional setup error detection. The exit-detector raw data were acquired and independently analysed using Python programming language. The raw data were extracted from the treatment machine's onboard computer, and converted into 2D array files. The contours of objects (phantom or patient) were acquired by applying a logarithmic function to the ratio of two sinograms, one with the object in the beam and one without. The setup variation between any two treatment deliveries can be detected by applying the same function to their corresponding exit-detector sinograms. The contour of the object was well defined by the secondary radiation from the treatment beam and validated with the imaging beam, although no internal structures were discernible due to the interference from the primary radiation. The sensitivity of the setup variation detection was down to 2 mm, which was mainly limited by the resolution of the exit-detector itself. The exit-detector data from treatment procedures contain valuable photon exit fluence maps which can be utilised for contour definition and verification of patient alignment without reconstruction. PMID:25636244

  13. The effect of a vertical expandable prosthetic titanium rib on shoulder balance in patients with congenital scoliosis

    PubMed Central

    Al Zayed, Zayed Saleh; Shaheen, Mahmood Farouk

    2009-01-01

    Purpose To evaluate the effect of a vertical expandable prosthetic titanium rib (VEPTR) on shoulder balance in patients with congenital scoliosis. Methods Fifteen patients had a thoracic congenital scoliosis. The Cobb angles of the thoracic primary curves were measured. Preoperative measurements of the coracoid height difference (CHD; expressed in millimeters) and the clavicular tilt angle difference (CTAD; expressed in degrees) were performed for all patients. All of the patients were treated with VEPTR open wedge thoracostomy. Result There was a statistically significant improvement in thoracic Cobb angle. At the end of follow-up there was a significant improvement in CHD; all but three of the patients had CHD < 9 mm. Preoperatively, CTAD was 8.9°. It improved to 4.4° postoperatively and significantly decreased to 3.9° by the end of follow-up. Complications included device migration (one patient), infection (one patient), and pedicle screw loosening or displacement (two patients). Conclusion VEPTR is able to produce a modest intraoperative correction of shoulder imbalance. PMID:19730916

  14. HLA-haploidentical bone marrow transplantation with posttransplant cyclophosphamide expands the donor pool for patients with sickle cell disease

    PubMed Central

    Fuchs, Ephraim J.; Luznik, Leo; Lanzkron, Sophie M.; Gamper, Christopher J.; Jones, Richard J.; Brodsky, Robert A.

    2012-01-01

    Allogeneic marrow transplantation can cure sickle cell disease; however, HLA-matched donors are difficult to find, and the toxicities of myeloablative conditioning are prohibitive for most adults with this disease. We developed a nonmyeloablative bone marrow transplantation platform using related, including HLA-haploidentical, donors for patients with sickle cell disease. The regimen consisted of antithymocyte globulin, fludarabine, cyclophosphamide, and total body irradiation, and graft-versus-host disease prophylaxis with posttransplantation high-dose cyclophosphamide, mycophenolate mofetil, and tacrolimus or sirolimus. After screening 19 patients, we transplanted 17, 14 from HLA-haploidentical and 3 from HLA-matched related donors. Eleven patients engrafted durably. With a median follow-up of 711 days (minimal follow up 224 days), 10 patients are asymptomatic, and 6 patients are off immunosupression. Only 1 patient developed skin-only acute graft-versus-host disease that resolved without any therapy; no mortality was seen. Nonmyeloablative conditioning with posttransplantation high-dose cyclophosphamide expands the donor pool, making marrow transplantation feasible for most patients with sickle cell disease, and is associated with a low risk of complications, even with haploidentical related donors. Graft failure, 43% in haploidentical pairs, remains a major obstacle but may be acceptable in a fraction of patients if the majority can be cured without serious toxicities. PMID:22955919

  15. Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know.

    PubMed

    Reiter, Michael J; Hannemann, Nathan P; Schwope, Ryan B; Lisanti, Christopher J; Learn, Peter A

    2015-10-01

    Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates. PMID:26194812

  16. ["Expanded prostate cancer index composite" (EPIC-26) : Results of functional treatment in patients with localized prostate cancer].

    PubMed

    Beyer, B; Huland, H; Feick, G; Graefen, M

    2015-11-01

    The standardized collation of the quality of treatment is a subject of discussion both nationally and internationally. This article presents the work of the International Consortium for Health Outcomes Measurement (ICHOM) and the validated German translation of the expanded prostate cancer index composite (EPIC-26). This questionnaire allows a standardized interdisciplinary collation of the quality of treatment for all therapy modalities of localized prostate cancer. Use of the ICHOM standard set and the EPIC-26 achieves a possibility for comparison of each form of therapy with respect to the curative success and the effect on health and quality of life of patients. PMID:26347350

  17. Expanding applications, accuracy, and interpretation of laser speckle contrast imaging of cerebral blood flow.

    PubMed

    Kazmi, S M Shams; Richards, Lisa M; Schrandt, Christian J; Davis, Mitchell A; Dunn, Andrew K

    2015-07-01

    Laser speckle contrast imaging (LSCI) provides a rapid characterization of cortical flow dynamics for functional monitoring of the microcirculation. The technique stems from interactions of laser light with moving particles. These interactions encode the encountered Doppler phenomena within a random interference pattern imaged in widefield, known as laser speckle. Studies of neurovascular function and coupling with LSCI have benefited from the real-time characterization of functional dynamics in the laboratory setting through quantification of perfusion dynamics. While the technique has largely been relegated to acute small animal imaging, its scalability is being assessed and characterized for both chronic and clinical neurovascular imaging. PMID:25944593

  18. Ipilimumab in the real world: the UK expanded access programme experience in previously treated advanced melanoma patients.

    PubMed

    Ahmad, Saif S; Qian, Wendi; Ellis, Sarah; Mason, Elaine; Khattak, Muhammad A; Gupta, Avinash; Shaw, Heather; Quinton, Amy; Kovarikova, Jarmila; Thillai, Kiruthikah; Rao, Ankit; Board, Ruth; Nobes, Jenny; Dalgleish, Angus; Grumett, Simon; Maraveyas, Anthony; Danson, Sarah; Talbot, Toby; Harries, Mark; Marples, Maria; Plummer, Ruth; Kumar, Satish; Nathan, Paul; Middleton, Mark R; Larkin, James; Lorigan, Paul; Wheater, Matthew; Ottensmeier, Christian H; Corrie, Pippa G

    2015-10-01

    Before licensing, ipilimumab was first made available to previously treated advanced melanoma patients through an expanded access programme (EAP) across Europe. We interrogated data from UK EAP patients to inform future clinical practice. Clinicians registered in the UK EAP provided anonymized patient data using a prespecified variable fields datasheet. Data collected were baseline patient characteristics, treatment delivered, toxicity, response, progression-free survival and overall survival (OS). Data were received for 193 previously treated metastatic melanoma patients, whose primary sites were cutaneous (82%), uveal (8%), mucosal (2%), acral (3%) or unknown (5%). At baseline, 88% of patients had a performance status (PS) of 0-1 and 20% had brain metastases. Of the patients, 53% received all four planned cycles of ipilimumab; the most common reason for stopping early was disease progression, including death from melanoma. Toxicity was recorded for 171 patients, 30% of whom experienced an adverse event of grade 3 or higher, the most common being diarrhoea (13%) and fatigue (9%). At a median follow-up of 23 months, the median progression-free survival and OS were 2.8 and 6.1 months, respectively; the 1-year and 2-year OS rates were 31 and 14.8%, respectively. The 2-year OS was significantly lower for patients with poorer PS (P<0.0001), low albumin concentrations (P<0.0001), the presence of brain metastases (P=0.007) and lactate dehydrogenase levels more than two times the upper limit of normal (P<0.0001) at baseline. These baseline characteristics are negative predictors of benefit from ipilimumab and should be taken into consideration before prescription. PMID:26225580

  19. Ipilimumab in the real world: the UK expanded access programme experience in previously treated advanced melanoma patients

    PubMed Central

    S. Ahmad, Saif; Qian, Wendi; Ellis, Sarah; Mason, Elaine; Khattak, Muhammad A.; Gupta, Avinash; Shaw, Heather; Quinton, Amy; Kovarikova, Jarmila; Thillai, Kiruthikah; Rao, Ankit; Board, Ruth; Nobes, Jenny; Dalgleish, Angus; Grumett, Simon; Maraveyas, Anthony; Danson, Sarah; Talbot, Toby; Harries, Mark; Marples, Maria; Plummer, Ruth; Kumar, Satish; Nathan, Paul; Middleton, Mark R.; Larkin, James; Lorigan, Paul; Wheater, Matthew; Ottensmeier, Christian H.

    2015-01-01

    Before licensing, ipilimumab was first made available to previously treated advanced melanoma patients through an expanded access programme (EAP) across Europe. We interrogated data from UK EAP patients to inform future clinical practice. Clinicians registered in the UK EAP provided anonymized patient data using a prespecified variable fields datasheet. Data collected were baseline patient characteristics, treatment delivered, toxicity, response, progression-free survival and overall survival (OS). Data were received for 193 previously treated metastatic melanoma patients, whose primary sites were cutaneous (82%), uveal (8%), mucosal (2%), acral (3%) or unknown (5%). At baseline, 88% of patients had a performance status (PS) of 0–1 and 20% had brain metastases. Of the patients, 53% received all four planned cycles of ipilimumab; the most common reason for stopping early was disease progression, including death from melanoma. Toxicity was recorded for 171 patients, 30% of whom experienced an adverse event of grade 3 or higher, the most common being diarrhoea (13%) and fatigue (9%). At a median follow-up of 23 months, the median progression-free survival and OS were 2.8 and 6.1 months, respectively; the 1-year and 2-year OS rates were 31 and 14.8%, respectively. The 2-year OS was significantly lower for patients with poorer PS (P<0.0001), low albumin concentrations (P<0.0001), the presence of brain metastases (P=0.007) and lactate dehydrogenase levels more than two times the upper limit of normal (P<0.0001) at baseline. These baseline characteristics are negative predictors of benefit from ipilimumab and should be taken into consideration before prescription. PMID:26225580

  20. Sexual Abuse Images in Cyberspace: Expanding the Ecology of the Child

    ERIC Educational Resources Information Center

    Martin, Jennifer; Alaggia, Ramona

    2013-01-01

    Cyberspace has added a new dimension to the ecology of children made the subjects of sexual abuse images distributed online. These images cannot be permanently removed and can continue to circulate in cyberspace forever. A review of the current literature suggests that helping professionals are not consistently aware of or do not probe…

  1. Imaging informatics for consumer health: towards a radiology patient portal

    PubMed Central

    Arnold, Corey W; McNamara, Mary; El-Saden, Suzie; Chen, Shawn; Taira, Ricky K; Bui, Alex A T

    2013-01-01

    Objective With the increased routine use of advanced imaging in clinical diagnosis and treatment, it has become imperative to provide patients with a means to view and understand their imaging studies. We illustrate the feasibility of a patient portal that automatically structures and integrates radiology reports with corresponding imaging studies according to several information orientations tailored for the layperson. Methods The imaging patient portal is composed of an image processing module for the creation of a timeline that illustrates the progression of disease, a natural language processing module to extract salient concepts from radiology reports (73% accuracy, F1 score of 0.67), and an interactive user interface navigable by an imaging findings list. The portal was developed as a Java-based web application and is demonstrated for patients with brain cancer. Results and discussion The system was exhibited at an international radiology conference to solicit feedback from a diverse group of healthcare professionals. There was wide support for educating patients about their imaging studies, and an appreciation for the informatics tools used to simplify images and reports for consumer interpretation. Primary concerns included the possibility of patients misunderstanding their results, as well as worries regarding accidental improper disclosure of medical information. Conclusions Radiologic imaging composes a significant amount of the evidence used to make diagnostic and treatment decisions, yet there are few tools for explaining this information to patients. The proposed radiology patient portal provides a framework for organizing radiologic results into several information orientations to support patient education. PMID:23739614

  2. Expanded palette of Nano-lanterns for real-time multicolor luminescence imaging

    PubMed Central

    Takai, Akira; Nakano, Masahiro; Saito, Kenta; Haruno, Remi; Watanabe, Tomonobu M.; Ohyanagi, Tatsuya; Jin, Takashi; Okada, Yasushi; Nagai, Takeharu

    2015-01-01

    Fluorescence live imaging has become an essential methodology in modern cell biology. However, fluorescence requires excitation light, which can sometimes cause potential problems, such as autofluorescence, phototoxicity, and photobleaching. Furthermore, combined with recent optogenetic tools, the light illumination can trigger their unintended activation. Because luminescence imaging does not require excitation light, it is a good candidate as an alternative imaging modality to circumvent these problems. The application of luminescence imaging, however, has been limited by the two drawbacks of existing luminescent protein probes, such as luciferases: namely, low brightness and poor color variants. Here, we report the development of bright cyan and orange luminescent proteins by extending our previous development of the bright yellowish-green luminescent protein Nano-lantern. The color change and the enhancement of brightness were both achieved by bioluminescence resonance energy transfer (BRET) from enhanced Renilla luciferase to a fluorescent protein. The brightness of these cyan and orange Nano-lanterns was ?20 times brighter than wild-type Renilla luciferase, which allowed us to perform multicolor live imaging of intracellular submicron structures. The rapid dynamics of endosomes and peroxisomes were visualized at around 1-s temporal resolution, and the slow dynamics of focal adhesions were continuously imaged for longer than a few hours without photobleaching or photodamage. In addition, we extended the application of these multicolor Nano-lanterns to simultaneous monitoring of multiple gene expression or Ca2+ dynamics in different cellular compartments in a single cell. PMID:25831507

  3. Nurse-led action research project for expanding nurses’ role in patient education in Iran: Process, structure, and outcomes

    PubMed Central

    Khorasani, Parvaneh; Rassouli, Maryam; Parvizy, Soroor; Zagheri-Tafreshi, Mansoureh; Nasr-Esfahani, Mahmood

    2015-01-01

    Background: Patient education is among the lowest met need of patients in Iran; therefore, expansion of that role can result in greater professional accountability. This study aimed to explain the practical science of the process, structure, and outcomes of a nurse-led action research project to expand the nurses’ role in patient education in Iran. Materials and Methods: This study was part of a participatory action research. Daily communications and monthly joint meetings were held from January 2012 to February 2014 for planning and management. These were based on the research protocol, and the conceptual framework included the Mobilizing for Action through Planning and Partnerships process by means of Leadership for Change skills. Data were produced and gathered through participant observations. Administrative data included project records, official documents, artifacts, news, and reports, which were analyzed through qualitative content analysis. Results: A participatory project was established with three groups of participants organized from both academic and clinical fields. These consisted of a “core research support team,” “two steering committees,” and community representatives of clients and professionals as “feedback groups.” A seven-stage process, named the “Nurse Educators: Al-Zahra Role Expansion Action Research” (NEAREAR) process, resulted from the project, in which strategic issues were gradually developed and implemented through 32 action plans and quality improvement cycles of action research. Audits and supervision evaluations showed meaningful changes in capacity building components. Conclusions: A nurse-led ad hoc structure with academic–clinical partnerships and strategic management process was suggested as a possible practical model for expanding nurses’ educational role in similar contexts. Implications and practical science introduced in this action research could also be applicable for top managers and health system policy makers in a wider range of practice. PMID:26120341

  4. Exercise thallium imaging in patients with diabetes mellitus. Prognostic implications

    SciTech Connect

    Felsher, J.; Meissner, M.D.; Hakki, A.H.; Heo, J.; Kane-Marsch, S.; Iskandrian, A.S.

    1987-02-01

    We used exercise thallium 201 imaging in 123 patients with diabetes mellitus (77 men and 46 women, aged 56 +/- 8 years), 75% of whom had angina pectoris (typical or atypical). During exercise testing, 18 patients (15%) had angina pectoris, 28 (23%) had ischemic ST changes, and 69 (56%) had abnormal thallium images. During follow-up (up to 36 months), there were 12 cardiac events; four patients died of cardiac causes and eight had nonfatal acute myocardial infarction. Univariate and multivariate survival analysis identified two independent predictors of cardiac events: the event rate was significantly less in patients with normal images and exercise heart rate over 120 beats per minute than in patients with abnormal images and exercise heart rate of 120 beats per minute or less (0% vs 22%). The patients with abnormal images or exercise heart rate of 120 beats per minute or less had an intermediate event rate (11.5%). Furthermore, two of the 54 patients with normal images and ten of 69 patients with abnormal images had subsequent cardiac events. Thus, exercise thallium imaging is useful in risk stratification in patients with diabetes mellitus.

  5. Designing the Expanded Programme on Immunisation (EPI) as a service: Prioritising patients over administrative logic.

    PubMed

    McKnight, Jacob; Holt, Douglas B

    2014-01-01

    Expanded Programme on Immunisation (EPI) vaccination rates remain well below herd immunity in regions of many countries despite huge international resources devoted to both financing and access. We draw upon service marketing theory, organisational sociology, development anthropology and cultural consumer research to conduct an ethnographic study of vaccination delivery in Jimma Zone, Ethiopia - one such region. We find that Western public health sector policies are dominated by an administrative logic. Critical failures in delivery are produced by a system that obfuscates the on-the-ground problems that mothers face in trying to vaccinate their children, while instead prioritising administrative processes. Our ethnographic analysis of 83 mothers who had not vaccinated their children reveals key barriers to vaccination from a 'customer' perspective. While mothers value vaccination, it is a 'low involvement' good compared to the acute daily needs of a subsistence life. The costs imposed by poor service - such as uncaring staff with class hostilities, unpredictable and missed schedules and long waits - are too much and so they forego the service. Our service design framework illuminates specific service problems from the mother's perspective and points towards simple service innovations that could improve vaccination rates in regions that have poor uptake. PMID:25363481

  6. Sexual abuse images in cyberspace: expanding the ecology of the child.

    PubMed

    Martin, Jennifer; Alaggia, Ramona

    2013-01-01

    Cyberspace has added a new dimension to the ecology of children made the subjects of sexual abuse images distributed online. These images cannot be permanently removed and can continue to circulate in cyberspace forever. A review of the current literature suggests that helping professionals are not consistently aware of or do not probe possibilities of online sexual victimization in the investigation, assessment, and treatment of child sexual abuse. Nor is this issue adequately addressed in their education and training. There are gaps in the literature regarding how to identify and provide treatment for these children. New assessment and treatment targets are needed to enhance existing practice approaches. A contemporary ecological model that incorporates an explicit consideration of the cybersystem is provided as a starting point for practitioners to be aware of the possibility that images of child sexual abuse were recorded and distributed online. PMID:23682766

  7. Near infra-red photoluminescent graphene nanoparticles greatly expand their use in noninvasive biomedical imaging.

    PubMed

    Nurunnabi, Md; Khatun, Zehedina; Reeck, Gerald R; Lee, Dong Yun; Lee, Yong-kyu

    2013-06-01

    A simple reaction process is developed to synthesize blue, green, yellow and red colour graphene nanoparticles (GNPs) from carbon fibers. Here, we have focused on synthesis of near infra-red GNPs and their biological application for optical imaging of deep tissues and organs. PMID:23624441

  8. A PILOT IMAGING LINE SURVEY OF RW LMi AND IK Tau USING THE EXPANDED VERY LARGE ARRAY

    SciTech Connect

    Claussen, M. J.; Sjouwerman, L. O.; Rupen, M. P.; Olofsson, H.; Schoeier, F. L.; Bergman, P.; Knapp, G. R.

    2011-09-20

    We report on a pilot imaging line survey (36.0-37.0 GHz, with {approx}1 km s{sup -1} spectral channels) with the Expanded Very Large Array for two asymptotic giant branch stars, RW LMi (= CIT6, which has a carbon-rich circumstellar envelope, CSE) and IK Tau (=NML Tau, with an oxygen-rich CSE). Radio continuum emission consistent with photospheric emission was detected from both stars. From RW LMi we imaged the HC{sub 3}N (J = 4{yields}3) emission. The images show several partial rings of emission; these multiple shells trace the evolution of the CSE from 400 to 1200 years. SiS (J = 2{yields}1) emission was detected from both RW LMi and IK Tau. For both stars the SiS emission is centrally condensed with the peak line emission coincident with the stellar radio continuum emission. In addition, we have detected weak HC{sub 7}N (J = 32{yields}31) emission from RW LMi.

  9. Ultrasonographic imaging of inflammatory bowel disease in pediatric patients

    PubMed Central

    Chiorean, Liliana; Schreiber-Dietrich, Dagmar; Braden, Barbara; Cui, Xin-Wu; Buchhorn, Reiner; Chang, Jian-Min; Dietrich, Christoph F

    2015-01-01

    Inflammatory bowel disease (IBD) is one of the most common chronic gastrointestinal diseases in pediatric patients. Choosing the optimal imaging modality for the assessment of gastrointestinal disease in pediatric patients can be challenging. The invasiveness and patient acceptance, the radiation exposure and the quality performance of the diagnostic test need to be considered. By reviewing the literature regarding imaging in inflammatory bowel disease the value of ultrasound in the clinical management of pediatric patients is highlighted. Transabdominal ultrasound is a useful, noninvasive method for the initial diagnosis of IBD in children; it also provides guidance for therapeutic decisions and helps to characterize and predict the course of the disease in individual patients. Ultrasound techniques including color Doppler imaging and contrast-enhanced ultrasound are promising imaging tools to determine disease activity and complications. Comparative studies between different imaging methods are needed. PMID:25954096

  10. Expanding patient access to quality medication-related information: the potential of medication hotlines to improve patient adherence in schizophrenia.

    PubMed

    Pettit, Amy R; Marcus, Steven C

    2015-05-01

    Medication nonadherence is a widespread problem that compromises treatment outcomes, particularly in schizophrenia. Weersink et al. (Soc Psychiatry Psychiatr Epidemiol, 2015) describe telephone calls to a national medicines information line, with a focus on queries related to antipsychotic medications. Their analysis of callers' questions and concerns offers a valuable window into patient and caregiver perspectives. Given that many callers reported that they had not shared these concerns with a health care provider, this study also highlights the capacity of medication hotlines to address unmet needs. Establishing and maintaining long-term treatment regimens is a complex task, and truly patient-centered care requires a variety of creative and accessible support resources. Medication lines have the potential to serve as a resource and to provide proactive and timely adherence support. PMID:25859753

  11. Geodetic Imaging: Expanding the Boundaries of Geodesy in the 21st Century

    NASA Astrophysics Data System (ADS)

    Fernandez Diaz, J. C.; Carter, W. E.; Shrestha, R. L.; Glennie, C. L.

    2013-12-01

    High resolution (sub-meter) geodetic images covering tens to thousands of square kilometers have extended the boundaries of geodesy into related areas of the earth sciences, such as geomorphology and geodynamics, during the past decade, to archaeological exploration and site mapping during the past few years, and are now poised to transform studies of flora and fauna in the more remote regions of the world. Geodetic images produced from airborne laser scanning (ALS), a.k.a. airborne light detection and ranging (LiDAR) have proven transformative to the modern practice of geomorphology where researchers have used decimeter resolution digital elevation models (DEMs) to determine the spatial frequencies of evenly spaced features in terrain, and developed models and mathematical equations to explain how the terrain evolved to its present state and how it is expected to change in the future (Perron et al., 2009). In geodynamics researchers have used ';before' and ';after' geodetic images of the terrain near earthquakes, such as the 2010 El Mayor-Cucapah Earthquake, to quantify surface displacements and suggest models to explain the observed deformations (Oskin et. al., 2012). In archaeology, the ability of ALS to produce ';bare earth' DEMs of terrain covered with dense vegetation, including even tropical rain forests, has revolutionized the study of archaeology in highly forested areas, finding ancient structures and human modifications of landscapes not discovered by archaeologists working at sites for decades (Chase et al., 2011 & Evans et al., 2013), and finding previously unknown ruins in areas that ground exploration has not been able to penetrate since the arrival of the conquistadors in the new world in the 17th century (Carter et al., 2012). The improved spatial resolution and ability of the third generation ALS units to obtain high resolution bare earth DEMs and canopy models in areas covered in dense forests, brush, and even shallow water (steams, lakes, and coastal waters) is just beginning to attract the attention of researchers studying such plant life as marsh vegetation and sea grasses, and the habitats of animals as diverse as fish, migratory birds, and lions (Vierling et al., 2008). From thousands and thousands of survey markers covering large regions of the earth common to geodesy a half century ago, the focus of some geodesist has changed to billions and billions of points covering landscapes, which are enabling them to redefine and extend the limits of geodesy in the 21st century. References: Carter, W. E. et al., (2012), 'Geodetic Imaging: A New Tool for Mesoamerican Archaeology,' Eos, Trans. American Geophysical Union, Vol. 93, No. 42, pages 413-415. Chase, A. F. et al., (2010) 'Airborne LiDAR, archaeology, and the ancient Maya landscape at Caracol, Belize,' Journal Of Archaeological Science, vol. 38, no. 2, p. 387-398. Evans, D. H. et al., (2013), 'Uncovering archaeological landscapes at Angkor using lidar.' PNAS. Oskin, M. E. et al., (2012), 'Near-Field Deformation from the El Mayor-Cucapah Earthquake Revealed by Differential LIDAR,' Science. Vol. 335 no.6069, pp. 702-705. Perron, J. Taylor, et al (2009), 'Formation of evenly spaced ridges and valleys,' Nature, Vol. 460/23. Vierling, K. T. et al., (2008),'Lidar: shedding new light on habitat characterization and modeling,' Front Ecol Environ 2008, 6(2): 90-98.

  12. Megapixel imaging camera for expanded H{sup {minus}} beam measurements

    SciTech Connect

    Simmons, J.E.; Lillberg, J.W.; McKee, R.J.; Slice, R.W.; Torrez, J.H.; McCurnin, T.W.; Sanchez, P.G.

    1994-02-01

    A charge coupled device (CCD) imaging camera system has been developed as part of the Ground Test Accelerator project at the Los Alamos National Laboratory to measure the properties of a large diameter, neutral particle beam. The camera is designed to operate in the accelerator vacuum system for extended periods of time. It would normally be cooled to reduce dark current. The CCD contains 1024 {times} 1024 pixels with pixel size of 19 {times} 19 {mu}m{sup 2} and with four phase parallel clocking and two phase serial clocking. The serial clock rate is 2.5{times}10{sup 5} pixels per second. Clock sequence and timing are controlled by an external logic-word generator. The DC bias voltages are likewise located externally. The camera contains circuitry to generate the analog clocks for the CCD and also contains the output video signal amplifier. Reset switching noise is removed by an external signal processor that employs delay elements to provide noise suppression by the method of double-correlated sampling. The video signal is digitized to 12 bits in an analog to digital converter (ADC) module controlled by a central processor module. Both modules are located in a VME-type computer crate that communicates via ethernet with a separate workstation where overall control is exercised and image processing occurs. Under cooled conditions the camera shows good linearity with dynamic range of 2000 and with dark noise fluctuations of about {plus_minus}1/2 ADC count. Full well capacity is about 5{times}10{sup 5} electron charges.

  13. The Self-Expanding Symetis Acurate Does Not Increase Cerebral Microembolic Load When Compared to the Balloon-Expandable Edwards Sapien Prosthesis: A Transcranial Doppler Study in Patients Undergoing Transapical Aortic Valve Implantation

    PubMed Central

    Erdoes, Gabor; Huber, Christoph; Basciani, Reto; Stortecky, Stefan; Windecker, Stephan; Wenaweser, Peter; Carrel, Thierry; Eberle, Balthasar

    2014-01-01

    Objectives The aim of this study was to quantify potential differences in count, frequency and pattern of high-intensity transient signals (HITS) during transapical transcatheter aortic valve implantation (TA-TAVI), by comparing the Symetis Acurate TA (SA) with the balloon-expandable Edwards Sapien XT (ES) system. Background Recently, the Symetis Acurate TA revalving system has been introduced for TA-TAVI. The Symetis Acurate TA aortic bioprosthesis is self-expanding and is deployed by a specific two-step implantation technique. Whether this novel method increases the load of intraprocedural emboli, detected by transcranial Doppler ultrasound (TCD) as HITS, or not is not clear. Methods Twenty-two patients (n?=?11 in each study arm, median logistic EuroScore 20%, median STS score 7%) displayed continuous TCD signals of good quality throughout the entire TA-TAVI procedure and were included in the final analysis. Data are presented as median with interquartile ranges. Results No significant differences were detected in total procedural or interval-related HITS load (SA: 303 [200; 594], ES: 499 [285; 941]; p?=?0.16). With both devices, HITS peaked during prosthesis deployment (PD), whereas significantly fewer HITS occurred during instrumentation (SA: p?=?0.002; ES: <0.001) or post-implantation PI (SA: p?=?0.007; ES: <0.001). PD-associated HITS amounted to almost half of the total HITS load. One patient suffered new disabling stroke at 30 days. Thirty-day mortality amounted to 13.6% (3 of 22 patients). Conclusions Simplified transapical delivery using the self-expanding SA device does not increase HITS, despite of a two-step deployment technique with more interactions with the native aortic valve, when compared to the balloon-expandable ES valve. The similarity in HITS count, frequency and pattern with the two systems suggests a common mechanism for the release of cerebral microemboli. PMID:25289688

  14. Coma Patient Monitoring System Using Image Processing

    NASA Astrophysics Data System (ADS)

    Sankalp, Meenu

    2011-12-01

    COMA PATIENT MONITORING SYSTEM provides high quality healthcare services in the near future. To provide more convenient and comprehensive medical monitoring in big hospitals since it is tough job for medical personnel to monitor each patient for 24 hours.. The latest development in patient monitoring system can be used in Intensive Care Unit (ICU), Critical Care Unit (CCU), and Emergency Rooms of hospital. During treatment, the patient monitor is continuously monitoring the coma patient to transmit the important information. Also in the emergency cases, doctor are able to monitor patient condition efficiently to reduce time consumption, thus it provides more effective healthcare system. So due to importance of patient monitoring system, the continuous monitoring of the coma patient can be simplified. This paper investigates about the effects seen in the patient using "Coma Patient Monitoring System" which is a very advanced product related to physical changes in body movement of the patient and gives Warning in form of alarm and display on the LCD in less than one second time. It also passes a sms to a person sitting at the distant place if there exists any movement in any body part of the patient. The model for the system uses Keil software for the software implementation of the developed system.

  15. Interaction of expanding abdominal aortic aneurysm with surrounding tissue: Retrospective CT image studies

    PubMed Central

    Kwon, Sebastian T.; Burek, William; Dupay, Alexander C.; Farsad, Mehdi; Baek, Seungik; Park, Eun-Ah; Lee, Whal

    2015-01-01

    Objectives Abdominal aortic aneurysms (AAA) that rupture have a high mortality rate. Rupture occurs when local mechanical stress exceeds the local mechanical strength of an AAA, so stress profiles such as those from finite element analysis (FEA) are useful. The role and effect of surrounding tissues, like the vertebral column, which have not been extensively studied, are examined in this paper. Methods Longitudinal CT scans from ten patients with AAAs were studied to see the effect of surrounding tissues on AAAs. Segmentation was performed to distinguish the AAA from other tissues and we studied how these surrounding tissues affected the shape and curvature of the AAA. Previously established methods by Veldenz et al. were used to split the AAA into 8 sections and examine the specific effects of surrounding tissues on these sections [1]. Three-dimensional models were created to better examine these effects over time. Registration was done in order to compare AAAs longitudinally. Results The vertebral column and osteophytes were observed to have been affecting the shape and the curvature of the AAA. Interaction with the spine caused focal flattening in certain areas of the AAA. In 16 of the 41 CT scans, the right posterior dorsal section (section 5), had the highest radius of curvature, which was by far the section that had the maximum radius for a specified CT scan. Evolution of the growing AAA showed increased flattening in this section when comparing the last CT scan to the first scan. Conclusion Surrounding tissues have a clear influence on the geometry of an AAA, which may in turn affect the stress profile of AAA. Incorporating these structures in FEA and G&R models will provide a better estimate of stress. Clinical Relevance Currently, size is the only variable considered when deciding whether to undergo elective surgery to repair AAA since it is an easy enough measure for clinicians to utilize. However, this may not be the best indicator of rupture risk because small aneurysms also contribute to a high mortality rate. AAA’s wall stress is a superior indicator and may be better predicted with the inclusion of these surrounding tissues, which then could be used by clinicians in their decision-making process on whether to operate on an AAA. PMID:26636132

  16. Comparison of balloon-expandable versus self-expandable valves for transcatheter aortic valve implantation in patients with low-gradient severe aortic stenosis and preserved left ventricular ejection fraction.

    PubMed

    Covolo, Elisa; Saia, Francesco; Napodano, Massimo; Frigo, Anna Chiara; Agostoni, Pierfrancesco; Mojoli, Marco; Fraccaro, Chiara; Ciuca, Cristina; Presbitero, Patrizia; Moretti, Claudio; D'Ascenzo, Fabrizio; Tarantini, Giuseppe

    2015-03-15

    A relevant proportion of patients, classified as severe aortic stenosis on the basis of valve area ?1 cm(2), have a mean transvalvular gradient ?40 mm Hg, despite a preserved left ventricular ejection fraction (LGSAS). We assessed the clinical and hemodynamic impact of transcatheter aortic valve implantation in patients with symptomatic LGSAS at high risk for surgery or inoperable, according to the type of percutaneous valve implanted. Ninety-five patients received an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California) and 51 received a Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota). The hemodynamic performance of the 2 valves was similar in term of final transvalvular gradients (10 mm Hg, p = 0.069). Early mortality rate was 7% and was not different between the 2 valves (p = 0.73). During follow-up, cardiovascular mortality rate was similar between groups, and valve type was not a predictor of outcome (p = 0.72). Estimated survival by Kaplan-Meier at 2 years was 70%. At multivariate analysis, life-threatening or major bleeding, postprocedural aortic insufficiency, and acute kidney injury were the major predictors of an adverse outcome. In patients with LGSAS treated by transcatheter aortic valve implantation, the use of balloon-expandable versus self-expandable valves resulted in similar hemodynamic, early, and long-term clinical outcomes. PMID:25620039

  17. Imaging features of Burkitt lymphoma in pediatric patients.

    PubMed

    Derinkuyu, Betül Emine; Boyuna?a, Öznur; Öztunal?, Çi?dem; Tekke?in, Funda; Damar, Ça?r?; Al?ml?, Ay?e Gül; Okur, Arzu

    2016-01-01

    Burkitt lymphoma is an aggressive and rapidly growing tumor that is curable and highly sensitive to chemotherapy. It can affect almost every tissue in the body, producing various clinical presentations and imaging appearances, according to the predilection of the different subtypes for certain sites. Awareness of its diagnostically specific imaging appearances plays an important role in rapid detection and treatment. In this pictorial review, we aimed to identify the most common imaging features of Burkitt lymphoma in pediatric patients. PMID:26611257

  18. Expand Your Horizon: A programme that improves body image and reduces self-objectification by training women to focus on body functionality.

    PubMed

    Alleva, Jessica M; Martijn, Carolien; Van Breukelen, Gerard J P; Jansen, Anita; Karos, Kai

    2015-09-01

    This study tested Expand Your Horizon, a programme designed to improve body image by training women to focus on the functionality of their body using structured writing assignments. Eighty-one women (Mage=22.77) with a negative body image were randomised to the Expand Your Horizon programme or to an active control programme. Appearance satisfaction, functionality satisfaction, body appreciation, and self-objectification were measured at pretest, posttest, and one-week follow-up. Following the intervention, participants in the Expand Your Horizon programme experienced greater appearance satisfaction, functionality satisfaction, and body appreciation, and lower levels of self-objectification, compared to participants in the control programme. Partial eta-squared effect sizes were of small to medium magnitude. This study is the first to show that focusing on body functionality can improve body image and reduce self-objectification in women with a negative body image. These findings provide support for addressing body functionality in programmes designed to improve body image. PMID:26280376

  19. Flow cytometric characterization of freshly isolated and culture expanded human synovial cell populations in patients with chronic arthritis

    PubMed Central

    2010-01-01

    Introduction The synovium is a major target tissue in chronic arthritis and is intensively studied at the cellular and molecular level. The aim of this study was to develop flow cytometry for the quantitative analysis of synovial cell populations pre and post culture and to characterize mesenchymal cell populations residing in the inflammatory synovium. Methods Knee synovium biopsies from 39 patients with chronic arthritis and from 15 controls were treated in a short, standardized tissue digestion procedure. Stored, thawed digests were routinely analyzed with flow cytometry including live-dead staining and use of the markers CD45, CD3, CD14, CD20, CD34, CD73, CD105, CD90, CD146, CD163 and HLA-DR to distinguish inflammatory and stromal cells. The influence of the digestion method on the detection of the different surface markers was studied separately. In addition, we studied the presence of a specific cell population hypothesized to be mesenchymal stem cells (MSC) based on the CD271 marker. Cell expansion cultures were set up and a MSC-related surface marker profile in passages 3 and 6 was obtained. Immunohistochemistry for CD34 and von Willebrand factor (vWF) was done to obtain additional data on synovium vascularity. Results The cell yield and viability normalized to tissue weight were significantly higher in inflammatory arthritis than in controls. Within the hematopoietic CD45-positive populations, we found no differences in relative amounts of macrophages, T-lymphocytes and B-lymphocytes between patient groups. Within the CD45-negative cells, more CD34-positive cells were seen in controls than in arthritis patients. In arthritis samples, a small CD271 positive population was detected. Culture expanded cells were found to fulfill the multipotent mesenchymal stromal cell marker profile, except for CD34 negativity. Detection of peripheral blood macrophage and B-cell markers was decreased after enzymatic exposure and mechanical forces, respectively, but stromal markers were not affected. Conclusions Flow cytometry can distinguish synovial cell populations in tissue digests. The preparation method can influence the detection levels of macrophage and B-cell populations. However, stromal cell markers seem not affected and quantification is possible, supporting flow cytometry tissue analysis as a tool to study these cell populations in arthritis. PMID:20105279

  20. Renal safety of intravenous gadolinium-enhanced magnetic resonance imaging in patients awaiting liver transplantation.

    PubMed

    Shaffer, Katherine M; Parikh, Mehul R; Runge, Thomas M; Perez, Sebastian D; Sakaria, Sonali S; Subramanian, Ram M

    2015-11-01

    Renal dysfunction in cirrhosis carries a high morbidity and mortality. Given the potential risk of contrast-induced nephropathy associated with iodinated intravenous contrast used in computed tomography (CT), alternate contrast modalities for abdominal imaging in liver transplant candidates need to be examined. The purpose of this study was to examine the renal safety of magnetic resonance imaging (MRI) with gadolinium in patients awaiting liver transplantation. The study involved a retrospective analysis of 352 patients of abdominal MRI with low-dose gadobenate dimeglumine (MultiHance) (0.05 mmol/kg) in patients with cirrhosis and without renal replacement therapy at a single center during the period from 2007 to 2013. For each case, serum creatinine before and within a few days after the MRI were compared. In addition, the patients were analyzed for the development of nephrogenic systemic fibrosis (NSF), a reported complication of gadolinium in chronic kidney disease. The pre-MRI serum creatinine values ranged from 0.36 to 4.86 mg/dL, with 70 patients (20%) having values???1.5 mg/dL. A comparison of the pre- and post-MRI serum creatinine values did not demonstrate a clinically significant difference (mean change?=?0.017 mg/dL; P?=?0.38), including those patients with a pre-MRI serum creatinine???1.5 mg/dL. In addition, no cases of NSF were noted. In conclusion, our findings suggest that MRI with low-dose gadobenate dimeglumine (MultiHance) is a nonnephrotoxic imaging modality in liver transplant candidates, and its use can be cautiously expanded to liver transplant candidates with concomitant renal insufficiency. Liver Transpl 21:1340-1346, 2015. © 2015 AASLD. PMID:25786913

  1. Patient dose and image quality from mega-voltage cone beam computed tomography imaging

    SciTech Connect

    Gayou, Olivier; Parda, David S.; Johnson, Mark; Miften, Moyed

    2007-02-15

    The evolution of ever more conformal radiation delivery techniques makes the subject of accurate localization of increasing importance in radiotherapy. Several systems can be utilized including kilo-voltage and mega-voltage cone-beam computed tomography (MV-CBCT), CT on rail or helical tomography. One of the attractive aspects of mega-voltage cone-beam CT is that it uses the therapy beam along with an electronic portal imaging device to image the patient prior to the delivery of treatment. However, the use of a photon beam energy in the mega-voltage range for volumetric imaging degrades the image quality and increases the patient radiation dose. To optimize image quality and patient dose in MV-CBCT imaging procedures, a series of dose measurements in cylindrical and anthropomorphic phantoms using an ionization chamber, radiographic films, and thermoluminescent dosimeters was performed. Furthermore, the dependence of the contrast to noise ratio and spatial resolution of the image upon the dose delivered for a 20-cm-diam cylindrical phantom was evaluated. Depending on the anatomical site and patient thickness, we found that the minimum dose deposited in the irradiated volume was 5-9 cGy and the maximum dose was between 9 and 17 cGy for our clinical MV-CBCT imaging protocols. Results also demonstrated that for high contrast areas such as bony anatomy, low doses are sufficient for image registration and visualization of the three-dimensional boundaries between soft tissue and bony structures. However, as the difference in tissue density decreased, the dose required to identify soft tissue boundaries increased. Finally, the dose delivered by MV-CBCT was simulated using a treatment planning system (TPS), thereby allowing the incorporation of MV-CBCT dose in the treatment planning process. The TPS-calculated doses agreed well with measurements for a wide range of imaging protocols.

  2. Imaging of cardiovascular risk in patients with Turner's syndrome

    PubMed Central

    Marin, A.; Weir-McCall, J.R.; Webb, D.J.; van Beek, E.J.R.; Mirsadraee, S.

    2015-01-01

    Turner's syndrome is a disorder defined by an absent or structurally abnormal second X chromosome and affects around 1 in 2000 newborn females. The standardised mortality ratio in Turner's syndrome is around three-times higher than in the general female population, mainly as a result of cardiovascular disorders. Most striking is the early age at which Turner's syndrome patients develop the life-threatening complications of cardiovascular disorders compared to the general population. The cardiovascular risk stratification in Turner's syndrome is challenging and imaging is not systematically used. The aim of this article is to review cardiovascular risks in this group of patients and discuss a systematic imaging approach for early identification of cardiovascular disorders in these patients. PMID:25917542

  3. Indium-111 leukocyte imaging in patients with rheumatoid arthritis

    SciTech Connect

    Uno, K.; Matsui, N.; Nohira, K.; Suguro, T.; Kitakata, Y.; Uchiyama, G.; Miyoshi, T.; Uematsu, S.; Inoue, S.; Arimizu, N.

    1986-03-01

    This study evaluates the usefulness of labeled leukocyte imaging in patients with rheumatoid arthritis. In 33 patients, the incidence of pain and swelling in 66 wrist joints and 66 knee joints was compared with the accumulation of (/sup 111/In)leukocytes. No accumulation of (/sup 111/In)leukocytes was seen in any of the patients' wrists (0/12) or knee joints (0/14) when both pain and swelling were absent. In contrast, 93% (25/27) of wrist joints and 80% (24/30) of knee joints with both pain and swelling were positive by (/sup 111/In)leukocyte scintigraphy. There was little correlation between the stage of the disease, as determined by radiography, and (/sup 111/In)leukocyte accumulation. This study suggests that (/sup 111/In)leukocyte imaging may be a reliable procedure for monitoring the activity of rheumatoid arthritis, especially for confirming the lack of an ongoing inflammatory response.

  4. Body Image Disturbance in Acromegaly Patients Compared to Nonfunctioning Pituitary Adenoma Patients and Controls

    PubMed Central

    Conaglen, Helen M.; de Jong, Dennis; Crawford, Veronica; Elston, Marianne S.; Conaglen, John V.

    2015-01-01

    Purpose. Excess growth hormone secretion in adults results in acromegaly, a condition in which multiple physical changes occur including bony and soft tissue overgrowth. Over time these changes can markedly alter a person's appearance. The aim of this study was to compare body image disturbance in patients with acromegaly to those with nonfunctioning pituitary adenomas (NFAs) and controls and assess the impact of obesity in these groups. Methods. A cross-sectional survey including quality of life, body image disturbance, anxiety and depression measures, growth hormone, and BMI measurement was carried out. Results. The groups did not differ with respect to body image disturbance. However separate analysis of obese participants demonstrated relationships between mood scales, body image disturbance, and pain issues, particularly for acromegaly patients. Conclusions. While the primary hypothesis that acromegaly might be associated with body image disturbance was not borne out, we have shown that obesity together with acromegaly and NFA can be associated with body image issues, suggesting that BMI rather than primary diagnosis might better indicate whether patients might experience body image disturbance problems. PMID:26078758

  5. Patient-Centered Imaging: Shared Decision Making for Cardiac Imaging Procedures with Exposure to Ionizing Radiation

    PubMed Central

    Einstein, Andrew J.; Berman, Daniel S.; Min, James K.; Hendel, Robert C.; Gerber, Thomas C.; Carr, J. Jeffrey; Cerqueira, Manuel D.; Cullom, S. James; DeKemp, Robert; Dickert, Neal; Dorbala, Sharmila; Garcia, Ernest V.; Gibbons, Raymond J.; Halliburton, Sandra S.; Hausleiter, Jörg; Heller, Gary V.; Jerome, Scott; Lesser, John R.; Fazel, Reza; Raff, Gilbert L.; Tilkemeier, Peter; Williams, Kim A.; Shaw, Leslee J.

    2014-01-01

    Objective To identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Background An NIH-NHLBI/NCI-sponsored symposium was held in November 2012 to address these issues. Methods Symposium participants, working in three tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. Results Use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ?3mSv is considered very low risk, not warranting extensive discussion or written consent. However, a protocol effective dose <20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. Conclusions The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization. PMID:24530677

  6. QUANTITATIVE T2? IMAGING IN PATIENTS WITH CLINICALLY ISOLATED SYNDROME

    PubMed Central

    Reitz, Liza Yamila; Inglese, Matilde; Fiehler, Jens; Finsterbusch, Jürgen; Holst, Brigitte; Heesen, Christoph; Martin, Roland; Schippling, Sven

    2011-01-01

    Objective T2? imaging has been shown to be sensitive to oxygen saturation changes in normal appearing white and grey matter (NAWM, NAGM) in patients with relapsing-remitting multiple sclerosis (RRMS). We aimed to explore the presence and extent of T2? changes in patients with a clinically isolated syndrome (CIS) and a possible association of T2? with conventional MRI and clinical outcomes. Material & methods Quantitative T2- and T2*-weighted images were acquired in 32 treatment-naive patients with a CIS within 3 months of presentation and 15 age-matched healthy controls (HC). Quantitative T2? values were determined in six regions of interest (ROIs). Results T2? values in CIS did not differ significantly from those in HC. Among patients, T2? values correlated positively with the T2 lesion volume (T2LV, r=0.34, p<0.05). T2? values of the frontal NAWM correlated with the T2LV (r=0.35, p<0.05) and T2 lesion count (r=0.4, p=0.02). Conclusion As opposed to RRMS, patients with CIS did not show T2? alterations compared to HC. However, the association between the T2LV and higher T2? values suggests that T2? reflects disease evolution. In CIS metabolic changes might be masked by compensatory mechanisms and become overt when disease progresses as has been shown for RRMS patients. PMID:22211987

  7. Risk Factors Associated With Complication Rates of Becker-Type Expander Implants in Relation to Implant Survival: Review of 314 Implants in 237 Patients.

    PubMed

    Taboada-Suarez, Antonio; Brea-García, Beatriz; Magán-Muñoz, Fernando; Couto-González, Iván; González-Álvarez, Eduardo

    2015-12-01

    Although autologous tissue reconstruction is the best option for breast reconstruction, using implants is still a reliable and simple method, offering acceptable aesthetic results. Becker-type implants are permanent implants that offer a 1-stage reconstructive option.A retrospective study was carried out in our center reviewing the clinical reports of 237 patients, in whom a total of 314 Becker-type prostheses were implanted. Overall survival was calculated using a Kaplan-Meier estimate. Cox proportional hazard models were used to calculate adjusted hazard ratios.At the end of the study, 214 expanders (68.15%) presented no complications, 40 (12.47%) developed significant capsular contracture, in 27 (8.60%) infection occurred, 24 (7.64%) suffered minor complications, and 9 (2.87%) ruptured.The mean survival time of the expanders was 120.41 months (95% CI: 109.62, 131.19).Radiotherapy, chemotherapy, high Molecular Immunology Borstel, age, mastectomy performed previously to the implant, ductal carcinoma, advanced tumoral stage, experience of the surgeon, and Becker 35-type implants were significantly related to a high number of complications in relation to the survival of the implants.Cox regression analysis revealed that the main risk factors for the survival of expander implants included radiotherapy and surgeon experience. The complication hazard ratio or relative risk caused by these 2 factors was 1.976 and 1.680, respectively.One-stage reconstruction using Becker-type expanders is an appropriate, simple, and reliable option in delayed breast reconstruction in patients who have not received radiotherapy and as long as the procedure is carried out by surgeons skilled in the technique. PMID:25003425

  8. Stress Imaging May Be Overused in Medicare Patients With Stable Coronary Artery Disease

    MedlinePLUS

    ... January 2013 Events Newsroom Research Activities, October 2013 Stress imaging may be overused in Medicare patients with ... for long-term adverse events after coronary stenting Stress imaging may be overused in Medicare patients with ...

  9. Using a patient image archive to diagnose retinopathy

    SciTech Connect

    Tobin Jr, Kenneth William; Abramoff, M.D.; Chaum, Edward; Giancardo, Luca; Govindaswamy, Priya; Karnowski, Thomas Paul; Tennant, M; Swainson, Stephen

    2008-01-01

    Diabetes has become an epidemic that is expected to impact 365 million people worldwide by 2025. Consequently, diabetic retinopathy is the leading cause of blindness in the industrialized world today. If detected early, treatments can preserve vision and significantly reduce debilitating blindness. Through this research we are developing and testing a method for automating the diagnosis of retinopathy in a screening environment using a patient archive and digital fundus imagery. We present an overview of our content-based image retrieval (CBIR) approach and provide performance results for a dataset of 98 images from a study in Canada when compared to an archive of 1,355 patients from a study in the Netherlands. An aggregate performance of 89% correct diagnosis is achieved, demonstrating the potential of automated, web-based diagnosis for a broad range of imagery collected under different conditions and with different cameras.

  10. Hyperspectral imaging is an emerging technique in remote sensing data processing that expands and improves capability of multispectral image analysis. It takes advantage

    E-print Network

    Chang, Chein-I

    role than does noise in hyperspectral image analysis. More importantly, the detection techniques in hyperspectral image analysis, specifically, subpixel detection and mixed pixel classificationvii PREFACE Hyperspectral imaging is an emerging technique in remote sensing data processing

  11. Head and neck MR imaging in the pediatric patient

    SciTech Connect

    Dietrich, R.B.; Lufkin, R.B.; Kangarloo, H.; Hanafee, W.N.; Wilson, G.H.

    1986-06-01

    Magnetic resonance (MR) imaging studies of the head and neck (excluding the brain) were obtained in 49 children believed to have lesions of the head and neck. Seven children had normal images; in the remaining 42, lesions were divided into four categories: midline lesions, lesions of symmetric paired structures, facial lesions, and naso-pharyngeal and oropharyngeal lesions. All entities were well delineated by MR imaging. The imaging planes and sequences chosen depended on the suspected abnormality. Midline lesions were best imaged in the sagittal plane, lesions of paired structures and the face in the axial or coronal planes, and naso-pharyngeal and oropharyngeal lesions in the axial or sagittal planes. Intracranial extension of head and neck neoplasms was best evaluated in the coronal plane. Surface coils provided better resolution and were thus more useful in evaluating small superficial lesions; head or body coils were more useful in defining the extent of large lesions. T2-weighted images provided better differentiation between normal and tumor tissue in patients with head and neck neoplasms.

  12. Estimated Radiation Exposure from Medical Imaging in Hemodialysis Patients

    PubMed Central

    De Mauri, Andreana; Chiarinotti, Doriana; Matheoud, Roberta; Carriero, Alessandro; De Leo, Martino

    2011-01-01

    Radiation exposure accompanying medical imaging associates with cancer risk. Patients with recurrent or chronic diseases may be especially at risk, because they may undergo more of these procedures. The aim of this study was to assess the individual cumulative effective doses (CEDs), which quantify radiation from medical imaging procedures, in a cohort of 106 hemodialysis patients during a median follow-up of 3 years. We retrospectively calculated individual radiation exposures by collecting the number and type of radiologic procedures from hospital records. We also estimated organ doses for computed tomography procedures. The mean and median annual CEDs were 21.9 and 11.7 mSv per patient-year, respectively. The mean and median total CEDs per patient during the study period were 57.7 and 27.3 mSv, respectively. By radiation dose group, we classified 22 patients as low (<3 mSv/yr), 51 as moderate (3 to <20 mSv/yr), 22 as high (20 to <50 mSv/yr), and 11 as very high (?50 mSv/yr). Seventeen patients had a total CED >100 mSv, a value associated with a substantial increase in risk for cancer- mortality. Of the total CED,s 76% was a result of CT scanning. The annual CED significantly associated with age and transplant waitlist status. In summary, this study shows that a significant fraction of surviving hemodialysis patients during a 3-year period receives estimated radiation doses that may put them at an increased risk for cancer. PMID:21355057

  13. Evaluation of cutaneous body image dissatisfaction in the dermatology patient.

    PubMed

    Gupta, Madhulika A; Gupta, Aditya K

    2013-01-01

    Cutaneous body image (CBI), defined as the individual's mental representation of his or her skin, hair, and nails, is an important clinical factor in dermatologic disorders and often the primary consideration in deciding whether to proceed with cosmetic procedures or institute treatment in some skin disorders such as acne. CBI is a highly subjective construct that can be significantly confounded by cultural, psychosocial, and psychiatric factors. Assessment of CBI in the dermatology patient is best accomplished using a biopsychosocial model that involves (1) evaluation of concerns about the appearance of the skin, hair, and nails, (2) assessment of comorbid body image pathologies, especially body dysmorphic disorder, and (3) assessment of other psychiatric comorbidities such as major depressive disorder that can confound the presentation of the CBI complaint. Depending on the psychiatric comobidities, an assessment of suicide risk may have to be done, and if necessary, a referral made to a mental health professional. The clinician should consider the patient's developmental stage (eg, body image concerns are likely to be much greater in the adolescent patient independent of his or her dermatologic disorder) and sociocultural background (eg, a desire for lighter skin in some ethnic groups), factors that can also have a major effect on CBI. PMID:23245977

  14. Imaging of cardiovascular complications in patients with systemic lupus erythematosus.

    PubMed

    Lin, K; Lloyd-Jones, D M; Li, D; Liu, Y; Yang, J; Markl, M; Carr, J C

    2015-10-01

    In the long-term survival of patients with systemic lupus erythematosus (SLE), cardiovascular disease (CVD) is a leading cause of death. Recently, multimodality cardiovascular imaging methods have been adopted for the evaluation of cardiovascular risk, which has shown to be associated with both traditional cardiovascular risk factors and SLE-specific conditions. Quantitative imaging biomarkers, which can describe both morphological and functional abnormalities in the heart, are expected to provide new insights to stratify cardiovascular risks and to guide SLE management by assessing individual responses to therapies either protecting the cardiovascular system or suppressing the autoimmune reactions. In this review, we will discuss cutting-edge cardiovascular imaging techniques and potential clinical applications and limitations of those techniques for the evaluation of major SLE-related heart disorders. PMID:26038342

  15. SUMMER 2013 CENTER EXPANDS

    E-print Network

    Bushman, Frederic

    a fellowship in move- ment disorders. She is currently completing a fellowship in Sleep Medicine. P arkinson rigorously studied in PD patients with RLS. Other primary motor sleep disorders often seen in PD includeSUMMER 2013 PENN SLEEP CENTER EXPANDS INPATIENT CONSULT SERVICE 10th ANNUAL CSCN RESEARCH RETREAT

  16. Clinical significance of expanded Foxp3+ Helios- regulatory T cells in patients with non-small cell lung cancer.

    PubMed

    Muto, Satoshi; Owada, Yuki; Inoue, Takuya; Watanabe, Yuzuru; Yamaura, Takumi; Fukuhara, Mitsuro; Okabe, Naoyuki; Matsumura, Yuki; Hasegawa, Takeo; Osugi, Jun; Hoshino, Mika; Higuchi, Mitsunori; Suzuki, Hiroyuki; Gotoh, Mitsukazu

    2015-12-01

    The functions of different regulatory T cell (Treg) types in cancer progression are unclear. Recently, expression of the transcription factor Helios was proposed as a marker for natural (non-induced) Tregs. The present study investigated the clinical significance of Helios expression in patients with non-small cell lung cancer (NSCLC). We enrolled 64 patients with NSCLC, of whom 45 were treated surgically and 19 received chemotherapy because of advanced/recurrent disease. Their peripheral blood mononuclear cells were examined by flow cytometry. From the 45 surgery patients, we matched 9 patients with recurrent disease with 9 stage-matched patients without recurrence (n=18), compared their specimens immunohistochemically for tumor infiltrating lymphocytes (TILs) and analyzed these data against clinicopathological factors. Helios expression in Foxp3+ Tregs was 47.5±13.3% in peripheral blood and 18.1±13.4% in tumor specimens. Percentage of Helios- Tregs among CD4+ T cells were significantly higher in the cancer patients (2.4%), especially those with stage IA disease (2.6%) than in healthy donors (1.5%; P<0.001). Patients with low levels of Helios expression in Tregs among their TILs had significantly poorer survival (P=0.038). Helios- Tregs may affect immune suppression, even in early stage NSCLC; they could also be a useful prognostic biomarker in patients with NSCLC, and possibly a novel cancer immunotherapy target. PMID:26460798

  17. Clinical significance of expanded Foxp3+ Helios? regulatory T cells in patients with non-small cell lung cancer

    PubMed Central

    MUTO, SATOSHI; OWADA, YUKI; INOUE, TAKUYA; WATANABE, YUZURU; YAMAURA, TAKUMI; FUKUHARA, MITSURO; OKABE, NAOYUKI; MATSUMURA, YUKI; HASEGAWA, TAKEO; OSUGI, JUN; HOSHINO, MIKA; HIGUCHI, MITSUNORI; SUZUKI, HIROYUKI; GOTOH, MITSUKAZU

    2015-01-01

    The functions of different regulatory T cell (Treg) types in cancer progression are unclear. Recently, expression of the transcription factor Helios was proposed as a marker for natural (non-induced) Tregs. The present study investigated the clinical significance of Helios expression in patients with non-small cell lung cancer (NSCLC). We enrolled 64 patients with NSCLC, of whom 45 were treated surgically and 19 received chemotherapy because of advanced/recurrent disease. Their peripheral blood mononuclear cells were examined by flow cytometry. From the 45 surgery patients, we matched 9 patients with recurrent disease with 9 stage-matched patients without recurrence (n=18), compared their specimens immunohistochemically for tumor infiltrating lymphocytes (TILs) and analyzed these data against clinicopathological factors. Helios expression in Foxp3+ Tregs was 47.5±13.3% in peripheral blood and 18.1±13.4% in tumor specimens. Percentage of Helios? Tregs among CD4+ T cells were significantly higher in the cancer patients (2.4%), especially those with stage IA disease (2.6%) than in healthy donors (1.5%; P<0.001). Patients with low levels of Helios expression in Tregs among their TILs had significantly poorer survival (P=0.038). Helios? Tregs may affect immune suppression, even in early stage NSCLC; they could also be a useful prognostic biomarker in patients with NSCLC, and possibly a novel cancer immunotherapy target. PMID:26460798

  18. Magnetic resonance imaging for patients with cardiac implantable electrical devices

    PubMed Central

    Chow, Grant V.; Nazarian, Saman

    2014-01-01

    Magnetic resonance imaging (MRI) has become an invaluable tool in the evaluation of both soft tissue and bony abnormalities, with an increasing number of studies ordered per year. The presence of a cardiac implantable electrical device (CIED) may complicate matters, however, as these devices are currently considered a relative contraindication to MRI scanning. When performed in patients with a CIED, risks of MRI include reed switch activation in older devices, lead heating, system malfunction, and significant radiofrequency noise resulting in inappropriate inhibition of demand pacing, tachycardia therapies, or programming changes. This report reviews the common indications and risk-benefit evaluation of MRI in patients with CIED, and provides a clinical algorithm which has been successfully implemented at our institution for performing MRI in patients with implanted devices. PMID:24793805

  19. Stem cell treatment for patients with autoimmune disease by systemic infusion of culture-expanded autologous adipose tissue derived mesenchymal stem cells

    PubMed Central

    2011-01-01

    Prolonged life expectancy, life style and environmental changes have caused a changing disease pattern in developed countries towards an increase of degenerative and autoimmune diseases. Stem cells have become a promising tool for their treatment by promoting tissue repair and protection from immune-attack associated damage. Patient-derived autologous stem cells present a safe option for this treatment since these will not induce immune rejection and thus multiple treatments are possible without any risk for allogenic sensitization, which may arise from allogenic stem cell transplantations. Here we report the outcome of treatments with culture expanded human adipose-derived mesenchymal stem cells (hAdMSCs) of 10 patients with autoimmune associated tissue damage and exhausted therapeutic options, including autoimmune hearing loss, multiple sclerosis, polymyotitis, atopic dermatitis and rheumatoid arthritis. For treatment, we developed a standardized culture-expansion protocol for hAdMSCs from minimal amounts of fat tissue, providing sufficient number of cells for repetitive injections. High expansion efficiencies were routinely achieved from autoimmune patients and from elderly donors without measurable loss in safety profile, genetic stability, vitality and differentiation potency, migration and homing characteristics. Although the conclusions that can be drawn from the compassionate use treatments in terms of therapeutic efficacy are only preliminary, the data provide convincing evidence for safety and therapeutic properties of systemically administered AdMSC in human patients with no other treatment options. The authors believe that ex-vivo-expanded autologous AdMSCs provide a promising alternative for treating autoimmune diseases. Further clinical studies are needed that take into account the results obtained from case studies as those presented here. PMID:22017805

  20. Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion

    PubMed Central

    Beyer, Sebastian E.; Hunink, Myriam G.; Schöberl, Florian; von Baumgarten, Louisa; Petersen, Steffen E.; Dichgans, Martin; Janssen, Hendrik; Ertl-Wagner, Birgit; Reiser, Maximilian F.

    2015-01-01

    Background and Purpose— This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. Methods— A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits, with a willingness-to-pay threshold of $80 000 per QALY. The strategy with the highest net monetary benefit was considered the most cost-effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values. Results— In the reference case analysis, CTA dominated all other imaging strategies. CTA yielded 0.02 QALYs more than magnetic resonance imaging and 0.04 QALYs more than duplex ultrasound followed by CTA. At a willingness-to-pay threshold of $80 000 per QALY, CTA yielded the highest net monetary benefits. The probability that CTA is cost-effective was 96% at a willingness-to-pay threshold of $80 000/QALY. Sensitivity analyses showed that duplex ultrasound was cost-effective only for a prior probability of ?0.02 and that these results were only minimally influenced by duplex ultrasound sensitivity and specificity. Nonenhanced CT and magnetic resonance imaging never became the most cost-effective strategy. Conclusions— Our results suggest that CTA in patients with possible basilar artery occlusion is cost-effective. PMID:26022634

  1. Ultrasound imaging of the nose in septorhinoplasty patients.

    PubMed

    Stenner, Markus; Rudack, Claudia

    2015-10-01

    Detailed preoperative planning based on available clinical information is an essential component of determining septorhinoplasty outcome. In addition to rhinoscopy and airway measurements, preoperative photographs are the only image modalities that are regularly used in septorhinoplasty patients and contribute to the preoperative planning of the surgery. The aim of this study was to evaluate the use of high-resolution ultrasonography in septorhinoplasty patients before surgery and during follow-up. We examined 35 patients before and after open septorhinoplasty using 12- and 15-MHz B-mode, linear array transducer ultrasound in noncontact mode. The patients presented with a variety of different functional and aesthetic problems, and all underwent septorhinoplasty for septal modification, and tip and dorsum refinement. The mean follow-up time for ultrasound after surgery was 4.5 weeks. Soft tissue, cartilaginous, and bony structures of the nose could be well-visualised. In the untreated nose, functional and aesthetic characteristics as well as preoperative anatomy relevant for the planning of the surgery could be documented. Surgical modifications of the treated nose postoperatively, that is, osteotomies, inserted spreader grafts, diced cartilage in fascia, and tip sutures could be visualized and followed. Ultrasonography of the nose with a high-frequency transducer may be a helpful tool during preoperative planning and postoperative follow-up in septorhinoplasty patients and might be a reasonable completion to the common photographic and functional diagnostic. PMID:25362558

  2. Deep Brain Stimulation: Expanding Applications.

    PubMed

    Tekriwal, Anand; Baltuch, Gordon

    2015-12-15

    For over two decades, deep brain stimulation (DBS) has shown significant efficacy in treatment for refractory cases of dyskinesia, specifically in cases of Parkinson's disease and dystonia. DBS offers potential alleviation from symptoms through a well-tolerated procedure that allows personalized modulation of targeted neuroanatomical regions and related circuitries. For clinicians contending with how to provide patients with meaningful alleviation from often debilitating intractable disorders, DBSs titratability and reversibility make it an attractive treatment option for indications ranging from traumatic brain injury to progressive epileptic supra-synchrony. The expansion of our collective knowledge of pathologic brain circuitries, as well as advances in imaging capabilities, electrophysiology techniques, and material sciences have contributed to the expanding application of DBS. This review will examine the potential efficacy of DBS for neurologic and psychiatric disorders currently under clinical investigation and will summarize findings from recent animal models. PMID:26466888

  3. FDG PET/CT imaging in canine cancer patients.

    PubMed

    Hansen, Anders E; McEvoy, Fintan; Engelholm, Svend A; Law, Ian; Kristensen, Annemarie T

    2011-01-01

    2-Deoxy-2-[¹?F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) is becoming increasingly available as an imaging modality in veterinary medicine. The purpose of this study was to report semiquantitative standard uptake values (SUV) of malignant and nonmalignant tissues and organs in canine cancer patients. FDG PET/CT was performed in 14 dogs including, nine mesenchymal tumors, four carcinomas, and one incompletely excised mast cell tumor. A generally higher FDG uptake was observed in carcinomas relative to sarcomas. Maximum SUV of carcinomas ranged from 7.6 to 27.0, and for sarcomas from 2.0 to 10.6. The FDG SUV of several organs and tissues, including regional brain uptake is reported, to serve as a reference for future FDG PET studies in canine cancer patients. Several potential pitfalls have been recognized in interpretation of FDG PET images of human patients, a number of these were also observed in this study. PMID:21388475

  4. Patient Specific Tumor Growth Prediction Using Multimodal Images

    PubMed Central

    Liu, Yixun; Sadowski, Samira M.; Weisbrod, Allison B.; Kebebew, Electron; Summers, Ronald M.; Yao, Jianhua

    2014-01-01

    Personalized tumor growth model is valuable in tumor staging and therapy planning. In this paper, we present a patient specific tumor growth model based on longitudinal multimodal imaging data including dual-phase CT and FDG-PET. The proposed Reaction-Advection-Diffusion model is capable of integrating cancerous cell proliferation, infiltration, metabolic rate and extracellular matrix biomechanical response. To bridge the model with multimodal imaging data, we introduce intracellular volume fraction (ICVF) measured from dual-phase CT and Standardized Uptake Value (SUV) measured from FDG-PET into the model. The patient specific model parameters are estimated by fitting the model to the observation, which leads to an inverse problem formalized as a coupled Partial Differential Equations (PDE)-constrained optimization problem. The optimality system is derived and solved by the Finite Difference Method. The model was evaluated by comparing the predicted tumors with the observed tumors in terms of average surface distance (ASD), root mean square difference (RMSD) of the ICVF map, average ICVF difference (AICVFD) of tumor surface and tumor relative volume difference (RVD) on six patients with pathologically confirmed pancreatic neuroendocrine tumors. The ASD between the predicted tumor and the reference tumor was 2.4±0.5 mm, the RMSD was 4.3±0.4%, the AICVFD was 2.6±0.6%, and the RVD was 7.7±1.3%. PMID:24607911

  5. Expanding the Parameters for Excellence in Patient Assignments: Is Leveraging an Evidence-Data-Based Acuity Methodology Realistic?

    PubMed

    Gray, Joel; Kerfoot, Karlene

    2016-01-01

    Finding the balance of equitable assignments continues to be a challenge for health care organizations seeking to leverage evidence-based leadership practices. Ratios and subjective acuity strategies for nurse-patient staffing continue to be the dominant approach in health care organizations. In addition to ratio-based assignments and acuity-based assignment models driven by financial targets, more emphasis on using evidence-based leadership strategies to manage and create science for effective staffing is needed. In particular, nurse leaders are challenged to increase the sophistication of management of patient turnover (admissions, discharges, and transfers) and integrate tools from Lean methodologies and quality management strategies to determine the effectiveness of nurse-patient staffing. PMID:26636229

  6. GPC3 mutation analysis in a spectrum of patients with overgrowth expands the phenotype of Simpson-Golabi-Behmel syndrome.

    PubMed

    Li, M; Shuman, C; Fei, Y L; Cutiongco, E; Bender, H A; Stevens, C; Wilkins-Haug, L; Day-Salvatore, D; Yong, S L; Geraghty, M T; Squire, J; Weksberg, R

    2001-08-01

    Simpson-Golabi-Behmel syndrome (SGBS) is an X-linked overgrowth syndrome caused by deletions in glypican 3 (GPC3). SGBS is characterized by pre- and postnatal overgrowth, a characteristic facial appearance, and a spectrum of congenital malformations which overlaps that of other overgrowth syndromes. We performed GPC3 deletion screening on 80 male patients with somatic overgrowth in the following categories: SGBS (n = 19), possible SGBS (n = 26), including families in which individuals had previously been diagnosed with other overgrowth syndromes, and Wiedemann-Beckwith syndrome (WBS) (n = 35). Using exon-specific PCR and Southern blot analysis, we identified seven GPC3 deletions. In most cases a clear X-linked family history was not present. In two cases, GPC3 deletions were identified in patients belonging to pedigrees published previously as other overgrowth syndromes: one with a diagnosis of Sotos syndrome and the other Perlman syndrome with nephroblastomatosis. A third patient developed hepatoblastoma, a tumor type not previously described in SGBS. No GPC3 deletions were identified among the WBS patients. Direct sequencing of all GPC3 exons in the remaining 13 SGBS patients without GPC3 deletions did not identify any further mutations, raising the possibility of alternative silencing mechanisms and/or other genes in the pathogenesis of SGBS. Our results validate the clinical specificity of the facial appearance, skeletal/hand anomalies, and supernumerary nipples in patients with GPC3 deletions. Our data also suggest that nephroblastomatosis and hepatoblastoma are included in the phenotypic spectrum of GPC3 deletions and SGBS, underscoring the importance of tumor surveillance in these children. PMID:11477610

  7. Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea.

    PubMed

    Kim, Sujin; Kwon, Soonman

    2015-08-01

    To increase financial protection for catastrophic illness, South Korean government expanded the National Health Insurance (NHI) benefit coverage for cancer patients in September 2005. This paper investigated whether the policy has reduced inequality in catastrophic payments, defined as annual out-of-pocket (OOP) health payments exceeding 10% annual income, across different income groups. This study used the NHI claims data from 2002 to 2004 and 2006 to 2010. Triple difference estimator was employed to compare cancer patients as a treatment group with those with liver and cardio-cerebrovascular diseases as control groups and the low-income with the high-income groups. While catastrophic payments decreased in cancer patients compared with those of two diseases, they appeared to decrease more in the high-income than the low-income group. Considering that increased health care utilization and poor economic capacity may lead to a smaller reduction in catastrophic payments for the low-income than the high-income patients, the government needs to consider additional policy measures to increase financial protection for the poor. PMID:26123883

  8. Expanding versus non expanding universe

    E-print Network

    Antonio Alfonso-Faus

    2012-07-03

    In cosmology the number of scientists using the framework of an expanding universe is very high. This model, the big-bang, is now overwhelmingly present in almost all aspects of society. It is the main stream cosmology of today. A small number of scientists are researching on the possibility of a non-expanding universe. The existence of these two groups, one very large and the other very small, is a good proof of the use of the scientific method: it does not drive to an absolute certainty. All models have to be permanently validated, falsified. Ockham's razor, a powerful philosophical tool, will probably change the amount of scientists working in each of these groups. We present here a model where a big-bang is unnecessary. It ends, in a finite time, in a second INFLATION, or a disaggregation to infinity. We also discuss the possibilities of a non-expanding universe model. Only a few references will be cited, mainly concerned with our own work in the past, thus purposely avoiding citing the many thousands of professionals working in this field.

  9. Visual search performance of patients with vision impairment: effect of JPEG image enhancement

    E-print Network

    Peli, Eli

    Visual search performance of patients with vision impairment: effect of JPEG image enhancement Gang & Peli E. Visual search performance of patients with vision impairment: effect of JPEG image enhancement the performance effect for a JPEG based image enhancement technique using the visual search task. Methods: One

  10. Instability of the expanded (CTG){sub n} repeats in the myotonin protein kinase gene in cultured lymphoblastoid cell lines from patients with myotonic dystrophy

    SciTech Connect

    Ashizawa, Tetsuo; Patel, B.J.; Monckton, D.G.

    1996-08-15

    The mutation associated with myotonic dystrophy (DM) is the expansion of an unstable trinucleotide repeat, (CTG){sub n}, in the 3{prime}-untranslated region of the myotonin protein kinase gene. Although expanded repeats show both germline and somatic instability, the mechanisms of the instability are poorly understood. To establish a model system in which somatic instability of the DM repeat could be studied in more detail, we established lymphoblastoid cell lines (LBCL) from DM patients. Analysis of the DNA from DM LBCL using Southern blotting showed that the (CTG). repeats were apparently stable up to 29 passages in culture. To study infrequent repeat size mutations that are undetectable due to the size heterogeneity, we established LBCL of single-cell origins by cloning using multiple steps of limiting dilution. After expansion to approximately 10{sup 6} cells (equivalent to approximately 20 cell cycles), the DNAs of these cell lines were analyzed by the small pool PCR technique using primers flanking the (CTG), repeat region. Two types of mutations of the expanded (CTG){sub n} repeat alleles were detected: (1) frequent mutations that show small changes of the (CTG){sub n} repeat size, resulting in alleles in a normal distribution around the progenitor allele, and (2) relatively rare mutations with large changes of the (CTG){sub n} repeat size, with a bias toward contraction. The former may represent the mechanism responsible for the so matic heterogeneity of the (CTG), repeat size observe in blood cells of DM patients. This in vitro experimental system will be useful for further studies on mechanisms involved in the regulation of the somatic stability of the (CTG). repeats in DM. 24 refs., 4 figs.

  11. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees.

    PubMed

    Liew, Yaoren; Beveridge, Erin; Demetriades, Andreas K; Hughes, Mark A

    2015-10-01

    We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees. PMID:25822093

  12. Multislice CT scans in patients on extracorporeal membrane oxygenation: emphasis on hemodynamic changes and imaging pitfalls.

    PubMed

    Liu, Kao-Lang; Wang, Yu-Feng; Chang, Yeun-Chung; Huang, Shu-Chien; Chen, Shyh-Jye; Tsang, Yuk-Ming; Chang, Chin-Chen

    2014-01-01

    This pictorial review provides the principles of extracorporeal membrane oxygenation (ECMO) support and associated CT imaging features with emphasis on the hemodynamic changes and possible imaging pitfalls encountered. It is important that radiologists in ECMO centers apply well-designed imaging protocols and familiarize themselves with post-contrast CT imaging findings in patients on ECMO. PMID:24843236

  13. A Case of Aorto-Bronchial Fistula After Insertion of Left Main Bronchial Self-Expanding Metallic Stent in a Patient with Recurrent Esophageal Cancer

    SciTech Connect

    Onishi, Hiroshi Kuriyama, Kengo; Komiyama, Takafumi; Tanaka, Shiho; Marino, Kan; Tsukamoto, Tatsuaki; Araki, Tsutomu

    2004-09-15

    We report a case of aorto-bronchial fistula (ABF) caused by a self-expanding metallic stent (EMS) 51 days after insertion into the left main bronchus. The patient presented with left main bronchial stenosis caused by post-operative local recurrence of esophageal cancer. Post-operative radio therapy totaling 40 Gy and post-recurrence radiotherapy totaling 34 Gy were administered, with daily fractions of 2 Gy. Stenosis of the left main bronchus improved slightly, and was followed with insertion of EMS to prevent re-stenosis. The patient experienced massive hemoptysis for 3 days before sudden death. Autopsy revealed the EMS edge perforating the descending aortic lumen. Tumor infiltration and bacterial infection were observed on the wall of the left bronchus, and atherosclerosis was present on the aortic wall around the fistula. It should be noted that the left main bronchus was at considerable risk of ABF after insertion of EMS for malignant stenosis, and prophylactic stent insertion into the bronchus without imperative need must be avoided.

  14. Efficacy of technetium Tc 99m pyrophosphate imaging in patients with equivocal myocardial infarction

    SciTech Connect

    Powers, T.A.; Tyler, J.L.; Kulkarni, M.V.

    1983-03-01

    We studied the efficacy of technetium Tc 99m pyrophosphate imaging in patients with equivocal evidence of acute myocardial infarction. Only patients with positive enzyme findings (regardless of ECG findings) had scans with greater than or equal to 2+ focal uptake. None of 26 patients with negative or equivocal enzyme findings (regardless of ECG findings) had greater than 2+ diffuse uptake. These results support the contention that infarct-avid imaging has little clinical utility in patients with equivocal evidence of myocardial infarction.

  15. Prospective Evaluation of Dual-Energy Imaging in Patients Undergoing Image Guided Radiation Therapy for Lung Cancer: Initial Clinical Results

    SciTech Connect

    Sherertz, Tracy; Hoggarth, Mark; Luce, Jason; Block, Alec M.; Nagda, Suneel; Harkenrider, Matthew M.; Emami, Bahman; Roeske, John C.

    2014-07-01

    Purpose: A prospective feasibility study was conducted to investigate the utility of dual-energy (DE) imaging compared to conventional x-ray imaging for patients undergoing kV-based image guided radiation therapy (IGRT) for lung cancer. Methods and Materials: An institutional review board-approved feasibility study enrolled patients with lung cancer undergoing IGRT and was initiated in September 2011. During daily setup, 2 sequential respiration-gated x-ray images were obtained using an on-board imager. Imaging was composed of 1 standard x-ray image at 120 kVp (1 mAs) and a second image obtained at 60 kVp (4 mAs). Weighted logarithmic subtraction of the 2 images was performed offline to create a soft tissue-selective DE image. Conventional and DE images were evaluated by measuring relative contrast and contrast-to-noise ratios (CNR) and also by comparing spatial localization, using both approaches. Imaging dose was assessed using a calibrated ion chamber. Results: To date, 10 patients with stage IA to IIIA lung cancer were enrolled and 57 DE images were analyzed. DE subtraction resulted in complete suppression of overlying bone in all 57 DE images, with an average improvement in relative contrast of 4.7 ± 3.3 over that of 120 kVp x-ray images (P<.0002). The improvement in relative contrast with DE imaging was seen for both smaller (gross tumor volume [GTV] ?5 cc) and larger tumors (GTV >5 cc), with average relative contrast improvement ratios of 3.4 ± 4.1 and 5.4 ± 3.6, respectively. Moreover, the GTV was reliably localized in 95% of the DE images versus 74% of the single energy (SE images, (P=.004). Mean skin dose per DE image set was 0.44 ± 0.03 mGy versus 0.43 ± 0.03 mGy, using conventional kV imaging parameters. Conclusions: Initial results of this feasibility study suggest that DE thoracic imaging may enhance tumor localization in lung cancer patients receiving kV-based IGRT without increasing imaging dose.

  16. Managing Body Image Difficulties of Adult Cancer Patients: Lessons from Available Research

    PubMed Central

    Fingeret, Michelle Cororve; Teo, Irene; Epner, Daniel E.

    2013-01-01

    Background Body image is a critical psychosocial issue for cancer patients as they often undergo significant changes to appearance and functioning. In this review article, our primary purpose was to identify empirically-supported approaches to treat body image difficulties of adult cancer patients that can be incorporated into high-quality comprehensive cancer care. Methods We provided an overview of theoretical models of body image relevant to cancer patients, and presented findings from published literature on body image and cancer from 2003–2013. We integrated these data with information from the patient-doctor communication literature to delineate a practical approach for assessing and treating body image concerns of adult cancer patients. Results Body image difficulties were found across patients with diverse cancer sites, and were most prevalent in the immediate postoperative and treatment period. Age, body mass index, and specific cancer treatments have been identified as potential risk factors for body image disturbance in cancer patients. Current evidence supports the use of time-limited cognitive-behavioral therapy interventions for addressing these difficulties. Other intervention strategies also show promise but require further study. We identified potential indicators of body image difficulties to alert healthcare professionals when to refer patients for psychosocial care, and proposed a framework for approaching conversations about body image that can be used by the oncologic treatment team. Conclusions Body image issues affect a wide array of cancer patients. Providers can use available evidence combined with information from the healthcare communication literature to develop practical strategies for treating body image concerns of cancer patients. PMID:24895287

  17. Protecting patient privacy against unauthorized release of medical images in a group communication environment

    E-print Network

    Poovendran, Radha

    ' medical records, efforts have been devoted to guaranteeing the confidentiality of data and medical images an important issue in the management of patients' medical records. As part of Health Insurance PortabilityProtecting patient privacy against unauthorized release of medical images in a group communication

  18. Quantification of radiographic image quality based on patient anatomical contrast-to-noise ratio: a preliminary study with chest images

    NASA Astrophysics Data System (ADS)

    Lin, Yuan; Wang, Xiaohui; Sehnert, William J.; Foos, David H.; Barski, Lori; Samei, Ehsan

    2010-02-01

    The quality of a digital radiograph for diagnostic imaging depends on many factors, such as the capture system DQE and MTF, the exposure technique factors, the patient anatomy, and the particular image processing method and processing parameters used. Therefore, the overall image quality as perceived by the radiologists depends on many factors. This work explores objective image quality metrics directly from display-ready patient images. A preliminary study was conducted based on a multi-frequency analysis of anatomy contrast and noise magnitude from 250 computed radiography (CR) chest radiographs (150 PA, 50 AP captured with anti-scatter grids, and 50 AP without grids). The contrast and noise values were evaluated in different sub-bands separately according to their frequency properties. Contrast-Noise ratio (CNR) was calculated, the results correlated well with the human observers' overall impression on the images captured with and without grids.

  19. Turkish hysterectomy and mastectomy patients - depression, body image, sexual problems and spouse relationships.

    PubMed

    Keskin, Gulseren; Gumus, Aysun Babacan

    2011-01-01

    The aim of this study was to compare hysterectomy and mastectomy patients in terms of depression, body image, sexual problems and spouse relations. The study group comprised 94 patients being treated in Ege University Radiation Oncology Clinic, Tulay Aktas Oncology Hospital, Izmir Aegean Obstetrics and Gynecology Training and Research Hospital for breast and gynecological cancer (42 patients underwent mastectomy, 52 patient underwent hysterectomy). Five scales were used in the study: Sociodemographic Data Form, Beck Depression Scale, Body Image Scale, Dyadic Adjustment Scale, Golombok Rust Sexual Functions Scale. Mastectomy patients were more depressive than hysterectomy patients (t = 2.78, p < 0.01). Body image levels of the patients were bad but there was no significant difference between the two patient groups (p > 0.05). Hysterectomy patients had more problems in terms of vaginismus (t = 2.32, p < 0.05), avoidance of sexual intercourse (t = 2.31, p < 0.05), communication (t = 2.06, p < 0.05), and frequency of sexual intercourse than mastectomy patients (t = 2.10, p < 0.05). As compared with compliance levels between patients and spouses; hysterectomy patients had more problems related to expression of emotions than mastectomy patients (t = 2.12, p < 0.05). In conclusion, body image was negative, mastectomy was associated with more depression and hysterectomy with greater sexual problems and difficulties with spouse relationships. PMID:21545207

  20. Patient positioning method based on binary image correlation between two edge images for proton-beam radiation therapy

    SciTech Connect

    Sawada, Akira; Yoda, Kiyoshi; Numano, Masumi; Futami, Yasuyuki; Yamashita, Haruo; Murayama, Shigeyuki; Tsugami, Hironobu

    2005-10-15

    A new technique based on normalized binary image correlation between two edge images has been proposed for positioning proton-beam radiotherapy patients. A Canny edge detector was used to extract two edge images from a reference x-ray image and a test x-ray image of a patient before positioning. While translating and rotating the edged test image, the absolute value of the normalized binary image correlation between the two edge images is iteratively maximized. Each time before rotation, dilation is applied to the edged test image to avoid a steep reduction of the image correlation. To evaluate robustness of the proposed method, a simulation has been carried out using 240 simulated edged head front-view images extracted from a reference image by varying parameters of the Canny algorithm with a given range of rotation angles and translation amounts in x and y directions. It was shown that resulting registration errors have an accuracy of one pixel in x and y directions and zero degrees in rotation, even when the number of edge pixels significantly differs between the edged reference image and the edged simulation image. Subsequently, positioning experiments using several sets of head, lung, and hip data have been performed. We have observed that the differences of translation and rotation between manual positioning and the proposed method were within one pixel in translation and one degree in rotation. From the results of the validation study, it can be concluded that a significant reduction in workload for the physicians and technicians can be achieved with this method.

  1. Automated movement correction for dynamic PET/CT images: evaluation with phantom and patient data.

    PubMed

    Ye, Hu; Wong, Koon-Pong; Wardak, Mirwais; Dahlbom, Magnus; Kepe, Vladimir; Barrio, Jorge R; Nelson, Linda D; Small, Gary W; Huang, Sung-Cheng

    2014-01-01

    Head movement during a dynamic brain PET/CT imaging results in mismatch between CT and dynamic PET images. It can cause artifacts in CT-based attenuation corrected PET images, thus affecting both the qualitative and quantitative aspects of the dynamic PET images and the derived parametric images. In this study, we developed an automated retrospective image-based movement correction (MC) procedure. The MC method first registered the CT image to each dynamic PET frames, then re-reconstructed the PET frames with CT-based attenuation correction, and finally re-aligned all the PET frames to the same position. We evaluated the MC method's performance on the Hoffman phantom and dynamic FDDNP and FDG PET/CT images of patients with neurodegenerative disease or with poor compliance. Dynamic FDDNP PET/CT images (65 min) were obtained from 12 patients and dynamic FDG PET/CT images (60 min) were obtained from 6 patients. Logan analysis with cerebellum as the reference region was used to generate regional distribution volume ratio (DVR) for FDDNP scan before and after MC. For FDG studies, the image derived input function was used to generate parametric image of FDG uptake constant (Ki) before and after MC. Phantom study showed high accuracy of registration between PET and CT and improved PET images after MC. In patient study, head movement was observed in all subjects, especially in late PET frames with an average displacement of 6.92 mm. The z-direction translation (average maximum = 5.32 mm) and x-axis rotation (average maximum = 5.19 degrees) occurred most frequently. Image artifacts were significantly diminished after MC. There were significant differences (P<0.05) in the FDDNP DVR and FDG Ki values in the parietal and temporal regions after MC. In conclusion, MC applied to dynamic brain FDDNP and FDG PET/CT scans could improve the qualitative and quantitative aspects of images of both tracers. PMID:25111700

  2. Automated Movement Correction for Dynamic PET/CT Images: Evaluation with Phantom and Patient Data

    PubMed Central

    Ye, Hu; Wong, Koon-Pong; Wardak, Mirwais; Dahlbom, Magnus; Kepe, Vladimir; Barrio, Jorge R.; Nelson, Linda D.; Small, Gary W.; Huang, Sung-Cheng

    2014-01-01

    Head movement during a dynamic brain PET/CT imaging results in mismatch between CT and dynamic PET images. It can cause artifacts in CT-based attenuation corrected PET images, thus affecting both the qualitative and quantitative aspects of the dynamic PET images and the derived parametric images. In this study, we developed an automated retrospective image-based movement correction (MC) procedure. The MC method first registered the CT image to each dynamic PET frames, then re-reconstructed the PET frames with CT-based attenuation correction, and finally re-aligned all the PET frames to the same position. We evaluated the MC method's performance on the Hoffman phantom and dynamic FDDNP and FDG PET/CT images of patients with neurodegenerative disease or with poor compliance. Dynamic FDDNP PET/CT images (65 min) were obtained from 12 patients and dynamic FDG PET/CT images (60 min) were obtained from 6 patients. Logan analysis with cerebellum as the reference region was used to generate regional distribution volume ratio (DVR) for FDDNP scan before and after MC. For FDG studies, the image derived input function was used to generate parametric image of FDG uptake constant (Ki) before and after MC. Phantom study showed high accuracy of registration between PET and CT and improved PET images after MC. In patient study, head movement was observed in all subjects, especially in late PET frames with an average displacement of 6.92 mm. The z-direction translation (average maximum?=?5.32 mm) and x-axis rotation (average maximum?=?5.19 degrees) occurred most frequently. Image artifacts were significantly diminished after MC. There were significant differences (P<0.05) in the FDDNP DVR and FDG Ki values in the parietal and temporal regions after MC. In conclusion, MC applied to dynamic brain FDDNP and FDG PET/CT scans could improve the qualitative and quantitative aspects of images of both tracers. PMID:25111700

  3. The Expanding Nebular Remnant of the Recurrent Nova RS Ophiuchi (2006). II. Modeling of Combined Hubble Space Telescope Imaging and Ground-based Spectroscopy

    NASA Astrophysics Data System (ADS)

    Ribeiro, V. A. R. M.; Bode, M. F.; Darnley, M. J.; Harman, D. J.; Newsam, A. M.; O'Brien, T. J.; Bohigas, J.; Echevarría, J. M.; Bond, H. E.; Chavushyan, V. H.; Costero, R.; Coziol, R.; Evans, A.; Eyres, S. P. S.; León-Tavares, J.; Richer, M. G.; Tovmassian, G.; Starrfield, S.; Zharikov, S. V.

    2009-10-01

    We report Hubble Space Telescope (HST) imaging, obtained 155 and 449 days after the 2006 outburst of the recurrent nova RS Ophiuchi, together with ground-based spectroscopic observations, obtained from the Observatorio Astronómico Nacional en San Pedro Mártir, Baja California, México and at the Observatorio Astrofísico Guillermo Haro, at Cananea, Sonora, México. The observations at the first epoch were used as inputs to model the geometry and kinematic structure of the evolving RS Oph nebular remnant. We find that the modeled remnant comprises two distinct co-aligned bipolar components; a low-velocity, high-density innermost (hour glass) region and a more extended, high-velocity (dumbbell) structure. This overall structure is in agreement with that deduced from radio observations and optical interferometry at earlier epochs. We find that the asymmetry observed in the west lobe is an instrumental effect caused by the profile of the HST filter and hence demonstrate that this lobe is approaching the observer. We then conclude that the system has an inclination to the line of sight of 39+1°-10. This is in agreement with the inclination of the binary orbit and lends support to the proposal that this morphology is due to the interaction of the outburst ejecta with either an accretion disk around the central white dwarf and/or a pre-existing red giant wind that is significantly denser in the equatorial regions of the binary than at the poles. The second epoch HST observation was also modeled. However, as no spectra were taken at this epoch, it is more difficult to constrain any model. Nevertheless, we demonstrate that between the two HST epochs the outer dumbbell structure seems to have expanded linearly. For the central (hour glass) region, there may be evidence of deceleration, but it is harder to draw firm conclusions in this case.

  4. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    SciTech Connect

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-09-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina.

  5. Echinocandins: The Expanding Antifungal Armamentarium.

    PubMed

    Aguilar-Zapata, Daniel; Petraitiene, Ruta; Petraitis, Vidmantas

    2015-12-01

    The echinocandins are large lipopeptide molecules that, since their discovery approximately 41 years ago, have emerged as important additions to the expanding armamentarium against invasive fungal diseases. Echinocandins exert in vitro and in vivo fungicidal action against most Candida species and fungistatic action against Aspergillus species. However, the population of patients at risk for developing invasive fungal infections continues to increase. New therapeutic strategies using echinocandins are needed to improve clinical outcomes in patients with invasive fungal disease. PMID:26567277

  6. Self-image and perception of mother and father in psychotic and borderline patients.

    PubMed

    Armelius, K; Granberg

    2000-02-01

    Psychotic and borderline patients rated their self-image and their perception of their mother and father using the Structural Analysis of Social Behavior model (SASB). The borderline patients had more negative images of themselves and their parents, especially their fathers, than did the psychotic patients and the normal subjects, while the psychotic patients' ratings did not differ much from those of the normal subjects. The self-image was related to the images of both parents for borderline patients and normal subjects, while for the psychotic patients only the image of the mother was important for the self-image. In addition, the psychotic patients did not differentiate between the poles of control and autonomy in the introjected self-image. It was concluded that borderline patients are characterized by negative attachment, while psychotic patients are characterized by poor separation from the mother and poor differentiation between autonomy and control. The paper also discusses how this may influence the patients' relations to others. Psychotische und Borderline Patienten beurteilten ihr Selbstbild und ihre Wahrnehmung von Mutter und Vater mit Hilfe der strukturalen Analyse sozialen Verhaltens (SASB). Die Borderline Patienten hattten negativere Selbstbilder und Elternbilder (speziell Vaterbilder) als die psychotischen Patienten und gesunde Personen. Die Beurteilungen der psychotischen Patienten unterschieden sich dagegen nicht besonders von jenen Gesunder. Das Selbstbild stand in Beziehung zu beiden Elternbildern bei den Borderline Patienten und den Gesunden, während bei den psychotischen Patienten nur das Mutterbild für das Selbstbild bedeutsam war. Außerdem konnte bei den psychotischen Patienten nicht zwischen den Polen der Kontrolle und Autonomie bzgl. der introjizierten Selbstbilder differenziert werden. Aus den Ergebnissen wird gefolgert, dass Borderline Patienten durch eine negative Bindung charackterisiert sind, psychotische Patienten dagegen durch eine mangelnde Separation von ihren Müttern und eine geringe Differenzierung zwischen Autonomie und Kontrolle. Es wird außerdem diskutiert, wie die Ergebnisse auf die realen Beziehungen der Patienten zu anderen Menschen Einflus nehmen könnten. Des patients psychotiques et Borderline ont évalué leur image d'eux-mêmes et leur perception de leur mère et père à l'aide du modèle de l'Analyse Structural du Comportement Social (SASB. Les patients Borderline avaient des imagess plus négatives d'eux-mêmes et de leurs parents, surtout de leur père, que les patients psychotiques et les sujets normaux, alors que les patients psychotiques se jugeaient à peine différemment des sujets normaux. L'image de soi était en relation avec les images des deux parents pour les patients Borderline et pour les sujets normaux, alors que pour les patients psychotiques, seulement l'image de la mère jouait un rôle pour leur image. En plus, les patients psychotiques ne différenciaient pas entre les pôles de contrôle et d'autonomie dans l'image de soi introjectée. Nous en avons conclu que les patients Borderline se caractérisent par un attachement négatif, et les patients psychotiques par une faible séparation de la mère ainsi qu'une différenciation modeste entre autonomie et contrôle. L'influence de ceci sur les relations des patients avec les autrs est discutée dans cet article. Pacientes limítrofes y psicóticos evaluaron su autoimagen y la percepción que tenían de sus padres usando el modelo de Análisis estructural del comportamiento social (SASB). Los pacientes limítrofes registraron imágenes más negativas de sí mismos y de sus progenitores, especialmente de su padre, que los pacientes psicóticos y los normales, mientras que las evaluaciones de los pacientes psicóticos no difirieron mucho de las de los sujetos normales. La autoimagen tuvo relación con la imagen de ambos progenitores tanto en el caso de los pacientes limítrofes como de los sujetos normales, mientras que para los pacientes psicóticos no diferenciaron entre control y autonomía en la a

  7. Brain Imaging Predicts Psychotherapy Success in Patients with Social Anxiety Disorder

    MedlinePLUS

    ... and his colleagues, used functional magnetic resonance imaging (fMRI) in 39 SAD patients before a 12-week ... angry versus neutral faces and scenes while undergoing fMRI examination (see first slide). Compared to neutral faces, ...

  8. Solitary fibrous tumors in the extremities: imaging findings for six patients.

    PubMed

    Hyodo, Ryota; Komada, Tomohiro; Takada, Akira; Kawai, Hisashi; Ito, Shinji; Nishida, Yoshihiro; Naganawa, Shinji

    2015-02-01

    The purpose of this study was to describe the magnetic resonance imaging (MRI) and computed tomography (CT) findings for solitary fibrous tumors (SFTs) in the extremities in correlation with histopathological findings. Between 2006 and 2013, 6 consecutive patients with SFT in an extremity were studied with MRI (6 patients) and CT (4 patients). Diffusion-weighted images were also performed in 3 patients and dynamic contrast-enhanced CT in 2 patients. All 6 tumors were diagnosed after surgical excision, and the pre-surgical imaging findings were correlated with the histopathological findings. As a result, all 6 patients were female, and each had a clearly palpable, well-circumscribed, round or oval mass adjacent to fascia in an extremity, of less than 10 cm maximum diameter in 5 patients. On MRI, the tumors were iso-intense with muscle on T1-weighted image, and appeared heterogeneous and high-intensity on T2-weighted image. After injection of a contrast agent, the tumors demonstrated strong enhancement. A vascular pedicle was detected in 4 patients with tumors having a maximum diameter more than 5 cm. Diffusion-weighted images demonstrated high signal intensities, and apparent diffusion coefficient values were iso to high compared to muscle (from 1.41-2.10×10(-3) mm(2)/s). All the tumors were benign histopathologically and clinically. In 1 patient, the imaging appearance revealed underlying histopathological components, including fibrous-rich, cellular-rich, and myxoid change areas. In conclusion, a SFT in an extremity comprises a well-circumscribed mass adjacent to fascia having a fibrous-dominant area, strong contrast enhancement, and a vascular pedicle. PMID:25797981

  9. Registration of electronic portal images for patient set-up verification

    NASA Astrophysics Data System (ADS)

    Matsopoulos, George K.; Asvestas, Pantelis A.; Delibasis, Konstantinos K.; Kouloulias, Vassilios; Uzunoglu, Nikolaos; Karaiskos, Pantelis; Sandilos, Panagiotis

    2004-07-01

    Images acquired from an electronic portal imaging device are aligned with digitally reconstructed radiographs (DRRs) or other portal images to verify patient positioning during radiation therapy. Most of the currently available computer aided registration methods are based on the manual placement of corresponding landmarks. The purpose of the paper is twofold: (a) the establishment of a methodology for patient set-up verification during radiotherapy based on the registration of electronic portal images, and (b) the evaluation of the proposed methodology in a clinical environment. The estimation of set-up errors, using the proposed methodology, can be accomplished by matching the portal image of the current fraction of the treatment with the portal image of the baseline treatment (reference portal image) using a nearly automated technique. The proposed registration method is tested on a number of phantom data as well as on data from four patients. The phantom data included portal images that corresponded to various positions of the phantom on the treatment couch. For each patient, a set of 30 portal images was used. For the phantom data (for both transverse and lateral portal images), the maximum absolute deviations of the translational shifts were within 1.5 mm, whereas the in-plane rotation angle error was less than 0.5°. The two-way Anova revealed no statistical significant variability both within observer and between-observer measurements (P > 0.05). For the patient data, the mean values obtained with manual and the proposed registration methods were within 0.5 mm. In conclusion, the proposed registration method has been incorporated within a system, called ESTERR-PRO. Its image registration capability achieves high accuracy and both intra- and inter-user reproducibility. The system is fully operational within the Radiotherapy Department of 'HYGEIA' Hospital in Athens and it could be easily installed in any other clinical environment since it requires standardized hardware specifications and minimal human intervention.

  10. 3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

    NASA Astrophysics Data System (ADS)

    Dhou, S.; Hurwitz, M.; Mishra, P.; Cai, W.; Rottmann, J.; Li, R.; Williams, C.; Wagar, M.; Berbeco, R.; Ionascu, D.; Lewis, J. H.

    2015-05-01

    3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we developed and performed initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and used these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparison to ground truth digital and physical phantom images. The performance of 4DCBCT-based and 4DCT-based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5?mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2?mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4?mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery.

  11. Occupational and patient exposure as well as image quality for full spine examinations with the EOS imaging system

    SciTech Connect

    Damet, J. Fournier, P.; Monnin, P.; Sans-Merce, M.; Verdun, F. R.; Baechler, S.; Ceroni, D.; Zand, T.

    2014-06-15

    Purpose: EOS (EOS imaging S.A, Paris, France) is an x-ray imaging system that uses slot-scanning technology in order to optimize the trade-off between image quality and dose. The goal of this study was to characterize the EOS system in terms of occupational exposure, organ doses to patients as well as image quality for full spine examinations. Methods: Occupational exposure was determined by measuring the ambient dose equivalents in the radiological room during a standard full spine examination. The patient dosimetry was performed using anthropomorphic phantoms representing an adolescent and a five-year-old child. The organ doses were measured with thermoluminescent detectors and then used to calculate effective doses. Patient exposure with EOS was then compared to dose levels reported for conventional radiological systems. Image quality was assessed in terms of spatial resolution and different noise contributions to evaluate the detector's performances of the system. The spatial-frequency signal transfer efficiency of the imaging system was quantified by the detective quantum efficiency (DQE). Results: The use of a protective apron when the medical staff or parents have to stand near to the cubicle in the radiological room is recommended. The estimated effective dose to patients undergoing a full spine examination with the EOS system was 290?Sv for an adult and 200 ?Sv for a child. MTF and NPS are nonisotropic, with higher values in the scanning direction; they are in addition energy-dependent, but scanning speed independent. The system was shown to be quantum-limited, with a maximum DQE of 13%. The relevance of the DQE for slot-scanning system has been addressed. Conclusions: As a summary, the estimated effective dose was 290?Sv for an adult; the image quality remains comparable to conventional systems.

  12. Imaging.

    PubMed

    Wilkinson, R

    1986-12-01

    Imaging of the musculoskeletal system includes many modalities and is an area that is changing rapidly. Selection of the most accurate techniques and avoidance of duplication are vital to both good patient care and cost containment. PMID:3466135

  13. Method and system for the diagnosis of disease using retinal image content and an archive of diagnosed human patient data

    SciTech Connect

    Tobin, Kenneth W; Karnowski, Thomas P; Chaum, Edward

    2013-08-06

    A method for diagnosing diseases having retinal manifestations including retinal pathologies includes the steps of providing a CBIR system including an archive of stored digital retinal photography images and diagnosed patient data corresponding to the retinal photography images, the stored images each indexed in a CBIR database using a plurality of feature vectors, the feature vectors corresponding to distinct descriptive characteristics of the stored images. A query image of the retina of a patient is obtained. Using image processing, regions or structures in the query image are identified. The regions or structures are then described using the plurality of feature vectors. At least one relevant stored image from the archive based on similarity to the regions or structures is retrieved, and an eye disease or a disease having retinal manifestations in the patient is diagnosed based on the diagnosed patient data associated with the relevant stored image(s).

  14. Imaging of pannus formation in patients with mechanical heart valves

    PubMed Central

    Gündüz, Sabahattin; Özkan, Mehmet; Yesin, Mahmut

    2015-01-01

    Patient-prosthesis mismatch (PPM) should be recognized in patients with elevated transprosthetic gradients but without leaflet immobility, since the treatment strategy may differ in either etiology. However, thrombus and/or pannus formation should be excluded before a diagnosis of PPM is made. Particularly, pannus formation may not be diagnosed with 2-dimensional transesophageal echocardiography. Electrocardiographically gated 64-section multidetector computed tomography (MDCT) may be a promising tool in diagnosing or excluding pannus formation. Our report underlines the utility of MDCT in this regard and also emphasizes the importance of recognition of PPM as a differential diagnosis in such patients. PMID:26635931

  15. Imaging acute complications in cancer patients: what should be evaluated in the emergency setting?

    PubMed Central

    2014-01-01

    Increased incidence world-wide of cancer and increased survival has also resulted in physicians seeing more complications in patients with cancer. In many cases, complications are the first manifestations of the disease. They may be insidious and develop over a period of months, or acute and manifest within minutes to days. Imaging examinations play an essential role in evaluating cancer and its complications. Plain radiography and ultrasonography (US) are generally performed initially in an urgent situation due to their wide availability, low cost, and minimal or no radiation exposure. However, depending on a patient’s symptoms, evaluation with cross-sectional imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI) is often necessary. In this review article, we discuss some of the most important acute noninfectious oncological complications for which imaging methods play an essential role in diagnosis. PMID:25609051

  16. Developing image-based electronic patient records for collaborative medical applications

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Sun, Jianyong; Yong, Yuanyuan; Chen, Xiaomeng; Yu, Fenghai; Zhang, Xiaoyan; Lian, Ping; Sun, Kun; Huang, H. K.

    2004-04-01

    We developed a Web-based system to interactively display image-based electronic patient records (EPR) for intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), Image-based EPR repository server (EPR-Server), Web Server and EPR DICOM viewer (EPR-Viewer). We have successfully used this system two times for the teleconsultation on Severe acute respiratory syndrome (SARS) in Shanghai Xinhua Hospital and Shanghai Infection Hospital. During the consultation, both the physicians in infection control area and the experts outside the control area could interactively study, manipulate and navigate the EPR of the SARS patients to make more precise diagnosis on images with this system assisting. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications.

  17. Overuse of imaging the male breast-findings in 557 patients.

    PubMed

    Lapid, Oren; Siebenga, Pieter; Zonderland, Harmien M

    2015-01-01

    Gynecomastia is the most common abnormality of the male breast. However, breast cancer may occur, albeit with a significantly lower incidence than in females. Imaging is often used as part of the diagnosis. The aim of this study was to assess the utilization and outcome of imaging with mammography or ultrasound of the male breast in a university hospital's department of radiology. A retrospective study assessing the imaging of the male breast in 557 patients over a 10-year period. Referral was done mainly by general surgeons and general practitioners. The most common indication was enlargement of the breast, described as gynecomastia or swelling in 74% of patients, followed by pain in 24% and "lumps" in 10%. The modalities used were mammography in 65%, ultrasound in 51% and both in 26%. Most examinations, 519, were BI-RADS 1 or 2, and 38 were BI-RADS 3 or higher. Altogether 160 patients had additional fine-needle aspiration or biopsy. Malignancies were diagnosed in five patients (0.89%). Imaging had a sensitivity of 80% and a specificity of 99%. The positive predictive value was 44% and the negative predictive value 99.8%. Malignancies are rare in the male breast. The probability of finding cancer when performing imaging of clinically benign findings in the male breast is negligible. Imaging is not warranted unless there are suspicious abnormalities. Routine imaging of gynecomastia should be discouraged. PMID:25772378

  18. Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art

    PubMed Central

    Guimaraes, Marcos Duarte; Hochhegger, Bruno; Santos, Marcel Koenigkam; Santana, Pablo Rydz Pinheiro; Sousa, Arthur Soares; Souza, Luciana Soares; Marchiori, Edson

    2015-01-01

    Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer patients with thoracic lesions, including involvement of the chest wall, pleura, lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis, staging, surgical planning, treatment response evaluation and follow-up of these patients. In the present review, the authors contextualize the relevance of MRI in the evaluation of thoracic lesions in cancer patients. Considering that MRI is a widely available method with high contrast and spatial resolution and without the risks associated with the use of ionizing radiation, its use combined with new techniques such as cine-MRI and functional methods such as perfusion- and diffusion-weighted imaging may be useful as an alternative tool with performance comparable or complementary to conventional radiological methods such as radiography, computed tomography and PET/CT imaging in the evaluation of patients with thoracic neoplasias. PMID:25798006

  19. Applying a patient-specific bio-mathematical model of glioma growth to develop virtual [18F]-FMISO-PET images.

    PubMed

    Gu, Stanley; Chakraborty, Gargi; Champley, Kyle; Alessio, Adam M; Claridge, Jonathan; Rockne, Russell; Muzi, Mark; Krohn, Kenneth A; Spence, Alexander M; Alvord, Ellsworth C; Anderson, Alexander R A; Kinahan, Paul E; Swanson, Kristin R

    2012-03-01

    Glioblastoma multiforme (GBM) is a class of primary brain tumours characterized by their ability to rapidly proliferate and diffusely infiltrate surrounding brain tissue. The aggressive growth of GBM leads to the development of regions of low oxygenation (hypoxia), which can be clinically assessed through [18F]-fluoromisonidazole (FMISO) positron emission tomography (PET) imaging. Building upon the success of our previous mathematical modelling efforts, we have expanded our model to include the tumour microenvironment, specifically incorporating hypoxia, necrosis and angiogenesis. A pharmacokinetic model for the FMISO-PET tracer is applied at each spatial location throughout the brain and an analytical simulator for the image acquisition and reconstruction methods is applied to the resultant tracer activity map. The combination of our anatomical model with one for FMISO tracer dynamics and PET image reconstruction is able to produce a patient-specific virtual PET image that reproduces the image characteristics of the clinical PET scan as well as shows no statistical difference in the distribution of hypoxia within the tumour. This work establishes proof of principle for a link between anatomical (magnetic resonance image [MRI]) and molecular (PET) imaging on a patient-specific basis as well as address otherwise untenable questions in molecular imaging, such as determining the effect on tracer activity from cellular density. Although further investigation is necessary to establish the predicitve value of this technique, this unique tool provides a better dynamic understanding of the biological connection between anatomical changes seen on MRI and biochemical activity seen on PET of GBM in vivo. PMID:21562060

  20. Anthrax Vaccine Approval Expanded

    MedlinePLUS

    ... nih.gov/medlineplus/news/fullstory_155893.html Anthrax Vaccine Approval Expanded Now sanctioned for adults 18 to ... and Drug Administration approval for the BioThrax anthrax vaccine has been expanded to include adults aged 18 ...

  1. Multimode C-arm fluoroscopy, tomosynthesis, and cone-beam CT for image-guided interventions: from proof of principle to patient protocols

    NASA Astrophysics Data System (ADS)

    Siewerdsen, J. H.; Daly, M. J.; Bachar, G.; Moseley, D. J.; Bootsma, G.; Brock, K. K.; Ansell, S.; Wilson, G. A.; Chhabra, S.; Jaffray, D. A.; Irish, J. C.

    2007-03-01

    High-performance intraoperative imaging is essential to an ever-expanding scope of therapeutic procedures ranging from tumor surgery to interventional radiology. The need for precise visualization of bony and soft-tissue structures with minimal obstruction to the therapy setup presents challenges and opportunities in the development of novel imaging technologies specifically for image-guided procedures. Over the past ~5 years, a mobile C-arm has been modified in collaboration with Siemens Medical Solutions for 3D imaging. Based upon a Siemens PowerMobil, the device includes: a flat-panel detector (Varian PaxScan 4030CB); a motorized orbit; a system for geometric calibration; integration with real-time tracking and navigation (NDI Polaris); and a computer control system for multi-mode fluoroscopy, tomosynthesis, and cone-beam CT. Investigation of 3D imaging performance (noise-equivalent quanta), image quality (human observer studies), and image artifacts (scatter, truncation, and cone-beam artifacts) has driven the development of imaging techniques appropriate to a host of image-guided interventions. Multi-mode functionality presents a valuable spectrum of acquisition techniques: i.) fluoroscopy for real-time 2D guidance; ii.) limited-angle tomosynthesis for fast 3D imaging (e.g., ~10 sec acquisition of coronal slices containing the surgical target); and iii.) fully 3D cone-beam CT (e.g., ~30-60 sec acquisition providing bony and soft-tissue visualization across the field of view). Phantom and cadaver studies clearly indicate the potential for improved surgical performance - up to a factor of 2 increase in challenging surgical target excisions. The C-arm system is currently being deployed in patient protocols ranging from brachytherapy to chest, breast, spine, and head and neck surgery.

  2. Imaging-Based Management of Acute Ischemic Stroke Patients: Current Neuroradiological Perspectives

    PubMed Central

    Na, Dong Gyu; Sohn, Chul-Ho

    2015-01-01

    Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation. PMID:25741200

  3. Clinical review: Lung imaging in acute respiratory distress syndrome patients - an update

    PubMed Central

    2013-01-01

    Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective. PMID:24238477

  4. Patient-centered Radiology.

    PubMed

    Itri, Jason N

    2015-10-01

    Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients' needs and preferences. In this model, providers respect patients' values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as "doctor-to-doctor" consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients' needs and preferences. Expanding radiology's core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction. (©)RSNA, 2015. PMID:26466190

  5. Magnetic resonance imaging in patients with a subcutaneous implantable cardioverter-defibrillator

    PubMed Central

    Keller, Ji?í; Neužil, Petr; Vymazal, Josef; Janotka, Marek; Brada, Ji?í; Žá?ek, Radovan; Vopálka, Roman; Weichet, Ji?í; Reddy, Vivek Y.

    2015-01-01

    Aims Our aim was to evaluate the potential for safely imaging patients with a new type of implantable cardioverter-defibrillator called the subcutaneous implantable cardioverter-defibrillator (S-ICD) in a 1.5 T magnetic resonance imaging (MRI) scanner. With the increasing number of patients with cardiac implantable devices who are indicated for MRI, there is a growing need for establishing MRI compatibility of cardiac implantable devices. Methods and Results Patients with implanted S-ICD systems underwent one or more types of anatomical MRI scans. The S-ICD was programmed off and patients were monitored throughout the imaging procedure. Device function was evaluated pre- and post-scan. Patients were asked to report immediately any pain, torqueing movement, or heating sensation in the area of the pocket or electrode. Fifteen patients underwent a total of 22 examinations at 1.5 T. Scans included brain, spine, knee, and heart. Two patients were re-scanned due to complaints of heating over the can during lumbar scans, which was caused by a thermistor probe placed on the skin to measure skin temperature. All the remaining scans occurred without incident. No evidence of device malfunction was observed. Conclusion This study is the first to domonstrate the feasibility of exposing S-ICD patients to MRI using the scanning and monitoring protocol described. More data are required to support S-ICD as a MRI conditional device. PMID:25687749

  6. A patient image-based technique to assess the image quality of clinical chest radiographs

    NASA Astrophysics Data System (ADS)

    Lin, Yuan; Samei, Ehsan; Luo, Hui; Dobbins, James T., III; McAdams, H. Page; Wang, Xiaohui; Sehnert, William J.; Barski, Lori; Foos, David H.

    2011-03-01

    Current clinical image quality assessment techniques mainly analyze image quality for the imaging system in terms of factors such as the capture system DQE and MTF, the exposure technique, and the particular image processing method and processing parameters. However, when assessing a clinical image, radiologists seldom refer to these factors, but rather examine several specific regions of the image to see whether the image is suitable for diagnosis. In this work, we developed a new strategy to learn and simulate radiologists' evaluation process on actual clinical chest images. Based on this strategy, a preliminary study was conducted on 254 digital chest radiographs (38 AP without grids, 35 AP with 6:1 ratio grids and 151 PA with 10:1 ratio grids). First, ten regional based perceptual qualities were summarized through an observer study. Each quality was characterized in terms of a physical quantity measured from the image, and as a first step, the three physical quantities in lung region were then implemented algorithmically. A pilot observer study was performed to verify the correlation between image perceptual qualities and physical quantitative qualities. The results demonstrated that our regional based metrics have promising performance for grading perceptual properties of chest radiographs.

  7. Dose reduction and image quality optimizations in CT of pediatric and adult patients: phantom studies

    NASA Astrophysics Data System (ADS)

    Jeon, P.-H.; Lee, C.-L.; Kim, D.-H.; Lee, Y.-J.; Jeon, S.-S.; Kim, H.-J.

    2014-03-01

    Multi-detector computed tomography (MDCT) can be used to easily and rapidly perform numerous acquisitions, possibly leading to a marked increase in the radiation dose to individual patients. Technical options dedicated to automatically adjusting the acquisition parameters according to the patient's size are of specific interest in pediatric radiology. A constant tube potential reduction can be achieved for adults and children, while maintaining a constant detector energy fluence. To evaluate radiation dose, the weighted CT dose index (CTDIw) was calculated based on the CT dose index (CTDI) measured using an ion chamber, and image noise and image contrast were measured from a scanned image to evaluate image quality. The dose-weighted contrast-to-noise ratio (CNRD) was calculated from the radiation dose, image noise, and image contrast measured from a scanned image. The noise derivative (ND) is a quality index for dose efficiency. X-ray spectra with tube voltages ranging from 80 to 140 kVp were used to compute the average photon energy. Image contrast and the corresponding contrast-to-noise ratio (CNR) were determined for lesions of soft tissue, muscle, bone, and iodine relative to a uniform water background, as the iodine contrast increases at lower energy (i.e., k-edge of iodine is 33 keV closer to the beam energy) using mixed water-iodine contrast normalization (water 0, iodine 25, 100, 200, and 1000 HU, respectively). The proposed values correspond to high quality images and can be reduced if only high-contrast organs are assessed. The potential benefit of lowering the tube voltage is an improved CNRD, resulting in a lower radiation dose and optimization of image quality. Adjusting the tube potential in abdominal CT would be useful in current pediatric radiography, where the choice of X-ray techniques generally takes into account the size of the patient as well as the need to balance the conflicting requirements of diagnostic image quality and radiation dose optimization.

  8. Initial Clinical Experience Performing Patient Treatment Verification With an Electronic Portal Imaging Device Transit Dosimeter

    SciTech Connect

    Berry, Sean L.; Polvorosa, Cynthia; Cheng, Simon; Deutsch, Israel; Chao, K. S. Clifford; Wuu, Cheng-Shie

    2014-01-01

    Purpose: To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry. Methods and Materials: Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm ? criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm ? criterion. Results: There were 288 transit images analyzed. The overall ? pass rate was 89.1% ± 9.8% (average ± 1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the ? pass rate was 95.7% ± 2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment. Conclusions: The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.

  9. Benign liver tumors in pediatric patients - Review with emphasis on imaging features

    PubMed Central

    Chiorean, Liliana; Cui, Xin-Wu; Tannapfel, Andrea; Franke, Doris; Stenzel, Martin; Kosiak, Wojciech; Schreiber-Dietrich, Dagmar; Jüngert, Jörg; Chang, Jian-Min; Dietrich, Christoph F

    2015-01-01

    Benign hepatic tumors are commonly observed in adults, but rarely reported in children. The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking. Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors. In pediatric patients, most benign focal liver lesions are inborn and may grow like the rest of the body. Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis. Selection of the appropriate imaging test is challenging, since it depends on a number of age-related factors. This paper will discuss the most frequently encountered benign liver tumors in children (infantile hepatic hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and hepatocellular adenoma), as well as a comparison to the current knowledge regarding such tumors in adult patients. The current emphasis is on imaging features, which are helpful not only for the initial diagnosis, but also for pre- and post-treatment evaluation and follow-up. In addition, future perspectives of contrast-enhanced ultrasound (CEUS) in pediatric patients are highlighted, with descriptions of enhancement patterns for each lesion being discussed. The role of advanced imaging tests such as CEUS and magnetic resonance imaging, which allow for non-invasive assessment of liver tumors, is of utmost importance in pediatric patients, especially when repeated imaging tests are needed and radiation exposure should be avoided. PMID:26229397

  10. IMAGE-GUIDED EVALUATION AND MONITORING OF TREATMENT RESPONSE IN PATIENTS WITH DRY EYE DISEASE

    PubMed Central

    Hamrah, Pedram

    2014-01-01

    Dry eye disease (DED) is one of the most common ocular disorders worldwide. The pathophysiological mechanisms involved in the development of DED are not well understood and thus treating DED has been a significant challenge for ophthalmologists. Most of the currently available diagnostic tests demonstrate low correlation to patient symptoms and have low reproducibility. Recently, sophisticated in vivo imaging modalities have become available for patient care, namely, in vivo confocal microscopy (IVCM) and optical coherence tomography (OCT). These emerging modalities are powerful and non-invasive, allowing real-time visualization of cellular and anatomical structures of the cornea and ocular surface. Here we discuss how, by providing both qualitative and quantitative assessment, these techniques can be used to demonstrate early subclinical disease, grade layer-by-layer severity, and allow monitoring of disease severity by cellular alterations. Imaging-guided stratification of patients may also be possible in conjunction with clinical examination methods. Visualization of subclinical changes and stratification of patients in vivo, allows objective image-guided evaluation of tailored treatment response based on cellular morphological alterations specific to each patient. This image-guided approach to DED may ultimately improve patient outcomes and allow studying the efficacy of novel therapies in clinical trials. PMID:24696045

  11. Longitudinal evaluation of patients with oral potentially malignant disorders using optical imaging and spectroscopy

    NASA Astrophysics Data System (ADS)

    Schwarz, Richard A.; Pierce, Mark C.; Mondrik, Sharon; Gao, Wen; Quinn, Mary K.; Bhattar, Vijayashree; Williams, Michelle D.; Vigneswaran, Nadarajah; Gillenwater, Ann M.; Richards-Kortum, Rebecca

    2012-02-01

    Dysplastic and cancerous alterations in oral tissue can be detected noninvasively in vivo using optical techniques including autofluorescence imaging, high-resolution imaging, and spectroscopy. Interim results are presented from a longitudinal study in which optical imaging and spectroscopy were used to evaluate the progression of lesions over time in patients at high risk for development of oral cancer. Over 100 patients with oral potentially malignant disorders have been enrolled in the study to date. Areas of concern in the oral cavity are measured using widefield autofluorescence imaging and depth-sensitive optical spectroscopy during successive clinical visits. Autofluorescence intensity patterns and autofluorescence spectra are tracked over time and correlated with clinical observations. Patients whose lesions progress and who undergo surgery are also measured in the operating room immediately prior to surgery using autofluorescence imaging and spectroscopy, with the addition of intraoperative high-resolution imaging to characterize nuclear size, nuclear crowding, and tissue architecture at selected sites. Optical measurements are compared to histopathology results from biopsies and surgical specimens collected from the measured sites. Autofluorescence imaging and spectroscopy measurements are continued during post-surgery followup visits. We examined correlations between clinical impression and optical classification over time with an average followup period of 4 months. The data collected to date suggest that multimodal optical techniques may aid in noninvasive monitoring of the progression of oral premalignant lesions, biopsy site selection, and accurate delineation of lesion extent during surgery.

  12. Imaging of Microglia in Patients with Neurodegenerative Disorders

    PubMed Central

    Politis, Marios; Su, Paul; Piccini, Paola

    2012-01-01

    Microglia constitute the main immune defense in the central nervous system. In response to neuronal injury, microglia become activated, acquire phagocytic properties, and release a wide range of pro-inflammatory mediators that are essential for the annihilation of the neuronal insult. Although the role of microglial activation in acute neuronal damage is well defined, the pathophysiological processes underlying destructive or protective role to neurons following chronic exposure to microglial activation is still a subject of debate. It is likely that chronic exposure induces detrimental effects by promoting neuronal death through the release of neurotoxic factors. Positron emission tomography (PET) imaging with the use of translocator protein (TSPO) radioligands provides an in vivo tool for tracking the progression and severity of neuroinflammation in neurodegenerative disease. TSPO expression is correlated to the extent of microglial activation and the measurement of TSPO uptake in vivo with PET is a useful indicator of active disease. Although understanding of the interaction between radioligands and TSPO is not completely clear, there is a wide interest in application of TSPO imaging in neurodegenerative disease. In this article, we aim to review the applications of in vivo microglia imaging in neurodegenerative disorders such as Parkinson’s disease, Huntington’s disease, Dementias, and Multiple Sclerosis. PMID:22661951

  13. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas

    SciTech Connect

    Pollock, Bruce E. . E-mail: pollock.bruce@mayo.edu; Stafford, Scott L.

    2005-08-01

    Introduction: The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. Methods: Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). Results: No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. Conclusions: Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit.

  14. Development of a Fast and Highly Efficient Gas Ionization Chamber For Patient Imaging and Dosimetry in Radiation Therapy

    E-print Network

    Hinderler, R; Keller, H; Mackie, T R

    2003-01-01

    In radiation therapy of cancer, more accurate delivery techniques spur the need for improved patient imaging during treatment. To this purpose, the megavoltage radiation protocol that is used for treatment is also used for imaging.

  15. Development of Fast and Highly Efficient Gas Ionization Chamber For Patient Imaging and Dosimetry in Radiation Therapy

    SciTech Connect

    R. Hinderler; H. Keller; T.R. Mackie; M.L. Corradini

    2003-09-08

    In radiation therapy of cancer, more accurate delivery techniques spur the need for improved patient imaging during treatment. To this purpose, the megavoltage radiation protocol that is used for treatment is also used for imaging.

  16. Clinical assessment and magnetic resonance imaging of the shoulder of patients with spinal cord injury

    PubMed Central

    Alves, Alex Pereira; Terrabuio Junior, Alberto Antonio; Pimenta, Ciro Jabur; Medina, Giovanna Ignácio Subirá; Rimkus, Carolina de Medeiros; Cliquet Júnior, Alberto

    2012-01-01

    Objective To study the shoulder of this group of patients using magnetic resonance imaging to detect clinical and subclinical disorders and establish a rehabilitation program. Methods Nine patients with spinal cord injury followed in the Laboratory of Biomechanics and Rehabilitation of the Locomotive System at HC/UNICAMP were divided into two groups according to the presence of paraplegia and tetraplegia and were clinically assessed for correlation with the imaging exams. Results Normal results were found in 41% of the shoulders. Most common injuries were tendinopathy of the supraspinatus and acromioclavicular joint degeneration. Eighty percent of injured shoulders had combined lesions. Conclusion A great variety of causes of shoulder pain was identified in paraplegic and tetraplegic subjects. Routine clinical assessment and imaging studies of the shoulder may contribute to the evolution of rehabilitation and reduction of pain and musculoskeletal disorders. Level of Evidence II, Development of Diagnostic Criteria on Consecutive Patients, With Universally Applied Reference "Gold" Standard. PMID:24453620

  17. THE VALUE OF RETINAL IMAGING WITH INFRARED SCANNING LASER OPHTHALMOSCOPY IN PATIENTS WITH STARGARDT DISEASE

    PubMed Central

    Chun, Robert; Fishman, Gerald A.; Collison, Frederick T.; Stone, Edwin M.; Zernant, Jana; Allikmets, Rando

    2014-01-01

    Purpose To demonstrate the value of infrared scanning laser ophthalmoscopy (SLO) for determining structural retinal and choroidal changes in patients with Stargardt disease and its comparison to findings on short-wavelength fundus autofluorescence (SW-AF) imaging, spectral-domain optical coherence tomography, and microperimetry measurements. Methods Forty-four eyes of 22 patients with Stargardt disease were studied using infrared-SLO, spectral-domain optical coherence tomography, macular microperimetry, SW-AF, electroretinography, and fundus photography. Results Although SW-AF imaging outlined the regions of retinal pigment epithelial (RPE) atrophy (hypofluorescence) and enhanced the visibility of more funduscopically apparent flecks (hyperfluorescence), infrared-SLO imaging outlined the regions of choroidal, and RPE, atrophic changes. Degenerative changes in photoreceptor and RPE cell layers, evident on spectral-domain optical coherence tomography imaging, were associated with either hyporeflective or hyperreflective images on infrared-SLO imaging, depending on whether both RPE and choroidal atrophy (hyperreflectance) or solely RPE atrophy (hyporeflectance) was present. Threshold elevations on microperimetry testing corresponded to both RPE and choroidal atrophy on infrared-SLO imaging and RPE atrophy on SW-AF. Conclusion Although SW-AF identifies regions of RPE atrophy, infrared-SLO also identifies the involvement of the choroid that has important implications for the potential improvement in visual function from treatment. Thus, infrared-SLO imaging offers an additional advantage beyond that obtained with SW-AF. PMID:24317291

  18. Errors in imaging the pregnant patient with acute abdomen.

    PubMed

    Casciani, Emanuele; De Vincentiis, Chiara; Mazzei, Maria Antonietta; Masselli, Gabriele; Guerrini, Susanna; Polettini, Elisabetta; Pinto, Antonio; Gualdi, Gianfranco

    2015-10-01

    Pregnant women with an acute abdomen present a critical issue due to the necessity for an immediate diagnosis and treatment; in fact, a diagnostic delay could worsen the outcome for both the mother and the fetus. There is evidence that emergencies during pregnancy are subject to mismanagement; however, the percentage of errors in the diagnosis of emergencies in pregnancy has not been studied in depth. The purpose of this article is to review the most common imaging error emergencies. The topics covered are divided into gynecological and non-gynecological entities and, for each pathology, possible errors have been dealt with in the diagnostic pathway, the possible technical errors in the exam execution, and finally the possible errors in the interpretation of the images. These last two entities are often connected owing to a substandard examination, which can cause errors in the interpretation. Consequently, the systemization of errors reduces the possibility of reoccurrences in the future by providing a valid approach in helping to learn from these errors. PMID:26194813

  19. Decreasing pediatric patient anxiety about radiology imaging tests: prospective evaluation of an educational intervention.

    PubMed

    Johnson, Annette J; Steele, Jennifer; Russell, Gregory B; Moran, Rhonda; Fredericks, Kirsten P; Jennings, S Gregory

    2009-12-01

    This trial investigated anxiety levels and effect of an educational coloring book (CB) among pediatric patients about to undergo radiology imaging tests. Control group (N = 101) and intervention group (N = 175) children ages 3-10 years and their parents were surveyed to determine anxiety levels before the imaging test, with the intervention group being surveyed after patient and parental review of the CB. Anxiety was low for all subjects overall compared with findings from previously published literature, perhaps related to systemic measures to make children's hospitals more child friendly in recent years. Review of the CB was not associated with decreased anxiety among patients or parents. However, among a subgroup with higher baseline parental anxiety, there was a trend toward lower patient anxiety in the intervention group. Most parents indicated that the CB was informative and helped them and their child be less worried, and that they were pleased to have received the CB. PMID:19833667

  20. Comparative assessment of three image reconstruction techniques for image quality and radiation dose in patients undergoing abdominopelvic multidetector CT examinations

    PubMed Central

    Desai, G S; Thabet, A; Elias, A Y A; Sahani, D V

    2013-01-01

    Objective To compare image quality and radiation dose of abdominal CT examinations reconstructed with three image reconstruction techniques. Methods In this Institutional Review Board-approved study, contrast-enhanced (CE) abdominopelvic CT scans from 23 patients were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASiR) and iterative reconstruction in image space (IRIS) and were reviewed by two blinded readers. Subjective (acceptability, sharpness, noise and artefacts) and objective (noise) measures of image quality were recorded for each image data set. Radiation doses in CT dose index (CTDI) dose–length product were also calculated for each examination type and compared. Imaging parameters were compared using the Wilcoxon signed rank test and a paired t-test. Results All 69 CECT examinations were of diagnostic quality and similar for overall acceptability (mean grade for ASiR, 3.9±0.3; p=0.2 for Readers 1 and 2; IRIS, 3.9±0.4, p=0.2; FBP, 3.8±0.9). Objective noise was considerably lower with both iterative techniques (p<0.0001 and 0.0016 for ASiR and IRIS). Recorded mean radiation dose, i.e. CTDIvol, was 24% and 10% less with ASiR (11.4±3.4 mGy; p<0.001) and IRIS (13.5±3.7 mGy; p=0.06), respectively, than with FBP: 15.0±3.5 mGy. Conclusion At the system parameters used in this study, abdominal CT scans reconstructed with ASiR and IRIS provide diagnostic images with reduced image noise and 10–24% lower radiation dose than FBP. Advances in knowledge CT images reconstructed with FBP are frequently noisy on lowering the radiation dose. Newer iterative reconstruction techniques have different approaches to produce images with less noise; ASiR and IRIS provide diagnostic abdominal CT images with reduced image noise and radiation dose compared with FBP. This has been documented in this study. PMID:23255538

  1. Image-guided radiosurgery for spinal tumors: methods, accuracy and patient intrafraction motion.

    PubMed

    Agazaryan, Nzhde; Tenn, Steve E; Desalles, Antonio A F; Selch, Michael T

    2008-03-21

    Image-guided frameless extracranial radiosurgery has become an established treatment option; however, without a frame to restrict patient movements, intrafraction field mispositioning becomes more probable. The primary aim of this study is to determine the intrafraction motion of spinal radiosurgery patients. This aim was approached in two steps. First, a phantom study demonstrated that the system can detect movements accurately within 0.1 mm and rotational changes within 0.2 degrees. Second, patient positioning and monitoring were carried out for a group of 15 patients with 20 treatment sites. For the patient pool in the study, vertebral anatomy movement was observed to vary as much as 3 mm between sequential measurements and could occur in as little as 5 min. These results suggest a need for intrafraction patient monitoring and correctional shifts, even for patients whose overall treatment times are expected to be relatively short. Small relative rotations with standard deviations of less than 1.5 degrees were observed. The small relative rotational movements observed do not, alone, justify patient monitoring using the image-guidance system during the treatments of generally small radiosurgical targets. PMID:18367799

  2. SU-E-J-204: Radiation Dose to Patients Resulting From Image Guidance Procedures and AAPM TG-180 Update

    SciTech Connect

    Ding, G; Alaei, P

    2014-06-01

    Purpose: Image-guided radiation therapy (IGRT) is the new paradigm for patient positioning and target localization in radiotherapy. Daily imaging procedures add additional dose to the patient's treatment volume and normal tissues and may expose the organs at risk to unaccounted doses. This presentation is to update the progress of AAPM TG-180 which aims to provide strategies to quantify and account the dose from both MV and kV imaging in patient treatment planning. Methods: Our current knowledge on image guidance dose is presented. A summary of doses from image guidance procedures delivered to patients in relationship with therapeutic doses is given. Different techniques in reducing the image guidance dose are summarized. Typical organ doses resulting from different image acquisition procedures used in IGRT are tabulated. Results: Many techniques to reduce the imaging doses are available in clinical applications. There are large variations between dose to bone and dose to soft tissues for x-rays at kilovoltage energy range. Methods for clinical implementation of accounting for the imaging dose from an imaging procedure are available. Beam data from imaging systems can be generated by combining Monte Carlo simulations and experimental measurements for commissioning imaging beams in the treatment planning. Conclusion: The current treatment planning systems are not yet equipped to perform patient specific dose calculations resulting from kV imaging procedures. The imaging dose from current kV image devices has been significantly reduced and is generally much less than that resulting from MV. Because the magnitude of kV imaging dose is significantly low and the variation between patients is modest, it is feasible to estimate dose based on imaging producers or protocols using tabulated values which provides an alternative to accomplish the task of accounting and reporting imaging doses.

  3. Construction of realistic liver phantoms from patient images using 3D printer and its application in CT image quality assessment

    NASA Astrophysics Data System (ADS)

    Leng, Shuai; Yu, Lifeng; Vrieze, Thomas; Kuhlmann, Joel; Chen, Baiyu; McCollough, Cynthia H.

    2015-03-01

    The purpose of this study is to use 3D printing techniques to construct a realistic liver phantom with heterogeneous background and anatomic structures from patient CT images, and to use the phantom to assess image quality with filtered back-projection and iterative reconstruction algorithms. Patient CT images were segmented into liver tissues, contrast-enhanced vessels, and liver lesions using commercial software, based on which stereolithography (STL) files were created and sent to a commercial 3D printer. A 3D liver phantom was printed after assigning different printing materials to each object to simulate appropriate attenuation of each segmented object. As high opacity materials are not available for the printer, we printed hollow vessels and filled them with iodine solutions of adjusted concentration to represent enhance levels in contrast-enhanced liver scans. The printed phantom was then placed in a 35×26 cm oblong-shaped water phantom and scanned repeatedly at 4 dose levels. Images were reconstructed using standard filtered back-projection and an iterative reconstruction algorithm with 3 different strength settings. Heterogeneous liver background were observed from the CT images and the difference in CT numbers between lesions and background were representative for low contrast lesions in liver CT studies. CT numbers in vessels filled with iodine solutions represented the enhancement of liver arteries and veins. Images were run through a Channelized Hotelling model observer with Garbor channels and ROC analysis was performed. The AUC values showed performance improvement using the iterative reconstruction algorithm and the amount of improvement increased with strength setting.

  4. Images of God used by self-injurious burn patients.

    PubMed

    Grossoehme, D H; Springer, L S

    1999-08-01

    Suicide by burning and other forms of self-injurious behaviors which involve burning are sometimes considered to have religious overtones. The ritual death of widows upon their husband's funeral pyre is closely associated with Hindu beliefs. Buddhists have used self-immolation as a form of protest. The Judaeo-Christian traditions have imagery of fire as cleansing and purifying; there is also secular imagery associating fire with images of condemnation and evil. Previous studies have described religiosity as a common theme among survivors. The present study describes the ways in which persons who inflicted self-injurious behaviors through burning, including attempted suicide, imagine the Divinity and use religious language to give meaning to their experience. PMID:10439154

  5. Follow-up study using iodine-131 metaiodobenzylguanidine imaging in a patient with neuroblastoma

    SciTech Connect

    Ikekubo, K.; Habuchi, Y.; Jeong, S.; Yamaguchi, H.; Saiki, Y.; Ito, H.; Hino, M.; Higa, T.

    1986-11-01

    A new radiopharmaceutical, I-131 metaiodobenzylguanidine (I-131 MIBG) was used to determine the location and to follow-up tumors in a 13-month-old girl with neuroblastoma. I-131 MIBG imaging revealed both a primary abdominal tumor and a distant metastatic orbital tumor. Follow-up study with I-131 MIBG imaging demonstrated significant resolution of tumors after external radiotherapy and chemotherapy. I-131 MIBG imaging is a simple, safe, and specific method of determining the location of tumors and also is clinically useful in the evaluation and management of patients with neuroblastoma.

  6. Pancreas imaging by computed tomography after endoscopic retrograde pancreatography. [Dogs; patients

    SciTech Connect

    Frick, M.P.; O'Leary, J.F.; Salomonowitz, E.; Stoltenberg, E.; Hutton, S.; Gedgaudas, E.

    1984-01-01

    A method using CT after endoscopic retrograde pancreatography (CT-ERP) is described for pancreatic imaging. When using an ERP technique in the canine model comparable to that used in humans, small amounts of contrast material in peripheral pancreatic radicles resulted in enhancement of the pancreas on CT scans. Nine patients were also studied by CT-ERP images. The main pancreatic duct was seen on delayed images. In cases of chronic pancreatitis (n = 2), pancreatic opacification was patchy and heterogeneous. There was no contrast-material enhancement in areas of pancreatic carcimomas (n = 2). CT-ERP showed the true extent of carcinoma better than ERP alone.

  7. Deformable image registration for geometrical evaluation of DIBH radiotherapy treatment of lung cancer patients

    NASA Astrophysics Data System (ADS)

    Ottosson, W.; Lykkegaard Andersen, J. A.; Borrisova, S.; Mellemgaard, A.; Behrens, C. F.

    2014-03-01

    Respiration and anatomical variation during radiotherapy (RT) of lung cancer yield dosimetric uncertainties of the delivered dose, possibly affecting the clinical outcome if not corrected for. Adaptive radiotherapy (ART), based on deformable image registration (DIR) and Deep-Inspiration-Breath-Hold (DIBH) gating can potentially improve the accuracy of RT. Purpose: The objective was to investigate the performance of contour propagation on repeated CT and Cone Beam CT (CBCT) images in DIBH compared to images acquired in free breathing (FB), using a recently released DIR software. Method: Three locally advanced non-small cell lung cancer patients were included, each with a planning-, midterm- and final CT (pCT, mCT, fCT) and 7 CBCTs acquired weekly and on the same day as the mCT and fCT. All imaging were performed in both FB and DIBH, using Varian RPM system for respiratory tracking. Delineations of anatomical structures were performed on each image set. The CT images were retrospective rigidly and deformable registered to all obtained images using the Varian Smart Adapt v. 11.0. The registered images were analysed for volume change and Dice Similarity Coefficient (DSC). Result: Geometrical similarities were found between propagated and manually delineated structures, with a slightly favour of FB imaging. Special notice should be taken to registrations where image artefacts or low tissue contrast are present. Conclusion: This study does not support the hypothesis that DIBH images perform better image registration than FB images. However DIR is a feasible tool for ART of lung cancer.

  8. Kilovoltage Imaging Doses in the Radiotherapy of Pediatric Cancer Patients

    SciTech Connect

    Deng Jun; Chen Zhe; Roberts, Kenneth B.; Nath, Ravinder

    2012-04-01

    Purpose: To investigate doses induced by kilovoltage cone-beam computed tomography (kVCBCT) to pediatric cancer patients undergoing radiotherapy, as well as strategies for dose reduction. Methods and Materials: An EGS4 Monte Carlo code was used to calculate three-dimensional dose deposition due to kVCBCT on 4 pediatric cancer patients. Absorbed doses to various organs were analyzed for both half-fan and full-fan modes. Clinical conditions, such as distance from organ at risk (OAR) to CBCT field border, kV peak energy, and testicular shielding, were studied. Results: The mean doses induced by one CBCT scan operated at 125 kV in half-fan mode to testes, liver, kidneys, femoral heads, spinal cord, brain, eyes, lens, and optical nerves were 2.9, 4.7, 7.7, 10.5, 8.8, 7.6, 7.7, 7.8, and 7.2 cGy, respectively. Increasing the distances from OARs to CBCT field border greatly reduced the doses to OARs, ranging from 33% reduction for spinal cord to 2300% reduction for testes. As photon beam energy increased from 60 to 125 kV, the dose increase due to kVCBCT ranged from 170% for lens to 460% for brain and spinal cord. A testicular shielding made of 1-cm cerrobend could reduce CBCT doses down to 31%, 51%, 68%, and 82%, respectively, for 60, 80, 100, and 125 kV when the testes lay within the CBCT field. Conclusions: Generally speaking, kVCBCT deposits much larger doses to critical structures in children than in adults, usually by a factor of 2 to 3. Increasing the distances from OARs to CBCT field border greatly reduces doses to OARs. Depending on OARs, kVCBCT-induced doses increase linearly or exponentially with photon beam energy. Testicular shielding works more efficiently at lower kV energies. On the basis of our study, it is essential to choose an appropriate scanning protocol when kVCBCT is applied to pediatric cancer patients routinely.

  9. Nationwide emergency department imaging practices for pediatric urolithiasis patients: room for improvement

    PubMed Central

    Johnson, Emilie K.; Graham, Dionne A.; Chow, Jeanne S.; Nelson, Caleb P.

    2014-01-01

    Purpose Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis are one group who may receive repeated radiation-intensive imaging tests. Our study aimed to characterize imaging practices for children presenting to the emergency department (ED) with suspected urolithiasis (SU) and determine factors associated with the choice of imaging study. Methods Using the 2006-10 Nationwide Emergency Department Sample (NEDS), we conducted a retrospective cohort study of patients <18 years old presenting with SU. We determined imaging practices for visits in EDs where billing codes for computed tomography (CT) and ultrasound were reliably reported. Logistic regression was used to delineate patient- and hospital-level factors associated with the use of CT vs. ultrasound. Results There were 18096 pediatric SU visits in the 1191 NEDS EDs with reliable imaging codes. Of the 11215 patients receiving a CT alone, an ultrasound alone, or both, 9773 (87%) were imaged with CT alone. CT use peaked in 2007, and declined thereafter. On multivariate analysis, the following factors were associated with the use of CT alone: lower proportion of pediatric patients treated in the ED, older age, location in the Midwest or South, evaluation at a non-teaching hospital, and visit on a weekend. Conclusions CT use is highly prevalent for children presenting with SU. The lowest CT use is in EDs that care for more children. Ultrasound is used very infrequently regardless of site. Awareness regarding risks of CT and consideration of alternatives including ultrasound are warranted in caring for these patients. PMID:24518772

  10. Quantum Margulis expanders

    E-print Network

    D. Gross; J. Eisert

    2008-05-25

    We present a simple way to quantize the well-known Margulis expander map. The result is a quantum expander which acts on discrete Wigner functions in the same way the classical Margulis expander acts on probability distributions. The quantum version shares all essential properties of the classical counterpart, e.g., it has the same degree and spectrum. Unlike previous constructions of quantum expanders, our method does not rely on non-Abelian harmonic analysis. Analogues for continuous variable systems are mentioned. Indeed, the construction seems one of the few instances where applications based on discrete and continuous phase space methods can be developed in complete analogy.

  11. Expandable space frames

    NASA Technical Reports Server (NTRS)

    Schoen, A. H. (inventor)

    1973-01-01

    Expandable space frames having essentially infinite periodicity limited only by practical considerations, are described. Each expandable space frame comprises a plurality of hinge joint assemblies having arms that extend outwardly in predetermined symmetrically related directions from a central or vertex point. The outer ends of the arms form one part of a hinge point. The outer expandable space frame also comprises a plurality of struts. The outer ends of the struts from the other part of the hinged joint. The struts interconnect the plurality of hinge point in sychronism, the spaceframes can be expanded or collapsed. Three-dimensional as well as two-dimensional spaceframes of this general nature are described.

  12. Platelet-based MPLE denoising of SPECT images: phantom and patient study.

    PubMed

    Riyahi-Alam, N; Alibabaei, N; Takavar, A; Sohrabi, M; Fard-Esfahani, A; Oghabian, M A; Bakhtiary, M

    2006-01-01

    In this study the evaluation of a Platelet-based Maximum Penalized Likelihood Estimation (MPLE) for denoising SPECT images was performed and compared with other denoising methods such as Wavelets or Butterworth filteration. Platelet-based MPLE factorization as a multiscale decomposition approach has been already proposed for better edges and surfaces representation due to Poisson noise and inherent smoothness of this kind of images. We applied this approach on both simulated and real SPECT images. For NEMA phantom images, the measured noise levels before (M(b)) and after (M(a)) denoising with Platelet-based MPLE approach were M(b)=2.1732, M(a)=0.1399. In patient study for 32 cardiac SPECT images, the difference between noise level and SNR before and after the approach were (M(b)=3.7607, SNR(b)=9.7762, M(a)=0.7374, SNR(a)=41.0848) respectively. Thus the Coefficient Variance (C.V) of SNR values for denoised images with this algorithm as compared with Butterworth filter, (145/33%) was found. For 32 brain SPECT images the Coefficient Variance of SNR values, (196/17%) was obtained. Our results shows that Platelet-based MPLE is a useful method for denoising SPECT images considering better homogenous image, improvements in SNR, better radioactive uptake in target organ and reduction of interfering activity from background radiation to compare to that of other conventional denoising methods. PMID:17946651

  13. Patient dose considerations for routine megavoltage cone-beam CT imaging.

    PubMed

    Morin, Olivier; Gillis, Amy; Descovich, Martina; Chen, Josephine; Aubin, Michèle; Aubry, Jean-François; Chen, Hong; Gottschalk, Alexander R; Xia, Ping; Pouliot, Jean

    2007-05-01

    Megavoltage cone-beam CT (MVCBCT), the recent addition to the family of in-room CT imaging systems for image-guided radiation therapy (IGRT), uses a conventional treatment unit equipped with a flat panel detector to obtain a three-dimensional representation of the patient in treatment position. MVCBCT has been used for more than two years in our clinic for anatomy verification and to improve patient alignment prior to dose delivery. The objective of this research is to evaluate the image acquisition dose delivered to patients for MVCBCT and to develop a simple method to reduce the additional dose resulting from routine MVCBCT imaging. Conventional CT scans of phantoms and patients were imported into a commercial treatment planning system (TPS: Phillips, Pinnacle) and an arc treatment mimicking the MVCBCT acquisition process was generated to compute the delivered acquisition dose. To validate the dose obtained from the TPS, a simple water-equivalent cylindrical phantom with spaces for MOSFETs and an ion chamber was used to measure the MVCBCT image acquisition dose. Absolute dose distributions were obtained by simulating MVCBCTs of 9 and 5 monitor units (MU) on pelvis and head and neck patients, respectively. A compensation factor was introduced to generate composite plans of treatment and MVCBCT imaging dose. The article provides a simple equation to compute the compensation factor. The developed imaging compensation method was tested on routinely used clinical plans for prostate and head and neck patients. The quantitative comparison between the calculated dose by the TPS and measurement points on the cylindrical phantom were all within 3%. The dose percentage difference for the ion chamber placed in the center of the phantom was only 0.2%. For a typical MVCBCT, the dose delivered to patients forms a small anterior-posterior gradient ranging from 0.6 to 1.2 cGy per MVCBCT MU. MVCBCT acquisitions in the pelvis and head and neck areas deliver slightly more dose than current portal imaging but render soft tissue information for positioning. Overall, the additional dose from daily 9 MU MVCBCTs of prostate patients is small compared to the treatment dose (<4%). Dose-volume histograms of compensated plans for pelvis and head and neck patients imaged daily with MVCBCT showed no additional dose to the target and small increases at low doses. The results indicate that the dose delivered for MVCBCT imaging can be precisely calculated in the TPS and therefore included in the treatment plan. This allows simple plan compensations, such as slightly reducing the treatment dose, to minimize the total dose received by critical structures from daily positioning with MVCBCT. The proposed compensation factor reduces the number of MU per treatment beam per fraction. Both the number of fractions and the beam arrangement are kept unchanged. Reducing the imaging volume in the cranio-caudal direction can further reduce the dose delivered for MVCBCT. This is a useful feature to eliminate the imaging dose to the eyes or to focus on a specific region of interest for alignment. PMID:17555263

  14. Comparison of setup error using different reference images: a phantom and lung cancer patients study

    SciTech Connect

    Jiang Bo; Dai Jianrong; Zhang Ye; Zhang Ke; Men Kuo; Zhou Zongmei; Liang Jun; Wang Lvhua

    2012-04-01

    The purpose of this study was to compare setup errors obtained with kilovoltage cone-beam computed tomography (CBCT) and 2 different kinds of reference images, free-breathing 3D localization CT images (FB-CT) and the average images of 4-D localization CT images (AVG-CT) for phantom and lung cancer patients. This study also explored the correlation between the difference of translational setup errors and the gross tumor volume (GTV) motion. A respiratory phantom and 14 patients were enrolled in this study. For phantom and each patient, 3D helical CT and 4D CT images were acquired, and AVG-CT images were generated from the 4D CT. The setup errors were determined based on the image registration between the CBCT and the 2 different reference images, respectively. The data for both translational and rotational setup errors were analyzed and compared. The GTV centroid movement as well as its correlation with the translational setup error differences was also evaluated. In the phantom study, the AVG-CT method was more accurate than the FB-CT method. For patients, the translational setup errors based on FB-CT were significantly larger than those from AVG-CT in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions (p < 0.05). Translational setup errors differed by >1 mm in 32.6% and >2 mm in 12.9% of CBCT scans. The rotational setup errors from FB-CT were significantly different from those from AVG-CT in the LR and AP directions (p < 0.05). The correlation coefficient of the translational setup error differences and the GTV centroid movement in the LR, SI, and AP directions was 0.515 (p = 0.060), 0.902 (p < 0.001), and 0.510 (p = 0.062), respectively. For lung cancer patients, respiration may affect the on-line target position location. AVG-CT provides different reference information than FB-CT. The difference in SI direction caused by the 2 methods increases with the GTV movement. Therefore, AVG-CT should be the prefered choice of reference images.

  15. Malignant lymphoma of the breast in a male patient: ultrasound imaging features.

    PubMed

    Ikeda, Tatsuhiko; Bando, Hiroko; Iguchi, Akiko; Tanaka, Yuko; Tohno, Eriko; Hara, Hisato

    2015-03-01

    Non-Hodgkin lymphoma (NHL) of the breast is a rare disease. Herein, we report a rare case of secondary involvement of the breast by NHL in a male patient and the ultrasound imaging findings. A 70-year-old man noticed an induration of the subareolar region of the right breast. He had been diagnosed as having mantle cell lymphoma 5 years before and treated with several series of chemoradiotherapy. On supine examination, palpation revealed bilateral breast enlargement, but detection of a lump was difficult. Ultrasonography showed a hypoechoic non-mass image-forming lesion in the subareolar region of the right breast. The final pathological diagnosis was recurrence of mantle cell lymphoma in the right breast. The diagnosis of malignant lymphoma of the breast by imaging modalities is difficult because there are no specific features. Breast lymphoma should be included with gynecomastia and breast cancer in the differential diagnosis of male patients with breast enlargement. PMID:22396322

  16. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs

    PubMed Central

    2011-01-01

    Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care. PMID:22032338

  17. Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement

    PubMed Central

    Jung, Young-Wook; Park, Sung-Hoon; On, Sung-Woon

    2015-01-01

    Objectives The purpose of this study was to clarify which findings in magnetic resonance imaging (MRI) are good predicators of pain and mouth opening limitation in patients with temporomandibular joint (TMJ) internal derangement (ID). Materials and Methods Clinical examinations for pain and mouth opening limitation were conducted for suspected TMJ ID. MRI scans were taken within a week of clinical examinations. On the oblique-sagittal plane image, readings were obtained in terms of the functional aspect of disc position, degree of displacement, disc deformity, joint effusion, and osteoarthrosis. Multiple logistic regression analyses were conducted to identify the predictors of pain and mouth opening limitation. Results A total of 48 patients (96 TMJs) were studied, including 39 female patients and 9 male patients whose ages ranged from 10 to 65 years. The resultant data showed significant correlations between pain and the MR imaging of the degree of disc displacement (P<0.05). The probability of there being pain in moderate to significant cases was 9.69 times higher than in normal cases. No significant correlation was found between mouth opening limitation and MRI findings. Conclusion We identified a significant correlation between clinical symptoms and MRI findings of ID. The degree of anterior disc displacement may be useful for predicting pain in patients with TMJ ID. PMID:26131429

  18. Muscle imaging in patients with tubular aggregate myopathy caused by mutations in STIM1.

    PubMed

    Tasca, Giorgio; D'Amico, Adele; Monforte, Mauro; Nadaj-Pakleza, Aleksandra; Vialle, Marc; Fattori, Fabiana; Vissing, John; Ricci, Enzo; Bertini, Enrico

    2015-11-01

    Tubular aggregate myopathy is a genetically heterogeneous disease characterized by tubular aggregates as the hallmark on muscle biopsy. Mutations in STIM1 have recently been identified as one genetic cause in a number of tubular aggregate myopathy cases. To characterize the pattern of muscle involvement in this disease, upper and lower girdles and lower limbs were imaged in five patients with mutations in STIM1, and the scans were compared with two patients with tubular aggregate myopathy not caused by mutations in STIM1. A common pattern of involvement was found in STIM1-mutated patients, although with variable extent and severity of lesions. In the upper girdle, the subscapularis muscle was invariably affected. In the lower limbs, all the patients showed a consistent involvement of the flexor hallucis longus, which is very rarely affected in other muscle diseases, and a diffuse involvement of thigh and posterior leg with sparing of gracilis, tibialis anterior and, to a lesser extent, short head of biceps femoris. Mutations in STIM1 are associated with a homogeneous involvement on imaging despite variable clinical features. Muscle imaging can be useful in identifying STIM1-mutated patients especially among other forms of tubular aggregate myopathy. PMID:26255678

  19. Strain/strain rate imaging of impaired left atrial function in patients with metabolic syndrome.

    PubMed

    Fang, Ning-Ning; Sui, Dong-Xin; Yu, Jin-Gui; Gong, Hui-Ping; Zhong, Ming; Zhang, Yun; Zhang, Wei

    2015-11-01

    Left ventricular (LV) dysfunction has been demonstrated in patients with metabolic syndrome (MetS). However, alterations in left atrial (LA) function in MetS are unknown. We aimed to use strain/strain rate (SR) imaging to investigate the effect of MetS on LA function. A total of 177 MetS patients and 156 normal subjects underwent echocardiography. Strain and SR tissue Doppler imaging values were used to evaluate LA function. Partial correlation and multiple stepwise regression analyses were used to determine the risk factors for impaired LA function. Compared with the controls, the MetS patients showed significantly lower levels of mean strain, mean peak systolic SR and mean peak early diastolic SR (P<0.001 for all), with no difference in the mean peak late diastolic SR. Central obesity, hypertension, dyslipidemia and LV diastolic abnormality were independent risk factors for impaired LA function. LA function was impaired in patients with MetS as a result of metabolic disturbance and LV diastolic abnormality. SR imaging is reliable in assessing LA function in MetS patients. PMID:26178155

  20. PET imaging in patients with coal workers pneumoconiosis and suspected malignancy

    SciTech Connect

    Reichert, M.; Bensadoun, E.S.

    2009-05-15

    Abstract: Positron Emission Tomography (PET) with F-18-fluorodeoxyglucose is commonly used in the evaluation of lung nodules; however, there is limited data on the PET appearance of coal worker's pneumoconiosis (CWP) and its utility for diagnosing lung malignancy in this setting. Six cases of CWP and suspected malignancy are reported. Each patient had at least one nodule >1 cm in diameter for a total of 19 nodules >1 cm. On PET imaging 18 of the 19 nodules were hypermetabolic and five of the six patients had at least one nodule that was PET positive. Based on pathologic data and clinical follow-up, none of the six patients had any evidence of malignancy. In this series, PET imaging was often positive in patients with CWP; however, all were false positives with standardized uptake value measurements in the range that are typically seen with malignant nodules. Due to its high rate of false positives, PET imaging seems to be of limited utility in diagnosing malignancy in patients with underlying coal worker's pneumoconiosis.

  1. Potential Applications of Imaging and Image-Guided Radiotherapy for Brain Metastases and Glioblastoma to Improve Patient Quality of Life

    PubMed Central

    Nguyen, Nam P.; Nguyen, Mai L.; Vock, Jacqueline; Lemanski, Claire; Kerr, Christine; Vinh-Hung, Vincent; Chi, Alexander; Khan, Rihan; Woods, William; Altdorfer, Gabor; D’Andrea, Mark; Karlsson, Ulf; Hamilton, Russ; Ampil, Fred

    2013-01-01

    Treatment of glioblastoma multiforme (GBM) and brain metastasis remains a challenge because of the poor survival and the potential for brain damage following radiation. Despite concurrent chemotherapy and radiation dose escalation, local recurrence remains the predominant pattern of failure in GBM most likely secondary to repopulation of cancer stem cells. Even though radiotherapy is highly effective for local control of radio-resistant tumors such as melanoma and renal cell cancer, systemic disease progression is the cause of death in most patients with brain metastasis. Preservation of quality of life (QOL) of cancer survivors is the main issue for patients with brain metastasis. Image-guided radiotherapy (IGRT) by virtue of precise radiation dose delivery may reduce treatment time of patients with GBM without excessive toxicity and potentially improve neurocognitive function with preservation of local control in patients with brain metastasis. Future prospective trials for primary brain tumors or brain metastasis should include IGRT to assess its efficacy to improve patient QOL. PMID:24312897

  2. To see or not to see: a qualitative interview study of patients’ views on their own diagnostic images

    PubMed Central

    Carlin, Leslie E; Smith, Helen E; Henwood, Flis

    2014-01-01

    Objectives To ascertain what meaning individuals attach to perceiving images of their own interior body and how the images and their meanings affect the clinical consultation. Design Face-to-face semistructured interviews. Participants 25 adult patients in southern England who, within the preceding 12?months, had been referred for diagnostic imaging. Setting Community. Results For patients, being shown their own X-rays, MRIs or CT images creates a variety of effects: (1) a sense of better understanding of the diagnosis; (2) validation of their sensory and emotional response to the illness or injury and (3) an alteration to the tenor and nature of the clinical encounter between patient and physician. In addition to meanings attached to these images, patients also impute meaning to the physician's decision not to share an image with them. The desire to see their image was greater in those patients with a skeletal injury; patients are less keen on viewing abdominal or other soft tissue images. Conclusions Viewing images of one's interior, invisible body is powerful and resonant in a number of ways. The experience of not seeing, whether through the patient's or the physician's choice, is also fraught with meaning. PMID:25082418

  3. Balancing dose and image registration accuracy for cone beam tomosynthesis (CBTS) for breast patient setup

    SciTech Connect

    Winey, B. A.; Zygmanski, P.; Cormack, R. A.; Lyatskaya, Y.

    2010-08-15

    Purpose: To balance dose reduction and image registration accuracy in breast setup imaging. In particular, the authors demonstrate the relationship between scan angle and dose delivery for cone beam tomosynthesis (CBTS) when employed for setup verification of breast cancer patients with surgical clips. Methods: The dose measurements were performed in a female torso phantom for varying scan angles of CBTS. Setup accuracy was measured using three registration methods: Clip centroid localization accuracy and the accuracy of two semiautomatic registration algorithms. The dose to the organs outside of the ipsilateral breast and registration accuracy information were compared to determine the optimal scan angle for CBTS for breast patient setup verification. Isocenter positions at the center of the patient and at the breast-chest wall interface were considered. Results: Image registration accuracy was within 1 mm for the CBTS scan angles {theta} above 20 deg. for some scenarios and as large as 80 deg. for the worst case, depending on the imaged breast and registration algorithm. Registration accuracy was highest based on clip centroid localization. For left and right breast imaging with the isocenter at the chest wall, the dose to the contralateral side of the patient was very low (<0.5 cGy) for all scan angles considered. For central isocenter location, the optimal scan angles were 30 deg. - 50 deg. for the left breast imaging and 40 deg. - 50 deg. for the right breast imaging, with the difference due to the geometric asymmetry of the current clinical imaging system. Conclusions: The optimal scan angles for CBTS imaging were found to be between 10 deg. and 50 deg., depending on the isocenter location and ipsilateral breast. Use of the isocenter at the breast-chest wall locations always resulted in greater accuracy of image registration (<1 mm) at smaller angles (10 deg. - 20 deg.) and at lower doses (<0.1 cGy) to the contralateral organs. For chest wall isocenters, doses delivered to organs outside of the target breast were much smaller than the scattered and leakage doses of the treatment beams. The complete volumetric information of all clips in the region of interest, combined with the small dose to the contralateral organs and the small scan angle, could result in an advantage for small angle CBTS with off center isocenters over simple orthogonal pairs.

  4. Thallium-201 versus technetium-99m pyrophosphate myocardial imaging in detection and evaluation of patients with acute myocardial infarction

    SciTech Connect

    Pitt, B.; Thrall, J.H.

    1980-12-18

    Thallium-201 myocardial imaging is of value in the early detection and evaluation of patients with suspected acute infarction. Thallium imaging may have a special value in characterizing patients with cardiogenic shock and in detecting patients at risk for subsequent infarction or death or death or both, before hospital discharge. Approximately 95 percent of pateints with transmural or nontransmural myocardial infarction can be detected with technetium-99m pyrophosphate myocardial imaging if the imaging is performed 24 to 72 hours after the onset of symptoms. Pyrophosphate imaging may have an important role in the evaluation of patients during the early follow-up period after hospital discharge from an episode of acute infarction. The finding of a persistently positive pyrophosphate image suggests a poor prognosis and is associated with a relatively large incidence of subsequent myocardial infarction and death.

  5. What Does PET Imaging Add to Conventional Staging of Head and Neck Cancer Patients?

    SciTech Connect

    Pohar, Surjeet . E-mail: poharss@evms.edu; Brown, Robert B.S.; Newman, Nancy; Koniarczyk, Michael; Hsu, Jack; Feiglin, David

    2007-06-01

    Purpose: To determine the value of PET scans in the staging of patients with head and neck carcinoma. Methods and Materials: The charts of 25 patients who underwent neck dissection, computed tomography (CT) scan, and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging as part of their initial work-up for a head and neck squamous cell cancer between 2000-2003 were reviewed. All patients underwent clinical examination, triple endoscopy, and chest radiograph as part of their clinical staging, adhering to American Joint Commission for Cancer criteria. In addition to the clinical nodal (N) stage, PET findings were incorporated to determine a second type of N staging: clinical N + PET stage. The number of neck sides and nodal levels involved on CT or PET and on pathologic examination were recorded. Results: The sensitivity and specificity for detection of nodal disease were similar for CT and FDG-PET. Positive and negative likelihood ratios were similar for both diagnostic tests. None of our 25 patients had unsuspected distant disease detected by PET. Conclusion: The addition of PET imaging did not improve diagnostic accuracy in our patients compared with CT. PET scanning did not alter clinical management in any of the patients.

  6. Measurement of patient imaging dose for real-time kilovoltage x-ray intra-fraction tumour position monitoring in prostate patients

    PubMed Central

    Crocker, James K; Ng, Jin Aun; Keall, Paul J; Booth, Jeremy T

    2012-01-01

    The dose for image-based motion monitoring of prostate tumours during radiotherapy delivery has not been established. This study aimed to provide quantitative analysis and optimisation of the fluoroscopic patient imaging dose during radiotherapy for IMRT and VMAT treatments using standard and hypofractionated treatment schedules. Twenty-two patients with type T1c N0/M0 prostate cancer and three implanted fiducial markers were considered. Minimum field sizes encompassing all fiducial markers plus a 7.5mm motion margin were determined for each treatment beam, each patient and the complete cohort. Imaging doses were measured for different field sizes and depths in a phantom at 75kV and 120kV. Based on these measurements, the patient imaging doses were then estimated according to beam-on time for clinical settings. The population minimum field size was 5.3 × 6.1cm2, yielding doses of 406mGy and 185mGy over the course of an IMRT treatment for 75kV (10 mAs) and 120kV (1.04 mAs) imaging, respectively at 1Hz. The imaging dose was reduced by an average of 28% and 32% by adopting patient specific and treatment-beam specific field sizes respectively. Standard fractionation VMAT imaging doses were 37% lower than IMRT doses over a complete treatment. Hypofractionated IMRT SBRT and VMAT SBRT imaging doses were 58% and 76% lower than IMRT doses respectively. The patient dose for kilovoltage intrafraction monitoring of the prostate was quantified. Tailoring imaging field sizes to specific patients yielded a significant reduction in the imaging dose, as did adoption of faster treatment modalities such as VMAT. PMID:22517054

  7. Indium-111 chloride imaging in patients with suspected abscesses: concise communication

    SciTech Connect

    Sayle, B.A.; Balachandran, S.; Rogers, C.A.

    1983-12-01

    Two hundred and fifty-eight patients with clinically suspected inflammatory processes were studied. Seventy-two images were categorized as true positive; 211 as true negative. There were nine false-positive studies, four of which were due to activity in beds of excised organs. There were six false-negative studies, four of which were due to walled-off abscesses found either at surgery or biopsy. The sensitivity was 92%, the specificity 95%, and the accuracy 94%. This study shows that indium-111 chloride imaging provides a reliable way to locate inflammatory processes and overcomes the disadvantages of other imaging agents, for example gastrointestinal activity or the demonstration of healing surgical wounds with gallium-67, and the false-positive images due to cystic fibrosis and other respiratory diseases, or accessory spleens as seen with In-111-labeled white cells.

  8. Imaging Plaques to Predict and Better Manage Patients with Acute Coronary Events

    PubMed Central

    Garcia-Garcia, Hector M.; Jang, Ik-Kyung; Serruys, Patrick W.; Kovacic, Jason C.; Narula, Jagat; Fayad, Zahi A.

    2014-01-01

    Culprit lesions of patients who have had an acute coronary syndrome commonly are ruptured coronary plaques with superimposed thrombus. The precursor of such lesions is an inflamed thin-capped fibroatheroma. These plaques can be imaged by means of invasive techniques such as intravascular ultrasound (and derived techniques), optical coherence tomography and near-infrared spectroscopy. Very often these patients exhibit similar (multiple) plaques beyond the culprit lesion. These remote plaques can be assessed non invasively by computed tomography angiography and magnetic resonance imaging and also using invasive imaging. The detection of these remote plaques is not only feasible, but also in natural history studies have been associated with clinical coronary events. Different systemic pharmacological treatments have been studied (mostly statins) with modest success and therefore newer approaches are being tested. Local treatment for such lesions is in its infancy and larger, prospective and randomized trials are needed. This review will describe the pathological and imaging findings in culprit lesions of patients with acute coronary syndrome and as well as the assessment of remote plaques. In addition, the pharmacological and local treatment options will be reviewed. PMID:24902974

  9. Functionalized expanded porphyrins

    DOEpatents

    Sessler, Jonathan L; Pantos, Patricia J

    2013-11-12

    Disclosed are functionalized expanded porphyrins that can be used as spectrometric sensors for high-valent actinide cations. The disclosed functionalized expanded porphyrins have the advantage over unfunctionalized systems in that they can be immobilized via covalent attachment to a solid support comprising an inorganic or organic polymer or other common substrates. Substrates comprising the disclosed functionalized expanded porphyrins are also disclosed. Further, disclosed are methods of making the disclosed compounds (immobilized and free), methods of using them as sensors to detect high valent actinides, devices that comprise the disclosed compounds, and kits.

  10. Imaging in diagnosis, treatment, and follow-up of stone patients.

    PubMed

    Dhar, Mrinal; Denstedt, John D

    2009-01-01

    Imaging has an essential role in the diagnosis, management, and follow-up of patients with stone disease. A variety of imaging modalities are available to the practicing urologist, including conventional radiography (KUB), intravenous urography (IVU), ultrasound (US), magnetic resonance urography, and computed tomography (CT) scans, each with its advantages and limitations. Traditionally, IVU was considered the gold standard for diagnosing renal calculi, but this modality has largely been replaced by unenhanced spiral CT scans at most centers. Renal US is recommended as the initial imaging modality for suspected renal colic in pregnant women and children, but recent literature suggests that a low-dose CT scan may be safe in pregnancy. Intraoperative imaging by fluoroscopy or US plays a large part in assisting the urologist with the surgical intervention chosen for the individual stone patient. Posttreatment imaging of stone patients is recommended to ensure complete fragmentation and stone clearance. Plain radiography is suggested for the follow-up of radiopaque stones, with ultrasound and limited IVU reserved for the follow-up of radiolucent stones to minimize cumulative radiation exposure from repeated CT scans. Patients with asymptomatic calyceal stones who prefer an observational approach should have a yearly KUB to monitor progression of stone burden. Current research has been aimed toward the development of a micro-CT scan and coherent-scatter analysis to determine stone composition in vivo. This may have a significant impact on the future clinical management of renal calculi by facilitating selection of the most appropriate surgical intervention based on stone composition at the time of presentation. PMID:19095204

  11. A technique for transferring a patient's smile line to a cone beam computed tomography (CBCT) image.

    PubMed

    Bidra, Avinash S

    2014-08-01

    Fixed implant-supported prosthodontic treatment for patients requiring a gingival prosthesis often demands that bone and implant levels be apical to the patient's maximum smile line. This is to avoid the display of the prosthesis-tissue junction (the junction between the gingival prosthesis and natural soft tissues) and prevent esthetic failures. Recording a patient's lip position during maximum smile is invaluable for the treatment planning process. This article presents a simple technique for clinically recording and transferring the patient's maximum smile line to cone beam computed tomography (CBCT) images for analysis. The technique can help clinicians accurately determine the need for and amount of bone reduction required with respect to the maximum smile line and place implants in optimal positions. PMID:24529841

  12. Myocardial perfusion defect on thallium-201 imaging in patients with chronic obstructive pulmonary disease

    SciTech Connect

    Mehrotra, P.P.; Weaver, Y.J.; Higginbotham, E.A.

    1983-08-01

    Six patients with angina pectoris had reversible perfusion defects on stress and redistribution thallium imaging. Three patients had a positive electrocardiographic response to exercise. No significant coronary artery lesions were seen on coronary arteriography in any of the six patients. All had mild to moderate hypoxemia at rest and physiologic evidence of chronic obstructive pulmonary disease as defined by the decrease in the ratio of forced expiratory volume at 1 second to forced vital capacity (FEV1/FVC X 100) or decrease in the forced midexpiratory flow rate (FEF25-75), or both. None had clinical findings suggestive of any of the reported causes of positive thallium scans in patients with normal coronary arteriograms. Cellular dysfunction produced by hypoxemia affecting the uptake of thallium seems to be the most likely mechanism of this abnormality.

  13. Quantitative Ultrasound Spectroscopic Imaging for Characterization of Disease Extent in Prostate Cancer Patients1

    PubMed Central

    Sadeghi-Naini, Ali; Sofroni, Ervis; Papanicolau, Naum; Falou, Omar; Sugar, Linda; Morton, Gerard; Yaffe, Martin J.; Nam, Robert; Sadeghian, Alireza; Kolios, Michael C.; Chung, Hans T.; Czarnota, Gregory J.

    2015-01-01

    Three-dimensional quantitative ultrasound spectroscopic imaging of prostate was investigated clinically for the noninvasive detection and extent characterization of disease in cancer patients and compared to whole-mount, whole-gland histopathology of radical prostatectomy specimens. Fifteen patients with prostate cancer underwent a volumetric transrectal ultrasound scan before radical prostatectomy. Conventional-frequency (~ 5 MHz) ultrasound images and radiofrequency data were collected from patients. Normalized power spectra were used as the basis of quantitative ultrasound spectroscopy. Specifically, color-coded parametric maps of 0-MHz intercept, midband fit, and spectral slope were computed and used to characterize prostate tissue in ultrasound images. Areas of cancer were identified in whole-mount histopathology specimens, and disease extent was correlated to that estimated from quantitative ultrasound parametric images. Midband fit and 0-MHz intercept parameters were found to be best associated with the presence of disease as located on histopathology whole-mount sections. Obtained results indicated a correlation between disease extent estimated noninvasively based on midband fit parametric images and that identified histopathologically on prostatectomy specimens, with an r2 value of 0.71 (P < .0001). The 0-MHz intercept parameter demonstrated a lower level of correlation with histopathology. Spectral slope parametric maps offered no discrimination of disease. Multiple regression analysis produced a hybrid disease characterization model (r2 = 0.764, P < .05), implying that the midband fit biomarker had the greatest correlation with the histopathologic extent of disease. This work demonstrates that quantitative ultrasound spectroscopic imaging can be used for detecting prostate cancer and characterizing disease extent noninvasively, with corresponding gross three-dimensional histopathologic correlation. PMID:25749174

  14. Comparative analysis of image guidance in two institutions for prostate cancer patients

    PubMed Central

    Piotrowski, Tomasz; Yartsev, Slav; Rodrigues, George; Bajon, Tomasz

    2014-01-01

    Aim/Background The analysis of systematic and random errors obtained from the pooled data on inter-fraction prostate motion during radiation therapy in two institutions. Materials and methods Data of 6085 observations for 216 prostate cancer patients treated on tomotherapy units in two institutions of position correction shifts obtained by co-registration of planning and daily CT studies were investigated. Three independent variables: patient position (supine or prone), target (prostate or prostate bed), and imaging mode (normal or coarse) were analyzed. Systematic and random errors were evaluated and used to calculate the margins for different options of referencing based on the position corrections observed with one, three, or five imaging sessions. Results Statistical analysis showed that only the difference between normal and coarse modes of imaging was significant, which allowed to merge the supine and prone position sub-groups as well as the prostate and prostate bed patients. In the normal and coarse imaging groups, the margins calculated using systematic and random errors in the medio-lateral and cranio-caudal directions (5.5 mm and 4.5 mm, respectively) were similar, but significantly different (5.3 mm for the normal mode and 7.1 mm for the coarse mode) in the anterio-posterior direction. The reference scheme based on the first three fractions (R3) was found to be the optimal one. Conclusions The R3 reference scheme effectively reduced systematic and random errors. Larger margins in the anterio-posterior direction should be used during prostate treatment on the tomotherapy unit, as coarse imaging mode is chosen in order to reduce imaging time and dose. PMID:24936341

  15. Tract-based diffusion tensor imaging in patients with schizophrenia and their non-psychotic siblings.

    PubMed

    Boos, Heleen B M; Mandl, René C W; van Haren, Neeltje E M; Cahn, Wiepke; van Baal, G Caroline M; Kahn, René S; Hulshoff Pol, Hilleke E

    2013-04-01

    Structural brain abnormalities have consistently been found in patients with schizophrenia. Diffusion tensor imaging (DTI) has been shown to be a useful method to measure white matter (WM) integrity in this illness, but findings in the earlier disease stages are inconclusive. Moreover, the relationship between WM microstructure and the familial risk for developing schizophrenia remains unresolved. From 126 patients with schizophrenia, 123 of their non-psychotic siblings and 109 healthy control subjects, DTI images were acquired on a 1.5 T MRI scanner. Mean fractional anisotropy (FA) was compared along averaged WM tracts, computed for the genu, splenium, left and right uncinate fasciculus, cingulum, inferior fronto-occipital fasciculus, fornix, arcuate fasciculus, and inferior longitudinal fasciculus. Fractional anisotropy (FA) was assessed for its unique environmental and familial (possibly heritable) aspects associated with schizophrenia, using structural equation modeling for these white matter tracts. The results of this study show that young adult (mean age 26.7 years) patients with schizophrenia did not differ in mean FA from healthy controls along WM fibers; siblings of patients showed higher mean FA in the left and right arcuate fasciculus as compared to patients and controls. With increasing age, an excessive decline in mean FA was found in patients as compared to siblings and healthy controls in the genu, left uncinate fasciculus, left inferior fronto-occipital fasciculus, and left inferior longitudinal fasciculus. Moreover, symptom severity was negatively correlated to mean FA in the arcuate fasciculus bilaterally in patients with schizophrenia. In young adult patients with schizophrenia integrity of individual tract-based (corticocortical) fibers can (still) be within normal limits. However, changes in the arcuate fasciculus may be relevant to (the risk to develop) psychosis, while a general and widespread loss of fiber integrity may be related to illness progression. PMID:22841128

  16. Impact of thallium-201 imaging on clinical assessment and management of patients with chest pain

    SciTech Connect

    Schmoliner, R.; Dudczak, R.; Kronik, G.; Moesslacher, H.; Zangeneh, M.; Pollak, C.; Schurz, B.; Schoberwalter, A.

    1984-12-01

    The histories, rest, and exercise ECG results of 60 patients without myocardial infarction complaining of chest pain were submitted to 6 physicians (3 cardiologists and 3 noncardiologists) who were unaware of the angiographic findings. The physicians were requested to estimate the probability of coronary artery disease present in percentages and to assess the need for coronary angiography on a five-point scale (1 . definitely not indicated, 5 . definitely indicated). After obtaining the results of thallium-201 imaging following dipyridamole (0.50 mg/kg intravenously) administration, the physicians were again requested to estimate probability and need for angiography. In the 43 patients with coronary artery disease the judgment of probability was increased significantly after /sup 201/Tl from 75.6 +/- 20.2% to 82.9 +/- 23.2% (p less than 0.001) and the need for angiography from 4.3 +/- 0.9% to 4.5 +/- 0.9% (p less than 0.001). In the subgroup of patients with atypical angina the relative change in probability was higher than in other subgroups of patients with coronary artery disease. In the 17 patients with normal coronary arteries the probability estimation fell after /sup 201/Tl from 36.7 +/- 22.0% to 24.8 +/- 21.0% (p less than 0.001), the need for angiography was decreased from 2.7 +/- 1.1% to 2.2 +/- 1.2% (p less than 0.001). With the /sup 201/Tl information, cardiologists performed a better diagnostic differentiation of patients with and without coronary artery disease than noncardiologists. The study demonstrates the improvement of clinical diagnosis in patients with chest pain by thallium-201 imaging and confirms the favorable influence of the method on the management of the patients in terms of indications for coronary angiography.

  17. The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes.

    PubMed

    Georgiopoulos, Charalampos; Davidsson, Anette; Engström, Maria; Larsson, Elna-Marie; Zachrisson, Helene; Dizdar, Nil

    2015-09-01

    The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinson's disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand (123)I-FP-CIT (DaTSCAN(®)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75%) had visually predominant dopamine depletion in putamen, while most APS patients (56%) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately. PMID:26122543

  18. Imaging-Based Patient Selection and Endovascular Therapy of Ischemic Stroke

    PubMed Central

    Zheng, Fanfan; Xie, Wuxiang

    2015-01-01

    Abstract The positive results of recent trials for the treatment of acute ischemic stroke have highlighted the importance of imaging selection before endovascular therapy. We performed a stratified meta-analysis to confirm this new understanding. We searched EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov in April 2015 for randomized controlled trials evaluating the effect of endovascular treatment in patients with acute ischemic stroke. The meta-analysis was stratified by whether computed tomographic angiography (CTA) was used to select patients. Outcome data were pooled using fixed-effects models. Seven randomized controlled trials with 2217 patients were included in this study. Endovascular therapy significantly increased the rate of 90-day functional independence (a modified Rankin score of 0–2) in patients with a CTA-confirmed large-vessel occlusion (relative risk [RR] = 1.75, 95% confidence interval [CI]: 1.48–2.06, I2?=?0.0%), and reduced 90-day mortality in patients with occlusion stroke with a small ischemic core (RR?=?0.58, 95% CI: 0.37–0.89, I2?=?0.0%). The functional benefit was significantly greater in patients with CTA-based selection than in those without (Z?=?5.04, P?patients with a large-vessel occlusion and a small ischemic core than in those without CTA-based selection (Z?=?2.04, P?=?0.041). There was no evidence of between-study heterogeneity or publication bias. This meta-analysis showed the effect of vascular imaging on identifying patients with acute ischemic stroke with a proximal vessel occlusion and a small ischemic core, who would benefit from endovascular therapy. PMID:26402810

  19. Nuclear Medicine Imaging of Infection in Cancer Patients (With Emphasis on FDG-PET)

    PubMed Central

    Vos, Fidel J.; van der Graaf, Winette T.A.; Oyen, Wim J.G.

    2011-01-01

    Infections are a common cause of death and an even more common cause of morbidity in cancer patients. Timely and adequate diagnosis of infection is very important. This article provides clinicians as well as nuclear medicine specialists with a concise summary of the most important and widely available nuclear medicine imaging techniques for infectious and inflammatory diseases in cancer patients with an emphasis on fluorodeoxyglucose positron emission tomography (FDG-PET). 67Ga-citrate has many unfavorable characteristics, and the development of newer radiopharmaceuticals has resulted in the replacement of 67Ga-citrate scintigraphy by scintigraphy with labeled leukocytes or FDG-PET for the majority of conditions. The sensitivity of labeled leukocyte scintigraphy in non-neutropenic cancer patients is comparable with that in patients without malignancy. The specificity, however, is lower because of the uptake of labeled leukocytes in many primary tumors and metastases, most probably as a result of their inflammatory component. In addition, labeled leukocyte scintigraphy cannot be used for febrile neutropenia because of the inability to harvest sufficient peripheral leukocytes for in vitro labeling. FDG-PET has several advantages over these conventional scintigraphic techniques. FDG-PET has shown its usefulness in diagnosing septic thrombophlebitis in cancer patients. It has also been shown that imaging of infectious processes using FDG-PET is possible in patients with severe neutropenia. Although larger prospective studies examining the value of FDG-PET in cancer patients suspected of infection, especially in those with febrile neutropenia, are needed, FDG-PET appears to be the most promising scintigraphic technique for the diagnosis of infection in this patient group. PMID:21680576

  20. Using patient-specific phantoms to evaluate deformable image registration algorithms for adaptive radiation therapy.

    PubMed

    Stanley, Nick; Glide-Hurst, Carri; Kim, Jinkoo; Adams, Jeffrey; Li, Shunshan; Wen, Ning; Chetty, Indrin J; Zhong, Hualiang

    2013-01-01

    The quality of adaptive treatment planning depends on the accuracy of its underlying deformable image registration (DIR). The purpose of this study is to evaluate the performance of two DIR algorithms, B-spline-based deformable multipass (DMP) and deformable demons (Demons), implemented in a commercial software package. Evaluations were conducted using both computational and physical deformable phantoms. Based on a finite element method (FEM), a total of 11 computational models were developed from a set of CT images acquired from four lung and one prostate cancer patients. FEM generated displacement vector fields (DVF) were used to construct the lung and prostate image phantoms. Based on a fast-Fourier transform technique, image noise power spectrum was incorporated into the prostate image phantoms to create simulated CBCT images. The FEM-DVF served as a gold standard for verification of the two registration algorithms performed on these phantoms. The registration algorithms were also evaluated at the homologous points quantified in the CT images of a physical lung phantom. The results indicated that the mean errors of the DMP algorithm were in the range of 1.0 ~ 3.1 mm for the computational phantoms and 1.9 mm for the physical lung phantom. For the computational prostate phantoms, the corresponding mean error was 1.0-1.9 mm in the prostate, 1.9-2.4mm in the rectum, and 1.8-2.1 mm over the entire patient body. Sinusoidal errors induced by B-spline interpolations were observed in all the displacement profiles of the DMP registrations. Regions of large displacements were observed to have more registration errors. Patient-specific FEM models have been developed to evaluate the DIR algorithms implemented in the commercial software package. It has been found that the accuracy of these algorithms is patient dependent and related to various factors including tissue deformation magnitudes and image intensity gradients across the regions of interest. This may suggest that DIR algorithms need to be verified for each registration instance when implementing adaptive radiation therapy. PMID:24257278

  1. Using patient-specific phantoms to evaluate deformable image registration algorithms for adaptive radiation therapy

    PubMed Central

    Stanley, Nick; Glide-Hurst, Carri; Kim, Jinkoo; Adams, Jeffrey; Li, Shunshan; Wen, Ning; Chetty, Indrin J.; Zhong, Hualiang

    2014-01-01

    The quality of adaptive treatment planning depends on the accuracy of its underlying deformable image registration (DIR). The purpose of this study is to evaluate the performance of two DIR algorithms, B-spline–based deformable multipass (DMP) and deformable demons (Demons), implemented in a commercial software package. Evaluations were conducted using both computational and physical deformable phantoms. Based on a finite element method (FEM), a total of 11 computational models were developed from a set of CT images acquired from four lung and one prostate cancer patients. FEM generated displacement vector fields (DVF) were used to construct the lung and prostate image phantoms. Based on a fast-Fourier transform technique, image noise power spectrum was incorporated into the prostate image phantoms to create simulated CBCT images. The FEM-DVF served as a gold standard for verification of the two registration algorithms performed on these phantoms. The registration algorithms were also evaluated at the homologous points quantified in the CT images of a physical lung phantom. The results indicated that the mean errors of the DMP algorithm were in the range of 1.0 ~ 3.1 mm for the computational phantoms and 1.9 mm for the physical lung phantom. For the computational prostate phantoms, the corresponding mean error was 1.0–1.9 mm in the prostate, 1.9–2.4 mm in the rectum, and 1.8–2.1 mm over the entire patient body. Sinusoidal errors induced by B-spline interpolations were observed in all the displacement profiles of the DMP registrations. Regions of large displacements were observed to have more registration errors. Patient-specific FEM models have been developed to evaluate the DIR algorithms implemented in the commercial software package. It has been found that the accuracy of these algorithms is patient-dependent and related to various factors including tissue deformation magnitudes and image intensity gradients across the regions of interest. This may suggest that DIR algorithms need to be verified for each registration instance when implementing adaptive radiation therapy. PMID:24257278

  2. [Towards a personalized digital patient for diagnosis and therapy guided by image].

    PubMed

    Ayache, Nicholas; Clatz, Olivier; Delingette, Hervé; Malandain, Grégoire; Pennec, Xavier; Sermesant, Maxime

    2011-02-01

    Recent advances in computer science and medical imaging allow the design of new computational models of the patient which are used to assist physicians. These models, whose parameters are optimized to fit in vivo acquired images, from cells to an entire body, are designed to better quantify the observations (computer aided diagnosis), to simulate the evolution of a pathology (computer aided prognosis), to plan and simulate an intervention to optimize its effects (computer aided therapy), therefore addressing some of the major challenges of medicine of 21(st) century. PMID:21382332

  3. Integration of patient specific modeling and advanced image processing techniques for image-guided neurosurgery

    NASA Astrophysics Data System (ADS)

    Archip, Neculai; Fedorov, Andriy; Lloyd, Bryn; Chrisochoides, Nikos; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.

    2006-03-01

    A major challenge in neurosurgery oncology is to achieve maximal tumor removal while avoiding postoperative neurological deficits. Therefore, estimation of the brain deformation during the image guided tumor resection process is necessary. While anatomic MRI is highly sensitive for intracranial pathology, its specificity is limited. Different pathologies may have a very similar appearance on anatomic MRI. Moreover, since fMRI and diffusion tensor imaging are not currently available during the surgery, non-rigid registration of preoperative MR with intra-operative MR is necessary. This article presents a translational research effort that aims to integrate a number of state-of-the-art technologies for MRI-guided neurosurgery at the Brigham and Women's Hospital (BWH). Our ultimate goal is to routinely provide the neurosurgeons with accurate information about brain deformation during the surgery. The current system is tested during the weekly neurosurgeries in the open magnet at the BWH. The preoperative data is processed, prior to the surgery, while both rigid and non-rigid registration algorithms are run in the vicinity of the operating room. The system is tested on 9 image datasets from 3 neurosurgery cases. A method based on edge detection is used to quantitatively validate the results. 95% Hausdorff distance between points of the edges is used to estimate the accuracy of the registration. Overall, the minimum error is 1.4 mm, the mean error 2.23 mm, and the maximum error 3.1 mm. The mean ratio between brain deformation estimation and rigid alignment is 2.07. It demonstrates that our results can be 2.07 times more precise then the current technology. The major contribution of the presented work is the rigid and non-rigid alignment of the pre-operative fMRI with intra-operative 0.5T MRI achieved during the neurosurgery.

  4. Expanding the Universe

    NASA Astrophysics Data System (ADS)

    Sterken, Christiaan; Leedjärv, Laurits; Tempel, Elmo

    2011-12-01

    Proceedings of the International Conference EXPANDING THE UNIVERSE, On the occasion of the 200th anniversary of the Tartu Observatory, Tartu, Estonia 2011 April 27-29. C. Sterken, L. Leedjarv, E. Tempel (Eds.)

  5. The expandable network disk

    E-print Network

    Muthitacharoen, Athicha, 1976-

    2008-01-01

    This thesis presents a virtual disk cluster called END, the Expandable Network Disk. END aggregates storage on a cluster of servers into a single virtual disk. END's main goals are to offer good performance during normal ...

  6. Problem-centric Organization and Visualization of Patient Imaging and Clinical Data

    PubMed Central

    Bashyam, Vijayaraghavan; Hsu, William; Watt, Emily; Bui, Alex A. T.; Kangarloo, Hooshang; Taira, Ricky K.

    2009-01-01

    A patient’s electronic medical record contains a large amount of unstructured textual information. As patient records become increasingly dense owing to an aging population and increased occurrence of chronic diseases, a tool is needed to help organize and navigate patient data in a way that facilitates a clinician’s ability to understand this information and that improves efficiency. A system has been developed for physicians that summarizes clinical information from a patient record. This system provides a gestalt view of the patient’s record by organizing information about each disease along four dimensions (axes): time (eg, disease progression over time), space (eg, tumor in left frontal lobe), existence (eg, certainty of existence of a finding), and causality (eg, response to treatment). A display is generated from information provided by radiology reports and discharge summaries. Natural language processing is used to identify clinical abnormalities (problems, symptoms, findings) from these reports as well as associated properties and relationships. This information is presented in an integrated format that organizes extracted findings into a problem list, depicts the information on a timeline grid, and provides direct access to relevant reports and images. The goal of this system is to improve the structure of clinical information and its presentation to the physician, thereby simplifying the information retrieval and knowledge discovery necessary to bridge the gap between acquiring raw data and making an informed diagnosis. © RSNA, 2009 PMID:19168763

  7. A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms

    PubMed Central

    Winchester, David E.; Zhang, Pengcheng; Jadhav, Manoj P.; Beyth, Rebecca J.

    2015-01-01

    Abstract Myocardial perfusion imaging (MPI) is commonly used to detect ischemia. Concerns about silent ischemia may encourage orders for MPI in asymptomatic patients. Factors contributing to this practice are poorly described and the clinical utility is questionable. We conducted a single center retrospective cohort investigation on Veterans who underwent MPI between December 2010 and July 2011. We gathered data on symptoms, baseline characteristics, results of MPI, and cardiovascular events within 1 year. MPI were categorized using 2009 appropriate use criteria (AUC). Of 592 patients, 127 (21.5%) had no symptoms at the time of MPI. Comparing symptomatic and asymptomatic patients, no differences were observed in baseline characteristics except abnormal ECG, more common in asymptomatic patients (n?=?86, 67.7% vs. n?=?232, 49.9% for symptomatic patients, P?patients with and without symptoms was not different (P?=?0.86); however, among asymptomatic MPI that also demonstrated ischemia, none were inappropriate (n?=?10 appropriate, n?=?7 uncertain). In multivariate regression, 2 factors were associated with asymptomatic status, abnormal ECG (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.5–3.49) and age over the median (OR 0.63, 95% CI: 0.41–0.95). A substantial portion of MPI tests are ordered for patients without symptoms. When compared to symptomatic patients, MPI for asymptomatic patient were more commonly inappropriate; however, the prevalence of ischemia was similar. MPI may be clinically relevant in some asymptomatic patients and decisions to test should be based on the AUC. PMID:26266347

  8. Dosimetry and Image Quality in Control Studies in Computerised Tomography Realized to Paediatric Patients

    SciTech Connect

    Hernandez, M. R.; Gamboa-deBuen, I.; Dies, P.; Rickards, J.; Ruiz, C.

    2008-08-11

    Computerised tomography (CT) is a favourite method of medical diagnosis. Its use has thus increased rapidly throughout the world, particularly in studies relating to children. However to avoid administering unnecessarily high doses of radiation to paediatric patients it is important to have correct dose reference levels to minimize risk. The research is being developed within the public health sector at the Hospital Infantil de Mexico 'Dr. Federico Gomez.' We measured the entrance surface air kerma (K{sub P}) in paediatric patients, during the radiological studies of control in CT (studies of head, thorax and abdomen). Phantom was used to evaluate image quality as the tomograph requires a high resolution image in order to operate at its optimum level.

  9. The role of multimodality imaging in the selection of patients for aortic valve repair.

    PubMed

    Regeer, Madelien V; Versteegh, Michel I M; Marsan, Nina Ajmone; Bax, Jeroen J; Delgado, Victoria

    2016-01-01

    Aortic valve sparing surgery for aortic regurgitation and/or aortopathy serves as an alternative to aortic valve and root replacement. One of the advantages of aortic valve sparing surgery over conventional replacement is that there is no need for life-long anticoagulation, which is particularly attractive in young patients who may receive a mechanical prosthesis otherwise. However, successful aortic valve repair requires high expertise. At present, reparability is determined intraoperatively by direct surgical inspection. Preoperative imaging techniques might improve the patient selection for aortic valve repair. The mechanism of aortic regurgitation, aortic valve morphology and calcification and aortic root dimensions are all of importance when aortic valve repair is considered. The present review focuses on the role of imaging techniques in determining aortic valve reparability. PMID:26536524

  10. Dosimetry and Image Quality in Control Studies in Computerised Tomography Realized to Paediatric Patients

    NASA Astrophysics Data System (ADS)

    Hernández, M. R.; Dies, P.; Gamboa-deBuen, I.; Rickards, J.; Ruiz, C.

    2008-08-01

    Computerised tomography (CT) is a favourite method of medical diagnosis. Its use has thus increased rapidly throughout the world, particularly in studies relating to children. However to avoid administering unnecessarily high doses of radiation to paediatric patients it is important to have correct dose reference levels to minimize risk. The research is being developed within the public health sector at the Hospital Infantil de México "Dr. Federico Gómez." We measured the entrance surface air kerma (KP) in paediatric patients, during the radiological studies of control in CT (studies of head, thorax and abdomen). Phantom was used to evaluate image quality as the tomograph requires a high resolution image in order to operate at its optimum level.

  11. Image-based reconstruction of 3D myocardial infarct geometry for patient specific applications

    NASA Astrophysics Data System (ADS)

    Ukwatta, Eranga; Rajchl, Martin; White, James; Pashakhanloo, Farhad; Herzka, Daniel A.; McVeigh, Elliot; Lardo, Albert C.; Trayanova, Natalia; Vadakkumpadan, Fijoy

    2015-03-01

    Accurate reconstruction of the three-dimensional (3D) geometry of a myocardial infarct from two-dimensional (2D) multi-slice image sequences has important applications in the clinical evaluation and treatment of patients with ischemic cardiomyopathy. However, this reconstruction is challenging because the resolution of common clinical scans used to acquire infarct structure, such as short-axis, late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) images, is low, especially in the out-of-plane direction. In this study, we propose a novel technique to reconstruct the 3D infarct geometry from low resolution clinical images. Our methodology is based on a function called logarithm of odds (LogOdds), which allows the broader class of linear combinations in the LogOdds vector space as opposed to being limited to only a convex combination in the binary label space. To assess the efficacy of the method, we used high-resolution LGE-CMR images of 36 human hearts in vivo, and 3 canine hearts ex vivo. The infarct was manually segmented in each slice of the acquired images, and the manually segmented data were downsampled to clinical resolution. The developed method was then applied to the downsampled image slices, and the resulting reconstructions were compared with the manually segmented data. Several existing reconstruction techniques were also implemented, and compared with the proposed method. The results show that the LogOdds method significantly outperforms all the other tested methods in terms of region overlap.

  12. Image-based Reconstruction of 3D Myocardial Infarct Geometry for Patient Specific Applications

    PubMed Central

    Ukwatta, Eranga; Rajchl, Martin; White, James; Pashakhanloo, Farhad; Herzka, Daniel A.; McVeigh, Elliot; Lardo, Albert C.; Trayanova, Natalia; Vadakkumpadan, Fijoy

    2015-01-01

    Accurate reconstruction of the three-dimensional (3D) geometry of a myocardial infarct from two-dimensional (2D) multi-slice image sequences has important applications in the clinical evaluation and treatment of patients with ischemic cardiomyopathy. However, this reconstruction is challenging because the resolution of common clinical scans used to acquire infarct structure, such as short-axis, late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) images, is low, especially in the out-of-plane direction. In this study, we propose a novel technique to reconstruct the 3D infarct geometry from low resolution clinical images. Our methodology is based on a function called logarithm of odds (LogOdds), which allows the broader class of linear combinations in the LogOdds vector space as opposed to being limited to only a convex combination in the binary label space. To assess the efficacy of the method, we used high-resolution LGE-CMR images of 36 human hearts in vivo, and 3 canine hearts ex vivo. The infarct was manually segmented in each slice of the acquired images, and the manually segmented data were downsampled to clinical resolution. The developed method was then applied to the downsampled image slices, and the resulting reconstructions were compared with the manually segmented data. Several existing reconstruction techniques were also implemented, and compared with the proposed method. The results show that the LogOdds method significantly outperforms all the other tested methods in terms of region overlap. PMID:26633913

  13. Three-dimensional left ventricular segmentation from magnetic resonance imaging for patient-specific modelling purposes

    PubMed Central

    Caiani, Enrico G.; Colombo, Andrea; Pepi, Mauro; Piazzese, Concetta; Maffessanti, Francesco; Lang, Roberto M.; Carminati, Maria Chiara

    2014-01-01

    Aims To propose a nearly automated left ventricular (LV) three-dimensional (3D) surface segmentation procedure, based on active shape modelling (ASM) and built on a database of 3D echocardiographic (3DE) LV surfaces, for cardiac magnetic resonance (CMR) images, and to test its accuracy for LV volumes computation compared with ‘gold standard’ manual tracings and discs-summation method. Methods and results The ASM was created based on segmented LV surfaces (4D LV analysis, Tomtec) from 3DE datasets of 205 patients. Then, it was applied to the cardiac magnetic resonance imaging short-axis (SAX) images stack of 12 consecutive patients. After proper realignment using two- and four-chambers CMR long-axis views both as reference and for initializing LV apex and base (six points in total), the ASM was iteratively and automatically updated to match the information of all the SAX planes contemporaneously, resulting in an endocardial LV 3D mesh from which volume was directly derived. The same CMR images were analysed by an experienced cardiologist to derive end-diastolic and end-systolic volumes. Linear correlation and Bland–Altman analyses were applied vs. the manual ‘gold standard’. Active shape modelling results showed high correlations with manual values both for LV volumes (r2 > 0.98) and ejection fraction (EF) (r2 > 0.90), non-significant biases and narrow limits of agreement. Conclusion The proposed method resulted in accurate detection of 3D LV endocardial surfaces, which lead to fast and reliable measurements of LV volumes and EF when compared with manual tracing of CMR SAX images. The segmented 3D mesh, including a realistic LV apex and base, could constitute a novel starting point for more realistic patient-specific finite element modelling. PMID:25362176

  14. Clinical Application of Magnetic Resonance Imaging in Management of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

    PubMed Central

    Chen, Jeon-Hor

    2013-01-01

    Neoadjuvant chemotherapy (NAC), also termed primary, induction, or preoperative chemotherapy, is traditionally used to downstage inoperable breast cancer. In recent years it has been increasingly used for patients who have operable cancers in order to facilitate breast-conserving surgery, achieve better cosmetic outcome, and improve prognosis by reaching pathologic complete response (pCR). Many studies have demonstrated that magnetic resonance imaging (MRI) can assess residual tumor size after NAC, and that provides critical information for planning of the optimal surgery. NAC also allows for timely adjustment of administered drugs based on response, so ineffective regimens could be terminated early to spare patients from unnecessary toxicity while allowing other effective regimens to work sooner. This review article summarizes the clinical application of MRI during NAC. The use of different MR imaging methods, including dynamic contrast-enhanced MRI, proton MR spectroscopy, and diffusion-weighted MRI, to monitor and evaluate the NAC response, as well as how changes of parameters measured at an early time after initiation of a drug regimen can predict final treatment outcome, are reviewed. MRI has been proven a valuable tool and will continue to provide important information facilitating individualized image-guided treatment and personalized management for breast cancer patients undergoing NAC. PMID:23862143

  15. Diffusion tensor imaging and white matter abnormalities in patients with disorders of consciousness

    PubMed Central

    Cavaliere, Carlo; Aiello, Marco; Di Perri, Carol; Fernandez-Espejo, Davinia; Owen, Adrian M.; Soddu, Andrea

    2015-01-01

    Progress in neuroimaging has yielded new powerful tools which, potentially, can be applied to clinical populations, improve the diagnosis of neurological disorders and predict outcome. At present, the diagnosis of consciousness disorders is limited to subjective assessment and objective measurements of behavior, with an emerging role for neuroimaging techniques. In this review we focus on white matter alterations measured using Diffusion Tensor Imaging on patients with consciousness disorders, examining the most common diffusion imaging acquisition protocols and considering the main issues related to diffusion imaging analyses. We conclude by considering some of the remaining challenges to overcome, the existing knowledge gaps and the potential role of neuroimaging in understanding the pathogenesis and clinical features of disorders of consciousness. PMID:25610388

  16. Patient dosimetry for 90Y selective internal radiation treatment based on 90Y PET imaging.

    PubMed

    Ng, Sherry C; Lee, Victor H; Law, Martin W; Liu, Rico K; Ma, Vivian W; Tso, Wai Kuen; Leung, To Wai

    2013-01-01

    Until recently, the radiation dose to patients undergoing the 90Y selective internal radiation treatment (SIRT) procedure is determined by applying the partition model to 99mTc MAA pretreatment scan. There can be great uncertainty in radiation dose calculated from this approach and we presented a method to compute the 3D dose distributions resulting from 90Y SIRT based on 90Y positron emission tomography (PET) imaging. Five 90Y SIRT treatments were retrospectively analyzed. After 90Y SIRT, patients had 90Y PET/CT imaging within 6 hours of the procedure. To obtain the 3D dose distribution of the patients, their respective 90Y PET images were convolved with a Monte Carlo generated voxel dose kernel. The sensitivity of the PET/CT scanner for 90Y was determined through phantom studies. The 3D dose distributions were then presented in DICOM RT dose format. By applying the linear quadratic model to the dose data, we derived the biologically effective dose and dose equivalent to 2 Gy/fraction delivery, taking into account the spatial and temporal dose rate variations specific for SIRT. Based on this data, we intend to infer tumor control probability and risk of radiation induced liver injury from SIRT by comparison with established dose limits. For the five cases, the mean dose to target ranged from 51.7 ± 28.6 Gy to 163 ± 53.7 Gy. Due to the inhomogeneous nature of the dose distribution, the GTVs were not covered adequately, leading to very low values of tumor control probability. The mean dose to the normal liver ranged from 21.4 ± 30.7 to 36.7 ± 25.9 Gy. According to QUANTEC recommendation, a patient with primary liver cancer and a patient with metastatic liver cancer has more than 5% risk of radiotherapy-induced liver disease (RILD). PMID:24036875

  17. A phantom evaluation of a stereo-vision surface imaging system for radiotherapy patient setup

    SciTech Connect

    Bert, Christoph; Metheany, Katherine G.; Doppke, Karen; Chen, George T.Y.

    2005-09-15

    External beam irradiation requires precise positioning of the target relative to the treatment planning coordinate system. A three-dimensional (3D) surface imaging system for patient positioning has recently been installed in one of our linear accelerator (linac) rooms. The device utilizes close-range photogrammetry to generate a 3D model of the patient's surface. This geometric model can be made to look like a digital camera image if wrapped with a gray-level image (texture mapping) that shows surface coloration. The system is calibrated to the linac coordinate system and has been designed as a patient setup device. To reproduce patient position in fractionated radiotherapy, the daily patient surface model is registered to a previously recorded reference surface. Using surface registration, the system calculates the rigid-body transformation that minimizes the distance between the treatment and the reference surface models in a region-of-interest (ROI). This transformation is expressed as a set of new couch coordinates at which the patient position best matches with the reference data. If respiratory motion is a concern, the surface can be obtained with a gated acquisition at a specified phase of the respiratory cycle. To analyze the accuracy of the system, we performed several experiments with phantoms to assess stability, alignment accuracy, precision of the gating function, and surface topology. The reproducibility of surface measurements was tested for periods up to 57 h. Each recorded frame was registered to the reference surface to calculate the required couch adjustment. The system stability over this time period was better than 0.5 mm. To measure the accuracy of the system to detect and quantify patient shift relative to a reference image, we compared the shift detected by the surface imaging system with known couch transitions in a phantom study. The maximum standard deviation was 0.75 mm for the three translational degrees of freedom, and less than 0.1 deg. for each rotation. Surface model precision was tested against computed tomography (CT)-derived surface topology. The root-mean-square rms of the distance between the surfaces was 0.65 mm, excluding regions where beam hardening caused artifacts in the CT data. Measurements were made to test the gated acquisition mode. The time-dependent amplitude was measured with the surface imaging system and an established respiratory gating system based on infrared (IR)-marker detection. The measured motion trajectories from both systems were compared to the known trajectory of the stage. The standard deviations of the amplitude differences to the motor trajectory were 0.04 and 0.15 mm for the IR-marker system and the 3D surface imaging system, respectively. A limitation of the surface-imaging device is the frame rate of 6.5 Hz, because rapid changes of the motion trajectory cannot be detected. In conclusion, the system is accurate and sufficiently stable to be used in the clinic. The errors computed when comparing the surface model with CT geometry were submillimeter, and deviations in the alignment and gating-signal tests were of the same magnitude.

  18. Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with diabetic retinopathy

    PubMed Central

    Price, Liam D; Au, Stephanie; Chong, N Victor

    2015-01-01

    Purpose To compare diabetic retinopathy (DR) severity grading between Optomap ultrawide field scanning laser ophthalmoscope (UWFSLO) 200° images and an Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard field view. Methods Optomap UWFSLO images (total: 266) were retrospectively selected for evidence of DR from a database of eye clinic attendees. The Optomap UWFSLO images were graded for DR severity by two masked assessors. An ETDRS seven-field mask was overlaid on the Optomap UWFSLO images, and the DR grade was assessed for the region inside the mask. Any interassessor discrepancies were adjudicated by a senior retinal specialist. Kappa agreement levels were used for statistical analysis. Results Fifty images (19%) (P<0.001) were assigned a higher DR level in the Optomap UWFSLO view compared to the ETDRS seven-field view, which resulted in 40 images (15%) (P<0.001) receiving a higher DR severity grade. DR severity grades in the ETDRS seven-field view compared with the Optomap UWFSLO view were identical in 85% (226) of the images and within one severity level in 100% (266) of the images. Agreement between the two views was substantial: unweighted ? was 0.74±0.04 (95% confidence interval: 0.67–0.81) and weighted ? was 0.80±0.03 (95% confidence interval: 0.74–0.86). Conclusion Compared to the ETDRS seven-field view, a significant minority of patients are diagnosed with more severe DR when using the Optomap UWFSLO view. The clinical significance of additional peripheral lesions requires evaluation in future prospective studies using large cohorts. PMID:25848202

  19. SU-E-T-387: Achieving Optimal Patient Setup Imaging and Treatment Workflow Configurations in Multi-Room Proton Centers

    SciTech Connect

    Zhang, H; Prado, K; Langen, K; Yi, B; Mehta, M; Regine, W; D'Souza, W

    2014-06-01

    Purpose: To simulate patient flow in proton treatment center under uncertainty and to explore the feasibility of treatment preparation rooms to improve patient throughput and cyclotron utilization. Methods: Three center layout scenarios were modeled: (S1: In-Tx room imaging) patient setup and imaging (planar/volumetric) performed in treatment room, (S2: Patient setup in preparation room) each treatment room was assigned with preparation room(s) that was equipped with lasers only for patient setup and gross patient alignment, and (S3: Patient setup and imaging in preparation room) preparation room(s) was equipped with laser and volumetric imaging for patient setup, gross and fine patient alignment. A 'snap' imaging was performed in treatment room. For each scenario, the number of treatment rooms and the number of preparation rooms serving each treatment room were varied. We examined our results (average of 100 16-hour (two shifts) working days) by evaluating patient throughput and cyclotron utilization. Results: When the number of treatment rooms increased ([from, to]) [1, 5], daily patient throughput increased [32, 161], [29, 184] and [27, 184] and cyclotron utilization increased [13%, 85%], [12%, 98%], and [11%, 98%] for scenarios S1, S2 and S3 respectively. However, both measures plateaued after 4 rooms. With the preparation rooms, the throughput and the cyclotron utilization increased by 14% and 15%, respectively. Three preparation rooms were optimal to serve 1-3 treatment rooms and two preparation rooms were optimal to serve 4 or 5 treatment rooms. Conclusion: Patient preparation rooms for patient setup may increase throughput and decrease the need for additional treatment rooms (cost effective). Optimal number of preparation rooms serving each gantry room varies as a function of treatment rooms and patient setup scenarios. A 5th treatment room may not be justified by throughput or utilization.

  20. MO-G-17A-07: Improved Image Quality in Brain F-18 FDG PET Using Penalized-Likelihood Image Reconstruction Via a Generalized Preconditioned Alternating Projection Algorithm: The First Patient Results

    SciTech Connect

    Schmidtlein, CR; Beattie, B; Humm, J; Li, S; Wu, Z; Xu, Y; Zhang, J; Shen, L; Vogelsang, L; Feiglin, D; Krol, A

    2014-06-15

    Purpose: To investigate the performance of a new penalized-likelihood PET image reconstruction algorithm using the 1{sub 1}-norm total-variation (TV) sum of the 1st through 4th-order gradients as the penalty. Simulated and brain patient data sets were analyzed. Methods: This work represents an extension of the preconditioned alternating projection algorithm (PAPA) for emission-computed tomography. In this new generalized algorithm (GPAPA), the penalty term is expanded to allow multiple components, in this case the sum of the 1st to 4th order gradients, to reduce artificial piece-wise constant regions (“staircase” artifacts typical for TV) seen in PAPA images penalized with only the 1st order gradient. Simulated data were used to test for “staircase” artifacts and to optimize the penalty hyper-parameter in the root-mean-squared error (RMSE) sense. Patient FDG brain scans were acquired on a GE D690 PET/CT (370 MBq at 1-hour post-injection for 10 minutes) in time-of-flight mode and in all cases were reconstructed using resolution recovery projectors. GPAPA images were compared PAPA and RMSE-optimally filtered OSEM (fully converged) in simulations and to clinical OSEM reconstructions (3 iterations, 32 subsets) with 2.6 mm XYGaussian and standard 3-point axial smoothing post-filters. Results: The results from the simulated data show a significant reduction in the 'staircase' artifact for GPAPA compared to PAPA and lower RMSE (up to 35%) compared to optimally filtered OSEM. A simple power-law relationship between the RMSE-optimal hyper-parameters and the noise equivalent counts (NEC) per voxel is revealed. Qualitatively, the patient images appear much sharper and with less noise than standard clinical images. The convergence rate is similar to OSEM. Conclusions: GPAPA reconstructions using the 1{sub 1}-norm total-variation sum of the 1st through 4th-order gradients as the penalty show great promise for the improvement of image quality over that currently achieved with clinical OSEM reconstructions.

  1. Radionuclide Imaging of Cardiovascular Infection.

    PubMed

    Ahmed, Fozia Zahir; James, Jackie; Memmott, Matthew J; Arumugam, Parthiban

    2016-02-01

    Owing to expanding clinical indications, cardiac implantable electronic devices (CIEDs) are being increasingly used. Despite improved surgical techniques and the use of prophylactic antimicrobial therapy, the rate of CIED-related infection is also increasing. Infection is a potentially serious complication, with clinical manifestations ranging from surgical site infection and local symptoms in the region of the generator pocket to fulminant endocarditis. The utility of radionuclide imaging as a stand-alone noninvasive diagnostic imaging test in patients with suspected endocarditis has been less frequently examined. This article summarizes the recent advances in radionuclide imaging for evaluation of patients with suspected cardiovascular infections. PMID:26590786

  2. Motor co-activation in siblings of patients with juvenile myoclonic epilepsy: an imaging endophenotype?

    PubMed Central

    Wandschneider, Britta; Centeno, Maria; Vollmar, Christian; Symms, Mark; Thompson, Pamela J.; Duncan, John S.

    2014-01-01

    Juvenile myoclonic epilepsy is a heritable idiopathic generalized epilepsy syndrome, characterized by myoclonic jerks and frequently triggered by cognitive effort. Impairment of frontal lobe cognitive functions has been reported in patients with juvenile myoclonic epilepsy and their unaffected siblings. In a recent functional magnetic resonance imaging study we reported abnormal co-activation of the motor cortex and increased functional connectivity between the motor system and prefrontal cognitive networks during a working memory paradigm, providing an underlying mechanism for cognitively triggered jerks. In this study, we used the same task in 15 unaffected siblings (10 female; age range 18–65 years, median 40) of 11 of those patients with juvenile myoclonic epilepsy (six female; age range 22–54 years, median 35) and compared functional magnetic resonance imaging activations with 20 age- and gender-matched healthy control subjects (12 female; age range 23–46 years, median 30.5). Unaffected siblings showed abnormal primary motor cortex and supplementary motor area co-activation with increasing cognitive load, as well as increased task-related functional connectivity between motor and prefrontal cognitive networks, with a similar pattern to patients (P < 0.001 uncorrected; 20-voxel threshold extent). This finding in unaffected siblings suggests that altered motor system activation and functional connectivity is not medication- or seizure-related, but represents a potential underlying mechanism for impairment of frontal lobe functions in both patients and siblings, and so constitutes an endophenotype of juvenile myoclonic epilepsy. PMID:25001494

  3. Elderly depression diagnostic of diabetic patients by brain tissue pulsatility imaging

    NASA Astrophysics Data System (ADS)

    Hachemi, Mélouka Elkateb; Remeniéras, Jean-pierre; Desmidt, Thomas; Camus, Vincent; Tranquart, François

    2010-01-01

    Pulsatile motion of brain parenchyma results from cardiac and breathing cycles and consists in a rapid displacement in systole, with slow diastolic recovery. Based on the vascular depression concept and recent studies where a correlation was found between cerebral haemodynamics and depression in the elderly, we emitted the hypothesis that tissue brain motion due to perfusion is correlated to elderly depression associated with cardiovascular risk factors. Tissue Pulsatlity Imaging (TPI) is a new ultrasound technique developed firstly at the University of Washington to assess the brain tissue motion. We used TPI technique to measure the brain displacement of two groups of elderly patients with diabetes as a vascular risk factor. The first group is composed of 11 depressed diabetic patients. The second group is composed of 12 diabetic patients without depressive symptoms. Transcranial acquisitions were performed with a 1.8 MHz ultrasound phased array probe through the right temporal bone window. The acquisition of six cardiac cycles was realized on each patient with a frame rate of 23 frames/s. Displacements estimation was performed by off-line analysis. A significant decrease in brain pulsatility was observed in the group of depressed patients compared to the group of non depressed patients. Mean displacement magnitude was about 44±7 ?m in the first group and 68±13 ?m in the second group.

  4. Schizophrenia patients differentiation based on MR vascular perfusion and volumetric imaging

    NASA Astrophysics Data System (ADS)

    Spanier, A. B.; Joskowicz, L.; Moshel, S.; Israeli, D.

    2015-03-01

    Candecomp/Parafac Decomposition (CPD) has emerged as a framework for modeling N-way arrays (higher-order matrices). CPD is naturally well suited for the analysis of data sets comprised of observations of a function of multiple discrete indices. In this study we evaluate the prospects of using CPD for modeling MRI brain properties (i.e. brain volume and gray-level) for schizophrenia diagnosis. Taking into account that 3D imaging data consists of millions of pixels per patient, the diagnosis of a schizophrenia patient based on pixel analysis constitutes a methodological challenge (e.g. multiple comparison problem). We show that the CPD could potentially be used as a dimensionality redaction method and as a discriminator between schizophrenia patients and match control, using the gradient of pre- and post Gd-T1-weighted MRI data, which is strongly correlated with cerebral blood perfusion. Our approach was tested on 68 MRI scans: 40 first-episode schizophrenia patients and 28 matched controls. The CPD subject's scores exhibit statistically significant result (P < 0.001). In the context of diagnosing schizophrenia with MRI, the results suggest that the CPD could potentially be used to discriminate between schizophrenia patients and matched control. In addition, the CPD model suggests for brain regions that might exhibit abnormalities in schizophrenia patients for future research.

  5. Image Analyzer Study of the Skin in Patients With Morbid Obesity and Massive Weight Loss

    PubMed Central

    Sami, Khaled; Moussa, Manal; Abbas, Alaa; Mahmoud, Amr

    2015-01-01

    Objective: Studies in literature on skin of patients with massive weight loss are limited and somehow conflicting in their results. The aim of this study was to quantitatively assess the skin change after massive weight loss. Method: This study was performed on 30 patients from whom skin biopsies were taken from the skin excised during operations, divided into 3 main groups. The first included patients who were undergoing cosmetic contouring procedures without history of massive weight loss. The second included patients with morbid obesity, who were undergoing bariatric surgery. The third included patients with massive weight loss submitted to cosmetic contouring procedures after stable weight reduction for 6 months. Biopsies were taken from the skin for histological testing. Hematoxylin and Eosin, Mallory, and Aldehyde fuchsin Stains were used to assess the skin collagen and elastic fibers. For quantitative assessment, the Image Analyzer System (Leica Q 500 MC program) was employed. Tensile tests were applied to skin samples using (Instron 5500R) Universal testing machine to measure the skin tensile strength to determine the maximum stress (Burst strength) that skin can induce before damage. Results: Collagen was significantly thinner in massive weight loss group in both papillary and reticular dermis and significantly less dense in reticular dermis with damage to the elastic fiber network. Conclusion: The skin of the patients with massive weight loss is weak due to lower density and thickness of collagen fibers and damage to its elastic fibers. PMID:25671051

  6. Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain

    SciTech Connect

    Brown, K.A.; Boucher, C.A.; Okada, R.D.; Guiney, T.E.; Newell, J.B.; Strauss, H.W.; Pohost, G.M.

    1983-04-01

    Accurate prognostic information is important in determining optimal management of patients presenting for evaluation of chest pain. In this study, the ability of exercise thallium-201 myocardial imaging to predict future cardiac events (cardiovascular death or nonfatal myocardial infarction) was correlated with clinical, coronary and left ventricular angiographic and exercise electrocardiographic data in 139 consecutive, nonsurgically managed patients followed-up over a 3 to 5 year period (mean follow-up, 3.7 +/- 0.9), using a logistic regression analysis. Among patients without prior myocardial infarction (100 of 139), the number of myocardial segments with transient thallium-201 defects was the only statistically significant predictor of future cardiac events when all patient variables were evaluated. Among patients with myocardial infarction before evaluation (39 of 139), angiographic ejection fraction was the only significant predictor of future cardiac events when all variables were considered. This study suggests an approach to evaluate the risk of future cardiac events in patients with possible ischemic heart disease.

  7. Neural substrate of quality of life in patients with schizophrenia: a magnetisation transfer imaging study

    PubMed Central

    Catherine, Faget-Agius; Boyer, Laurent; Jonathan, Wirsich; Jean-Philippe, Ranjeva; Raphaelle, Richieri; Elisabeth, Soulier; Sylviane, Confort-Gouny; Pascal, Auquier; Maxime, Guye; Christophe, Lançon

    2015-01-01

    The aim of this study was to investigate the neural substrate underlying quality of life (QoL) and to demonstrate the microstructural abnormalities associated with impaired QoL in a large sample of patients with schizophrenia, using magnetisation transfer imaging. A total of 81 right-handed men with a diagnosis of schizophrenia and 25 age- and sex-similar healthy controls were included and underwent a 3T MRI with magnetization transfer ratio (MTR) to detect microstructural abnormalities. Compared with healthy controls, patients with schizophrenia had grey matter (GM) decreased MTR values in the temporal lobe (BA21, BA37 and BA38), the bilateral insula, the occipital lobe (BA17, BA18 and BA19) and the cerebellum. Patients with impaired QoL had lower GM MTR values relative to patients with preserved QoL in the bilateral temporal pole (BA38), the bilateral insula, the secondary visual cortex (BA18), the vermis and the cerebellum. Significant correlations between MTR values and QoL scores (p?patients in the right temporal pole (BA38), the bilateral insula, the vermis and the right cerebellum. Our study shows that QoL impairment in patients with schizophrenia is related to the microstructural changes in an extensive network, suggesting that QoL is a bio-psychosocial marker. PMID:26632639

  8. Body Image Disturbances Have Impact on the Sexual Problems in Chinese Systemic Lupus Erythematosus Patients

    PubMed Central

    Shen, Biyu; He, Yan; Chen, Haoyang; Zhao, Chunmei; Zhu, Li; Gao, Yingying; Ren, Yunli; Wang, Xueqing; Liu, Jingwei

    2015-01-01

    SLE might affect all aspects of life including sexual functioning; previous study found that body image disturbance (BID) was the most powerful predictors of impaired partner relationships and sexual function. The current study investigated the relationship among disease parameters, quality of life, the psychological status, BID, and sexual problems in Chinese patients with SLE. A self-report survey design was administered to 168 SLE patients and 210 healthy individuals. Our results showed that 86 (55.1%) SLE patients reported impaired relationships with a sexual partner or partners, and 100 (64.1%) patients reported impaired sexual function which were significantly higher than the control group (31.6%, 35.7%, rep.). Age, marital status, depression, and BIDQ were the most powerful predictors of impaired partner relationships, while BIDQ3 and education, disease activity, and depression were the most significant causes of impaired sexual function. The study for first time reported Chinese SLE patients had sexual problems and BID was associated with sexual problems. So, early detection and interventions might not only rehabilitate the patients and their loved ones, but also improve overall health outcomes and reduce the direct and indirect costs of their medical care. PMID:26090484

  9. Quality of life for our patients: how media images and messages: influence their perceptions.

    PubMed

    Carr, Ellen R

    2008-02-01

    Media messages and images shape patients' perceptions about quality of life (QOL) through various "old" media-literature, film, television, and music-and so-called "new" media-the Internet, e-mail, blogs, and cell phones. In this article, the author provides a brief overview of QOL from the academic perspectives of nursing, psychology, behavioral medicine, multicultural studies, and consumer marketing. Selected theories about mass communication are discussed, as well as new technologies and their impact on QOL in our society. Examples of media messages about QOL and the QOL experience reported by patients with cancer include an excerpt from the Canadian Broadcasting Corporation radio interview with author Carol Shields, the 60 Minutes television interview focusing on Elizabeth Edwards (wife of presidential candidate John Edwards), and an excerpt from the 1994 filmThe Shawshank Redemption. Nurses are challenged to think about how they and their patients develop their perceptions about QOL through the media. PMID:18258574

  10. Evolution of T1 black holes in patients with multiple sclerosis imaged monthly for 4 years.

    PubMed

    Bagnato, Francesca; Jeffries, Neal; Richert, Nancy D; Stone, Roger D; Ohayon, Joan M; McFarland, Henry F; Frank, Joseph A

    2003-08-01

    T1 black holes (BHs) on MRIs may represent either areas of oedema or axonal loss in patients with multiple sclerosis. BHs begin as contrast enhancing lesions (CELs) and evolve differently from patient to patient, and within the same patient over time. We analysed BHs formation over a 4-year period. Forty-eight monthly MRIs of nine non-treated multiple sclerosis patients were evaluated for numbers of CELs and BHs. A BH was defined as a hypointense lesion on a T1 pre-contrast image that coincided with a region of high signal intensity on the T2-weighted images. A BH was considered as acute (ABH) when it occurred coincidently with the presence of enhancement and as persisting (PBH) when present after the cessation of enhancement. The present study aimed to analyse: (i) the incidence of CELs and new PBHs, and the accumulation of PBHs; (ii) the relationship between the quantity of the CELs in a given month and the likelihood of accumulating PBHs in the subsequent month; and (iii) the relationship between the duration of CELs and PBHs. Pitman's correlation test evaluated the effect of time on either the increase of CELs and new PBHs or the accumulation of PBHs, while a multiple logistic regression analysis evaluated the relationship between progression of time and CELs, and the increase of PBHs in a multivariate model. The relationship between the enhancing lesions duration and the PBHs duration, or the time to revert back to an isointense lesion was analysed using Kaplan-Meier survival models. PBHs accumulated (P < 0.001) in all patients, but the formation of new PBHs increased in four patients (P < or = 0.007) in conjunction with an increase in either the quantity of CELs (P < 0.001, for two patients) or the proportion of CELs turning into PBHs (P < or = 0.02, for two patients). Logistic regression analysis showed that neither progression of time nor the number of CELs in a given month were able to predict the probability of increasing the number of PBHs in the subsequent month in any patient. Out of 397 ABHs, 55.7% evolved to a PBH. The duration of PBHs correlated with the duration of enhancement. PBHs preceded by CELs observable on a single MRI persisted for a shorter time (P < 0.002) than those preceded by CELs visible on > or =2 monthly MRIs. The formation of a new PBH was found to be related to CELs activity; however, duration of PBHs is most likely a consequence of the duration of the enhancement. PMID:12821527

  11. Differences in body image between anorexics and in-vitro-fertilization patients - a study with Body Grid

    PubMed Central

    Borkenhagen, Ada; Klapp, Burghard F.; Schoeneich, Frank; Brähler, Elmar

    2005-01-01

    Objectives: The purpose of the investigation was to explore the body image disturbance of anorexics and in-vitro-fertilization patients (IvF-patients) with Body Grid and Body Identity Plot. Methods: The paper reports on an empirical study conducted with 32 anorexic patients and 30 IvF-patients. The structure of the body image was derived from the Body Grid, an idiographic approach following the Role Repertory Grid developed by George A. Kelly [17]. The representation of the body image and the degree of body-acceptance is represented graphically. Results: By the Body Grid and Body Identity Plot measures we were able to identify important differences in body image between anorexics and IvF-patients. Conclusion: The tendencies of dissociation in the body image of anorexics which we found must be seen in the sense of a specific body image disturbance which differs significantly from the body-experience profile of IvF-patients. With the grid approach it was possible to elicit the inner structure of body image and determine the acceptance of the body and integration of single body parts. PMID:19742059

  12. Vector Analysis of Prostate Patient Setup With Image-Guided Radiation Therapy via kV Cone Beam Computed Tomography

    SciTech Connect

    Perks, Julian; Turnbull, Helen; Liu Tianxiao; Purdy, James; Valicenti, Richard

    2011-03-01

    Purpose: To analyze the daily setup variations in a cohort of intensity-modulated radiation therapy (IMRT) prostate cancer patients who had received daily image-guided RT without the use of fiducial markers to determine if daily image guidance is necessary. Methods and Materials: 2134 Kilovoltage (kV) cone beam computed tomography (CBCT) images were analyzed, with three shifts recorded for each image. The number of times that the vector of the combined shifts would have exceeded the planning tumor volume (PTV) margin was tallied. Then, the average scalar shift of the first five images was removed from all subsequent images for a given patient, and the number of days for which the shift vector was greater than the three-dimensional clinical tumor volume-PTV (3D CTV-PTV) margin (8 mm, created with rolling ball technique) was recorded. Additionally, the scalar shifts from every other fraction were studied to determine if the individual patient's shift vector would be adequately sampled if CBCT was not performed daily, thus reducing patient imaging dose without compromising treatment quality. Results: There were 297 cases where the vector shift was initially greater than the PTV margin. By correcting each patient's data set by the average shift of their first five images the total was 248 cases. By considering only every other image of each patient data set (after correction for the first 5 days), only 137 days in which the CTV was outside the PTV would have been seen. Conclusions: Daily imaging is recommended for prostate cancer IMRT patients in order to know the 3D (vector) position of the CTV and to ensure that it is always within the PTV margin. Correcting the data set by the average shift from the first 5 days reduces the overall number of outlier days but does not eliminate them completely.

  13. Expanding the Focus of Admissions Marketing Utility.

    ERIC Educational Resources Information Center

    Lolli, Anthony; Scannell, James

    1983-01-01

    An expanded perspective for admissions marketing is suggested and examples of how such information can become a force for planning are provided. Implementing a broad-based program of information dissemination will better serve the prime interest groups of the university and enhance the image of professional admissions personnel. (MLW)

  14. Silicon microfabricated beam expander

    SciTech Connect

    Othman, A. Ibrahim, M. N.; Hamzah, I. H.; Sulaiman, A. A.; Ain, M. F.

    2015-03-30

    The feasibility design and development methods of silicon microfabricated beam expander are described. Silicon bulk micromachining fabrication technology is used in producing features of the structure. A high-precision complex 3-D shape of the expander can be formed by exploiting the predictable anisotropic wet etching characteristics of single-crystal silicon in aqueous Potassium-Hydroxide (KOH) solution. The beam-expander consist of two elements, a micromachined silicon reflector chamber and micro-Fresnel zone plate. The micro-Fresnel element is patterned using lithographic methods. The reflector chamber element has a depth of 40?µm, a diameter of 15?mm and gold-coated surfaces. The impact on the depth, diameter of the chamber and absorption for improved performance are discussed.

  15. Silicon microfabricated beam expander

    NASA Astrophysics Data System (ADS)

    Othman, A.; Ibrahim, M. N.; Hamzah, I. H.; Sulaiman, A. A.; Ain, M. F.

    2015-03-01

    The feasibility design and development methods of silicon microfabricated beam expander are described. Silicon bulk micromachining fabrication technology is used in producing features of the structure. A high-precision complex 3-D shape of the expander can be formed by exploiting the predictable anisotropic wet etching characteristics of single-crystal silicon in aqueous Potassium-Hydroxide (KOH) solution. The beam-expander consist of two elements, a micromachined silicon reflector chamber and micro-Fresnel zone plate. The micro-Fresnel element is patterned using lithographic methods. The reflector chamber element has a depth of 40 µm, a diameter of 15 mm and gold-coated surfaces. The impact on the depth, diameter of the chamber and absorption for improved performance are discussed.

  16. Attitudinal and perceptual factors in body image distortion: an exploratory study in patients with anorexia nervosa

    PubMed Central

    2013-01-01

    Background Body image disturbance is a core feature of anorexia nervosa (AN). Attitudinal and cognitive biases as well as fundamental perceptual differences have been hypothesized to play a role in this disturbance. Method This study investigated body image dissatisfaction and distortion, haptic perception and perfectionism in 30 patients with AN and 31 age-matched healthy controls. Participants completed perceptual tasks and self-report measures. Results As predicted, participants with AN scored significantly higher on body dissatisfaction, perfectionism measures and had greater body distortion (as assessed by a body size estimation task). Cognitive–affective factors and perfectionism were highly correlated with body image distortion in AN. No significant differences were found between groups on the generic perception task. Conclusions Findings did not confirm the hypothesis of fundamental perceptual inefficiencies in body image disturbance in individuals with AN. Despite renewed interest in fundamental perceptual factors implicated in body image disturbance, these findings suggest that it continues to be important to focus treatment on cognitive affective biases versus fundamental perceptual inefficiencies. PMID:24999398

  17. Assessment of a radiotherapy patient cranial immobilization device using daily on-board kilovoltage imaging.

    PubMed

    Harmon, Joseph; Van Ufflen, Derek; Larue, Susan

    2009-01-01

    The purpose of this study was to utilize state-of-the-art on-board digital kilovoltage (kV) imaging to determine the systematic and random set-up errors of an immobilization device designed for canine and feline cranial radiotherapy treatments. The immobilization device is comprised of a custom made support bridge, bite block, vacuum-based foam mold and a modified thermoplastic mask attached to a commercially available head rest designed for human radiotherapy treatments. The immobilization device was indexed to a Varian exact couch-top designed for image guided radiation therapy (IGRT). Daily orthogonal kV images were compared to Eclipse treatment planning digitally reconstructed radiographs (DRRs). The orthogonal kV images and DRRs were directly compared online utilizing the Varian on-board imaging (OBI) system with set-up corrections mmediately and remotely transferred to the treatment couch prior to treatment delivery. Off-line review of 124 patient treatments indicates systematic errors consisting of +0.18 mm vertical, +0.39mm longitudinal and -0.08 mm lateral. The random errors corresponding to 2 standard deviations (95% CI) consist of 4.02 mm vertical, 2.97 mm longitudinal and 2.53 mm lateral and represent conservative CTV to PTV margins if kV OBI is not available. Use of daily kV OBI along with the cranial immobilization device permits reduction of the CTV to PTV margins to approximately 2.0 mm. PMID:19400474

  18. Electrophysiological and diffusion tensor imaging evidence of delayed corollary discharges in patients with schizophrenia

    PubMed Central

    Whitford, T. J.; Mathalon, D. H.; Shenton, M. E.; Roach, B. J.; Bammer, R.; Adcock, R. A.; Bouix, S.; Kubicki, M.; De Siebenthal, J.; Rausch, A. C.; Schneiderman, J. S.; Ford, J. M.

    2013-01-01

    Patients with schizophrenia (SZ) characteristically exhibit supranormal levels of cortical activity to self-induced sensory stimuli, ostensibly because of abnormalities in the neural signals (corollary discharges, CDs) normatively involved in suppressing the sensory consequences of self-generated actions. The nature of these abnormalities is unknown. This study investigated whether SZ patients experience CDs that are abnormally delayed in their arrival at the sensory cortex. Twenty-one patients with SZ and 25 matched control participants underwent electroencephalography (EEG). Participants’ level of cortical suppression was calculated as the amplitude of the N1 component evoked by a button press-elicited auditory stimulus, subtracted from the N1 amplitude evoked by the same stimulus presented passively. In the three experimental conditions, the auditory stimulus was delivered 0, 50 or 100 ms subsequent to the button-press. Fifteen SZ patients and 17 healthy controls (HCs) also underwent diffusion tensor imaging (DTI), and the fractional anisotropy (FA) of participants’ arcuate fasciculus was used to predict their level of cortical suppression in the three conditions. While the SZ patients exhibited subnormal N1 suppression to undelayed, self-generated auditory stimuli, these deficits were eliminated by imposing a 50-ms, but not a 100-ms, delay between the button-press and the evoked stimulus. Furthermore, the extent to which the 50-ms delay normalized a patient’s level of N1 suppression was linearly related to the FA of their arcuate fasciculus. These data suggest that SZ patients experience temporally delayed CDs to self-generated auditory stimuli, putatively because of structural damage to the white-matter (WM) fasciculus connecting the sites of discharge initiation and destination. PMID:20663254

  19. TH-C-18A-06: Combined CT Image Quality and Radiation Dose Monitoring Program Based On Patient Data to Assess Consistency of Clinical Imaging Across Scanner Models

    SciTech Connect

    Christianson, O; Winslow, J; Samei, E

    2014-06-15

    Purpose: One of the principal challenges of clinical imaging is to achieve an ideal balance between image quality and radiation dose across multiple CT models. The number of scanners and protocols at large medical centers necessitates an automated quality assurance program to facilitate this objective. Therefore, the goal of this work was to implement an automated CT image quality and radiation dose monitoring program based on actual patient data and to use this program to assess consistency of protocols across CT scanner models. Methods: Patient CT scans are routed to a HIPPA compliant quality assurance server. CTDI, extracted using optical character recognition, and patient size, measured from the localizers, are used to calculate SSDE. A previously validated noise measurement algorithm determines the noise in uniform areas of the image across the scanned anatomy to generate a global noise level (GNL). Using this program, 2358 abdominopelvic scans acquired on three commercial CT scanners were analyzed. Median SSDE and GNL were compared across scanner models and trends in SSDE and GNL with patient size were used to determine the impact of differing automatic exposure control (AEC) algorithms. Results: There was a significant difference in both SSDE and GNL across scanner models (9–33% and 15–35% for SSDE and GNL, respectively). Adjusting all protocols to achieve the same image noise would reduce patient dose by 27–45% depending on scanner model. Additionally, differences in AEC methodologies across vendors resulted in disparate relationships of SSDE and GNL with patient size. Conclusion: The difference in noise across scanner models indicates that protocols are not optimally matched to achieve consistent image quality. Our results indicated substantial possibility for dose reduction while achieving more consistent image appearance. Finally, the difference in AEC methodologies suggests the need for size-specific CT protocols to minimize variability in image quality across CT vendors.

  20. Images created in a model eye during simulated cataract surgery can be the basis for images perceived by patients during cataract surgery

    PubMed Central

    Inoue, M; Uchida, A; Shinoda, K; Taira, Y; Noda, T; Ohnuma, K; Bissen-Miyajima, H; Hirakata, A

    2014-01-01

    Purpose To evaluate the images created in a model eye during simulated cataract surgery. Patients and methods This study was conducted as a laboratory investigation and interventional case series. An artificial opaque lens, a clear intraocular lens (IOL), or an irrigation/aspiration (I/A) tip was inserted into the ‘anterior chamber' of a model eye with the frosted posterior surface corresponding to the retina. Video images were recorded of the posterior surface of the model eye from the rear during simulated cataract surgery. The video clips were shown to 20 patients before cataract surgery, and the similarity of their visual perceptions to these images was evaluated postoperatively. Results The images of the moving lens fragments and I/A tip and the insertion of the IOL were seen from the rear. The image through the opaque lens and the IOL without moving objects was the light of the surgical microscope from the rear. However, when the microscope light was turned off after IOL insertion, the images of the microscope and operating room were observed by the room illumination from the rear. Seventy percent of the patients answered that the visual perceptions of moving lens fragments were similar to the video clips and 55% reported similarity with the IOL insertion. Eighty percent of the patients recommended that patients watch the video clip before their scheduled cataract surgery. Conclusions The patients' visual perceptions during cataract surgery can be reproduced in the model eye. Watching the video images preoperatively may help relax the patients during surgery. PMID:24788007

  1. Semiautomatic registration of 3D transabdominal ultrasound images for patient repositioning during postprostatectomy radiotherapy

    SciTech Connect

    Presles, Benoît Rit, Simon; Sarrut, David; Fargier-Voiron, Marie; Liebgott, Hervé; Biston, Marie-Claude; Munoz, Alexandre; Pommier, Pascal; Lynch, Rod

    2014-12-15

    Purpose: The aim of the present work is to propose and evaluate registration algorithms of three-dimensional (3D) transabdominal (TA) ultrasound (US) images to setup postprostatectomy patients during radiation therapy. Methods: Three registration methods have been developed and evaluated to register a reference 3D-TA-US image acquired during the planning CT session and a 3D-TA-US image acquired before each treatment session. The first method (method A) uses only gray value information, whereas the second one (method B) uses only gradient information. The third one (method C) combines both sets of information. All methods restrict the comparison to a region of interest computed from the dilated reference positioning volume drawn on the reference image and use mutual information as a similarity measure. The considered geometric transformations are translations and have been optimized by using the adaptive stochastic gradient descent algorithm. Validation has been carried out using manual registration by three operators of the same set of image pairs as the algorithms. Sixty-two treatment US images of seven patients irradiated after a prostatectomy have been registered to their corresponding reference US image. The reference registration has been defined as the average of the manual registration values. Registration error has been calculated by subtracting the reference registration from the algorithm result. For each session, the method has been considered a failure if the registration error was above both the interoperator variability of the session and a global threshold of 3.0 mm. Results: All proposed registration algorithms have no systematic bias. Method B leads to the best results with mean errors of ?0.6, 0.7, and ?0.2 mm in left–right (LR), superior–inferior (SI), and anterior–posterior (AP) directions, respectively. With this method, the standard deviations of the mean error are of 1.7, 2.4, and 2.6 mm in LR, SI, and AP directions, respectively. The latter are inferior to the interoperator registration variabilities which are of 2.5, 2.5, and 3.5 mm in LR, SI, and AP directions, respectively. Failures occur in 5%, 18%, and 10% of cases in LR, SI, and AP directions, respectively. 69% of the sessions have no failure. Conclusions: Results of the best proposed registration algorithm of 3D-TA-US images for postprostatectomy treatment have no bias and are in the same variability range as manual registration. As the algorithm requires a short computation time, it could be used in clinical practice provided that a visual review is performed.

  2. Magnetic resonance imaging of intracranial tumors: intra-patient comparison of gadoteridol and ferumoxytol

    PubMed Central

    Dósa, Edit; Guillaume, Daniel J.; Haluska, Marianne; Lacy, Cynthia A.; Hamilton, Bronwyn E.; Njus, Jeffrey M.; Rooney, William D.; Kraemer, Dale F.; Muldoon, Leslie L.; Neuwelt, Edward A.

    2011-01-01

    This study aims to compare gadoteridol with ferumoxytol for contrast-enhanced and perfusion-weighted (PW) MRI of intracranial tumors. The final analysis included 26 patients, who underwent 3 consecutive days of 3T MRI. Day 1 consisted of anatomical pre- and postcontrast images, and PW MRI was acquired using gadoteridol (0.1 mmol/kg). On Day 2, the same MRI sequences were obtained with ferumoxytol (510 mg) and on Day 3, the anatomical images were repeated to detect delayed ferumoxytol-induced signal changes. The T1-weighted images were evaluated qualitatively and quantitatively for enhancement volume and signal intensity (SI) changes; PW data were used to estimate the relative cerebral blood volume (rCBV). All 26 lesions showed 24-hour T1-weighted ferumoxytol enhancement; 16 also had T2-weighted hypointensities. In 6 patients, ferumoxytol-induced signal changes were noted in areas with no gadoteridol enhancement. Significantly greater (P< .0001) SI changes were seen with gadoteridol, and qualitative analyses (lesion border delineation, internal morphology, contrast enhancement) also showed significant preferences (P= .0121; P = .0015; P < .0001, respectively) for this agent. There was no significant difference in lesion enhancement volumes between contrast materials. The ferumoxytol-rCBV values were significantly higher (P = .0016) compared with the gadoteridol-rCBV values. In conclusion, ferumoxytol provides important information about tumor biology that complements gadoteridol imaging. The rCBV measurements indicate areas of tumor undergoing rapid growth, whereas the 24-hour scans mark the presence of inflammatory cells. Both of these functions provide useful information about tumor response to treatment. We suggest that dynamic and anatomical imaging with ferumoxytol warrant further assessment in brain tumor therapy. PMID:21163809

  3. Influence of the characteristic curve on the clinical image quality and patient absorbed dose in lumbar spine radiography

    NASA Astrophysics Data System (ADS)

    Tingberg, Anders; Herrmann, Clemens; Lanhede, Birgitta; Almen, Anja; Mattsson, Saron; Panzer, Werner; Besjakov, Jack; Mansson, Lars G.; Kheddache, Susanne; Zankl, Maria

    2001-06-01

    The 'European Guidelines on Quality Criteria for Diagnostic Radiographic Images' do not address the choice of film characteristic (H/D) curve, which is an important parameter for the description of a radiographic screen-film system. Since it is not possible to investigate this influence by taking repeated exposures of the same patients on films with systematically varied H/D curves, patient images of lumbar spine were digitised in the current study. The image contrast was altered by digital image processing techniques, simulating images with H/D curves varying from flat over standard latitude to a film type steeper than a mammography film. The manipulated images were printed on film for evaluation. Seven European radiologists evaluated the clinical image quality of in total 224 images by analysing the fulfilment of the European Image Criteria and by visual grading analysis of the images. The results show that the local quality can be significantly improved by the application of films with a steeper film H/D curve compared to the standard latitude film. For images with an average optical density of about 1.25, the application of the steeper film results in a reduction of patient absorbed dose by about 10-15% without a loss of diagnostically relevant image information. The results also show that the patient absorbed dose reduction obtained by altering the tube voltage from 70 kV to 90 kV coincides with a loss of image information that cannot be compensated for by simply changing the shape of the H/D curve.

  4. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    PubMed

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-06-21

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With 'MR-conditional' devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  5. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    PubMed Central

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-01-01

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  6. Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

    PubMed Central

    Valeriani, Maurizio; Carnevale, Alessia; Bonome, Paolo; Montalto, Adelaide; Nicosia, Luca; Osti, Mattia F.; De Sanctis, Vitaliana; Minniti, Giuseppe; Maurizi Enrici, Riccardo

    2014-01-01

    Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT) in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT). Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60?Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 11.9% and 40.7%, respectively. Grade 1?GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ?2 late toxicities were recorded. Acute grade 2-3?GU toxicity resulted significantly lower (P = 0.04) in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2?GU toxicity was significantly higher (P < 0.001) for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT. PMID:24864248

  7. How Sensor, Signal, and Imaging Informatics May Impact Patient Centered Care and Care Coordination

    PubMed Central

    Moreau-Gaudry, A.

    2015-01-01

    Summary Objective This synopsis presents a selection for the IMIA (International Medical Informatics Association) Yearbook 2015 of excellent research in the broad field of Sensor, Signal, and Imaging Informatics published in the year 2014, with a focus on patient centered care coordination. Methods The two section editors performed a systematic initial selection and a double blind peer review process to select a list of candidate best papers in the domain published in 2014, from the PubMed and Web of Science databases. A set of MeSH keywords provided by experts was used. This selection was peer-reviewed by external reviewers. Results The review process highlighted articles illustrating two current trends related to care coordination and patient centered care: the enhanced capacity to predict the evolution of a disease based on patient-specific information can impact care coordination; similarly, better perception of the patient and his treatment could lead to enhanced personalized care with a potential impact on care coordination. Conclusions This review shows the multiplicity of angles from which the question of patient-centered care can be addressed, with consequences on care coordination that will need to be confirmed and demonstrated in the future. PMID:26293856

  8. Uninterpretable Dynamic Susceptibility Contrast-Enhanced Perfusion MR Images in Patients with Post-Treatment Glioblastomas: Cross-Validation of Alternative Imaging Options

    PubMed Central

    Heo, Young Jin; Kim, Ho Sung; Park, Ji Eun; Choi, Choong-Gon; Kim, Sang Joon

    2015-01-01

    Purpose The purpose of this study was to evaluate the accuracy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) perfusion MR imaging for distinguishing tumor recurrence from post-treatment effect as alternatives to dynamic-susceptibility contrast-enhanced (DSC) perfusion MR imaging when the DSC image is uninterpretable. Materials and Methods This retrospective study was approved by our institutional review board. Seventy one post-treatment glioblastoma patients who showed enlarged contrast-enhancing lesions on follow-up MR images after concurrent chemoradiotherapy and uninterpretable DSC images for corresponding enhancing lesions, underwent additional DWI and DCE MR imaging. The primary outcome was the frequency of interpretable DWI and DCE MR cases in these 71 patients. The secondary outcome was the area under the receiver operating characteristic curve (AUC) of DWI and DCE imaging parameters for distinguishing tumor recurrence from post-treatment effect in selected patients with interpretable DWI and DCE images. The imaging parameters were quantified as 10% cumulative histogram cutoff of apparent diffusion coefficient (ADC10) and 90% cumulative histogram cutoff of initial area under the time signal intensity curve (IAUC90). The AUCs were cross-validated by using leave-one-out method. Results Of the 71 patients, the uninterpretable DSC images were associated with treatment-related hemorrhage within the corresponding enhancing lesions (n = 54, 76.1%) and a near skull base location (n = 17, 23.9%). The frequencies of interpretable DWI and DCE image were 51 (71.8%) and 59 (83.1%) of the 71 cases with uninterpretable DSC images, respectively. Of the 45 selected patients with interpretable DWI and DCE images, the combination of DWI with DCE imaging showed a superior diagnostic performance than DWI or DCE imaging alone for differentiating tumor recurrence from post-treatment effect (cross-validated AUC: 0.78 versus 0.55 and 0.73 for reader 1; cross-validated AUC: 0.78 versus 0.53 and 0.75 for reader 2, respectively). Cross-validated accuracy of the single and combined imaging parameters also showed the highest for the combination of DWI with DCE MR imaging (72.9% for reader 1; 72.5% for reader 2) and the lowest for DWI alone (54.0% for reader 1; 56.4% for reader 2). Inter-reader agreement for DCE imaging was higher than that for DWI (intraclass correlation coefficient: 0.95 versus 0.87). Conclusion DCE MR imaging could be a superior and more reproducible imaging biomarker than DWI for differentiating tumor recurrence from post-treatment effect in patients with post-treatment glioblastoma when DSC MR images are not interpretable. PMID:26296086

  9. Promoting medical tourism to India: messages, images, and the marketing of international patient travel.

    PubMed

    Crooks, Valorie A; Turner, Leigh; Snyder, Jeremy; Johnston, Rory; Kingsbury, Paul

    2011-03-01

    The practice of medical tourism depends on successfully informing potential patients about procedure options, treatment facilities, tourism opportunities, travel arrangements, and destination countries. The promotion of medical tourism includes a wide range of marketing materials such as flyers, booklets, and websites. Yet, there is a paucity of knowledge about the dissemination, content, and reception of these promotional materials. Drawing on a thematic content analysis of the promotional print material distributed at the first medical tourism trade show in Canada in 2009, the main purpose of this article is to identify and understand the messages and images that companies use to market India as a global destination. While researchers and news media frequently cite low cost procedures as a key determinant for international patient travel, particularly to developing nations, our analysis reveals few low cost-related images or messages in the promotional materials distributed at the trade show. To help explain this surprising disjuncture, we consider four related issues: (1) promotional materials may be designed to be circulated amongst potential patients' concerned family and friends who privilege knowing about things such as the use of advanced technologies; (2) developing nations need to portray safe and advanced treatment facilities in order to dispel potential patients' suspicions that their medical care is inferior; (3) companies may avoid making cost saving claims that cannot be fulfilled for all of their international patients, especially those traveling from developing nations; and (4) messages of low cost may detract from and even undermine messages about quality. We conclude by identifying numerous avenues for future research by social and health scientists, and by considering the implications of our findings for existing knowledge gaps and debates within health geography specifically. PMID:21310519

  10. Survival analysis in patients with newly diagnosed glioblastoma using pre- and postradiotherapy MR spectroscopic imaging

    PubMed Central

    Li, Yan; Lupo, Janine M.; Parvataneni, Rupa; Lamborn, Kathleen R.; Cha, Soonmee; Chang, Susan M.; Nelson, Sarah J.

    2013-01-01

    Background The objective of this study was to examine the predictive value of parameters of 3D 1H magnetic resonance spectroscopic imaging (MRSI) prior to treatment with radiation/chemotherapy (baseline) and at a postradiation 2-month follow-up (F2mo) in relationship to 6-month progression-free survival (PFS6) and overall survival (OS). Methods Sixty-four patients with newly diagnosed glioblastoma multiforme (GBM) being treated with radiation and concurrent chemotherapy were involved in this study. Evaluated were metabolite indices and metabolite ratios. Logistic linear regression and Cox proportional hazards models were utilized to evaluate PFS6 and OS, respectively. These analyses were adjusted by age and MR scanner field strength (1.5 T or 3 T). Stepwise regression was performed to determine a subset of the most relevant variables. Results Associated with shorter PFS6 were a decrease in the ratio of N-acetyl aspartate to choline-containing compounds (NAA/Cho) in the region with a Cho-to-NAA index (CNI) >3 at baseline and an increase of the CNI within elevated CNI regions (>2) at F2mo. Patients with higher normalized lipid and lactate at either time point had significantly worse OS. Patients who had larger volumes with abnormal CNI at F2mo had worse PFS6 and OS. Conclusions Our study found more 3D MRSI parameters that predicted PFS6 and OS for patients with GBM than did anatomic, diffusion, or perfusion imaging, which were previously evaluated in the same population of patients. PMID:23393206

  11. Automated measurement of CT noise in patient images with a novel structure coherence feature

    NASA Astrophysics Data System (ADS)

    Chun, Minsoo; Choi, Young Hun; Hyo Kim, Jong

    2015-12-01

    While the assessment of CT noise constitutes an important task for the optimization of scan protocols in clinical routine, the majority of noise measurements in practice still rely on manual operation, hence limiting their efficiency and reliability. This study presents an algorithm for the automated measurement of CT noise in patient images with a novel structure coherence feature. The proposed algorithm consists of a four-step procedure including subcutaneous fat tissue selection, the calculation of structure coherence feature, the determination of homogeneous ROIs, and the estimation of the average noise level. In an evaluation with 94 CT scans (16?517 images) of pediatric and adult patients along with the participation of two radiologists, ROIs were placed on a homogeneous fat region at 99.46% accuracy, and the agreement of the automated noise measurements with the radiologists’ reference noise measurements (PCC??=??0.86) was substantially higher than the within and between-rater agreements of noise measurements (PCCwithin??=??0.75, PCCbetween??=??0.70). In addition, the absolute noise level measurements matched closely the theoretical noise levels generated by a reduced-dose simulation technique. Our proposed algorithm has the potential to be used for examining the appropriateness of radiation dose and the image quality of CT protocols for research purposes as well as clinical routine.

  12. Automated measurement of CT noise in patient images with a novel structure coherence feature.

    PubMed

    Chun, Minsoo; Choi, Young Hun; Kim, Jong Hyo

    2015-12-01

    While the assessment of CT noise constitutes an important task for the optimization of scan protocols in clinical routine, the majority of noise measurements in practice still rely on manual operation, hence limiting their efficiency and reliability. This study presents an algorithm for the automated measurement of CT noise in patient images with a novel structure coherence feature. The proposed algorithm consists of a four-step procedure including subcutaneous fat tissue selection, the calculation of structure coherence feature, the determination of homogeneous ROIs, and the estimation of the average noise level. In an evaluation with 94 CT scans (16?517 images) of pediatric and adult patients along with the participation of two radiologists, ROIs were placed on a homogeneous fat region at 99.46% accuracy, and the agreement of the automated noise measurements with the radiologists' reference noise measurements (PCC??=??0.86) was substantially higher than the within and between-rater agreements of noise measurements (PCCwithin??=??0.75, PCCbetween??=??0.70). In addition, the absolute noise level measurements matched closely the theoretical noise levels generated by a reduced-dose simulation technique. Our proposed algorithm has the potential to be used for examining the appropriateness of radiation dose and the image quality of CT protocols for research purposes as well as clinical routine. PMID:26561914

  13. Subgenual prefrontal cortex of child and adolescent bipolar patients: a morphometric magnetic resonance imaging study.

    PubMed

    Sanches, Marsal; Sassi, Roberto B; Axelson, David; Nicoletti, Mark; Brambilla, Paolo; Hatch, John P; Keshavan, Matcheri S; Ryan, Neal D; Birmaher, Boris; Soares, Jair C

    2005-01-30

    The subgenual prefrontal cortex (SGPFC) plays an important role in emotional processing. We carried out a magnetic resonance imaging (MRI) study comparing the volume of the SGPFC in child and adolescent bipolar patients and healthy controls. The sample consisted of 15 children and adolescents who met DSM-IV criteria for bipolar disorder (mean age +/- S.D.=15.5 +/- 3.5 years) and 21 healthy adolescents (mean age +/- S.D.=16.9 +/- 3.8 years). MR images were obtained with a 1.5 T GE Signa Imaging System with Signa 5.4.3 software. SGPFC volumes were measured with the semi-automated software MedX (Sensor Systems, Sterling, VA, USA). ANCOVA was performed to compare SGPFC volumes between groups, using age, gender and intra-cranial volume (ICV) as covariates. The volumes (mean +/- S.D.) of the right and left SGPFC for bipolar patients were 291.27 +/- 88.70 mm(3) and 284.86 +/- 83.98 mm(3), respectively. For healthy controls, the right and left SGPFC volumes were 284.95 +/- 73.33 mm(3) and 307.55 +/- 73.67 mm(3), respectively. There were no statistically significant differences between groups regarding right or left SGPFC volumes. We found no evidence of volumetric abnormalities in the SGPFC of bipolar children and adolescents. PMID:15708300

  14. Adaptive optics-assisted optical coherence tomography for imaging of patients with age related macular degeneration

    NASA Astrophysics Data System (ADS)

    Sudo, Kenta; Cense, Barry

    2013-03-01

    We developed an optical coherence tomography (OCT) prototype with a sample arm that uses a 3.4 mm beam, which is considerably larger than the 1.2 to 1.5 mm beam that is used in commercialized OCT systems. The system is equipped with adaptive optics (AO), and to distinguish it from traditional AO-OCT systems with a larger 6 mm beam we have coined this concept AO-assisted OCT. Compared to commercialized OCT systems, the 3.4 mm aperture combined with AO improves light collection efficiency and imaging lateral resolution. In this paper, the performance of the AOa-OCT system was compared to a standard OCT system and demonstrated for imaging of age-related macular degeneration (AMD). Measurements were performed on the retinas of three human volunteers with healthy eyes and on one eye of a patient diagnosed with AMD. The AO-assisted OCT system imaged retinal structures of healthy human eyes and a patient eye affected by AMD with higher lateral resolution and a 9° by 9° field of view. This combination of a large isoplanatic patch and high lateral resolution can be expected to fill a gap between standard OCT with a 1.2 mm beam and conventional AO-OCT with a 6 mm beam and a 1.5° by 1.5° isoplanatic patch.

  15. EXPANDED BED BIOLOGICAL TREATMENT

    EPA Science Inventory

    A three-year pilot-scale research investigation at the EPA Lebanon Pilot Plant was conducted to evaluate the feasibility of a unique biological secondary treatment process, designated the Expanded Bed Biological Treatment Process (EBBT). The EBBT process is a three-phase (oxygen/...

  16. An Ever Expanding Universe?

    E-print Network

    B. G. Sidharth

    2015-09-30

    It is pointed out that very recent results based on supernovae observations that the universe will accelerate and expand for ever with ever decreasing density have been predicted in a recent cosmological model which also deduces hitherto purely empirical features like the mysterious relation between the pion mass and the Hubble Constant.

  17. Observer success rates for identification of 3D surface reconstructed facial images and implications for patient privacy and security

    NASA Astrophysics Data System (ADS)

    Chen, Joseph J.; Siddiqui, Khan M.; Fort, Leslie; Moffitt, Ryan; Juluru, Krishna; Kim, Woojin; Safdar, Nabile; Siegel, Eliot L.

    2007-03-01

    3D and multi-planar reconstruction of CT images have become indispensable in the routine practice of diagnostic imaging. These tools cannot only enhance our ability to diagnose diseases, but can also assist in therapeutic planning as well. The technology utilized to create these can also render surface reconstructions, which may have the undesired potential of providing sufficient detail to allow recognition of facial features and consequently patient identity, leading to violation of patient privacy rights as described in the HIPAA (Health Insurance Portability and Accountability Act) legislation. The purpose of this study is to evaluate whether 3D reconstructed images of a patient's facial features can indeed be used to reliably or confidently identify that specific patient. Surface reconstructed images of the study participants were created used as candidates for matching with digital photographs of participants. Data analysis was performed to determine the ability of observers to successfully match 3D surface reconstructed images of the face with facial photographs. The amount of time required to perform the match was recorded as well. We also plan to investigate the ability of digital masks or physical drapes to conceal patient identity. The recently expressed concerns over the inability to truly "anonymize" CT (and MRI) studies of the head/face/brain are yet to be tested in a prospective study. We believe that it is important to establish whether these reconstructed images are a "threat" to patient privacy/security and if so, whether minimal interventions from a clinical perspective can substantially reduce this possibility.

  18. Illusory movements of the contralesional hand in patients with body image disorders

    PubMed Central

    Zampini, M; Moro, V; Aglioti, S

    2004-01-01

    Methods: Ten RBD patients (three with disorders of bodily representations) were asked to report whether movements of their right hand induced any illusory somatic or motor sensations. Inquiries on anomalous sensation of movement of the left hand were carried out while subjects: 1) observed the moving hand in a mirror propped vertically along the parasagittal plane; 2) looked directly at the moving hand; 3) looked at the still hand; 4) kept their eyes closed. Twelve healthy subjects served as controls. Results: Movement of the right hand induced a very clear sensation of movement of the left, contralesional hand in two patients affected by body image disorders. Remarkably, this occurred mainly while subjects were looking in the mirror, that is, when conflicts between visual, somatic, and motor information were maximal. In no condition did control subjects report any consistent anomalous evoked movement or sensation. Conclusions: Illusory movements of the left, plegic hand contingent upon sensorimotor conflicts can be evoked in brain damaged patients with body image disorders. PMID:15489402

  19. In vivo molecular imaging of chemokine receptor CXCR4 expression in patients with advanced multiple myeloma

    PubMed Central

    Philipp-Abbrederis, Kathrin; Herrmann, Ken; Knop, Stefan; Schottelius, Margret; Eiber, Matthias; Lückerath, Katharina; Pietschmann, Elke; Habringer, Stefan; Gerngroß, Carlos; Franke, Katharina; Rudelius, Martina; Schirbel, Andreas; Lapa, Constantin; Schwamborn, Kristina; Steidle, Sabine; Hartmann, Elena; Rosenwald, Andreas; Kropf, Saskia; Beer, Ambros J; Peschel, Christian; Einsele, Hermann; Buck, Andreas K; Schwaiger, Markus; Götze, Katharina; Wester, Hans-Jürgen; Keller, Ulrich

    2015-01-01

    CXCR4 is a G-protein-coupled receptor that mediates recruitment of blood cells toward its ligand SDF-1. In cancer, high CXCR4 expression is frequently associated with tumor dissemination and poor prognosis. We evaluated the novel CXCR4 probe [68Ga]Pentixafor for in vivo mapping of CXCR4 expression density in mice xenografted with human CXCR4-positive MM cell lines and patients with advanced MM by means of positron emission tomography (PET). [68Ga]Pentixafor PET provided images with excellent specificity and contrast. In 10 of 14 patients with advanced MM [68Ga]Pentixafor PET/CT scans revealed MM manifestations, whereas only nine of 14 standard [18F]fluorodeoxyglucose PET/CT scans were rated visually positive. Assessment of blood counts and standard CD34+ flow cytometry did not reveal significant blood count changes associated with tracer application. Based on these highly encouraging data on clinical PET imaging of CXCR4 expression in a cohort of MM patients, we conclude that [68Ga]Pentixafor PET opens a broad field for clinical investigations on CXCR4 expression and for CXCR4-directed therapeutic approaches in MM and other diseases. PMID:25736399

  20. Nephrogenic Systemic Fibrosis Risk After Liver Magnetic Resonance Imaging With Gadoxetate Disodium in Patients With Moderate to Severe Renal Impairment

    PubMed Central

    Lauenstein, Thomas; Ramirez-Garrido, Francisco; Kim, Young Hoon; Rha, Sung Eun; Ricke, Jens; Phongkitkarun, Sith; Boettcher, Joachim; Gupta, Rajan T.; Korpraphong, Pornpim; Tanomkiat, Wiwatana; Furtner, Julia; Liu, Peter S.; Henry, Maren; Endrikat, Jan

    2015-01-01

    Objective The objective of this study was to assess the risk of gadoxetate disodium in liver imaging for the development of nephrogenic systemic fibrosis (NSF) in patients with moderate to severe renal impairment. Materials and Methods We performed a prospective, multicenter, nonrandomized, open-label phase 4 study in 35 centers from May 2009 to July 2013. The study population consisted of patients with moderate to severe renal impairment scheduled for liver imaging with gadoxetate disodium. All patients received a single intravenous bolus injection of 0.025-mmol/kg body weight of liver-specific gadoxetate disodium. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period. Results A total of 357 patients were included, with 85 patients with severe and 193 patients with moderate renal impairment, which were the clinically most relevant groups. The mean time period from diagnosis of renal disease to liver magnetic resonance imaging (MRI) was 1.53 and 5.46 years in the moderate and severe renal impairment cohort, respectively. Overall, 101 patients (28%) underwent additional contrast-enhanced MRI with other gadolinium-based MRI contrast agents within 12 months before the start of the study or in the follow-up. No patient developed symptoms conclusive of NSF within the 2-year follow-up. Conclusions Gadoxetate disodium in patients with moderate to severe renal impairment did not raise any clinically significant safety concern. No NSF cases were observed. PMID:25756684

  1. The Primary Patency and Fracture Rates of Self-Expandable Nitinol Stents Placed in the Popliteal Arteries, Especially in the P2 and P3 Segments, in Korean Patients

    PubMed Central

    Chang, Il Soo; Park, Sang Woo; Yun, Ik Jin; Hwang, Jae Joon; Lee, Song Am; Kim, Jun Seok; Chang, Seong-Hwan; Jung, Hong Geun

    2011-01-01

    Objective We wanted to evaluate the status of self-expandable nitinol stents implanted in the P2 and P3 segments of the popliteal artery in Korean patients. Materials and Methods We retrospectively analyzed 189 consecutive patients who underwent endovascular treatment for stenoocclusive lesions in the femoropopliteal artery from July 2003 to March 2009, and 18 patients who underwent stent placement in popliteal arterial P2 and P3 segments were finally enrolled. Lesion patency was evaluated by ultrasound or CT angiography, and stent fracture was assessed by plain X-rays at 1, 3, 6 and 12 months and annually thereafter. Results At the 1-month follow-up, stent fracture (Type 2) was seen in one limb (up to P3, 1 of 18, 6%) and it was identified in seven limbs at the 3-month follow-up (Type 2, Type 3, Type 4) (n = 1: up to P2; n = 6: P3). At the 6-month follow-up, one more fracture (Type 1) (up to P3) was noted. At the 1-year follow-up, there were no additional stent fractures. Just four limbs (up to P2) at the 2-year follow-up did not have stent fracture. The primary patency was 94%, 61% and 44% at 1, 3 and 6 months, respectively, and the group with stent implantation up to P3 had a higher fracture rate than that of the group that underwent stenting up to P2 (p < 0.05). Conclusion We suggest that stent placement up to the popliteal arterial P3 segment and over P2 in an Asian population can worsen the stent patency owing to stent fracture. It may be necessary to develop a stent design and structure for the Asian population that can resist the bending force in the knee joint. PMID:21430937

  2. Silent ischemia after coronary angioplasty: Evaluation of restenosis and extent of ischemia in asymptomatic patients by tomographic thallium-201 exercise imaging and comparison with symptomatic patients

    SciTech Connect

    Hecht, H.S.; Shaw, R.E.; Chin, H.L.; Ryan, C.; Stertzer, S.H.; Myler, R.K. )

    1991-03-01

    One hundred sixteen patients were evaluated to determine the ability of single photon emission computed tomographic (SPECT) thallium-201 exercise and redistribution imaging to detect silent ischemia secondary to restenosis in asymptomatic patients after single and multiple vessel percutaneous transluminal coronary angioplasty and the findings were compared with SPECT imaging detection of restenosis in symptomatic patients. The value of exercise electrocardiography (ECG) and the amount of ischemic myocardium in symptomatic and asymptomatic patients were determined. Forty-one patients were asymptomatic after angioplasty; 77% of these had chest pain before angioplasty. Seventy-five patients had chest pain after angioplasty; 99% of these had chest pain before angioplasty. Restenosis occurred in 61% of asymptomatic and 59% of symptomatic patients and in 46% of the vessels in both asymptomatic and symptomatic patients. Sensitivity, specificity and accuracy for detection of restenosis by SPECT in individual patients were 96%, 75% and 88% versus 91%, 77% and 85%, respectively, in the asymptomatic versus symptomatic groups (p = NS). Sensitivity, specificity and accuracy for restenosis detection in individual vessels were 90%, 89% and 89% versus 84%, 77% and 84%, respectively, in the asymptomatic and symptomatic groups (p = NS), with similar results for the three major arteries. Sensitivity and accuracy of exercise ECG were significantly less than those of SPECT imaging for the patients with silent (40% and 44%) and symptomatic (59% and 64%) ischemia (p less than 0.001). Restenosis of vessels in the patients with silent and symptomatic ischemia was associated with an equal amount and degree of severity of ischemic myocardium in the two groups.

  3. Automated Patient Identification and Localization Error Detection Using 2-Dimensional to 3-Dimensional Registration of Kilovoltage X-Ray Setup Images

    SciTech Connect

    Lamb, James M. Agazaryan, Nzhde; Low, Daniel A.

    2013-10-01

    Purpose: To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Methods and Materials: Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. Results: A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. Conclusions: An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments.

  4. CMR Imaging With Rapid Visual T1 Assessment Predicts Mortality in Patients Suspected of Cardiac Amyloidosis

    PubMed Central

    White, James A.; Kim, Han W.; Shah, Dipan; Fine, Nowell; Kim, Ki-Young; Wendell, David C.; Al-Jaroudi, Wael; Parker, Michele; Patel, Manesh; Gwadry-Sridhar, Femida; Judd, Robert M.; Kim, Raymond J.

    2014-01-01

    OBJECTIVES This study tested the diagnostic and prognostic utility of a rapid, visual T1 assessment method for identification of cardiac amyloidosis (CA) in a “real-life” referral population undergoing cardiac magnetic resonance for suspected CA. BACKGROUND In patients with confirmed CA, delayed-enhancement cardiac magnetic resonance (DE-CMR) frequently shows a diffuse, global hyperenhancement (HE) pattern. However, imaging is often technically challenging, and the prognostic significance of diffuse HE is unclear. METHODS Ninety consecutive patients referred for suspected CA and 64 hypertensive patients with left ventricular hypertrophy (LVH) were prospectively enrolled and underwent a modified DE-CMR protocol. After gadolinium administration a method for rapid, visual T1 assessment was used to identify the presence of diffuse HE during the scan, allowing immediate optimization of settings for the conventional DE-CMR that followed. The primary endpoint was all-cause mortality. RESULTS Among patients with suspected CA, 66% (59 of 90) demonstrated HE, with 81% (48 of 59) of these meeting pre-specified visual T1 assessment criteria for diffuse HE. Among hypertensive LVH patients, 6% (4 of 64) had HE, with none having diffuse HE. During 29 months of follow-up (interquartile range: 12 to 44 months), there were 50 (56%) deaths in patients with suspected CA and 4 (6%) in patients with hypertensive LVH. Multivariable analysis demonstrated that the presence of diffuse HE was the most important predictor of death in the group with suspected CA (hazard ratio: 5.5, 95% confidence interval: 2.7 to 11.0; p < 0.0001) and in the population as a whole (hazard ratio: 6.0, 95% confidence interval 3.0 to 12.1; p < 0.0001). Among 25 patients with myocardial histology obtained during follow-up, the sensitivity, specificity, and accuracy of diffuse HE in the diagnosis of CA were 93%, 70%, and 84%, respectively. CONCLUSIONS Among patients suspected of CA, the presence of diffuse HE by visual T1 assessment accurately identifies patients with histologically-proven CA and is a strong predictor of mortality. PMID:24412191

  5. Multi-observation PET image analysis for patient follow-up quantitation and therapy assessment

    PubMed Central

    David, Simon; Visvikis, Dimitris; Roux, Christian; Hatt, Mathieu

    2011-01-01

    In Positron Emission Tomography (PET) imaging, an early therapeutic response is usually characterized by variations of semi-quantitative parameters restricted to maximum SUV measured in PET scans during the treatment. Such measurements do not reflect overall tumour volume and radiotracer uptake variations. The proposed approach is based on multi-observation image analysis for merging several PET acquisitions to assess tumour metabolic volume and uptake variations. The fusion algorithm is based on iterative estimation using stochastic expectation maximization (SEM) algorithm. The proposed method was applied to simulated and clinical follow-up PET images. We compared the multi-observation fusion performance to threshold-based methods, proposed for the assessment of the therapeutic response based on functional volumes. On simulated datasets, the adaptive threshold applied independently on both images led to higher errors than the ASEM fusion and on the clinical datasets, it failed to provide coherent measurements for four patients out of seven due to aberrant delineations. The ASEM method demonstrated improved and more robust estimation of the evaluation leading to more pertinent measurements. Future work will consist in extending the methodology and applying it to clinical multi-tracers datasets in order to evaluate its potential impact on the biological tumour volume definition for radiotherapy applications. PMID:21846937

  6. Multi-observation PET image analysis for patient follow-up quantitation and therapy assessment

    NASA Astrophysics Data System (ADS)

    David, S.; Visvikis, D.; Roux, C.; Hatt, M.

    2011-09-01

    In positron emission tomography (PET) imaging, an early therapeutic response is usually characterized by variations of semi-quantitative parameters restricted to maximum SUV measured in PET scans during the treatment. Such measurements do not reflect overall tumor volume and radiotracer uptake variations. The proposed approach is based on multi-observation image analysis for merging several PET acquisitions to assess tumor metabolic volume and uptake variations. The fusion algorithm is based on iterative estimation using a stochastic expectation maximization (SEM) algorithm. The proposed method was applied to simulated and clinical follow-up PET images. We compared the multi-observation fusion performance to threshold-based methods, proposed for the assessment of the therapeutic response based on functional volumes. On simulated datasets the adaptive threshold applied independently on both images led to higher errors than the ASEM fusion and on clinical datasets it failed to provide coherent measurements for four patients out of seven due to aberrant delineations. The ASEM method demonstrated improved and more robust estimation of the evaluation leading to more pertinent measurements. Future work will consist in extending the methodology and applying it to clinical multi-tracer datasets in order to evaluate its potential impact on the biological tumor volume definition for radiotherapy applications.

  7. Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients.

    PubMed

    Sarwer, David B; Steffen, Kristine J

    2015-11-01

    This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. PMID:26608946

  8. 3D imaging options and ultrasound contrast agents for the ultrasound assessment of pediatric rheumatic patients

    PubMed Central

    2013-01-01

    The application of 3D imaging in pediatric rheumatology helps to make the assessment of inflammatory changes more objective and to estimate accurately their volume and the actual response to treatment in the course of follow-up examinations. Additional interesting opportunities are opened up by the vascularity analysis with the help of power Doppler and color Doppler in 3D imaging. Contrast-enhanced ultrasound examinations enable a more sensitive assessment of the vascularity of inflamed structures of the locomotor system, and a more accurate analysis of treatment's effect on changes in vascularity, and thereby the inflammation process activity, as compared to the classical options of power and color Doppler. The equipment required, time limitations, as well as the high price in the case of contrast-enhanced ultrasound, contribute to the fact that the 3D analysis of inflammatory changes and contrast-enhanced ultrasound examinations are not routinely applied for pediatric patients.

  9. SU-E-J-86: Lobar Lung Function Quantification by PET Galligas and CT Ventilation Imaging in Lung Cancer Patients

    SciTech Connect

    Eslick, E; Kipritidis, J; Keall, P; Bailey, D; Bailey, E

    2014-06-01

    Purpose: The purpose of this study was to quantify the lobar lung function using the novel PET Galligas ([68Ga]-carbon nanoparticle) ventilation imaging and the investigational CT ventilation imaging in lung cancer patients pre-treatment. Methods: We present results on our first three lung cancer patients (2 male, mean age 78 years) as part of an ongoing ethics approved study. For each patient a PET Galligas ventilation (PET-V) image and a pair of breath hold CT images (end-exhale and end-inhale tidal volumes) were acquired using a Siemens Biograph PET CT. CT-ventilation (CT-V) images were created from the pair of CT images using deformable image registration (DIR) algorithms and the Hounsfield Unit (HU) ventilation metric. A comparison of ventilation quantification from each modality was done on the lobar level and the voxel level. A Bland-Altman plot was used to assess the difference in mean percentage contribution of each lobe to the total lung function between the two modalities. For each patient, a voxel-wise Spearmans correlation was calculated for the whole lungs between the two modalities. Results: The Bland-Altman plot demonstrated strong agreement between PET-V and CT-V for assessment of lobar function (r=0.99, p<0.001; range mean difference: ?5.5 to 3.0). The correlation between PET-V and CT-V at the voxel level was moderate(r=0.60, p<0.001). Conclusion: This preliminary study on the three patients data sets demonstrated strong agreement between PET and CT ventilation imaging for the assessment of pre-treatment lung function at the lobar level. Agreement was only moderate at the level of voxel correlations. These results indicate that CT ventilation imaging has potential for assessing pre-treatment lobar lung function in lung cancer patients.

  10. Semiannual Imaging Surveillance Is Associated with Better Survival in Patients with Non-B, Non-C Hepatocellular Carcinoma

    PubMed Central

    Shindo, Kuniaki; Maekawa, Shinya; Komatsu, Nobutoshi; Tatsumi, Akihisa; Miura, Mika; Sato, Mitsuaki; Suzuki, Yuichiro; Matsuda, Shuya; Muraoka, Masaru; Amemiya, Fumitake; Fukasawa, Mitsuharu; Yamaguchi, Tatsuya; Nakayama, Yasuhiro; Uetake, Tomoyoshi; Inoue, Taisuke; Sakamoto, Minoru; Sato, Tadashi; Enomoto, Nobuyuki

    2015-01-01

    Since it remains elusive whether and how the imaging surveillance affects the survival in patients with non-B, non-C hepatocellular carcinoma (NBNC-HCC), we conducted this retrospective study which investigated the association between the semiannual surveillance prior to HCC diagnosis and the survival in patients with the initial diagnosis of HCC induced by hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infections (N = 141) and non-B, non-C etiology (N = 30). It was demonstrated that surveillance was less frequently performed in the NBNC-HCC patients compared to that in HCC patients with HBV and/or HCV infections (B/C-HCC patients), and the survival was unfavorable in NBNC-HCC patients. On the other hand, the survival of NBNC-HCC patients with semiannual surveillance was significantly favorable than those patients without semiannual surveillance, and the survival was similar between B/C-HCCs and NBNC-HCCs with semiannual surveillance. In conclusion, though NBNC-HCC patients compared to B/C-HCC patients had poorer prognosis overall, these NBNC-HCC patients with semiannual surveillance had a better survival almost equivalent to the survival of B/C-HCC patients with semiannual surveillance, demonstrating the clinical utility of the semiannual imaging surveillance program for NBNC-HCCs. PMID:26494948

  11. An Unusual Case of Laryngeal Paraganglioma in a Patient with Carotid Body Paraganglioma: Multimodality Imaging Findings

    PubMed Central

    Dogan, Serap; Senol, Serkan; Imamoglu, Hakan; Abdulrezzak, Ummuhan; Ekinci, Afra; Yuce, Imdat; Ozturk, Mustafa

    2015-01-01

    Multiple paragangliomas of the head and neck are rare conditions. Carotid paragangliomas are most common multiple paragangliomas. Laryngeal paragangliomas are very rare neuroendocrine tumors and usually are seen as symptomatic solitary lesions. We present multimodality imaging findings of incidentally detected laryngeal paraganglioma in a woman with synchronous carotid body paraganglioma and positive family history. To the best of our knowledge, this is the first case of laryngeal and carotid body paragangliomas in a patient with positive family history. Radiologists should keep in mind that paragangliomas may occur in various locations as multiple tumors. PMID:26649218

  12. An Unusual Case of Laryngeal Paraganglioma in a Patient with Carotid Body Paraganglioma: Multimodality Imaging Findings.

    PubMed

    Dogan, Serap; Senol, Serkan; Imamoglu, Hakan; Abdulrezzak, Ummuhan; Ekinci, Afra; Yuce, Imdat; Ozturk, Mustafa

    2015-01-01

    Multiple paragangliomas of the head and neck are rare conditions. Carotid paragangliomas are most common multiple paragangliomas. Laryngeal paragangliomas are very rare neuroendocrine tumors and usually are seen as symptomatic solitary lesions. We present multimodality imaging findings of incidentally detected laryngeal paraganglioma in a woman with synchronous carotid body paraganglioma and positive family history. To the best of our knowledge, this is the first case of laryngeal and carotid body paragangliomas in a patient with positive family history. Radiologists should keep in mind that paragangliomas may occur in various locations as multiple tumors. PMID:26649218

  13. Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents.

    PubMed Central

    Deviere, J; Cremer, M; Baize, M; Love, J; Sugai, B; Vandermeeren, A

    1994-01-01

    Twenty patients with chronic pancreatitis and signs of biliary obstruction were treated by endoscopic placement of self expandable metal mesh stents, and followed up prospectively. Eleven had been treated previously with plastic endoprostheses. All had persistent cholestasis, seven patients had jaundice, and three overt cholangitis. Endoscopic stent placement was successful in all cases. No early clinical complication was seen and cholestasis, jaundice or cholangitis rapidly resolved in all patients. Mean follow up was 33 months (range 24 to 42) and consisted of clinical evaluation, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). In 18 patients, successive ERCPs and cholangioscopies have shown that the metal mesh initially embeds in the bile duct wall and is rapidly covered by a continuous tissue by three months. The stent lumen remained patent and functional throughout the follow up period except in two patients who developed epithelial hyperplasia within the stent resulting in recurrent biliary obstruction, three and six months after placement. They were treated endoscopically with standard plastic stents with one of these patients ultimately requiring surgical drainage. No patient free of clinical or radiological signs of epithelial hyperplasia after six months developed obstruction later. This new treatment could become an effective alternative to surgical biliary diversion if further controlled follow up studies confirm the initial impression that self expandable metal mesh stents offer a low morbidity alternative for longterm biliary drainage in chronic pancreatitis without the inconvenience associated with plastic stents. Images Figure 1 Figure 4 PMID:8307432

  14. Comparison Between Infrared Optical and Stereoscopic X-Ray Technologies for Patient Setup in Image Guided Stereotactic Radiotherapy

    SciTech Connect

    Tagaste, Barbara; Riboldi, Marco; Spadea, Maria F.; Bellante, Simone; Baroni, Guido; Cambria, Raffaella; Garibaldi, Cristina; Ciocca, Mario; Catalano, Gianpiero; Alterio, Daniela; Orecchia, Roberto

    2012-04-01

    Purpose: To compare infrared (IR) optical vs. stereoscopic X-ray technologies for patient setup in image-guided stereotactic radiotherapy. Methods and Materials: Retrospective data analysis of 233 fractions in 127 patients treated with hypofractionated stereotactic radiotherapy was performed. Patient setup at the linear accelerator was carried out by means of combined IR optical localization and stereoscopic X-ray image fusion in 6 degrees of freedom (6D). Data were analyzed to evaluate the geometric and dosimetric discrepancy between the two patient setup strategies. Results: Differences between IR optical localization and 6D X-ray image fusion parameters were on average within the expected localization accuracy, as limited by CT image resolution (3 mm). A disagreement between the two systems below 1 mm in all directions was measured in patients treated for cranial tumors. In extracranial sites, larger discrepancies and higher variability were observed as a function of the initial patient alignment. The compensation of IR-detected rotational errors resulted in a significantly improved agreement with 6D X-ray image fusion. On the basis of the bony anatomy registrations, the measured differences were found not to be sensitive to patient breathing. The related dosimetric analysis showed that IR-based patient setup caused limited variations in three cases, with 7% maximum dose reduction in the clinical target volume and no dose increase in organs at risk. Conclusions: In conclusion, patient setup driven by IR external surrogates localization in 6D featured comparable accuracy with respect to procedures based on stereoscopic X-ray imaging.

  15. An evaluation of the impact of digital imaging on radiographic practice and patient doses

    NASA Astrophysics Data System (ADS)

    Horrocks, J.; Violaki, K.

    2015-09-01

    Direct digital imaging technology was implemented in all areas in general and mobile radiology at Barts and the Royal London Hospitals in 2012. Evidence from recent radiation incident investigations indicates optimum exposure factors are not consistently selected, with the greater dynamic range of the digital detectors allowing sub-optimal practice. To investigate further patient dose data were extracted from the Radiology Information System for adult chest X-ray examinations in 2014, covering over 50,000 studies in the Trust. Chest X-ray examinations were selected as they are low dose but frequent examinations. The patient dose data were evaluated taking into account X-ray system type and detector performance measurements, and individual cases studies were used to highlight where practice can be improved.

  16. Hybrid PET/MR imaging in two sarcoma patients - clinical benefits and implications for future trials.

    PubMed

    Partovi, Sasan; Kohan, Andres A; Zipp, Lisa; Faulhaber, Peter; Kosmas, Christos; Ros, Pablo R; Robbin, Mark R

    2014-01-01

    PET/MRI is an evolving hybrid imaging modality which combines the inherent strengths of MRIs soft-tissue and contrast resolution and PETs functional metabolic capabilities. Bone and soft-tissue sarcoma are a relatively rare tumor entity, relying on MRI for local staging and often on PET/CT for lymph node involvement and metastatic spread evaluation. The purpose of this article is to demonstrate the successful use of PET/MRI in two sarcoma patients. We also use these patients as a starting point to discuss how PET/MRI might be of value in sarcoma. Among its potential benefits are: superior TNM staging than either modality alone, decreased radiation dose, more sensitive and specific follow-up and better assessment of treatment response. These potentials need to be investigated in future PET/MRI soft-tissue sarcoma trials. PMID:24753758

  17. Radionuclide scrotal imaging: further experience with 210 patients. Part I. Anatomy, pathophysiology, and methods

    SciTech Connect

    Chen, D.C.P.; Holder, L.E.; Melloul, M.

    1983-08-01

    Ten years' experience with radionuclide scrotal imaging (RSI) to evaluate perfusion of the scrotal contents has confirmed the value of this examination. In 1973, Nadel et al. first proposed using sodium pertechnetate (Tc-99m) to diagnose testicular torsion. By the end of 1982, more than thirty articles have been published on this topic, with most emphasizing the usefulness of RSI in managing patients with acute scrotal pain. The present communication describes our findings in 210 patients, not previously reported. There were four groups with relatively distinct clinical presentations: (a) acute scrotal pain, (b) chronic scrotal pain, (c) scrotal injury, and (d) scrotal mass. The anatomic and pathophysiologic bases for the scan findings will be emphasized. We discuss the staging of testicular torsion; viability of the compromised testicle; variability in the presentation of acute infection; anatomy of trauma, varicocele, and inguinal hernia; and the correlation with scrotal sonography.

  18. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction

    SciTech Connect

    Gibson, R.S.; Watson, D.D. )

    1991-09-01

    Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction.

  19. Pharmacokinetics and Imaging of 212Pb-TCMC-Trastuzumab After Intraperitoneal Administration in Ovarian Cancer Patients

    PubMed Central

    Torgue, Julien; Azure, Michael T.; Shen, Sui; Saddekni, Souheil; Banaga, Eileen; Carlise, Ronda; Bunch, Patty; Yoder, Daniel; Alvarez, Ronald

    2014-01-01

    Abstract Purpose: Study distribution, pharmacokinetics, and safety of intraperitoneal (IP) 212Pb-TCMC-trastuzumab in patients with HER-2-expressing malignancy. Experimental Design: IP 212Pb-TCMC-trastuzumab was delivered, after 4?mg/kg intravenous (IV) trastuzumab, to 3 patients with HER-2-expressing cancer who had failed standard therapies. Patients were monitored for toxicity and pharmacokinetics/dosimetry parameters. Results: Imaging studies after 0.2?mCi/m2 (7.4?MBq/m2) show little redistribution out of the peritoneal cavity and no significant uptake in major organs. Peak blood level of the radiolabeled antibody, determined by decay corrected counts, was <23% injected dose at 63 hours; maximum blood radioactivity concentration was 6.3nCi/mL at 18 hours. Cumulative urinary excretion was ?6% in 2.3 half-lives. The maximum external exposure rate immediately post-infusion at skin contact over the abdomen averaged 7.67?mR/h and dropped to 0.67?mR/h by 24 hours. The exposure rates at the other positions monitored (axilla, chest, and femur) decreased as a function of distance from the abdomen. The data points correlate closely with 212Pb physical decay (T1/2=10.6 hours). Follow-up >6 months showed no evidence of agent-related toxicity. Conclusions: Pharmacokinetics and imaging after 0.2?mCi/m2 IP 212Pb-TCMC-trastuzumab in patients with HER-2-expressing malignancy showed minimal distribution outside the peritoneal cavity, ?6% urinary excretion, and good tolerance. PMID:24229395

  20. CT and MR Imaging in a Large Series of Patients with Craniofacial Fibrous Dysplasia

    PubMed Central

    Atalar, Mehmet Haydar; Salk, Ismail; Savas, Recep; Uysal, Ismail Onder; Egilmez, Hulusi

    2015-01-01

    Summary Background In this retrospective review of patients with craniofacial fibrous dysplasia (FD), the clinical and radiological findings of CT and MR scan were analyzed. Material/Methods The study material included 32 patients, at 9 to 68 years of age that were directed for differential diagnostics of several disorders in the head. We recorded CT and MRI data related to the lesion number, location, sidedness, appearance, and sex of the cases with craniofacial FD. Results Of 32 patients involved in this study, 17 had monostotic and 15 had polyostotic involvement pattern. Bones most commonly involved by monostotic involvement in females were, in descending order, mandibular, maxillary, and sphenoid bones, while the sphenoid bone was involved the most in males. Leontiasis ossea was observed in 2 patients. Sclerotic and mixed lesion types were more common in both females and males. In T1- and T2-weighted MRI sequences, hypointensity was more common compared to hyperintensity or heterogeneous intensity. The type of enhancement of lesions was found similar after contrast medium administration. Conclusions In the presence of craniofacial FD during CT or MRI imaging of the head, a detailed description of FD lesions may provide an important clinical benefit by increasing radiological experience during the diagnostics of this rare disorder. PMID:26000068

  1. Comparison of FDG-PET/CT images between chronic renal failure patients on hemodialysis and controls

    PubMed Central

    Toriihara, Akira; Kitazume, Yoshio; Nishida, Hidenori; Kubota, Kazunori; Nakadate, Masashi; Tateishi, Ukihide

    2015-01-01

    The whole-body 2-deoxy-2-[18F]fluoro-D-glucose (FDG) distribution in chronic renal failure (CRF) patients on hemodialysis would be different from that in subjects with normal renal function, because they lack urinary FDG excretion and remain in a constant volume overload. We evaluated the difference in the physiological uptake pattern of FDG between chronic renal failure patients on hemodialysis and control subjects. The subjects for this retrospective study consisted of 24 chronic renal failure patients on hemodialysis (HD group) and 24 age- and sex-matched control subjects (NC group). Standardized uptake values normalized by the body weight (SUVbw), ideal body weight (SUVibw), lean body mass (SUVlbm), and body surface area (SUVbsa) in the cerebellum, lungs, liver, gluteal muscles and subcutaneous fat, spleen, thoracolumbar spine, thoracic and abdominal aorta, and right atrium were calculated in positron emission tomography/computed tomography (PET/CT) images. SUVbw in the gluteal muscles, subcutaneous fat, spleen and right atrium was significantly higher in the HD group as compared to that in the NC group (p < 0.05; unpaired t test). In addition, SUVibm, SUVlbm, as well as SUVbsa in the abdominal aorta were significantly higher in the HD group as compared to those in the NC group (p < 0.05; unpaired t test). In conclusion, as compared to normal subjects, chronic renal failure patients on hemodialysis show significantly higher physiological FDG uptake in the soft tissues, spleen and blood pool. PMID:25973341

  2. Grazing incidence beam expander

    SciTech Connect

    Akkapeddi, P.R.; Glenn, P.; Fuschetto, A.; Appert, Q.; Viswanathan, V.K.

    1985-01-01

    A Grazing Incidence Beam Expander (GIBE) telescope is being designed and fabricated to be used as an equivalent end mirror in a long laser resonator cavity. The design requirements for this GIBE flow down from a generic Free Electron Laser (FEL) resonator. The nature of the FEL gain volume (a thin, pencil-like, on-axis region) dictates that the output beam be very small. Such a thin beam with the high power levels characteristic of FELs would have to travel perhaps hundreds of meters or more before expanding enough to allow reflection from cooled mirrors. A GIBE, on the other hand, would allow placing these optics closer to the gain region and thus reduces the cavity lengths substantially. Results are presented relating to optical and mechanical design, alignment sensitivity analysis, radius of curvature analysis, laser cavity stability analysis of a linear stable concentric laser cavity with a GIBE. Fabrication details of the GIBE are also given.

  3. Expandable LED array interconnect

    DOEpatents

    Yuan, Thomas Cheng-Hsin; Keller, Bernd

    2011-03-01

    A light emitting device that can function as an array element in an expandable array of such devices. The light emitting device comprises a substrate that has a top surface and a plurality of edges. Input and output terminals are mounted to the top surface of the substrate. Both terminals comprise a plurality of contact pads disposed proximate to the edges of the substrate, allowing for easy access to both terminals from multiple edges of the substrate. A lighting element is mounted to the top surface of the substrate. The lighting element is connected between the input and output terminals. The contact pads provide multiple access points to the terminals which allow for greater flexibility in design when the devices are used as array elements in an expandable array.

  4. The Role of the Nurse in the Rehabilitation of Patients with Radical Changes in Body Image Due to Burn Injuries

    PubMed Central

    Aacovou, I.

    2005-01-01

    Summary Burn injuries are among the most serious causes of radical changes in body image. The subject of body image and self-image is essential in rehabilitation, and the nurse must be aware of the issues related to these concepts and take them seriously into account in drafting out the nursing programme. This paper defines certain key words related to body image and discusses the social context of body image. Burn injuries are considered in relation to the way each of these affects the patient's body image. The aim of nursing is defined and the nurse's role in cases of severe changes in body image due to burn injuries is discussed. PMID:21990985

  5. Effect of disease and recovery on functional anatomy in brain tumor patients: insights from functional MRI and diffusion tensor imaging

    PubMed Central

    Abd-El-Barr, Muhammad M; Saleh, Emam; Huang, Raymond Y; Golby, Alexandra J

    2014-01-01

    Patients with brain tumors provide a unique opportunity to understand functional brain plasticity. Using advanced imaging techniques, such as functional MRI and diffusion tensor imaging, we have gained tremendous knowledge of brain tumor behavior, transformation, infiltration and destruction of nearby structures. Using these advanced techniques as an adjunct with more proven techniques, such as direct cortical stimulation, intraoperative navigation and advanced microsurgical techniques, we now are able to better formulate safer resection trajectories, perform larger resections at reduced risk and better counsel patients and their families about possible complications. Brain mapping in patients with brain tumors and other lesions has shown us that the old idea of fixed function of the adult cerebral cortex is not entirely true. Improving care for patients with brain lesions in the future will depend on better understanding of the functional organization and plasticity of the adult brain. Advanced noninvasive brain imaging will undoubtedly play a role in advancing this understanding. PMID:24660024

  6. Intra-fraction setup variability: IR optical localization vs. X-ray imaging in a hypofractionated patient population

    PubMed Central

    2011-01-01

    Background The purpose of this study is to investigate intra-fraction setup variability in hypo-fractionated cranial and body radiotherapy; this is achieved by means of integrated infrared optical localization and stereoscopic kV X-ray imaging. Method and Materials We analyzed data coming from 87 patients treated with hypo-fractionated radiotherapy at cranial and extra-cranial sites. Patient setup was realized through the ExacTrac X-ray 6D system (BrainLAB, Germany), consisting of 2 infrared TV cameras for external fiducial localization and X-ray imaging in double projection for image registration. Before irradiation, patients were pre-aligned relying on optical marker localization. Patient position was refined through the automatic matching of X-ray images to digitally reconstructed radiographs, providing 6 corrective parameters that were automatically applied using a robotic couch. Infrared patient localization and X-ray imaging were performed at the end of treatment, thus providing independent measures of intra-fraction motion. Results According to optical measurements, the size of intra-fraction motion was (median ± quartile) 0.3 ± 0.3 mm, 0.6 ± 0.6 mm, 0.7 ± 0.6 mm for cranial, abdominal and lung patients, respectively. X-ray image registration estimated larger intra-fraction motion, equal to 0.9 ± 0.8 mm, 1.3 ± 1.2 mm, 1.8 ± 2.2 mm, correspondingly. Conclusion Optical tracking highlighted negligible intra-fraction motion at both cranial and extra-cranial sites. The larger motion detected by X-ray image registration showed significant inter-patient variability, in contrast to infrared optical tracking measurement. Infrared localization is put forward as the optimal strategy to monitor intra-fraction motion, featuring robustness, flexibility and less invasivity with respect to X-ray based techniques. PMID:21496255

  7. Expanding the Visibility of Women's Work: Policy Implications.

    ERIC Educational Resources Information Center

    Messias, DeAnne K. Hilfinger; Regev, Hanna; Im, Eun-Ok; Spiers, Judith A.; Van, Paulina; Meleis, Afaf Ibrahim

    1997-01-01

    Social conceptualization and media images of women's work affect health and social policy formation. Nurses can expand the visibility of women's work and promote gender-sensitive policies within and outside the profession. (SK)

  8. The incidence and location of prostatic calculi on noncontrast computed tomography images in patients with renal calculi.

    PubMed

    Balasar, Mehmet; Poyraz, Necdet; Gö?er, Yunus Emre; Unal, Yunus; Pi?kin, Mehmet Mesut

    2015-08-01

    In this study, the incidence and location of prostatic calculi on noncontrast abdominal computed tomography (NCACT) images of patients with and without renal stones were investigated. Between 2006 and 2013, NCACT images were taken of 133 patients treated for renal stones (Group I) and of 100 age-matched control patients with putative urinary stone disease (Group II) in our clinic. The incidence and location of prostatic calculi on these images were determined. The location of prostatic calculus was classified as type A if they were located in the main prostatic ducts, and type B if they were located outside the ducts. Prostatic calculi were present in 44.4% of patients in Group I and 21.0% of patients in Group II. The incidence of prostatic calculi was significantly higher in patients with urinary stones compared with those without (P<0.001). The location of prostatic calculi in Group I included 74.6% type A and 25.4% type B while in Group II the locations were 76.2% type A and 23.8% type B. The incidence of prostatic calculi is more prevalent in patients with renal stones. On NCACT images, prostatic calculi were mostly detected in the main prostatic ducts, which were defined as type A. PMID:25991494

  9. Intraoperative laser speckle contrast imaging for monitoring cerebral blood flow: results from a 10-patient pilot study

    NASA Astrophysics Data System (ADS)

    Richards, Lisa M.; Weber, Erica L.; Parthasarathy, Ashwin B.; Kappeler, Kaelyn L.; Fox, Douglas J.; Dunn, Andrew K.

    2012-02-01

    Monitoring cerebral blood flow (CBF) during neurosurgery can provide important physiological information for a variety of surgical procedures. Although multiple intraoperative vascular monitoring technologies are currently available, a quantitative method that allows for continuous monitoring is still needed. Laser speckle contrast imaging (LSCI) is an optical imaging method with high spatial and temporal resolution that has been widely used to image CBF in animal models in vivo. In this pilot clinical study, we adapted a Zeiss OPMI Pentero neurosurgical microscope to obtain LSCI images by attaching a camera and a laser diode. This LSCI adapted instrument has been used to acquire full field flow images from 10 patients during tumor resection procedures. The patient's ECG was recorded during acquisition and image registration was performed in post-processing to account for pulsatile motion artifacts. Digital photographs confirmed alignment of vasculature and flow images in four cases, and a relative change in blood flow was observed in two patients after bipolar cautery. The LSCI adapted instrument has the capability to produce real-time, full field CBF image maps with excellent spatial resolution and minimal intervention to the surgical procedure. Results from this study demonstrate the feasibility of using LSCI to monitor blood flow during neurosurgery.

  10. Respiration-Correlated Image Guidance Is the Most Important Radiotherapy Motion Management Strategy for Most Lung Cancer Patients

    SciTech Connect

    Korreman, Stine; Persson, Gitte; Nygaard, Ditte; Brink, Carsten; Juhler-Nottrup, Trine

    2012-07-15

    Purpose: The purpose of this study was to quantify the effects of four-dimensional computed tomography (4DCT), 4D image guidance (4D-IG), and beam gating on calculated treatment field margins in a lung cancer patient population. Materials and Methods: Images were acquired from 46 lung cancer patients participating in four separate protocols at three institutions in Europe and the United States. Seven patients were imaged using fluoroscopy, and 39 patients were imaged using 4DCT. The magnitude of respiratory tumor motion was measured. The required treatment field margins were calculated using a statistical recipe (van Herk M, et al. Int J Radiat Oncol Biol Phys 2000;474:1121-1135), with magnitudes of all uncertainties, except respiratory peak-to-peak displacement, the same for all patients, taken from literature. Required margins for respiratory motion management were calculated using the residual respiratory tumor motion for each patient for various motion management strategies. Margin reductions for respiration management were calculated using 4DCT, 4D-IG, and gated beam delivery. Results: The median tumor motion magnitude was 4.4 mm for the 46 patients (range 0-29.3 mm). This value corresponded to required treatment field margins of 13.7 to 36.3 mm (median 14.4 mm). The use of 4DCT, 4D-IG, and beam gating required margins that were reduced by 0 to 13.9 mm (median 0.5 mm), 3 to 5.2 mm (median 5.1 mm), and 0 to 7 mm (median 0.2 mm), respectively, to a total of 8.5 to 12.4 mm (median 8.6 mm). Conclusion: A respiratory management strategy for lung cancer radiotherapy including planning on 4DCT scans and daily image guidance provides a potential reduction of 37% to 47% in treatment field margins. The 4D image guidance strategy was the most effective strategy for >85% of the patients.

  11. SU-E-J-160: Comparing the Setup Accuracy of Non-Ionizing Patient Localization Systems with CBCT to Reduce Imaging Dose in Prone Breast Treatments

    SciTech Connect

    Chung, E; Yamamoto, T; Mayadev, J; Dieterich, S

    2014-06-01

    Purpose: CBCT is the current gold standard to verify prone breast patient setup. We investigated in a phantom if non-ionizing localization systems can replace ionizing localization systems for prone breast treatments. Methods: An anthropomorphic phantom was positioned on a prone breast board. Electromagnetic transponders were attached on the left chest surface. The CT images of the phantom were imported to the treatment planning system. The isocenter was set to the center of the transponders. The positions of the isocenter and transponders transferred to the transponder tracking system. The posterior phantom surface was contoured and exported to the optical surface tracking system. A CBCT was taken for the initial setup alignment on the treatment machine. Using the electromagnetic and optical localization systems, the deviation of the phantom setup from the original CT images was measured. This was compared with the difference between the original CT and kV-CBCT images. Results: For the electromagnetic localization system, the phantom position deviated from the original CT in 1.5 mm, 0.0 mm and 0.5 mm in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. For the optical localization system, the phantom position deviated from the original CT in 2.0 mm, ?2.0 mm and 0.1 mm in the AP, SI and LR directions. For the CBCT, the phantom position deviated from the original CT in 4.0 mm, 1.0 mm and ?1.0 mm in the AP, SI and LR directions. The measured values from the non-ionizing localization systems differed from those with the CBCT less than 3.0 mm in all directions. Conclusions: This phantom study showed the feasibility of using a combination of non-ionizing localization systems to achieve a similar setup accuracy as CBCT for prone breast patients. This could potentially eliminate imaging dose. As a next step, we are expanding this study to actual patients. This work has been in part supported by Departmental Research Award RODEPT1-JS001, Department of Radiation Oncology, UC Davis Medical Center.

  12. Assessment of allograft function using diffusion-weighted magnetic resonance imaging in kidney transplant patients.

    PubMed

    Kaul, Anupma; Sharma, Raj Kumar; Gupta, Rakesh Kumar; Lal, Hira; Yadav, Abhishek; Bhadhuria, Dharmendra; Prasad, Narayan; Gupta, Amit

    2014-11-01

    Developing a non-invasive method such as diffusion-weighted magnetic resonance imaging (DWMRI) could be used as a feasible and reproducible modality in the differential diagnosis of allograft dysfunction. We assessed the functional status of the renal allograft by DWMRI and its applicability in assessment of graft dysfunction on all end-stage renal transplant patients who attained normal renal function on the 7th day post-transplantation. Follow-up imaging of the recipient allograft was performed at the end of 90 and 180 days and in case of graft dysfunction. Kidney biopsies were performed to correlate with the corresponding MRI. The apparent diffusion coefficient (ADC) maps of the cortex and medulla were obtained by studying the DWMRI. The ADC values were significantly lower in the medulla compared with the cortex in normal donor kidneys and normally functioning transplanted kidneys, while they decreased significantly when rejection occurred. The reduction in ADC values occurred both in the cortex and in the medulla, and correlated with the degree of rejection on the kidney biopsies. The ADC values increased significantly during the recovery from rejection. We conclude that DWMRI can be beneficial in the diagnosis and follow-up of transplant patients during acute rejection. PMID:25394428

  13. Brown tumor of the sphenoid sinus in a patient with secondary hyperparathyroidism: CT and MR imaging findings.

    PubMed

    Takeshita, Tohru; Tanaka, Hiroko; Harasawa, Arimi; Kaminaga, Tatsuro; Imamura, Tetsuo; Furui, Shigeru

    2004-01-01

    We present a case of brown tumor of the sphenoid sinus in a patient with secondary hyperparathyroidism. CT showed an expansile soft-tissue attenuation mass centered in the sphenoid sinus. CT at bone window setting demonstrated expansile, lytic change and remodeling of the surrounding bone. On MR imaging, the lesion showed iso-intensity to gray matter on T1-weighted images and heterogeneous hyperintensity on T2-weighted images, and showed intense enhancement. The extent of the lesion and its relationship to the surrounding structures were best evaluated by CT and MR imaging. PMID:15468948

  14. Feeling unreal: a functional imaging study in patients with Kleine-Levin syndrome.

    PubMed

    Kas, Aurelie; Lavault, Sophie; Habert, Marie-Odile; Arnulf, Isabelle

    2014-07-01

    Kleine-Levin syndrome is characterized by relapsing-remitting episodes of severe hypersomnia, cognitive impairment, apathy, derealization and behavioural disturbances. Between episodes, patients have normal sleep, mood and behaviour. Functional imaging studies performed in small series of patients with Kleine-Levin syndrome with visual or semi-quantitative, uncontrolled analysis yielded equivocal brain changes. Using whole brain voxel-based group analysis, we compared brain perfusion scintigraphy during and between episodes in consecutive patients with Kleine-Levin syndrome versus healthy control subjects and correlated perfusion changes with disease severity and symptoms, focusing on less studied but disabling symptoms, such as apathy and derealization. During asymptomatic periods, 41 patients (mean age of 22.3 ± 8.1 years, 56.1% male) and 15 age- and sex-matched healthy control subjects underwent single-photon emission computed tomography scanning with technetium-99m ethyl cysteinate dimer. Eleven patients repeated the test during a symptomatic period. Compared with controls, patients during asymptomatic periods had persistent hypoperfusion in the hypothalamus, the thalamus (mainly the right posterior part), the caudate nucleus, and cortical associative areas, including the anterior cingulate, (Brodmann area 25), the orbito-frontal (Brodmann area 11) and the right superior temporal cortices (Brodmann area 22), extending to the insula (P < 0.001 in all area). Two additional hypoperfused areas emerged during symptomatic periods (P < 0.001), located in the right dorsomedial prefrontal cortex (Brodmann area 8) and the right parieto-temporal junction (Brodmann areas 22 and 39). These two areas were more affected between episodes, when the mean episode duration was longer (r = -0.53; P < 0.001). The score for the Depersonalization/Derealization Inventory during symptomatic periods strongly correlated with the hypoperfusion of the right (r = -0.74, P < 0.001) and left (r = -0.59, P < 0.005) parieto-temporal junctions. No hyperperfusion was found. Because the parieto-temporal junction (including the angular gyrus) is involved in cross-modal association between somatosensory (body knowledge), auditory and visual information, the robust hypoperfusions and correlations observed in this area may underlie the striking derealization reported by patients during episodes. Defects in the dorsomedial prefrontal cortex may cause apathy. Persistent hypoperfusion in the diencephalic and associative cortical area during asymptomatic periods is a marker of the disease, suggestive of a scenario wherein patients compensate for these deficient circuitries. PMID:24785943

  15. Ocular findings in patients with alopecia areata: role of ultra-wide-field retinal imaging.

    PubMed

    De Andrade, Francisco Assis; Giavedoni, Priscila; Keller, Johannes; Sainz-de-la-Maza, Maria Tereza; Ferrando, Juan

    2014-12-01

    Alopecia areata is understood as an autoimmune disease T cell-mediated mainly involving hair follicles in humans. It is a multifactorial aetiologic disease characterised by non-scarring alopecia and asymptomatic areas, affecting approximately 2 % of dermatology patients. Recent studies suggest that the pathogenesis of AA plays an important role in the association of certain HLA groups, neuroendocrine parameters and immunogenic factors. During 3 months (March to May 2013) at Hospital Clínic de Barcelona, 22 patients with severe alopecia areata underwent ophthalmic examination to determine whether there were ocular findings in the following parameters: Best-corrected visual acuity on decimal Snellen optotype, anterior segment slit-lamp examination and photograph, intraocular pressure measurement and dilated fundoscopy. Ultra-wide-field retinal imaging with or without red-free photograph was carried out with the Optomap 200 Tx (Optos, DunFermline, UK). Forty-four eyes of 22 patients were analysed [15 females (68.2 %)]. The mean age was 38.9 (SD 13.7) and mean time of evolution was 19.9 years (SD 16.3). Alopecia areata clinical patterns were multifocal [n = 10 (45.5 %)], universalis [n = 7 (31.8 %)], totalis [n = 3 (13.6 %)] and focal [n = 2 (9.1 %)]. Best-corrected visual acuity was 1.0 in almost all patients, but only three eyes (6.8 %) had vision of 0.7. Ocular findings were as follows: madarosis [n = 7 partial loss of eyelashes (31.85 %) and n = 4 total loss (18.2 %)], lens changes [n = 4 (18.2 %)], cataract [n = 3 (13.65 %)]. Ultra-wide fundus photography examination showed peripheral drusen [n = 17 eyes (38.6 %)], white-without-pressure changes [n = 8 eyes (18.22 %)] and peripheral retinal degenerations [n = 3 eyes (6.81 %)]. Ocular findings in patients with alopecia areata are reported and discussed by dermatologic and ophthalmic evaluation. PMID:25450413

  16. Altered Functional Magnetic Resonance Imaging Responses to Nonpainful Sensory Stimulation in Fibromyalgia Patients

    PubMed Central

    López-Solá, Marina; Pujol, Jesus; Wager, Tor D.; Garcia-Fontanals, Alba; Blanco-Hinojo, Laura; Garcia-Blanco, Susana; Poca-Dias, Violant; Harrison, Ben J.; Contreras-Rodríguez, Oren; Monfort, Jordi; Garcia-Fructuoso, Ferran; Deus, Joan

    2015-01-01

    Objective Fibromyalgia (FM) is a disorder characterized by chronic pain and enhanced responses to acute noxious events. However, the sensory systems affected in FM may extend beyond pain itself, as FM patients show reduced tolerance to non-nociceptive sensory stimulation. Characterizing the neural substrates of multisensory hypersensitivity in FM may thus provide important clues about the underlying pathophysiology of the disorder. The aim of this study was to characterize brain responses to non-nociceptive sensory stimulation in FM patients and their relationship to subjective sensory sensitivity and clinical pain severity. Methods Functional magnetic resonance imaging (MRI) was used to assess brain response to auditory, visual, and tactile motor stimulation in 35 women with FM and 25 matched controls. Correlation and mediation analyses were performed to establish the relationship between brain responses and 3 types of outcomes: subjective hypersensitivity to daily sensory stimulation, spontaneous pain, and functional disability. Results Patients reported increased subjective sensitivity (increased unpleasantness) in response to multisensory stimulation in daily life. Functional MRI revealed that patients showed reduced task-evoked activation in primary/secondary visual and auditory areas and augmented responses in the insula and anterior lingual gyrus. Reduced responses in visual and auditory areas were correlated with subjective sensory hypersensitivity and clinical severity measures. Conclusion FM patients showed strong attenuation of brain responses to nonpainful events in early sensory cortices, accompanied by an amplified response at later stages of sensory integration in the insula. These abnormalities are associated with core FM symptoms, suggesting that they may be part of the pathophysiology of the disease. PMID:25220783

  17. Diffusion tensor imaging in evaluation of thigh muscles in patients with polymyositis and dermatomyositis

    PubMed Central

    Yu, K; Gao, L; Zhang, P; Goerner, F; Runge, V M

    2014-01-01

    Objective: To explore the diffusion tensor imaging (DTI) characteristics of thigh muscles in patients with polymyositis (PM) and dermatomyositis (DM). Methods: 12 patients with known PM/DM and 10 healthy volunteers were enrolled in this study. Both DTI and conventional MR sequences were performed on both thighs of all subjects. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) and three eigenvalues were compared between the PM/DM group and the healthy group. One-way analysis of variance and Student's t-test were used for statistical analyses with a significance of p?patients) and normal muscles (p?patients) showed no statistical differences from those in normal muscles (p?>?0.05). Conclusion: DTI can be used to quantitatively evaluate the anisotropic diffusion characteristics of muscles in patients with PM/DM. Advances in knowledge: A new application of DTI is proposed for inflammatory myopathies. The results show that ADC and the three eigenvalues were significantly different between diseased and normal muscles, a finding of potential value in both diagnosis and treatment monitoring of myopathies. PMID:25183381

  18. Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure

    PubMed Central

    van Zalen, Jet; Patel, Nikhil R; J Podd, Steven; Raju, Prashanth; McIntosh, Rob; Brickley, Gary; Beale, Louisa; Sturridge, Lydia P

    2015-01-01

    Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E?), but LVEF has some major limitations. Systolic annular velocity (S?) provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S?, E/E? and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S? measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO2 peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S? at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3?cm/s for death and 5.7?cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S? at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO2 peak. Results indicate that measuring S? during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF.

  19. Radiation dose to patients and image quality evaluation from coronary 256-slice computed tomographic angiography

    NASA Astrophysics Data System (ADS)

    Chen, Liang-Kuang; Wu, Tung-Hsin; Yang, Ching-Ching; Tsai, Chia-Jung; Lee, Jason J. S.

    2010-07-01

    The aim of this study is to assess radiation dose and the corresponding image quality from suggested CT protocols which depends on different mean heart rate and high heart rate variability by using 256-slice CT. Fifty consecutive patients referred for a cardiac CT examination were included in this study. All coronary computed tomographic angiography (CCTA) examinations were performed on a 256-slice CT scanner with one of five different protocols: retrospective ECG-gating (RGH) with full dose exposure in all R-R intervals (protocol A), RGH of 30-80% pulsing window with tube current modulation (B), RGH of 78±5% pulsing window with tube current modulation (C), prospective ECG-triggering (PGT) of 78% R-R interval with 5% padding window (D) and PGT of 78% R-R interval without padding window (E). Radiation dose parameters and image quality scoring were determined and compared. In this study, no significant differences were found in comparison on image quality of the five different protocols. Protocol A obtained the highest radiation dose comparing with those of protocols B, C, D and E by a factor of 1.6, 2.4, 2.5 and 4.3, respectively ( p<0.001), which were ranged between 2.7 and 11.8 mSv. The PGT could significantly reduce radiation dose delivered to patients, as compared to the RGH. However, the use of PGT has limitations and is only good in assessing cases with lower mean heart rate and stable heart rate variability. With higher mean heart rate and high heart rate variability circumstances, the RGH within 30-80% of R-R interval pulsing window is suggested as a feasible technique for assessing diagnostic performance.

  20. Three-Dimensional Microwave Breast Imaging: Dispersive Dielectric Properties Estimation using Patient-Specific Basis Functions

    PubMed Central

    Winters, David W.; Shea, Jacob D.; Kosmas, Panagiotis; Van Veen, Barry D.; Hagness, Susan C.

    2009-01-01

    Breast imaging via microwave tomography involves estimating the distribution of dielectric properties within the patient's breast on a discrete mesh. The number of unknowns in the discrete mesh can be very large for three-dimensional imaging, and this results in computational challenges. We propose a new approach where the discrete mesh is replaced with a relatively small number of smooth basis functions. The dimension of the tomography problem is reduced by estimating the coefficients of the basis functions instead of the dielectric properties at each element in the discrete mesh. The basis functions are constructed using knowledge of the location of the breast surface. The number of functions used in the basis can be varied to balance resolution and computational complexity. The reduced dimension of the inverse problem enables application of a computationally efficient, multiple-frequency inverse scattering algorithm in 3-D. The efficacy of the proposed approach is verified using two 3-D anatomically realistic numerical breast phantoms. It is shown for the case of single-frequency microwave tomography that the imaging accuracy is comparable to that obtained when the original discrete mesh is used, despite the reduction of the dimension of the inverse problem. Results are also shown for a multiple-frequency algorithm where it is computationally challenging to use the original discrete mesh. PMID:19211350

  1. Lesion comparison of multiple sclerosis in hispanic and caucasian patients utilizing an imaging informatics-based eFolder system

    NASA Astrophysics Data System (ADS)

    Ma, Kevin; Fernandez, James; Amezcua, Lilyana; Lerner, Alex; Shiroishi, Mark; Liu, Brent

    2012-02-01

    Multiple sclerosis (MS) is a demyelinating disease in the central nervous system. Genetics have been considered as a leading factor in the prevalence and disease course of MS. We have presented an informatics-based eFolder system for integrating patients' clinical data with MR images and lesion quantification results. The completed eFolder system has been designed and developed in aiding to evaluate disease manifestation differences in Hispanic and Caucasian MS patients. MS lesion data, as shown in MRI, can be extracted by the 3-D automatic lesion detection tool in the eFolder, and data storing and mining tools in eFolder is able to extract and compare data from individual patients. The computer-aided detection (CAD) algorithm has been modified and enhanced to include spatial information as detection criteria. For this study, 36 Caucasian MS patients and 36 matched Hispanic patients have been selected. Most recent MR images of the patients are collected, and images are evaluated both by the CAD tool in the eFolder and radiologists. The results are compared between Caucasian and Hispanic patients and statistically evaluated to see if the two populations have significant difference in lesion presentations. The results can be used to evaluate differences in the two groups of patients and to evaluate the new CAD algorithm's performance with radiologists' contours. Significant findings can further evaluate effectiveness of MS eFolder in MS-related research.

  2. Pancreatitis in patients with pancreas divisum: Imaging features at MRI and MRCP

    PubMed Central

    Wang, Deng-Bin; Yu, Jinxing; Fulcher, Ann S; Turner, Mary A

    2013-01-01

    AIM: To determine the magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) features of pancreatitis with pancreas divisum (PD) and the differences vs pancreatitis without divisum. METHODS: Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study. During one year period, 1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner. Two experienced radiologists retrospectively reviewed all the studies in consensus. Disputes were resolved via consultation with a third experienced radiologist. The assessment included presence and the imaging findings of PD, pancreatitis, and distribution of abnormalities. The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group. MRCP and MRI findings were correlated with final diagnosis. Fisher exact tests and Pearson × 2 tests were performed. RESULTS: Pancreatitis was demonstrated at MRCP and MRI in 173 cases (38 cases with and 135 cases without divisum) among the 1439 consecutive cases. The recurrent acute pancreatitis accounted for 55.26% (21 of 38) in pancreatitis patients associated with PD, which was higher than 6.67% (9 of 135) in the control group, whereas the chronic pancreatitis was a dominant type in the control group (85.19%, 115 of 135) when compared to the study group (42.11%, 16 of 38) (?2 = 40.494, P < 0.0001). In cases of pancreatitis with PD, the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD (17 of 38, 44.74% vs 30 of 135, 22.22%) (?2 = 7.257, P < 0.05). CONCLUSION: MRCP and MRI can depict the features of pancreatitis associated with divisum. Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum. PMID:23946595

  3. The Benefits of Prone SPECT Myocardial Perfusion Imaging in Reducing Both Artifact Defects and Patient Radiation Exposure

    PubMed Central

    Stathaki, Maria; Koukouraki, Sophia; Papadaki, Emmanouela; Tsaroucha, Angeliki; Karkavitsas, Nikolaos

    2015-01-01

    Background Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation. Objectives To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure. Methods We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the “gold standard” for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings. Results Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects. Conclusion Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed. PMID:26559981

  4. SU-E-J-16: A Review of the Magnitude of Patient Imaging Shifts in Relation to Departmental Policy Changes

    SciTech Connect

    O'Connor, M; Sansourekidou, P

    2014-06-01

    Purpose: To evaluate how changes in imaging policy affect the magnitude of shifts applied to patients. Methods: In June 2012, the department's imaging policy was altered to require that any shifts derived from imaging throughout the course of treatment shall be considered systematic only after they were validated with two data points that are consistent in the same direction. Multiple additions and clarifications to the imaging policy were implemented throughout the course of the data collection, but they were mostly of administrative nature. Entered shifts were documented in MOSAIQ (Elekta AB) through the localization offset. The MOSAIQ database was queried to identify a possible trend. A total of 25,670 entries were analyzed, including four linear accelerators with a combination of MV planar, kV planar and kV three dimensional imaging. The monthly average of the magnitude of the vector was used. Plan relative offsets were excluded. During the evaluated period of time, one of the satellite facilities acquired and implemented Vision RT (AlignRT Inc). Results: After the new policy was implemented the shifts variance and standard deviation decreased. The decrease is linear with time elapsed. Vision RT implementation at one satellite facility reduced the number of overall shifts, specifically for breast patients. Conclusion: Changes in imaging policy have a significant effect on the magnitude of shifts applied to patients. Using two statistical points before applying a shift as persistent decreased the overall magnitude of the shifts applied to patients.

  5. Retrospective imaging study on the diagnosis of pathological false positive iodine-131 scans in patients with thyroid cancer

    PubMed Central

    JIA, QIANG; MENG, ZHAOWEI; TAN, JIAN; ZHANG, GUIZHI; HE, YAJING; SUN, HAORAN; YU, CHUNSHUI; LI, DONG; ZHENG, WEI; WANG, RENFEI; WANG, SHEN; LI, XUE; ZHANG, JIANPING; HU, TIANPENG; LIU, NA; UPADHYAYA, ARUN

    2015-01-01

    Iodine-131 (I-131) therapy and post-therapy I-131 scanning are essential in the management of differentiated thyroid cancer (DTC). However, pathological false positive I-131 scans can lead to misdiagnosis and inappropriate I-131 treatment. This retrospective study aimed to investigate the best imaging modality for the diagnosis of pathological false positive I-131 scans in a DTC patient cohort, and to determine its incidence. DTC patient data archived from January 2008 to January 2010 was retrieved. Post-therapeutic I-131 scans were conducted and interpreted. The imaging modalities of magnetic resonance imaging (MRI), computed tomography and ultrasonography were applied and compared to check all suspected lesions. Biopsy or needle aspiration was conducted for patients who consented to the acquisition of histopathological confirmation. Data for 156 DTC patients were retrieved. Only 6 cases of pathological false-positives were found among these (incidence, 3.85%), which included 3 cases of thymic hyperplasia in the mediastinum, 1 case of pleomorphic adenoma in the parapharyngeal space and 1 case of thyroglossal duct cyst in the neck. MRI was demonstrated as the best imaging modality for diagnosis due to its superior soft tissue resolution. However, no imaging modality was able to identify the abdominal false positive-lesions observed in 2 cases, one of whom also had thymic hyperplasia. In conclusion, pathological false positive I-131 scans occurred with an incidence of 3.85%. MRI was the best imaging modality for diagnosing these pathological false-positives. PMID:26640586

  6. Patient-specific minimum-dose imaging protocols for statistical image reconstruction in C-arm cone-beam CT using correlated noise injection

    NASA Astrophysics Data System (ADS)

    Wang, A. S.; Stayman, J. W.; Otake, Y.; Khanna, A. J.; Gallia, G. L.; Siewerdsen, J. H.

    2014-03-01

    Purpose: A new method for accurately portraying the impact of low-dose imaging techniques in C-arm cone-beam CT (CBCT) is presented and validated, allowing identification of minimum-dose protocols suitable to a given imaging task on a patient-specific basis in scenarios that require repeat intraoperative scans. Method: To accurately simulate lower-dose techniques and account for object-dependent noise levels (x-ray quantum noise and detector electronics noise) and correlations (detector blur), noise of the proper magnitude and correlation was injected into the projections from an initial CBCT acquired at the beginning of a procedure. The resulting noisy projections were then reconstructed to yield low-dose preview (LDP) images that accurately depict the image quality at any level of reduced dose in both filtered backprojection and statistical image reconstruction. Validation studies were conducted on a mobile C-arm, with the noise injection method applied to images of an anthropomorphic head phantom and cadaveric torso across a range of lower-dose techniques. Results: Comparison of preview and real CBCT images across a full range of techniques demonstrated accurate noise magnitude (within ~5%) and correlation (matching noise-power spectrum, NPS). Other image quality characteristics (e.g., spatial resolution, contrast, and artifacts associated with beam hardening and scatter) were also realistically presented at all levels of dose and across reconstruction methods, including statistical reconstruction. Conclusion: Generating low-dose preview images for a broad range of protocols gives a useful method to select minimum-dose techniques that accounts for complex factors of imaging task, patient-specific anatomy, and observer preference. The ability to accurately simulate the influence of low-dose acquisition in statistical reconstruction provides an especially valuable means of identifying low-dose limits in a manner that does not rely on a model for the nonlinear reconstruction process or a model of observer performance.

  7. Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients with Lumbar Intervertebral Disc Herniation

    PubMed Central

    Lurie, Jon D.; Moses, Rachel A.; Tosteson, Anna N. A.; Tosteson, Tor D.; Carragee, Eugene J.; Carrino, John A.; Kaiser, Jay A.; Herzog, Richard J.

    2013-01-01

    Study Design A retrospective cohort design Objective To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect. Summary of Background Data Intervertebral Disc Herniation (IDH)remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes. Methods Three-hundred-and-seven “complete” images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores. Results The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (?26.4 versus ?39.7 for none and ?39.2 for type 2, p=0.002) and smaller treatment effect (?3.5 versus ?19.3 for none and ?15.7 for type 2, p=0.003). Those with compression >=1/3 showed the greatest improvement within the surgical group (?41.9 for >=1/3 versus ?31.6 for none and ?38.1 for <1/3,p=0.007), and the highest TE (?23 compared to ?11.7 for none and ?15.2 for <1/3, p=0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes(?26.5 versus ?41.1 for “displaced” and ?38.9 for “compressed”, p=0.016). Conclusion Among patients with IDH, those with thecal sac compression >=1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root “compression” and “displacement” benefit more from surgery than those with minimal nerve-root impingement. PMID:23429684

  8. In the mind’s eye: Provider and patient attitudes on functional brain imaging

    PubMed Central

    Illes, J.; Lombera, S.; Rosenberg, J.; Arnow, B.

    2008-01-01

    Success in functional neuroimaging has brought the promise of quantitative data in the form of brain images to the diagnosis of disorders of the central nervous system for which only qualitative clinical criteria have previously existed. Even though the translation of research to clinical neuroimaging for conditions such as major depression may not be available yet, rapid innovation along this trajectory of discovery to implementation compels exploration of how such information will eventually affect providers and patients. Clinical neuroethics is devoted to elucidating ethical challenges prior to and during the transfer of new research capabilities to the bedside. Through a model of proactive ethics, clinical neuroethics promotes the development of responsible social and public policies in response to new diagnostic and prognostic capabilities for the benefit of patients and their families, and for providers within the health care systems in which they practice. To examine views about the potential interaction of clinical neuroimaging and depression, we surveyed both mental health providers and outpatients and inpatients diagnosed with major depressive disorder. From responses of 52 providers and 72 patients, we found high receptivity to brain scans for treatment tailoring and choice, for improving understanding of and coping with disease, and for mitigating the effects of stigma and self-blame. Our results suggest that, once ready, roll out of the fully validated technology has significant potential to reduce social burden associated with highly stigmatized illnesses like depression. PMID:18423669

  9. Predictors of intramedullary lesion expansion rate on MR images of patients with subaxial spinal cord injury.

    PubMed

    Le, Elizabeth; Aarabi, Bizhan; Hersh, David S; Shanmuganathan, Kathirkamanthan; Diaz, Cara; Massetti, Jennifer; Akhtar-Danesh, Noori

    2015-06-01

    OBJECT Studies of preclinical spinal cord injury (SCI) in rodents indicate that expansion of intramedullary lesions (IMLs) seen on MR images may be amenable to neuroprotection. In patients with subaxial SCI and motor-complete American Spinal Injury Association (ASIA) Impairment Scale (AIS) Grade A or B, IML expansion has been shown to be approximately 900 ?m/hour. In this study, the authors investigated IML expansion in a cohort of patients with subaxial SCI and AIS Grade A, B, C, or D. METHODS Seventy-eight patients who had at least 2 MRI scans within 6 days of SCI were enrolled. Data were analyzed by regression analysis. RESULTS In this cohort, the mean age was 45.3 years (SD 18.3 years), 73 patients were injured in a motor vehicle crash, from a fall, or in sport activities, and 77% of them were men. The mean Injury Severity Score (ISS) was 26.7 (SD 16.7), and the AIS grade was A in 23 patients, B in 7, C in 7, and D in 41. The mechanism of injury was distraction in 26 patients, compression in 22, disc/osteophyte complex in 29, and Chance fracture in 1. The mean time between injury onset and the first MRI scan (Interval 1) was 10 hours (SD 8.7 hours), and the mean time to the second MRI scan (Interval 2) was 60 hours (SD 29.6 hours). The mean IML lengths of the first and second MR images were 38.8 mm (SD 20.4 mm) and 51 mm (SD 36.5 mm), respectively. The mean time from the first to the second MRI scan (Interval 3) was 49.9 hours (SD 28.4 hours), and the difference in IML lengths was 12.6 mm (SD 20.7 mm), reflecting an expansion rate of 366 ?m/ hour (SD 710 ?m/hour). IML expansion in patients with AIS Grades A and B was 918 ?m/hour (SD 828 ?m/hour), and for those with AIS Grades C and D, it was 21 ?m/hour (SD 304 ?m/hour). Univariate analysis indicated that AIS Grade A or B versus Grades C or D (p < 0.0001), traction (p= 0.0005), injury morphology (p < 0.005), the surgical approach (p= 0.009), vertebral artery injury (p= 0.02), age (p < 0.05), ISS (p < 0.05), ASIA motor score (p < 0.05), and time to decompression (p < 0.05) were all predictors of lesion expansion. In multiple regression analysis, however, the sole determinant of IML expansion was AIS grade (p < 0.005). CONCLUSIONS After traumatic subaxial cervical spine or spinal cord injury, patients with motor-complete injury (AIS Grade A or B) had a significantly higher rate of IML expansion than those with motor-incomplete injury (AIS Grade C or D). PMID:25746115

  10. Contralateral Prophylactic Mastectomy in the American College of Radiology Imaging Network 6667 Trial: Effect of Breast MR Imaging Assessments and Patient Characteristics

    PubMed Central

    Hanna, Lucy G.; Gatsonis, Constantine; Mahoney, Mary C.; Schnall, Mitchell D.; DeMartini, Wendy B.; Lehman, Constance D.

    2014-01-01

    Purpose To assess which patient and magnetic resonance (MR) imaging factors are associated with the likelihood of contralateral prophylactic mastectomy (CPM) in patients with newly diagnosed breast cancer. Materials and Methods The American College of Radiology Imaging Network 6667 trial was compliant with HIPAA; institutional review board approval was obtained at each site. All patients provided written informed consent. This study was a retrospective review of data from 934 women enrolled in the trial who did not have a known contralateral breast cancer at the time of surgical planning. The authors assessed age, menopausal status, index breast cancer histologic results, contralateral breast histologic results, breast density, family history, race and/or ethnicity, MR imaging Breast Imaging Reporting and Data System (BI-RADS) assessment, and number of MR imaging lesions for association with CPM by using the Fisher exact test, exact ?2 test, and multivariate logistic regression analyses. Results Eighty-six of the 934 (9.2%) women underwent CPM and were more likely to be younger (mean age, 48 years [range, 27–78 years] vs mean age, 54 years [range, 25–86 years]; P < .0001), be premenopausal (55 of 86 [64%] vs 349 of 845 [41%], P < .0001), have ductal carcinoma in situ (DCIS) in the index breast (31% [27 of 86] vs 19% [164 of 848], P = .02), have greater breast density (71 of 86 [83%] vs 572 of 848 [68%], P = .004), and have a family history of breast cancer (44 of 86 [30%] vs 150 of 488 [18%], P = .01) than those who did not undergo CPM. Distributions of race and/or ethnicity, contralateral lesion pathologic results, and number of MR imaging lesions were similar in both groups. With multivariate modeling, younger age, greater breast density, DCIS index cancer, and family history remained significant, whereas menopausal status did not. Positive MR imaging assessments were not significantly more frequent in the CPM group than in the group of women who did not undergo CPM (14 of 86 [16.3%] vs 113 of 848 [13.3%], P = .43). Conclusion In patients with newly diagnosed breast cancer who underwent breast MR imaging at which a contralateral breast cancer was not identified, patient factors and not breast MR imaging BI-RADS scores were chief determinants in decisions regarding CPM. © RSNA, 2014 Online supplemental material is available for this article. PMID:24937691

  11. Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance

    PubMed Central

    2014-01-01

    Background Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). Methods A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1–2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5–7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. Results The 2-year actuarial likelihood of developing grade?>?= 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p??= 2 GI toxicity compared to IG-IMRT (p?image guidance and margin reduction. PMID:24495815

  12. Distribution of Proliferating Bone Marrow in Adult Cancer Patients Determined Using FLT-PET Imaging

    SciTech Connect

    Hayman, James A.; Callahan, Jason W.; Herschtal, Alan; Everitt, Sarah; Binns, David S.; Hicks, Rod J.; Mac Manus, Michael

    2011-03-01

    Purpose: Given that proliferating hematopoietic stem cells are especially radiosensitive, the bone marrow is a potential organ at risk, particularly with the use of concurrent chemotherapy and radiotherapy. Existing data on bone marrow distribution have been determined from the weight and visual appearance of the marrow in cadavers. {sup 18}F-fluoro-L-deoxythymidine concentrates in bone marrow, and we used its intensity on positron emission tomography imaging to quantify the location of the proliferating bone marrow. Methods and Materials: The {sup 18}F-fluoro-L-deoxythymidine positron emission/computed tomography scans performed at the Peter MacCallum Cancer Centre between 2006 and 2009 on adult cancer patients were analyzed. At a minimum, the scans included the mid-skull through the proximal femurs. A software program developed at our institution was used to calculate the percentage of administered activity in 11 separately defined bony regions. Results: The study population consisted of 13 patients, 6 of whom were men. Their median age was 61 years. Of the 13 patients, 9 had lung cancer, 2 had colon cancer, and 1 each had melanoma and leiomyosarcoma; 6 had received previous, but not recent, chemotherapy. The mean percentage of proliferating bone marrow by anatomic site was 2.9% {+-} 2.1% at the skull, 1.9% {+-} 1.2% at the proximal humeri, 2.9% {+-} 1.3% at the sternum, 8.8% {+-} 4.7% at the ribs and clavicles, 3.8% {+-} 0.9% at the scapulas, 4.3% {+-} 1.6% at the cervical spine, 19.9% {+-} 2.6% at the thoracic spine, 16.6% {+-} 2.2% at the lumbar spine, 9.2% {+-} 2.3% at the sacrum, 25.3% {+-} 4.9% at the pelvis, and 4.5% {+-} 2.5% at the proximal femurs. Conclusion: Our modern estimates of bone marrow distribution in actual cancer patients using molecular imaging of the proliferating marrow provide updated data for optimizing normal tissue sparing during external beam radiotherapy planning.

  13. WE-D-18A-05: Construction of Realistic Liver Phantoms From Patient Images and a Commercial 3D Printer

    SciTech Connect

    Leng, S; Vrieze, T; Kuhlmann, J; Yu, L; Matsumoto, J; Morris, J; McCollough, C

    2014-06-15

    Purpose: To assess image quality and radiation dose reduction in abdominal CT imaging, physical phantoms having realistic background textures and lesions are highly desirable. The purpose of this work was to construct a liver phantom with realistic background and lesions using patient CT images and a 3D printer. Methods: Patient CT images containing liver lesions were segmented into liver tissue, contrast-enhanced vessels, and liver lesions using commercial software (Mimics, Materialise, Belgium). Stereolithography (STL) files of each segmented object were created and imported to a 3D printer (Object350 Connex, Stratasys, MN). After test scans were performed to map the eight available printing materials into CT numbers, printing materials were assigned to each object and a physical liver phantom printed. The printed phantom was scanned on a clinical CT scanner and resulting images were compared with the original patient CT images. Results: The eight available materials used to print the liver phantom had CT number ranging from 62 to 117 HU. In scans of the liver phantom, the liver lesions and veins represented in the STL files were all visible. Although the absolute value of the CT number in the background liver material (approx. 85 HU) was higher than in patients (approx. 40 HU), the difference in CT numbers between lesions and background were representative of the low contrast values needed for optimization tasks. Future work will investigate materials with contrast sufficient to emulate contrast-enhanced arteries. Conclusion: Realistic liver phantoms can be constructed from patient CT images using a commercial 3D printer. This technique may provide phantoms able to determine the effect of radiation dose reduction and noise reduction techniques on the ability to detect subtle liver lesions in the context of realistic background textures.

  14. Daily patient setup error in prostate image guided radiation therapy with fiducial-based kilovoltage onboard imaging and conebeam computed tomography

    PubMed Central

    Qureshi, Muhammad M.; Clancy, Pauline; Dise, Lauren N.; Willins, John; Hirsch, Ariel E.

    2015-01-01

    Background This study examined the interfraction setup error in patients undergoing prostate radiotherapy using fiducial markers and on-board imaging. Methods Patients (n=53) were aligned to the treatment isocenter by laser followed by orthogonal kilovoltage (kV) radiographs to visualize bony anatomy and implanted fiducial markers. The magnitude and direction of couch shifts for isocenter correction required was determined by image registration for bony anatomy and fiducial markers. Twice weekly, 25 of the 53 patients also underwent conebeam computed tomography (CBCT) to measure any residual error in patient positioning. Based on individual coordinate shifts from CBCT, a net three-dimensional (3D) residual shift magnitude vector R was calculated. Results The average couch shifts were 0.26 and 0.40 cm in inferior direction and 0.25 and 0.33 cm in superior direction for alignments made with bony anatomy and fiducial markers, respectively (P<0.0001). There were no significant differences noted in the vertical or lateral planes between the two image registration methods. In subset of 25 patients, no residual shift from fiducial plain film set up was required with CBCT matching in 66.5%, 52.4% and 57.9% of fractions for longitudinal, vertical and lateral planes, respectively, with majority (79%) of patients having a net residual 3D shifts of <0.3 cm. The use of CBCT increased average treatment time by approximately 6 min compared to kV radiographs alone. Conclusions The residual setup errors following daily kV image guided localization, as determined by CBCT, were small, which demonstrates high accuracy of kV localization when fiducial markers are present. PMID:26682136

  15. SU-E-J-30: Benchmark Image-Based TCP Calculation for Evaluation of PTV Margins for Lung SBRT Patients

    SciTech Connect

    Li, M; Chetty, I; Zhong, H

    2014-06-01

    Purpose: Tumor control probability (TCP) calculated with accumulated radiation doses may help design appropriate treatment margins. Image registration errors, however, may compromise the calculated TCP. The purpose of this study is to develop benchmark CT images to quantify registration-induced errors in the accumulated doses and their corresponding TCP. Methods: 4DCT images were registered from end-inhale (EI) to end-exhale (EE) using a “demons” algorithm. The demons DVFs were corrected by an FEM model to get realistic deformation fields. The FEM DVFs were used to warp the EI images to create the FEM-simulated images. The two images combined with the FEM DVF formed a benchmark model. Maximum intensity projection (MIP) images, created from the EI and simulated images, were used to develop IMRT plans. Two plans with 3 and 5 mm margins were developed for each patient. With these plans, radiation doses were recalculated on the simulated images and warped back to the EI images using the FEM DVFs to get the accumulated doses. The Elastix software was used to register the FEM-simulated images to the EI images. TCPs calculated with the Elastix-accumulated doses were compared with those generated by the FEM to get the TCP error of the Elastix registrations. Results: For six lung patients, the mean Elastix registration error ranged from 0.93 to 1.98 mm. Their relative dose errors in PTV were between 0.28% and 6.8% for 3mm margin plans, and between 0.29% and 6.3% for 5mm-margin plans. As the PTV margin reduced from 5 to 3 mm, the mean TCP error of the Elastix-reconstructed doses increased from 2.0% to 2.9%, and the mean NTCP errors decreased from 1.2% to 1.1%. Conclusion: Patient-specific benchmark images can be used to evaluate the impact of registration errors on the computed TCPs, and may help select appropriate PTV margins for lung SBRT patients.

  16. Magnetic resonance images in patients with acute traumatic injury of the temporomandibular joint: a preliminary report.

    PubMed

    Takaku, S; Yoshida, M; Sano, T; Toyoda, T

    1996-06-01

    Condylar or subcondylar fractures are severe traumatic lesions of the temporomandibular joint (TMJ) but the damage to the intracapsular soft tissues is not fully defined. In this study, twelve joints in ten patients with condylar and subcondylar fractures of the TMJ between two and twelve days after injury, were examined by magnetic resonance imaging to evaluate the damage to the intracapsular soft tissues in the acute phase. The joint capsule and the retrodiscal tissue were both swollen and showed increased signal intensity. Tears were recognized in the capsule of the eight joints and in the retrodiscal tissue of six joints. All discs were displaced in an anteromedial direction along with the fractured condylar fragments, but tear (rupture) was not recognized. In all cases, high signal intensity was seen in the joint spaces, and haemarthrosis was recognized in six joints during open reduction surgery. PMID:8842909

  17. Choosing a Hyperacute Stroke Imaging Protocol for Proper Patient Selection and Time Efficient Endovascular Treatment: Lessons from Recent Trials

    PubMed Central

    Lee, Jin Soo; Demchuk, Andrew M.

    2015-01-01

    Recently, several prospective randomized control trials regarding endovascular treatment for patients with intracranial large artery occlusions causing acute ischemic stroke have been successfully reported. Effort to minimize time delays to endovascular treatment, patient selection and the use of retrievable stent were important factors for the success of these trials. The inclusion and exclusion criteria for each of these trials did include differences in imaging protocols. In this review, we focus on the importance of baseline non-invasive angiography prior to deciding endovascular treatment. Then imaging protocols are described for each trial according to measurement of infarct volume and collateral grading. PMID:26437989

  18. Magnetic resonance imaging and BMB score in the evaluation of bone involvement in Gaucher’s disease patients*

    PubMed Central

    de Mello, Ricardo Andrade Fernandes; Mello, Melissa Bozzi Nonato; Pessanha, Laís Bastos

    2015-01-01

    Objective To evaluate by magnetic resonance imaging changes in bone marrow of patients undergoing treatment for type I Gaucher’s disease. Materials and Methods Descriptive, cross-sectional study of Gaucher’s disease patients submitted to 3 T magnetic resonance imaging of femurs and lumbar spine. The images were blindly reviewed and the findings were classified according to the semiquantitative bone marrow burden (BMB) scoring system. Results All of the seven evaluated patients (three men and four women) presented signs of bone marrow infiltration. Osteonecrosis of the femoral head was found in three patients, Erlenmeyer flask deformity in five, and no patient had vertebral body collapse. The mean BMB score was 11, ranging from 9 to 14. Conclusion Magnetic resonance imaging is currently the method of choice for assessing bone involvement in Gaucher’s disease in adults due to its high sensitivity to detect both focal and diffuse bone marrow changes, and the BMB score is a simplified method for semiquantitative analysis, without depending on advanced sequences or sophisticated hardware, allowing for the classification of the disease extent and assisting in the treatment monitoring. PMID:26379319

  19. Treating patients with advanced rectal cancer and lateral pelvic lymph nodes with preoperative chemoradiotherapy based on pretreatment imaging

    PubMed Central

    Otowa, Yasunori; Yamashita, Kimihiro; Kanemitsu, Kiyonori; Sumi, Yasuo; Yamamoto, Masashi; Kanaji, Shingo; Imanishi, Tatsuya; Nakamura, Tetsu; Suzuki, Satoshi; Tanaka, Kenichi; Kakeji, Yoshihiro

    2015-01-01

    Preoperative chemoradiotherapy (CRT) and lateral pelvic lymph node (LPLN) dissection (LPLD) based on pretreatment imaging are performed to improve oncological outcomes at our institution. However, the advantage of LPLD following preoperative CRT in advanced rectal cancer remains unclear. The objective of the present study was to assess the validity of this approach. Thirty-two patients with advanced rectal cancer were included in the study. All patients were treated with preoperative CRT and curative operation. Of these, 16 patients who were treated between August 2005 and June 2008 underwent LPLD on both sides (LPLD group). Sixteen patients who were treated between July 2008 and January 2013 underwent LPLD only on the side with suspected LPLN metastasis determined by pretreatment imaging; in cases without LPLN metastasis, only total mesorectal excision was performed (limited-LPLD group). The overall survival and relapse-free survival between the LPLD and the limited-LPLD groups were compared. Preoperative CRT was able to lower clinical lymph node status in 50% of the cases. In addition, pathological lymph node status did not exceed the pretreatment clinical lymph node status stage in the LPLD group. There were no differences in the overall survival and relapse-free survival between the two groups (P=0.729 and P=0.874, respectively). We conclude that multi-imaging studies have a very low risk of overlooking pathologically positive LPLN metastases. Therefore, limited LPLD is a feasible strategy for patients with advanced rectal cancer and suspicious LPLN metastases based on pretreatment imaging.

  20. Three-dimensional brain metabolic imaging in patients with toxic encephalopathy

    SciTech Connect

    Callender, T.J.; Duhon, D.; Ristovv, M. ); Morrow, L. ); Subramanian, K. )

    1993-02-01

    Thirty-three workers, ages 24 to 63, developed clinical toxic encephalopathy after exposure to neurotoxins and were studied by SPECT brain scans. Five were exposed to pesticides, 13 were acutely exposed to mixtures of solvents, 8 were chronically exposed to mixtures of hazardous wastes that contained organic solvents, 2 were acutely exposed to phosgene and other toxins, and 5 had exposures to hydrogen sulfide. Twenty-nine had neuropsychological testing and all had a medical history and physical. Of the workers who had a clinical diagnosis of toxic encephalopathy, 31 (93.9%) had abnormal SPECT brain scans with the most frequent areas of abnormality being temporal lobes (67.7%), frontal lobes (61.3%), basal ganglia (45.2%), thalamus (29.0%), parietal lobes (12.9%), motorstrip (9.68%), cerebral hemisphere (6.45%), occipital lobes (3.23%), and caudate nucleus (3.23%). Twenty-three out of 29 (79.3%) neuropsychological evaluations were abnormal. Other modalities when performed included the following percentages of abnormals: NCV, 33.3%; CPT sensory nerve testing, 91.3%, vestibular function testing, 71.4%; olfactory testing, 89.2%; sleep EEG analysis, 85.7%; EEG, 8.33%; CT, 7.14%; and MRI brain scans, 28.6%. The complex of symptoms seen in toxic encephalopathy implies dysfunction involving several CNS regions. This series of patients adds to the previous experience of brain metabolic imaging and demonstrates that certain areas of the brain are typically affected despite differences in toxin structure, that these lesions can be globally defined by SPECT/PET brain scans, that these lesions correlate well with clinical and neuropsychological testing, and that such testing is a useful adjunct to previous methods. EEG and structural brain imaging such as CT and MRI are observed to have poor sensitivity in this type of patient. 32 refs., 5 tabs.

  1. Evidence of outer retinal changes in glaucoma patients as revealed by ultrahigh-resolution in vivo retinal imaging

    PubMed Central

    Choi, Stacey S; Zawadzki, Robert J; Lim, Michele C; Brandt, James D; Keltner, John L; Doble, Nathan; Werner, John S

    2010-01-01

    Aims It is well established that glaucoma results in a thinning of the inner retina. To investigate whether the outer retina is also involved, ultrahigh-resolution retinal imaging techniques were utilised. Methods Eyes from 10 glaucoma patients (25–78 years old), were imaged using three research-grade instruments: (1) ultrahigh-resolution Fourier-domain optical coherence tomography (UHR-FD-OCT), (2) adaptive optics (AO) UHR-FD-OCT and (3) AO-flood illuminated fundus camera (AO-FC). UHR-FD-OCT and AO-UHR-FD-OCT B-scans were examined for any abnormalities in the retinal layers. On some patients, cone density measurements were made from the AO-FC en face images. Correlations between retinal structure and visual sensitivity were measured by Humphrey visual-field (VF) testing made at the corresponding retinal locations. Results All three in vivo imaging modalities revealed evidence of outer retinal changes along with the expected thinning of the inner retina in glaucomatous eyes with VF loss. AO-UHR-FD-OCT images identified the exact location of structural changes within the cone photoreceptor layer with the AO-FC en face images showing dark areas in the cone mosaic at the same retinal locations with reduced visual sensitivity. Conclusion Losses in cone density along with expected inner retinal changes were demonstrated in well-characterised glaucoma patients with VF loss. PMID:20956277

  2. Expanding hollow metal rings

    DOEpatents

    Peacock, Harold B. (Evans, GA); Imrich, Kenneth J. (Grovetown, GA)

    2009-03-17

    A sealing device that may expand more planar dimensions due to internal thermal expansion of a filler material. The sealing material is of a composition such that when desired environment temperatures and internal actuating pressures are reached, the sealing materials undergoes a permanent deformation. For metallic compounds, this permanent deformation occurs when the material enters the plastic deformation phase. Polymers, and other materials, may be using a sealing mechanism depending on the temperatures and corrosivity of the use. Internal pressures are generated by either rapid thermal expansion or material phase change and may include either liquid or solid to gas phase change, or in the gaseous state with significant pressure generation in accordance with the gas laws. Sealing material thickness and material composition may be used to selectively control geometric expansion of the seal such that expansion is limited to a specific facing and or geometric plane.

  3. Mechanically expandable annular seal

    DOEpatents

    Gilmore, R.F.

    1983-07-19

    A mechanically expandable annular reusable seal assembly to form an annular hermetic barrier between two stationary, parallel, and planar containment surfaces is described. A rotatable ring, attached to the first surface, has ring wedges resembling the saw-tooth array of a hole saw. Matching seal wedges are slidably attached to the ring wedges and have their motion restricted to be perpendicular to the second surface. Each seal wedge has a face parallel to the second surface. An annular elastomer seal has a central annular region attached to the seal wedges' parallel faces and has its inner and outer circumferences attached to the first surface. A rotation of the ring extends the elastomer seal's central region perpendicularly towards the second surface to create the fluid tight barrier. A counter rotation removes the barrier. 6 figs.

  4. A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma.

    PubMed

    Mai, Elias K; Hielscher, Thomas; Kloth, Jost K; Merz, Maximilian; Shah, Sofia; Raab, Marc S; Hillengass, Michaela; Wagner, Barbara; Jauch, Anna; Hose, Dirk; Weber, Marc-André; Delorme, Stefan; Goldschmidt, Hartmut; Hillengass, Jens

    2015-06-01

    Diffuse and focal bone marrow infiltration patterns detected by magnetic resonance imaging have been shown to be of prognostic significance in all stages of monoclonal plasma cell disorders and have, therefore, been incorporated into the definition of the disease. The aim of this retrospective analysis was to develop a rapidly evaluable prognostic scoring system, incorporating the most significant information acquired from magnetic resonance imaging. Therefore, the impact of bone marrow infiltration patterns on progression-free and overall survival in 161 transplant-eligible myeloma patients was evaluated. Compared to salt and pepper/minimal diffuse infiltration, moderate/severe diffuse infiltration had a negative prognostic impact on both progression-free survival (P<0.001) and overall survival (P=0.003). More than 25 focal lesions on whole-body magnetic resonance imaging or more than seven on axial magnetic resonance imaging were associated with an adverse prognosis (progression-free survival: P=0.001/0.003 and overall survival: P=0.04/0.02). A magnetic resonance imaging-based prognostic scoring system, combining grouped diffuse and focal infiltration patterns, was formulated and is applicable to whole-body as well as axial magnetic resonance imaging. The score identified high-risk patients with median progression-free and overall survival of 23.4 and 55.9 months, respectively (whole-body-based). Multivariate analyses demonstrated that the magnetic resonance imaging-based prognostic score stage III (high-risk) and adverse cytogenetics are independent prognostic factors for both progression-free and overall survival (whole-body-based, progression-free survival: hazard ratio=3.65, P<0.001; overall survival: hazard ratio=5.19, P=0.005). In conclusion, we suggest a magnetic resonance imaging-based prognostic scoring system which is a robust, easy to assess and interpret parameter summarizing significant magnetic resonance imaging findings in transplant-eligible patients with multiple myeloma. PMID:25795721

  5. Measuring the relative extent of pulmonary infiltrates by hierarchical classification of patient-specific image features

    NASA Astrophysics Data System (ADS)

    Tsevas, S.; Iakovidis, D. K.

    2011-11-01

    Pulmonary infiltrates are common radiological findings indicating the filling of airspaces with fluid, inflammatory exudates, or cells. They are most common in cases of pneumonia, acute respiratory syndrome, atelectasis, pulmonary oedema and haemorrhage, whereas their extent is usually correlated with the extent or the severity of the underlying disease. In this paper we propose a novel pattern recognition framework for the measurement of the extent of pulmonary infiltrates in routine chest radiographs. The proposed framework follows a hierarchical approach to the assessment of image content. It includes the following: (a) sampling of the lung fields; (b) extraction of patient-specific grey-level histogram signatures from each sample; (c) classification of the extracted signatures into classes representing normal lung parenchyma and pulmonary infiltrates; (d) the samples for which the probability of belonging to one of the two classes does not reach an acceptable level are rejected and classified according to their textural content; (e) merging of the classification results of the two classification stages. The proposed framework has been evaluated on real radiographic images with pulmonary infiltrates caused by bacterial infections. The results show that accurate measurements of the infiltration areas can be obtained with respect to each lung field area. The average measurement error rate on the considered dataset reached 9.7% ± 1.0%.

  6. SRXRF imaging of a single brain cell from a patient with Parkinson's disease

    SciTech Connect

    Takada, K.; Ektessabi, A. M.; Yoshida, S.

    1999-06-10

    Synchrotron radiation X-ray fluorescence spectroscopy (SRXRF) is a potential imaging technique with regard to minimum detection limit, measuring time and being non-destructive on biological samples. These advantages are important for measuring trace elements in biological samples. In this paper, we investigated the distribution of trace elements in the cerebral neurons of the brains of patients with Parkinson's disease (PD), using SRXRF spectroscopy. The cause of PD is unknown but many researchers consider that excessive accumulation of trace metal elements (mainly iron) has strong influence on the generative process of PD. Micro beam imaging (mapping of the elements) with a beam size of 6x8 {mu}m{sup 2}, and the energy of 13.5 keV was carried out in a single neuron. The distribution of trace elements in the neurons was successfully obtained in an area of about 100x100 {mu}m{sup 2}. The same sample was histologically studied with an optical microscope.

  7. High-Resolution Images of Retinal Structure in Patients with Choroideremia

    PubMed Central

    Syed, Reema; Sundquist, Sanna M.; Ratnam, Kavitha; Zayit-Soudry, Shiri; Zhang, Yuhua; Crawford, J. Brooks; MacDonald, Ian M.; Godara, Pooja; Rha, Jungtae; Carroll, Joseph; Roorda, Austin; Stepien, Kimberly E.; Duncan, Jacque L.

    2013-01-01

    Purpose. To study retinal structure in choroideremia patients and carriers using high-resolution imaging techniques. Methods. Subjects from four families (six female carriers and five affected males) with choroideremia (CHM) were characterized with best-corrected visual acuity (BCVA), kinetic and static perimetry, full-field electroretinography, and fundus autofluorescence (FAF). High-resolution macular images were obtained with adaptive optics scanning laser ophthalmoscopy (AOSLO) and spectral domain optical coherence tomography (SD-OCT). Coding regions of the CHM gene were sequenced. Results. Molecular analysis of the CHM gene identified a deletion of exons 9 to 15 in family A, a splice site mutation at position 79+1 of exon 1 in family B, deletion of exons 6 to 8 in family C, and a substitution at position 106 causing a premature stop in family D. BCVA ranged from 20/16 to 20/63 in carriers and from 20/25 to 5/63 in affected males. FAF showed abnormalities in all subjects. SD-OCT showed outer retinal layer loss, outer retinal tubulations at the margin of outer retinal loss, and inner retinal microcysts. Patchy cone loss was present in two symptomatic carriers. In two affected males, cone mosaics were disrupted with increased cone spacing near the fovea but more normal cone spacing near the edge of atrophy. Conclusions. High-resolution retinal images in CHM carriers and affected males demonstrated RPE and photoreceptor cell degeneration. As both RPE and photoreceptor cells were affected, these cell types may degenerate simultaneously in CHM. These findings provide insight into the effect of CHM mutations on macular retinal structure, with implications for the development of treatments for CHM. (ClinicalTrials.gov number, NCT00254605.) PMID:23299470

  8. Frontal White Matter Alterations in Short-Term Medicated Panic Disorder Patients without Comorbid Conditions: A Diffusion Tensor Imaging Study

    PubMed Central

    Kim, Borah; Kim, Jeong Hoon; Kim, Min-Kyoung; Lee, Kang Soo; Kim, Youngki; Choi, Tai Kiu; Kim, Yun Tai; Lee, Sang-Hyuk

    2014-01-01

    The frontal cortex might play an important role in the fear network, and white matter (WM) integrity could be related to the pathophysiology of panic disorder (PD). A few studies have investigated alterations of WM integrity in PD. The aim of this study was to determine frontal WM integrity differences between patients with PD without comorbid conditions and healthy control (HC) subjects by using diffusion tensor imaging. Thirty-six patients with PD who had used medication within 1 week and 27 age- and sex-matched HC subjects participated in this study. Structural brain magnetic resonance imaging was performed on all participants. Panic Disorder Severity Scale and Beck Anxiety Inventory (BAI) scores were assessed. Tract-based spatial statistics (TBSS) was used for image analysis. TBSS analysis showed decreased fractional anisotropy (FA) in frontal WM and WM around the frontal lobe, including the corpus callosum of both hemispheres, in patients with PD compared to HC subjects. Moreover, voxel-wise correlation analysis revealed that the BAI scores for patients with PD were positively correlated with their FA values for regions showing group differences in the FA of frontal WM of both hemispheres. Altered integrity in frontal WM of patients with PD without comorbid conditions might represent the structural pathophysiology in these patients, and these changes could be related to clinical symptoms of PD. PMID:24788587

  9. Pancreatic Candidiasis That Mimics a Malignant Pancreatic Cystic Tumor on Magnetic Resonance Imaging: A Case Report in an Immunocompetent Patient

    PubMed Central

    Seong, Minjung; Ha, Sang Yun

    2015-01-01

    Candida is a commensal organism that is frequently found in the human gastrointestinal tract. It is the most common organism that causes pancreatic fungal infections. However, magnetic resonance imaging findings of Candida infection in the pancreas have not been described. We report imaging findings of pancreatic candidiasis in a patient in immunocompetent condition. It presented as a multi-septated cystic mass with a peripheral solid component in the background of pancreatitis and restricted diffusion on diffusion-weighted image that mimicked a malignant pancreatic cystic tumor. PMID:26576113

  10. Magnetic Resonance Imaging (MRI) Evaluation of Developmental Delay in Pediatric Patients

    PubMed Central

    Syed, Naziya P.; Murthy, G.S.N.; Nori, Madhavi; Abkari, Anand; Pooja, B.K.; Venkateswarlu, J.

    2015-01-01

    Introduction: Developmental delay is defined as significant delay in one or more developmental domains. Magnetic Resonance Imaging (MRI) is the best modality to investigate such patients. Evaluation of a child with developmental delay is important not only because it allows early diagnosis and treatment but also helpful for parental counseling regarding the outcome of their child and to identify any possible risk of recurrence in the siblings. Thus this study was undertaken to evaluate the developmental delay in Indian children which will help the clinicians in providing an estimation of the child’s ultimate developmental potential and organize specific treatment requirement and also relieve parental apprehension. Aims and Objectives: To study the prevalence of normal and abnormal MRI in pediatric patients presenting with developmental delay and further categorize the abnormal MRI based on its morphological features. Materials and Methods: It is a prospective, observational & descriptive study of MRI Brain in 81 paediatric patients (46 Males and 35 Females), aged between three months to 12 years; presenting with developmental delay in Deccan College of Medical Sciences, Hyderabad; over a period of three years (Sept 2011 to Sept 2014). MRI brain was done on 1.5T Siemens Magnetom Essenza & 0.35T Magnetom C with appropriate sequences and planes after making the child sleep/sedated/ anesthetized. Various anatomical structures like Ventricles, Corpus callosum, etc were systematically assessed. The MRI findings were divided into various aetiological subgroups. Results: Normal MRI findings were seen in 32% cases and 68% had abnormal findings of which the proportion of Traumatic/ Neurovascular Diseases, Congenital & Developmental, Metabolic and Degenerative, neoplastic and non specific were 31%, 17%, 10%, 2.5% and 7.5% respectively. The ventricles and white matter mainly the corpus callosum were the most commonly affected anatomical structures. The diagnostic yield was found to be 68% and higher yield was seen in patients presenting with developmental delay plus. Conclusion: The clinical diagnosis of developmental delay should not be the end point, but rather a springboard for an effective search for causal factors. MRI is the best investigation with a high yield in such patients. PMID:25738057

  11. Comparison of daily megavoltage electronic portal imaging or kilovoltage imaging with marker seeds to ultrasound imaging or skin marks for prostate localization and treatment positioning in patients with prostate cancer

    SciTech Connect

    Serago, Christopher F. . E-mail: serago.christopher@mayo.edu; Buskirk, Steven J.; Igel, Todd C.; Gale, Ashley A.; Serago, Nicole E.; Earle, John D.

    2006-08-01

    Purpose: To compare the accuracy of imaging modalities, immobilization, localization, and positioning techniques in patients with prostate cancer. Methods and Materials: Thirty-five patients with prostate cancer had gold marker seeds implanted transrectally and were treated with fractionated radiotherapy. Twenty of the 35 patients had limited immobilization; the remaining had a vacuum-based immobilization. Patient positioning consisted of alignment with lasers to skin marks, ultrasound or kilovoltage X-ray imaging, optical guidance using infrared reflectors, and megavoltage electronic portal imaging (EPI). The variance of each positioning technique was compared to the patient position determined from the pretreatment EPI. Results: With limited immobilization, the average difference between the skin marks' laser position and EPI pretreatment position is 9.1 {+-} 5.3 mm, the average difference between the skin marks' infrared position and EPI pretreatment position is 11.8 {+-} 7.2 mm, the average difference between the ultrasound position and EPI pretreatment position is 7.0 {+-} 4.6 mm, the average difference between kV imaging and EPI pretreatment position is 3.5 {+-} 3.1 mm, and the average intrafraction movement during treatment is 3.4 {+-} 2.7 mm. For the patients with the vacuum-style immobilization, the average difference between the skin marks' laser position and EPI pretreatment position is 10.7 {+-} 4.6 mm, the average difference between kV imaging and EPI pretreatment position is 1.9 {+-} 1.5 mm, and the average intrafraction movement during treatment is 2.1 {+-} 1.5 mm. Conclusions: Compared with use of skin marks, ultrasound imaging for positioning provides an increased degree of agreement to EPI-based positioning, though not as favorable as kV imaging fiducial seeds. Intrafraction movement during treatment decreases with improved immobilization.

  12. Neuroimaging of HIV-associated cryptococcal meningitis: comparison of magnetic resonance imaging findings in patients with and without immune reconstitution.

    PubMed

    Katchanov, Juri; Branding, Gordian; Jefferys, Laura; Arastéh, Keikawus; Stocker, Hartmut; Siebert, Eberhard

    2016-02-01

    To determine the frequency, imaging characteristics, neuroanatomical distribution and dynamics of magnetic resonance imaging findings in HIV-associated cryptococcal meningitis in immunocompromised patients we compared patients without antiretroviral therapy with patients undergoing immune reconstitution. Neuroimaging and clinical data of 21 consecutive patients presenting to a German HIV centre in a 10-year period between 2005 and 2014 were reviewed. We identified eight patients with magnetic resonance imaging findings related to cryptococcal disease: five patients without antiretroviral therapy and three patients receiving effective antiretroviral therapy resulting in immune reconstitution. The pattern of magnetic resonance imaging manifestations was different in the two groups. In patients not on antiretroviral therapy, pseudocysts (n?=?3) and lacunar ischaemic lesions (n?=?2) were detected. Contrast-enhancing focal leptomeningeal and/or parenchymal lesions were found in all patients under immune reconstitution (n?=?3). Magnetic resonance imaging lesions suggestive of leptomeningitis or meningoencephalitis were detected in all patients with a recurrence of cryptococcal meningitis under immune reconstitution, which differs from the classical magnetic resonance imaging findings in patients without antiretroviral therapy. In antiretroviral therapy-treated patients with past medical history of cryptococcal meningitis, detection of contrast-enhancing focal meningeal and/or parenchymal lesions should prompt further investigations for a recurrence of cryptococcal meningitis under immune reconstitution. PMID:25693580

  13. Selecting a Variable for Predicting the Diagnosis of PTB Patients From Comparison of Chest X-ray Images

    NASA Astrophysics Data System (ADS)

    Mohd. Rijal, Omar; Mohd. Noor, Norliza; Teng, Shee Lee

    A statistical method of comparing two digital chest radiographs for Pulmonary Tuberculosis (PTB) patients has been proposed. After applying appropriate image registration procedures, a selected subset of each image is converted to an image histogram (or box plot). Comparing two chest X-ray images is equivalent to the direct comparison of the two corresponding histograms. From each histogram, eleven percentiles (of image intensity) are calculated. The number of percentiles that shift to the left (NLSP) when second image is compared to the first has been shown to be an indicator of patients` progress. In this study, the values of NLSP is to be compared with the actual diagnosis (Y) of several medical practitioners. A logistic regression model is used to study the relationship between NLSP and Y. This study showed that NLSP may be used as an alternative or second opinion for Y. The proposed regression model also show that important explanatory variables such as outcomes of sputum test (Z) and degree of image registration (W) may be omitted when estimating Y-values.

  14. Feasibility study of patient positioning verification in electron beam radiotherapy with an electronic portal imaging device (EPID).

    PubMed

    Ramm, U; Köhn, J; Rodriguez Dominguez, R; Licher, J; Koch, N; Kara, E; Scherf, C; Rödel, C; Weiß, C

    2014-03-01

    The purpose of this study is to demonstrate the feasibility of verification and documentation in electron beam radiotherapy using the photon contamination detected with an electronic portal imaging device. For investigation of electron beam verification with an EPID, the portal images are acquired irradiating two different tissue equivalent phantoms at different electron energies. Measurements were performed on an Elekta SL 25 linear accelerator with an amorphous-Si electronic portal imaging device (EPID: iViewGT, Elekta Oncology Systems, Crawley, UK). As a measure of EPID image quality contrast (CR) and signal-to-noise ratio (SNR) are determined. For characterisation of the imaging of the EPID RW3 slabs and a Gammex 467 phantom with different material inserts are used. With increasing electron energy the intensity of photon contamination increases, yielding an increasing signal-to-noise ratio, but images are showing a decreasing contrast. As the signal-to-noise ratio saturates with increasing dose a minimum of 50 MUs is recommended. Even image quality depends on electron energy and diameter of the patient, the acquired results are mostly sufficient to assess the accuracy of beam positioning. In general, the online EPID acquisition has been demonstrated to be an effective electron beam verification and documentation method. The results are showing that this procedure can be recommended to be routinely and reliably done in patient treatment with electron beams. PMID:23850512

  15. The limit of detection in scintigraphic imaging with I-131 in patients with differentiated thyroid carcinoma

    NASA Astrophysics Data System (ADS)

    Hänscheid, H.; Lassmann, M.; Buck, A. K.; Reiners, C.; Verburg, F. A.

    2014-05-01

    Radioiodine scintigraphy influences staging and treatment in patients with differentiated thyroid carcinoma. The limit of detection for fractional uptake in an iodine avid focus in a scintigraphic image was determined from the number of lesion net counts and the count density of the tissue background. The count statistics were used to calculate the diagnostic activity required to elevate the signal from a lesion with a given uptake significantly above a homogeneous background with randomly distributed counts per area. The dependences of the minimal uptake and the minimal size of lesions visible in a scan on several parameters of influence were determined by linking the typical biokinetics observed in iodine avid tissue to the lesion mass and to the absorbed dose received in a radioiodine therapy. The detection limits for fractional uptake in a neck lesion of a typical patient are about 0.001% after therapy with 7000 MBq, 0.01% for activities typically administered in diagnostic assessments (74-185 MBq), and 0.1% after the administration of 10 MBq I-131. Lesions at the limit of detection in a diagnostic scan with biokinetics eligible for radioiodine therapy are small with diameters of a few millimeters. Increasing the diagnostic activity by a factor of 4 reduces the diameter of visible lesions by 25% or about 1 mm. Several other determinants have a comparable or higher influence on the limit of detection than the administered activity; most important are the biokinetics in both blood pool and target tissue and the time of measurement. A generally valid recommendation for the timing of the scan is impossible as the time of the highest probability to detect iodine avid tissue depends on the administered activity as well as on the biokinetics in the lesion and background in the individual patient.

  16. Clinical and Muscle Imaging Findings in 14 Mainland Chinese Patients with Oculopharyngodistal Myopathy

    PubMed Central

    Zhao, Juan; Liu, Jing; Xiao, Jiangxi; Du, Jing; Que, Chengli; Shi, Xin; Liang, Wei; Sun, Weiping; Zhang, Wei; Lv, He; Yuan, Yun; Wang, Zhaoxia

    2015-01-01

    Oculopharyngodistal myopathy (OPDM) is an extremely rare, adult-onset hereditary muscular disease characterized by progressive external ocular, pharyngeal, and distal muscle weakness and myopathological rimmed vacuole changes. The causative gene is currently unknown; therefore, diagnosis of OPDM is based on clinical and histopathological features and genetic exclusion of similar conditions. Moreover, variable manifestations of this disorder are reported in terms of muscle involvement and severity. We present the clinical profile and magnetic resonance imaging (MRI) changes of lower limb muscles in 14 mainland Chinese patients with OPDM, emphasizing the role of muscle MRI in disease identification and differential diagnosis. The patients came from 10 unrelated families and presented with progressive external ocular, laryngopharyngeal, facial, distal limb muscle weakness that had been present since early adulthood. Serum creatine kinase was mildly to moderately elevated. Electromyography revealed myogenic changes with inconsistent myotonic discharge. The respiratory function test revealed subclinical respiratory muscle involvement. Myopathological findings showed rimmed vacuoles with varying degrees of muscular dystrophic changes. All known genes responsible for distal and myofibrillar myopathies, vacuolar myopathies, and muscular dystrophies were excluded by PCR or targeted next-generation sequencing. Muscle MRI revealed that the distal lower legs had more severe fatty replacement than the thigh muscles. Serious involvement of the soleus and long head of the biceps femoris was observed in all patients, whereas the popliteus, gracilis and short head of biceps femoris were almost completely spared, even in advanced stages. Not only does our study widen the spectrum of OPDM in China, but it also demonstrates that OPDM has a specific pattern of muscle involvement that may provide valuable information for its differential diagnosis and show further evidence supporting the conclusion that OPDM is a unique disease phenotype. PMID:26039504

  17. Functional diffusion map as an imaging predictor of functional outcome in patients with primary intracerebral haemorrhage

    PubMed Central

    Tsai, Y-H; Hsu, L-M; Weng, H-H; Lee, M-H; Yang, J-T; Lin, C-P

    2013-01-01

    Objective Predicting outcome in patients with primary intracerebral haemorrhage (ICH) in the acute stage can provide information to determine the best therapeutic and rehabilitation strategies. We prospectively investigated the predictive value of the functional diffusion map (fDM) in the acute stage of ICH. Methods 47 patients with ICH were enrolled for clinical evaluation and MRI within 24 h of symptom onset and 5 days after ICH. Functional diffusion mapping prospectively monitored the apparent diffusion coefficient (ADC) maps of perihaematomal oedema. Consequently, the change in perihaematomal oedema was classified into three categories: increased, decreased, or no significant change. Clinical outcomes were evaluated 6 months after ICH according to the modified Rankin Scale. Correlation between clinical outcome and the fDMs was performed. Results Among the clinical variables, thalamic haematoma, serum glucose level and National Institutes of Health Stroke Scale scores were significantly different between the good- and poor-outcome groups. The percentage of oedematous tissue undergoing significant change between baseline and Day 5 was also significantly different between the groups. Conclusion fDMs allow for spatial voxel-by-voxel tracking of changes in ADC values. It may be feasible to use fDMs to predict the functional outcome of patients with ICH during the acute stage. Advances in knowledge The use of fDMs for stroke study is demonstrated. fDMs may be more suitable to reflect the pathophysiological heterogeneity within oedemas and may facilitate another thinking process for imaging study of stroke and other neurological diseases. PMID:23255534

  18. Clinical and muscle imaging findings in 14 mainland chinese patients with oculopharyngodistal myopathy.

    PubMed

    Zhao, Juan; Liu, Jing; Xiao, Jiangxi; Du, Jing; Que, Chengli; Shi, Xin; Liang, Wei; Sun, Weiping; Zhang, Wei; Lv, He; Yuan, Yun; Wang, Zhaoxia

    2015-01-01

    Oculopharyngodistal myopathy (OPDM) is an extremely rare, adult-onset hereditary muscular disease characterized by progressive external ocular, pharyngeal, and distal muscle weakness and myopathological rimmed vacuole changes. The causative gene is currently unknown; therefore, diagnosis of OPDM is based on clinical and histopathological features and genetic exclusion of similar conditions. Moreover, variable manifestations of this disorder are reported in terms of muscle involvement and severity. We present the clinical profile and magnetic resonance imaging (MRI) changes of lower limb muscles in 14 mainland Chinese patients with OPDM, emphasizing the role of muscle MRI in disease identification and differential diagnosis. The patients came from 10 unrelated families and presented with progressive external ocular, laryngopharyngeal, facial, distal limb muscle weakness that had been present since early adulthood. Serum creatine kinase was mildly to moderately elevated. Electromyography revealed myogenic changes with inconsistent myotonic discharge. The respiratory function test revealed subclinical respiratory muscle involvement. Myopathological findings showed rimmed vacuoles with varying degrees of muscular dystrophic changes. All known genes responsible for distal and myofibrillar myopathies, vacuolar myopathies, and muscular dystrophies were excluded by PCR or targeted next-generation sequencing. Muscle MRI revealed that the distal lower legs had more severe fatty replacement than the thigh muscles. Serious involvement of the soleus and long head of the biceps femoris was observed in all patients, whereas the popliteus, gracilis and short head of biceps femoris were almost completely spared, even in advanced stages. Not only does our study widen the spectrum of OPDM in China, but it also demonstrates that OPDM has a specific pattern of muscle involvement that may provide valuable information for its differential diagnosis and show further evidence supporting the conclusion that OPDM is a unique disease phenotype. PMID:26039504

  19. Development of a mobile emergency patient information and imaging communication system based on CDMA-1X EVDO

    NASA Astrophysics Data System (ADS)

    Yang, Keon Ho; Jung, Haijo; Kang, Won-Suk; Jang, Bong Mun; Kim, Joong Il; Han, Dong Hoon; Yoo, Sun-Kook; Yoo, Hyung-Sik; Kim, Hee-Joung

    2006-03-01

    The wireless mobile service with a high bit rate using CDMA-1X EVDO is now widely used in Korea. Mobile devices are also increasingly being used as the conventional communication mechanism. We have developed a web-based mobile system that communicates patient information and images, using CDMA-1X EVDO for emergency diagnosis. It is composed of a Mobile web application system using the Microsoft Windows 2003 server and an internet information service. Also, a mobile web PACS used for a database managing patient information and images was developed by using Microsoft access 2003. A wireless mobile emergency patient information and imaging communication system is developed by using Microsoft Visual Studio.NET, and JPEG 2000 ActiveX control for PDA phone was developed by using the Microsoft Embedded Visual C++. Also, the CDMA-1X EVDO is used for connections between mobile web servers and the PDA phone. This system allows fast access to the patient information database, storing both medical images and patient information anytime and anywhere. Especially, images were compressed into a JPEG2000 format and transmitted from a mobile web PACS inside the hospital to the radiologist using a PDA phone located outside the hospital. Also, this system shows radiological images as well as physiological signal data, including blood pressure, vital signs and so on, in the web browser of the PDA phone so radiologists can diagnose more effectively. Also, we acquired good results using an RW-6100 PDA phone used in the university hospital system of the Sinchon Severance Hospital in Korea.

  20. Characterization of mammographic masses based on level set segmentation with new image features and patient information

    SciTech Connect

    Shi Jiazheng; Sahiner, Berkman; Chan Heangping; Ge Jun; Hadjiiski, Lubomir; Helvie, Mark A.; Nees, Alexis; Wu Yita; Wei Jun; Zhou Chuan; Zhang Yiheng; Cui Jing

    2008-01-15

    Computer-aided diagnosis (CAD) for characterization of mammographic masses as malignant or benign has the potential to assist radiologists in reducing the biopsy rate without increasing false negatives. The purpose of this study was to develop an automated method for mammographic mass segmentation and explore new image based features in combination with patient information in order to improve the performance of mass characterization. The authors' previous CAD system, which used the active contour segmentation, and morphological, textural, and spiculation features, has achieved promising results in mass characterization. The new CAD system is based on the level set method and includes two new types of image features related to the presence of microcalcifications with the mass and abruptness of the mass margin, and patient age. A linear discriminant analysis (LDA) classifier with stepwise feature selection was used to merge the extracted features into a classification score. The classification accuracy was evaluated using the area under the receiver operating characteristic curve. The authors' primary data set consisted of 427 biopsy-proven masses (200 malignant and 227 benign) in 909 regions of interest (ROIs) (451 malignant and 458 benign) from multiple mammographic views. Leave-one-case-out resampling was used for training and testing. The new CAD system based on the level set segmentation and the new mammographic feature space achieved a view-based A{sub z} value of 0.83{+-}0.01. The improvement compared to the previous CAD system was statistically significant (p=0.02). When patient age was included in the new CAD system, view-based and case-based A{sub z} values were 0.85{+-}0.01 and 0.87{+-}0.02, respectively. The study also demonstrated the consistency of the newly developed CAD system by evaluating the statistics of the weights of the LDA classifiers in leave-one-case-out classification. Finally, an independent test on the publicly available digital database for screening mammography with 132 benign and 197 malignant ROIs containing masses achieved a view-based A{sub z} value of 0.84{+-}0.02.

  1. Microscopy image analysis of p63 immunohistochemically stained laryngeal cancer lesions for predicting patient 5-year survival.

    PubMed

    Ninos, Konstantinos; Kostopoulos, Spiros; Kalatzis, Ioannis; Sidiropoulos, Konstantinos; Ravazoula, Panagiota; Sakellaropoulos, George; Panayiotakis, George; Economou, George; Cavouras, Dionisis

    2016-01-01

    The aim of the present study was to design a microscopy image analysis (MIA) system for predicting the 5-year survival of patients with laryngeal squamous cell carcinoma, employing histopathology images of lesions, which had been immunohistochemically (IHC) stained for p63 expression. Biopsy materials from 42 patients, with verified laryngeal cancer and follow-up, were selected from the archives of the University Hospital of Patras, Greece. Twenty six patients had survived more than 5 years and 16 less than 5 years after the first diagnosis. Histopathology images were IHC stained for p63 expression. Images were first processed by a segmentation method for isolating the p63-expressed nuclei. Seventy-seven features were evaluated regarding texture, shape, and physical topology of nuclei, p63 staining, and patient-specific data. Those features, the probabilistic neural network classifier, the leave-one-out (LOO), and the bootstrap cross-validation methods, were used to design the MIA-system for assessing the 5-year survival of patients with laryngeal cancer. MIA-system accuracy was about 90 % and 85 %, employing the LOO and the Bootstrap methods, respectively. The image texture of p63-expressed nuclei appeared coarser and contained more edges in the 5-year non-survivor group. These differences were at a statistically significant level (p < 0.05). In conclusion, this study has proposed an MIA-system that may be of assistance to physicians, as a second opinion tool in assessing the 5-year survival of patients with laryngeal cancer, and it has revealed useful information regarding differences in nuclei texture between 5-year survivors and non-survivors. PMID:26285779

  2. Efficiency of Non-Contrast-Enhanced Liver Imaging Sequences Added to Initial Rectal MRI in Rectal Cancer Patients

    PubMed Central

    Kwon, Gene-hyuk; Kim, Kyung Ah; Hwang, Seong Su; Park, Soo Youn; Kim, Hyun A.; Choi, Sun Young; Kim, Ji Woong

    2015-01-01

    Purpose The purpose of this study was to estimate the value of addition of liver imaging to initial rectal magnetic resonance imaging (MRI) for detection of liver metastasis and evaluate imaging predictors of a high risk of liver metastasis on rectal MRI. Methods We enrolled 144 patients who from October 2010 to May 2013 underwent rectal MRI with T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) (b values = 50, 500, and 900 s/mm2) of the liver and abdominopelvic computed tomography (APCT) for the initial staging of rectal cancer. Two reviewers scored the possibility of liver metastasis on different sets of liver images (T2WI, DWI, and combined T2WI and DWI) and APCT and reached a conclusion by consensus for different analytic results. Imaging features from rectal MRI were also analyzed. The diagnostic performances of CT and an additional liver scan to detect liver metastasis were compared. Multivariate logistic regression to determine independent predictors of liver metastasis among rectal MRI features and tumor markers was performed. This retrospective study was approved by the Institutional Review Board, and the requirement for informed consent was waived. Results All sets of liver images were more effective than APCT for detecting liver metastasis, and DWI was the most effective. Perivascular stranding and anal sphincter invasion were statistically significant for liver metastasis (p = 0.0077 and p = 0.0471), while extramural vascular invasion based on MRI (mrEMVI) was marginally significant (p = 0.0534). Conclusion The addition of non-contrast-enhanced liver imaging, particularly DWI, to initial rectal MRI in rectal cancer patients could facilitate detection of liver metastasis without APCT. Perivascular stranding, anal sphincter invasion, and mrEMVI detected on rectal MRI were important imaging predictors of liver metastasis. PMID:26348217

  3. Study and design of beam expander with wide aperture

    NASA Astrophysics Data System (ADS)

    Guo, Ming; Jin, Guangyong; Cai, Jixing; Zhang, Wei; Wei, Zhi

    2014-12-01

    In order to improve the capacity of beam collimation for laser beam expander, it is necessary to design a more reasonable and feasible structure of beam expander system. Laser beam expander is used to compress the laser divergence angle, in order to reduce the energy losing in long distance scanning acquisition system. This paper introduces the working principle and design idea of the laser beam expander, the collimating multiplying power focal length and the collimated magnification formula of expander main, secondary mirror. According to the third-order aberration theory, Considering the spherical aberration, sine difference and divergence angle, the reasonable analysis of optical path, ZEMAX optical design software was used to design large-diameter laser beam expander and analysis and optimize, And given the actual design data and results. Display the maximum optical path difference is +/-0.01? of the main light ray and each light ray. To combination the rear- group objective lens of Galileo and Kepler beam expander, a large-diameter(1.475m) laser beam expander was designed with 0.2m in the diameter, 1/2m in the relative caliber. In the objective lens System, a high-order aspherical was used to the aberration of extra-axial point. we can see that the image quality is close to the diffraction limit from the curves of wavefront. In addition to improve image quality effectively, the system has the characteristics of simple structure, less costly and less design difficulty to compare with the other beam expanding system. And make the output beam's divergence angle smaller, energy density higher, and the beam quality has been greatly improved. The results show that the beam expander is fully meet the design requirements, the use effect is good. Design and research of laser beam expanding system not only improves the quality of the laser beam in the laser system, but also enlarge the application field of laser technology in photoelectric system.

  4. Acute Radiation Effects on Cardiac Function Detected by Strain Rate Imaging in Breast Cancer Patients

    SciTech Connect

    Erven, Katrien; Jurcut, Ruxandra; Weltens, Caroline; Giusca, Sorin; Ector, Joris; Wildiers, Hans; Van den Bogaert, Walter; Voigt, Jens-Uwe

    2011-04-01

    Purpose: To investigate the occurrence of early radiation-induced changes in regional cardiac function using strain rate imaging (SRI) by tissue Doppler echocardiography. Methods and Materials: We included 20 left-sided and 10 right-sided breast cancer patients receiving radiotherapy (RT) to the breast or chest wall. Standard echocardiography and SRI were performed before RT (baseline), immediately after RT (post-RT), and at 2 months follow-up (FUP) after RT. Regional strain (S) and strain rate (SR) values were obtained from all 18 left ventricular (LV) segments. Data were compared to the regional radiation dose. Results: A reduction in S was observed post-RT and at FUP in left-sided patients (S{sub post-RT}: -17.6 {+-} 1.5%, and S{sub FUP}: -17.4 {+-} 2.3%, vs. S{sub baseline}: -19.5 {+-} 2.1%, p < 0.001) but not in right-sided patients. Within the left-sided patient group, S and SR were significantly reduced after RT in apical LV segments (S{sub post-RT}: -15.3 {+-} 2.5%, and S{sub FUP}: -14.3 {+-} 3.7%, vs. S{sub baseline}: -19.3 {+-} 3.0%, p < 0.01; and SR{sub post-RT}: -1.06 {+-} 0.15 s {sup -1}, and SR{sub FUP}: -1.16 {+-} 0.28 s {sup -1}, vs. SR{sub baseline}: -1.29 {+-} 0.27s {sup -1}, p = 0.01), but not in mid- or basal segments. Furthermore, we observed that segments exposed to more than 3 Gy showed a significant decrease in S after RT (S{sub post-RT}: -16.1 {+-} 1.6%, and S{sub FUP}: -15.8 {+-} 3.4%, vs. S{sub baseline}: -18.9 {+-} 2.6%, p < 0.001). This could not be observed in segments receiving less than 3 Gy. Conclusions: SRI shows a dose-related regional decrease in myocardial function after RT. It might be a useful tool in the evaluation of modern RT techniques, with respect to cardiac toxicity.

  5. Soviet gas processing expands

    SciTech Connect

    Sagers, M.J.

    1987-09-01

    The Soviet gas processing industry expanded with the recent completion of two new gas processing plants, the Krasnoleninskiy and Noyabr'sk plants, both located in West Siberia. Both process associated gas from nearby oil fields to remove valuable liquid hydrocarbons before putting the dry gas into pipelines; previously the gas was flared or vented. These plants represent part of a major program, ongoing since the 1970s, to increase the level of utilization of the tremendous amount of valuable associated gas now being produced in West Siberia. Another major effort to develop gas processing is under way in western Kazakhstan at the Tengiz and Zhanazhol' fields. At Zhanazhol', a small gas recovery plant went into operation in late 1984 in conjunction with a separation plant with a processing capacity of 1 million tons of oil per year. A much larger enterprise to refine oil and process associated gas is under construction at the Tengiz field. This enterprise is different from the major petrochemical operation planned to use feedstocks from Tengiz; the petrochemical operation will be constructed at Kulsary, 120 kilometers from Tengiz, and produce polyethylene, polypropylene, and other plastics.

  6. Quantitative cone-beam CT imaging in radiation therapy using planning CT as a prior: First patient studies

    SciTech Connect

    Niu Tianye; Al-Basheer, Ahmad; Zhu Lei

    2012-04-15

    Purpose: Quantitative cone-beam CT (CBCT) imaging is on increasing demand for high-performance image guided radiation therapy (IGRT). However, the current CBCT has poor image qualities mainly due to scatter contamination. Its current clinical application is therefore limited to patient setup based on only bony structures. To improve CBCT imaging for quantitative use, we recently proposed a correction method using planning CT (pCT) as the prior knowledge. Promising phantom results have been obtained on a tabletop CBCT system, using a correction scheme with rigid registration and without iterations. More challenges arise in clinical implementations of our method, especially because patients have large organ deformation in different scans. In this paper, we propose an improved framework to extend our method from bench to bedside by including several new components. Methods: The basic principle of our correction algorithm is to estimate the primary signals of CBCT projections via forward projection on the pCT image, and then to obtain the low-frequency errors in CBCT raw projections by subtracting the estimated primary signals and low-pass filtering. We improve the algorithm by using deformable registration to minimize the geometry difference between the pCT and the CBCT images. Since the registration performance relies on the accuracy of the CBCT image, we design an optional iterative scheme to update the CBCT image used in the registration. Large correction errors result from the mismatched objects in the pCT and the CBCT scans. Another optional step of gas pocket and couch matching is added into the framework to reduce these effects. Results: The proposed method is evaluated on four prostate patients, of which two cases are presented in detail to investigate the method performance for a large variety of patient geometry in clinical practice. The first patient has small anatomical changes from the planning to the treatment room. Our algorithm works well even without the optional iterations and the gas pocket and couch matching. The image correction on the second patient is more challenging due to the effects of gas pockets and attenuating couch. The improved framework with all new components is used to fully evaluate the correction performance. The enhanced image quality has been evaluated using mean CT number and spatial nonuniformity (SNU) error as well as contrast improvement factor. If the pCT image is considered as the ground truth, on the four patients, the overall mean CT number error is reduced from over 300 HU to below 16 HU in the selected regions of interest (ROIs), and the SNU error is suppressed from over 18% to below 2%. The average soft-tissue contrast is improved by an average factor of 2.6. Conclusions: We further improve our pCT-based CBCT correction algorithm for clinical use. Superior correction performance has been demonstrated on four patient studies. By providing quantitative CBCT images, our approach significantly increases the accuracy of advanced CBCT-based clinical applications for IGRT.

  7. Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era.

    PubMed

    Offiah, Curtis E; Naseer, Aisha

    2016-01-01

    Cryptococcus neoformans infection is the most common fungal infection of the central nervous system (CNS) in advanced human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients, but remains a relatively uncommon CNS infection in both the immunocompromised and immunocompetent patient population, rendering it a somewhat elusive and frequently overlooked diagnosis. The morbidity and mortality associated with CNS cryptococcal infection can be significantly reduced by early recognition of the imaging appearances by the radiologist in order to focus and expedite clinical management and treatment. The emergence and evolution of anti-retroviral therapy have also impacted significantly on the imaging appearances, morbidity, and mortality of this neuro-infection. The constellation of varied imaging appearances associated with cryptococcal CNS infection in the HIV and AIDS population in the era of highly active anti-retroviral therapy (HAART) will be presented in this review. PMID:26564776

  8. Positioning accuracy for lung stereotactic body radiotherapy patients determined by on-treatment cone-beam CT imaging

    PubMed Central

    Richmond, N D; Pilling, K E; Peedell, C; Shakespeare, D; Walker, C P

    2012-01-01

    Stereotactic body radiotherapy for early stage non-small cell lung cancer is an emerging treatment option in the UK. Since relatively few high-dose ablative fractions are delivered to a small target volume, the consequences of a geometric miss are potentially severe. This paper presents the results of treatment delivery set-up data collected using Elekta Synergy (Elekta, Crawley, UK) cone-beam CT imaging for 17 patients immobilised using the Bodyfix system (Medical Intelligence, Schwabmuenchen, Germany). Images were acquired on the linear accelerator at initial patient treatment set-up, following any position correction adjustments, and post-treatment. These were matched to the localisation CT scan using the Elekta XVI software. In total, 71 fractions were analysed for patient set-up errors. The mean vector error at initial set-up was calculated as 5.3±2.7 mm, which was significantly reduced to 1.4±0.7 mm following image guided correction. Post-treatment the corresponding value was 2.1±1.2 mm. The use of the Bodyfix abdominal compression plate on 5 patients to reduce the range of tumour excursion during respiration produced mean longitudinal set-up corrections of ?4.4±4.5 mm compared with ?0.7±2.6 mm without compression for the remaining 12 patients. The use of abdominal compression led to a greater variation in set-up errors and a shift in the mean value. PMID:22665927

  9. Advanced expander test bed engine

    NASA Technical Reports Server (NTRS)

    Mitchell, J. P.

    1992-01-01

    The Advanced Expander Test Bed (AETB) is a key element in NASA's Space Chemical Engine Technology Program for development and demonstration of expander cycle oxygen/hydrogen engine and advanced component technologies applicable to space engines as well as launch vehicle upper stage engines. The AETB will be used to validate the high pressure expander cycle concept, study system interactions, and conduct studies of advanced mission focused components and new health monitoring techniques in an engine system environment. The split expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust.

  10. Advanced expander test bed program

    NASA Technical Reports Server (NTRS)

    Masters, A. I.; Mitchell, J. C.

    1991-01-01

    The Advanced Expander Test Bed (AETB) is a key element in NASA's Chemical Transfer Propulsion Program for development and demonstration of expander cycle oxygen/hydrogen engine technology component technology for the next space engine. The AETB will be used to validate the high-pressure expander cycle concept, investigate system interactions, and conduct investigations of advanced missions focused components and new health monitoring techniques. The split-expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust.

  11. Cardiac Imaging System

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Although not available to all patients with narrowed arteries, balloon angioplasty has expanded dramatically since its introduction with an estimated further growth to 562,000 procedures in the U.S. alone by 1992. Growth has fueled demand for higher quality imaging systems that allow the cardiologist to be more accurate and increase the chances of a successful procedure. A major advance is the Digital Cardiac Imaging (DCI) System designed by Philips Medical Systems International, Best, The Netherlands and marketed in the U.S. by Philips Medical Systems North America Company. The key benefit is significantly improved real-time imaging and the ability to employ image enhancement techniques to bring out added details. Using a cordless control unit, the cardiologist can manipulate images to make immediate assessment, compare live x-ray and roadmap images by placing them side-by-side on monitor screens, or compare pre-procedure and post procedure conditions. The Philips DCI improves the cardiologist's precision by expanding the information available to him.

  12. Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression

    PubMed Central

    Lee, Seungbo; Lee, Young Han; Chung, Tae-Sub; Jeong, Eun-Kee; Yoo, Yeon Hwa; Kim, In Seong; Yoon, Choon-Sik; Suh, Jin-Suck; Park, Jung Hyun

    2015-01-01

    Objective To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. Materials and Methods A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD?FA (considered positive when both the MD and FA results were positive), LD?FA (considered positive when both the LD and FA results were positive), and RD?FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. Results The MD, LD, and RD cut-off values were 1.079 × 10-3, 1.719 × 10-3, and 0.749 × 10-3 mm2/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD?FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD?FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD?FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD?FA (p = 0.003), FA and LD?FA (p < 0.001), FA and RD?FA (p < 0.001), MD and LD?FA (p = 0.024) and MD and RD?FA (p = 0.024). Conclusion Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI. PMID:26576120

  13. IMAGES, IMAGES, IMAGES

    SciTech Connect

    Marcus, A.

    1980-07-01

    The role of images of information (charts, diagrams, maps, and symbols) for effective presentation of facts and concepts is expanding dramatically because of advances in computer graphics technology, increasingly hetero-lingual, hetero-cultural world target populations of information providers, the urgent need to convey more efficiently vast amounts of information, the broadening population of (non-expert) computer users, the decrease of available time for reading texts and for decision making, and the general level of literacy. A coalition of visual performance experts, human engineering specialists, computer scientists, and graphic designers/artists is required to resolve human factors aspects of images of information. The need for, nature of, and benefits of interdisciplinary effort are discussed. The results of an interdisciplinary collaboration are demonstrated in a product for visualizing complex information about global energy interdependence. An invited panel will respond to the presentation.

  14. Image Guided Hypofractionated 3-Dimensional Radiation Therapy in Patients With Inoperable Advanced Stage Non-Small Cell Lung Cancer

    SciTech Connect

    Osti, Mattia Falchetto; Agolli, Linda; Valeriani, Maurizio; Falco, Teresa; Bracci, Stefano; De Sanctis, Vitaliana; Enrici, Riccardo Maurizi

    2013-03-01

    Purpose: Hypofractionated radiation therapy (HypoRT) can potentially improve local control with a higher biological effect and shorter overall treatment time. Response, local control, toxicity rates, and survival rates were evaluated in patients affected by inoperable advanced stage non-small cell lung cancer (NSCLC) who received HypoRT. Methods and Materials: Thirty patients with advanced NSCLC were enrolled; 27% had stage IIIA, 50% had stage IIIB, and 23% had stage IV disease. All patients underwent HypoRT with a prescribed total dose of 60 Gy in 20 fractions of 3 Gy each. Radiation treatment was delivered using an image guided radiation therapy technique to verify correct position. Toxicities were graded according to Radiation Therapy Oncology Group morbidity score. Survival rates were estimated using the Kaplan-Meier method. Results: The median follow-up was 13 months (range, 4-56 months). All patients completed radiation therapy and received the total dose of 60 Gy to the primary tumor and positive lymph nodes. The overall response rate after radiation therapy was 83% (3 patients with complete response and 22 patients with partial response). The 2-year overall survival and progression-free survival rates were 38.1% and 36%, respectively. Locoregional recurrence/persistence occurred in 11 (37%) patients. Distant metastasis occurred in 17 (57%) patients. Acute toxicities occurred consisting of grade 1 to 2 hematological toxicity in 5 patients (17%) and grade 3 in 1 patient; grade 1 to 2 esophagitis in 12 patients (40%) and grade 3 in 1 patient; and grade 1 to 2 pneumonitis in 6 patients (20%) and grade 3 in 2 patients (7%). Thirty-three percent of patients developed grade 1 to 2 late toxicities. Only 3 patients developed grade 3 late adverse effects: esophagitis in 1 patient and pneumonitis in 2 patients. Conclusions: Hypofractionated curative radiation therapy is a feasible and well-tolerated treatment for patients with locally advanced NSCLC. Randomized studies are needed to compare HypoRT to conventional treatment.

  15. Images

    Cancer.gov

    Home News and Events Multimedia Library Images Images:  Cancer Biology Image: Cell with DNA 72 DPI | 300 DPIDrawing depicting DNA molecule unwinding from a chromosome inside the nucleus of a cell. NHGRI >> View All Cancer Pathology/Imaging Image: Female

  16. When does Subliminal Affective Image Priming Influence the Ability of Schizophrenic Patients to Perceive Face Emotions?

    PubMed Central

    Vaina, Lucia M.; Rana, Kunjan D.; Cotos, Ionela; Li-Yang, Chen; Huang, Melissa A.; Podea, Delia

    2014-01-01

    Background Deficits in face emotion perception are among the most pervasive aspects of schizophrenia impairments which strongly affects interpersonal communication and social skills. Material/Methods Schizophrenic patients (PSZ) and healthy control subjects (HCS) performed 2 psychophysical tasks. One, the SAFFIMAP test, was designed to determine the impact of subliminally presented affective or neutral images on the accuracy of face-expression (angry or neutral) perception. In the second test, FEP, subjects saw pictures of face-expression and were asked to rate them as angry, happy, or neutral. The following clinical scales were used to determine the acute symptoms in PSZ: Positive and Negative Syndrome (PANSS), Young Mania Rating (YMRS), Hamilton Depression (HAM-D), and Hamilton Anxiety (HAM-A). Results On the SAFFIMAP test, different from the HCS group, the PSZ group tended to categorize the neutral expression of test faces as angry and their response to the test-face expression was not influenced by the affective content of the primes. In PSZ, the PANSS-positive score was significantly correlated with correct perception of angry faces for aggressive or pleasant primes. YMRS scores were strongly correlated with PSZ’s tendency to recognize angry face expressions when the prime was a pleasant or a neutral image. The HAM-D score was positively correlated with categorizing the test-faces as neutral, regardless of the affective content of the prime or of the test-face expression (angry or neutral). Conclusions Despite its exploratory nature, this study provides the first evidence that conscious perception and categorization of facial emotions (neutral or angry) in PSZ is directly affected by their positive or negative symptoms of the disease as defined by their individual scores on the clinical diagnostic scales. PMID:25537115

  17. Automatic detection and segmentation of ischemic lesions in computed tomography images of stroke patients

    NASA Astrophysics Data System (ADS)

    Vos, Pieter C.; Biesbroek, J. Matthijs; Weaver, Nick A.; Velthuis, Birgitta K.; Viergever, Max A.

    2013-03-01

    Stroke is the third most common cause of death in developed countries. Clinical trials are currently investigating whether advanced Computed Tomography can be of benefit for diagnosing stroke at the acute phase. These trials are based on large patients cohorts that need to be manually annotated to obtain a reference standard of tissue loss at follow-up, resulting in extensive workload for the radiologists. Therefore, there is a demand for accurate and reliable automatic lesion segmentation methods. This paper presents a novel method for the automatic detection and segmentation of ischemic lesions in CT images. The method consists of multiple sequential stages. In the initial stage, pixel classification is performed using a naive Bayes classifier in combination with a tissue homogeneity algorithm in order to localize ischemic lesion candidates. In the next stage, the candidates are segmented using a marching cubes algorithm. Regional statistical analysis is used to extract features based on local information as well as contextual information from the contra-lateral hemisphere. Finally, the extracted features are summarized into a likelihood of ischemia by a supervised classifier. An area under the Receiver Operating Characteristic curve of 0.91 was obtained for the identification of ischemic lesions. The method performance on lesion segmentation reached a Dice similarity coeficient (DSC) of 0.74+/-0.09, whereas an independent human observer obtained a DSC of 0.79+/-0.11 in the same dataset. The experiments showed that it is feasible to automatically detect and segment ischemic lesions in CT images, obtaining a comparable performance as human observers.

  18. Survival Analysis of Patients with High-Grade Gliomas Based on Data Mining of Imaging Variables

    PubMed Central

    Zacharaki, E.I.; Morita, N.; Bhatt, P.; O’Rourke, D.M.; Melhem, E.R.; Davatzikos, C.

    2015-01-01

    BACKGROUND AND PURPOSE The prediction of prognosis in HGGs is poor in the majority of patients. Our aim was to test whether multivariate prediction models constructed by machine-learning methods provide a more accurate predictor of prognosis in HGGs than histopathologic classification. The prediction of survival was based on DTI and rCBV measurements as an adjunct to conventional imaging. MATERIALS AND METHODS The relationship of survival to 55 variables, including clinical parameters (age, sex), categoric or continuous tumor descriptors (eg, tumor location, extent of resection, multifocality, edema), and imaging characteristics in ROIs, was analyzed in a multivariate fashion by using data-mining techniques. A variable selection method was applied to identify the overall most important variables. The analysis was performed on 74 HGGs (18 anaplastic gliomas WHO grades III/IV and 56 GBMs or gliosarcomas WHO grades IV/IV). RESULTS Five variables were identified as the most significant, including the extent of resection, mass effect, volume of enhancing tumor, maximum B0 intensity, and mean trace intensity in the nonenhancing/edematous region. These variables were used to construct a prediction model based on a J48 classification tree. The average classification accuracy, assessed by cross-validation, was 85.1%. Kaplan-Meier survival curves showed that the constructed prediction model classified malignant gliomas in a manner that better correlates with clinical outcome than standard histopathology. CONCLUSIONS Prediction models based on data-mining algorithms can provide a more accurate predictor of prognosis in malignant gliomas than histopathologic classification alone. PMID:22322603

  19. A patient specific 4D MRI liver motion model based on sparse imaging and registration

    NASA Astrophysics Data System (ADS)

    Noorda, Y. H.; Bartels, L. W.; van Stralen, Marijn; Pluim, J. P. W.

    2013-03-01

    Introduction: Image-guided minimally invasive procedures are becoming increasingly popular. Currently, High-Intensity Focused Ultrasound (HIFU) treatment of lesions in mobile organs, such as the liver, is in development. A requirement for such treatment is automatic motion tracking, such that the position of the lesion can be followed in real time. We propose a 4D liver motion model, which can be used during planning of this procedure. During treatment, the model can serve as a motion predictor. In a similar fashion, this model could be used for radiotherapy treatment of the liver. Method: The model is built by acquiring 2D dynamic sagittal MRI data at six locations in the liver. By registering these dynamics to a 3D MRI liver image, 2D deformation fields are obtained at every location. The 2D fields are ordered according to the position of the liver at that specific time point, such that liver motion during an average breathing period can be simulated. This way, a sparse deformation field is created over time. This deformation field is finally interpolated over the entire volume, yielding a 4D motion model. Results: The accuracy of the model is evaluated by comparing unseen slices to the slice predicted by the model at that specific location and phase in the breathing cycle. The mean Dice coefficient of the liver regions was 0.90. The mean misalignment of the vessels was 1.9 mm. Conclusion: The model is able to predict patient specific deformations of the liver and can predict regular motion accurately.

  20. Objected constrained registration and manifold learning: A new patient setup approach in image guided radiation therapy of thoracic cancer

    SciTech Connect

    Chen Ting; Jabbour, Salma K.; Haffty, Bruce G.; Yue, Ning; Qin Songbing

    2013-04-15

    Purpose: The management of thoracic malignancies with radiation therapy is complicated by continuous target motion. In this study, a real time motion analysis approach is proposed to improve the accuracy of patient setup. Methods: For 11 lung cancer patients a long training fluoroscopy was acquired before the first treatment, and multiple short testing fluoroscopies were acquired weekly at the pretreatment patient setup of image guided radiotherapy (IGRT). The data analysis consisted of three steps: first a 4D target motion model was constructed from 4DCT and projected to the training fluoroscopy through deformable registration. Then the manifold learning method was used to construct a 2D subspace based on the target motion (kinetic) and location (static) information in the training fluoroscopy. Thereafter the respiratory phase in the testing fluoroscopy was determined by finding its location in the subspace. Finally, the phase determined testing fluoroscopy was registered to the corresponding 4DCT to derive the pretreatment patient position adjustment for the IGRT. The method was tested on clinical image sets and numerical phantoms. Results: The registration successfully reconstructed the 4D motion model with over 98% volume similarity in 4DCT, and over 95% area similarity in the training fluoroscopy. The machine learning method derived the phase values in over 98% and 93% test images of the phantom and patient images, respectively, with less than 3% phase error. The setup approach achieved an average accumulated setup error less than 1.7 mm in the cranial-caudal direction and less than 1 mm in the transverse plane. All results were validated against the ground truth of manual delineations by an experienced radiation oncologist. The expected total time for the pretreatment setup analysis was less than 10 s. Conclusions: By combining the registration and machine learning, the proposed approach has the potential to improve the accuracy of pretreatment setup for patients with thoracic malignancy.

  1. SIMS imaging of gadolinium isotopes in tissue from Nephrogenic Systemic Fibrosis patients: Release of free Gd from magnetic resonance imaging (MRI) contrast agents

    NASA Astrophysics Data System (ADS)

    Abraham, Jerrold L.; Chandra, Subhash; Thakral, Charu; Abraham, Joshua M.

    2008-12-01

    Recently, Gd-based magnetic resonance imaging (MRI) contrast agents (GBMCA) have been linked to a new disease, Nephrogenic Systemic Fibrosis (NSF), with skin and systemic toxicity and death in certain patients with renal failure. Due to widespread use of GBMCA in diagnostic MRI, it is essential to study their excretion, metabolism, and target sites in cells and tissues. A CAMECA IMS-3f SIMS ion microscope and scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS) were used for imaging Gd isotopes in relation to calcium distributions in histologic sections of human tissues. SIMS imaging revealed two types of Gd localization in skin biopsies of patients who received GBMCA. The Gd was present in micrometer size deposits in association with calcium, and in detectable amounts in a more diffuse cellular distribution. Only the Gd-containing deposits associated with Ca and P were detectable using SEM/EDS. As only insoluble deposits remain in the biopsy tissues after aqueous and organic solvent processing of the tissue, our observations support release of free Gd from the GBMCA and selective localization of insoluble Gd in the target tissue from patients with NSF. This study opens new novel applications of SIMS for characterization of the safety of GBMCA.

  2. Pathologic findings in patients with targeted magnetic resonance imaging-guided prostate needle core biopsies

    PubMed Central

    Geller, Rachel L; Nour, Sherif G; Osunkoya, Adeboye O

    2015-01-01

    In contrast to the routine (non-targeted) sampling approach of transrectal ultrasound guided biopsies (TRUS-GB), targeted magnetic resonance imaging-guided biopsies (TMRI-GB) target regions of the prostate suspicious for prostate cancer (PCa), based on findings on multiparametric MRI. We sought to examine the pathologic findings identified on TMRI-GB, due to the fact that there are limited studies on this in the Pathology literature. A search was made through our Urologic Pathology files for prostate needle core biopsies that were obtained via TMRI-GB. Forty-six patients were identified. Mean patient (PT) age was 62 years (range: 50-78 years). Twenty one of 46 PTs (46%) had a history of PCa, 10/46 PTs (22%) had a history of negative TRUS-GB and rising PSA, and the remaining 15/46 PTs (32%) had never undergone biopsy. Cancer detection rate on TMRI-GB was 57% for PTs with a prior diagnosis of PCa, 50% for PTs with a history of benign biopsy, and 67% who were biopsy naïve. An average of 3.16 cores were sampled from malignant lesions and an average of 2.74 were sampled from benign lesions (P=0.02). TMRI-GB has a higher cancer detection rate than TRUS-GB. TMRI-GB may have a critical role as a tool for active surveillance, tumor mapping, and primary detection of PCa, which will likely evolve as the ability to identify malignant lesions improve. The roles of pathologists and radiologists in the validation of this procedure will continue to be even more vital in the future. PMID:26617689

  3. Definitions and outlook targeting x-ray exposure of patients in diagnostic imaging

    NASA Astrophysics Data System (ADS)

    Regulla, Dieter F.

    2011-03-01

    Computer tomography (CT) is vital and currently irreplaceable in diagnostic radiology. But CT operates with ionizing radiation which may cause cancer or non-cancer diseases in humans. The degree of radiation impact depends on the dose administered by an investigation. And this is the core issue: Even CT exams executed lege artis, administer doses to patients which by magnitude are far beyond the level of hitherto known doses of conventional film-screen techniques. Patients undergoing one or multiple CT examinations, digital angiographies or interventions will be exposed to effective doses between roughly several mSv and several 100 mSv depending on type and frequency of the diagnostic investigations. From the radiation protection point of view, there is therefore the worldwide problem of formulating firm rules for the control of these high-dose investigations, as dose limits can not be established for reasons of the medical benefit. This makes the difference compared with radiation protection for occupationally exposed persons. What remains is "software", namely "justification" and "optimization". Justification requires balancing the interests between the health benefit and the potential harm of an exam which has to be responsibly executed by the physician himself; therefore the radiologists' associations are in the duty to prepare practicable rules for justification. Optimization again needs a cooperative solution, and that is the establishment of reference doses for diagnostic examinations, to be checked by the technical service of the producers' companies. Experts and authorities have been aware of the high-dose dilemma in diagnostic imaging since long. It is time for the reflection of active solutions and their implementation into practice.

  4. The Artful Universe Expanded

    NASA Astrophysics Data System (ADS)

    Barrow, John D.

    2005-07-01

    Our love of art, writes John Barrow, is the end product of millions of years of evolution. How we react to a beautiful painting or symphony draws upon instincts laid down long before humans existed. Now, in this enhanced edition of the highly popular The Artful Universe , Barrow further explores the close ties between our aesthetic appreciation and the basic nature of the Universe. Barrow argues that the laws of the Universe have imprinted themselves upon our thoughts and actions in subtle and unexpected ways. Why do we like certain types of art or music? What games and puzzles do we find challenging? Why do so many myths and legends have common elements? In this eclectic and entertaining survey, Barrow answers these questions and more as he explains how the landscape of the Universe has influenced the development of philosophy and mythology, and how millions of years of evolutionary history have fashioned our attraction to certain patterns of sound and color. Barrow casts the story of human creativity and thought in a fascinating light, considering such diverse topics as our instinct for language, the origins and uses of color in nature, why we divide time into intervals as we do, the sources of our appreciation of landscape painting, and whether computer-generated fractal art is really art. Drawing on a wide variety of examples, from the theological questions raised by St. Augustine and C.S. Lewis to the relationship between the pure math of Pythagoras and the music of the Beatles, The Artful Universe Expanded covers new ground and enters a wide-ranging debate about the meaning and significance of the links between art and science.

  5. Reconstruction of congenital microtia by using a tissue expander.

    PubMed

    Hata, Y; Umeda, T

    2000-06-01

    In the conventional reconstruction of microtia, skin grafting is an absolute necessity because of the scantiness of the skin tissue at the affected site. As the result, color- and texture- matching as well as sensory preservation remain to be improved. To solve these problems, we developed a surgical procedure for reconstruction of microtia by using a tissue expander, which allowed us to reconstruct the erect auricle without the need for skin grafting. In this paper, we introduce and discuss our method using the tissue expander with a review of the literature. We operated on a total of 38 patients with microtia. Most of the patients were around 10 years of age, but 3 were adults. Autogenous cartilage was used, and the helix, antihelix, concha, and tragus were reproduced. Initially, 70 ml custom-made expanders were used; after that, 75 ml or 95 ml ready-made expanders were used. The erect auricle was reconstructed by the primary procedure in 33 patients. The reconstructed auricle was satisfactory in color- and texture-matching and had nearly normal sensation. No major absorption of the cartilage has been noted for 15 years, although a slight retraction of the expanded skin was observed in each patient. In conclusion, microtia repair by using a tissue expander is superior to that by conventional procedures in color- and texture- matching and sensory preservation of the reconstructed auricle. PMID:12160182

  6. SPECT imaging for brain improvement quantification in a patient with cerebrotendinous xanthomatosis.

    PubMed

    Selva-O'Callaghan, Albert; Bardes, Ignasi; Jacas, Carlos; Jubany, Lluis; Lorenzo-Bosquet, Carles; Cuberas-Borrós, Gemma; Vilardell-Tarres, Miquel

    2011-01-01

    Cerebrotendinous xanthomatosis is a rare recessive autosomal disease caused by mutations of the sterol 27-hydroxylase gene (CYP27), which leads to reduced synthesis of bile acids, particularly chenodeoxycholic acid (Cali et al, J Biol Chem. 1991;266:7779-7783; Gallus et al, Neurol Sci. 2006;27:143-149). The disease is characterized by progressive neurologic dysfunction due to accumulation of cholestanol in neurologic tissues (Moghadasian et al, Arch Neurol. 2002;59:527-529; Selva-O'Callaghan et al, Rheumatology. 2007;46:1212-1213). Long-term treatment with chenodeoxycholic acid can arrest or even reverse progression of the disease (Pierre et al, J Inherit Metab Dis. In press).Brain SPECT with 740 MBq of Tc-99m ethyl cysteinate dimmer, using a double-head gamma camera (Siemens E.cam) with high-resolution, low-energy parallel collimators was performed in our patient at onset and 2 years after starting chenodeoxycholic acid treatment. SPECT acquisitions were performed using a 360-degree orbit, 1 image/30 seg/3 degree, and 128 × 128 matrix. Reconstruction was by means of filtered back-projection, Butterworth 5/0.25, without attenuation correction. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam (Segami Corporation). To visually identify abnormal perfusion regions, volume render brain image was computed, where abnormal perfusion regions were found by comparing with age-matched normal database, and Brodmann areas (BA) were quantified. Pre- versus post-treatment changes were computed by means of relative percentage between counts. Post-treatment SPECT showed better perfusion than pretreatment SPECT with an increase between 5% and 10% in frontal cortex (BA 9, BA 24, BA 32, BA 46, BA 47), parietal cortex (BA 5, BA 31), and temporal cortex (BA 20, BA 22, BA 28, BA 36, BA 37, BA 38), and with an increase of more than 10% in frontal cortex (BA 45) and parietal cortex (BA 23). This case illustrates the benefit of bile acid therapy for halting and even reversing neurologic retardation in this condition. PMID:21157207

  7. Assessment of the diagnostic value of diffusion tensor imaging in patients with spinal cord compression: a meta-analysis.

    PubMed

    Li, X F; Yang, Y; Lin, C B; Xie, F R; Liang, W G

    2016-01-01

    We investigated the diagnostic value of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of magnetic resonance diffusion tensor imaging (DTI) in patients with spinal cord compression (SCC) using a meta-analysis framework. Multiple scientific literature databases were exhaustively searched to identify articles relevant to this study. Mean values and standardized mean differences (SMDs) were calculated for the ADC and FA in normal and diseased tissues. The STATA version 12.0 software was used for statistical analysis. Of the 41 articles initially retrieved through database searches, 11 case-control studies were eligible for the meta-analysis and contained a combined total of 645 human subjects (394 patients with SCC and 251 healthy controls). All 11 studies reported data on FA, and 9 contained data related to the ADC. The combined SMDs of the ADC and FA showed that the ADC was significantly higher and the FA was lower in patients with SCC than in healthy controls. Subgroup analysis based on the b value showed higher ADCs in patients with SCC than in healthy controls at b values of both ?500 and >500 s/mm2. In summary, the main findings of this meta-analysis revealed an increased ADC and decreased FA in patients with SCC, indicating that DTI is an important diagnostic imaging tool to assess patients suspected to have SCC. PMID:26628393

  8. Assessment of the diagnostic value of diffusion tensor imaging in patients with spinal cord compression: a meta-analysis

    PubMed Central

    Li, X.F.; Yang, Y.; Lin, C.B.; Xie, F.R.; Liang, W.G.

    2015-01-01

    We investigated the diagnostic value of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of magnetic resonance diffusion tensor imaging (DTI) in patients with spinal cord compression (SCC) using a meta-analysis framework. Multiple scientific literature databases were exhaustively searched to identify articles relevant to this study. Mean values and standardized mean differences (SMDs) were calculated for the ADC and FA in normal and diseased tissues. The STATA version 12.0 software was used for statistical analysis. Of the 41 articles initially retrieved through database searches, 11 case-control studies were eligible for the meta-analysis and contained a combined total of 645 human subjects (394 patients with SCC and 251 healthy controls). All 11 studies reported data on FA, and 9 contained data related to the ADC. The combined SMDs of the ADC and FA showed that the ADC was significantly higher and the FA was lower in patients with SCC than in healthy controls. Subgroup analysis based on the b value showed higher ADCs in patients with SCC than in healthy controls at b values of both ?500 and >500 s/mm2. In summary, the main findings of this meta-analysis revealed an increased ADC and decreased FA in patients with SCC, indicating that DTI is an important diagnostic imaging tool to assess patients suspected to have SCC. PMID:26628393

  9. Smaragdyrins: emeralds of expanded porphyrin family.

    PubMed

    Pareek, Yogita; Ravikanth, M; Chandrashekar, T K

    2012-10-16

    Porphyrins are tetrapyrrolic 18 ? electron conjugated macrocycles with wide applications that range from materials to medicine. Expanded porphyrins, synthetic analogues of porphyrins that contain more than 18 ? electrons in the conjugated pathway, have an increased number of pyrroles or other heterocyles or multiple meso-carbon bridges. The expanded porphyrins have attracted tremendous attention because of unique features such as anion binding or transport that are not present in porphyrins. Expanded porphyrins exhibit wide applications that include their use in the coordination of large metal ions, as contrasting agents in magnetic resonance imaging (MRI), as sensitizers for photodynamic therapy (PDT) and as materials for nonlinear optical (NLO) studies. Pentaphyrin 1, sapphyrin 2, and smaragdyrin 3 are expanded porphyrins that include five pyrroles or heterocyclic rings. They differ from each other in the number of bridging carbons and direct bonds that connect the five heterocyclic rings. Sapphyrins were the first stable expanded porphyrins reported in the literature and remain one of the most extensively studied macrocycles. The strategies used to synthesize sapphyrins are well established, and these macrocycles are versatile anion binding agents. They possess rich porphyrin-like coordination chemistry and have been used in diverse applications. This Account reviews developments in smaragdyrin chemistry. Although smaragdyrins were discovered at the same time as sapphyrins, the chemistry of smaragdyrins remained underdeveloped because of synthetic difficulties and their comparative instability. Earlier efforts resulted in the isolation of stable ?-substituted smaragdyrins and meso-aryl isosmaragdyrins. Recently, researchers have synthesized stable meso-aryl smaragdyrins by [3 + 2] oxidative coupling reactions. These results have stimulated renewed research interest in the exploration of these compounds for anion and cation binding, energy transfer, fluorescent sensors, and their NLO properties. Recently reported results on smaragdyrin macrocycles have set the stage for further synthetic studies to produce stable meso-aryl smaragdyrins with different inner cores to study their properties and potential for various applications. PMID:22939582

  10. Growth of arachnoid cysts in patients with autosomal dominant polycystic kidney disease: serial imaging and clinical relevance

    PubMed Central

    Krauer, Fabienne; Ahmadli, Uzeyir; Kollias, Spyros; Bleisch, Jörg; Wüthrich, Rudolf P.; Serra, Andreas L.; Poster, Diane

    2012-01-01

    Background Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder that results in the growth of cysts in the kidneys and other organs. Multisystemic involvement is common including affection of the central nervous system with cerebral aneurysms and arachnoid cysts. Methods This is a prospective cohort study to investigate the prevalence and growth rate of arachnoid cysts in ADPKD patients. Participants enrolled in the SUISSE ADPKD cohort were offered cranial imaging for the detection of intracranial alterations. In the case of identified arachnoid cysts, patients were suggested to undergo follow-up imaging to assess the growth rate of the cysts. Volume of arachnoid cysts at the baseline and at follow-up visits was assessed by manual segmentation on a dedicated workstation. Results A total of 109 ADPKD patients agreed to undergo cranial imaging. In 14 (12.8%) patients (9 males and 5 females), 18 singular arachnoid cysts were identified. The baseline volumes of individual cysts ranged from 1.8 to 337.6 cm3. During a mean follow-up period of 24 months, the volume changes of 12 individual arachnoid cysts of nine patients ranged from ?3.1 to 3.7 cm3. Cystic lesions were mostly localized in the middle fossa. All affected patients were clinically asymptomatic. Conclusions We found a higher prevalence of arachnoid cysts in ADPKD patients with more advanced disease. There was a large variability in size and growth. These arachnoid cysts were clinically silent and their growth pattern was subtle and unpredictable, in contrast to the much more foreseeable growth of the renal cysts. PMID:26019816

  11. A multimedia Electronic Patient Record (ePR) system for Image-Assisted Minimally Invasive Spinal Surgery

    PubMed Central

    Documet, Jorge; Le, Anh; Liu, Brent; Chiu, John; Huang, HK

    2009-01-01

    Purpose This paper presents the concept of bridging the gap between diagnostic images and image-assisted surgical treatment through the development of a one-stop multimedia electronic patient record (ePR) system that manages and distributes the real-time multimodality imaging and informatics data that assists the surgeon during all clinical phases of the operation from planning Intra-Op to post-care follow-up. We present the concept of this multimedia ePR for surgery by first focusing on Image-Assisted Minimally Invasive Spinal Surgery as a clinical application. Methods Three clinical Phases of Minimally Invasive Spinal Surgery workflow in Pre-Op, Intra-Op, and Post Op are discussed. The ePR architecture was developed based on the three-phased workflow, which includes the Pre-Op, Intra-Op, and Post-Op modules and four components comprising of the input integration unit, fault-tolerant gateway server, fault-tolerant ePR server, and the visualization and display. A prototype was built and deployed to a Minimally Invasive Spinal Surgery clinical site with user training and support for daily use. Summary A step-by step approach was introduced to develop a multi-media ePR system for Imaging-Assisted Minimally Invasive Spinal Surgery that includes images, clinical forms, waveforms, and textual data for planning the surgery, two real-time imaging techniques (digital fluoroscopic, DF) and endoscope video images (Endo), and more than half a dozen live vital signs of the patient during surgery. Clinical implementation experiences and challenges were also discussed. PMID:20033507

  12. Dosimetric evaluation for exposure of patient to a z-gradient coil in magnetic resonance imaging

    SciTech Connect

    Lu Mai; Ueno, Shoogo

    2011-04-01

    In magnetic resonance imaging, time-varied gradient magnetic fields may stimulate nerves and muscles by inducing electric fields and currents in patients, which may potentially cause health problems. In this paper, a realistic z-gradient coil was numerically designed and the exposure level in a 3D real human man model was calculated by using the impedance method. It was found that the z-gradient coil produces a magnetic flux density (B-field) with two regions of good homogeneity along the coil length, separated by a very weak B-field in the middle of the coil. The spatially averaged B-field is 281 times greater than that of the International Commission on Non-Ionizing Radiation Protection's (ICNIRP) reference level. The 1-cm{sup 2}-averaged induced current density in the central nervous system is 87 times greater than that of the ICNIRP's basic restriction. The maximum current density in all of the body tissues is above the nerve stimulation threshold.

  13. Dosimetric evaluation for exposure of patient to a z-gradient coil in magnetic resonance imaging

    NASA Astrophysics Data System (ADS)

    Lu, Mai; Ueno, Shoogo

    2011-04-01

    In magnetic resonance imaging, time-varied gradient magnetic fields may stimulate nerves and muscles by inducing electric fields and currents in patients, which may potentially cause health problems. In this paper, a realistic z-gradient coil was numerically designed and the exposure level in a 3D real human man model was calculated by using the impedance method. It was found that the z-gradient coil produces a magnetic flux density (B-field) with two regions of good homogeneity along the coil length, separated by a very weak B-field in the middle of the coil. The spatially averaged B-field is 281 times greater than that of the International Commission on Non-Ionizing Radiation Protection's (ICNIRP) reference level. The 1-cm2-averaged induced current density in the central nervous system is 87 times greater than that of the ICNIRP's basic restriction. The maximum current density in all of the body tissues is above the nerve stimulation threshold.

  14. Expanded-bed adsorption chromatography.

    PubMed

    Kennedy, Robert M

    2005-06-01

    Expanded-bed adsorption (EBA) chromatography is a convenient and effective technique for the capture of proteins directly from unclarified crude sample. In EBA chromatography, the settled bed is first expanded by upward flow of equilibration buffer. The crude feed, a mixture of soluble proteins, contaminants, cells, and cell debris, is then passed upward through the expanded bed. Target proteins are captured on the adsorbent, while particulates and contaminants pass through. A change to elution buffer while maintaining upward flow results in desorption of the target protein in expanded-bed mode. Alternatively, if the flow is reversed, the adsorbed particles will quickly settle and the proteins can be desorbed by an elution buffer. The mode used for elution (expanded-bed versus settled-bed) depends on the characteristics of the feed. After elution, the adsorbent is cleaned with a predefined cleaning-in-place (CIP) solution, with cleaning followed by either column regeneration (for further use) or storage. PMID:18429292

  15. [F-18]-Fluoromisonidazole Quantification of Hypoxia in Human Cancer Patients using Image-derived Blood Surrogate Tissue Reference Regions

    PubMed Central

    Muzi, Mark; Peterson, Lanell M.; O’Sullivan, Janet N.; Fink, James R.; Rajendran, Joseph G.; McLaughlin, Lena J.; Muzi, John P.; Mankoff, David A.; Krohn, Kenneth A.

    2015-01-01

    18F-FMISO is the most widely used PET agent for imaging hypoxia, a condition associated with resistance to tumor therapy. 18F-FMISO equilibrates in normoxic tissues, but is retained under hypoxic conditions because of reduction and binding to macromolecules. A simple tissue-to-blood ratio (TB) is suitable for quantifying hypoxia. A threshold of TB ? 1.2 is useful in discriminating the hypoxic volume (HV) of tissue; TBmax is the maximum intensity of the hypoxic region and does not invoke a threshold. Because elimination of blood sampling would simplify clinical use, we tested the validity of using imaging regions as a surrogate for blood sampling. Methods Patients underwent 20 min 18F-FMISO scans during the 90–140 min interval post-injection with venous blood sampling. 223 18F-FMISO patient studies had detectable surrogate blood regions in the field-of-view. Quantitative parameters of hypoxia (TBmax, HV) derived from blood samples were compared to values using surrogate blood regions derived from heart, aorta and/or cerebellum. In a subset of brain cancer patients, parameters from blood samples and from cerebellum were compared for their ability to independently predict outcome. Results Vascular regions of heart showed the highest correlation to measured blood activity (R2 = 0.84). For brain studies, cerebellar activity was similarly correlated to blood samples. In brain cancer patients, Kaplan-Meier analysis showed that image-derived reference regions had nearly identical predictive power as parameters derived from blood, thus obviating the need for venous sampling in these patients. Conclusions Simple static analysis of 18F-FMISO PET captures both the intensity (TBmax) and spatial extent (HV) of tumor hypoxia. An image-derived region to assess blood activity can be used as a surrogate for blood sampling in quantification of hypoxia. PMID:26112020

  16. Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty

    PubMed Central

    Stirling, Paul; Valsalan Mannambeth, Rejith; Soler, Agustin; Batta, Vineet; Malhotra, Rajeev Kumar; Kalairajah, Yegappan

    2015-01-01

    AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation (PSI) surgery. METHODS: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography (CT) or magnetic resonance imaging (MRI). RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant. CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery. PMID:25793170

  17. Baseline brain perfusion and brain structure in patients with major depression: a multimodal magnetic resonance imaging study

    PubMed Central

    Vasic, Nenad; Wolf, Nadine D.; Grön, Georg; Sosic-Vasic, Zrinka; Connemann, Bernhard J.; Sambataro, Fabio; von Strombeck, Anna; Lang, Dirk; Otte, Stefanie; Dudek, Manuela; Wolf, Robert C.

    2015-01-01

    Background Abnormal regional cerebral blood flow (rCBF) and grey matter volume have been frequently reported in patients with major depressive disorder (MDD). However, it is unclear to what extent structural and functional change co-occurs in patients with MDD and whether markers of neural activity, such as rCBF, can be predicted by structural change. Methods Using MRI, we investigated resting-state rCBF and brain structure in patients with MDD and healthy controls between July 2008 and January 2013. We acquired perfusion images obtained with continuous arterial spin labelling, used voxel-based morphometry to assess grey matter volume and integrated biological parametric mapping analyses to investigate the impact of brain atrophy on rCBF. Results We included 43 patients and 29 controls in our study. Frontotemporal grey matter volume was reduced in patients compared with controls. In patients, rCBF was reduced in the anterior cingulate and bilateral parahippocampal areas and increased in frontoparietal and striatal regions. These abnormalities were confirmed by analyses with brain volume as a covariate. In patients with MDD there were significant negative correlations between the extent of depressive symptoms and bilateral parahippocampal rCBF. We found a positive correlation between depressive symptoms and rCBF for right middle frontal cortical blood flow. Limitations Medication use in patients has to be considered as a limitation of our study. Conclusion Our data suggest that while changes of cerebral blood flow and brain volume co-occur in patients with MDD, structural change is not sufficient to explain altered neural activity in patients at rest. Abnormal brain structure and function in patients with MDD appear to reflect distinct levels of neuropathology. PMID:26125119

  18. Denial and Self-Image in Stroke, Lung Cancer, and Heart Disease Patients

    ERIC Educational Resources Information Center

    Levine, Jacob; Zigler, Edward

    1975-01-01

    Stroke, lung cancer, and heart disease patients were found to employ denial, as indicated by the relatively small difference between their real and ideal selves before and after the onset of illness. The greatest amount of denial was found for stroke patients. Cancer patients displayed more denial than did heart patients. (Author)

  19. Serum S100A12 and Temporomandibular Joint Magnetic Resonance Imaging in Juvenile Idiopathic Arthritis Egyptian Patients: Acase Control Study

    PubMed Central

    Aziez, Ola A. Abdul; Saber, Nayera Z.; El Bakry, Samah A.; Mohammad, Ahmed A.; Maksud, Sahar S. Abdel; Ali, Yaser

    2010-01-01

    This study aimed to measure serum levels of the proinflammatory protein S100A12, investigate clinical as well as contrast enhanced magnetic resonance imaging findings of temporomandibular joint inflammation among juvenile idiopathic arthritis patients and to find out the correlation between each of them, moreover with different disease parameters as temporomandibular joint inflammation may occur without clinical manifestations; it is in need for thorough evaluation and S100A12 may be a future anti-inflammatory treatment in JIA. Twenty patients with Juvenile Idiopathic Arthritis (JIA) and 10 healthy control subjects underwent measurement of S100A12 serum concentrations by sandwich ELISA. Temporomandibular Joints (TMJs); clinical and post contrast Magnetic Resonance Imaging (MRI) examinations were performed. MRI findings were scored. Results showed that TMJ arthritis was detected in 80% of JIA patients using MRI. Serum S100A12 levels were significantly increased in patients compared to controls. Serum concentrations of S100A12 and total MRI scores were significantly higher in JIA patients with active disease compared to those without activity. Systemic and polyarticular JIA patients showed significant increase in S100A12 levels and total MRI scores compared to those with oligoarticular JIA. The MRI TMJ abnormalities revealed significant association with clinical signs of TMJ inflammation but not with symptoms. A significant correlation was found between serum S100A12 concentrations and MRI score as well as between each of them and different clinical, laboratory disease parameters. Serum S100A12 levels showed significant positive correlation with synovial enhancement score. To conclude TMJ arthritis could be detected in most cases of JIA patients using contrast enhanced MRI. Increased S100A12 levels may point to synovial inflammation. Clinical signs of TMJ arthritis may be used as filter for MRI examination. Further studies on larger scale of JIA patients are needed for monitoring TMJ inflammation and S100A12 may be a potential target of future anti-inflammatory therapy. PMID:20437698

  20. Imaging in resectable colorectal liver metastasis patients with or without preoperative chemotherapy: results of the PROMETEO-01 study

    PubMed Central

    Rojas Llimpe, F L; Di Fabio, F; Ercolani, G; Giampalma, E; Cappelli, A; Serra, C; Castellucci, P; D'Errico, A; Golfieri, R; Pinna, A D; Pinto, C

    2014-01-01

    Background: The aim of the PROMETEO-01 Study was to define the diagnostic accuracy of imaging techniques in colorectal cancer liver metastasis (CRCLM) patients. Methods: Patients referred to Bologna S. Orsola-Malpighi Hospital performed a computed-tomography scan (CT), magnetic resonance (MR), 18F-FDG-PET/CTscan (PET/CT) and liver contrast-enhanced-ultrasound (CEUS); CEUS was also performed intraoperatively (i-CEUS). Every pathological lesion was compared with imaging data. Results: From December 2007 to August 2010, 84 patients were enrolled. A total of 51 (60.71%) resected patients were eligible for analysis. In the lesion-by-lesion analysis 175 resected lesions were evaluated: 67(38.3%) belonged to upfront resected patients (group-A) and 108 (61.7%) to chemotherapy-pretreated patients (group-B). In all patients the sensitivity of MR proved better than CT (91% vs 82% P=0.002), CEUS (91 vs 81% P=0.008) and PET/CT (91% vs 60% P=0.000), whereas PET/CT showed the lowest sensitivity. In group-A the sensitivity of i-CEUS, MR, CT, CEUS and PET/CT was 98%, 94%, 91%, 84% and 78%, respectively. In group-B the i-CEUS proved equivalent in sensitivity to MR (95% and 90%, respectively, P=0.227) and both were significantly more sensitive than other procedures. The CT sensitivity in group-B was lower than in group-A (77% vs 91%, P=0.024). Conclusions: A thoraco-abdominal CT provides an adequate baseline evaluation and guides judgment as to the resectability of CRCLM patients. In the subset of candidates for induction chemotherapy to increase the chance of liver resection, the most rational approach is to add MR for the staging and restaging of CRCLM. PMID:24983362

  1. Patient Alignment Estimation in Six Degrees of Freedom Using a CT-scan and a Single X-ray Image

    NASA Astrophysics Data System (ADS)

    Selby, B. P.; Sakas, G.; Walter, S.; Groch, W.-D.; Stilla, U.

    Particle beam treatment allows accurate dose delivery onto carcinogen tissue. The reachable accuracy is limited by patient alignment errors relative to the beam source. Errors can be corrected manually or by automatic comparison of two X-ray images to a CT-scan but correction mostly does not cover all degrees of freedom (DoF). In this contribution we present a solution that makes use of one X-ray image and computes full 6 DoF alignment correction by gray value based comparison to a CT. By using regions of interest, we are able to increase performance and reliability.

  2. Validation of the use of photogrammetry to register pre-procedure MR images to intra-procedure patient position for image-guided cardiac catheterization procedures

    NASA Astrophysics Data System (ADS)

    Gao, Gang; Tarte, Segolene; King, Andy; Ma, Yingliang; Chinchapatnam, Phani; Schaeffter, Tobias; Razavi, Reza; Hawkes, Dave; Hill, Derek; Rhode, Kawal

    2008-03-01

    A hybrid X-ray and magnetic resonance imaging system (XMR) has been proposed as an interventional guidance for cardiovascular catheterisation procedure. However, very few hospitals can benefit from the XMR system because of its limited availability. In this paper we describe a new guidance strategy for cardiovascular catheterisation procedure. In our technique, intra-operative patient position is estimated by using a chest surface reconstructed from a photogrammetry system. The chest surface is then registered with the same surface derived from pre-procedure magnetic resonance (MR) images. The catheterisation procedure can therefore be guided by a roadmap derived from the MR images. Patients were required to hold the breath at end expiration during MRI acquisition. The surface matching accuracy is improved by using a robust trimmed iterative closest point (ICP) matching algorithm, which is especially designed for incomplete surface matching. Compared to the XMR system, the proposed guidance strategy is low cost and easy to set up. Experimental data were acquired from 6 volunteers and 1 patient. The patient data were collected during an electrophysiology procedure. In 6 out of 7 subjects, the experimental results show our method is accurate in term of reciprocal residual error (range from 1.66m to 3.75mm) and constant (closed-loop TREs range from 1.49mm to 3.55mm). For one subject, trimmed ICP failed to find the optimal transform matrix (residual = 4.89, TRE = 9.32) due to the poor quality of the photogrammetry-reconstructed surface. More studies are being carried on in clinical trials.

  3. Prognostic value of thallium-201 myocardial perfusion imaging in patients with unstable angina who respond to medical treatment

    SciTech Connect

    Brown, K.A. )

    1991-04-01

    Although the prognostic value of thallium-201 imaging is well established, its ability to risk stratify patients who present with unstable angina is unclear. Fifty-two consecutive patients admitted with unstable angina who responded to medical treatment and underwent stress thallium-201 imaging within 1 week of discharge were studied. Patients were followed up for 39 +/- 11 months. Cardiac events included cardiac death (n = 3), nonfatal myocardial infarction (n = 4) and admission for unstable angina or revascularization (n = 17). The ability of thallium-201 data (redistribution, fixed defects, normal) to predict cardiac events was compared with clinical data (age, gender, prior myocardial infarction, anginal syndrome, rest and stress electrocardiogram) and cardiac catheterization data using logistic regression. Thallium-201 redistribution was the only significant predictor of cardiac death or nonfatal myocardial infarction (p less than 0.05). The number of myocardial segments with thallium-201 redistribution (p less than 0.0005) and a history of prior myocardial infarction (p less than 0.05) were the only significant predictors of all cardiac events. Cardiac death or nonfatal myocardial infarction occurred more frequently in patients with thallium-201 redistribution (6 (26%) of 23) than in those without redistribution (1 (3%) of 29, p less than 0.05). Similarly, total cardiac events developed more frequently in patients with thallium-201 redistribution (p less than 0.001). Stress thallium-201 imaging has important prognostic value in patients admitted with unstable angina who respond to medical therapy and can identify subgroups at high versus low risk for future cardiac events.

  4. The Palliative care has an expanding future in the heart of health care in New Zealand. It is founded on an interdisciplinary, patient centered model of care delivered in people's homes, hospice,

    E-print Network

    Hickman, Mark

    The Palliative care has an expanding future in the heart of health care in New Zealand Diploma in Health Sciences (Palliative Care) This qualification consists of four papers, HLTH401: Health and Health Systems, HLTH450: Palliative Care: Advanced theory and practice, Students who have the Whitiriea

  5. Megavoltage Computed Tomography Image Guidance With Helical Tomotherapy in Patients With Vertebral Tumors: Analysis of Factors Influencing Interobserver Variability

    SciTech Connect

    Levegruen, Sabine; Poettgen, Christoph; Abu Jawad, Jehad; Berkovic, Katharina; Hepp, Rodrigo; Stuschke, Martin

    2013-02-01

    Purpose: To evaluate megavoltage computed tomography (MVCT)-based image guidance with helical tomotherapy in patients with vertebral tumors by analyzing factors influencing interobserver variability, considered as quality criterion of image guidance. Methods and Materials: Five radiation oncologists retrospectively registered 103 MVCTs in 10 patients to planning kilovoltage CTs by rigid transformations in 4 df. Interobserver variabilities were quantified using the standard deviations (SDs) of the distributions of the correction vector components about the observers' fraction mean. To assess intraobserver variabilities, registrations were repeated after {>=}4 weeks. Residual deviations after setup correction due to uncorrectable rotational errors and elastic deformations were determined at 3 craniocaudal target positions. To differentiate observer-related variations in minimizing these residual deviations across the 3-dimensional MVCT from image resolution effects, 2-dimensional registrations were performed in 30 single transverse and sagittal MVCT slices. Axial and longitudinal MVCT image resolutions were quantified. For comparison, image resolution of kilovoltage cone-beam CTs (CBCTs) and interobserver variability in registrations of 43 CBCTs were determined. Results: Axial MVCT image resolution is 3.9 lp/cm. Longitudinal MVCT resolution amounts to 6.3 mm, assessed as full-width at half-maximum of thin objects in MVCTs with finest pitch. Longitudinal CBCT resolution is better (full-width at half-maximum, 2.5 mm for CBCTs with 1-mm slices). In MVCT registrations, interobserver variability in the craniocaudal direction (SD 1.23 mm) is significantly larger than in the lateral and ventrodorsal directions (SD 0.84 and 0.91 mm, respectively) and significantly larger compared with CBCT alignments (SD 1.04 mm). Intraobserver variabilities are significantly smaller than corresponding interobserver variabilities (variance ratio [VR] 1.8-3.1). Compared with 3-dimensional registrations, 2-dimensional registrations have significantly smaller interobserver variability in the lateral and ventrodorsal directions (VR 3.8 and 2.8, respectively) but not in the craniocaudal direction (VR 0.75). Conclusion: Tomotherapy image guidance precision is affected by image resolution and residual deviations after setup correction. Eliminating the effect of residual deviations yields small interobserver variabilities with submillimeter precision in the axial plane. In contrast, interobserver variability in the craniocaudal direction is dominated by the poorer longitudinal MVCT image resolution. Residual deviations after image guidance exist and need to be considered when dose gradients ultimately achievable with image guided radiation therapy techniques are analyzed.

  6. Task-based measures of image quality and their relation to radiation dose and patient risk

    NASA Astrophysics Data System (ADS)

    Barrett, Harrison H.; Myers, Kyle J.; Hoeschen, Christoph; Kupinski, Matthew A.; Little, Mark P.

    2015-01-01

    The theory of task-based assessment of image quality is reviewed in the context of imaging with ionizing radiation, and objective figures of merit (FOMs) for image quality are summarized. The variation of the FOMs with the task, the observer and especially with the mean number of photons recorded in the image is discussed. Then various standard methods for specifying radiation dose are reviewed and related to the mean number of photons in the image and hence to image quality. Current knowledge of the relation between local radiation dose and the risk of various adverse effects is summarized, and some graphical depictions of the tradeoffs between image quality and risk are introduced. Then various dose-reduction strategies are discussed in terms of their effect on task-based measures of image quality.

  7. Intraventricular cerebrospinal fluid temperature analysis using MR diffusion-weighted imaging thermometry in Parkinson's disease patients, multiple system atrophy patients, and healthy subjects

    PubMed Central

    Sumida, Kaoru; Sato, Noriko; Ota, Miho; Sakai, Koji; Nippashi, Yasumasa; Sone, Daichi; Yokoyama, Kota; Ito, Kimiteru; Maikusa, Norihide; Imabayashi, Etsuko; Matsuda, Hiroshi; Yamada, Kei; Murata, Miho; Kunimatsu, Akira; Ohtomo, Kuni

    2015-01-01

    Purpose We examined the temperature of the intraventricular cerebrospinal fluid (Tv) in patients with Parkinson's disease (PD) and those with multiple system atrophy (MSA) in comparison with healthy subjects, and we examined normal changes in this temperature with aging. Methods Tv was estimated by magnetic resonance (MR) diffusion-weighted imaging (DWI) thermometry in 36 PD patients (19 males, 17 females), 34 MSA patients (17 males, 17 females), 64 age-matched controls (27 men, 37 women), and 114 all-age adult controls (47 men, 67 women; 28–89 years old). The volume of lateral ventricles was also estimated using FreeSurfer in all subjects. Tv and ventricular volume data were compared among the PD and MSA patients and age-matched controls. We also evaluated the relationship between Tv and age in the 114 all-age controls, controlling for ventricular volume. Men and women were analyzed separately. Results The male PD and MSA patients had significantly higher Tv values compared to the male controls, with no significant difference in ventricular volume among them. There was no significant difference in Tv between the female patients and controls. In the all-age male controls, there was a significant negative correlation between Tv and age controlling for ventricular volume, and this was not observed in the women. Conclusion DWI thermometry is a useful and easy method for demonstrating an altered intracranial environment in male patients and healthy controls, but not in females. DWI thermometry can thus be used to help to explore the pathophysiology of Parkinsonian syndromes and to differentiate individuals affected by neurodegenerative disease with autonomic dysfunction from those without it. PMID:26085965

  8. Biomarkers and Molecular Imaging as Predictors of Response to Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer.

    PubMed

    Molinari, Chiara; Matteucci, Federica; Caroli, Paola; Passardi, Alessandro

    2015-12-01

    Standard treatment of patients with locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiotherapy (NCRT) followed by surgery. Tumor regression after NCRT varies substantially among individuals and pathological complete response is a known prognostic factor for LARC. The identification of a predictive model for response to chemoradiotherapy would help clinicians to identify patients who would probably benefit from multimodal treatment and to perform an early assessment of individual prognosis. Carcinoembryonic antigen has proven to be a good predictor of response in several clinical trials. Other widely studied predictive models in LARC include molecular biomarkers, analyzed at various levels and by different techniques, and molecular imaging, in particular magnetic resonance imaging and positron emission tomography/computed tomography. Although none of the studied markers have been approved in clinical practice, their evaluation in larger, prospective trials and in combined predictive models could be of use to define tailored therapeutic strategies. PMID:26170142

  9. Noninvasive Cardiac Imaging in Patients with Known and Suspected Coronary Artery Disease: What is in it for the Interventional Cardiologist?

    PubMed

    Rodriguez-Granillo, Gaston A; Campisi, Roxana; Carrascosa, Patricia

    2016-01-01

    The long-standing coronary artery disease (CAD) paradigm simplified by the discrimination between patients with or without CAD warrants to be revisited by the insightful information provided by noninvasive cardiac imaging, leading to a comprehensive physiopathological assessment rather than a mainly anatomical approach. This review will address (1) the role of non-invasive cardiac imaging for the appropriate selection of stable patients referred to invasive coronary angiography (ICA), and the evolving concept and prognostic implications of myocardial ischemia; (2) the usefulness of computed tomography coronary angiography for the guidance of percutaneous coronary interventions; and (3) the role and potential clinical impact of novel anatomical and functional non-invasive prognostic markers. PMID:26694725

  10. Evaluation of overall setup accuracy and adequate setup margins in pelvic image-guided radiotherapy: Comparison of the male and female patients

    SciTech Connect

    Laaksomaa, Marko; Kapanen, Mika; Tulijoki, Tapio; Peltola, Seppo; Hyödynmaa, Simo; Kellokumpu-Lehtinen, Pirkko-Liisa

    2014-04-01

    We evaluated adequate setup margins for the radiotherapy (RT) of pelvic tumors based on overall position errors of bony landmarks. We also estimated the difference in setup accuracy between the male and female patients. Finally, we compared the patient rotation for 2 immobilization devices. The study cohort included consecutive 64 male and 64 female patients. Altogether, 1794 orthogonal setup images were analyzed. Observer-related deviation in image matching and the effect of patient rotation were explicitly determined. Overall systematic and random errors were calculated in 3 orthogonal directions. Anisotropic setup margins were evaluated based on residual errors after weekly image guidance. The van Herk formula was used to calculate the margins. Overall, 100 patients were immobilized with a house-made device. The patient rotation was compared against 28 patients immobilized with CIVCO's Kneefix and Feetfix. We found that the usually applied isotropic setup margin of 8 mm covered all the uncertainties related to patient setup for most RT treatments of the pelvis. However, margins of even 10.3 mm were needed for the female patients with very large pelvic target volumes centered either in the symphysis or in the sacrum containing both of these structures. This was because the effect of rotation (p ? 0.02) and the observer variation in image matching (p ? 0.04) were significantly larger for the female patients than for the male patients. Even with daily image guidance, the required margins remained larger for the women. Patient rotations were largest about the lateral axes. The difference between the required margins was only 1 mm for the 2 immobilization devices. The largest component of overall systematic position error came from patient rotation. This emphasizes the need for rotation correction. Overall, larger position errors and setup margins were observed for the female patients with pelvic cancer than for the male patients.

  11. SU-E-J-01: 3D Fluoroscopic Image Estimation From Patient-Specific 4DCBCT-Based Motion Models

    SciTech Connect

    Dhou, S; Hurwitz, M; Lewis, J; Mishra, P

    2014-06-01

    Purpose: 3D motion modeling derived from 4DCT images, taken days or weeks before treatment, cannot reliably represent patient anatomy on the day of treatment. We develop a method to generate motion models based on 4DCBCT acquired at the time of treatment, and apply the model to estimate 3D time-varying images (referred to as 3D fluoroscopic images). Methods: Motion models are derived through deformable registration between each 4DCBCT phase, and principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated based on cone-beam projections simulating kV treatment imaging. PCA coefficients are optimized iteratively through comparison of these cone-beam projections and projections estimated based on the motion model. Digital phantoms reproducing ten patient motion trajectories, and a physical phantom with regular and irregular motion derived from measured patient trajectories, are used to evaluate the method in terms of tumor localization, and the global voxel intensity difference compared to ground truth. Results: Experiments included: 1) assuming no anatomic or positioning changes between 4DCT and treatment time; and 2) simulating positioning and tumor baseline shifts at the time of treatment compared to 4DCT acquisition. 4DCBCT were reconstructed from the anatomy as seen at treatment time. In case 1) the tumor localization error and the intensity differences in ten patient were smaller using 4DCT-based motion model, possible due to superior image quality. In case 2) the tumor localization error and intensity differences were 2.85 and 0.15 respectively, using 4DCT-based motion models, and 1.17 and 0.10 using 4DCBCT-based models. 4DCBCT performed better due to its ability to reproduce daily anatomical changes. Conclusion: The study showed an advantage of 4DCBCT-based motion models in the context of 3D fluoroscopic images estimation. Positioning and tumor baseline shift uncertainties were mitigated by the 4DCBCT-based motion models, while they caused errors when using 4DCT-based motion models. Partially funded by Varian research grant.

  12. SU-C-BRF-02: Surface Imaging Based Analysis of Intra-Fraction Motion for Breast Radiotherapy Patients

    SciTech Connect

    Wiant, D; Wentworth, S; Maurer, J; Vanderstraeten, C; Terrell, J; Sintay, B

    2014-06-15

    Purpose: To quantify and characterize intrafraction motion for breast radiotherapy treatments using 3D surface imaging. Methods: Thirty free breathing breast patients were monitored with 3D surface imaging over a total of 831 monitoring sessions. Mean translations and rotations were calculated over each minute, each session, and over all sessions combined. The percentage of each session that the root mean square (RMS) of the linear translations were outside of 2 mm, 3 mm, 4 mm, and 5 mm were determined for each patient. Correlations between mean translations per minute and time and between standard deviation per minute and time were evaluated using Pearson's r value. Results: The mean RMS translation averaged over all patients was 2.63 mm +/- 1.63 mm. The patients spent an average of 52%, 24%, 11%, and 5% of the monitoring time outside of 2 mm, 3 mm, 4 mm, and 5 mm RMS tolerances, respectively. The RMS values averaged over all patients were 2.95 mm +/- 1.67 mm, 3.21 +/- 2.11, and 3.57 mm +/- 2.23 mm over the 5th, 10th, and 15th minutes of monitoring, respectively. The RMS values (r = 0.95, p = 0) and the standard deviations of the RMS values (r = 0.97, p = 0) both showed strong significant correlations with time. Conclusion: The majority of patients treatment time is spent within 5 mm of the isocenter. Patient position tends to drift with increasing time in the session. Treatment length should be considered when determining planning margins. An 8 mm margin on a target volume would account for two standard deviations of motion for a treatment up to 15 minutes in length.

  13. Office-based laryngeal imaging in awake patients with swept-source optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Yu, Lingfeng; Liu, Gangjun; Guo, Shuguang; Wong, Brian J. F.; Chen, Zhongping

    2009-02-01

    Optical coherence tomography (OCT) is an evolving noninvasive imaging modality and has been used to image the human larynx during surgical endoscopy. The design of a long GRIN lens based probe capable of capturing images of the human larynx by use of a swept-source OCT during a typical office-based laryngoscopy examination is presented. An optical-ballast-based 4F optical relay system is proposed to realize variable working distance with a constant optical delay. In vivo OCT imaging of the human larynx is demonstrated with 40 fame/second. Office-based OCT is a promising imaging modality to study the larynx.

  14. MO-G-BRE-03: Automated Continuous Monitoring of Patient Setup with Second-Check Independent Image Registration

    SciTech Connect

    Jiang, X; Fox, T; Schreibmann, E

    2014-06-15

    Purpose: To create a non-supervised quality assurance program to monitor image-based patient setup. The system acts a secondary check by independently computing shifts and rotations and interfaces with Varian's database to verify therapist's work and warn against sub-optimal setups. Methods: Temporary digitally-reconstructed radiographs (DRRs) and OBI radiographic image files created by Varian's treatment console during patient setup are intercepted and used as input in an independent registration module customized for accuracy that determines the optimal rotations and shifts. To deal with the poor quality of OBI images, a histogram equalization of the live images to the DDR counterparts is performed as a pre-processing step. A search for the most sensitive metric was performed by plotting search spaces subject to various translations and convergence analysis was applied to ensure the optimizer finds the global minima. Final system configuration uses the NCC metric with 150 histogram bins and a one plus one optimizer running for 2000 iterations with customized scales for translations and rotations in a multi-stage optimization setup that first corrects and translations and subsequently rotations. Results: The system was installed clinically to monitor and provide almost real-time feedback on patient positioning. On a 2 month-basis uncorrected pitch values were of a mean 0.016° with standard deviation of 1.692°, and couch rotations of ? 0.090°± 1.547°. The couch shifts were ?0.157°±0.466° cm for the vertical, 0.045°±0.286 laterally and 0.084°± 0.501° longitudinally. Uncorrected pitch angles were the most common source of discrepancies. Large variations in the pitch angles were correlated with patient motion inside the mask. Conclusion: A system for automated quality assurance of therapist's registration was designed and tested in clinical practice. The approach complements the clinical software's automated registration in terms of algorithm configuration and performance and constitutes a practical approach to implement safe and cost-effective radiotherapy.

  15. Sentinel lymph node detection in breast cancer patients using surgical navigation system based on fluorescence molecular imaging technology

    NASA Astrophysics Data System (ADS)

    Chi, Chongwei; Kou, Deqiang; Ye, Jinzuo; Mao, Yamin; Qiu, Jingdan; Wang, Jiandong; Yang, Xin; Tian, Jie

    2015-03-01

    Introduction: Precision and personalization treatments are expected to be effective methods for early stage cancer studies. Breast cancer is a major threat to women's health and sentinel lymph node biopsy (SLNB) is an effective method to realize precision and personalized treatment for axillary lymph node (ALN) negative patients. In this study, we developed a surgical navigation system (SNS) based on optical molecular imaging technology for the precise detection of the sentinel lymph node (SLN) in breast cancer patients. This approach helps surgeons in precise positioning during surgery. Methods: The SNS was mainly based on the technology of optical molecular imaging. A novel optical path has been designed in our hardware system and a feature-matching algorithm has been devised to achieve rapid fluorescence and color image registration fusion. Ten in vivo studies of SLN detection in rabbits using indocyanine green (ICG) and blue dye were executed for system evaluation and 8 breast cancer patients accepted the combination method for therapy. Results: The detection rate of the combination method was 100% and an average of 2.6 SLNs was found in all patients. Our results showed that the method of using SNS to detect SLN has the potential to promote its application. Conclusion: The advantage of this system is the real-time tracing of lymph flow in a one-step procedure. The results demonstrated the feasibility of the system for providing accurate location and reliable treatment for surgeons. Our approach delivers valuable information and facilitates more detailed exploration for image-guided surgery research.

  16. Advanced expander test bed program

    NASA Technical Reports Server (NTRS)

    Riccardi, D. P.; Mitchell, J. C.

    1993-01-01

    The Advanced Expander Test Bed (AETB) is a key element in NASA's Space Chemical Engine Technology Program for development and demonstration of expander cycle oxygen/hydrogen engine and advanced component technologies applicable to space engines as well as launch vehicle upper stage engines. The AETB will be used to validate the high-pressure expander cycle concept, investigate system interactions, and conduct investigations of advanced mission focused components and new health monitoring techniques in an engine system environment. The split expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust. Contract work began 27 Apr. 1990. During 1992, a major milestone was achieved with the review of the final design of the oxidizer turbopump in Sep. 1992.

  17. Digital images taken with a mobile phone can assist in the triage of neurosurgical patients to a level 1 trauma centre.

    PubMed

    Bullard, Timothy B; Rosenberg, Marcy S; Ladde, Jay; Razack, Nizam; Villalobos, Hunaldo J; Papa, Linda

    2013-02-01

    We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record. The images were photographed in a darkened room using a smart phone. The mobile phone images and clinical history were reviewed by two neurosurgeons independently. The neurosurgeons rated the adequacy and quality of the images, and indicated whether the images would have changed their transfer decision. Based on clinical data alone, neurosurgeon A would have transferred 64 (73%) patients and neurosurgeon B 39 (44%). After images were provided, A would have transferred 67 (76%) and B would have transferred 49 (56%). The availability of the images significantly altered the transfer decision by A in 25 cases (28%) (P = 0.024) and by B in 28 cases (32%) (P < 0.001). The level of agreement between the two neurosurgeons significantly increased from 53% (kappa = 0.11) to 75% (kappa = 0.47) (P < 0.001). Mobile-phone images of CT scans appear to provide adequate images for triaging patients and helping with transfer decisions of neurosurgical cases. PMID:23528786

  18. The use of modern imaging techniques in the diagnosis and treatment planning of patients with orbital floor fractures

    PubMed Central

    Loba, Piotr; Kozakiewicz, Marcin; Elgalal, Marcin; Stefa?czyk, Ludomir; Broniarczyk-Loba, Anna; Omulecki, Wojciech

    2011-01-01

    Summary Background Ocular motility impairment associated with orbital trauma may have several causes and manifest with various clinical symptoms. In some cases orbital reconstructive surgery can be very challenging and the results are often unsatisfactory. The use of modern imaging techniques aids proper diagnosis and surgical planning. Case Report The authors present the case of a 29-year-old male who sustained trauma to the left orbit. Orthoptic examination revealed limited supra- and infraduction of the left eye. The patient reported diplopia in upgaze and downgaze with primary position spared. Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section. A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant. The patient underwent reconstructive surgery of the orbital floor. Conclusions Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment. PMID:21804469

  19. Positron emission tomography/computed tomography imaging of brown tumors mimicking multiple skeletal metastases in patient with primary hyperparathyroidism.

    PubMed

    Sager, Sait; Aliyev, Anar; Halac, Metin; Oztürk, Tulin

    2012-09-01

    Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process usually seen in patients with hyperparathyroidism. These tumors can behave aggressively and be destructive. We report a 49-year-old male patient who was admitted to our hospital with a long-term history of right shoulder and right hip pain. Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images. These bone lesions mimicked multiple skeletal metastatic lesions and seemed to be those of the terminal stage of malignancy. PET scan was requested for the evaluation of FDG uptake of these lesions and to search the unknown primary tumor site. Positron emission tomography/computed tomography (PET/CT) images showed multiple hypermetabolic malignant or metastatic FDG avid bone lesions in skeletal system. However the biopsy results revealed no signs of malignancy and laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone, low serum phosphate and parathyroid scintigraphy was performed. Adenoma in the left parathyroid gland was seen with Tc-99m MIBI parathyroid scintigraphy. Pathological results confirmed the diagnosis of parathyroid adenoma. Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging. PMID:23087882

  20. Positron emission tomography/computed tomography imaging of brown tumors mimicking multiple skeletal metastases in patient with primary hyperparathyroidism

    PubMed Central

    Sager, Sait; Aliyev, Anar; Halac, Metin; Oztürk, Tulin

    2012-01-01

    Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process usually seen in patients with hyperparathyroidism. These tumors can behave aggressively and be destructive. We report a 49-year-old male patient who was admitted to our hospital with a long-term history of right shoulder and right hip pain. Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images. These bone lesions mimicked multiple skeletal metastatic lesions and seemed to be those of the terminal stage of malignancy. PET scan was requested for the evaluation of FDG uptake of these lesions and to search the unknown primary tumor site. Positron emission tomography/computed tomography (PET/CT) images showed multiple hypermetabolic malignant or metastatic FDG avid bone lesions in skeletal system. However the biopsy results revealed no signs of malignancy and laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone, low serum phosphate and parathyroid scintigraphy was performed. Adenoma in the left parathyroid gland was seen with Tc-99m MIBI parathyroid scintigraphy. Pathological results confirmed the diagnosis of parathyroid adenoma. Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging. PMID:23087882

  1. Investigation of four-dimensional computed tomography-based pulmonary ventilation imaging in patients with emphysematous lung regions

    NASA Astrophysics Data System (ADS)

    Yamamoto, Tokihiro; Kabus, Sven; Klinder, Tobias; Lorenz, Cristian; von Berg, Jens; Blaffert, Thomas; Loo, Billy W., Jr.; Keall, Paul J.

    2011-04-01

    A pulmonary ventilation imaging technique based on four-dimensional (4D) computed tomography (CT) has advantages over existing techniques. However, physiologically accurate 4D-CT ventilation imaging has not been achieved in patients. The purpose of this study was to evaluate 4D-CT ventilation imaging by correlating ventilation with emphysema. Emphysematous lung regions are less ventilated and can be used as surrogates for low ventilation. We tested the hypothesis: 4D-CT ventilation in emphysematous lung regions is significantly lower than in non-emphysematous regions. Four-dimensional CT ventilation images were created for 12 patients with emphysematous lung regions as observed on CT, using a total of four combinations of two deformable image registration (DIR) algorithms: surface-based (DIRsur) and volumetric (DIRvol), and two metrics: Hounsfield unit (HU) change (VHU) and Jacobian determinant of deformation (VJac), yielding four ventilation image sets per patient. Emphysematous lung regions were detected by density masking. We tested our hypothesis using the one-tailed t-test. Visually, different DIR algorithms and metrics yielded spatially variant 4D-CT ventilation images. The mean ventilation values in emphysematous lung regions were consistently lower than in non-emphysematous regions for all the combinations of DIR algorithms and metrics. VHU resulted in statistically significant differences for both DIRsur (0.14 ± 0.14 versus 0.29 ± 0.16, p = 0.01) and DIRvol (0.13 ± 0.13 versus 0.27 ± 0.15, p < 0.01). However, VJac resulted in non-significant differences for both DIRsur (0.15 ± 0.07 versus 0.17 ± 0.08, p = 0.20) and DIRvol (0.17 ± 0.08 versus 0.19 ± 0.09, p = 0.30). This study demonstrated the strong correlation between the HU-based 4D-CT ventilation and emphysema, which indicates the potential for HU-based 4D-CT ventilation imaging to achieve high physiologic accuracy. A further study is needed to confirm these results.

  2. Analysis of indium-111 platelet kinetics and imaging in patients with aortic grafts and abdominal aortic aneurysms

    SciTech Connect

    Hanson, S.R.; Kotze, H.F.; Pieters, H.; Heyns, A.D. )

    1990-11-01

    To quantitatively characterize processes of platelet thrombus formation in vivo, the kinetics and incorporation into thrombus of autologous In-111-labeled platelets were compared in six patients with aortic aneurysms and in seven patients with prosthetic aortic grafts. Although platelet survival was comparably shortened in both patient groups (mean, 5.8 days), the maximum radioactivity as determined by gamma camera imaging was higher in the aneurysms than in the grafts (3.3% +/- 1.6% vs. 1.6% +/- 1.1%, p = 0.05). Maximum In-111 uptake was also attained more quickly in the aneurysm patients (2.3 +/- 0.8 days vs. 3.5 +/- 1.3 days; p = 0.07). The experimental platelet kinetic and imaging data were subsequently evaluated by compartmental analysis to estimate both normal and disease-related components of platelet destruction. This analysis indicated that deposited platelet radioactivity had a longer residence time on grafts (2.9 +/- 1.7 days vs. 1.4 +/- 0.9 days, p = 0.07) but accumulated at a faster rate in aneurysms (5.0% +/- 3.4% per day vs. 1.4% +/- 0.9% per day, p = 0.02). As determined by imaging, only a proportion of increased platelet destruction was specifically due to the aneurysms (55% +/- 38%) or grafts (17% +/- 11%, p = 0.03). This result indicates additional components of platelet destruction unrelated to graft and aneurysm thrombus formation which, in some graft patients, may reflect a greater severity of vascular disease or other mechanisms causing a preferential shortening of platelet survival. Thus, the analytical approach described may be a useful one for discriminating components of in vivo platelet utilization including platelet removal due to normal hemostatic and senescent mechanisms, localized thrombus formation, and more generalized vascular disease.

  3. Correlation of Computed Tomography Imaging Features With Pain Response in Patients With Spine Metastases After Radiation Therapy

    SciTech Connect

    Mitera, Gunita; Probyn, Linda; Ford, Michael; Donovan, Andrea; Rubenstein, Joel; Finkelstein, Joel; Christakis, Monique; Zhang, Liying; Campos, Sarah; Culleton, Shaelyn; Nguyen, Janet; Sahgal, Arjun; Barnes, Elizabeth; Tsao, May; Danjoux, Cyril; Holden, Lori; Yee, Albert; Khan, Luluel; Chow, Edward

    2011-11-01

    Purpose: To correlate computed tomography (CT) imaging features of spinal metastases with pain relief after radiotherapy (RT). Methods and Materials: Thirty-three patients receiving computed tomography (CT)-simulated RT for spinal metastases in an outpatient palliative RT clinic from January 2007 to October 2008 were retrospectively reviewed. Forty spinal metastases were evaluated. Pain response was rated using the International Bone Metastases Consensus Working Party endpoints. Three musculoskeletal radiologists and two orthopaedic surgeons evaluated CT features, including osseous and soft tissue tumor extent, presence of a pathologic fracture, severity of vertebral height loss, and presence of kyphosis. Results: The mean patient age was 69 years; 24 were men and 9 were women. The mean worst pain score was 7/10, and the mean total daily oral morphine equivalent was 77.3 mg. Treatment doses included 8 Gy in one fraction (22/33), 20 Gy in five fractions (10/33), and 20 Gy in eight fractions (1/33). The CT imaging appearance of spinal metastases included vertebral body involvement (40/40), pedicle involvement (23/40), and lamina involvement (18/40). Soft tissue component (10/40) and nerve root compression (9/40) were less common. Pathologic fractures existed in 11/40 lesions, with resultant vertebral body height loss in 10/40 and kyphosis in 2/40 lesions. At months 1, 2, and 3 after RT, 18%, 69%, and 70% of patients experienced pain relief. Pain response was observed with various CT imaging features. Conclusions: Pain response after RT did not differ in patients with and without pathologic fracture, kyphosis, or any other CT features related to extent of tumor involvement. All patients with painful spinal metastases may benefit from palliative RT.

  4. Neutrinos in an expanding Universe

    NASA Astrophysics Data System (ADS)

    Wigmans, Richard

    2015-09-01

    The Universe contains several billion neutrinos for each nucleon. In this paper, we follow the history of these relic neutrinos as the Universe expanded. At present, their typical velocity is a few hundred km/s and, therefore, their spectra are affected by gravitational forces. This may have led to a phenomenon that could explain two of todays great mysteries: The large-scale structure of the Universe and the increasing rate at which it expands.

  5. Flavors in an expanding plasma

    E-print Network

    Johannes Große; Romuald A. Janik; Piotr Surówka

    2008-02-05

    We consider the effect of an expanding plasma on probe matter by determining time-dependent D7 embeddings in the holographic dual of an expanding viscous plasma. We calculate the chiral condensate and meson spectra including contributions of viscosity. The chiral condensate essentially confirms the expectation from the static black hole. For the meson spectra we propose a scheme that is in agreement with the adiabatic approximation. New contributions arise for the vector mesons at the order of the viscosity terms.

  6. MR Imaging of Patients with Lateral Epicondylitis of the Elbow: Is the Common Extensor Tendon an Isolated Lesion?

    PubMed Central

    Li, Feng; Wang, Ren-Fa

    2013-01-01

    Objective To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. Results Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe). Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r?=?0.877,p<0.01) was found in injuries of CET and lateral ulnar collateral ligament (LUCL). Conclusion Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL. PMID:24244512

  7. [Imaging protocols for the management of respiratory motions in the radiotherapy planning for early stage lung cancer patients].

    PubMed

    Pócza, Tamás; Pesznyák, Csilla; Lövey, József; Bajcsay, András; Szilágyi, András; Almády, Balázs; Major, Tibor; Polgár, Csaba

    2015-06-01

    The aim of our work is to present the imaging techniques used at the National Institute of Oncology for taking into consideration the breathing motion at radiation therapy treatment planning. Internationally recommended imaging techniques, such as 4D CT, respiratory gating and ITV (Internal Target Volume) definition were examined. The different imaging techniques were analysed regarding the delivered dose during imaging, the required time to adapt the technique, and the necessary equipment. The differences in size of PTVs (Planning Target Volume) due to diverse volume defining methods were compared in 5 cases. For 4D CT breath monitoring is crucial, which requires special equipment. To decrease the relatively high exposure of 4D CT it is possible to scan only a few predefined breathing phases. The possible positions of the tumour can be well approximated with CT scans taken in the inhale maximum, the exhale maximum and in intermediate phase. The intermediate phase can be exchanged with an ordinary CT image set, and the extreme phase CT images can be ensured by given verbal instructions for the patient. This way special gating equipment is not required. Based on these 3 breathing phases an ITV can be defined. Using this ITV definition method the margin between the CTV (Clinical Target Volume) and the PTV can be reduced by 1 cm. Using this imaging protocol PTV can be reduced by 30%. A further 10% PTV reduction can be achieved with respiratory gating. In the routine clinical practice respiratory motion management with a 3-phase CT-imaging protocol the PTV for early-stage lung cancer can be significantly reduced without the use of 4D CT and/or respiratory gating. For special, high precision treatment techniques 4D CT is recommended. PMID:26035161

  8. MR Imaging in Patients with Suspected Liver Metastases: Value of Liver-Specific Contrast Agent Gadoxetic Acid

    PubMed Central

    Lee, Kyung Hee; Park, Ji Hoon; Kim, Jung Hoon; Park, Hee Sun; Yu, Mi Hye; Yoon, Jeong-Hee; Han, Joon Koo; Choi, Byung Ihn

    2013-01-01

    Objective To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging with that of triple-phase multidetector-row computed tomography (MDCT) in the detection of liver metastasis. Materials and Methods Our institutional review board approved this retrospective study and waived informed consent. The study population consisted of 51 patients with hepatic metastases and 62 patients with benign hepatic lesions, who underwent triple-phase MDCT and gadoxetic acid-enhanced MRI within one month. Two radiologists independently and randomly reviewed MDCT and MRI images regarding the presence and probability of liver metastasis. In order to determine additional value of hepatobiliary-phase (HBP), the dynamic-MRI set alone and combined dynamic-and-HBP set were evaluated, respectively. The standard of reference was a combination of pathology diagnosis and follow-up imaging. For each reader, diagnostic accuracy was compared using the jackknife alternative free-response receiver-operating-characteristic (JAFROC). Results For both readers, average JAFROC figure-of-merit (FOM) was significantly higher on the MR image sets than on the MDCT images: average FOM was 0.582 on the MDCT, 0.788 on the dynamic-MRI set and 0.847 on the combined HBP set, respectively (p < 0.0001). The differences were more prominent for small (? 1 cm) lesions: average FOM values were 0.433 on MDCT, 0.711 on the dynamic-MRI set and 0.828 on the combined HBP set, respectively (p < 0.0001). Sensitivity increased significantly with the addition of HBP in gadoxetic acid-enhanced MR imaging (p < 0.0001). Conclusion Gadoxetic acid-enhanced MRI shows a better performance than triple-phase MDCT for the detection of hepatic metastasis, especially for small (? 1 cm) lesions. PMID:24265564

  9. Evaluation of the Degradation of the Selected Projectile, Commissural and Association White Matter Tracts Within Normal Appearing White Matter in Patients with Multiple Sclerosis Using Diffusion Tensor MR Imaging – a Preliminary Study

    PubMed Central

    Banaszek, Anna; Bladowska, Joanna; Pokryszko-Dragan, Anna; Podemski, Ryszard; S?siadek, Marek J.

    2015-01-01

    Summary Backround The aim of the study was to assess the impairment of the selected white matter tracts within normal appearing white matter (NAWM) in multiple sclerosis (MS) patients using diffusion tensor imaging (DTI). Material/Methods Thirty-six patients (mean age 33.4 yrs) with clinically definite, relapsing-remitting MS and mild disability (EDSS – Expanded Disability Status Scale 1–3.5) and 16 control subjects (mean age 34.4 yrs) were enrolled in the study. DTI examinations were performed on a 1.5T MR scanner. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained with a small ROI method in several white matter tracts within NAWM including: the middle cerebellar peduncles (MCP), the inferior longitudinal fasciculi (ILF), inferior frontooccipital fasciculi (IFOF), genu (GCC) and splenium of the corpus callosum (SCC), posterior limbs of the internal capsules (PLIC), superior longitudinal fasciculi (SLF) and posterior cingula (CG). There were no demyelinative lesions within the ROIs in any of the patients. Results A significant decrease in FA was found in MS patients in both the ILFs and IFOFs (p<0.001) and in the left MCP and right SLF (p<0.05), compared to the normal subjects. There were no significant differences in FA values in the remaining evaluated ROIs, between MS patients and the control group. A significant increase in ADC (p<0.05) was found only in the right PLIC and the right SLF in MS subjects, compared to the control group. Conclusions The FA values could be a noninvasive neuroimaging biomarker for assessing the microstructural changes within NAWM tracts in MS patients. PMID:26516389

  10. Brain Activation Evoked by Sensory Stimulation in Patients with Spinal Cord Injury : Functional Magnetic Resonance Imaging Correlations with Clinical Features

    PubMed Central

    Lee, Jun Ki; Oh, Chang Hyun; Kim, Ji Yong; Park, Hyung-Chun

    2015-01-01

    Objective The purpose of this study is to determine whether the changes of contralateral sensorimotor cortical activation on functional magnetic resonance imaging (fMRI) can predict the neurological outcome among spinal cord injury (SCI) patients when the great toes are stimulated without notice. Methods This study enrolled a total of 49 patients with SCI and investigated each patient's preoperative fMRI, postoperative fMRI, American Spinal Injury Association (ASIA) score, and neuropathic pain occurrence. Patients were classified into 3 groups according to the change of blood oxygenation level dependent (BOLD) response on perioperative fMRI during proprioceptive stimulation with repetitive passive toe movements : 1) patients with a response of contralateral sensorimotor cortical activation in fMRI were categorized; 2) patients with a response in other regions; and 3) patients with no response. Correlation between the result of fMRI and each parameter was analyzed. Results In fMRI data, ASIA score was likely to show greater improvement in patients in group A compared to those belonging to group B or C (p<0.001). No statistical significance was observed between the result of fMRI and neuropathic pain (p=0.709). However, increase in neuropathic pain in response to the signal change of the ipsilateral frontal lobe on fMRI was statistically significant (p=0.030). Conclusion When there was change of BOLD response at the contralateral sensorimotor cortex on perioperative fMRI after surgery, relief of neurological symptoms was highly likely for traumatic SCI patients. In addition, development of neuropathic pain was likely to occur when there was change of BOLD response at ipsilateral frontal lobe. PMID:26539268

  11. Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study.

    PubMed

    Zwir, Liete M L Figueiredo; Terreri, Maria Teresa R A; Sousa, Soraia Ale; Fernandes, Artur Rocha Corrêa; Guimarães, Antônio Sérgio; Hilário, Maria Odete E

    2015-12-01

    The aims of this longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the clinical and magnetic resonance imaging (MRI) findings in the TMJs of patients with juvenile idiopathic arthritis (JIA). Seventy-five patients with JIA participated in this study. All patients underwent a rheumatological examination performed by a paediatric rheumatologist, a TMJ examination performed by a single dentist and an MRI with contrast of the TMJs. These examinations were scheduled on the same date. The patients were examined again 1 year later. Twenty-eight (37.3 %) patients reported symptoms at the first evaluation and 11 (14.7 %) patients at the second evaluation. In relation to signs, 35 (46.7 %) of the patients presented at least one sign at the first evaluation and 29 (38.7 %) at the second. Intense contrast enhancement of TMJ was significantly associated with disease activity (p?patients, with asymptomatic children presenting severe structural alterations of the TMJ. The TMJ should always be evaluated in JIA patients, even in the absence of signs and symptoms. PMID:25846832

  12. Quantifying the image quality and dose reduction of respiratory triggered 4D cone-beam computed tomography with patient-measured breathing

    NASA Astrophysics Data System (ADS)

    Cooper, Benjamin J.; O’Brien, Ricky T.; Kipritidis, John; Shieh, Chun-Chien; Keall, Paul J.

    2015-12-01

    Respiratory triggered four dimensional cone-beam computed tomography (RT 4D CBCT) is a novel technique that uses a patient’s respiratory signal to drive the image acquisition with the goal of imaging dose reduction without degrading image quality. This work investigates image quality and dose using patient-measured respiratory signals for RT 4D CBCT simulations. Studies were performed that simulate a 4D CBCT image acquisition using both the novel RT 4D CBCT technique and a conventional 4D CBCT technique. A set containing 111 free breathing lung cancer patient respiratory signal files was used to create 111 pairs of RT 4D CBCT and conventional 4D CBCT image sets from realistic simulations of a 4D CBCT system using a Rando phantom and the digital phantom, XCAT. Each of these image sets were compared to a ground truth dataset from which a mean absolute pixel difference (MAPD) metric was calculated to quantify the degradation of image quality. The number of projections used in each simulation was counted and was assumed as a surrogate for imaging dose. Based on 111 breathing traces, when comparing RT 4D CBCT with conventional 4D CBCT, the average image quality was reduced by 7.6% (Rando study) and 11.1% (XCAT study). However, the average imaging dose reduction was 53% based on needing fewer projections (617 on average) than conventional 4D CBCT (1320 projections). The simulation studies have demonstrated that the RT 4D CBCT method can potentially offer a 53% saving in imaging dose on average compared to conventional 4D CBCT in simulation studies using a wide range of patient-measured breathing traces with a minimal impact on image quality.

  13. Predicting Pathological Features at Radical Prostatectomy in Patients with Prostate Cancer Eligible for Active Surveillance by Multiparametric Magnetic Resonance Imaging

    PubMed Central

    de Cobelli, Ottavio; Terracciano, Daniela; Tagliabue, Elena; Raimondi, Sara; Bottero, Danilo; Cioffi, Antonio; Jereczek-Fossa, Barbara; Petralia, Giuseppe; Cordima, Giovanni; Almeida, Gilberto Laurino; Lucarelli, Giuseppe; Buonerba, Carlo; Matei, Deliu Victor; Renne, Giuseppe; Di Lorenzo, Giuseppe; Ferro, Matteo

    2015-01-01

    Purpose The aim of this study was to investigate the prognostic performance of multiparametric magnetic resonance imaging (mpMRI) and Prostate Imaging Reporting and Data System (PIRADS) score in predicting pathologic features in a cohort of patients eligible for active surveillance who underwent radical prostatectomy. Methods A total of 223 patients who fulfilled the criteria for “Prostate Cancer Research International: Active Surveillance”, were included. Mp–1.5 Tesla MRI examination staging with endorectal coil was performed at least 6–8 weeks after TRUS-guided biopsy. In all patients, the likelihood of the presence of cancer was assigned using PIRADS score between 1 and 5. Outcomes of interest were: Gleason score upgrading, extra capsular extension (ECE), unfavorable prognosis (occurrence of both upgrading and ECE), large tumor volume (?0.5ml), and seminal vesicle invasion (SVI). Receiver Operating Characteristic (ROC) curves and Decision Curve Analyses (DCA) were performed for models with and without inclusion of PIRADS score. Results Multivariate analysis demonstrated the association of PIRADS score with upgrading (P<0.0001), ECE (P<0.0001), unfavorable prognosis (P<0.0001), and large tumor volume (P = 0.002). ROC curves and DCA showed that models including PIRADS score resulted in greater net benefit for almost all the outcomes of interest, with the only exception of SVI. Conclusions mpMRI and PIRADS scoring are feasible tools in clinical setting and could be used as decision-support systems for a more accurate selection of patients eligible for AS. PMID:26444548

  14. Myocardial iron overload assessment by T2* magnetic resonance imaging in adult transfusion dependent patients with acquired anemias.

    PubMed

    Di Tucci, Anna Angela; Matta, Gildo; Deplano, Simona; Gabbas, Attilio; Depau, Cristina; Derudas, Daniele; Caocci, Giovanni; Agus, Annalisa; Angelucci, Emanuele

    2008-09-01

    Only limited data are available regarding myocardial iron overload in adult patients with transfusion dependent acquired anemias. To address this topic using MRI T2* we studied 27 consecutive chronic transfusion dependent patients with acquired anemias: (22 myelodysplastic syndrome, 5 primary myelofibrosis). Cardiac MRI T2* values obtained ranged from 5.6 to 58.7 (median value 39.8) milliseconds. Of the 24 analyzable patients, cardiac T2* correlated with transfusion burden (p=0.0002). No patient who had received less than 290 mL/kg of packed red blood cells (101 units=20 grams of iron) had a pathological cardiac T2* value (< 20 ms). All patients who had received at least 24 PRBC units showed MRI T2* detectable hepatic iron (liver T2* value patients with severe hepatic iron overload (T2* <1.4 ms) showed cardiac T2* value indicative of dangerous myocardial iron deposition. Serum ferritin was not significantly correlated with cardiac T2* (p=0.24). Gradient echo T2* magnetic resonance imaging provides a rapid and reproducible method for detecting myocardial iron overload which developed after a heavy transfusion burden equal to or greater than 290 mL/kg of packed red blood cell units. PMID:18603557

  15. Can the HEART Score Safely Reduce Stress Testing and Cardiac Imaging in Patients at Low Risk for Acute Coronary Syndrome?

    PubMed Central

    Mahler, Simon A.; Hiestand, Brian C.; Goff, David C.; Hoekstra, James W.; Miller, Chadwick D.

    2011-01-01

    Background Patients with low risk chest pain have high utilization of stress testing and cardiac imaging, but low rates of acute coronary syndrome (ACS). The objective of this study was to determine if the HEART score could safely reduce objective cardiac testing in patients with low risk chest pain. Methods A cohort of chest pain patients was identified from an Emergency Department-based observation unit registry. HEART scores were determined using registry data elements and blinded chart review. HEART scores were dichotomized into low (0–3) or high risk (>3). The outcome was MACE; a composite endpoint of all cause mortality, myocardial infarction, or coronary revascularization during the index visit or within 30 days. Sensitivity, specificity, and potential reduction of cardiac testing were calculated. Results Over 28 months, the registry included 1070 low risk chest pain patients. MACE occurred in 0.6% (5/904) of patients with low-risk HEART scores compared to 4.2% (7/166) with a high-risk HEART scores, OR=7.92, (95%CI 2.48–25.25). A HEART score >3 was 58% sensitive (95% CI 32–81%) and 85% specific (95% CI 83–87%) for MACE. The HEART score missed 5 cases of ACS among 1070 patients (0.5%) and could have reduced cardiac testing by 84.5% (904/1070). Combination of serial troponin > 0.065 ng/ml or HEART score >3 resulted in 100% sensitivity (95% CI 72–100%), specificity of 83% (95%CI 81–85%), and potential reduction in cardiac testing of 82% (879/1070). Conclusions If used to guide stress testing and cardiac imaging, the HEART score could substantially reduce cardiac testing in a population with low pre-test probability of ACS. PMID:21989033

  16. Determining the risks of magnetic resonance imaging at 1.5 tesla for patients with pacemakers and implantable cardioverter defibrillators.

    PubMed

    Cohen, Jennifer D; Costa, Heather S; Russo, Robert J

    2012-12-01

    Conventional pacemaker and implantable cardioverter-defibrillator product labeling currently cautions against exposure to magnetic resonance imaging (MRI). However, there is a growing clinical need for MRI, without an acceptable alternative imaging modality in many patients with cardiac devices. The purpose of this study was to determine the risk of MRI at 1.5 T for patients with cardiac devices by measuring the frequency of device failures and clinically relevant device parameter changes. Data from a single-center retrospective review of 109 patients with pacemakers and implantable cardioverter-defibrillators (the MRI group) who underwent 125 clinically indicated MRI studies were compared to data from a prospective cohort of 50 patients with cardiac devices who did not undergo MRI (the control group). In the MRI group, there were no deaths, device failures requiring generator or lead replacement, induced arrhythmias, losses of capture, or electrical reset episodes. Decreases in battery voltage of ?0.04 V occurred in 4%, pacing threshold increases of ?0.5 V in 3%, and pacing lead impedance changes of ?50 ? in 6%. Although there were statistically significant differences between the MRI and control groups for the mean change in pacing lead impedance (-6.2 ± 23.9 vs 3.0 ± 22.1 ?) and left ventricular pacing threshold (-0.1 ± 0.3 vs 0.1 ± 0.2 V), these differences were not clinically important. In conclusion, MRI in patients with cardiac devices resulted in no device or lead failures. A small number of clinically relevant changes in device parameter measurements were noted. However, these changes were similar to those in a control group of patients who did not undergo MRI. PMID:22921995

  17. Evaluation of Patient Doses from Verification Techniques in Image-Guided Radiotherapy (IGRT)

    SciTech Connect

    Dufek, Vladimir; Horakova, Ivana; Novak, Leos; Koncek, Ondrej; Richter, Vit; Janeckova, Lenka

    2010-01-05

    The purpose of this work was an evaluation of organ doses and effective doses from kilovoltage (kV) cone-beam CT (CBCT) scans and from pairs of orthogonal kV image projections for two different treatment sites (a head and a pelvis). Measurements of organ doses were performed in an anthropomorphic rando phantom by means of thermoluminescent dosimeters (TLDs). Irradiations were performed using on-board imager (OBI) and X-ray volume imaging (XVI) systems.

  18. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent.

    PubMed Central

    Stock, K. W.; Jacob, A. L.; Proske, M.; Bolliger, C. T.; Rochlitz, C.; Steinbrich, W.

    1995-01-01

    BACKGROUND--Obstruction of the superior vena cava (SVC) in malignant disease can cause considerable distress to patients. Symptomatic relief can be achieved by the percutaneous implantation of a self-expanding stent (Wallstent) into the stenosis. METHODS--Fourteen patients with obstruction of the SVC were treated with one to three Wallstent endoprostheses. They suffered from advanced bronchogenic carcinoma (n = 12), thyroid carcinoma (n = 1), and breast carcinoma (n = 1). The indication for stent placement was symptomatic obstruction of the SVC and incurable disease. Stenting was performed for symptom relief, and before, during, and after courses of radiotherapy or chemotherapy as needed. RESULTS--Twelve patients experienced complete symptomatic relief within two days of stent placement. Two patients did not benefit. Three patients not given anticoagulation developed stent thrombosis between one week and eight months after initial placement, and within one day of endobronchial stent implantation with bronchial laser therapy or balloon dilatation in all three. Patency of the SVC was achieved again by a repeat procedure. CONCLUSIONS--Stent placement for obstruction of the SVC gives rapid symptomatic relief. Subsequent endobronchial stent implantation with bronchial laser therapy or balloon dilatation could be a risk for caval stent occlusion. Stent thrombosis remains a problem in patients who are not anticoagulated. Images PMID:8553270

  19. Indium-111-antimyosin images compared with triphenyl tetrazolium chloride staining in a patient six days after myocardial infarction

    SciTech Connect

    Jain, D.; Crawley, J.C.; Lahiri, A.; Raftery, E.B. )

    1990-02-01

    The results of indium-111 ({sup 111}In) antimyosin imaging during life and the findings on postmortem imaging and triphenyl tetrazolium chloride (TTC) staining of the heart are reported from a patient who received {sup 111}In-antimyosin on the sixth day following myocardial infarction and died after imaging the next day. The planar images obtained during life showed abnormal {sup 111}In-antimyosin uptake in the posterior, lateral, and apical walls of the left ventricle. Autopsy revealed extensive infarction of the left ventricular lateral and posterior walls with cardiac rupture, which was the cause of sudden death. Direct imaging of the sliced specimen of heart revealed abnormal tracer uptake in the lateral and posterior walls of the left ventricle, which correlated closely with the area of necrosis outlined by TTC staining. Our results confirm the experimental findings that antimyosin antibody binds specifically to the acute irreversibly damaged myocardial cells. A high degree of tracer uptake can be seen even when {sup 111}In-antimyosin is injected six days postinfarction.

  20. Accuracy of imaging methods for detection of bone tissue invasion in patients with oral squamous cell carcinoma

    PubMed Central

    Uribe, S; Rojas, LA; Rosas, CF

    2013-01-01

    The objective of this review is to evaluate the diagnostic accuracy of imaging methods for detection of mandibular bone tissue invasion by squamous cell carcinoma (SCC). A systematic review was carried out of studies in MEDLINE, SciELO and ScienceDirect, published between 1960 and 2012, in English, Spanish or German, which compared detection of mandibular bone tissue invasion via different imaging tests against a histopathology reference standard. Sensitivity and specificity data were extracted from each study. The outcome measure was diagnostic accuracy. We found 338 articles, of which 5 fulfilled the inclusion criteria. Tests included were: CT (four articles), MRI (four articles), panoramic radiography (one article), positron emission tomography (PET)/CT (one article) and cone beam CT (CBCT) (one article). The quality of articles was low to moderate and the evidence showed that all tests have a high diagnostic accuracy for detection of mandibular bone tissue invasion by SCC, with sensitivity values of 94% (MRI), 91% (CBCT), 83% (CT) and 55% (panoramic radiography), and specificity values of 100% (CT, MRI, CBCT), 97% (PET/CT) and 91.7% (panoramic radiography). Available evidence is scarce and of only low to moderate quality. However, it is consistently shown that current imaging methods give a moderate to high diagnostic accuracy for the detection of mandibular bone tissue invasion by SCC. Recommendations are given for improving the quality of future reports, in particular provision of a detailed description of the patients' conditions, the imaging instrument and both imaging and histopathological invasion criteria. PMID:23420854

  1. Experimental validation of 3D printed patient-specific implants using digital image correlation and finite element analysis.

    PubMed

    Sutradhar, Alok; Park, Jaejong; Carrau, Diana; Miller, Michael J

    2014-09-01

    With the dawn of 3D printing technology, patient-specific implant designs are set to have a paradigm shift. A topology optimization method in designing patient-specific craniofacial implants has been developed to ensure adequate load transfer mechanism and restore the form and function of the mid-face. Patient-specific finite element models are used to design these implants and to validate whether they are viable for physiological loading such as mastication. Validation of these topology optimized finite element models using mechanical testing is a critical step. Instead of inserting the implants into a cadaver or patient, we embed the implants into the computer-aided skull model of a patient and, fuse them together to 3D print the complete skull model with the implant. Masticatory forces are applied in the molar region to simulate chewing and measure the stress-strain trajectory. Until recently, strain gages have been used to measure strains for validation. Digital Image Correlation (DIC) method is a relatively new technique for full-field strain measurement which provides a continuous deformation field data. The main objective of this study is to validate the finite element model of patient-specific craniofacial implants against the strain data from the DIC obtained during the mastication simulation and show that the optimized shapes provide adequate load-transfer mechanism. Patient-specific models are obtained from CT scans. The principal maximum and minimum strains are compared. The computational and experimental approach to designing patient-specific implants proved to be a viable technique for mid-face craniofacial reconstruction. PMID:24992729

  2. SU-E-T-248: Near Real-Time Analysis of Radiation Delivery and Imaging, Accuracy to Ensure Patient Safety

    SciTech Connect

    Wijesooriya, K; Seitter, K; Desai, V; Read, P; Larner, J

    2014-06-01

    Purpose: To develop and optimize an effective software method for comparing planned to delivered control point machine parameters for all VARIAN TrueBeam treatments so as to permit (1) assessment of a large patient pool throughout their treatment course to quantify treatment technique specific systematic and random uncertainty of observables, (2) quantify the site specific daily imaging shifts required for target alignment, and (3) define tolerance levels for mechanical parameters and imaging parameters based on statistical analysis data gathered, and the dosimetric impact of variations. Methods: Treatment and imaging log files were directly compared to plan parameters for Eclipse and Pinnacle planned treatments via 3D, IMRT, control point, RapidArc, and electrons. Each control point from all beams/arcs (7984) for all fractions (1940) of all patients treated over six months were analyzed. At each control point gantry angle, collimator angle, couch angle, jaw positions, MLC positions, MU were compared. Additionally per-treatment isocenter shifts were calculated. Results were analyzed as a whole in treatment type subsets: IMRT, 3D, RapidArc; and in treatment site subsets: brain, chest/mediastinum, esophagus, H and N, lung, pelvis, prostate. Results: Daily imaging isocenter shifts from initial external tattoo alignment were dependent on the treatment site with < 0.5 cm translational shifts for H and N, Brain, and lung SBRT, while pelvis, esophagus shifts were ?1 cm. Mechanical delivery parameters were within tolerance levels for all sub-beams. The largest variations were for RapidArc plans: gantry angle 0.11±0.12,collimator angle 0.00±0.00, jaw positions 0.48±0.26, MLC leaf positions 0.66±0.08, MU 0.14±0.34. Conclusion: Per-control point validation reveals deviations between planned and delivered parameters. If used in a near real-time error checking system, patient safety can be improved by equipping the treatment delivery system with additional forcing functions which by-pass human error avenues.

  3. Clinical and Imaging Heterogeneity of Polymicrogyria: A Study of 328 Patients

    ERIC Educational Resources Information Center

    Leventer, Richard J.; Jansen, Anna; Pilz, Daniela T.; Stoodley, Neil; Marini, Carla; Dubeau, Francois; Malone, Jodie; Mitchell, L. Anne; Mandelstam, Simone; Scheffer, Ingrid E.; Berkovic, Samuel F.; Andermann, Frederick; Andermann, Eva; Guerrini, Renzo; Dobyns, William B.

    2010-01-01

    Polymicrogyria is one of the most common malformations of cortical development and is associated with a variety of clinical sequelae including epilepsy, intellectual disability, motor dysfunction and speech disturbance. It has heterogeneous clinical manifestations and imaging patterns, yet large cohort data defining the clinical and imaging

  4. Effects of antithrombotic drugs in patients with left ventricular thrombi: assessment with indium-111 platelet imaging and two-dimensional echocardiography

    SciTech Connect

    Stratton, J.R.; Ritchie, J.L.

    1984-03-01

    Patients with left ventricular thrombi not caused by recent myocardial infarction were prospectively studied by indium-111 platelet imaging and two-dimensional echocardiography to determine the reproducibility of these techniques and the short-term effects of sulfinpyrazone (200 mg four times daily), aspirin (325 mg three times daily) plus dipyridamole (75 mg three times daily), and full-dose warfarin. At baseline, all patients underwent indium-111 platelet imaging and echocardiography, and the results were positive for thrombus. In six patients on no antithrombotic drug therapy, repeat platelet scans and echocardiographic studies at 6.0 +/- 3.3 weeks remained positive and were unchanged. In seven patients studied on sulfinpyrazone, three platelet scans became negative, two became equivocal, and two were unchanged; the presence and size of thrombus was constant by echocardiography in all seven patients. Of the six patients studied on aspirin plus dipyridamole, one platelet scan became negative, those of three became equivocal, and two were unchanged; all echocardiographic findings remained positive, but one patient had decreased thrombus size. Among four warfarin-treated patients, three had resolution of platelet deposition and one was unchanged; by echocardiography, thrombus resolved in one patient, was decreased in size in one, and was unchanged in two. We conclude that, in the absence of antithrombotic drug therapy, platelet imaging and echocardiographic findings are stable in patients with left ventricular thrombi not caused by recent myocardial infarction. Sulfinpyrazone, aspirin plus dipyridamole, and warfarin all interrupt platelet deposition in some patients with chronic left ventricular thrombi.

  5. Patient-specific scatter correction for flat-panel detector-based cone-beam CT imaging

    NASA Astrophysics Data System (ADS)

    Zhao, Wei; Brunner, Stephen; Niu, Kai; Schafer, Sebastian; Royalty, Kevin; Chen, Guang-Hong

    2015-02-01

    A patient-specific scatter correction algorithm is proposed to mitigate scatter artefacts in cone-beam CT (CBCT). The approach belongs to the category of convolution-based methods in which a scatter potential function is convolved with a convolution kernel to estimate the scatter profile. A key step in this method is to determine the free parameters introduced in both scatter potential and convolution kernel using a so-called calibration process, which is to seek for the optimal parameters such that the models for both scatter potential and convolution kernel is able to optimally fit the previously known coarse estimates of scatter profiles of the image object. Both direct measurements and Monte Carlo (MC) simulations have been proposed by other investigators to achieve the aforementioned rough estimates. In the present paper, a novel method has been proposed and validated to generate the needed coarse scatter profile for parameter calibration in the convolution method. The method is based upon an image segmentation of the scatter contaminated CBCT image volume, followed by a reprojection of the segmented image volume using a given x-ray spectrum. The reprojected data is subtracted from the scatter contaminated projection data to generate a coarse estimate of the needed scatter profile used in parameter calibration. The method was qualitatively and quantitatively evaluated using numerical simulations and experimental CBCT data acquired on a clinical CBCT imaging system. Results show that the proposed algorithm can significantly reduce scatter artefacts and recover the correct CT number. Numerical simulation results show the method is patient specific, can accurately estimate the scatter, and is robust with respect to segmentation procedure. For experimental and in vivo human data, the results show the CT number can be successfully recovered and anatomical structure visibility can be significantly improved.

  6. SU-E-J-183: Quantifying the Image Quality and Dose Reduction of Respiratory Triggered 4D Cone-Beam Computed Tomography with Patient- Measured Breathing

    SciTech Connect

    Cooper, B; OBrien, R; Kipritidis, J; Keall, P

    2014-06-01

    Purpose: Respiratory triggered four dimensional cone-beam computed tomography (RT 4D CBCT) is a novel technique that uses a patient's respiratory signal to drive the image acquisition with the goal of imaging dose reduction without degrading image quality. This work investigates image quality and dose using patient-measured respiratory signals for RT 4D CBCT simulations instead of synthetic sinusoidal signals used in previous work. Methods: Studies were performed that simulate a 4D CBCT image acquisition using both the novel RT 4D CBCT technique and a conventional 4D CBCT technique from a database of oversampled Rando phantom CBCT projections. A database containing 111 free breathing lung cancer patient respiratory signal files was used to create 111 RT 4D CBCT and 111 conventional 4D CBCT image datasets from realistic simulations of a 4D RT CBCT system. Each of these image datasets were compared to a ground truth dataset from which a root mean square error (RMSE) metric was calculated to quantify the degradation of image quality. The number of projections used in each simulation is counted and was assumed as a surrogate for imaging dose. Results: Based on 111 breathing traces, when comparing RT 4D CBCT with conventional 4D CBCT the average image quality was reduced by 7.6%. However, the average imaging dose reduction was 53% based on needing fewer projections (617 on average) than conventional 4D CBCT (1320 projections). Conclusion: The simulation studies using a wide range of patient breathing traces have demonstrated that the RT 4D CBCT method can potentially offer a substantial saving of imaging dose of 53% on average compared to conventional 4D CBCT in simulation studies with a minimal impact on image quality. A patent application (PCT/US2012/048693) has been filed which is related to this work.

  7. Prognostic importance of silent myocardial ischemia detected by intravenous dipyridamole thallium myocardial imaging in asymptomatic patients with coronary artery disease

    SciTech Connect

    Younis, L.T.; Byers, S.; Shaw, L.; Barth, G.; Goodgold, H.; Chaitman, B.R. )

    1989-12-01

    One hundred seven asymptomatic patients who underwent intravenous dipyridamole thallium imaging were evaluated to determine prognostic indicators of subsequent cardiac events over an average follow-up period of 14 +/- 10 months. Univariate analysis of 18 clinical, scintigraphic and angiographic variables revealed that a reversible thallium defect, a combined fixed and reversible thallium defect, number of segmental thallium defects and extent of coronary artery disease were significant predictors of subsequent cardiac events. Of the 13 patients who died or had a nonfatal infarction, 12 had a reversible thallium defect. Stepwise logistic regression analysis selected a reversible thallium defect as the only significant predictor of cardiac events. When death or myocardial infarction was the outcome variable, a combined fixed and reversible thallium defect was the only predictor of outcome. In patients without previous myocardial infarction, the cardiac event rate was significantly greater in those with an abnormal versus normal thallium scan (55% versus 12%, p less than 0.001). Thus, intravenous dipyridamole thallium scintigraphy is a useful noninvasive test to risk stratify asymptomatic patients with coronary artery disease. A reversible thallium defect most likely indicates silent myocardial ischemia in a sizable fraction of patients in this clinical subset and is associated with an unfavorable prognosis.

  8. Diffusion tensor imaging of the auditory nerve in patients with long-term single-sided deafness.

    PubMed

    Vos, Sjoerd B; Haakma, Wieke; Versnel, Huib; Froeling, Martijn; Speleman, Lucienne; Dik, Pieter; Viergever, Max A; Leemans, Alexander; Grolman, Wilko

    2015-05-01

    A cochlear implant (CI) can restore hearing in patients with profound sensorineural hearing loss by direct electrical stimulation of the auditory nerve. Therefore, the viability of the auditory nerve is vitally important in successful hearing recovery. However, the nerve typically degenerates following cochlear hair cell loss, and the amount of degeneration may considerably differ between the two ears, also in patients with bilateral deafness. A measure that reflects the nerve's condition would help to assess the best of both nerves and decide accordingly which ear should be implanted for optimal benefit from a CI. Diffusion tensor MRI (DTI) may provide such a measure, by allowing noninvasive investigations of the nerve's microstructure. In this pilot study, we show the first use of DTI to image the auditory nerve in five normal-hearing subjects and five patients with long-term profound single-sided sensorineural hearing loss. A specialized acquisition protocol was designed for a 3 T MRI scanner to image the small nerve bundle. The nerve was reconstructed using fiber tractography and DTI metrics - which reflect the nerve's microstructural properties - were computed per tract. Comparing DTI metrics from the deaf-sided with the healthy-sided nerves in patients showed no significant differences. There was a small but significant reduction in fractional anisotropy in both auditory nerves in patients compared with normal-hearing controls. These results are the first evidence of possible changes in the microstructure of the bilateral auditory nerves as a result of single-sided deafness. Our results also indicate that it is too early to assess the degenerative status of the auditory nerve of a subject-specific basis. PMID:25655832

  9. Sequential identification of boundary support parameters in a fluid-structure vascular model using patient image data.

    PubMed

    Moireau, P; Bertoglio, C; Xiao, N; Figueroa, C A; Taylor, C A; Chapelle, D; Gerbeau, J-F

    2013-06-01

    Viscoelastic support has been previously established as a valuable modeling ingredient to represent the effect of surrounding tissues and organs in a fluid-structure vascular model. In this paper, we propose a complete methodological chain for the identification of the corresponding boundary support parameters, using patient image data. We consider distance maps of model to image contours as the discrepancy driving the data assimilation approach, which then relies on a combination of (1) state estimation based on the so-called SDF filtering method, designed within the realm of Luenberger observers and well adapted to handling measurements provided by image sequences, and (2) parameter estimation based on a reduced-order UKF filtering method which has no need for tangent operator computations and features natural parallelism to a high degree. Implementation issues are discussed, and we show that the resulting computational effectiveness of the complete estimation chain is comparable to that of a direct simulation. Furthermore, we demonstrate the use of this framework in a realistic application case involving hemodynamics in the thoracic aorta. The estimation of the boundary support parameters proves successful, in particular in that direct modeling simulations based on the estimated parameters are more accurate than with a previous manual expert calibration. This paves the way for complete patient-specific fluid-structure vascular modeling in which all types of available measurements could be used to estimate additional uncertain parameters of biophysical and clinical relevance. PMID:22802016

  10. Is the Universe really expanding?

    E-print Network

    John G. Hartnett

    2011-11-19

    The Hubble law, determined from the distance modulii and redshifts of galaxies, for the past 80 years, has been used as strong evidence for an expanding universe. This claim is reviewed in light of the claimed lack of necessary evidence for time dilation in quasar and gamma-ray burst luminosity variations and other lines of evidence. It is concluded that the observations could be used to describe either a static universe (where the Hubble law results from some as-yet-unknown mechanism) or an expanding universe described by the standard Lambda cold dark matter model. In the latter case, size evolution of galaxies is necessary for agreement with observations. Yet the simple non-expanding Euclidean universe fits most data with the least number of assumptions. From this review it is apparent that there are still many unanswered questions in cosmology and the title question of this paper is still far from being answered.

  11. [Magnetic Resonance Imaging Improvement in a Patient with Wilson's Disease Following Treatment with Trientine Hydrochloride and Zinc Acetate].

    PubMed

    Kim, Younhee; Koide, Reiji; Kawata, Akihiro

    2015-05-01

    A 37-year-old male patient presented with psychiatric symptoms, dysarthria, limb dystonia, increased tendon reflexes, and a Kayser-Fleischer ring in his late teens. Laboratory examinations showed decreased concentrations of serum copper and ceruloplasmin, and increased urinary copper levels. Magnetic resonance imaging (MRI) showed high-signal-intensity lesions in the bilateral putamen, globus pallidus, thalamus, and brainstem on T2-weighted images (T2WI). Based on the MRI results and laboratory data, we diagnosed this patient with Wilson's disease (WD). He was treated with trientine hydrochloride and zinc acetate. Four months after the initiation of treatment, the patient'symptoms began to improve. On a follow-up MRI that was obtained 6 years after treatment, the high-signal-intensity lesions on the T2WI had disappeared completely. However, the low-signal-intensity lesions in the basal ganglia had spread to the caudate nuclei. Here, we discuss the characteristics of the MRI changes in WD following treatment. The Pathological basis for the low-signal-intensity lesions on T2WI in WD remains unclear. Our results suggest that this lesion may reflect the accumulation of materials other than copper. PMID:25957210

  12. Impact of patient weight on tumor visibility based on human-shaped phantom simulation study in PET imaging system

    NASA Astrophysics Data System (ADS)

    Musarudin, M.; Saripan, M. I.; Mashohor, S.; Saad, W. H. M.; Nordin, A. J.; Hashim, S.

    2015-10-01

    Energy window technique has been implemented in all positron emission tomography (PET) imaging protocol, with the aim to remove the unwanted low energy photons. Current practices in our institution however are performed by using default energy threshold level regardless of the weight of the patient. Phantom size, which represents the size of the patient's body, is the factor that determined the level of scatter fraction during PET imaging. Thus, the motivation of this study is to determine the optimum energy threshold level for different sizes of human-shaped phantom, to represent underweight, normal, overweight and obese patients. In this study, the scanner was modeled by using Monte Carlo code, version MCNP5. Five different sizes of elliptical-cylinder shaped of human-sized phantoms with diameter ranged from 15 to 30 cm were modeled. The tumor was modeled by a cylindrical line source filled with 1.02 MeV positron emitters at the center of the phantom. Various energy window widths, in the ranged of 10-50% were implemented to the data. In conclusion, the phantom mass volume did influence the scatter fraction within the volume. Bigger phantom caused more scattering events and thus led to coincidence counts lost. We evaluated the impact of phantom sizes on the sensitivity and visibility of the simulated models. Implementation of wider energy window improved the sensitivity of the system and retained the coincidence photons lost. Visibility of the tumor improved as an appropriate energy window implemented for the different sizes of phantom.

  13. Altered Functional Connectivity in Patients with Subcortical Vascular Cognitive Impairment—A Resting-State Functional Magnetic Resonance Imaging Study

    PubMed Central

    Wang, Yao; Sun, Yawen; Chen, Xue; Xu, Jianrong

    2015-01-01

    Recent neuroimaging studies have shown that people with subcortical vascular cognitive impairment (sVCI) have structural and functional abnormalities in the frontal lobe and subcortical brain sites. In this study, we used seed-based resting-state functional connectivity (rsFC) analysis and voxel-mirrored homotopic connectivity (VMHC) techniques to investigate the alteration of rsFC in patients with sVCI. rsFC and structural magnetic resonance images were acquired for 51 patients with subcortical cerebrovascular disease. All patients were subdivided based on cognitive status into 29 with sVCI and 22 controls; patient characteristics were matched. rsFC of the posterior cingulate cortex (PCC) and VMHC were calculated separately, and rsFC of the PCC and VMHC between the two groups were compared. The regions showing abnormal rsFC of the PCC or VMHC in sVCI patients were adopted as regions of interest for correlation analyses. Our results are as follows: The patients with sVCI exhibited increases in rsFC in the left middle temporal lobe, right inferior temporal lobe and left superior frontal gyrus, and significant decreases in rsFC of the left thalamus with the PCC. sVCI patients showed a significant deficit in VMHC between the bilateral lingual gyrus, putamen, and precentral gyrus. Additionally, the z-memory score was significantly positively associated with connectivity between the left thalamus and the PCC (r = 0.41, p = 0.03, uncorrected) in the sVCI group. Our findings suggest that the frontal lobe and subcortical brain sites play an important role in the pathogenesis of sVCI. Furthermore, rsFC between the left thalamus and the PCC might indicate the severity of sVCI. PMID:26376180

  14. The distance discordance metric—a novel approach to quantifying spatial uncertainties in intra- and inter-patient deformable image registration

    NASA Astrophysics Data System (ADS)

    Saleh, Ziad H.; Apte, Aditya P.; Sharp, Gregory C.; Shusharina, Nadezhda P.; Wang, Ya; Veeraraghavan, Harini; Thor, Maria; Muren, Ludvig P.; Rao, Shyam S.; Lee, Nancy Y.; Deasy, Joseph O.

    2014-02-01

    Previous methods to estimate the inherent accuracy of deformable image registration (DIR) have typically been performed relative to a known ground truth, such as tracking of anatomic landmarks or known deformations in a physical or virtual phantom. In this study, we propose a new approach to estimate the spatial geometric uncertainty of DIR using statistical sampling techniques that can be applied to the resulting deformation vector fields (DVFs) for a given registration. The proposed DIR performance metric, the distance discordance metric (DDM), is based on the variability in the distance between corresponding voxels from different images, which are co-registered to the same voxel at location (X) in an arbitrarily chosen ‘reference’ image. The DDM value, at location (X) in the reference image, represents the mean dispersion between voxels, when these images are registered to other images in the image set. The method requires at least four registered images to estimate the uncertainty of the DIRs, both for inter- and intra-patient DIR. To validate the proposed method, we generated an image set by deforming a software phantom with known DVFs. The registration error was computed at each voxel in the ‘reference’ phantom and then compared to DDM, inverse consistency error (ICE), and transitivity error (TE) over the entire phantom. The DDM showed a higher Pearson correlation (Rp) with the actual error (Rp ranged from 0.6 to 0.9) in comparison with ICE and TE (Rp ranged from 0.2 to 0.8). In the resulting spatial DDM map, regions with distinct intensity gradients had a lower discordance and therefore, less variability relative to regions with uniform intensity. Subsequently, we applied DDM for intra-patient DIR in an image set of ten longitudinal computed tomography (CT) scans of one prostate cancer patient and for inter-patient DIR in an image set of ten planning CT scans of different head and neck cancer patients. For both intra- and inter-patient DIR, the spatial DDM map showed large variation over the volume of interest (the pelvis for the prostate patient and the head for the head and neck patients). The highest discordance was observed in the soft tissues, such as the brain, bladder, and rectum, due to higher variability in the registration. The smallest DDM values were observed in the bony structures in the pelvis and the base of the skull. The proposed metric, DDM, provides a quantitative tool to evaluate the performance of DIR when a set of images is available. Therefore, DDM can be used to estimate and visualize the uncertainty of intra- and/or inter-patient DIR based on the variability of the registration rather than the absolute registration error.

  15. Evaluation of the Accuracy of a 3D Surface Imaging System for Patient Setup in Head and Neck Cancer Radiotherapy

    SciTech Connect

    Gopan, Olga; Wu Qiuwen

    2012-10-01

    Purpose: To evaluate the accuracy of three-dimensional (3D) surface imaging system (AlignRT) registration algorithms for head-and-neck cancer patient setup during radiotherapy. Methods and Materials: Eleven patients, each undergoing six repeated weekly helical computed tomography (CT) scans during treatment course (total 77 CTs including planning CT), were included in the study. Patient surface images used in AlignRT registration were not captured by the 3D cameras; instead, they were derived from skin contours from these CTs, thereby eliminating issues with immobilization masks. The results from surface registrations in AlignRT based on CT skin contours were compared to those based on bony anatomy registrations in Pinnacle{sup 3}, which was considered the gold standard. Both rigid and nonrigid types of setup errors were analyzed, and the effect of tumor shrinkage was investigated. Results: The maximum registration errors in AlignRT were 0.2 Degree-Sign for rotations and 0.7 mm for translations in all directions. The rigid alignment accuracy in the head region when applied to actual patient data was 1.1 Degree-Sign , 0.8 Degree-Sign , and 2.2 Degree-Sign in rotation and 4.5, 2.7, and 2.4 mm in translation along the vertical, longitudinal, and lateral axes at 90% confidence level. The accuracy was affected by the patient's weight loss during treatment course, which was patient specific. Selectively choosing surface regions improved registration accuracy. The discrepancy for nonrigid registration was much larger at 1.9 Degree-Sign , 2.4 Degree-Sign , and 4.5 Degree-Sign and 10.1, 11.9, and 6.9 mm at 90% confidence level. Conclusions: The 3D surface imaging system is capable of detecting rigid setup errors with good accuracy for head-and-neck cancer. Further investigations are needed to improve the accuracy in detecting nonrigid setup errors.

  16. Expanding roles for radiology administrators.

    PubMed

    Bouchard, E A; Bonno, L

    1995-01-01

    In a fast-moving trend, radiology administrators are being asked to assume responsibility for other hospital departments. Pressure to reduce costs is the primary force behind restructuring that results in expanded roles for managers. The changes mean fewer management positions and increased responsibilities for those who retain their jobs. To maximize their opportunities for success, radiology administrators should actively seek expanded duties; cultivate the support of medical leadership; use mentors, professional literature and organizations such as the AHRA to gear up for new responsibilities; and recognize negotiation and presentation skills as extremely valuable assets. PMID:10141099

  17. Gated cardiac imaging using a continuously rotating CT scanner: clinical evaluation of 91 patients

    SciTech Connect

    Oyama, Y.; Uji, T.; Hirayama, T.; Inada, Y.; Ishikawa, T.; Fujii, M.

    1984-05-01

    To produce electrocardiographically (ECG)-gated computed tomographic (CT) image of the heart, a post-data-acquisition ECG correlation technique was used in which data for missing angular projections are derived from the original scan data to complete 360 angular projections. Improved image quality and clinical usefulness were demonstrated compared with routine nongated CT and two-dimensional echocardiography. The equipment required for CT gating is of low cost, but the examination time is lengthy and less conveniently performed than echocardiography. However, when echocardiography is indecisive or suspected to be falsely negative, gated CT imaging of the heart is recommended.

  18. [The essence of doctor-patient relationship in creating image of a medical institution].

    PubMed

    Dworza?ski, Wojciech; Dworza?ska, Anna; Burdan, Franciszek

    2012-01-01

    Irrespective of changing standards and continuous reforms in health service, the patient should always remain the principal focus. The patient is a person who should be treated not only as a customer or a recipient of medical services but also as a person being in a situation which is difficult and often unacceptable. Among the factors affecting patients' satisfaction and contentment in the course of the disease it is profoundly important that he cooperates with his doctor. For years it has been attempted to create an ideal model of doctor-patient relationship which would be mutually beneficial and not violating privacy or welfare of any of them. These attempts focused on various theoretical models, among others paternalistic, informative and interpretive. However, special attention should be paid to adherence to principles which is based on respect for patient autonomy, harmlessness, charity and fairness. PMID:22400178

  19. SPECT imaging of serotonin transporter binding in patients with generalized anxiety disorder.

    PubMed

    Maron, Eduard; Kuikka, Jyrki T; Ulst, Kai; Tiihonen, Jari; Vasar, Veiko; Shlik, Jakov

    2004-12-01

    The purpose of this study was to characterize the binding properties of serotonin transporter (5-HTT) in the brain of the patients with generalized anxiety disorder (GAD) in comparison to healthy subjects using single photon emission computer tomography (SPECT) with the radioligand [123I]nor-beta-CIT. The subjects were 7 patients with GAD and 7 matched healthy volunteers. The regions of interest (ROI) were the midbrain and the thalamus. The comparison of the volumes of distribution did not show significant differences between the patients and controls in the binding of nor-beta-CIT to 5-HTT in the ROI. Binding of 5-HTT in the midbrain of patients was significantly and negatively correlated with their anxiety levels measured by the visual analogue scale immediately before the first scan (r=-0.79, p=0.035). This study failed to demonstrate an altered functional activity of 5-HTT in patients with GAD when compared with controls. PMID:15538601

  20. Magnetic resonance imaging features of cerebellar vermis medulloblastoma in an adult canine patient.

    PubMed

    Patsikas, M; Jakovljevic, S; Papadopoulou, P; Polizopoulou, Z; Kazakos, G; Tontis, D; Soultani, C; Charitanti, A; Chrissogonidis, I; Tsifountoudis, I

    2014-01-01

    A seven-year-old, not-castrated male, Airedale Terrier presented with a history of ataxia and intention tremor of the head of three-week duration. Neurologic examination demonstrated severe hypermetria, intention tremor of the head and a bilateral menace response deficit. Magnetic resonance imaging revealed a well demarcated cerebellar vermis mass, hypointense on T1-weighted images, hyperintense on T2-weighted images, with multiple small foci of high signal similar to that of CSF. Foci dispersed in the mass creating a speckled appearance. Homogeneous faint, wispy post-contrast enhancement of the mass was noted; as a result the tumor became isointense to gray matter and was not clearly evident in post contrast images. The histopathological diagnosis of the excised tumor was cerebellar medulloblastoma. PMID:25001666

  1. Recent Advances in Image Assisted Neurosurgical Procedures: Improved Navigational Accuracy and Patient Safety

    ScienceCinema

    Olivi, Alessandro, M.D.

    2010-09-01

    Neurosurgical procedures require precise planning and intraoperative support. Recent advances in image guided technology have provided neurosurgeons with improved navigational support for more effective and safer procedures. A number of exemplary cases will be presented.

  2. Multimodality imaging for patient evaluation and guidance of catheter ablation for atrial fibrillation - current status and future perspective.

    PubMed

    Bhagirath, P; van der Graaf, A W M; Karim, R; van Driel, V J H M; Ramanna, H; Rhode, K S; de Groot, N M S; Götte, M J W

    2014-08-20

    Left atrial catheter ablation is an established non-pharmacological therapy for the treatment of atrial fibrillation. The importance of a noninvasive multimodality imaging approach is emphasized by the current guidelines for the various phases of the ablation work-up e.g. patient identification, therapy guidance and procedural evaluation. Advances in the capabilities of imaging modalities and the increasing cost of healthcare warrant a review of the multimodality approach. This review discusses the application of cardiac imaging for pulmonary vein and left atrial ablation divided into stages: pre-procedural stage (assessment of left atrial dimensions, left atrial appendage thrombus and pulmonary vein anatomy), peri-procedural stage (integration of anatomical and electrical information) and post-procedural stage (evaluation of efficacy by assessment of tissue properties). Each section is dedicated to one of the subtopics of a stage, allowing a thorough comparison to be made between the strengths and weaknesses of the different imaging modalities and the identification of one that exhibits the potential for a single technique approach. PMID:25012494

  3. [18F]FET-PET Imaging for Treatment and Response Monitoring of Radiation Therapy in Malignant Glioma Patients – A Review

    PubMed Central

    Götz, I.; Grosu, A. L.

    2013-01-01

    In the treatment of patients suffering from malignant glioma, it is a paramount importance to deliver a high radiation dose to the tumor on the one hand and to spare organs at risk at one the other in order to achieve a sufficient tumor control and to avoid severe side effects. New radiation therapy techniques have emerged like intensity modulated radiotherapy and image guided radiotherapy that help facilitate this aim. In addition, there are advanced imaging techniques like Positron emission tomography (PET) and PET/CT which can help localize the tumor with higher sensitivity, and thus contribute to therapy planning, tumor control, and follow-up. During follow-up care, it is crucial to differentiate between recurrence and treatment-associated, unspecific lesions, like radiation necrosis. Here, too, PET/CT can facilitate in differentiating tumor relapse from unspecific changes. This review article will discuss therapy response criteria according to the current imaging methods like Magnet resonance imaging, CT, and PET/CT. It will focus on the significance of PET in the clinical management for treatment and follow-up. PMID:23630666

  4. The role of technetium-99m stannous pyrophosphate in myocardial imaging to recognize, localize and identify extension of acute myocardial infarction in patients

    NASA Technical Reports Server (NTRS)

    Willerson, J. T.; Parkey, R. W.; Bonte, F. J.; Stokely, E. M.; Buja, E. M.

    1975-01-01

    The ability of technetium-99m stannous pyrophosphate myocardial scintigrams to aid diagnostically in recognizing, localizing, and identifying extension of acute myocardial infarction in patients was evaluated. The present study is an extension of previous animal and patient evaluations that were recently performed utilizing this myocardial imaging agent.

  5. Breast Patient Setup Error Assessment: Comparison of Electronic Portal Image Devices and Cone-Beam Computed Tomography Matching Results

    SciTech Connect

    Topolnjak, Rajko; Sonke, Jan-Jakob; Nijkamp, Jasper; Rasch, Coen; Minkema, Danny; Remeijer, Peter; Vliet-Vroegindeweij, Corine van

    2010-11-15

    Purpose: To quantify the differences in setup errors measured with the cone-beam computed tomography (CBCT) and electronic portal image devices (EPID) in breast cancer patients. Methods and Materials: Repeat CBCT scan were acquired for routine offline setup verification in 20 breast cancer patients. During the CBCT imaging fractions, EPID images of the treatment beams were recorded. Registrations of the bony anatomy for CBCT to planning CT and EPID to digitally reconstructed-radiographs (DRRs) were compared. In addition, similar measurements of an anthropomorphic thorax phantom were acquired. Bland-Altman and linear regression analysis were performed for clinical and phantom registrations. Systematic and random setup errors were quantified for CBCT and EPID-driven correction protocols in the EPID coordinate system (U, V), with V parallel to the cranial-caudal axis and U perpendicular to V and the central beam axis. Results: Bland-Altman analysis of clinical EPID and CBCT registrations yielded 4 to 6-mm limits of agreement, indicating that both methods were not compatible. The EPID-based setup errors were smaller than the CBCT-based setup errors. Phantom measurements showed that CBCT accurately measures setup error whereas EPID underestimates setup errors in the cranial-caudal direction. In the clinical measurements, the residual bony anatomy setup errors after offline CBCT-based corrections were {Sigma}{sub U} = 1.4 mm, {Sigma}{sub V} = 1.7 mm, and {sigma}{sub U} = 2.6 mm, {sigma}{sub V} = 3.1 mm. Residual setup errors of EPID driven corrections corrected for underestimation were estimated at {Sigma}{sub U} = 2.2mm, {Sigma}{sub V} = 3.3 mm, and {sigma}{sub U} = 2.9 mm, {sigma}{sub V} = 2.9 mm. Conclusion: EPID registration underestimated the actual bony anatomy setup error in breast cancer patients by 20% to 50%. Using CBCT decreased setup uncertainties significantly.

  6. SU-E-J-159: Intra-Patient Deformable Image Registration Uncertainties Quantified Using the Distance Discordance Metric

    SciTech Connect

    Saleh, Z; Thor, M; Apte, A; Deasy, J; Sharp, G; Muren, L

    2014-06-01

    Purpose: The quantitative evaluation of deformable image registration (DIR) is currently challenging due to lack of a ground truth. In this study we test a new method proposed for quantifying multiple-image based DIRrelated uncertainties, for DIR of pelvic images. Methods: 19 patients were analyzed, each with 6 CT scans, who previously had radiotherapy for prostate cancer. Manually delineated structures for rectum and bladder, which served as ground truth structures, were delineated on the planning CT and each subsequent scan. For each patient, voxel-by-voxel DIR-related uncertainties were evaluated, following B-spline based DIR, by applying a previously developed metric, the distance discordance metric (DDM; Saleh et al., PMB (2014) 59:733). The DDM map was superimposed on the first acquired CT scan and DDM statistics were assessed, also relative to two metrics estimating the agreement between the propagated and the manually delineated structures. Results: The highest DDM values which correspond to greatest spatial uncertainties were observed near the body surface and in the bowel due to the presence of gas. The mean rectal and bladder DDM values ranged from 1.1–11.1 mm and 1.5–12.7 mm, respectively. There was a strong correlation in the DDMs between the rectum and bladder (Pearson R = 0.68 for the max DDM). For both structures, DDM was correlated with the ratio between the DIR-propagated and manually delineated volumes (R = 0.74 for the max rectal DDM). The maximum rectal DDM was negatively correlated with the Dice Similarity Coefficient between the propagated and the manually delineated volumes (R= ?0.52). Conclusion: The multipleimage based DDM map quantified considerable DIR variability across different structures and among patients. Besides using the DDM for quantifying DIR-related uncertainties it could potentially be used to adjust for uncertainties in DIR-based accumulated dose distributions.

  7. The Expanding Marketplace for Applied Geophysics

    NASA Astrophysics Data System (ADS)

    Carlson, N.; Sirles, P.

    2012-12-01

    While the image of geophysics for the proverbial "layman" often seems limited to volcanoes and earthquakes, and to the geoscientist this image enlarges to include oil or minerals exploration and whole earth studies, there has been a steady increase in the application of geophysics into the realm of "daily life", such as real estate deals, highway infrastructure, and flood protection. This expansion of applications can be attributed to the improved economics from advances in equipment and interpretation. Traditional geophysical methods that at one time often only fit within the budgets of oil, gas, and minerals exploration programs can now be economically applied to much smaller scale needs like contaminant mapping, landfill delineation, and levee investigations. A real-world, economic example of this expanding marketplace is our company, which began very small and was aimed almost exclusively at the minerals exploration market. Most of our growth has been in the last 10 years, when we have expanded to five offices and a staff with almost 40 geoscientist degrees (21 in geophysics); much of this growth has been in the non-oil, non-minerals arenas. While much of our work still includes minerals exploration, other projects this year include wind-farm foundation studies, cavity detection above underground nuclear tests, landfill studies, acid mine drainage problems, and leaks in evaporation ponds. A methodology example of this expanding market is the induced polarization (IP) survey, once primarily used for minerals exploration, particularly large porphyry copper deposits, but now efficient enough to also use in environmental studies. The IP method has been particularly useful in delineating and characterizing old, poorly documented landfills, and recent research suggests it may also be useful in monitoring the accelerated biodegradation processes used in some cases to rehabilitate the sites. Compared to temperature monitoring systems, IP may be more useful in providing a better image of the subsurface to locate areas that are not being properly decomposed due to poor fluid flow or inefficient air circulation.Raw IP data in traditional pseudosection format, prior to modeling, showing the change in IP effects after four years of accelerated biodegradation of an old, buried, municipal solid waste landfill. Posted values are chargeability in milliseconds.

  8. Impact of more detailed categorization of shrinkage or progression ratio at initial imaging response after sorafenib treatment in advanced hepatocellular carcinoma patients

    PubMed Central

    Wada, Yoshiyuki; Takami, Yuko; Tateishi, Masaki; Ryu, Tomoki; Mikagi, Kazuhiro; Saitsu, Hideki

    2015-01-01

    Background Sorafenib therapy improves survival in unresectable hepatocellular carcinoma (HCC) patients without an objective response. The present study investigated whether the initial imaging response might be a prognostic indicator after administration of sorafenib therapy in HCC patients. Patients and methods This retrospective study reviewed unresectable HCC patients undergoing sorafenib therapy. Patients evaluated without complete response, partial response (PR), or progressive disease (PD) at the initial imaging response evaluation by modified Response Evaluation Criteria in Solid Tumors were divided into three groups according to more detailed categorization of the shrinkage/progression ratio in initial imaging response. A comparison of progression-free and overall survival among these groups was performed. Results Of the 43 non-PR non-PD patients with target lesions, ten (23.3%) exhibited mild response (MR; ?30% to ?5%), 14 (32.6%) exhibited no change (NC; ?5% to +5%), and 19 (44.2%) exhibited mild-PD (MPD; +5% to +20%). There was no statistical difference in progression-free or overall survival between MR and NC patients. The median progression-free survivals in NC+MR and mild-PD patients were 15.0 and 5.3 months, respectively (P<0.01), and the median survival times were 31.9 and 17.1 months, respectively (P<0.001). In multivariate analysis, etiology (hepatitis C virus) and initial imaging response (MR+NC) was identified as an independently good prognostic factor. Conclusion More detailed categorization of shrinkage or progression at the initial imaging response evaluation may be a useful marker for predicting sorafenib treatment outcomes in HCC patients. If the initial imaging response is not progression but stability, sorafenib may have a survival benefit. PMID:26586953

  9. Exposing medical students to expanding populations

    PubMed Central

    Lindenthal, JJ; DeLisa, JA; Heinrich, GF; Calderón Gerstein, WS

    2015-01-01

    Physicians are required to advocate for and counsel patients based on the best science and the interests of the individual while avoiding discrimination, ensuring equal access to health and mental services. Nonetheless, the communication gap between physician and patients has long been observed. To this end, the Institute for the Public Understanding of Health and Medicine of the Rutgers University New Jersey Medical School has expanded its efforts. This report describes two new programs: a legacy lecture series for medical students and an international “experience”, in Huancayo, Peru, for medical students and faculty. The MiniMed outreach program, now in its ninth year and first described in this journal in 2012, was designed to empower the powerless to communicate more effectively with clinicians, thus improving both the effectiveness of the physician–patient relationship and health care outcomes. The approach of the two new programs and their effects on patients, particularly the underserved, and medical students and faculty, are outlined in the following article. PMID:25834472

  10. ERBU, Expanding Rubber Band Universe

    E-print Network

    Soares, Domingos

    2015-01-01

    I put forward a simple unidimensional mechanical analogue of the three-dimensional universe models of modern relativistic cosmology. The main goal of the proposal is the appropriate appreciation of the intrinsic relationship between Hubble's law and the homogeneity of expanding relativistic models.

  11. Expanding the Universe of Education.

    ERIC Educational Resources Information Center

    Parsons, Elizabeth

    1996-01-01

    Definitions of "education" and "rural" are debunked and expanded. The three major tasks of rural education are educating people to understand their own needs, the unavoidable changes that will transform rural Australia within their lifetimes, and the range of technologies that can enhance their well-being. Presents a strategy for educating…

  12. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W. (Cambridge, GB); Cropp, T. Ashton (Bethesda, MD); Anderson, J. Christopher (San Francisco, CA); Schultz, Peter G. (La Jolla, CA)

    2009-11-17

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  13. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W. (Cambridge, GB); Cropp, T. Ashton (Bethesda, MD); Anderson, J. Christopher (San Francisco, CA); Schultz, Peter G. (La Jolla, CA)

    2012-05-08

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  14. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W. (Cambridge, GB); Cropp, T. Ashton (Bethesda, MD); Anderson, J. Christopher (San Francisco, CA); Schultz, Peter G. (La Jolla, CA)

    2010-09-14

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  15. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W. (Cambridge, GB); Cropp, T. Ashton (Bethesda, MD); Anderson, J. Christopher (San Francisco, CA); Schultz, Peter G. (La Jolla, CA)

    2009-12-01

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  16. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W.; Cropp, T. Ashton; Anderson, J. Christopher; Schultz, Peter G.

    2013-01-22

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  17. Expanding the eukaryotic genetic code

    SciTech Connect

    Chin, Jason W; Cropp, T. Ashton; Anderson, J. Christopher; Schultz, Peter G

    2015-02-03

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  18. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W. (Cambridge, GB); Cropp, T. Ashton (Bethesda, MD); Anderson, J. Christopher (San Francisco, CA); Schultz, Peter G. (La Jolla, CA)

    2012-02-14

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  19. Finite simple groups as expanders

    PubMed Central

    Kassabov, Martin; Lubotzky, Alexander; Nikolov, Nikolay

    2006-01-01

    We prove that there exist k ? ? and 0 < ? ? ? such that every non-abelian finite simple group G, which is not a Suzuki group, has a set of k generators for which the Cayley graph Cay(G; S) is an ?-expander. PMID:16601101

  20. Expanding the eukaryotic genetic code

    DOEpatents

    Chin, Jason W. (Cambridge, GB); Cropp, T. Ashton (Bethesda, MD); Anderson, J. Christopher (San Francisco, CA); Schultz, Peter G. (La Jolla, CA)

    2009-10-27

    This invention provides compositions and methods for producing translational components that expand the number of genetically encoded amino acids in eukaryotic cells. The components include orthogonal tRNAs, orthogonal aminoacyl-tRNA synthetases, orthogonal pairs of tRNAs/synthetases and unnatural amino acids. Proteins and methods of producing proteins with unnatural amino acids in eukaryotic cells are also provided.

  1. Direct expanded snacks from sorghum 

    E-print Network

    Maranphal, Nitit

    2003-01-01

    Food type white sorghum (ATx631xRTx436) grown in College Station, 2001 was used to produce direct expanded snacks. Corn meal was used as reference. Sorghum grains were analyzed for their density, hardness, weight, and size. Sorghum was decorticated...

  2. Entropy of expanding QCD matter

    E-print Network

    Tamas S Biro; Jozsef Zimanyi

    2007-04-13

    Using the lattice QCD equation of state for an isentropically expanding fireball we follow the evolution of the effective number of particles in an ideal gas pV/T. This number reduces roughly to its third around the crossover temperature, which helps to circumvent the entropy obstacle inherent in quark coalescence models of the hadronization.

  3. Entropy of expanding QCD matter

    E-print Network

    Biro, T S; Biro, Tamas S; Zimanyi, Jozsef

    2007-01-01

    We utilize the equation of state obtained in lattice QCD for an isentropically expanding fireball. We investigate the number of particles in an equivalent ideal gas, N=pV/T, by keeping the entropy, S, constant. We realize that this number reduces roughly to its one third, the fastest reduction rate occurs around the crossover temperature, T_c.

  4. [Cerebral microhaemorrhage as imaging correlate of high-altitude cerebral edema in a patient under long-term ventilation].

    PubMed

    Esser, H-W; Schellhammer, F; Galetke, W

    2014-01-01

    Within the scope of a cerebral magnetic resonance imaging to diagnose a dysphagia in a patient on long-term artificial respiration, the morphological criteria for a HACE (high-altitude cerebral edema) have been met. We found microangiopathic white matter lesions in the area of the corpus callosum and splenium, characteristic features of a HACE. HACE is a severe form of altitude sickness with truncal ataxia, disturbance of consciousness through to unconsciousness and coma. The exact pathophysiology is still not known but hypoxia seems to be the triggering stimulus. Thus the question arises: long-term ventilated patients suffering from severe gas exchange disorders develop constellations which are equivalent to HACE? PMID:24343241

  5. Expanding the Oral Hygiene Curriculum in a Nursing Program.

    ERIC Educational Resources Information Center

    Briggs, Susan; Griego, Elizabeth

    A program was implemented to expand the curriculum materials within the Licensed Practical Nursing (LPN) Program at Clark County Community College (CCCC) which relate to oral hygiene care for the hospital patient. The instructional materials included a video tape and a written instructional packet which were researched, prepared, and presented by…

  6. An open-label expanded-access trial of bendamustine in patients with rituximab-refractory indolent non-Hodgkin lymphoma or previously untreated chronic lymphocytic leukemia: BEND-ACT

    PubMed Central

    Kouroukis, C.T.; Crump, M.; MacDonald, D.; Larouche, J.F.; Stewart, D.A.; Johnston, J.; Sauvageau, S.; Beausoleil, E.; Sage, P.; Dubois, S.G.; Christofides, A.; Di Clemente, S.; Sehn, L.

    2015-01-01

    Background Bendamustine is a bifunctional alkylating agent with unique properties that distinguish it from other agents in its class. Bendamustine is used as monotherapy or in combination with other agents to treat patients with non-Hodgkin lymphoma (nhl) and chronic lymphocytic leukemia (cll). Methods The prospective interventional open-label bend-act trial evaluated bendamustine in patients with rituximab-refractory indolent nhl (inhl) and previously untreated cll. Study objectives were to assess the safety and tolerability of bendamustine monotherapy and to provide patients with access to bendamustine before Health Canada approval. The study aimed to enrol up to 100 patients. All patients with inhl received an intravenous dose of bendamustine 120 mg/m2 over 60 minutes on days 1 and 2 for up to eight 21- or 28-day treatment cycles. All patients with cll received an intravenous dose of bendamustine 100 mg/m2 over 30 minutes on days 1 and 2 for up to six 28-day treatment cycles. Results Of 90 patients treated on study (16 with cll and 74 with inhl), 35 completed the study (4 with cll and 31 with inhl). The most common treatment-emergent adverse events (teaes) were nausea (70%), fatigue (57%), vomiting (40%), and diarrhea (33%)—mostly grades 1 and 2. Ondansetron was the most common supportive medication used in the patients (63.5% of those with inhl and 68.8% of those with cll). Neutropenia (32%), anemia (23%), and thrombocytopenia (21%) were the most frequent hematologic teaes, with neutropenia being the most common grade 3 or 4 teae leading to dose modification. Dose delays occurred in 28 patients (31.3%) because of grade 3 or 4 teaes, with a higher incidence of dose delays being observed in inhl patients on the 21-day treatment cycle than in those on the 28-day treatment cycle (50.0% vs. 24.1%). During the study, 33 patients (36.7%) experienced at least 1 serious adverse event, and 4 deaths were reported (all in patients with inhl). Conclusions The type and frequency of the teaes reported accorded with observations in earlier clinical trials and post-marketing experiences, thus confirming the acceptable and manageable safety profile of bendamustine. PMID:26300664

  7. Stress Cardiac Magnetic Resonance Imaging With Observation Unit Care Reduces Cost for Patients With Emergent Chest Pain: A Randomized Trial

    PubMed Central

    Miller, Chadwick D.; Hwang, Wenke; Hoekstra, James W.; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B.; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory

    2013-01-01

    Study objective We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. Methods Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups. Results There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission. Conclusion Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain. PMID:20554078

  8. Pretreatment Evaluation of Microcirculation by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Predicts Survival in Primary Rectal Cancer Patients

    SciTech Connect

    DeVries, Alexander Friedrich; Piringer, Gudrun; Kremser, Christian; Judmaier, Werner; Saely, Christoph Hubert; Lukas, Peter; Öfner, Dietmar

    2014-12-01

    Purpose: To investigate the prognostic value of the perfusion index (PI), a microcirculatory parameter estimated from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), which integrates information on both flow and permeability, to predict overall survival and disease-free survival in patients with primary rectal cancer. Methods and Materials: A total of 83 patients with stage cT3 rectal cancer requiring neoadjuvant chemoradiation were investigated with DCE-MRI before start of therapy. Contrast-enhanced dynamic T{sub 1} mapping was obtained, and a simple data analysis strategy based on the calculation of the maximum slope of the tissue concentration–time curve divided by the maximum of the arterial input function was used as a measure of tumor microcirculation (PI), which integrates information on both flow and permeability. Results: In 39