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Sample records for repeated fluoroscopic examinations

  1. Basal cell carcinoma and breast carcinoma following repeated fluoroscopic examinations of the chest.

    PubMed

    Myskowski, P L; Gumpertz, E; Safai, B

    1985-03-01

    A 69-year-old white Italian woman was first seen at Memorial Sloan-Kettering Cancer Center in 1981 concerning several skin growths on her back. The patient had had several basal cell carcinomas surgically removed from her back during the preceding 5 years. There was no history of arsenic ingestion or prolonged sun exposure and her family history was negative for skin cancer. The patient had developed pulmonary tuberculosis in 1938 and was treated with pneumothorax therapy. She had had more than 50 fluoroscopic examinations of the chest following this therapy, as well as multiple diagnostic x-ray films since that time. She recalled that she had faced the fluoroscopy beam during the procedure. In 1959, she had a transabdominal hysterectomy for fibroid tumors. In 1980 she underwent a right modified radical mastectomy for adenoid cystic carcinoma of the breast; biopsies of lymph nodes were negative. Physical examination revealed a thin, white woman with a right mastectomy scar. On the back, clustered in the interscapular region, were multiple scars and nine erythematous nodules with pearly borders, telangiectasia, and translucent surfaces. Within several nodules there were areas of light and dark brown pigmentation. There were no other suspicious lesions on the head, chest, or extremities, nor did the patient show any evidence of the basal cell nevus syndrome. Biopsy of all lesions revealed basal cell carcinoma, some of which were pigmented, without evidence of chronic radiodermatitis. All lesions were treated with curettage and electrodesiccation three times with good cosmetic results (Fig. 1).

  2. Basal cell carcinoma and breast carcinoma following repeated fluoroscopic examinations of the chest

    SciTech Connect

    Myskowski, P.L.; Gumpertz, E.; Safai, B.

    1985-03-01

    A 69-year-old white Italian woman was first seen at Memorial Sloan-Kettering Cancer Center in 1981 concerning several skin growths on her back. The patient had had several basal cell carcinomas surgically removed from her back during the preceding 5 years. There was no history of arsenic ingestion or prolonged sun exposure and her family history was negative for skin cancer. The patient had developed pulmonary tuberculosis in 1938 and was treated with pneumothorax therapy. She had had more than 50 fluoroscopic examinations of the chest following this therapy, as well as multiple diagnostic x-ray films since that time. On the back, clustered in the interscapular region, were multiple scars and nine erythematous nodules with pearly borders, telangiectasia, and translucent surfaces. Within several nodules there were areas of light and dark brown pigmentation. Biopsy of all lesions revealed basal cell carcinoma, some of which were pigmented, without evidence of chronic radiodermatitis. All lesions were treated with curettage and electrodesiccation three times with good cosmetic results.

  3. Cancer mortality in women after repeated fluoroscopic examinations of the chest

    SciTech Connect

    Boice, J.D.; Monson, R.R.; Rosenstein, M.

    1981-05-01

    Among 1,047 women fluoroscopically examined in average of 102 times during pneumothorax therapy for tuberculosis and followed up to 45 years (average . 27 yr), no increase in the total number of cancer deaths occurred when these women were compared to 717 women who received other treatments (relative risk (RR) . 0.8). However, elevated risks of mortality from stomach cancer (RR . 2.3), rectal cancer (RR . 3.8), breast cancer (RR . 1.2), lung cancer (RR . 1.8), and leukemia (RR . 1.2) were observed, but none was statistically significant and all were based on very small numbers of deaths. These increases were balanced by decreases of genital cancer (RR . 0.2), pancreatic cancer (RR . 0.9), lymphoma (RR . 0.6), and all other cancers (RR . 0.1). Average cumulative absorbed doses were 110 rads for the lungs, 33 rads for the trunk, 13 rads for the active bone marrow, and 7 rads for the stomach. The following upper levels of excess risk could be excluded with 95% confidence: 3.5 deaths/10(6) woman-year (WY)-rad for lung cancer, 4.8 deaths/10(6) WY-rad for lymphoma, and 12 deaths/10(6) WY-rad for leukemia. These findings indicated that the carcinogenic effect of multiple low-dose X-ray exposures was not greater than that currently assumed.

  4. RADCOM: a computerized translation device for use during fluoroscopic examination of non-English-speaking patients.

    PubMed

    Cohn, M J; Cohen, A J

    1994-02-01

    We developed and have implemented RADCOM (RADiology COMmunicator), a computerized speech-based language translator for use during fluoroscopic examination of non-English-speaking patients. It is controlled completely by voice commands issued into a headset microphone. The system output is digital audio via a small speaker, in the native language of the patient. RADCOM currently supports more than 40 commands in more than a dozen languages. The language data base is easily expandable. We have performed more than 20 fluoroscopic examinations with the RADCOM system. The non-English-speaking patients respond well, following the selected instructions appropriately.

  5. Experience with modified remotely controlled fluoroscopic equipment for gastrointestinal examination in debilitated patients.

    PubMed

    Hayt, D B; Perez, L A

    1975-06-01

    The concept and realization of a highly automated remotely controlled fluoroscopic system, applicable to the examination of debilitated or uncooperative patients, have been described. The addition of a rotating cradle, remotely controlled barium administration, magazine-fed roll film camera, remotely inflated paddle for prone-pressure spot filming, and a vacuum restraining device have been described for the examination of uncooperative as well as cooperative patients. These patients can be examined with as high a degree of sophistication and automation as is now available. Future developments in this area may lie in the realm of multitable remotely controlled fluoroscopic rooms, operation of the above equipment by a super technologist, programmed gastrointestinal examinations utilizing the above equipment and automated programming, and teleremote controlled fluoroscopy from a centralized location with coaxial cable or microwave transmission.

  6. Organ and effective doses in infants undergoing upper gastrointestinal (UGI) fluoroscopic examination

    SciTech Connect

    Staton, Robert J.; Williams, Jonathon L.; Arreola, Manuel M.; Hintenlang, David E.; Bolch, Wesley E.

    2007-02-15

    To provide more detailed data on organ and effective doses in digital upper gastrointestinal (UGI) fluoroscopy studies of newborns and infants, the present study was conducted employing the time-sequence videotape-analysis technique used in a companion study of newborn and infant voiding cystourethrograms (VCUG). This technique was originally pioneered [O. H. Suleiman, J. Anderson, B. Jones, G. U. Rao, and M. Rosenstein, Radiology 178, 653-658 (1991)] for adult UGI examinations. Individual video frames were analyzed to include combinations of field size, field center, x-ray projection, image intensifier, and magnification mode. Additionally, the peak tube potential and the mA or mAs values for each segment/subsegment or digital photospot were recorded for both the fluoroscopic and radiographic modes of operation. The data from videotape analysis were then used in conjunction with a patient-scalable newborn tomographic computational phantom to report both organ and effective dose values via Monte Carlo radiation transport. The study includes dose estimates for five simulated UGI examinations representative of patients ranging from three to six months of age. Effective dose values for UGI examinations ranged from 1.17 to 6.47 mSv, with a mean of 3.14 mSv and a large standard deviation of 2.15 mSv. The colon, lungs, stomach, liver, and esophagus absorbed doses in sum were found to constitute between 63 and 75% of the effective dose in these UGI studies. Representing 23-30% of the effective dose, the lungs were found to be the most significant organ in the effective dose calculation. Approximately 80-95% of the effective dose is contributed by the dynamic fluoroscopy segments with larger percentages found in longer studies. The mean effective dose for newborn UGI examinations was not found to be statistically different from that seen in newborn VCUG examinations.

  7. Thyroid, parathyroid, and salivary gland evaluations in patients exposed to multiple fluoroscopic examinations during tuberculosis therapy: a pilot study

    SciTech Connect

    Kaplan, M.M.; Boice, J.D. Jr.; Ames, D.B.; Rosenstein, M.

    1988-02-01

    The prevalence of thyroid, parathyroid, and salivary abnormalities was determined in 91 women who received an average of 112 fluoroscopic chest examinations during pneumothorax treatment for tuberculosis more than 40 yr previously and in 72 women treated for tuberculosis by other modalities. Thyroid abnormalities were determined by physical examination, scintiscans, and measurements of serum free T4 index, TSH, and thyroid microsomal antibodies. Thyroid nodules were diagnosed in 7.7% of the exposed and 4.2% of the comparison group (prevalence ratio, 1.8; 90% confidence interval 0.6-5.7). Autoimmune thyroid disease was diagnosed in 15.2% of the exposed and 6.9% of the comparison group (prevalence ratio, 2.2; 95% confidence interval, 0.8-6.2). No salivary tumors were detected. Two exposed women and 1 comparison woman had primary hyperparathyroidism. Although absorbed dose to the thyroid could not be precisely determined, approximately 60 rads would be expected to yield the observed excess of thyroid nodules. While the prevalence ratios were not significantly increased in the exposed group, the results suggest that susceptibility of the thyroid to nodules from cumulative radiation doses of this magnitude could be increased even when the doses are accumulated over years and that such x-ray exposure of the thyroid gland may predispose the patient to the development of autoimmune disease.

  8. Repeatability and Reproducibility of Decisions by Latent Fingerprint Examiners

    PubMed Central

    Ulery, Bradford T.; Hicklin, R. Austin; Buscaglia, JoAnn; Roberts, Maria Antonia

    2012-01-01

    The interpretation of forensic fingerprint evidence relies on the expertise of latent print examiners. We tested latent print examiners on the extent to which they reached consistent decisions. This study assessed intra-examiner repeatability by retesting 72 examiners on comparisons of latent and exemplar fingerprints, after an interval of approximately seven months; each examiner was reassigned 25 image pairs for comparison, out of total pool of 744 image pairs. We compare these repeatability results with reproducibility (inter-examiner) results derived from our previous study. Examiners repeated 89.1% of their individualization decisions, and 90.1% of their exclusion decisions; most of the changed decisions resulted in inconclusive decisions. Repeatability of comparison decisions (individualization, exclusion, inconclusive) was 90.0% for mated pairs, and 85.9% for nonmated pairs. Repeatability and reproducibility were notably lower for comparisons assessed by the examiners as “difficult” than for “easy” or “moderate” comparisons, indicating that examiners' assessments of difficulty may be useful for quality assurance. No false positive errors were repeated (n = 4); 30% of false negative errors were repeated. One percent of latent value decisions were completely reversed (no value even for exclusion vs. of value for individualization). Most of the inter- and intra-examiner variability concerned whether the examiners considered the information available to be sufficient to reach a conclusion; this variability was concentrated on specific image pairs such that repeatability and reproducibility were very high on some comparisons and very low on others. Much of the variability appears to be due to making categorical decisions in borderline cases. PMID:22427888

  9. Computerized tomography using video recorded fluoroscopic images

    NASA Technical Reports Server (NTRS)

    Kak, A. C.; Jakowatz, C. V., Jr.; Baily, N. A.; Keller, R. A.

    1975-01-01

    A computerized tomographic imaging system is examined which employs video-recorded fluoroscopic images as input data. By hooking the video recorder to a digital computer through a suitable interface, such a system permits very rapid construction of tomograms.

  10. Computerized tomography using video recorded fluoroscopic images

    NASA Technical Reports Server (NTRS)

    Kak, A. C.; Jakowatz, C. V., Jr.; Baily, N. A.; Keller, R. A.

    1977-01-01

    The use of video-recorded fluoroscopic images as input data for digital reconstruction of objects from their projections is examined. The fluoroscopic and the scanning apparatus used for the experiments are of a commercial type already in existence in most hospitals. It is shown that for beams with divergence up to about 15 deg, one can use a convolution algorithm designed for the parallel radiation case with negligible degradation both quantitatively and from a visual quality standpoint. This convolution algorithm is computationally more efficient than either the algebraic techniques or the convolution algorithms for radially diverging data. Results from studies on Lucite phantoms and a freshly sacrificed rat are included.

  11. Fluoroscopically Guided Balloon Dilation for Postintubation Tracheal Stenosis

    SciTech Connect

    Lee, Woong Hee; Kim, Jin Hyoung Park, Jung-Hun

    2013-10-15

    Purpose: Little was known about the safety and long-term efficacy of fluoroscopically guided balloon dilation for postintubation tracheal stenosis. The purpose of this study was to evaluate the safety and long-term efficacy of fluoroscopically guided balloon dilation in patients with postintubation tracheal stenosis. Methods: From February 2000 to November 2010, 14 patients underwent fluoroscopically guided balloon dilation for postintubation tracheal stenosis. Technical success, clinical success, and complications were evaluated. Patients were followed up for recurrent symptoms. Results: In all patients, fluoroscopically guided balloon dilation was technically and clinically successful with no major complications. Following the initial procedure, six patients (43 %) remained asymptomatic during a follow-up period. Obstructive symptoms recurred in eight patients (57 %) within 6 months (mean, 1.7 months), who were treated with repeat balloon dilation (n = 4) and other therapies. Of the four patients who underwent repeat balloon dilation, three became asymptomatic. One patient became asymptomatic after a third balloon dilation. On long-term (mean, 74 months) follow-up, 71 % of patients experienced relief of symptoms following fluoroscopically guided balloon dilation. Conclusions: Fluoroscopically guided balloon dilation may be safe, is easy to perform, and resulted in effective treatment in patients with postintubation tracheal stenosis.

  12. Fluoroscopic evaluation of skeletal problems

    SciTech Connect

    Choplin, R.H.; Gilula, L.A.; Murphy, W.A.

    1981-12-01

    Fluoroscopically positioned spot films are widely used in gastrointestinal and chest roentgenography. Little or no mention is made of the diagnostic use of fluoroscopic spot filming for skeletal roentgenography in major texts or recent literature, and a rough survey of practicing radiologists showed us that such procedure was frequently underutilized or not utilized. While skeletal pathology is usually depicted quite accurately by plain radiographs there are times when a problem may be rapidly and simply clarified by fluoroscopically positioned spot films. In an attempt to assess the value of fluoroscopy for evaluation of musculoskeletal problems, we reviewed 46 cases in which fluoroscopically positioned spot films were obtained.

  13. Intra-examiner repeatability and agreement in accommodative response measurements.

    PubMed

    Antona, B; Sanchez, I; Barrio, A; Barra, F; Gonzalez, E

    2009-11-01

    Clinical measurement of the accommodative response (AR) identifies the focusing plane of a subject with respect to the accommodative target. To establish whether a significant change in AR has occurred, it is important to determine the repeatability of this measurement. This study had two aims: First, to determine the intraexaminer repeatability of AR measurements using four clinical methods: Nott retinoscopy, monocular estimate method (MEM) retinoscopy, binocular crossed cylinder test (BCC) and near autorefractometry. Second, to study the level of agreement between AR measurements obtained with the different methods. The AR of the right eye at one accommodative demand of 2.50 D (40 cm) was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18-32 years). The intraexaminer repeatability of the tests, and agreement between them, were estimated by the Bland-Altman method. We determined mean differences (MD) and the 95% limits of agreement [coefficient of repeatability (COR) and coefficient of agreement (COA)]. Nott retinoscopy and BCC offered the best repeatability, showing the lowest MD and narrowest 95% interval of agreement (Nott: -0.10 +/- 0.66 D, BCC: -0.05 +/- 0.75 D). The 95% limits of agreement for the four techniques were similar (COA = +/- 0.92 to +/-1.00 D) yet clinically significant, according to the expected values of the AR. The two dynamic retinoscopy techniques (Nott and MEM) had a better agreement (COA = +/-0.64 D) although this COA must be interpreted in the context of the low MEM repeatability (COR = +/-0.98 D). The best method of assessing AR was Nott retinoscopy. The BCC technique was also repeatable, and both are recommended as suitable methods for clinical use. Despite better agreement between MEM and Nott, agreement among the remaining methods was poor such that their interchangeable use in clinical practice is not recommended.

  14. Fluoroscopic dose reduction using a digital television nose-reduction device

    SciTech Connect

    Albow, R.C.; Jaffe, C.C.; Orphanoudakis, S.C.; Markowitz, R.I.; Rosenfield, N.S.

    1983-07-01

    A digital video image processor, connected to a video system in a conventional pediatric fluoroscopy room, was used to determine whether the device could provide satisfactory fluoroscopic images during routine examinations when the x-ray tube was operated at substantially lower than normal radiation-dose levels. A 50% reduction resulted in image quality which was indistinguishable from conventional fluoroscopic views.

  15. Fluoroscopic studies of the upper gastrointestinal tract: techniques and indications.

    PubMed

    Sánchez-Carpintero de la Vega, M; García Villar, C

    2017-01-25

    Fluoroscopic studies of the gastrointestinal tract are becoming increasing less common due to the introduction of other imaging techniques such as computed tomography and magnetic resonance imaging and to the increased availability of endoscopy. Nevertheless, fluoroscopic studies of the gastrointestinal tract continue to appear in clinical guidelines and some of their indications are still valid. These studies are dynamic, operator-dependent examinations that require training to obtain the maximum diagnostic performance. This review aims to describe the technique and bring the indications for this imaging modality up to date.

  16. Re-Examining Risk of Repeated HLA Mismatch in Kidney Transplantation

    PubMed Central

    Tinckam, Kathryn J.; Rose, Caren; Hariharan, Sundaram

    2016-01-01

    Kidney retransplantation is a risk factor for decreased allograft survival. Repeated mismatched HLA antigens between first and second transplant may be a stimulus for immune memory responses and increased risk of alloimmune damage to the second allograft. Historical data identified a role of repeated HLA mismatches in allograft loss. However, evolution of HLA testing methods and a modern transplant era necessitate re-examination of this role to more accurately risk-stratify recipients. We conducted a contemporary registry analysis of data from 13,789 patients who received a second kidney transplant from 1995 to 2011, of which 3868 had one or more repeated mismatches. Multivariable Cox proportional hazards modeling revealed no effect of repeated mismatches on all–cause or death–censored graft loss. Analysis of predefined subgroups, however, showed that any class 2 repeated mismatch increased the hazard of death–censored graft loss, particularly in patients with detectable panel–reactive antibody before second transplant (hazard ratio [HR], 1.15; 95% confidence interval [95% CI], 1.02 to 1.29). Furthermore, in those who had nephrectomy of the first allograft, class 2 repeated mismatches specifically associated with all–cause (HR, 1.30; 95% CI, 1.07 to 1.58) and death–censored graft loss (HR, 1.41; 95% CI, 1.12 to 1.78). These updated data redefine the effect of repeated mismatches in retransplantation and challenge the paradigm that repeated mismatches in isolation confer increased immunologic risk. We also defined clear recipient categories for which repeated mismatches may be of greater concern in a contemporary cohort. Additional studies are needed to determine appropriate interventions for these recipients. PMID:26888475

  17. Examination of repeated sprinting ability and fatigue index of soccer players according to their positions.

    PubMed

    Kaplan, Turgut

    2010-06-01

    The aim of this study is to evaluate repeated sprinting ability and fatigue index of amateur soccer players according to their positions. A total of 85 amateur soccer players were examined in different clubs in Turkey. The repeated sprint test, which was designed by Bangsbo, was used for soccer players. We did not find any statistical differences for repeated sprints, best time, average time, and fatigue index values according to positions of soccer players (p>0.05). On the other hand, there was a statistical difference between 7 maximal sprints for the defense players, midfielders, and forwards (p<0.05) but there was not a statistical difference between 7 maximal sprints for the goalkeeper (p>0.05). In conclusion, it is considered that speed at soccer is very important and there must be fast moving players in all positions. This study reveals that defense players, midfielders and forwards are able to maintain 5 repeated sprints at the same compactness during the match. For goalkeepers, it could not be found any difference at the repeated sprints. It is considered that on choosing or transferring players, the trainers must take into account their sprint abilities. But repeated sprints are not a specific indicator for goal keepers, and this characteristic should not be used for the choice of goalkeepers. In addition, the players' ability of managing to do several repeated sprints at the same compactness during the match should be pursued by the trainers. And it should be given place to the repeated sprint exercises in the training schedules.

  18. Intra- and inter- examiner repeatability of cycloplegic retinoscopy among young children.

    PubMed

    McCullough, Sara J; Doyle, Lesley; Saunders, Kathryn J

    2017-01-01

    To evaluate the intra- and inter-examiner repeatability of cycloplegic retinoscopy in young children aged 4-5 years old. Examiner 1 refracted all children in the first sample (n = 108); firstly with masked loose lenses, then using unmasked loose lenses (intra-examiner repeatability). Examiners 1 and 2 refracted all children in the second sample (n = 97) using unmasked loose lenses, blind to the child's refractive error, presence/magnitude of habitual spectacle correction and to each other's findings (inter-examiner repeatability). Refractions were performed on one eye chosen at random. Mean differences, 95% limits of agreement (LOAs) and confidence intervals were calculated for intra- and inter-examiner repeatability of sphere, cylinder and spherical equivalent refraction (SER). Participants had a wide range of refractive errors (-1.50DS to +7.25DS; ≥4.50DC). Mean differences (95% LOAs) were small for both intra- and inter-examiner repeatability [Intra: Sphere 0.00D (-0.85, +0.85D), Cylinder -0.03D (-0.68, +0.62D), SER -0.06D (-0.90, +0.78D); Inter: Sphere -0.08D (-0.92, +0.76D), Cylinder -0.08D (-0.75, +0.59D), SER -0.13D (-0.95, +0.69D). A statistically significant proportional bias was present for intra-examiner repeatability of cylinder (ρ = 0.20, p = 0.04) and SER measurement (ρ = 0.19, p = 0.049). Proportional bias was not present for any other measure (p > 0.12). Examiners agreed on cylinder axis within ±20(°) in 71% of refractions where astigmatism of -0.75D or higher was present. 80% of intra- and inter-examiner measures fell within ±0.50D for spherical and cylindrical components. Differences of ±1.00D and ±0.75D or more for spherical and cylindrical measures respectively can be considered significant when performing cycloplegic retinoscopy on young children. © 2016 The Authors Ophthalmic & Physiological Optics © 2016 The College of Optometrists.

  19. Quantification of fluoroscopic imaging system contrast by using video waveform monitoring.

    PubMed

    Taubel, J P; Schueler, B A; Vrieze, T J; Gray, J E

    2001-01-01

    A noninvasive method was developed for quantifying the overall contrast of fluoroscopic imaging systems within the clinical setting by using a simple phantom and common video test equipment. In this method, an acrylic phantom with four holes filled with varying amounts of air and aluminum is placed on the entrance exposure side of a patient-equivalent acrylic phantom. The air- and aluminum-filled holes provide a stepped gray-scale pattern that is displayed on the examination room viewing monitor when the phantom is fluoroscopically imaged under automatic brightness control. A video waveform monitor or oscilloscope is then used to quantify those video signal voltage levels as a contrast index value, which is defined as the maximum range of the video signal voltage levels of the gray-scale steps. The method is repeatable and allows quantification of the contrast of the imaging system. It can also be used to optimize video parameters, provide comparative data for quality control monitoring, and characterize overall contrast differences between systems. Experience with this method suggests that there is excellent correlation between the clinical perception of image contrast and the contrast index, with contrast index changes of approximately 15% being seen clinically.

  20. Radiation injuries after fluoroscopic procedures.

    PubMed

    Mettler, Fred A; Koenig, Titus R; Wagner, Louis K; Kelsey, Charles A

    2002-10-01

    Fluoroscopically guided diagnostic and interventional procedures have become much more commonplace over the last decade. Current fluoroscopes are easily capable of producing dose rates in the range of 0.2 Gy (20 rads) per minute. The dose rate often changes dramatically with patient positioning and size. Most machines currently in use have no method to display approximate patient dose other than the rough surrogate of total fluoroscopy time. This does not include patient dose incurred during fluorography (serial imaging or cine runs), which can be considerably greater than dose during fluoroscopy. There have been over 100 cases of documented radiation skin and underlying tissue injury, a large portion of which resulted in dermal necrosis. The true number of injuries is undoubtedly much higher. The highest dose procedures are complex interventions such as those involving percutaneous angioplasties, stent placements, embolizations, and TIPS. In some cases skin doses have been in excess of 60 Gy (6000 rads). In many instances the procedures have been performed by physicians with little training in radiation effects, little appreciation of the radiation injuries that are possible or the strategies that could have been used to reduce both patient and staff doses. Almost all of the severe injuries that have occurred were avoidable.

  1. Evaluating construct equivalence and criterion-related validity for repeat examinees on a standardized patient examination.

    PubMed

    Raymond, Mark R; Kahraman, Nilufer; Swygert, Kimberly A; Balog, Kevin P

    2011-10-01

    Prior studies report large score gains for examinees who fail and later repeat standardized patient (SP) assessments. Although research indicates that score gains on SP exams cannot be attributed to memorizing previous cases, no studies have investigated the empirical validity of scores for repeat examinees. This report compares single-take and repeat examinees in terms of both internal (construct) validity and external (criterion-related) validity. Data consisted of test scores for examinees who took the United States Medical Licensing Examination Step 2 Clinical Skills (CS) exam between July 16, 2007, and September 12, 2009. The sample included 12,090 examinees who completed Step 2 CS on one occasion and another 4,030 examinees who completed the exam on two occasions. The internal measures included four separately scored performance domains of the Step 2 CS examination, whereas the external measures consisted of scores on three written assessments of medical knowledge (Step 1, Step 2 clinical knowledge, and Step 3). The authors subjected the four Step 2 CS domains to confirmatory factor analysis and evaluated correlations between Step 2 CS scores and the three written assessments for single-take and repeat examinees. The factor structure for repeat examinees on their first attempt was markedly different from the factor structure for single-take examinees, but it became more similar to that for single-take examinees by their second attempt. Scores on the second attempt correlated more highly with all three external measures. The findings support the validity of scores for repeat examinees on their second attempt.

  2. Re-examining repeated testing and teacher effects in a remedial mathematics course.

    PubMed

    Martinez, J G; Martinez, N C

    1992-11-01

    This study examined the impact of repeated testing and teachers' effects on student achievement in a remedial mathematics course. A 2 x 2 completely randomised factorial design was used, with final examination performance the dependent variable and testing attempts and the teacher factor the independent variables. The study found no main effects for teacher but a main effect for testing attempts and a teacher-factor/testing-attempt interaction. Post hoc findings qualified a direct interpretation of the main effect. The implications for further research and application are discussed, giving special attention to teacher effects, the needs of remedial mathematics instruction, and the claims of mastery-learning pedagogies.

  3. 21 CFR 1020.32 - Fluoroscopic equipment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... fluoroscopic image receptor using photographic film or a video camera when the x-ray source is operated in a...-hold feature that are not recorded. (C) When a mode of operation has an optional high-level control...

  4. Effectiveness of repeated examination to diagnose enterobiasis in nursery school groups.

    PubMed

    Remm, Mare; Remm, Kalle

    2009-09-01

    The aim of this study was to estimate the benefit from repeated examinations in the diagnosis of enterobiasis in nursery school groups, and to test the effectiveness of individual-based risk predictions using different methods. A total of 604 children were examined using double, and 96 using triple, anal swab examinations. The questionnaires for parents, structured observations, and interviews with supervisors were used to identify factors of possible infection risk. In order to model the risk of enterobiasis at individual level, a similarity-based machine learning and prediction software Constud was compared with data mining methods in the Statistica 8 Data Miner software package. Prevalence according to a single examination was 22.5%; the increase as a result of double examinations was 8.2%. Single swabs resulted in an estimated prevalence of 20.1% among children examined 3 times; double swabs increased this by 10.1%, and triple swabs by 7.3%. Random forest classification, boosting classification trees, and Constud correctly predicted about 2/3 of the results of the second examination. Constud estimated a mean prevalence of 31.5% in groups. Constud was able to yield the highest overall fit of individual-based predictions while boosting classification tree and random forest models were more effective in recognizing Enterobius positive persons. As a rule, the actual prevalence of enterobiasis is higher than indicated by a single examination. We suggest using either the values of the mean increase in prevalence after double examinations compared to single examinations or group estimations deduced from individual-level modelled risk predictions.

  5. Brain pathology after mild traumatic brain injury: an exploratory study by repeated magnetic resonance examination.

    PubMed

    Lannsjö, Marianne; Raininko, Raili; Bustamante, Mariana; von Seth, Charlotta; Borg, Jörgen

    2013-09-01

    To explore brain pathology after mild traumatic brain injury by repeated magnetic resonance examination. A prospective follow-up study. Nineteen patients with mild traumatic brain injury presenting with Glasgow Coma Scale (GCS) 14-15. The patients were examined on day 2 or 3 and 3-7 months after the injury. The magnetic resonance protocol comprised conventional T1- and T2-weighted sequences including fluid attenuated inversion recovery (FLAIR), two susceptibility-weighted sequences to reveal haemorrhages, and diffusion-weighted sequences. Computer-aided volume comparison was performed. Clinical outcome was assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Hospital Anxiety and Depression Scale (HADS) and Glasgow Outcome Scale Extended (GOSE). At follow-up, 7 patients (37%) reported ≥  3 symptoms in RPQ, 5 reported some anxiety and 1 reported mild depression. Fifteen patients reported upper level of good recovery and 4 patients lower level of good recovery (GOSE 8 and 7, respectively). Magnetic resonance pathology was found in 1 patient at the first examination, but 4 patients (21%) showed volume loss at the second examination, at which 3 of them reported < 3 symptoms and 1 ≥ 3 symptoms, all exhibiting GOSE scores of 8. Loss of brain volume, demonstrated by computer-aided magnetic resonance imaging volumetry, may be a feasible marker of brain pathology after mild traumatic brain injury.

  6. 21 CFR 1020.32 - Fluoroscopic equipment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... Radiation therapy simulation systems shall be exempt from this requirement provided the systems are intended... 10, 2006, other than radiation therapy simulation systems, the following applies: (A) Neither the... fluoroscopic equipment manufactured on or after June 10, 2006, other than radiation therapy simulation systems...

  7. 21 CFR 1020.32 - Fluoroscopic equipment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... Radiation therapy simulation systems shall be exempt from this requirement provided the systems are intended... 10, 2006, other than radiation therapy simulation systems, the following applies: (A) Neither the... fluoroscopic equipment manufactured on or after June 10, 2006, other than radiation therapy simulation systems...

  8. New Jersey's Thomas Edison and the fluoroscope.

    PubMed

    Tselos, G D

    1995-11-01

    Thomas Edison played a major role in the development of early x-ray technology in 1896, notably increasing tube power and reliability and making the fluoroscope a practical instrument. Eventually, Edison would move x-ray technology from the laboratory to the marketplace.

  9. A low-cost, durable, combined ultrasound and fluoroscopic phantom for cervical transforaminal injections.

    PubMed

    Lerman, Imanuel R; Souzdalnitski, Dmitri; Narouze, Samer

    2012-01-01

    This technical report describes a durable, low-cost, anatomically accurate, and easy-to-prepare combined ultrasound (US) and fluoroscopic phantom of the cervical spine. This phantom is meant to augment training in US- and fluoroscopic-guided pain medicine procedures. The combined US and fluoroscopic phantom (CUF-P) is prepared from commercially available liquid plastic that is ordinarily used to prepare synthetic fishing lures. The liquid plastic is heated and then poured into a metal canister that houses an anatomical cervical spine model. Drops of dark purple dye are added to make the phantom opaque. After cooling, tubing is attached to the CUF-P to simulate blood vessels. The CUF-P accurately simulates human tissue by imitating both the tactile texture of skin and the haptic resistance of human tissue as the needle is advanced. This phantom contains simulated fluid-filled vertebral arteries that exhibit pulsed flow under color Doppler US. Under fluoroscopic examination, the CUF-P-simulated vertebral arteries also exhibit uptake of contrast dye if mistakenly injected. The creation of a training phantom allows the pain physician to practice needle positioning technique while simultaneously visualizing both targeted and avoidable vascular structures under US and fluoroscopic guidance. This low-cost CUF-P is easy to prepare and is reusable, making it an attractive alternative to current homemade and commercially available phantom simulators.

  10. Fluoroscopically guided balloon dilation for benign bronchial stricture occurring after radiotherapy in patients with lung cancer.

    PubMed

    Cho, Young Chul; Kim, Jin Hyoung; Park, Jung-Hoon; Shin, Ji Hoon; Ko, Heung Kyu; Song, Ho-Young

    2014-06-01

    To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in patients with benign bronchial stricture occurring after radiotherapy (RT). From March 2002 to January 2013, ten patients with benign bronchial stricture occurring after RT underwent fluoroscopically guided balloon dilation as their initial treatment. Technical success, primary and secondary clinical success, improvement in respiratory status, and complications were evaluated. The symptomatic improvement period was calculated. A total of 15 balloon dilation sessions were performed in ten patients, with a range of 1-4 sessions per patient (mean 1.5 sessions). Technical success was achieved in 100 %. Six of the ten patients exhibited no symptom recurrence and required no further treatment until the end of follow-up (range 4-105 months). Four patients (40 %) experienced recurrent symptom, and two of four patients underwent repeat balloon dilations. The remaining two patients underwent cutting balloon dilation and temporary stent placement, respectively, and they exhibited symptom improvement after adjuvant treatment until the end of our study. Finally, primary clinical success was achieved in six of ten patients (60 %) and secondary clinical success was achieved in eight of ten patients (80 %). The mean symptom improvement period was 61.9 ± 16 months (95 % confidence interval 30.6-93.3). Fluoroscopically guided balloon dilation seems to be safe and clinically effective for the treatment of RT-induced benign bronchial stricture. Temporary stent placement or cutting balloon dilation could be considered in patients with benign bronchial strictures resistant to fluoroscopically guided balloon dilation.

  11. Spinal cord injury from fluoroscopically guided intercostal blocks with phenol.

    PubMed

    Kissoon, Narayan R; Graff-Radford, Jonathan; Watson, James C; Laughin, Ruple S

    2014-01-01

    Image guided intercostal blocks are commonly performed and considered relatively safe. Chemical denervation is commonly used in clinical practice for treatment of chronic non-cancer associated pain. To report a case of spinal cord injury resulting from fluoroscopically guided intercostal blocks with phenol. Case report. Inpatient hospital service. RESULTS/CASE REPORTS: A 53 year-old women was transferred from her local facility for acute onset of lower extremity paresis beginning shortly after right intercostal nerve injections of 2 mL of preservative-free phenol at the T7, 8, 9 levels. She had previous intercostal blocks for chronic right-sided mid thoracic/abdominal pain every 3 months for at least one year without sequelae. Within 20 minutes of the injection, she developed a sensation of right leg weakness and heaviness. Over several hours she developed worsening right leg weakness, and then left leg weakness, followed by urinary retention. Admission examination revealed severe right greater than left leg weakness, right lower extremity hyperesthesia to T10, absent lower extremity reflexes, and bilateral extensor plantar responses. Magnetic resonance imaging (MRI) of the entire spine demonstrated extensive T2/DWI hyperintensity in the central spinal cord from T1 to L1 with mild cord enlargement and enhancement at T7-9 (sites of injection). Extensive serum and cerebrospinal fluid (CSF) evaluation did not show any evidence of an infectious, inflammatory, or metabolic cause to her myelopathy. Repeat MRI of the entire spine demonstrated near complete resolution of the T2 signal abnormality. One month after presentation, despite radiographic improvement, the patient showed some clinical improvement, but remained walker dependent and with neurogenic bowel and bladder. This report describes a single case report. This case offers several lessons for a pain specialist including 1) the potential for a neurologic catastrophe (spinal cord injury) from aqueous neurolytic

  12. A new tool for benchmarking cardiovascular fluoroscopes.

    PubMed

    Balter, S; Heupler, F A; Lin, P J; Wondrow, M H

    2001-01-01

    This article reports the status of a new cardiovascular fluoroscopy benchmarking phantom. A joint working group of the Society for Cardiac Angiography and Interventions (SCA&I) and the National Electrical Manufacturers Association (NEMA) developed the phantom. The device was adopted as NEMA standard XR 21-2000, "Characteristics of and Test Procedures for a Phantom to Benchmark Cardiac Fluoroscopic and Photographic Performance," in August 2000. The test ensemble includes imaging field geometry, spatial resolution, low-contrast iodine detectability, working thickness range, visibility of moving targets, and phantom entrance dose. The phantom tests systems under conditions simulating normal clinical use for fluoroscopically guided invasive and interventional procedures. Test procedures rely on trained human observers.

  13. Fluoroscopic chest tube insertion and patient care.

    PubMed Central

    Collins, J. D.; Shaver, M. L.; Disher, A. C.; Miller, T. Q.

    1992-01-01

    Catheters and chest tubes may be placed under fluoroscopic control to reduce pleural effusions. This procedure has been adopted as a routine procedure at the UCLA School of Medicine in Los Angeles, California to improve patient care. This technique was modified for the placement of large chest tubes, which can be placed by a radiologist without multiple attempts or complications. Our experience with 2234 patients who underwent this procedure between 1977 and 1990 is described. PMID:1404463

  14. Fluoroscopic image-guided intervention system for transbronchial localization

    NASA Astrophysics Data System (ADS)

    Rai, Lav; Keast, Thomas M.; Wibowo, Henky; Yu, Kun-Chang; Draper, Jeffrey W.; Gibbs, Jason D.

    2012-02-01

    Reliable transbronchial access of peripheral lung lesions is desirable for the diagnosis and potential treatment of lung cancer. This procedure can be difficult, however, because accessory devices (e.g., needle or forceps) cannot be reliably localized while deployed. We present a fluoroscopic image-guided intervention (IGI) system for tracking such bronchoscopic accessories. Fluoroscopy, an imaging technology currently utilized by many bronchoscopists, has a fundamental shortcoming - many lung lesions are invisible in its images. Our IGI system aligns a digitally reconstructed radiograph (DRR) defined from a pre-operative computed tomography (CT) scan with live fluoroscopic images. Radiopaque accessory devices are readily apparent in fluoroscopic video, while lesions lacking a fluoroscopic signature but identifiable in the CT scan are superimposed in the scene. The IGI system processing steps consist of: (1) calibrating the fluoroscopic imaging system; (2) registering the CT anatomy with its depiction in the fluoroscopic scene; (3) optical tracking to continually update the DRR and target positions as the fluoroscope is moved about the patient. The end result is a continuous correlation of the DRR and projected targets with the anatomy depicted in the live fluoroscopic video feed. Because both targets and bronchoscopic devices are readily apparent in arbitrary fluoroscopic orientations, multiplane guidance is straightforward. The system tracks in real-time with no computational lag. We have measured a mean projected tracking accuracy of 1.0 mm in a phantom and present results from an in vivo animal study.

  15. Fluoroscopic tomography. [for body section synthesis

    NASA Technical Reports Server (NTRS)

    Baily, N. A.; Crepeau, R. L.; Lasser, E. C.

    1974-01-01

    A fluoroscopic tomography system capable of synthesizing body sections at a number of levels within the body has been developed. The synthesized body sections may lie either in a range of planes parallel to, tilted with respect to, skewed with respect to, or both tilted and skewed with respect to the plane of motion of the X-ray tube target. In addition, body sections can be presented which are contoured to the patient's anatomy. That is to say, they may even encompass such complex surfaces as a quadratic hyperplane. In addition, tomograms of organs in motion can be imaged.

  16. Relationship between fluoroscopic time, dose-area product, body weight, and maximum radiation skin dose in cardiac interventional procedures.

    PubMed

    Chida, Koichi; Saito, Haruo; Otani, Hiroki; Kohzuki, Masahiro; Takahashi, Shoki; Yamada, Shogo; Shirato, Kunio; Zuguchi, Masayuki

    2006-03-01

    Real-time maximum dose monitoring of the skin is unavailable on many of the X-ray machines that are used for cardiac intervention procedures. Therefore, some reports have recommended that physicians record the fluoroscopic time for patients undergoing fluoroscopically guided intervention procedures. However, the relationship between the fluoroscopic time and the maximum radiation skin dose is not clear. This article describes the correlation between the maximum radiation skin dose and fluoroscopic time for patients undergoing cardiac intervention procedures. In addition, we examined whether the correlations between maximum radiation skin dose and body weight, fluoroscopic time, and dose-area product (DAP) were useful for estimating the maximum skin dose during cardiac intervention procedures. Two hundred consecutive cardiac intervention procedures were studied: 172 percutaneous coronary interventions and 28 cardiac radiofrequency catheter ablation (RFCA) procedures. The patient skin dose and DAP were measured using Caregraph with skin-dose-mapping software. For the RFCA procedures, we found a good correlation between the maximum radiation skin dose and fluoroscopic time (r = 0.801, p < 0.0001), whereas we found a poor correlation between the maximum radiation skin dose and fluoroscopic time for the percutaneous coronary intervention procedures (r = 0.628, p < 0.0001). There was a strong correlation between the maximum radiation skin dose and DAP in RFCA procedures (r = 0.942, p < 0.0001). There was also a significant correlation between the maximum radiation skin dose and DAP (r = 0.724, p < 0.0001) and weight-fluoroscopic time product (WFP) (r = 0.709, p < 0.0001) in percutaneous coronary intervention procedures. The correlation between the maximum radiation skin dose with DAP is more striking than that with fluoroscopic time in both RFCA and percutaneous coronary intervention procedures. We recommend that physicians record the DAP when it can be monitored and

  17. [Repeatability and reliability of the visual acuity examination on logMAR ETDRS and Snellen chart].

    PubMed

    Veselý, P; Synek, S

    2012-05-01

    The main goal of our study was to prove the statistical significant correlation between repeated measurements and test-retest variability TRV expressed with confidence interval CI according to Bland-Altman's method on 95% level of statistical confidence. The methods are threshold interpolation logMAR method on ETDRS chart, whole-line method on Snellen chart and modified threshold interpolation method on Snellen chart with Sloan letters. We had 468 measurements measured with threshold interpolation log MAR method on ETDRS chart, whole-line method on Snellen chart and modified threshold interpolation method on Snellen chart with Sloan letters. The average value of the first sequence of measurements measured with whole-line method on Snellen chart was -0.043 logMAR (min. 1, max. -0.30. SD 0.25) and of the second sequence of measurements was -0.045 logMAR (min. 1, max. -0.30. SD 0.23). The average value of the first sequence of measurements measured with interpolation method on Snellen chart was -0.018 logMAR (min. 0.98, max. -0.30. SD 0.29) and of the second sequence of measurements was -0.024 logMAR (min. 1, max. -0.80. SD 0.29). The average value of the first sequence of measurements measured with interpolation method on ETDRS chart was -0.0612 logMAR (min. 0.72, max. -0.30. SD 0.21) and of the second sequence of measurements was -0.0610 log MAR (min. 0.8, max. -0.28, SD 0.21). We have proved that all methods do not have statistical significant difference between repeated measurements (Wilcoxon paired test, whole-line method on Snellen chart p = 0.74, interpolation method on Snellen chart p = 0.33 and interpolation method on ETDRS p = 0.95) and they also have statistical significant correlations (Spearman correlation coefficient, whole-line method on Snellen chart r = 0.91, p < 0.0001, interpolation method on Snellen chart r = 0.89, p < 0.0001 and interpolation method on ETDRS chart r = 0.89, p < 0.0001). TRV expressed with CI on 95% statistical significance level

  18. Time-Dependent Inner Core Structures Examined by Repeating Earthquakes in the Southwest Pacific Subduction Zones

    NASA Astrophysics Data System (ADS)

    Yu, W. C.

    2014-12-01

    Time-dependent inner core structure is interpreted as differential rotation of the Earth's inner core. This inference is made on the basis of variations deviated from an isotropic and homogeneous inner core structure and the amount of velocity perturbations progressively evolving as a function of calendar time. Most compelling evidences for inner core rotation come from the inner core structures beneath Colombia and Venezuela, characterized by strong anisotropy and lateral variation, for the South Sandwich Islands earthquakes recorded by College (COL) and other seismic stations in Alaska. Repeating earthquakes with highly similar waveforms can minimize the potential artifacts due to inter-event separation and unknown short-scale mantle heterogeneities, and can acquire robust measurement of time shift due to temporal change of inner core structures. Moderate repeating earthquake sequences (RES) in the Tonga-Kermadec-Vanuatu in the southwest Pacific subduction zones are studied over a 20-year time window between 1990 and 2009. I select 13 RES consisting of two or three events with time separation of 2 - 14.4 years and analyze the PKiKP-PKPdf, PKPbc-PKPdf, and PKPab-PKPdf phase pairs recorded by the European, African, and central Asian stations sampling the eastern hemisphere of the inner core. I measure the double differential time of the phase pairs using waveform cross-correlation. Majority of the double differential time measurements within ±50 millisecond can largely be explained by the time shift due to inter-event distance on the order of hundreds of meters or less and null change of the PKPdf phase. These observations indicate inner core structures in the eastern hemisphere are uniform and probably insensitive to motion of the inner core.

  19. Reproducibility of Brain Morphometry from Short-Term Repeat Clinical MRI Examinations: A Retrospective Study

    PubMed Central

    Liu, Hon-Man; Chen, Shan-Kai; Chen, Ya-Fang; Lee, Chung-Wei; Yeh, Lee-Ren

    2016-01-01

    Purpose To assess the inter session reproducibility of automatic segmented MRI-derived measures by FreeSurfer in a group of subjects with normal-appearing MR images. Materials and Methods After retrospectively reviewing a brain MRI database from our institute consisting of 14,758 adults, those subjects who had repeat scans and had no history of neurodegenerative disorders were selected for morphometry analysis using FreeSurfer. A total of 34 subjects were grouped by MRI scanner model. After automatic segmentation using FreeSurfer, label-wise comparison (involving area, thickness, and volume) was performed on all segmented results. An intraclass correlation coefficient was used to estimate the agreement between sessions. Wilcoxon signed rank test was used to assess the population mean rank differences across sessions. Mean-difference analysis was used to evaluate the difference intervals across scanners. Absolute percent difference was used to estimate the reproducibility errors across the MRI models. Kruskal-Wallis test was used to determine the across-scanner effect. Results The agreement in segmentation results for area, volume, and thickness measurements of all segmented anatomical labels was generally higher in Signa Excite and Verio models when compared with Sonata and TrioTim models. There were significant rank differences found across sessions in some labels of different measures. Smaller difference intervals in global volume measurements were noted on images acquired by Signa Excite and Verio models. For some brain regions, significant MRI model effects were observed on certain segmentation results. Conclusions Short-term scan-rescan reliability of automatic brain MRI morphometry is feasible in the clinical setting. However, since repeatability of software performance is contingent on the reproducibility of the scanner performance, the scanner performance must be calibrated before conducting such studies or before using such software for retrospective

  20. The Role of Teacher Trust in Segregated Elementary Schools: A Multilevel Repeated Measures Examination

    ERIC Educational Resources Information Center

    Dewulf, Lisa; van Braak, Johan; Van Houtte, Mieke

    2017-01-01

    This study aims to investigate how teachers' trust in their students relates to reading comprehension achievement in socially and ethnically segregated elementary schools in Flanders (Belgium) by taking into account class composition characteristics. It is examined how student variables, ethnic diversity and the proportion of non-native students…

  1. Lower radiation burden in state of the art fluoroscopic cystography compared to direct isotope cystography in children.

    PubMed

    Haid, Bernhard; Becker, Tanja; Koen, Mark; Berger, Christoph; Langsteger, Werner; Gruy, Bernhard; Putz, Ernst; Haid, Stephanie; Oswald, Josef

    2015-02-01

    filling until calculated bladder capacity, mean radiation burden accounted to .07 mSv (median 0.07 mSv) and the values were less scattered. As it had to be expected from literature, radiation dose from fVCUG, if modern image acquisition techniques are used, is even less than from DIC. In our protocol, according to nuclear medicine standards, bladders were filled until calculated capacity. This resulted in a longer examination time for the patients with a higher functional capacity, resulting in relatively higher radiation burden. However, also if the protocol is changed or only the patients with relatively fast bladder emptying are considered, radiation burden conferred by DIC is higher (at least × 2.9, comparing the "worst" case for fVCUG with the "best" case for DIC). Absolute radiation burden conferred by either exam is extremely low compared to other medical radiation exposures as well as to environmental radiation. Consequently it is most probably not relevant for the individual childs future risk for cancer or other radiation damage. However, because of repeated investigations with correspondingly higher radiation burden in this patient group the ALARA (as low as reasonably achievable) principle should lead to a optimized use of fVCUG rather than an uncritical use of DIC, given that modern acquisition standards are available and radiation measurement is performed. Also, fVCUG provides more information concerning anatomical details compared to DIC. Contrary to common beliefs, effective radiation dose conferred during fluoroscopic voiding cystourethrography is significantly lower than during direct isotope cystography. The prerequisite for our findings, however, is the use of modern image acquisition tools and an optimized protocol. Both exams confer low radiation doses probably only relevant to children undergoing repeated radiation exposure. Nevertheless, this findings should be considered in indication for either exam in order to reduce the radiation burden to a

  2. FLUOROSCOPIC EVALUATION OF ORO-PHARYNGEAL DYSPHAGIA: ANATOMY, TECHNIQUE, AND COMMON ETIOLOGIES

    PubMed Central

    Edmund, Dr; Au, Frederick Wing-Fai; Steele, Catriona M.

    2015-01-01

    Target Audience Radiologists and other professionals involved in imaging of oropharyngeal swallowing Objectives To review anatomy of the upper GI tract To review techniques and contrast agents used in the fluoroscopic examination of the oropharynx and hypopharynx To provide a pictorial review of some important causes of oropharyngeal dysphagia, and to link these to key findings in the clinical history to assist in establishing a clinical diagnosis To provide self-assessment questions to reinforce key learning points PMID:25539237

  3. Fluoroscopic-guided lumbar puncture: fluoroscopic time and implications of body mass index--a baseline study.

    PubMed

    Boddu, S R; Corey, A; Peterson, R; Saindane, A M; Hudgins, P A; Chen, Z; Wang, X; Applegate, K E

    2014-08-01

    Fluoroscopic-guided lumbar puncture is an effective alternative to bedside lumbar puncture in challenging patients. However, no published guidelines are available for an acceptable range of fluoroscopic time for this procedure. The purpose of this study was to set department benchmark fluoroscopic times for lumbar puncture, accounting for body mass index in our patient population. We identified and reviewed all patients who underwent fluoroscopic-guided lumbar puncture at 4 hospitals during a 2-year period (July 2011 to June 2013). Data collection included patient information (demographics, body mass index, history of prior lumbar surgery and/or lumbar hardware, scoliosis); procedure details (fluoroscopic time, level of access, approach, needle gauge and length); level of operator experience; and hospital site. A generalized linear model was used to test whether body mass index influenced fluoroscopic time while controlling other factors. Five hundred eighty-four patients (mean age, 47.8 ± 16.2 years; range, 16-92 years; 33% male) had successful fluoroscopic-guided lumbar puncture s. Mean body mass index and fluoroscopic time were higher in female patients (34.4 ± 9.9 kg/m(2) and 1.07 minutes; 95% CI, 0.95-1.20) than in male patients (29.2 ± 7.3 kg/m(2) and 0.91 minutes; 95% CI, 0.79-1.03). Body mass index (P = .001), hospital site (P < .001), and level of experience (P = .03) were factors significantly affecting fluoroscopic time on multivariate analysis. Benchmark fluoroscopic times in minutes were the following: 0.48 (95% CI, 0.40-0.56) for normal, 0.61 for overweight (95% CI, 0.52-0.71), 0.63(95% CI, 0.58-0.73) for obese, and 0.86 (95% CI, 0.74-1.01) in extremely obese body mass index categories. In patients undergoing fluoroscopic-guided lumbar punctures, fluoroscopy time increased with body mass index We established benchmark fluoroscopic-guided lumbar puncture time ranges as related to body mass index in our patient population. © 2014 by American Journal

  4. Is there a link between preoperative fluoroscopic cough stress testing and synthetic midurethral tape outcome?

    PubMed

    Zacchè, Martino Maria; Giarenis, Ilias; Thiagamoorthy, Ganesh; Robinson, Dudley; Cardozo, Linda

    2015-10-01

    The primary aim of our study was to assess the utility of fluoroscopic cough stress testing as a predictor of synthetic midurethral tape (MUT) outcome. The secondary aim was to examine whether baseline demographics, clinical symptoms and urodynamic variables could predict MUT success. We carried out a retrospective study including women with stress urinary incontinence (SUI) who underwent retropubic MUT in a tertiary referral urogynaecology unit. We excluded cases where concurrent pelvic organ prolapse surgery was performed. Patients were subdivided into groups based on the pre-operative fluoroscopic cough stress testing, using Blaivas and Versi classifications. Subjective outcome was evaluated at 6 weeks based on self-reported SUI in the symptom domain of the King's Health Questionnaire. Logistic regression models were used to identify predictors of treatment success. 143 patients were included in the study. Blaivas and Versi classifications were not useful in predicting subjective success (p=0.44 and p=0.40, respectively). Baseline demographics, clinical and other urodynamic variables failed to predict subjective outcome. Fluoroscopic cough stress testing is not a useful predictor of MUT outcome. No preoperative variables have been found to predict MUT success. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Fluoroscopic tumor tracking for image-guided lung cancer radiotherapy

    NASA Astrophysics Data System (ADS)

    Lin, Tong; Cerviño, Laura I.; Tang, Xiaoli; Vasconcelos, Nuno; Jiang, Steve B.

    2009-02-01

    Accurate lung tumor tracking in real time is a keystone to image-guided radiotherapy of lung cancers. Existing lung tumor tracking approaches can be roughly grouped into three categories: (1) deriving tumor position from external surrogates; (2) tracking implanted fiducial markers fluoroscopically or electromagnetically; (3) fluoroscopically tracking lung tumor without implanted fiducial markers. The first approach suffers from insufficient accuracy, while the second may not be widely accepted due to the risk of pneumothorax. Previous studies in fluoroscopic markerless tracking are mainly based on template matching methods, which may fail when the tumor boundary is unclear in fluoroscopic images. In this paper we propose a novel markerless tumor tracking algorithm, which employs the correlation between the tumor position and surrogate anatomic features in the image. The positions of the surrogate features are not directly tracked; instead, we use principal component analysis of regions of interest containing them to obtain parametric representations of their motion patterns. Then, the tumor position can be predicted from the parametric representations of surrogates through regression. Four regression methods were tested in this study: linear and two-degree polynomial regression, artificial neural network (ANN) and support vector machine (SVM). The experimental results based on fluoroscopic sequences of ten lung cancer patients demonstrate a mean tracking error of 2.1 pixels and a maximum error at a 95% confidence level of 4.6 pixels (pixel size is about 0.5 mm) for the proposed tracking algorithm.

  6. Prediction of fluoroscopic angulations for transcatheter aortic valve implantation by CT angiography: influence on procedural parameters.

    PubMed

    Hell, Michaela M; Biburger, Lukas; Marwan, Mohamed; Schuhbaeck, Annika; Achenbach, Stephan; Lell, Michael; Uder, Michael; Arnold, Martin

    2017-05-01

    Repeated angiograms to achieve an exactly orthogonal visualization of the aortic valve plane can substantially contribute to the total contrast amount required for transcatheter aortic valve implantation (TAVI). We investigated whether pre-procedural identification of an optimal fluoroscopic projection by cardiac computed tomography (CT) can significantly reduce the amount of a procedure-related contrast agent compared with angiographic determination of suitable angulations. Eighty consecutive patients (81 ± 5 years, 55% male) with symptomatic severe aortic valve stenosis and normal renal function who underwent cardiac CT prior to TAVI were prospectively randomized. In 40 patients, a CT-predicted suitable angulation was used for the first aortic angiogram (CT cohort); in the other 40 patients, the first aortogram was acquired at LAO 10°/cranial 10 (angiography cohort). Additional aortograms were performed if no satisfactory view of the aortic valve plane was obtained. The number of aortograms needed to achieve a satisfactory fluoroscopic projection (1.2 ± 0.6 vs. 3.2 ± 1.7; P < 0.001) and the total amount of contrast agent per TAVI procedure were significantly lower in the CT cohort (95 ± 21 vs. 125 ± 36 mL; P < 0.001). Incidence of acute kidney injury was not significantly different. There was no significant difference regarding radiation dose, time of procedure, degree of post-procedural aortic regurgitation, complications and 30-day mortality between the cohorts. Pre-procedural identification of a suitable fluoroscopic projection by cardiac CT significantly reduces a procedural contrast agent volume required for TAVI.

  7. Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study

    PubMed Central

    Winkelman, Chris; Johnson, Kimberly D.; Hejal, Rana; Gordon, Nahida H.; Rowbottom, James; Daly, Janis; Peereboom, Karen; Levine, Alan D.

    2013-01-01

    Summary Background Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol. We examined the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes. Methods Prospective, repeated measures study with a control (standard care) and intervention (protocol) period. Results 75 heterogeneous subjects admitted to a Medical or Surgical intensive care unit (ICU) were enrolled. In <5% of exercise periods, there was a concerning alteration in respiratory rate or peripheral oxygen saturation; no other adverse events occurred. Findings suggested the use of a protocol with one 20 minute episode of exercise daily for 2 or more days reduced ICU length of stay. Duration of exercise was linked to increased IL-10, suggesting brief episodes of low intensity exercise positively altered inflammatory dysregulation in this sample. Conclusion A growing body of evidence demonstrates that early, progressive exercise has significant benefits to intubated adults. These results should encourage clinicians to add mobility protocols to the care of ICU adults and lead to future studies to determine optimal “dosing” of exercise in ICU patients. PMID:22458998

  8. The value of the repeated examination of BRAF V600E mutation status in diagnostics of papillary thyroid cancer.

    PubMed

    Beiša, Augustas; Beiša, Virgilijus; Stoškus, Mindaugas; Ostanevičiūtė, Elvyra; Griškevičius, Laimonas; Strupas, Kęstutis

    2016-01-01

    Nodular thyroid disease is one of the most frequently diagnosed pathologies of the adult population in iodine-deficient regions. Approximately 30% of thyroid aspirates are classified as nondiagnostic/unsatisfactory or indeterminate. However, patients with indeterminate cytology still undergo surgery. The object of this study was to determine the diagnostic value of re-examining the BRAF V600E mutation in papillary thyroid carcinoma patients. All patients underwent ultrasound guided fine-needle aspiration of a thyroid nodule. They were assigned to one of the four groups (indeterminate or positive for malignant cells) of the Bethesda System for Reporting Thyroid Cytopathology. Genetic investigation of the BRAF V600E mutation was performed for all of the fine-needle aspiration cytology specimens. All of the patients underwent surgery. Subsequently, histological investigation of the removed tissues was performed. Additional analysis of the BRAF V600E mutation from the histology specimen was then performed for the initially BRAF-negative cases. Two hundred and fourteen patients were involved in the study. One hundred and six (49.53%) patients were diagnosed with thyroid cancer. Of these 106 patients, 95 (89.62%) patients were diagnosed with papillary thyroid cancer. The BRAF V600E mutation was positive in 62 (65.26%) and negative in 33 (34.74%) histologically confirmed papillary thyroid cancer cases. After the genetic investigation, a total of 74 (77.89%) papillary thyroid cancer cases were positive for the BRAF V600E mutation and 21 (22.11%) were negative. Repeated examination of the BRAF V600E mutation status in the fine-needle aspiration may potentially increase the sensitivity of papillary thyroid cancer diagnostics.

  9. 21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Image-intensified fluoroscopic x-ray system. 892... fluoroscopic x-ray system. (a) Identification. An image-intensified fluoroscopic x-ray system is a device intended to visualize anatomical structures by converting a pattern of x-radiation into a visible image...

  10. 21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Non-image-intensified fluoroscopic x-ray system... fluoroscopic x-ray system. (a) Identification. A non-image-intensified fluoroscopic x-ray system is a device... of x-radiation into a visible image. This generic type of device may include signal analysis and...

  11. Simulation system for understanding the lag effect in fluoroscopic images.

    PubMed

    Tanaka, Rie; Kawashima, Hiroki; Ichikawa, Katsuhiro; Matsubara, Kosuke; Iida, Hiroji; Sanada, Shigeru

    2013-07-01

    Real-time tumor tracking in external radiotherapy can be achieved by diagnostic (kV) X-ray imaging with a dynamic flat-panel detector (FPD). It is crucial to understand the effects of image lag for real-time tumor tracking. Our purpose in this study was to develop a lag simulation system based on the image lag properties of an FPD system. Image lag properties were measured on flat-field images both in direct- and indirect-conversion dynamic FPDs. A moving target with image lag was simulated based on the lag properties in all combinations of FPD types, imaging rates, exposure doses, and target speeds, and then compared with actual moving targets for investigation of the reproducibility of image lag. Image lag was simulated successfully and agreed well with the actual lag as well as with the predicted effect. In the indirect-conversion FPD, a higher dose caused greater image lag on images. In contrast, there were no significant differences among dose levels in a direct-conversion FPD. There were no relationships between target speed and amount of image blurring in either type of FPD. The maximum contour blurring and the rate of increase in pixel value due to image lag were 1.1 mm and 10.0 %, respectively, in all combinations of imaging parameters examined in this study. Blurred boundaries and changes in pixel value due to image lag were estimated under various imaging conditions with use of the simulation system. Our system would be helpful for a better understanding of the effects of image lag in fluoroscopic images.

  12. Repeated mappings of arm veins by physical examination: role of nephrologists in the selection of suitable veins for AV fistula surgery.

    PubMed

    Nguyen, Vo D; Griffith, Chris N

    2017-03-21

    Multidisciplinary team work is important for a successful hemodialysis vascular access program. The authors present a clinical case to illustrate the potential dynamic factors that can affect vein sizes, independent from the operators' skills and experiences. Therefore, if the first examination fails to detect suitable veins, repeated examinations of arm veins by nephrologists during routine office visits may greatly assist the surgeons in the selection of suitable arm veins for arteriovenous fistula surgery.

  13. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

    PubMed Central

    Herz-Ruelas, Maira Elizabeth; Gómez-Flores, Minerva; Moxica-del Angel, Joaquín; Miranda-Maldonado, Ivett; Gutiérrez-Villarreal, Ilse Marilú; Villarreal-Rodríguez, Adriana Orelia

    2014-01-01

    Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time. PMID:25276441

  14. A novel marker enhancement filter (MEF) for fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Peshko, Olesya; Davidson, Timothy N.; Modersitzki, Jan; Terlaky, Tamás; Moseley, Douglas J.

    2014-03-01

    To enhance the measurements of radio-opaque cylindrical fiducial markers in low contrast x-ray and fluoroscopic images, a novel nonlinear marker enhancement filter (MEF) has been designed. It was primarily developed to assist in automatic initialization of a tracking procedure for intra-fraction organ motion analysis in fluoroscopic sequences. Conventional procedures were not able to provide sufficient improvement due to the complications of noise, small marker size, cylindrical shape and multiple orientations, intensity variations of the background, and the presence of overlaying anatomical measurements in this application. The proposed MEF design is based on the principles of linear scale space. It includes measures that assess the probability of each pixel to belong to a marker measurement, morphological operations, and a novel contrast enhancement function for standardization of the filter output. The MEF was tested on fluoroscopic images of two phantoms and three prostate patients, and was shown to perform better or comparable to the existing filters in terms of marker enhancement and background suppression, while performing significantly better in marker shape preservation.

  15. Automated quantification of lumbar vertebral kinematics from dynamic fluoroscopic sequences

    NASA Astrophysics Data System (ADS)

    Camp, Jon; Zhao, Kristin; Morel, Etienne; White, Dan; Magnuson, Dixon; Gay, Ralph; An, Kai-Nan; Robb, Richard

    2009-02-01

    We hypothesize that the vertebra-to-vertebra patterns of spinal flexion and extension motion of persons with lower back pain will differ from those of persons who are pain-free. Thus, it is our goal to measure the motion of individual lumbar vertebrae noninvasively from dynamic fluoroscopic sequences. Two-dimensional normalized mutual information-based image registration was used to track frame-to-frame motion. Software was developed that required the operator to identify each vertebra on the first frame of the sequence using a four-point "caliper" placed at the posterior and anterior edges of the inferior and superior end plates of the target vertebrae. The program then resolved the individual motions of each vertebra independently throughout the entire sequence. To validate the technique, 6 cadaveric lumbar spine specimens were potted in polymethylmethacrylate and instrumented with optoelectric sensors. The specimens were then placed in a custom dynamic spine simulator and moved through flexion-extension cycles while kinematic data and fluoroscopic sequences were simultaneously acquired. We found strong correlation between the absolute flexionextension range of motion of each vertebra as recorded by the optoelectric system and as determined from the fluoroscopic sequence via registration. We conclude that this method is a viable way of noninvasively assessing twodimensional vertebral motion.

  16. Examination of the effect of the annealing cation on higher order structures containing guanine or isoguanine repeats

    PubMed Central

    Pierce, Sarah E.; Wang, Junmei; Jayawickramarajah, Janarthanan; Hamilton, Andrew D.; Brodbelt, Jennifer S.

    2010-01-01

    Isoguanine (2-oxo-6-amino-guanine), a natural but non-standard base, exhibits unique self-association properties compared to its isomer, guanine, and results in formation of different higher order DNA structures. In this work, the higher order structures formed by oligonucleotides containing guanine repeats or isoguanine repeats after annealing in solutions containing various cations are evaluated by electrospray ionization mass spectrometry (ESI-MS) and circular dichroism (CD) spectroscopy. The guanine-containing strand (G9) consistently formed quadruplexes upon annealing, whereas the isoguanine strand (Ig9) formed both pentaplexes and quadruplexes depending on the annealing cation. Quadruplex formation with G9 showed some dependence on the identity of the cation present during annealing with high relative quadruplex formation detected with six of ten cations. Analogous annealing experiments with Ig9 resulted in complex formation with all ten cations, and the majority of the resulting complexes were pentaplexes. CD results indicated most of the original complexes survived the desalting process necessary for ESI-MS analysis. In addition, several complexes, especially the pentaplexes, were found to be capable of cation exchange with ammonium ions. Ab initio calculations were conducted for isoguanine tetrads and pentads coordinated with all ten cations to predict the most energetically stable structures of the complexes in the gas phase. The observed preference of forming quadruplexes versus pentaplexes as a function of the coordinated cation can be interpreted by the calculated reaction energies of both the tetrads and pentads in combination with the distortion energies of tetrads. PMID:19746468

  17. A Re-Examination of the Mere Exposure Effect: The Influence of Repeated Exposure on Recognition, Familiarity, and Liking.

    PubMed

    Montoya, R Matthew; Horton, Robert S; Vevea, Jack L; Citkowicz, Martyna; Lauber, Elissa A

    2017-03-06

    To evaluate the veracity of models of the mere exposure effect and to understand the processes that moderate the effect, we conducted a meta-analysis of the influence of repeated exposure on liking, familiarity, recognition, among other evaluations. We estimated parameters from 268 curve estimates drawn from 81 articles and revealed that the mere exposure effect was characterized by a positive slope and negative quadratic effect consistent with an inverted-U shaped curve. In fact, such curves were associated with (a) all visual, but not auditory stimuli; (b) exposure durations shorter than 10 s and longer than 1 min; (c) both homogeneous and heterogeneous presentation types; and (d) ratings that were taken after all stimuli were presented. We conclude that existing models for the mere exposure effect do not adequately account for the findings, and we provide a framework to help guide future research. (PsycINFO Database Record

  18. Repeated versus wide reading: A randomized control design study examining the impact of fluency interventions on underlying reading behavior.

    PubMed

    Ardoin, Scott P; Binder, Katherine S; Foster, Tori E; Zawoyski, Andrea M

    2016-12-01

    Repeated readings (RR) has garnered much attention as an evidence based intervention designed to improve all components of reading fluency (rate, accuracy, prosody, and comprehension). Despite this attention, there is not an abundance of research comparing its effectiveness to other potential interventions. The current study presents the findings from a randomized control trial study involving the assignment of 168second grade students to a RR, wide reading (WR), or business as usual condition. Intervention students were provided with 9-10weeks of intervention with sessions occurring four times per week. Pre- and post-testing were conducted using Woodcock-Johnson III reading achievement measures (Woodcock, McGrew, & Mather, 2001, curriculum-based measurement (CBM) probes, measures of prosody, and measures of students' eye movements when reading. Changes in fluency were also monitored using weekly CBM progress monitoring procedures. Data were collected on the amount of time students spent reading and the number of words read by students during each intervention session. Results indicate substantial gains made by students across conditions, with some measures indicating greater gains by students in the two intervention conditions. Analyses do not indicate that RR was superior to WR. In addition to expanding the RR literature, this study greatly expands research evaluating changes in reading behaviors that occur with improvements in reading fluency. Implications regarding whether schools should provide more opportunities to repeatedly practice the same text (i.e., RR) or practice a wide range of text (i.e., WR) are provided. Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  19. Is strength of handedness reliable over repeated testing? An examination of typical development and autism spectrum disorder

    PubMed Central

    Scharoun, Sara M.; Bryden, Pamela J.

    2015-01-01

    Despite a lack of agreement concerning the age at which adult-like patterns of handedness emerge, it is generally understood that hand preference presents early in life and development is variable. Young children (ages 3–5 years) are described as having weak hand preference; however, older children (ages 7–10 years) display stronger patterns. Here, strength of hand preference refers to reliable use of the preferred hand. In comparison to their typically developing (TD) peers, individuals with autism spectrum disorder (ASD) are described as having a weak hand preference. This study aimed to extend the literature to assess three measures of handedness (Waterloo Handedness Questionnaire – WHQ, Annett pegboard – AP, and WatHand Cabinet Test – WHCT) in two repeated sessions. The first research question aimed to delineate if the strength of hand use changes across testing sessions as a function of age in typical development. Right-handed children reported a reliable preference for the right hand on the WHQ, similar to adults. A marginally significant difference was revealed between 3- to 4- and 5- to 6-year-olds on the AP. This was attributed to weak lateralization in 3- to 4-year-olds, where the establishment of hand preference by age 6 leads to superior performance with the preferred hand in 5- to 6-year-olds. Finally, for the WHCT, 3- to 4-year-olds had the highest bimanual score, indicating use of the same hand to lift the cabinet door and retrieve an object. It is likely that the task was not motorically complex enough to drive preferred hand selection for older participants. The second research question sought to determine if there is difference between (TD) children and children with ASD. No differences were revealed; however, children with ASD did display variable AP performance, providing partial support for previous literature. Findings will be discussed in light of relevant literature. PMID:25691875

  20. Three-dimensional curvilinear device reconstruction from two fluoroscopic views

    NASA Astrophysics Data System (ADS)

    Delmas, Charlotte; Berger, Marie-Odile; Kerrien, Erwan; Riddell, Cyril; Trousset, Yves; Anxionnat, René; Bracard, Serge

    2015-03-01

    In interventional radiology, navigating devices under the sole guidance of fluoroscopic images inside a complex architecture of tortuous and narrow vessels like the cerebral vascular tree is a difficult task. Visualizing the device in 3D could facilitate this navigation. For curvilinear devices such as guide-wires and catheters, a 3D reconstruction may be achieved using two simultaneous fluoroscopic views, as available on a biplane acquisition system. The purpose of this paper is to present a new automatic three-dimensional curve reconstruction method that has the potential to reconstruct complex 3D curves and does not require a perfect segmentation of the endovascular device. Using epipolar geometry, our algorithm translates the point correspondence problem into a segment correspondence problem. Candidate 3D curves can be formed and evaluated independently after identifying all possible combinations of compatible 3D segments. Correspondence is then inherently solved by looking in 3D space for the most coherent curve in terms of continuity and curvature. This problem can be cast into a graph problem where the most coherent curve corresponds to the shortest path of a weighted graph. We present quantitative results of curve reconstructions performed from numerically simulated projections of tortuous 3D curves extracted from cerebral vascular trees affected with brain arteriovenous malformations as well as fluoroscopic image pairs of a guide-wire from both phantom and clinical sets. Our method was able to select the correct 3D segments in 97.5% of simulated cases thus demonstrating its ability to handle complex 3D curves and can deal with imperfect 2D segmentation.

  1. Examination of a novel head-stalk protein family in Giardia lamblia characterised by the pairing of ankyrin repeats and coiled-coil domains.

    PubMed

    Elmendorf, Heidi G; Rohrer, Sally C; Khoury, Rasha S; Bouttenot, Rachel E; Nash, Theodore E

    2005-08-01

    The intestinal pathogen Giardia lamblia possesses several unusual organelle features, including two equivalent nuclei, no mitochondria or peroxisomes, and a developmentally regulated rough endoplasmic reticulum and Golgi. Giardia also possesses a number of complex and unique cytoskeleton structures that dictate cell shape, motility and attachment. Our investigations of cytoskeletal proteins have revealed the presence of a new protein family. Proteins in this family contain both ankyrin repeats and coiled-coil domains; although these are common protein motifs, their pairing is unique, thus establishing a new class of head-stalk proteins. Examination of the G. lamblia genome shows evidence for at least 18 genes coding for proteins with a series of ankyrin repeats followed by a lengthy coiled-coil domain and at least an additional 14 genes coding for proteins with a prominent coiled-coil domain flanked by two series of ankyrin repeats. We have examined one of these proteins, Giardia Axoneme Associated Protein (GASP-180), in detail. GASP-180 is a 180 kDa protein containing five ankyrin repeats in a 200 amino acid N-terminal domain separated by a short spacer from an approximately 1375 amino acid coiled-coil domain. Using anti-peptide antibodies raised against a unique 20 amino acid sequence found at the C-terminus, we have determined that GASP-180 is present in cytoskeleton extractions of the parasite and localises to the proximal base of the anterior flagellar axonemes. The combination of the localisation and the structural and functional motifs of GASP-180 make it a strong candidate to participate in control of flagellar activity.

  2. CT fluoroscopic guided insertion of inferior vena cava filters.

    PubMed

    Ignotus, P; Wetton, C; Berry, J

    2006-03-01

    The value and use of inferior vena cava (IVC) filters is well documented and has been growing since the first reported filter placement in 1973 and the first percutaneous insertion in 1982. Access routes now include both jugular veins, both ante-cubital veins and both femoral veins. However, all insertions require some form of imaging, usually fluoroscopy, to identify the location of the filter with respect to the IVC and the renal veins. We describe two cases where the patients' weight was significantly greater than the weight limit of the angiography table, necessitating insertion under CT fluoroscopic guidance.

  3. Occupational exposure from common fluoroscopic projections used in orthopaedic surgery.

    PubMed

    Theocharopoulos, Nicholas; Perisinakis, Kostas; Damilakis, John; Papadokostakis, George; Hadjipavlou, Alexander; Gourtsoyiannis, Nicholas

    2003-09-01

    Personnel assisting in or performing fluoroscopically guided procedures may be exposed to high doses of radiation. Accurate occupational dosimetric data for the orthopaedic theater staff are of paramount importance for practicing radiation safety. Fluoroscopic screening was performed on an anthropomorphic phantom with use of four projections common in image-guided orthopaedic surgery. The simulated projections were categorized, according to the imaged anatomic area and the beam orientation, as (1) hip joint posterior-anterior, (2) hip joint lateral cross-table 45 degrees, (3) lumbar spine anterior-posterior, and (4) lumbar spine lateral 90 degrees. The scattered air kerma rate was measured on a grid surrounding the operating table. For each grid point, the effective dose, eye lens dose, and face skin dose values, normalized over the tube dose area product, were derived. For the effective dose calculations, three radiation protection conditions were considered: (1) with the exposed personnel using no protection measures, (2) with the exposed personnel wearing a 0.5-mm lead-equivalent protective apron, and (3) with the exposed personnel wearing both an apron and a thyroid collar. Maximum permissible workloads for typical hip, spine, and kyphoplasty procedures were derived on the basis of compliance with effective dose, eye lens dose, and skin dose limits. We found that the effective dose, eye lens dose, and face skin dose to an orthopaedic surgeon wearing a 0.5-mm lead-equivalent apron will not exceed the corresponding limits if the dose area product of the fluoroscopically guided procedure is <0.38 Gy m (2). When protective eye goggles are also worn, the maximum permissible dose area product increases to 0.70 Gy m (2), while the additional use of a thyroid shield allows a workload of 1.20 Gy m (2). The effective dose to the orthopaedic surgeon working tableside during a typical hip, spine, kyphoplasty procedure was 5.1, 21, and 250 micro Sv, respectively, when a 0

  4. The lixiscope: A portable X-ray fluoroscope

    NASA Astrophysics Data System (ADS)

    van Pelt, Bruce; Plevak, Joseph F.

    1986-01-01

    The lixi imaging scope is a portable fluoroscope which is a substantial improvement over the original concept and prototype of the lixiscope invented by NASA . This device has found widespread use in industrial, medical and security screening applications. Users of it have found its small size and high quality real-time image to provide early detection of defects in some cases, save time and money in others, and reduce patient dose and inconvenience in still others. NASA patent 4, 142, 101 July, 1977, Lo I Yin, Lixi, Inc. is the exclusive Licensee of the radioisotope version of the lixiscope.

  5. Management of pediatric radiation dose using GE fluoroscopic equipment.

    PubMed

    Belanger, Barry; Boudry, John

    2006-09-01

    In this article, we present GE Healthcare's design philosophy and implementation of X-ray imaging systems with dose management for pediatric patients, as embodied in its current radiography and fluoroscopy and interventional cardiovascular X-ray product offerings. First, we present a basic framework of image quality and dose in the context of a cost-benefit trade-off, with the development of the concept of imaging dose efficiency. A set of key metrics of image quality and dose efficiency is presented, including X-ray source efficiency, detector quantum efficiency (DQE), detector dynamic range, and temporal response, with an explanation of the clinical relevance of each. Second, we present design methods for automatically selecting optimal X-ray technique parameters (kVp, mA, pulse width, and spectral filtration) in real time for various clinical applications. These methods are based on an optimization scheme where patient skin dose is minimized for a target desired image contrast-to-noise ratio. Operator display of skin dose and Dose-Area Product (DAP) is covered, as well. Third, system controls and predefined protocols available to the operator are explained in the context of dose management and the need to meet varying clinical procedure imaging demands. For example, fluoroscopic dose rate is adjustable over a range of 20:1 to adapt to different procedure requirements. Fourth, we discuss the impact of image processing techniques upon dose minimization. In particular, two such techniques, dynamic range compression through adaptive multiband spectral filtering and fluoroscopic noise reduction, are explored in some detail. Fifth, we review a list of system dose-reduction features, including automatic spectral filtration, virtual collimation, variable-rate pulsed fluoroscopic, grid and no-grid techniques, and fluoroscopic loop replay with store. In addition, we describe a new feature that automatically minimizes the patient-to-detector distance, along with an

  6. Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

    PubMed Central

    Mannava, Sandeep; Howse, Elizabeth A.; Stone, Austin V.; Stubbs, Allston J.

    2015-01-01

    Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases. PMID:26759783

  7. THE SHOE-FITTING FLUOROSCOPE AS A RADIATION HAZARD

    PubMed Central

    Lewis, Leon; Caplan, Paul E.

    1950-01-01

    Tests of direct beam intensity and stray radiation from shoe-fitting fluoroscopes indicate wide variability of exposure of patrons and salesmen, with some exposures far in excess of standards proposed for safe use of the apparatus. The principal potential danger is interference with bone growth in children as a result of careless use or uncontrolled dosage of x-ray. Although less likely, there is also some possibility of excessive exposure of shoe salesmen in exceptional circumstances. The growing probability of increasing use of ionizing radiations warrants vigorous governmental control or possibly elimination of procedures of questionable merit which involve public risk. PMID:15408494

  8. EYE LENS DOSIMETRY FOR FLUOROSCOPICALLY GUIDED CLINICAL PROCEDURES: PRACTICAL APPROACHES TO PROTECTION AND DOSE MONITORING.

    PubMed

    Martin, Colin J

    2016-06-01

    Doses to the eye lenses of clinicians undertaking fluoroscopically guided procedures can exceed the dose annual limit of 20 mSv, so optimisation of radiation protection is essential. Ceiling-suspended shields and disposable radiation absorbing pads can reduce eye dose by factors of 2-7. Lead glasses that shield against exposures from the side can lower doses by 2.5-4.5 times. Training in effective use of protective devices is an essential element in achieving good protection and acceptable eye doses. Effective methods for dose monitoring are required to identify protection issues. Dosemeters worn adjacent to the eye provide the better option for interventional clinicians, but an unprotected dosemeter worn at the neck will give an indication of eye dose that is adequate for most interventional staff. Potential requirements for protective devices and dose monitoring can be determined from risk assessments using generic values for dose linked to examination workload.

  9. Short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders as a method of follow-up in hernia surgery.

    PubMed

    López-Cano, M; Vilallonga, R; Sánchez, J L; Hermosilla, E; Armengol, M

    2007-10-01

    We assessed the usefulness of a short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders for quality assessment in hernia surgery. All patients (n = 1153) who underwent tension-free hernioplasty through an open preperitoneal approach between 1999 and 2003 received a six-item questionnaire with a covering letter and a stamped addressed envelope. Nonresponders received two successive new questionnaires and a telephone call. A total of 841 (72.9%) patients returned questionnaires after three reminders (512 after the first mailing, 205 after the second, and 124 after the third). Positive questionnaire answers were documented for 152 (18.1%) of repairs and negative answers for 689 (81.9%). Of the 152 patients who answered "yes" to either of the questions regarding recurrence and/or current pain, 91 declined clinical appointments, 24 could not be contacted by phone, and 37 underwent physical examination. Of the 312 patients who did not return the questionnaire, eight had died, 124 did not want to be visited, and 180 could not be located. The recurrence rate was 2.7% and the chronic pain rate 5.9%. Repeat mailing was a useful strategy to improve response to self-administered postal questionnaires on hernia surgery quality assessment. However, contacting the group that responded with positive questionnaire answers was a poorly effective way to encourage subjects to come for a physical examination.

  10. MO-F-CAMPUS-I-02: Occupational Conceptus Doses From Fluoroscopically-Guided Interventional Procedures

    SciTech Connect

    Damilakis, J; Perisinakis, K; Solomou, G; Stratakis, J

    2015-06-15

    Purpose: The aim of this method was to provide dosimetric data on conceptus dose for the pregnant employee who participates in fluoroscopically-guided interventional procedures. Methods: Scattered air-kerma dose rates were obtained for 17 fluoroscopic projections involved in interventional procedures. These projections were simulated on an anthropomorphic phantom placed on the examination table supine. The operating theater was divided into two grids relative to the long table sides. Each grid consisted of 33 cells spaced 0.50 m apart. During the simulated exposures, at each cell, scatter air-kerma rate was measured at 110 cm from the floor i.e. at the height of the waist of the pregnant worker. Air-kerma rates were divided by the dose area product (DAP) rate of each exposure to obtain normalized data. For each projection, measurements were performed for 3 kVp and 3 filtration values i.e. for 9 different x-ray spectra. All measurements were performed by using a modern C-arm angiographic system (Siemens Axiom Artis, Siemens, Germany) and a radiation meter equipped with an ionization chamber. Results: The results consist of 153 iso-dose maps, which show the spatial distribution of DAP-normalized scattered air-kerma doses at the waist level of a pregnant worker. Conceptus dose estimation is possible using air-kerma to embryo/fetal dose conversion coefficients published in a previous study (J Cardiovasc Electrophysiol, Vol. 16, pp. 1–8, July 2005). Using these maps, occupationally exposed pregnant personnel may select a working position for a certain projection that keeps abdominal dose as low as reasonably achievable. Taking into consideration the regulatory conceptus dose limit for occupational exposure, determination of the maximum workload allowed for the pregnant personnel is also possible. Conclusion: Data produced in this work allow for the anticipation of conceptus dose and the determination of the maximum workload for a pregnant worker from any

  11. Fluoroscopically Guided Peritendinous Corticosteroid Injection for Proximal Hamstring Tendinopathy

    PubMed Central

    Nicholson, Luke T.; DiSegna, Steven; Newman, Joel S.; Miller, Suzanne L.

    2014-01-01

    Background: Proximal hamstring tendinopathy is an uncommon but debilitating cause of posterior thigh pain in athletes subjected to repetitive eccentric hamstring contraction, such as runners. Minimal data exist evaluating treatment options for proximal hamstring tendinopathy. Purpose: This retrospective study evaluates the effectiveness of fluoroscopically guided corticosteroid injections in treating proximal hamstring tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: Eighteen athletes with 22 cases of magnetic resonance imaging–confirmed proximal hamstring tendinopathy were treated with corticosteroid injection and later contacted to evaluate the efficacy of the injection with the use of a questionnaire. Results: The visual analog score decreased from 7.22 preinjection to 3.94 postinjection (P < .001), level of athletic participation increased from 28.76% to 68.82% (P < .001) at a mean follow-up of 21 months, and 38.8% of patients experienced complete resolution at a mean follow-up of 24.8 months. The mean lower extremity function score at the time of follow-up was 60. Conclusion: A trial of fluoroscopically guided corticosteroid injection is warranted in patients presenting with symptoms of proximal hamstring tendinopathy refractory to conservative therapy. PMID:26535310

  12. Cryo-balloon catheter localization in fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2013-03-01

    Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

  13. Nonsurgical Fluoroscopically Guided Dacryocystoplasty of Common Canalicular Obstructions

    SciTech Connect

    Wilhelm, Kai E.; Hofer, Ulrich; Textor, Hans J.; Boeker, Thorsten; Strunk, Holger; Schild, Hans H.

    2000-01-15

    Purpose: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus.Methods: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months).Results: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed.Conclusion: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results.

  14. Feasibility and safety of infracolic fluoroscopically guided percutaneous radiologic gastrostomy.

    PubMed

    Cantwell, Colin P; Gervais, Debra A; Hahn, Peter F; Mueller, Peter R

    2008-01-01

    We study the feasibility and safety of infracolic fluoroscopically guided percutaneous gastrostomy when patient anatomy prevents conventional supracolic puncture. From September 2004 to April 2007, 508 gastrostomy and gastrojejunostomy catheters were inserted in a single institution, and in six patients, the position of the transverse colon prevented conventional supracolic puncture. All were male, with a mean age of 57 years. Four patients had head and neck cancer and two had neurologic conditions. With fluoroscopic guidance, a 14-F gastrostomy tube was inserted with T-fastener gastropexy caudal to the colon. The medical records of patients treated with this technique were reviewed for demographics, indication, technique, complications, function of gastrostomy, timing of removal of the gastrostomy, and subsequent hospital admissions. All procedures were technically successful and there was no procedure-related morbidity or mortality. The mean follow-up was 16 months (range, 7-25 months) and the mean duration of therapy was 7 months. Five patients had their gastrostomy removed after clinical improvement and one of these patients had a gastrostomy reinserted cephalic to the colon after recurrence of head and neck cancer. Two patients died of disease progression and one still had the gastrostomy in position. No patient was subsequently admitted for a complication of the technique or catheter malfunction. In conclusion, infracolic percutaneous radiologic gastrostomy with gastropexy is feasible in patients without an access route cephalic to the transverse colon.

  15. Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction

    PubMed Central

    Chitnavis, JP; Karthikesaligam, A; Macdonald, A; Brown, C

    2010-01-01

    INTRODUCTION Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients. PATIENTS AND METHODS Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient. RESULTS The median age of 58 patients included in data analysis was 28 years (range, 14–52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 ± 0.0029 Gy. The mean ED was 0.001 ± 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%. CONCLUSIONS Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure. PMID:20501019

  16. Examination of the kinematic structures in İzmir (Western Anatolia) with repeated GPS observations (2009, 2010 and 2011)

    NASA Astrophysics Data System (ADS)

    Çırmık, Ayça; Pamukçu, Oya; Gönenç, Tolga; Kahveci, Muzaffer; Şalk, Müjgan; Herring, Thomas

    2017-02-01

    The Western Anatolia and the Aegean Sea regions are one of the most significant seismically active and rapidly deforming fields in the world. Generally, seismic activities cause deformations and these deformations are monitored with Global Positioning System (GPS) /Global Navigation System (GNSS). In this context, GPS data were used to determine the deformation of İzmir and its surrounding to estimate the relative plate motions. In this study, the kinematic structures of the faults, which control the seismic hazard in İzmir and its surroundings, processing results of the three-year (2009, 2010 and 2011) episodic GPS observations and the estimation of displacements for 21 GPS stations were presented. The aim of this study is to examine interplate motion of the stations and their relations with the tectonic structures, seismicity and paleomagnetism and additionally, to interprete the motions of the study area relative to different block motions. Consequently, the mean motion of the study area was found approximately 25 mm/yr (towards the SSW) in the Eurasia fixed frame solution. The Aegean block fixed frame and the Anatolian block fixed frame solutions were computed relative to Euler vectors. In Aegean and Anatolian block solutions it was determined that the stations move separately, not as a group. In Euler pole solution, some stations are separated from each other and meanwhile some stations are grouped by considering the differences and similarities of the station motions. According to this solution three lines and two regions were described in the study area. The relations between seismicity and paleomagnetic studies and the kinematic structures determined in Anatolian block fixed frame and Euler pole solution were also investigated. When the Anatolian block fixed frame solution and the earthquakes occurred between the years 1973 and 2011 were evaluated together, it was found that in the high seismically active region especially near to Sığacık bay, the

  17. Intraoperative fluoroscopic dose assessment in prostate brachytherapy patients.

    PubMed

    Reed, Daniel R; Wallner, Kent E; Narayanan, Sreeram; Sutlief, Steve G; Ford, Eric C; Cho, Paul S

    2005-09-01

    To evaluate a fluoroscopy-based intraoperative dosimetry system to guide placement of additional sources to underdosed areas, and perform computed tomography (CT) verification. Twenty-six patients with prostate carcinoma treated with either I-125 or Pd-103 brachytherapy at the Puget Sound VA using intraoperative postimplant dosimetry were analyzed. Implants were performed by standard techniques. After completion of the initial planned brachytherapy procedure, the initial fluoroscopic intraoperative dose reconstruction analysis (I-FL) was performed with three fluoroscopic images acquired at 0 (AP), +15, and -15 degrees. Automatic seed identification was performed and the three-dimensional (3D) seed coordinates were computed and imported into VariSeed for dose visualization. Based on a 3D assessment of the isodose patterns additional seeds were implanted, and the final fluoroscopic intraoperative dose reconstruction was performed (FL). A postimplant computed tomography (CT) scan was obtained after the procedure and dosimetric parameters and isodose patterns were analyzed and compared. An average of 4.7 additional seeds were implanted after intraoperative analysis of the dose coverage (I-FL), and a median of 5 seeds. After implantation of additional seeds the mean V100 increased from 89% (I-FL) to 92% (FL) (p < 0.001). In I-125 patients an improvement from 91% to 94% (p = 0.01), and 87% to 93% (p = 0.001) was seen for Pd-103. The D90 increased from 105% (I-FL) to 122% (FL) (p < 0.001) for I-125, and 92% (I-FL) to 102% (FL) (p = 0.008) for Pd-103. A minimal change occurred in the R100 from a mean of 0.32 mL (I-FL) to 0.6 mL (FL) (p = 0.19). No statistical difference was noted in the R100 (rectal volume receiving 100% of the prescribed dose) between the two techniques. The rate of adverse isodose patterns decreased between I-FL and FL from 42% to 8%, respectively. The I-125 patients demonstrated a complete resolution of adverse isodose patterns after the initial isodose

  18. Variability in Radiation Dose From Repeat Identical CT Examinations: Longitudinal Analysis of 2851 Patients Undergoing 12,635 Thoracoabdominal CT Scans in an Academic Health System.

    PubMed

    Mileto, Achille; Nelson, Rendon C; Larson, Douglas G; Samei, Ehsan; Wilson, Joshua M; Christianson, Olav; Marin, Daniele; Boll, Daniel T

    2017-06-01

    The purpose of this study was to conduct longitudinal analyses of radiation dose data from adult patients undergoing clinically indicated, repeat identical thoracoabdominal CT examinations. Radiation dose data were electronically collected from 2851 subjects undergoing 12,635 repeat identical CT scans (mean number of scans per patient, 4.8; range, 2-33) in one health system. Included CT protocols were chest-abdomen-pelvis with contrast administration (n = 4621 CT studies of 1064 patients), abdomen-pelvis with contrast administration (n = 876 CT studies of 261 patients), renal stone (n = 1053 CT studies of 380 patients), and chest (n = 6085 CT studies of 1146 patients) without contrast administration. A radiation-tracking software infrastructure was adopted to extract data from DICOM headers in PACS. Size-specific dose estimate (SSDE) was calculated. A trend was observed toward global reduction in SSDE values with all protocols investigated (chest-abdomen-pelvis slope, -1.78; abdomen-pelvis slope, -0.82; renal stone slope, -0.83; chest slope, -0.47; p < 0.001 for all comparisons). The intraindividual analyses of radiation dose distribution showed widespread variability in SSDE values across the four protocols investigated (chest-abdomen-pelvis mean coefficient of variance, 14.02 mGy; abdomen-pelvis mean coefficient of variance, 10.26 mGy; renal stone mean coefficient of variance, 34.18 mGy; chest mean coefficient of variance, 6.74 mGy). Although there is a trend toward global reduction in radiation doses, this study showed widespread variability in the radiation dose that each patient undergoing identical repeat thoracoabdominal CT protocols absorbs. These data may provide a foundation for the future development of best-practice guidelines for patient-specific radiation dose monitoring.

  19. The response of fluoroscopic image intensifier-TV systems

    NASA Technical Reports Server (NTRS)

    Baily, N. A.; Keller, R. A.

    1976-01-01

    Three different types of X-ray fluoroscopic TV chains were investigated: two standard clinical units, one with a vidicon camera tube, the other with a plumbicon camera tube; and the third was a large flat-screen unit. In each an X-ray beam generated at 100 kVp was passed through 10 cm of H2O before aluminum absorbers of varying thickness were introduced. Five video recordings were made at each absorber thickness. The video image was digitized directly from the disk recording and quantized into 128 gray levels. The five recordings were averaged on a point-to-point basis, and the central 900 averaged points were again averaged to yield a value for the gray level assigned to each particular image. This 30 by 30 matrix of points corresponds to input screen areas of 29, 8.2, and 3.6 sq cm for the three units investigated.

  20. Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only

    PubMed Central

    Zhang, Ji; Gu, Yi-feng; Li, Ming-hua

    2008-01-01

    Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient. PMID:19039277

  1. Lumbar Catheter Placement Using Paramedian Approach Under Fluoroscopic Guidance

    PubMed Central

    Qureshi, Adnan I.; Khan, Asif A.; Malik, Ahmed A.; Afzal, Mohammad Rauf; Herial, Nabeel A.; Qureshi, Mushtaq H.; Suri, M. Fareed K.

    2016-01-01

    Background Lumbar catheter placement under fluoroscopic guidance may reduce the rate of technical failures and associated complications seen with insertion guided by manually palpable landmarks. Methods We reviewed our experience with 43 attempted lumbar catheter placements using paramedian approach under fluoroscopic guidance and ascertained rates of technical success, and clinical events. Results Among the 43 patients, 18, 1, and 1 patients were on aspirin (with dipyrimadole in 2), clopidogrel, and combination of both, respectively. Lumbar catheter placement was successful in 42 of 43 attempted placements. Floroscopic guidance was critical in three patients; one patient had severe cerebrospinal fluid (CSF) depletion (empty thecal sac phenomenon) following pituitary surgery leading to no cerebrospinal fluid return despite correct placement confirmation under fluoroscopy. Two patients had spinal needle placement at the junction between epidural and cerebrospinal fluid spaces (junctional position) leading to cerebrospinal fluid return but inability to introduce the lumbar catheter. After confirmation of position by the injection of contrast or radiographic landmarks the needle was advanced by indenting the subcutaneous tissue or reinserting at a spinal level above the first insertion. The lumbar catheter remained in position over a mean period (±standard deviation) of 4.1(±2.3) days. Improvement in hydrocephalus was seen in two patients with intracranial mass lesions. One patient developed cerebrospinal fluid leakage through the insertion track following removal of catheter and required skin suturing at the site of insertion. Conclusions We observed a high technical success rate with low rate of complications even in patients with intracranial mass lesions, those on ongoing antiplatelet medications or in whom insertion would not be possible guided by manually palpable landmarks. PMID:26958156

  2. Order of magnitude reduction of fluoroscopic x-ray dose

    NASA Astrophysics Data System (ADS)

    Bal, Abhinav; Robert, Normand; Machan, Lindsay; Deutsch, Meir; Kisselgoff, David; Babyn, Paul; Rowlands, John A.

    2012-03-01

    The role of fluoroscopic imaging is critical for diagnostic and image guided therapy. However, fluoroscopic imaging can require significant radiation leading to increased cancer risk and non-stochastic effects such as radiation burns. Our purpose is to reduce the exposure and dose to the patient by an order of magnitude in these procedures by use of the region of interest method. Method and Materials: Region of interest fluoroscopy (ROIF) uses a partial attenuator. The central region of the image has full exposure while the image periphery, there to provide context only, has a reduced exposure rate. ROIF using a static partial attenuator has been shown in our previous studies to reduce the dose area product (DAP) to the patient by at least 2.5 times. Significantly greater reductions in DAP would require improvements in flat panel detectors performance at low x-ray exposures or a different x-ray attenuation strategy. Thus we have investigated a second, dynamic, approach. We have constructed an x-ray shutter system allowing a normal x-ray exposure in the region of interest while reducing the number of x-ray exposures in the periphery through the rapid introduction, positioning and removal of an x-ray attenuating shutter to block radiation only for selected frames. This dynamic approach eliminates the DQE(0) loss associated with the use of static partial attenuator applied to every frame thus permitting a greater reduction in DAP. Results: We have compared the two methods by modeling and determined their fundamental limits.

  3. Endoscopic necrosectomy under fluoroscopic guidance – a single center experience

    PubMed Central

    Smoczyński, Marian; Jabłońska, Anna; Adrych, Krystian

    2015-01-01

    Introduction Our report presents a technique of necrotic tissue removal during transmural drainage of walled-off pancreatic necrosis (WOPN) that is an alternative to the one that has already been described in the literature. Aim To assess the effectiveness and safety of endoscopic necrosectomy performed during transmural drainage of symptomatic WOPN. Material and methods Within the years 2012–2013, 64 patients underwent endoscopic treatment of symptomatic WOPN in our center. Eight patients underwent endoscopic necrosectomy during transmural drainage. Fragments of necrotic tissues were removed from the collection's cavity under fluoroscopic guidance using a Dormia basket. The results and complications of treatment were compared retrospectively. Results Sixty-four patients with WOPN underwent transmural drainage under endoscopic ultrasonography (EUS) guidance. Eight patients (12.5%, 5 women and 3 men, mean age 57.25 years) were qualified for endoscopic necrosectomy. Transmural transgastric access was made in 7 patients and transduodenal access in 1 patient. Additional percutaneous drainage was used in 2 patients. Active drainage was continued for 24 days (11–44 days). The mean number of endoscopic procedures was 4.75 (3–9). The average number of necrosectomy procedures during drainage was 1.75 (1–4). Complications of endotherapy occurred in 2/8 (25%) patients, and they were not directly connected with necrosectomy. Therapeutic success after the end of active drainage was achieved in all patients. During a 6-month follow-up no recurrence of the collection was observed. Conclusions Endoscopic necrosectomy under fluoroscopic guidance is an effective and safe method of minimally invasive treatment in a selected group of patients with symptomatic WOPN. PMID:26240624

  4. Lung tumor tracking in fluoroscopic video based on optical flow.

    PubMed

    Xu, Qianyi; Hamilton, Russell J; Schowengerdt, Robert A; Alexander, Brian; Jiang, Steve B

    2008-12-01

    Respiratory gating and tumor tracking for dynamic multileaf collimator delivery require accurate and real-time localization of the lung tumor position during treatment. Deriving tumor position from external surrogates such as abdominal surface motion may have large uncertainties due to the intra- and interfraction variations of the correlation between the external surrogates and internal tumor motion. Implanted fiducial markers can be used to track tumors fluoroscopically in real time with sufficient accuracy. However, it may not be a practical procedure when implanting fiducials bronchoscopically. In this work, a method is presented to track the lung tumor mass or relevant anatomic features projected in fluoroscopic images without implanted fiducial markers based on an optical flow algorithm. The algorithm generates the centroid position of the tracked target and ignores shape changes of the tumor mass shadow. The tracking starts with a segmented tumor projection in an initial image frame. Then, the optical flow between this and all incoming frames acquired during treatment delivery is computed as initial estimations of tumor centroid displacements. The tumor contour in the initial frame is transferred to the incoming frames based on the average of the motion vectors, and its positions in the incoming frames are determined by fine-tuning the contour positions using a template matching algorithm with a small search range. The tracking results were validated by comparing with clinician determined contours on each frame. The position difference in 95% of the frames was found to be less than 1.4 pixels (approximately 0.7 mm) in the best case and 2.8 pixels (approximately 1.4 mm) in the worst case for the five patients studied.

  5. Auto-shape lossless compression of pharynx and esophagus fluoroscopic images.

    PubMed

    Arif, Arif Sameh; Mansor, Sarina; Logeswaran, Rajasvaran; Karim, Hezerul Abdul

    2015-02-01

    The massive number of medical images produced by fluoroscopic and other conventional diagnostic imaging devices demand a considerable amount of space for data storage. This paper proposes an effective method for lossless compression of fluoroscopic images. The main contribution in this paper is the extraction of the regions of interest (ROI) in fluoroscopic images using appropriate shapes. The extracted ROI is then effectively compressed using customized correlation and the combination of Run Length and Huffman coding, to increase compression ratio. The experimental results achieved show that the proposed method is able to improve the compression ratio by 400 % as compared to that of traditional methods.

  6. Three-Station Three-dimensional Bolus-Chase MR Angiography with Real-time Fluoroscopic Tracking

    PubMed Central

    Johnson, Casey P.; Weavers, Paul T.; Borisch, Eric A.; Grimm, Roger C.; Hulshizer, Thomas C.; LaPlante, Christine C.; Rossman, Phillip J.; Glockner, James F.; Young, Phillip M.

    2014-01-01

    Purpose To determine the feasibility of using real-time fluoroscopic tracking for bolus-chase magnetic resonance (MR) angiography of peripheral vasculature to image three stations from the aortoiliac bifurcation to the pedal arteries. Materials and Methods This prospective study was institutional review board approved and HIPAA compliant. Eight healthy volunteers (three men; mean age, 48 years; age range, 30–81 years) and 13 patients suspected of having peripheral arterial disease (five men; mean age, 67 years; age range, 47–81 years) were enrolled and provided informed consent. All subjects were imaged with the fluoroscopic tracking MR angiographic protocol. Ten patients also underwent a clinical computed tomographic (CT) angiographic runoff examination. Two readers scored the MR angiographic studies for vessel signal intensity and sharpness and presence of confounding artifacts and venous contamination at 35 arterial segments. Mean aggregate scores were assessed. The paired MR angiographic and CT angiographic studies also were scored for visualization of disease, reader confidence, and overall diagnostic quality and were compared by using a Wilcoxon signed rank test. Results Real-time fluoroscopic tracking performed well technically in all studies. Vessel segments were scored good to excellent in all but the following categories: For vessel signal intensity and sharpness, the abdominal aorta, iliac arteries, distal plantar arteries, and plantar arch were scored as fair to good; and for presence of confounding artifacts, the abdominal aorta and iliac arteries were scored as fair. The MR angiograms and CT angiograms did not differ significantly in any scoring category (reader 1: P = .50, .39, and .39; reader 2: P = .41, .61, and .33, respectively). CT scores were substantially better in 20% (four of 20) and 25% (five of 20) of the pooled evaluations for the visualization of disease and overall image quality categories, respectively, versus 5% (one of 20) for MR

  7. An examination of the origin and evolution of additional tandem repeats in the mitochondrial DNA control region of Japanese sika deer (Cervus Nippon).

    PubMed

    Ba, Hengxing; Wu, Lang; Liu, Zongyue; Li, Chunyi

    2016-01-01

    Tandem repeat units are only detected in the left domain of the mitochondrial DNA control region in sika deer. Previous studies showed that Japanese sika deer have more tandem repeat units than its cousins from the Asian continent and Taiwan, which often have only three repeat units. To determine the origin and evolution of these additional repeat units in Japanese sika deer, we obtained the sequence of repeat units from an expanded dataset of the control region from all sika deer lineages. The functional constraint is inferred to act on the first repeat unit because this repeat has the least sequence divergence in comparison to the other units. Based on slipped-strand mispairing mechanisms, the illegitimate elongation model could account for the addition or deletion of these additional repeat units in the Japanese sika deer population. We also report that these additional repeat units could be occurring in the internal positions of tandem repeat regions, possibly via coupling with a homogenization mechanism within and among these lineages. Moreover, the increased number of repeat units in the Japanese sika deer population could reflect a balance between mutation and selection, as well as genetic drift.

  8. Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures.

    PubMed

    Strauss, Keith J; Racadio, John M; Johnson, Neil; Patel, Manish; Nachabe, Rami A

    2015-06-01

    The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates. Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes. The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope. Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.

  9. A Bayesian hierarchical model for multi-level repeated ordinal data: analysis of oral practice examinations in a large anaesthesiology training programme.

    PubMed

    Tan, M; Qu, Y; Mascha, E; Schubert, A

    1999-08-15

    Oral practice examinations (OPEs) are used in many anaesthesiology programmes to familiarize anaesthesiology residents with the format of the oral examination administered by the American Board of Anesthesiology. The OPE outcome (final grade) consists of 'Definite Not Pass', 'Probable Not Pass', 'Probable Pass' and 'Definite Pass'. In our study to assess the validity of the OPE, residents took an average of two (ranging from one to six) OPEs, each of which was evaluated by two board certified anaesthesiologists randomly selected from a pool of 12. A key question of interest was to identify factors, for example, the length of training, didactic experience and other characteristics, that most influence OPE outcome. In addition, we were interested in assessing the reliability of the final grade, that is, the covariance parameters are of interest as well. However, estimating variance components in multi-level data with an unequal number of repeated ordinal outcomes presents several statistical challenges, such as how to estimate high dimensional random effects parameters, especially for ordinal outcomes. We propose a Bayesian hierarchical proportional odds model for data with such complexity. The flexibility of such a model allows us to make inference on the association of OPE outcomes with other factors and to estimate the variance components as well.

  10. Robust Fluoroscopic Tracking of Fiducial Markers: Exploiting the Spatial Constraints

    PubMed Central

    Li, Rui; Sharp, Gregory

    2013-01-01

    Two new fluoroscopic fiducial tracking methods that exploit the spatial relationship among the multiple implanted fiducial to achieve fast, accurate and robust tracking are proposed in this paper. The spatial relationship between multiple implanted markers are modeled as Gaussian distributions of their pairwise distances over time. The means and standard deviations of these distances are learned from training sequences, and pairwise distances that deviate from these learned distributions are assigned a low spatial matching score. The spatial constraints are incorporated in two different algorithms: a stochastic tracking method and a detection based method. In the stochastic method, hypotheses of the “true” fiducial position are sampled from a pre-trained respiration motion model. Each hypothesis is assigned an importance value based on image matching score and spatial matching score. Learning the parameters of the motion model is needed in addition to the learning the distribution parameters of the pairwise distances in the proposed stochastic tracking approach. In the detection based method, a set of possible marker locations are identified by using a template matching based fiducial detector. The best location is obtained by optimizing the image matching score and spatial matching score through non-serial dynamic programming. In this detection based approach, there is no need to learn the respiration motion model. The two proposed algorithms are compared with a recent work using multiple hypothesis tracking algorithm which is denoted by MHT[19]. Phantom experiments were performed using fluoroscopic videos captured with known motion relative to an anthropomorphic phantom. The patient experiments were performed using a retrospective study of 16 fluoroscopic videos of liver cancer patients with implanted fiducials. For the motion phantom data sets, the detection based approach has the smallest tracking error (μerr: 0.78 – 1.74 mm, σerr: 0.39 – 1.16 mm) for

  11. Robust fluoroscopic tracking of fiducial markers: exploiting the spatial constraints

    NASA Astrophysics Data System (ADS)

    Li, Rui; Sharp, Gregory

    2013-03-01

    Two new fluoroscopic fiducial tracking methods that exploit the spatial relationship among the multiple implanted fiducial to achieve fast, accurate and robust tracking are proposed in this paper. The spatial relationship between multiple implanted markers are modeled as Gaussian distributions of their pairwise distances over time. The means and standard deviations of these distances are learned from training sequences, and pairwise distances that deviate from these learned distributions are assigned a low spatial matching score. The spatial constraints are incorporated in two different algorithms: a stochastic tracking method and a detection based method. In the stochastic method, hypotheses of the ‘true’ fiducial position are sampled from a pre-trained respiration motion model. Each hypothesis is assigned an importance value based on image matching score and spatial matching score. Learning the parameters of the motion model is needed in addition to learning the distribution parameters of the pairwise distances in the proposed stochastic tracking approach. In the detection based method, a set of possible marker locations are identified by using a template matching based fiducial detector. The best location is obtained by optimizing the image matching score and spatial matching score through non-serial dynamic programming. In this detection based approach, there is no need to learn the respiration motion model. The two proposed algorithms are compared with a recent work using a multiple hypothesis tracking (MHT) algorithm which is denoted by MHT, Tang et al (2007 Phys. Med. Biol. 52 4081-98). Phantom experiments were performed using fluoroscopic videos captured with known motion relative to an anthropomorphic phantom. The patient experiments were performed using a retrospective study of 16 fluoroscopic videos of liver cancer patients with implanted fiducials. For the motion phantom data sets, the detection based approach has the smallest tracking error (

  12. Fluoroscopic study of the normal gastrointestinal motility and measurements in the Hispaniolan Amazon parrot (Amazona ventralis).

    PubMed

    Beaufrère, Hugues; Nevarez, Javier; Taylor, W Michael; Jankowski, Gwendolyn; Rademacher, Nathalie; Gaschen, Lorrie; Pariaut, Romain; Tully, Thomas N

    2010-01-01

    Contrast fluoroscopy is a valuable tool to examine avian gastrointestinal motility. However, the lack of a standardized examination protocol and reference ranges prevents the objective interpretation of motility disorders and other gastrointestinal abnormalities. Our goals were to evaluate gastrointestinal motility in 20 Hispaniolan Amazon parrots (Amazona ventralis) by contrast fluoroscopy. Each parrot was crop-fed an equal part mixture of barium sulfate and hand-feeding formula and placed in a cardboard box for fluoroscopy. Over a 3-h period, 1.5 minute segments of lateral and ventrodorsal fluoroscopy were recorded every 30 min. The gastric cycle and patterns of intestinal motility were described. The frequency of crop contractions, esophageal boluses, and gastric cycles were determined in lateral and ventrodorsal views. A range of 3.4-6.6 gastric cycles/min was noted on the lateral view and 3.0-6.6 gastric cycles/min on the ventrodorsal view. Circular measurements of the proventriculus diameter, ventriculus width, and length were obtained using the midshaft femoral diameter as a standard reference unit. The upper limits of the reference ranges were 3.6 and 4.7 femoral units for the proventriculus diameter in the lateral and ventrodorsal view, respectively. Two consecutive measurements were obtained and the measurement technique was found to have high reproducibility. In this study, we established a standardized protocol for contrast fluoroscopic examination of the gastrointestinal tract and a reliable measurement method of the proventriculus and ventriculus using femoral units in the Hispaniolan Amazon parrot.

  13. Measuring radiation dose to patients undergoing fluoroscopically-guided interventions

    NASA Astrophysics Data System (ADS)

    Lubis, L. E.; Badawy, M. K.

    2016-03-01

    The increasing prevalence and complexity of fluoroscopically guided interventions (FGI) raises concern regarding radiation dose to patients subjected to the procedure. Despite current evidence showing the risk to patients from the deterministic effects of radiation (e.g. skin burns), radiation induced injuries remain commonplace. This review aims to increase the awareness surrounding radiation dose measurement for patients undergoing FGI. A review of the literature was conducted alongside previous researches from the authors’ department. Studies pertaining to patient dose measurement, its formalism along with current advances and present challenges were reviewed. Current patient monitoring techniques (using available radiation dosimeters), as well as the inadequacy of accepting displayed dose as patient radiation dose is discussed. Furthermore, advances in real-time patient radiation dose estimation during FGI are considered. Patient dosimetry in FGI, particularly in real time, remains an ongoing challenge. The increasing occurrence and sophistication of these procedures calls for further advances in the field of patient radiation dose monitoring. Improved measuring techniques will aid clinicians in better predicting and managing radiation induced injury following FGI, thus improving patient care.

  14. Radiation dose to the operator during fluoroscopically guided spine procedures.

    PubMed

    Roccatagliata, Luca; Presilla, Stefano; Pravatà, Emanuele; Cianfoni, Alessandro

    2017-07-18

    Fluoroscopy is widely used to guide diagnostic and therapeutic spine procedures. The purpose of this study was to quantify radiation incident on the operator (operator Air Kerma) during a wide range of fluoroscopy-guided spine procedures and its correlation with the amount of radiation incident on the patient (Kerma Area Product-KAP). We retrospectively included 57 consecutive fluoroscopically guided spine procedures. KAP [Gy cm(2)] and total fluoroscopy time were recorded for each procedure. An electronic dosimeter recorded the operator Air Kerma [μGy] for each procedure. Operator Air Kerma for each procedure, correlation between KAP and operator Air Kerma, and between KAP and fluoroscopy time was obtained. Operator Air Kerma was widely variable across procedures, with median value of 6.4 μGy per procedure. Median fluoroscopy time and median KAP per procedure were 2.6 min and 4.7 Gy cm(2), respectively. There was correlation between operator Air Kerma and KAP (r (2) = 0.60), with a slope of 1.6 μGy Air Kerma per unit Gy cm(2) KAP incident on the patient and between fluoroscopy time and KAP (r (2) = 0.63). Operator Air Kerma during individual fluoroscopy-guided spine procedures can be approximated from the commonly and readily available information of the total amount of radiation incident on the patient, measured as KAP.

  15. Silent aspiration: results of 2,000 video fluoroscopic evaluations.

    PubMed

    Garon, Bernard R; Sierzant, Tess; Ormiston, Charles

    2009-08-01

    The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as "red-flag" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.

  16. Fluoroscopy: recording of fluoroscopic images and automatic exposure control.

    PubMed

    Geise, R A

    2001-01-01

    Some means of recording images is a necessary part of most fluoroscopic systems. Several methods are available for recording images during fluoroscopy. Screen-film recording methods such as use of spot film devices and automatic film changers provide high-spatial-resolution images. Recording images by using the image intensifier (fluorography) provides film or digital images at relatively lower doses but with poorer spatial resolution. Digitally recorded images have better contrast resolution than analog images but lower spatial resolution and represent a compromise between dose and image quality. Motion picture (cine fluorographic) recording requires extremely high dose rates compared with those of lower-resolution videotape recording of motion. Recording systems in fluoroscopy require automatic exposure control for optimum image quality. The same feedback system used to control fluorographic exposures can be used to control exposure rates during fluoroscopy as well. Automatic brightness control maintains intensifier exposure rates on the basis of subject thickness by adjusting various technique factors. The type of control mechanism depends on the imaging task and the complexity (age and cost) of the equipment. The operator can choose between better image quality (higher contrast) or lower radiation dose.

  17. Digital Subtraction Fluoroscopic System With Tandem Video Processing Units

    NASA Astrophysics Data System (ADS)

    Gould, Robert G.; Lipton, Martin J.; Mengers, Paul; Dahlberg, Roger

    1981-07-01

    A real-time digital fluoroscopic system utilizing two video processing units (Quantex) in tandem to produce continuous subtraction images of peripheral and internal vessels following intravenous contrast media injection has been inves-tigated. The first processor subtracts a mask image consisting of an exponentially weighted moving average of N1 frames (N1 = 2k where k = 0.7) from each incoming video frame, divides by N1, and outputs the resulting difference image to the second processor. The second unit continuously averages N2 incoming frames (N2 = 2k) and outputs to a video monitor and analog disc recorder. The contrast of the subtracted images can be manipulated by changing gain or by a non-linear output transform. After initial equipment adjustments, a subtraction sequence can be produced without operator interaction with the processors. Alternatively, the operator can freeze the mask and/or the subtracted output image at any time during the sequence. Raw data is preserved on a wide band video tape recorder permitting retrospective viewing of an injection sequence with different processor settings. The advantage of the tandem arrangement is that it has great flexibility in varying the duration and the time of both the mask and injection images thereby minimizing problems of registration between them. In addition, image noise is reduced by compiling video frames rather than by using a large radiation dose for a single frame, which requires a wide dynamic range video camera riot commonly available in diagnostic x-ray equipment. High quality subtraction images of arteries have been obtained in 15 anesthetized dogs using relatively low exposure rates (10-12 μR/video frame) modest volumes of contrast medium (0.5-1 ml/kg), and low injection flow rates (6-10 ml/sec). The results/ achieved so far suggest that this system has direct clinical applications.

  18. Patient doses from fluoroscopically guided cardiac procedures in pediatrics

    NASA Astrophysics Data System (ADS)

    Martinez, L. C.; Vano, E.; Gutierrez, F.; Rodriguez, C.; Gilarranz, R.; Manzanas, M. J.

    2007-08-01

    Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

  19. Intraoperative fluoroscopic assessment of proper prosthetic radial head height.

    PubMed

    Kim, H Mike; Roush, Evan P; Kiser, Casey

    2016-11-01

    Selecting a properly sized radial head prosthesis is imperative during radial head replacement. Although there has been much emphasis on avoiding overlengthening of the radius, little has been studied about how to avoid shortening. The purpose of this study was to characterize how a radial head replacement appears on intraoperative fluoroscopy depending on the height of the prosthetic radial head. Articular cartilage thickness of the radial head was measured in 9 cadaveric elbows. Radial head replacement was performed in each specimen with 4 different prosthetic head heights: 4 mm and 2 mm shortening, anatomic, and 2 mm overlengthening. Anteroposterior fluoroscopic images were obtained for each head height, and the prosthetic radial head height was measured at 3 forearm positions (supination, neutral, and pronation) using the subchondral bone of the lateral edge of the coronoid at the reference point. The mean cartilage thickness of the radial head was 1.3 ± 0.4 mm. The prosthetic radial head appeared 2.2 ± 0.4 mm more proximal than the subchondral bone of the coronoid lateral edge in anteroposterior radiographs when the articular surface of the prosthesis was completely even with the coronoid articular surface. Unlike the native radial head, a prosthetic radial head showed a significant change of height with different forearm rotation (P < .001). This study found that a perfectly anatomic radial head replacement appears overlengthened by approximately 2 mm in intraoperative radiographs. This finding can be useful in guiding the appropriate height of a prosthetic radial head. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Patient doses from fluoroscopically guided cardiac procedures in pediatrics.

    PubMed

    Martinez, L C; Vano, E; Gutierrez, F; Rodriguez, C; Gilarranz, R; Manzanas, M J

    2007-08-21

    Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm(2) respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

  1. Temporomandibular joint arthrography: a comparison between a fluoroscopic and a nonfluoroscopic technique

    SciTech Connect

    Benson, B.W.; Langlais, R.P.; Abramovitch, K.

    1989-05-01

    A nonfluoroscopic temporomandibular joint arthrographic technique is contrasted with a more widely employed fluoroscopically guided technique. The nonfluoroscopic technique uses a posterior approach to joint injection, as contrasted with the lateral injection approach of the fluoroscopically guided technique. The advantages of the nonfluoroscopic technique are less radiation dose to the patient, less expensive and less sophisticated imaging equipment, and less potential for neurovascular trauma. The fluoroscopic technique offers greater control of the procedure, less patient and operator time, and the capability for a dynamic videofluoroscopic study. Both techniques appear to be safe and efficacious. Differences in anatomy, imaging modalities, patient radiation exposure, and potential complications are also discussed as part of this comparison.48 references.

  2. Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

    PubMed Central

    Sommer, Philipp; Kircher, Simon; Rolf, Sascha; Richter, Sergio; Doering, Micha; Arya, Arash; Bollmann, Andreas; Hindricks, Gerhard

    2015-01-01

    A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab. Furthermore, in a subset of indications such as supraventricular tachycardias, NFCV enables a fully non-fluoroscopic procedure and allows the lab staff to work without wearing lead aprons. With this protocol, we demonstrate that even complex procedures such as ablations of atrial fibrillation, that are typically associated with fluoroscopy times of >30 min in conventional settings, can safely be performed with a reduction of >90% in fluoroscopy exposure by the additional use of NFCV. PMID:26066541

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

    PubMed Central

    Dhou, Salam; Hurwitz, Martina; Mishra, Pankaj; Cai, Weixing; Rottmann, Joerg; Li, Ruijiang; Williams, Christopher; Wagar, Matthew; Berbeco, Ross; Ionascu, Dan; Lewis, John H.

    2015-01-01

    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 develop and perform initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and use these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparing to ground truth digital and physical phantom images. The performance of 4DCBCT- 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. PMID:25905722

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

    PubMed

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

    2015-05-07

    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.

  5. 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.

  6. NOTE: A feasibility study of markerless fluoroscopic gating for lung cancer radiotherapy using 4DCT templates

    NASA Astrophysics Data System (ADS)

    Li, Ruijiang; Lewis, John H.; Cerviño, Laura I.; Jiang, Steve B.

    2009-10-01

    A major difficulty in conformal lung cancer radiotherapy is respiratory organ motion, which may cause clinically significant targeting errors. Respiratory-gated radiotherapy allows for more precise delivery of prescribed radiation dose to the tumor, while minimizing normal tissue complications. Gating based on external surrogates is limited by its lack of accuracy, while gating based on implanted fiducial markers is limited primarily by the risk of pneumothorax due to marker implantation. Techniques for fluoroscopic gating without implanted fiducial markers (markerless gating) have been developed. These techniques usually require a training fluoroscopic image dataset with marked tumor positions in the images, which limits their clinical implementation. To remove this requirement, this study presents a markerless fluoroscopic gating algorithm based on 4DCT templates. To generate gating signals, we explored the application of three similarity measures or scores between fluoroscopic images and the reference 4DCT template: un-normalized cross-correlation (CC), normalized cross-correlation (NCC) and normalized mutual information (NMI), as well as average intensity (AI) of the region of interest (ROI) in the fluoroscopic images. Performance was evaluated using fluoroscopic and 4DCT data from three lung cancer patients. On average, gating based on CC achieves the highest treatment accuracy given the same efficiency, with a high target coverage (average between 91.9% and 98.6%) for a wide range of nominal duty cycles (20-50%). AI works well for two patients out of three, but failed for the third patient due to interference from the heart. Gating based on NCC and NMI usually failed below 50% nominal duty cycle. Based on this preliminary study with three patients, we found that the proposed CC-based gating algorithm can generate accurate and robust gating signals when using 4DCT reference template. However, this observation is based on results obtained from a very limited

  7. Patient radiation dose audits for fluoroscopically guided interventional procedures

    SciTech Connect

    Balter, Stephen; Rosenstein, Marvin; Miller, Donald L.; Schueler, Beth; Spelic, David

    2011-03-15

    Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL. Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K{sub a,r}) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K{sub a,r} exceeds the 75th percentile of the ADS and (2) when the percent of instances where K{sub a,r} exceeds the facility-selected SRDL is greater for the FDS than for the ADS. Conclusions: Analysis of the two data sets (ADS and FDS) and

  8. Radiation injury is a potentially serious complication to fluoroscopically-guided complex interventions

    PubMed Central

    Wagner, LK

    2007-01-01

    Radiation-induced injury to skin is an infrequent but potentially serious complication to complex fluoroscopically-guided interventional procedures. Due to a lack of experience with such injuries, the medical community has found fluoroscopically-induced injuries difficult to diagnose. Injuries have occurred globally in many countries. Serious injuries most frequently occur on the back but have also occurred on the neck, buttocks and anterior of the chest. Severities of injuries range from skin rashes and epilation to necrosis of the skin and its underlying structures. This article reviews the characteristics of these injuries and some actions that can be taken to reduce their likelihood or seriousness. PMID:21614271

  9. Technique for Percutaneous Fluoroscopically Guided G-Tube Placement in a High-BMI Patient.

    PubMed

    Best, Irwin M

    2012-01-01

    Enteral feeding is still the preferred method of nutritional support even in patients with excessive body mass index. Often, this mass poses a hindrance in performing routine procedures. We present a case describing the technique used to safely place a fluoroscopically guided G-tube in a patient with a significant nutritional deficit after repair of a ruptured thoracic aneurysm. Her admission weight was in excess of 180 Kg. However, protracted respiratory insufficiency and mechanical ventilation prolonged her hospital course. The G-tube was successfully placed using a fluoroscopically guided technique. The advantages of such an approach are discussed.

  10. SU-E-I-36: A Study to Compare Operator Dosimeter Exposure versus Fluoroscopic Time and Air Kerma in Fluoroscopically Guided Interventional Procedures.

    PubMed

    McKetty, M

    2012-06-01

    The total effective dose equivalent limit for occupationally radiation exposed persons has remained at 50 millisieverts per year since the 1960s. There is ongoing discussion whether this limit should be lowered. Whether or not it is lowered, all facilities have to adhere to the principle of ALARA (as low as reasonably achievable). In a hospital environment, the workers who typically have exposures which Result in ALARA investigations having to be performed include interventional radiologists, cardiologists, and mobile C-arm operators. At our institution there are a limited number of interventional radiologists with one person being responsible for performing the majority of the procedures and sometimes exceeding the ALARA investigational levels. A limited study was performed to compare the number, type of studies, cumulative air kerma, and fluoroscopic time versus the exposure measured by the personnel dosimeters worn by the radiologists. This was also related to the type of angiographic equipment in use. The length of fluoroscopic time and cumulative air kerma and cumulative DAP appeared to be related to the higher exposures received by the operator. The number of procedures performed did not correlate with the personnel dosimeter exposure; rather it was the type and complexity of a study and the length of fluoroscopic time that was related. The number of ALARA investigations required has decreased gradually. This could be attributed to several factors. These include increased use of available safety items. With an increase in the number of interventionalists the work load is distributed more equitably. The purchase of new angiographic equipment has resulted in better image quality and more shielding options for the operators. The operators are periodically reminded to keep fluoroscopic time to a minimum and use appropriate settings on the equipment. The equipment is calibrated to provide adequate image quality at mid-dose settings. © 2012 American Association of

  11. Repeated nightmares

    MedlinePlus

    ... different from night terrors . Alternative Names Nightmares - repeated; Dream anxiety disorder References American Academy of Family Physicians. Information from your family doctor. Nightmares and night terrors in children. ...

  12. Recommended tissue list for histopathologic examination in repeat-dose toxicity and carcinogenicity studies: a proposal of the Society of Toxicologic Pathology (STP).

    PubMed

    Bregman, Carla L; Adler, Rick R; Morton, Daniel G; Regan, Karen S; Yano, Barry L

    2003-01-01

    The Executive Committee of the Society of Toxicologic Pathology (STP) appointed an ad hoc task force to devise and recommend a standard list of tissues to be evaluated histopathologically in repeat-dose toxicity and carcinogenicity studies that are used to support the registration of new pharmaceutical products. The recommended tissue list is intended to be a minimum core list that can be used for all types of repeat-dose toxicity and carcinogenicity studies, regardless of route of administration, species or strain of mammalian laboratory animal, duration, or class of drug to be tested. The resulting recommendations of the task force, presented here, were subsequently reviewed by the STP membership and endorsed by the STP Executive Committee.

  13. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray...

  14. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray...

  15. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray...

  16. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray...

  17. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray for...

  18. 21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1650...

  19. 21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1660...

  20. 21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1650...

  1. 21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1650...

  2. 21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1650...

  3. 21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1660...

  4. 21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1660...

  5. 21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1660...

  6. HEU Holdup Measurements in the 321-M Draw Bench, Straightener, and Fluoroscope Components

    SciTech Connect

    Dewberry, R.A.

    2001-07-10

    The Analytical Development Section of Savannah River Technology Center (SRTC) was requested by the Facilities Disposition Division (FDD) to determine the holdup of enriched uranium in the 321-M facility as part of an overall deactivation project of the facility. This report covers holdup measurements of uranium residue on the draw bench, straightener, and the fluoroscope components of the 321-M facility.

  7. Toward Simultaneous Real-Time Fluoroscopic and Nuclear Imaging in the Intervention Room.

    PubMed

    Beijst, Casper; Elschot, Mattijs; Viergever, Max A; de Jong, Hugo W A M

    2016-01-01

    To investigate the technical feasibility of hybrid simultaneous fluoroscopic and nuclear imaging. An x-ray tube, an x-ray detector, and a gamma camera were positioned in one line, enabling imaging of the same field of view. Since a straightforward combination of these elements would block the lines of view, a gamma camera setup was developed to be able to view around the x-ray tube. A prototype was built by using a mobile C-arm and a gamma camera with a four-pinhole collimator. By using the prototype, test images were acquired and sensitivity, resolution, and coregistration error were analyzed. Nuclear images (two frames per second) were acquired simultaneously with fluoroscopic images. Depending on the distance from point source to detector, the system resolution was 1.5-1.9-cm full width at half maximum, the sensitivity was (0.6-1.5) × 10(-5) counts per decay, and the coregistration error was -0.13 to 0.15 cm. With good spatial and temporal alignment of both modalities throughout the field of view, fluoroscopic images can be shown in grayscale and corresponding nuclear images in color overlay. Measurements obtained with the hybrid imaging prototype device that combines simultaneous fluoroscopic and nuclear imaging of the same field of view have demonstrated the feasibility of real-time simultaneous hybrid imaging in the intervention room. © RSNA, 2015

  8. Reducing Radiation Exposure in an Electrophysiology Lab with Introduction of Newer Fluoroscopic Technology.

    PubMed

    Sharma, Munish; Khalighi, Koroush

    2017-06-07

    The use of fluoroscopic devices exposes patients and operators to harmful effects of ionizing radiation in an electrophysiology (EP) lab. We sought to know if the newer fluoroscopic technology (Allura Clarity) installed in a hybrid EP helps to reduce prescribed radiation dose. We performed radiation dose analysis of 90 patients who underwent various procedures in the EP lab at a community teaching hospital after the introduction of newer fluoroscopic technology in June of 2016. Watchman device insertion, radiofrequency ablation procedures, permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) placement and battery changes were included in the study to compare radiation exposure during different procedures performed commonly in an EP lab. In all cases of watchman device placement, radiofrequency ablation procedures, PPM/ICD placement and battery changes, there was a statistically significant difference (<0.05) in radiation dose exposure. Significant reduction in radiation exposure during various procedures performed in an EP lab was achieved with aid of newer fluoroscopic technology and better image detection technology.

  9. Percent depth doses and X-ray beam characterizations of a fluoroscopic system incorporating copper filtration.

    PubMed

    Wunderle, Kevin A; Godley, Andrew R; Shen, Zhilei Liu; Rakowski, Joseph T; Dong, Frank F

    2017-04-01

    In this investigation, we sought to characterize X-ray beam qualities and quantitate percent depth dose (PDD) curves for fluoroscopic X-ray beams incorporating added copper (Cu) filtration, such as those commonly used in fluoroscopically guided interventions (FGI). The intended application of this research is for dosimetry in soft tissue from FGI procedures using these data. All measurements in this study were acquired on a Siemens (Erlangen, Germany) Artis zeego fluoroscope. X-ray beam characteristics of first half-value layer (HVL), second HVL, homogeneity coefficients (HCs), backscatter factors (BSFs) and kVp accuracy and precision were determined to characterize the X-ray beams used for the PDD measurements. A scanning water tank was used to measure PDD curves for 60, 80, 100, and 120 kVp X-ray beams with Cu filtration thicknesses of 0.0, 0.1, 0.3, 0.6, and 0.9 mm at 11 cm, 22 cm, and 42 cm nominal fields of view, in water depths of 0 to 150 mm. X-ray beam characteristics of first HVLs and HCs differed from previous published research of fluoroscopic X-ray beam qualities without Cu filtration. PDDs for 60, 80, 100, and 120 kVp with 0 mm of Cu filtration were comparable to previous published research, accounting for differences in fluoroscopes, geometric orientation, type of ionization chamber, X-ray beam quality, and the water tank used for data collection. PDDs and X-ray beam characteristics for beam qualities with Cu filtration are presented, which have not been previously reported. The data sets of X-ray beam characteristics and PDDs presented in this study can be used to estimate organ or soft tissue doses at depth involving similar beam qualities or to compare with mathematical models. © 2017 American Association of Physicists in Medicine.

  10. Application of a Repeat-Measure Biomarker Measurement Error Model to 2 Validation Studies: Examination of the Effect of Within-Person Variation in Biomarker Measurements

    PubMed Central

    Preis, Sarah Rosner; Spiegelman, Donna; Zhao, Barbara Bojuan; Moshfegh, Alanna; Baer, David J.; Willett, Walter C.

    2011-01-01

    Repeat-biomarker measurement error models accounting for systematic correlated within-person error can be used to estimate the correlation coefficient (ρ) and deattenuation factor (λ), used in measurement error correction. These models account for correlated errors in the food frequency questionnaire (FFQ) and the 24-hour diet recall and random within-person variation in the biomarkers. Failure to account for within-person variation in biomarkers can exaggerate correlated errors between FFQs and 24-hour diet recalls. For 2 validation studies, ρ and λ were calculated for total energy and protein density. In the Automated Multiple-Pass Method Validation Study (n = 471), doubly labeled water (DLW) and urinary nitrogen (UN) were measured twice in 52 adults approximately 16 months apart (2002–2003), yielding intraclass correlation coefficients of 0.43 for energy (DLW) and 0.54 for protein density (UN/DLW). The deattenuated correlation coefficient for protein density was 0.51 for correlation between the FFQ and the 24-hour diet recall and 0.49 for correlation between the FFQ and the biomarker. Use of repeat-biomarker measurement error models resulted in a ρ of 0.42. These models were similarly applied to the Observing Protein and Energy Nutrition Study (1999–2000). In conclusion, within-person variation in biomarkers can be substantial, and to adequately assess the impact of correlated subject-specific error, this variation should be assessed in validation studies of FFQs. PMID:21343245

  11. MR cone-beam CT fusion image overlay for fluoroscopically guided percutaneous biopsies in pediatric patients.

    PubMed

    Thakor, Avnesh S; Patel, Premal A; Gu, Richard; Rea, Vanessa; Amaral, Joao; Connolly, Bairbre L

    2016-03-01

    Lesions only visible on magnetic resonance (MR) imaging cannot easily be targeted for image-guided biopsy using ultrasound or X-rays but instead require MR guidance with MR-compatible needles and long procedure times (acquisition of multiple MR sequences). We developed an alternative method for performing these difficult biopsies in a standard interventional suite, by fusing MR with cone-beam CT images. The MR cone-beam CT fusion image is then used as an overlay to guide a biopsy needle to the target area under live fluoroscopic guidance. Advantages of this technique include (i) the ability for it to be performed in a conventional interventional suite, (ii) three-dimensional planning of the needle trajectory using cross-sectional imaging, (iii) real-time fluoroscopic guidance for needle trajectory correction and (iv) targeting within heterogeneous lesions based on MR signal characteristics to maximize the potential biopsy yield.

  12. Nonrigid 2D registration of fluoroscopic coronary artery image sequence with propagated deformation field

    NASA Astrophysics Data System (ADS)

    Park, Taewoo; Shin, Seung Yeon; Hong, Youngtaek; Lee, Soochahn; Chang, Hyuk-Jae; Yun, Il Dong

    2017-03-01

    We propose a novel method for nonrigid registration of coronary arteries within frames of a fluoroscopic X-ray angiogram sequence with propagated deformation field. The aim is to remove the motion of coronary arteries in order to simplify further registration of the 3D vessel structure obtained from computed tomography angiography, with the x-ray sequence. The Proposed methodology comprises two stages: propagated adjacent pairwise nonrigid registration, and, sequence-wise fixed frame nonrigid registration. In the first stage, a propagated nonrigid transformation reduces the disparity search range for each frame sequentially. In the second stage, nonrigid registration is applied for all frames with a fixed target frame, thus generating a motion-aligned sequence. Experimental evaluation conducted on a set of 7 fluoroscopic angiograms resulted in reduced target registration error, compared to previous methods, showing the effectiveness of the proposed methodology.

  13. Nonrigid 2D registration of fluoroscopic coronary artery image sequence with layered motion

    NASA Astrophysics Data System (ADS)

    Park, Taewoo; Jung, Hoyup; Yun, Il Dong

    2016-03-01

    We present a new method for nonrigid registration of coronary artery models with layered motion information. 2D nonrigid registration method is proposed that brings layered motion information into correspondence with fluoroscopic angiograms. The registered model is overlaid on top of interventional angiograms to provide surgical assistance during image-guided chronic total occlusion procedures. The proposed methodology is divided into two parts: layered structures alignments and local nonrigid registration. In the first part, inpainting method is used to estimate a layered rigid transformation that aligns layered motion information. In the second part, a nonrigid registration method is implemented and used to compensate for any local shape discrepancy. Experimental evaluation conducted on a set of 7 fluoroscopic angiograms results in a reduced target registration error, which showed the effectiveness of the proposed method over single layered approach.

  14. A small, battery-operated fluoroscopic system - Lixiscope with X-ray generator

    NASA Technical Reports Server (NTRS)

    Yin, L. I.; Trombka, J. I.; Ruitberg, A. P.; Seltzer, S. M.

    1983-01-01

    A small, battery-operated X-ray generator has been developed to be used as part of a small-format fluoroscopic system, the Lixiscope (Low Intensity X-ray Imaging Scope). The X-ray generator consists of a grounded rod-anode X-ray tube with a 0.2 mm focal spot and a specially designed, battery-operated, 0 to -80 kV high-voltge supply. Total power consumption is about 10 W. The fine focal spot, in conjunction with the continuously variable X-ray intensity and spectral distribution, helps to extend both the versatility and the performance of the Lixiscope toward a much wider range of terrestrial and spacecraft applications. The complete fluoroscopic system is described, and some examples of possible applications are shown.

  15. Improving Patient Safety: Implementing Dose Monitoring Software in Fluoroscopically Guided Interventions.

    PubMed

    Heilmaier, Christina; Niklaus, Zuber; Berthold, Christian; Kara, Levent; Weishaupt, Dominik

    2015-11-01

    To assess whether dose monitoring software can be successfully implemented in fluoroscopically guided interventions and to provide dose data based on levels of complexity. After launching the software (DoseWatch; GE Healthcare Systems, Buc, France), data were collected for 6 months and analyzed by means of kerma-area product (KAP; Gy/cm(2)), cumulative air kerma (KA,R; Gy), and fluoroscopic time (minutes). Data analysis was executed by level of complexity as graded by the operators. Complexity grading was based on factors such as tortuosity and calcification of vessel, variant anatomy, and patient cooperation. The software successfully transferred dose data of 357 fluoroscopically guided procedures. KAP was 0.238-400 Gy/cm(2) with mean, median, and 75th percentile values of 46.0 Gy/cm(2), 163.2 Gy/cm(2), and 541.1 Gy/cm(2) (KA,R, 0.013-4.1 Gy; mean, median, 75th percentile, 0.48 Gy, 0.97 Gy, 3.98 Gy). Highest dose values were seen in transarterial chemoembolization (KAP mean, median, 75th percentile, 229.5 Gy/cm(2), 216.4 Gy/cm(2), 299.9 Gy/cm(2); KA,R mean, median, 75th percentile, 1.9 Gy, 1.2 Gy, 1.7 Gy). Analysis revealed that the level of complexity strongly correlated with KAP (r = 0.88; P < .001) whereas there was no direct correlation of KAP and fluoroscopy time. During the same intervention, KA,R and fluoroscopy time increased with level of complexity, but the correlation was not statistically significant. Implementation of dose monitoring software in fluoroscopically guided interventions can be successfully accomplished, and it facilitates data comparison. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  16. The capability of fluoroscopic systems to determine differential Roentgen-ray absorption

    NASA Technical Reports Server (NTRS)

    Baily, N. A.; Crepeau, R. L.

    1975-01-01

    A clinical fluoroscopic unit used in conjunction with a TV image digitization system was investigated to determine its capability to evaluate differential absorption between two areas in the same field. Fractional contrasts and minimum detectability for air, several concentrations of Renografin-60, and aluminum were studied using phantoms of various thicknesses. Results showed that the videometric response, when treated as contrast, shows a linear response with absorber thickness up to considerable thicknesses.

  17. Leukemia Risk After Cardiac Fluoroscopic Interventions Stratified by Procedure Number, Exposure Latent Time, and Sex

    PubMed Central

    Wei, Kai-Che; Lin, Hon-Yi; Hung, Shih-Kai; Huang, Yu-Tung; Lee, Moon-Sing; Wang, Wen-Hua; Wu, Chieh-Shan; Su, Yu-Chieh; Shen, Bing-Jie; Tsai, Shiang-Jiun; Tsai, Wei-Ta; Chen, Liang-Cheng; Li, Chung-Yi; Chiou, Wen-Yen

    2016-01-01

    Abstract A number of cardiac fluoroscopic interventions have increased rapidly worldwide over the past decade. Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation have become increasingly popular, and these advancements have allowed patients to receive repetitive treatments for restenosis. However, these advancements also significantly increase radiation exposure that may lead to higher cumulative doses of radiation. In the present study, a nationwide population-based case-controlled study was used to explore the risk of leukemia after cardiac angiographic fluoroscopic intervention. A total of 5026 patients with leukemia and 100,520 control patients matched for age and sex (1:20) by a propensity score method without any cancer history were enrolled using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan between 2008 and 2010. All subjects were retrospectively surveyed (from year 2000) to determine receipt of cardiac fluoroscopic interventions. Data were analyzed using conditional logistic regression models, and estimated crude and adjusted odds ratios (95% confidence interval). After adjusting for age, gender, and comorbidities, PTCA was found to be associated with an increased risk of leukemia with an adjusted OR of 1.566 (95% CI, 1.282–1.912), whereas coronary angiography alone without PTCA and cardiac electrophysiologic study were not. Our results also showed that an increased frequency of PTCA and coronary angiography was associated with a higher risk of leukemia (adjusted OR: 1.326 to 1.530 [all P < 0.05]). Gender subgroup analyses demonstrated that men were associated with a higher risk of leukemia compared with women. These results provide additional data in the quantification of the long-term health effects of radiation exposure derived from the cardiac fluoroscopic diagnostic and therapeutic intervention. PTCA alone or PTCA with coronary angiography was associated

  18. Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures

    PubMed Central

    Ikuma, Hisanori; Tokashiki, Takuya; Maehara, Takashi; Nagamachi, Akihiro; Takata, Yoichiro; Sakai, Toshinori; Higashino, Kosaku; Sairyo, Koichi

    2017-01-01

    Study Design Prospective study. Purpose During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. Overview of Literature Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed. Methods This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure. Results The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb. Conclusions Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure. PMID:28243373

  19. Fluoroscopic coronary calcification and exercise stress test in asymptomatic elderly Asian-Indians.

    PubMed

    Singh, Nishith K; Narang, Rajiv; Dey, Aparajit B

    2008-01-01

    Provide preliminary data on prevalence and functional significance (association with atherosclerotic risk factors and stress test positivity) of fluoroscopically detected CAC (Coronary Artery Calcification) in asymptomatic elderly Indian-Asian. Prospective observational study. Outpatient services at 1000-bed tertiary care hospital in Northern India. 100 sedentary elderly (>60 years) Asian-Indian subjects (70 males, 30 females, age 65.9 +/- 5.1 years) with no history of CAD (asymptomatic). CAC assessment was done using high intensity cine fluoroscopy and semi quantitative CAC scoring (scores 0-3) in all subjects (n = 100). Risk factor profile (diabetes, hypertension, smoking, serum lipids, body-mass index, waist-hip ratio) documented for all subjects. In 50 (the latter half of 100) consecutive subjects (29 males and 21 females, age 64.2 +/- 4.9 years), exercise stress test (treadmill test, TMT) was also done using standard Bruce protocol. 92% (84.8-96.1, 95% CI) had fluoroscopic calcification and there was no significant association of higher CAC scores and risk factors, except for a positive trend with serum total cholesterol (p = 0.086). 20% (11-33.2, 95% CI) tested positive on exercise stress test and a positive trend (OR = 7.2, 95% CI = 0.8-63, p value = 0.067) with higher CAC scores was seen. High prevalence of fluoroscopic CAC and stress test positivity was observed in asymptomatic elderly Asian-Indians. The newly observed positive trend with increasing total cholesterol levels and stress test positivity highlights the importance of fluoroscopic CAC in asymptomatic elderly and should be corroborated with larger studies.

  20. Evaluation of the Monte Carlo method (KTMAN-2) in fluoroscopic dosimetry and comparison with experiment

    NASA Astrophysics Data System (ADS)

    Kim, Minho; Lee, Hyounggun; Kim, Hyosim; Park, Hongmin; Lee, Wonho; Park, Sungho

    2014-03-01

    This study evaluated the Monte Carlo method for determining the dose calculation in fluoroscopy by using a realistic human phantom. The dose was calculated by using Monte Carlo N-particle extended (MCNPX) in simulations and was measured by using Korean Typical Man-2 (KTMAN-2) phantom in the experiments. MCNPX is a widely-used simulation tool based on the Monte-Carlo method and uses random sampling. KTMAN-2 is a virtual phantom written in MCNPX language and is based on the typical Korean man. This study was divided into two parts: simulations and experiments. In the former, the spectrum generation program (SRS-78) was used to obtain the output energy spectrum for fluoroscopy; then, each dose to the target organ was calculated using KTMAN-2 with MCNPX. In the latter part, the output of the fluoroscope was calibrated first and TLDs (Thermoluminescent dosimeter) were inserted in the ART (Alderson Radiation Therapy) phantom at the same places as in the simulation. Thus, the phantom was exposed to radiation, and the simulated and the experimental doses were compared. In order to change the simulation unit to the dose unit, we set the normalization factor (NF) for unit conversion. Comparing the simulated with the experimental results, we found most of the values to be similar, which proved the effectiveness of the Monte Carlo method in fluoroscopic dose evaluation. The equipment used in this study included a TLD, a TLD reader, an ART phantom, an ionization chamber and a fluoroscope.

  1. Fluoroscopic performance tests using a portable computer/frame grabber: Wiener spectra measurements.

    PubMed

    Goldman, L W

    1992-01-01

    Currently, routine tests of fluoroscopic image quality in common use are highly subjective. As part of an effort to develop more quantitative routine tests of fluoroscopic image quality, a method was developed to quickly and easily measure Wiener spectra (WS) of TV-viewed fluoroscopic systems that considers both spatial and temporal noise correlations. A PC-mounted frame grabber captures images at the TV frame rate to form a three-dimensional (3-D) array of pixels. Scans of a "two-dimensional slit" are then synthesized from which a one-dimensional central section of a 3-D WS is calculated. To avoid errors due to coarse (8-bit) quantization, a video amplifier is used to expand a portion of the signal to the full digitizer range. A reference signal (2 mm of aluminum) is then used to normalize image contrast. Ensemble averages of 250 spectra were obtained in approximately 1 min, including all processing. Results are presented to demonstrate reproducibility, sensitivity, and behavior of the WS. The eventual goal of this work is to use this method in conjunction with measurements of an MTF to calculate fundamental descriptors of image quality, such as SNR and NEQ.

  2. Long term safety of fluoroscopically guided selective salpingography and tubal catheterization.

    PubMed

    Papaioannou, S; Afnan, M; Coomarasamy, A; Ola, B; Hammadieh, N; Temperton, D H; McHugo, J M; Sharif, K

    2002-02-01

    The irradiation of the ovaries of reproductive age women during fluoroscopically guided selective salpingography and tubal catheterization has raised concern about the safety of the procedure. In addition to the risk of cancer induction, which exists with the irradiation of all tissues, with the gonads, the induction of hereditary disorders is possible. The objective of this study was to estimate these risks and present them in a clinically meaningful way. Retrospective analysis was undertaken of 366 consecutive cases of selective salpingography and tubal catheterization performed at the Birmingham Women's Hospital, UK. The radiation doses of different types of procedure were compared with the background annual radiation dose. The risks of cancer and genetic disorders induction were calculated using conversion coefficients published by the International Commission on Radiological Protection. The radiation dose women were exposed to during selective salpingography and tubal catheterization under fluoroscopic guidance was a fraction of the background annual radiation dose. The excess lifetime risks of cancer and hereditary disorders were in the order of four to 13 and two to six per million procedures respectively. The long term risks of selective salpingography and tubal catheterization under fluoroscopic guidance are low.

  3. A spatio-temporal detective quantum efficiency and its application to fluoroscopic systems.

    PubMed

    Friedman, S N; Cunningham, I A

    2010-11-01

    Fluoroscopic x-ray imaging systems are used extensively in spatio-temporal detection tasks and require a spatio-temporal description of system performance. No accepted metric exists that describes spatio-temporal fluoroscopic performance. The detective quantum efficiency (DQE) is a metric widely used in radiography to quantify system performance and as a surrogate measure of patient "dose efficiency". It has been applied previously to fluoroscopic systems with the introduction of a temporal correction factor. However, the use of a temporally-corrected DQE does not provide system temporal information and it is only valid under specific conditions, many of which are not likely to be satisfied by suboptimal systems. The authors propose a spatio-temporal DQE that describes performance in both space and time and is applicable to all spatio-temporal quantum-based imaging systems. The authors define a spatio-temporal DQE (two spatial-frequency axes and one temporal-frequency axis) in terms of a small-signal spatio-temporal modulation transfer function (MTF) and spatio-temporal noise power spectrum (NPS). Measurements were made on an x-ray image intensifier-based bench-top system using continuous fluoroscopy with an RQA-5 beam at 3.9 microR/frame and hardened 50 kVp beam (0.8 mm Cu filtration added) at 1.9 microR/frame. A zero-frequency DQE value of 0.64 was measured under both conditions. Nonideal performance was noted at both larger spatial and temporal frequencies; DQE values decreased by approximately 50% at the cutoff temporal frequency of 15 Hz. The spatio-temporal DQE enables measurements of decreased temporal system performance at larger temporal frequencies analogous to previous measurements of decreased (spatial) performance. This marks the first time that system performance and dose efficiency in both space and time have been measured on a fluoroscopic system using DQE and is the first step toward the generalized use of DQE on clinical fluoroscopic systems.

  4. A spatio-temporal detective quantum efficiency and its application to fluoroscopic systems

    SciTech Connect

    Friedman, S. N.; Cunningham, I. A.

    2010-11-15

    Purpose: Fluoroscopic x-ray imaging systems are used extensively in spatio-temporal detection tasks and require a spatio-temporal description of system performance. No accepted metric exists that describes spatio-temporal fluoroscopic performance. The detective quantum efficiency (DQE) is a metric widely used in radiography to quantify system performance and as a surrogate measure of patient ''dose efficiency.'' It has been applied previously to fluoroscopic systems with the introduction of a temporal correction factor. However, the use of a temporally-corrected DQE does not provide system temporal information and it is only valid under specific conditions, many of which are not likely to be satisfied by suboptimal systems. The authors propose a spatio-temporal DQE that describes performance in both space and time and is applicable to all spatio-temporal quantum-based imaging systems. Methods: The authors define a spatio-temporal DQE (two spatial-frequency axes and one temporal-frequency axis) in terms of a small-signal spatio-temporal modulation transfer function (MTF) and spatio-temporal noise power spectrum (NPS). Measurements were made on an x-ray image intensifier-based bench-top system using continuous fluoroscopy with an RQA-5 beam at 3.9 {mu}R/frame and hardened 50 kVp beam (0.8 mm Cu filtration added) at 1.9 {mu}R/frame. Results: A zero-frequency DQE value of 0.64 was measured under both conditions. Nonideal performance was noted at both larger spatial and temporal frequencies; DQE values decreased by {approx}50% at the cutoff temporal frequency of 15 Hz. Conclusions: The spatio-temporal DQE enables measurements of decreased temporal system performance at larger temporal frequencies analogous to previous measurements of decreased (spatial) performance. This marks the first time that system performance and dose efficiency in both space and time have been measured on a fluoroscopic system using DQE and is the first step toward the generalized use of DQE on

  5. SU-D-209-02: Percent Depth Dose Curves for Fluoroscopic X-Ray Beam Qualities Incorporating Copper Filtration

    SciTech Connect

    Wunderle, K; Godley, A; Shen, Z; Dong, F; Rakowski, J

    2016-06-15

    Purpose: The purpose of this investigation was to quantify percent depth dose (PDD) curves for fluoroscopic x-ray beam qualities incorporating added copper filtration. Methods: A PTW (Freiburg, Germany) MP3 water tank was used with a Standard Imaging (Middleton, WI) Exradin Model 11 Spokas Chamber to measure PDD curves for 60, 80, 100 and 120 kVp x-ray beams with copper filtration ranging from 0.0–0.9 mm at 22cm and 42cm fields of view from 0 to 150 mm of water. A free-in-air monitor chamber was used to normalize the water tank data to fluctuations in output from the fluoroscope. The measurements were acquired on a Siemens (Erlangen, Germany) Artis ZeeGo fluoroscope. The fluoroscope was inverted from the typical orientation providing an x-ray beam originating from above the water tank. The water tank was positioned so that the water level was located at 60cm from the focal spot; which also represents the focal spot to interventional reference plane distance for that fluoroscope. Results: PDDs for 60, 80, 100, and 120 kVp with 0 mm of copper filtration compared well to previously published data by Fetterly et al. [Med Phys, 28, 205 (2001)] for those beam qualities given differences in fluoroscopes, geometric orientation, type of ionization chamber, and the water tank used for data collection. PDDs for 60, 80, 100, and 120 kVp with copper filtration were obtained and are presented, which have not been previously investigated and published. Conclusion: The equipment and processes used to acquire the reported data were sound and compared well with previously published data for PDDs without copper filtration. PDD data for the fluoroscopic x-ray beams incorporating copper filtration can be used as reference data for estimating organ or soft tissue dose at depth involving similar beam qualities or for comparison with mathematical models.

  6. Accuracy of Percutaneous Lumbosacral Pedicle Screw Placement Using the Oblique Fluoroscopic View Based on Computed Tomography Evaluations

    PubMed Central

    Sato, Koji; Kanemura, Tokumi; Iwase, Toshiki; Togawa, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    Study Design Retrospective. Purpose This study aims to investigate the accuracy of the oblique fluoroscopic view, based on preoperative computed tomography (CT) images for accurate placement of lumbosacral percutaneous pedicle screws (PPS). Overview of Literature Although PPS misplacement has been reported as one of the main complications in minimally invasive spine surgery, there is no comparative data on the misplacement rate among different fluoroscopic techniques, or comparing such techniques with open procedures. Methods We retrospectively selected 230 consecutive patients who underwent posterior spinal fusion with a pedicle screw construct for degenerative lumbar disease, and divided them into 3 groups, those who had undergone: minimally invasive percutaneous procedure using biplane (lateral and anterior-posterior views using a single C-arm) fluoroscope views (group M-1), minimally invasive percutaneous procedure using the oblique fluoroscopic view based on preoperative CT (group M-2), and conventional open procedure using a lateral fluoroscopic view (group O: controls). The relative position of the screw to the pedicle was graded for the pedicle breach as no breach, <2 mm, 2–4 mm, or >4 mm. Inaccuracy was calculated and assessed according to the spinal level, direction and neurological deficit. Inter-group radiation exposure was estimated using fluoroscopy time. Results Inaccuracy involved an incline toward L5, causing medial or lateral perforation of pedicles in group M-1, but it was distributed relatively equally throughout multiple levels in groups M-2 and controls. The mean fluoroscopy time/case ranged from 1.6 to 3.9 minutes. Conclusions Minimally invasive lumbosacral PPS placement using the conventional fluoroscopic technique carries an increased risk of inaccurate screw placement and resultant neurological deficits, compared with that of the open procedure. Inaccuracy tended to be distributed between medial and lateral perforations of the L5 pedicle

  7. Examination of exhaustive cloning attempts reveals that C. elegans piRNAs, transposons, and repeat sequences are efficiently cloned in yeast, but not in bacteria.

    PubMed

    Sagy, Or; Shamir, Ron; Rechavi, Oded

    2014-01-01

    Genome sequencing requires insertion of random fragments of the sequenced organism's DNA into a unicellular host, most often Escherichia coli bacteria. This manipulation was found in the past to be analogous to naturally occurring horizontal gene transfer, and moreover has proved valuable to understanding toxicity of foreign genetic elements to E. coli. Sequencing of the Caenorhabditis elegans genome was similarly achieved via DNA transformation into E. coli. However, numerous attempts have proven a significant percentage of the genome unclonable using bacteria, although clonable via yeast. We examined the genomic segments that were not clonable in bacteria but were clonable in yeast, and observed that, in line with previous hypotheses, such sequences are more repetitive on average compared with the entire C. elegans genome. In addition, we found that these gap-sequences encode significantly more for DNA transposons. Surprisingly, we discovered that although the vast majority of the C. elegans genome is clonable in bacteria (77.5%), almost all the thousands of sequences that encode for PIWI-interacting small RNAs, or 21U-RNAs (91.6%) were only clonable in yeast. These results might help understanding why most piRNAs in C. elegans are physically clustered on particular loci on chromosome IV. In worms and in a large number of other organisms, piRNAs serve to distinguish "Self" from "Non-Self" sequences, and thus to protect the integrity of the genome against foreign genetic elements, such as transposons. We discuss the possible implications of these discoveries.

  8. Multiple imputation of completely missing repeated measures data within person from a complex sample: application to accelerometer data in the National Health and Nutrition Examination Survey.

    PubMed

    Liu, Benmei; Yu, Mandi; Graubard, Barry I; Troiano, Richard P; Schenker, Nathaniel

    2016-12-10

    The Physical Activity Monitor component was introduced into the 2003-2004 National Health and Nutrition Examination Survey (NHANES) to collect objective information on physical activity including both movement intensity counts and ambulatory steps. Because of an error in the accelerometer device initialization process, the steps data were missing for all participants in several primary sampling units, typically a single county or group of contiguous counties, who had intensity count data from their accelerometers. To avoid potential bias and loss in efficiency in estimation and inference involving the steps data, we considered methods to accurately impute the missing values for steps collected in the 2003-2004 NHANES. The objective was to come up with an efficient imputation method that minimized model-based assumptions. We adopted a multiple imputation approach based on additive regression, bootstrapping and predictive mean matching methods. This method fits alternative conditional expectation (ace) models, which use an automated procedure to estimate optimal transformations for both the predictor and response variables. This paper describes the approaches used in this imputation and evaluates the methods by comparing the distributions of the original and the imputed data. A simulation study using the observed data is also conducted as part of the model diagnostics. Finally, some real data analyses are performed to compare the before and after imputation results. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  9. Validation of 'variable number of tandem repeat'-based approach for examination of 'Candidatus Liberibacter asiaticus' diversity and its applications for the analysis of the pathogen populations in the areas of recent introduction.

    PubMed

    Matos, Luis A; Hilf, Mark E; Chen, Jianchi; Folimonova, Svetlana Y

    2013-01-01

    Citrus greening (Huanglongbing, HLB) is one of the most destructive diseases of citrus worldwide. In South Asia HLB has been known for more than a century, while in Americas the disease was found relatively recently. HLB is associated with three species of 'Candidatus Liberibacter' among which 'Ca. Liberibacter asiaticus' (CLas) has most wide distribution. Recently, a number of studies identified different regions in the CLas genome with variable number of tandem repeats (VNTRs) that could be used for examination of CLas diversity. One of the objectives of the work presented here was to further validate the VNTR analysis-based approach by assessing the stability of these repeats upon multiplication of the pathogen in a host over an extended period of time and upon its passaging from a host to a host using CLas populations from Florida. Our results showed that the numbers of tandem repeats in the four loci tested display very distinguishable "signature profiles" for the two Florida-type CLas haplotype groups. Remarkably, the profiles do not change upon passage of the pathogen in citrus and psyllid hosts as well as after its presence within a host over a period of five years, suggesting that VNTR analysis-based approach represents a valid methodology for examination of the pathogen populations in various geographical regions. Interestingly, an extended analysis of CLas populations in different locations throughout Florida and in several countries in the Caribbean and Central America regions and in Mexico where the pathogen has been introduced recently demonstrated the dispersion of the same haplotypes of CLas. On the other hand, these CLas populations appeared to differ significantly from those obtained from locations where the disease has been present for a much longer time.

  10. Repeated Causal Decision Making

    ERIC Educational Resources Information Center

    Hagmayer, York; Meder, Bjorn

    2013-01-01

    Many of our decisions refer to actions that have a causal impact on the external environment. Such actions may not only allow for the mere learning of expected values or utilities but also for acquiring knowledge about the causal structure of our world. We used a repeated decision-making paradigm to examine what kind of knowledge people acquire in…

  11. Solid-state fluoroscopic imager for high-resolution angiography: Parallel-cascaded linear systems analysis

    PubMed Central

    Vedantham, Srinivasan; Karellas, Andrew; Suryanarayanan, Sankararaman

    2008-01-01

    Cascaded linear systems based modeling techniques have been used in the past to predict important system parameters that have a direct impact on image quality. Such models are also useful in optimizing system parameters to improve image quality. In this work, detailed analysis of a solid-state fluoroscopic imaging system intended for high-resolution angiography is presented with the use of such a model. The imaging system analyzed through this model uses four 8×8 cm three-side buttable interlined charge-coupled devices (CCDs) specifically designed for high-resolution angiography and tiled in a seamless fashion to achieve a field of view (FOV) of 16×16 cm. Larger FOVs can be achieved by tiling more CCDs in a similar manner. The system employs a CsI:Tl scintillator coupled to the CCDs by straight (nontapering) fiberoptics and can potentially be operated in 78, 156, or 234 μm pixel pitch modes. The system parameters analyzed through this model include presampling modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE). The results of the simulations performed indicate that DQE(0) in excess of 0.6 is achievable, with the imager operating at 156 μm pixel pitch, 30 frames/s, and employing a 450-μm-thick CsI:Tl scintillator, even at a low fluoroscopic exposure rate of 1 μR/frame. Further, at a nominal fluoroscopic exposure rate of 2.5 μR/frame there was no noticeable degradation of the DQE even at the 78 μm pixel pitch mode suggesting that it is feasible to perform high-resolution angiography hitherto unattainable in clinical practice. PMID:15191318

  12. Solid-state fluoroscopic imager for high-resolution angiography: parallel-cascaded linear systems analysis.

    PubMed

    Vedantham, Srinivasan; Karellas, Andrew; Suryanarayanan, Sankararaman

    2004-05-01

    Cascaded linear systems based modeling techniques have been used in the past to predict important system parameters that have a direct impact on image quality. Such models are also useful in optimizing system parameters to improve image quality. In this work, detailed analysis of a solid-state fluoroscopic imaging system intended for high-resolution angiography is presented with the use of such a model. The imaging system analyzed through this model uses four 8 x 8 cm three-side buttable interlined charge-coupled devices (CCDs) specifically designed for high-resolution angiography and tiled in a seamless fashion to achieve a field of view (FOV) of 16 x 16 cm. Larger FOVs can be achieved by tiling more CCDs in a similar manner. The system employs a CsI:Tl scintillator coupled to the CCDs by straight (nontapering) fiberoptics and can potentially be operated in 78, 156, or 234 microm pixel pitch modes. The system parameters analyzed through this model include presampling modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE). The results of the simulations performed indicate that DQE(0) in excess of 0.6 is achievable, with the imager operating at 156 microm pixel pitch, 30 frames/s, and employing a 450-microm-thick CsI:Tl scintillator, even at a low fluoroscopic exposure rate of 1 microR/frame. Further, at a nominal fluoroscopic exposure rate of 2.5 microR/frame there was no noticeable degradation of the DQE even at the 78 microm pixel pitch mode suggesting that it is feasible to perform high-resolution angiography hitherto unattainable in clinical practice.

  13. Complete supine PCNL: ultrasound vs. fluoroscopic guided: a randomized clinical trial

    PubMed Central

    Falahatkar, Siavash; Allahkhah, Aliakbar; Kazemzadeh, Majid; Enshaei, Ahmad; Shakiba, Maryam; Moghaddas, Fahimeh

    2016-01-01

    ABSTRACT Introduction and Hypothesis: To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with ultrasound guided and fluoroscopically guided procedure. Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position. Statistical analysis was performed with SPSS16 software. Results: Mean BMI was 28.14 in group A and 26.31 in group B (p=0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (p=0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (p=0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (p=0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (p=0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (p=0.22). There was no visceral injury in groups. Conclusions: This randomized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL. Ultrasonography can be an alternative rather than fluoroscopy in PCNL. We believe that more randomized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation. PMID:27564281

  14. Percutaneous Radiofrequency Thermocoagulation Under Fluoroscopic Image-Guidance for Idiopathic Trigeminal Neuralgia

    PubMed Central

    Kim, Hyung-Suk; Kim, Il-Sup; Yang, Seung-Ho; Lee, Sang-Won

    2011-01-01

    Objective We retrospectively investigated the long-term results of percutaneous radiofrequency thermocoagulation (RFT) using fluoroscopic image-guidance for treatment of trigeminal neuralgia. Methods A total of 38 patients diagnosed and treated with RFT as an idiopathic trigeminal neuralgia were investigated. To minimize the risks related to conventional technique based on cutaneous landmarks, and to eliminate the need to frequent reposition of cannula, we adopted a technique of image-guided fluoroscopic cannulation of the foramen ovale. To minimize sensory complication following thermal lesion, our target response was a generation of a lesion with mild to moderate hypalgesia rather than dense hypalgesia. Results The immediate pain-relief was achieved in all patients underwent RFT. With mean duration of follow-up of 38.2 months (range,12-72), 11 (28.9%) experienced recurrence of pain. The mean timing of recurrence was 26.1 months (range,12-46). A 42.7% recurrence rate was estimated by Kaplan-Meier analysis for the 38 patients at 46 months; 20.2% within 2 years, 29.1% within 3 years. In the long-term, 27 patients (71%) and 6 patients (15.8%) showed Barrow Neurological Institute (BNI) score I and BNI score II responses. 3 (7.9%) patients was assessed as BNI score III, 2 patients (5.3%) showed BNI score IV response. As a complication, troublesome dysesthesia occurred in 3 of 38 patients (7.9%), however, there was no permanent cranial nerve palsy or morbidity. Conclusion These results indicates that RFT under fluoroscopic image-guided cannulation of foramen ovale is a safe, effective, and reliable means of treating trigeminal neuralgia. PMID:22259692

  15. 4DCBCT-based motion modeling and 3D fluoroscopic image generation for lung cancer radiotherapy

    NASA Astrophysics Data System (ADS)

    Dhou, Salam; Hurwitz, Martina; Mishra, Pankaj; Berbeco, Ross; Lewis, John

    2015-03-01

    A method is developed to build patient-specific motion models based on 4DCBCT images taken at treatment time and use them to generate 3D time-varying images (referred to as 3D fluoroscopic images). Motion models are built by applying Principal Component Analysis (PCA) on the displacement vector fields (DVFs) estimated by performing deformable image registration on each phase of 4DCBCT relative to a reference phase. The resulting PCA coefficients are optimized iteratively by comparing 2D projections captured at treatment time with projections estimated using the motion model. The optimized coefficients are used to generate 3D fluoroscopic images. The method is evaluated using anthropomorphic physical and digital phantoms reproducing real patient trajectories. For physical phantom datasets, the average tumor localization error (TLE) and (95th percentile) in two datasets were 0.95 (2.2) mm. For digital phantoms assuming superior image quality of 4DCT and no anatomic or positioning disparities between 4DCT and treatment time, the average TLE and the image intensity error (IIE) in six datasets were smaller using 4DCT-based motion models. When simulating positioning disparities and tumor baseline shifts at treatment time compared to planning 4DCT, the average TLE (95th percentile) and IIE were 4.2 (5.4) mm and 0.15 using 4DCT-based models, while they were 1.2 (2.2) mm and 0.10 using 4DCBCT-based ones, respectively. 4DCBCT-based models were shown to perform better when there are positioning and tumor baseline shift uncertainties at treatment time. Thus, generating 3D fluoroscopic images based on 4DCBCT-based motion models can capture both inter- and intra- fraction anatomical changes during treatment.

  16. Fluoroscopically-guided micropuncture femoral artery access for large-caliber sheath insertion.

    PubMed

    Cilingiroglu, Mehmet; Feldman, Ted; Salinger, Michael H; Levisay, Justin; Turi, Zoltan G

    2011-04-01

    Over the last decade, significant developments have been made in the treatment of structural heart disease. Some of these techniques require placement of large arterial sheaths for device delivery. Optimal vascular access is essential for successful large-vessel sheath insertion as well as to avoid vascular complications. The critical step for ideal percutaneous vessel entry is single anterior wall-only puncture of the common femoral artery in a location above the femoral bifurcation and below the inguinal ligament. We describe a fluoroscopically-guided micropuncture technique for accurate placement of large-caliber arterial sheaths.

  17. Combined MRI and Fluoroscopic Guided Radiofrequency Ablation of a Renal Tumor

    SciTech Connect

    Fotiadis, Nikolas I.; Sabharwal, Tarun; Gangi, Afshin; Adam, Andreas

    2009-01-15

    Percutaneous CT- and ultrasound-guided radiofrequency ablation of renal cell carcinoma (RCC) has been shown to have very promising medium-term results. We present a unique case of recurrent RCC after partial nephrectomy in a patient with a single kidney and impaired renal function. This tumor could not be visualized either with CT or with ultrasound. A combination of magnetic resonance imaging and fluoroscopic guidance was used, to the best of our knowledge for the first time, to ablate the tumor with radiofrequency. The patient was cancer-free and off dialysis at 30-month follow up.

  18. A comparison of optical and electromagnetic computer-assisted navigation systems for fluoroscopic targeting.

    PubMed

    Ricci, William M; Russell, Thomas A; Kahler, David M; Terrill-Grisoni, Lauralan; Culley, Patrick

    2008-03-01

    Freehand targeting using fluoroscopic guidance is routine for placement of interlocking screws associated with intramedullary nailing and for insertion of screws for reconstruction of pelvic and acetabular injuries. New technologies that use fluoroscopy with the assistance of computer guidance have the potential to improve accuracy and reduce radiation exposure to patient and surgeon. We sought to compare 2 fluoroscopic navigation tracking technologies, optical and electromagnetic versus standard freehand fluoroscopic targeting in a standardized model. Three experienced orthopaedic trauma surgeons placed 3.2-mm guide pins through test foam blocks that simulate cancellous bone. The entry site for each pin was within a circular (18-mm) entry zone. On the opposite surface of the test block (130-mm across), the target was a 1-mm-diameter radioopaque spherical ball marker. Each surgeon placed 10 pins using freehand targeting (control group) navigation using Medtronic iON StealthStation (Optical A), navigation using BrainLAB VectorVision (Optical B), or navigation using GE Medical Systems InstaTrak 3500 system (EM). Data were collected for accuracy (the distance from the exit site of the guidewire to the target spherical ball marker), fluoroscopy time (seconds), and total number of individual fluoroscopy images taken. The 2 optical systems and the electromagnetic system provided significantly improved accuracy compared to freehand technique. The average distance from the target was significantly (3.5 times) greater for controls (7.1 mm) than for each of the navigated systems (Optical A = 2.1 mm, Optical B = 1.9 mm EM = 2.4 mm; P < .05). Accuracy was similar for the 3 navigated systems, (P > 0.05). The ability to place guidewires in a 5-mm safe zone surrounding the target sphere was also significantly improved with the optical systems and the EM system (99% of wires in the safe zone) compared to controls (47% in the safe zone) (P < 0.002). Safe zone placement was similar

  19. Breast cancer mortality following fluoroscopic irradiation in a cohort of tuberculosis patients

    SciTech Connect

    Howe, G.R.; Miller, A.B.; Sherman, G.J.

    1982-01-01

    A study has been conducted to determine the mortality experience from 1950-1977 of a cohort of women treated for tuberculosis in Canadian sanatoria between 1930 and 1952. Approximately 50 percent of these women received substantial breast tissue doses of fluoroscopic irradiation in conjunction with their treatment by artificial pneumothorax. A preliminary analysis of 23572 women known alive at the beginning of 1950 has shown a highly significant breast cancer mortality risk for those women exposed to such radiation. There is evidence of decreasing effect with increasing age at first exposure, and no increase in risk is observed until ten years after first exposure.

  20. To Repeat or Not to Repeat a Course

    ERIC Educational Resources Information Center

    Armstrong, Michael J.; Biktimirov, Ernest N.

    2013-01-01

    The difficult transition from high school to university means that many students need to repeat (retake) 1 or more of their university courses. The authors examine the performance of students repeating first-year core courses in an undergraduate business program. They used data from university records for 116 students who took a total of 232…

  1. To Repeat or Not to Repeat a Course

    ERIC Educational Resources Information Center

    Armstrong, Michael J.; Biktimirov, Ernest N.

    2013-01-01

    The difficult transition from high school to university means that many students need to repeat (retake) 1 or more of their university courses. The authors examine the performance of students repeating first-year core courses in an undergraduate business program. They used data from university records for 116 students who took a total of 232…

  2. Integrated contour detection and pose estimation for fluoroscopic analysis of knee implants.

    PubMed

    Prins, A H; Kaptein, B L; Stoel, B C; Nelissen, R G H H; Reiber, J H C; Valstar, E R

    2011-08-01

    With fluoroscopic analysis of knee implant kinematics the implant contour must be detected in each image frame, followed by estimation of the implant pose. With a large number of possibly low-quality images, the contour detection is a time-consuming bottleneck. The present paper proposes an automated contour detection method, which is integrated in the pose estimation. In a phantom experiment the automated method was compared with a standard method, which uses manual selection of correct contour parts. Both methods demonstrated comparable precision, with a minor difference in the Y-position (0.08 mm versus 0.06 mm). The precision of each method was so small (below 0.2 mm and 0.3 degrees) that both are sufficiently accurate for clinical research purposes. The efficiency of both methods was assessed on six clinical datasets. With the automated method the observer spent 1.5 min per image, significantly less than 3.9 min with the standard method. A Bland-Altman analysis between the methods demonstrated no discernible trends in the relative femoral poses. The threefold increase in efficiency demonstrates that a pose estimation approach with integrated contour detection is more intuitive than a standard method. It eliminates most of the manual work in fluoroscopic analysis, with sufficient precision for clinical research purposes.

  3. Improving accuracy of markerless tracking of lung tumours in fluoroscopic video by incorporating diaphragm motion

    NASA Astrophysics Data System (ADS)

    Schwarz, M.; Teske, H.; Stoll, M.; Bendl, Rolf

    2014-03-01

    Purpose: Conformal radiation of moving tumours is a challenging task in radiotherapy. Tumour motion induced by respiration can be visualized in fluoroscopic images recorded during patients breathing. Markerless methods making use of registration techniques can be used to estimate tumour motion. However, registration methods might fail when the tumour is hidden by ribs. Using motion of anatomical surrogates, like the diaphragm, is promising to model tumour motion. Methods: A sequence of 116 fluoroscopic images was analyzed and the tumour positions were manually defined by three experts. A block matching (BM) technique is used to calculate the displacement vector relatively to a selected reference image of the first breathing cycle. An enhanced method was developed: Positions, when the tumour is not located behind a rib, are taken as valid estimations of the tumour position. Furthermore, these valid estimations are used to establish a linear model of tumour position and diaphragm motion. For invalid estimations the calculated tumour positions are not taken into consideration, and instead the model is used to determine tumour motion. Results: Enhancing BM with a model of tumour motion from diaphragm motion improves the tracking accuracy when the tumour moves behind a rib. The error (mean ± SD) in longitudinal dimension was 2.0 ± 1.5mm using only BM and 1.0 ± 1.1mm when the enhanced approach was used. Conclusion: The enhanced tracking technique is capable to improve tracking accuracy compared to BM in the case that the tumour is occluded by ribs.

  4. Posterior atlantoaxial fixation: A cadaveric and fluoroscopic step-by-step technical guide.

    PubMed

    Sattarov, Kamran; Skoch, Jesse; Abbasifard, Salman; Patel, Apar S; Avila, Mauricio J; Walter, Christina M; Baaj, Ali A

    2015-01-01

    Atlantoaxial surgical fixation is widely employed treatment strategy for a myriad of pathologies affecting the stability of the atlantoaxial joint. The most common technique used in adults, and in certain cases in children, involves a posterior construct with C1 lateral mass screws, and C2 pars or pedicle screws. This technical note aims to provide a step-by-step guide to this procedure using cadaveric and fluoroscopic images. An embalmed, human, cadaveric, specimen was used for this study. The subject did not have obvious occipital-cervical pathology. Dissections and techniques were performed to mimic actual surgical technique. Photographs were taken during each step, and the critical aspects of each step were highlighted. Fluoroscopic images from a real patient undergoing C1/C2 fixation were also utilized to further highlight the anatomic-radiographic relationships. This study was performed without external or industry funding. Photographic and radiographic pictures and drawings are presented to illustrate the pertinent anatomy and technical aspects of this technique. The nuances of each step, including complication avoidance strategies are also highlighted. Given the widespread utilization of this technique, described step-by-step guide is timely for surgeons and trainees alike.

  5. A C-arm calibration method with application to fluoroscopic image-guided procedures

    NASA Astrophysics Data System (ADS)

    Rai, Lav; Gibbs, Jason D.; Wibowo, Henky

    2012-02-01

    C-arm fluoroscopy units provide continuously updating X-ray video images during surgical procedure. The modality is widely adopted for its low cost, real-time imaging capabilities, and its ability to display radio-opaque tools in the anatomy. It is, however, important to correct for fluoroscopic image distortion and estimate camera parameters, such as focal length and camera center, for registration with 3D CT scans in fluoroscopic imageguided procedures. This paper describes a method for C-arm calibration and evaluates its accuracy in multiple C-arm units and in different viewing orientations. The proposed calibration method employs a commerciallyavailable unit to track the C-arm and a calibration plate. The method estimates both the internal calibration parameters and the transformation between the coordinate systems of tracker and C-arm. The method was successfully tested on two C-arm units (GE OEC 9800 and GE OEC 9800 Plus) of different image intensifier sizes and verified with a rigid airway phantom model. The mean distortion-model error was found to be 0.14 mm and 0.17 mm for the respective C-arms. The mean overall system reprojection error (which measures the accuracy of predicting an image using tracker coordinates) was found to be 0.63 mm for the GE OEC 9800.

  6. Primary and conversion percutaneous gastrojejunostomy under fluoroscopic guidance: 10 years of experience.

    PubMed

    Shin, Kwang-Ho; Shin, Ji Hoon; Song, Ho-Young; Yang, Zheng Qiang; Kim, Jin Hyoung; Kim, Kyung-Rae

    2008-01-01

    The objective of this study was to evaluate the safety and effectiveness of primary and conversion percutaneous radiologic gastrojejunostomy (PRGJ) under fluoroscopic guidance. Between January 1998 and July 2007, 29 patients (M/F=26:3) were enrolled. Indications for primary PRGJ (n=16) included recurrent aspiration pneumonia (n=8), prevention of gastroesophageal reflux in cases of disrupted gastrointestinal tract (n=6), or bypass of surgical anastomosis (n=1) or duodenal obstruction (n=1). Indications for conversion PRGJ (n=13) included recurrent aspiration pneumonia (n=11), malignant duodenal obstruction (n=1), or previous gastrostomy-related complication (n=1). All 29 procedures were successfully completed with 10.2-16.5-Fr feeding gastrojejunostomy tube tip located in the proximal jejunum. A single anchor was used in all patients with primary PRGJ. Clinical success was achieved in all study patients. There were no major complications. There was no evidence of gastroesophageal reflux or aspiration aggravation in any patient during the follow-up period. Four tubes were electively removed after healing of the esophageal rupture. The indwelling period was 10 to 429 days (mean, 110 days) after tube placement in the remaining 25 patients. Primary and conversion PRGJ under fluoroscopic guidance was a safe and effective procedure for enteral feeding as well as for preventing gastroesophageal reflux or aspiration pneumonia. In cases of primary gastrojejunostomy, use of single gastropexy was feasible and sufficient.

  7. A moving slanted-edge method to measure the temporal modulation transfer function of fluoroscopic systems

    SciTech Connect

    Friedman, S. N.; Cunningham, I. A.

    2008-06-15

    Lag in fluoroscopic systems introduces a frame-averaging effect that reduces measurements of image noise and incorrectly inflates measurements of the detective quantum efficiency (DQE). A correction can be implemented based on measurements of the temporal modulation transfer function (MTF). We introduce a method of measuring the temporal MTF under fluoroscopic conditions using a moving slanted edge, a generalization of the slanted-edge method used to measure the (spatial) MTF, providing the temporal MTF of the entire imaging system. The method uses a single x-ray exposure, constant edge velocity, and assumes spatial and temporal blurring are separable. The method was validated on a laboratory x-ray image intensifier (XRII) system by comparison with direct measurements of the XRII optical response, showing excellent agreement over the entire frequency range tested ({+-}100 Hz). With proper access to linearized data and continuous fluoroscopy, this method can be implemented in a clinical setting on both XRII and flat-panel detectors. It is shown that the temporal MTF of the CsI-based validation system is a function of exposure rate. The rising-edge response showed more lag than the falling edge, and the temporal MTF decreased with decreasing exposure rate. It is suggested that a small-signal approach, in which the range of exposure rates is restricted to a linear range by using a semitransparent moving edge, would be appropriate for measuring the DQE of these systems.

  8. A study of the x-ray image quality improvement in the examination of the respiratory system based on the new image processing technique

    NASA Astrophysics Data System (ADS)

    Nagai, Yuichi; Kitagawa, Mayumi; Torii, Jun; Iwase, Takumi; Aso, Tomohiko; Ihara, Kanyu; Fujikawa, Mari; Takeuchi, Yumiko; Suzuki, Katsumi; Ishiguro, Takashi; Hara, Akio

    2014-03-01

    Recently, the double contrast technique in a gastrointestinal examination and the transbronchial lung biopsy in an examination for the respiratory system [1-3] have made a remarkable progress. Especially in the transbronchial lung biopsy, better quality of x-ray fluoroscopic images is requested because this examination is performed under a guidance of x-ray fluoroscopic images. On the other hand, various image processing methods [4] for x-ray fluoroscopic images have been developed as an x-ray system with a flat panel detector [5-7] is widely used. A recursive filtering is an effective method to reduce a random noise in x-ray fluoroscopic images. However it has a limitation for its effectiveness of a noise reduction in case of a moving object exists in x-ray fluoroscopic images because the recursive filtering is a noise reduction method by adding last few images. After recursive filtering a residual signal was produced if a moving object existed in x-ray images, and this residual signal disturbed a smooth procedure of the examinations. To improve this situation, new noise reduction method has been developed. The Adaptive Noise Reduction [ANR] is the brand-new noise reduction technique which can be reduced only a noise regardless of the moving object in x-ray fluoroscopic images. Therefore the ANR is a very suitable noise reduction method for the transbronchial lung biopsy under a guidance of x-ray fluoroscopic images because the residual signal caused of the moving object in x-ray fluoroscopic images is never produced after the ANR. In this paper, we will explain an advantage of the ANR by comparing of a performance between the ANR images and the conventional recursive filtering images.

  9. Image-guided transapical aortic valve implantation: sensorless tracking of stenotic valve landmarks in live fluoroscopic images.

    PubMed

    Merk, Denis R; Karar, Mohamed Esmail; Chalopin, Claire; Holzhey, David; Falk, Volkmar; Mohr, Friedrich W; Burgert, Oliver

    2011-07-01

    Aortic valve stenosis is one of the most frequently acquired valvular heart diseases, accounting for almost 70% of valvular cardiac surgery. Transapical transcatheter aortic valve implantation has recently become a suitable minimally invasive technique for high-risk and elderly patients with severe aortic stenosis. In this article, we aim to automatically define a target area of valve implantation, namely, the area between the coronary ostia and the lowest points of two aortic valve cusps. Therefore, we present a new image-based tracking method of these aortic landmarks to assist in the placement of aortic valve prosthesis under live 2D fluoroscopy guidance. We propose a rigid intensity-based image registration technique for tracking valve landmarks in 2D fluoroscopic image sequences, based on a real-time alignment of a contrast image including the initialized manual valve landmarks to each image of sequence. The contrast image is automatically detected to visualize aortic valve features when the aortic root is filled with a contrast agent. Our registration-based tracking method has been retrospectively applied to 10 fluoroscopic image sequences from routine transapical aortic valve implantation procedures. Most of all tested fluoroscopic images showed a successful tracking of valve landmarks, especially for the images without contrast agent injections. A new intraoperative image-based method has been developed for tracking aortic valve landmarks in live 2D fluoroscopic images to assist transapical aortic valve implantations and to increase the overall safety of surgery as well.

  10. Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

    PubMed Central

    Yin, Guowen; Chen, Shixi; Bai, Xiangjun; Jiang, Feng; Zhang, Qin; Xu, Lin; Xu, Weidong

    2012-01-01

    Objective To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). Materials and Methods From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. Results The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). Conclusion Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary

  11. Simultaneous fluoroscopic and nuclear imaging: impact of collimator choice on nuclear image quality.

    PubMed

    van der Velden, Sandra; Beijst, Casper; Viergever, Max A; de Jong, Hugo W A M

    2017-01-01

    X-ray-guided oncological interventions could benefit from the availability of simultaneously acquired nuclear images during the procedure. To this end, a real-time, hybrid fluoroscopic and nuclear imaging device, consisting of an X-ray c-arm combined with gamma imaging capability, is currently being developed (Beijst C, Elschot M, Viergever MA, de Jong HW. Radiol. 2015;278:232-238). The setup comprises four gamma cameras placed adjacent to the X-ray tube. The four camera views are used to reconstruct an intermediate three-dimensional image, which is subsequently converted to a virtual nuclear projection image that overlaps with the X-ray image. The purpose of the present simulation study is to evaluate the impact of gamma camera collimator choice (parallel hole versus pinhole) on the quality of the virtual nuclear image. Simulation studies were performed with a digital image quality phantom including realistic noise and resolution effects, with a dynamic frame acquisition time of 1 s and a total activity of 150 MBq. Projections were simulated for 3, 5, and 7 mm pinholes and for three parallel hole collimators (low-energy all-purpose (LEAP), low-energy high-resolution (LEHR) and low-energy ultra-high-resolution (LEUHR)). Intermediate reconstruction was performed with maximum likelihood expectation-maximization (MLEM) with point spread function (PSF) modeling. In the virtual projection derived therefrom, contrast, noise level, and detectability were determined and compared with the ideal projection, that is, as if a gamma camera were located at the position of the X-ray detector. Furthermore, image deformations and spatial resolution were quantified. Additionally, simultaneous fluoroscopic and nuclear images of a sphere phantom were acquired with a physical prototype system and compared with the simulations. For small hot spots, contrast is comparable for all simulated collimators. Noise levels are, however, 3 to 8 times higher in pinhole geometries than in parallel

  12. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections.

    PubMed

    Manchikanti, Laxmaiah; Malla, Yogesh; Wargo, Bradley W; Cash, Kimberly A; Pampati, Vidyasagar; Fellows, Bert

    2012-01-01

    Among the multiple modalities of treatments available in managing chronic spinal pain, including surgery and multiple interventional techniques, epidural injections by various routes, such as interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, and percutaneous adhesiolysis are common. Even though the complications of fluoroscopically directed epidural injections are fewer than blind epidural injections, and have better effectiveness, multiple complications have been reported in scattered case reports, with only minor complications in randomized or non-randomized studies and systematic reviews. Thus, prospective studies with large patient series are essential to determine the types and incidences of complications. A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009. A private interventional pain management practice, a specialty referral center in the United States. To assess the complication rate of fluoroscopically directed epidural injections. This study was carried out over a period of 20 months and included over 10,000 procedures: 39% caudal epidurals, 23% cervical interlaminar epidurals, 14% lumbar interlaminar epidurals, 13% lumbar transforaminal epidurals, 8% percutaneous adhesiolysis, and 3% thoracic interlaminar epidural procedures. All of the interventions were performed under fluoroscopic guidance in an ambulatory surgery center by one of 3 physicians. The complications encountered during the procedure and postoperatively were prospectively evaluated. Measurable outcomes employed were intravascular entry of the needle, profuse bleeding, local hematoma, bruising, dural puncture and headache, nerve root or spinal cord irritation with resultant injury, infectious complications, vasovagal reactions, and facial flushing. Intravascular entry was higher for adhesiolysis (11.6%) and lumbar transforaminal (7.9%) procedures compared to other epidurals which

  13. Comparison of Inferior Vena Cava Filters Placed at the Bedside via Intravenous Ultrasound Guidance Versus Fluoroscopic Guidance.

    PubMed

    Ganguli, Suvranu; Hawkins, Beau M; Abtahian, Farhad; Abu-Fadel, Mazen S; Walker, Thomas G; MacKay, Cheryl; Jaff, Michael R; Weinberg, Ido

    2017-02-01

    IVCFs are usually placed under fluoroscopic guidance in dedicated angiography suites. Bedside placement of inferior vena cava filters (IVCF) is possible in patients not suitable for transportation, but data regarding their use are limited. The objective of this study is to compare utilization, procedural outcomes, complications, and long-term patient outcomes associated with bedside placement of IVCFs using intravascular ultrasound (IVUS) and fluoroscopic placement of IVCF. All patients receiving IVCF between January 2009 and December 2011 at a tertiary care institution were retrospectively identified. Data regarding patient characteristics, IVCF indications, complications, and outcomes were collected, and comparisons were made between patients receiving fluoroscopic-guided and IVUS-guided bedside IVCF. There were 117 bedside and 571 fluoroscopic-guided IVCF placed during this period. Patients receiving bedside IVCF were younger (50.8 vs. 60.7 years, P < 0.001), less often had malignancy (22.2% vs. 42.6%, P < 0.001), and received prophylactic filters more commonly (59.9% vs. 29.9%, P < 0.001). Placement-related complications occurred in 4.3% and 0.6%, respectively (bedside IVCF: 4 malpositions, 1 severe tilt; fluoroscopic-guided IVCF: 1 malposition, 1 severe tilt, P = 0.01). Indwelling IVCF-related complications occurred equally during median follow-up of 463 and 488 days, respectively (deep vein thrombosis: 13.7% vs. 13.3%, P = 0.92; pulmonary embolism: 5.1% vs. 4.0%, P = 0.61; filter thrombosis: 3.4% vs. 3.9%, P = 0.82). Time to indwelling complication was similar between groups (74 vs. 127 days, P = 0.29). Bedside placement of IVUS-guided IVCF is safe, but with higher procedural complications when compared with fluoroscopic placement. Long-term indwelling complications are similar between IVCF placed via bedside IVUS guidance and fluoroscopic approach. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Measurement of hyoid and laryngeal displacement in video fluoroscopic swallowing studies: variability, reliability, and measurement error.

    PubMed

    Sia, Isaac; Carvajal, Pamela; Carnaby-Mann, Giselle D; Crary, Michael A

    2012-06-01

    Video fluoroscopy is commonly used in the study of swallowing kinematics. However, various procedures used in linear measurements obtained from video fluoroscopy may contribute to increased variability or measurement error. This study evaluated the influence of calibration referent and image rotation on measurement variability for hyoid and laryngeal displacement during swallowing. Inter- and intrarater reliabilities were also estimated for hyoid and laryngeal displacement measurements across conditions. The use of different calibration referents did not contribute significantly to variability in measures of hyoid and laryngeal displacement but image rotation affected horizontal measures for both structures. Inter- and intrarater reliabilities were high. Using the 95% confidence interval as the error index, measurement error was estimated to range from 2.48 to 3.06 mm. These results address procedural decisions for measuring hyoid and laryngeal displacement in video fluoroscopic swallowing studies.

  15. Contrast changes in fluoroscopic imaging systems and statistical variations of these changes

    NASA Technical Reports Server (NTRS)

    Bailey, N. A.

    1973-01-01

    Experimental studies have indicated that: (1) The response of digitized fluoroscopic imaging systems is linear systems is linear with contrast over a rather wide range of absorber and cavity thicknesses. (2) Contrast changes associated with the addition of aluminum, iodine containing contrast agents and air of thicknesses 1mm or less can be detected with a 95% confidence level. (3) The standard deviation associated with such determination using clinically available X-ray generators and video disc recording is less than 1 percent. A large flat screen X-ray image intensifier has been constructed and some preliminary results obtained. Sensitivity achieved makes dose reduction a factor often greater than previously reported for a system using a conventional X-ray image intensifier.

  16. A deformable lung tumor tracking method in fluoroscopic video using active shape models: a feasibility study.

    PubMed

    Xu, Qianyi; Hamilton, Russell J; Schowengerdt, Robert A; Jiang, Steve B

    2007-09-07

    A dynamic multi-leaf collimator (DMLC) can be used to track a moving target during radiotherapy. One of the major benefits for DMLC tumor tracking is that, in addition to the compensation for tumor translational motion, DMLC can also change the aperture shape to conform to a deforming tumor projection in the beam's eye view. This paper presents a method that can track a deforming lung tumor in fluoroscopic video using active shape models (ASM) (Cootes et al 1995 Comput. Vis. Image Underst. 61 38-59). The method was evaluated by comparing tracking results against tumor projection contours manually edited by an expert observer. The evaluation shows the feasibility of using this method for precise tracking of lung tumors with deformation, which is important for DMLC-based real-time tumor tracking.

  17. Dynamic imaging of pulmonary ventilation. Description of a novel digital fluoroscopic system.

    PubMed

    Kiuru, A; Svedström, E; Kuuluvainen, I

    1991-03-01

    A new fluoroscopic imaging device consisting of an AT-microcomputer and a digital image memory unit has been used in experimental and clinical ventilation studies during a 2-year period. Digital images with 256 shades of gray were collected during one to 3 ventilation cycles at the rate of 6 to 25 images/s and stored on an optical laser disc. Both subtracted time interval difference (TID-) images and images relative, for example, to the mean image of the cycle (REL-images) were produced. The series of images could also be evaluated dynamically using animation sequences or analyzed using region of interest calculations. The method gave dynamic information with adequate spatial resolution and was easy to use in clinical practice. The radiation dose was kept low due to the high kilovoltage and heavy beam filtration technique. In experimental studies the software enabled flexible measurements of physiological pulmonary parameters.

  18. Conversion of percutaneous endoscopic gastrostomy to gastrojejunostomy under fluoroscopic guidance for treatment of gastrocutaneous fistula.

    PubMed

    Kim, Joon-Sung; Baik, Jun Hyun; Lim, Seong Hoon; Hong, Bo Young; Jo, Leechan

    2015-02-01

    Persistent enterocutaneous fistula after the removal of a gastrostomy tube is an unusual complication of percutaneous endoscopic gastrostomy (PEG). The following case report describes an 81-year-old man diagnosed with stroke and dysphagia in May 2008. The patient had been using a PEG since 2008, and PEG site infection occurred in June 2013. The PEG tube was removed and a new PEG tube was inserted. Thereafter, formation of gastrocutaneous fistula around the previous infected PEG site was observed. The fistula was refractory to medical management, accompanied by long duration of fasting and peripheral alimentation. Therefore, gastrojejunostomy tube insertion via the previously inserted PEG tube was performed, under fluoroscopic guidance; this mode of management was successful. For patients who have a gastrocutaneous fistula, gastrojejunostomy tube insertion via the pre-existing PEG tube is a safe and effective alternative management for enteral feeding.

  19. Multiresolution parametric estimation of transparent motions and denoising of fluoroscopic images.

    PubMed

    Auvray, Vincent; Liénard, Jean; Bouthemy, Patrick

    2005-01-01

    We describe a novel multiresolution parametric framework to estimate transparent motions typically present in X-Ray exams. Assuming the presence if two transparent layers, it computes two affine velocity fields by minimizing an appropriate objective function with an incremental Gauss-Newton technique. We have designed a realistic simulation scheme of fluoroscopic image sequences to validate our method on data with ground truth and different levels of noise. An experiment on real clinical images is also reported. We then exploit this transparent-motion estimation method to denoise two layers image sequences using a motion-compensated estimation method. In accordance with theory, we show that we reach a denoising factor of 2/3 in a few iterations without bringing any local artifacts in the image sequence.

  20. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

    PubMed Central

    See, Jason; Amora, Jonah L; Lee, Sheldon; Lim, Paul; Teo, Wee Siong; Tan, Boon Yew; Ho, Kah Leng; Lee, Chee Wan; Ching, Chi Keong

    2016-01-01

    INTRODUCTION The use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. METHODS We prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSite™ NavX™ or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported. RESULTS A total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups. CONCLUSION The use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time. PMID:26805664

  1. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure.

    PubMed

    See, Jason; Amora, Jonah L; Lee, Sheldon; Lim, Paul; Teo, Wee Siong; Tan, Boon Yew; Ho, Kah Leng; Lee, Chee Wan; Ching, Chi-Keong

    2016-07-01

    The use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. We prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported. A total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups. The use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time. Copyright © Singapore Medical Association.

  2. Biplane reconstruction and visualization of virtual endoscopic and fluoroscopic views for interventional device navigation

    NASA Astrophysics Data System (ADS)

    Wagner, Martin G.; Strother, Charles M.; Schafer, Sebastian; Mistretta, Charles A.

    2016-03-01

    Biplane fluoroscopic imaging is an important tool for minimally invasive procedures for the treatment of cerebrovascular diseases. However, finding a good working angle for the C-arms of the angiography system as well as navigating based on the 2D projection images can be a difficult task. The purpose of this work is to propose a novel 4D reconstruction algorithm for interventional devices from biplane fluoroscopy images and to propose new techniques for a better visualization of the results. The proposed reconstruction methods binarizes the fluoroscopic images using a dedicated noise reduction algorithm for curvilinear structures and a global thresholding approach. A topology preserving thinning algorithm is then applied and a path search algorithm minimizing the curvature of the device is used to extract the 2D device centerlines. Finally, the 3D device path is reconstructed using epipolar geometry. The point correspondences are determined by a monotonic mapping function that minimizes the reconstruction error. The three dimensional reconstruction of the device path allows the rendering of virtual fluoroscopy images from arbitrary angles as well as 3D visualizations like virtual endoscopic views or glass pipe renderings, where the vessel wall is rendered with a semi-transparent material. This work also proposes a combination of different visualization techniques in order to increase the usability and spatial orientation for the user. A combination of synchronized endoscopic and glass pipe views is proposed, where the virtual endoscopic camera position is determined based on the device tip location as well as the previous camera position using a Kalman filter in order to create a smooth path. Additionally, vessel centerlines are displayed and the path to the target is highlighted. Finally, the virtual endoscopic camera position is also visualized in the glass pipe view to further improve the spatial orientation. The proposed techniques could considerably improve

  3. Accurate 3D kinematic measurement of temporomandibular joint using X-ray fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Yamazaki, Takaharu; Matsumoto, Akiko; Sugamoto, Kazuomi; Matsumoto, Ken; Kakimoto, Naoya; Yura, Yoshiaki

    2014-04-01

    Accurate measurement and analysis of 3D kinematics of temporomandibular joint (TMJ) is very important for assisting clinical diagnosis and treatment of prosthodontics and orthodontics, and oral surgery. This study presents a new 3D kinematic measurement technique of the TMJ using X-ray fluoroscopic images, which can easily obtain the TMJ kinematic data in natural motion. In vivo kinematics of the TMJ (maxilla and mandibular bone) is determined using a feature-based 2D/3D registration, which uses beads silhouette on fluoroscopic images and 3D surface bone models with beads. The 3D surface models of maxilla and mandibular bone with beads were created from CT scans data of the subject using the mouthpiece with the seven strategically placed beads. In order to validate the accuracy of pose estimation for the maxilla and mandibular bone, computer simulation test was performed using five patterns of synthetic tantalum beads silhouette images. In the clinical applications, dynamic movement during jaw opening and closing was conducted, and the relative pose of the mandibular bone with respect to the maxilla bone was determined. The results of computer simulation test showed that the root mean square errors were sufficiently smaller than 1.0 mm and 1.0 degree. In the results of clinical application, during jaw opening from 0.0 to 36.8 degree of rotation, mandibular condyle exhibited 19.8 mm of anterior sliding relative to maxillary articular fossa, and these measurement values were clinically similar to the previous reports. Consequently, present technique was thought to be suitable for the 3D TMJ kinematic analysis.

  4. Efficient segmentation of 3D fluoroscopic datasets from mobile C-arm

    NASA Astrophysics Data System (ADS)

    Styner, Martin A.; Talib, Haydar; Singh, Digvijay; Nolte, Lutz-Peter

    2004-05-01

    The emerging mobile fluoroscopic 3D technology linked with a navigation system combines the advantages of CT-based and C-arm-based navigation. The intra-operative, automatic segmentation of 3D fluoroscopy datasets enables the combined visualization of surgical instruments and anatomical structures for enhanced planning, surgical eye-navigation and landmark digitization. We performed a thorough evaluation of several segmentation algorithms using a large set of data from different anatomical regions and man-made phantom objects. The analyzed segmentation methods include automatic thresholding, morphological operations, an adapted region growing method and an implicit 3D geodesic snake method. In regard to computational efficiency, all methods performed within acceptable limits on a standard Desktop PC (30sec-5min). In general, the best results were obtained with datasets from long bones, followed by extremities. The segmentations of spine, pelvis and shoulder datasets were generally of poorer quality. As expected, the threshold-based methods produced the worst results. The combined thresholding and morphological operations methods were considered appropriate for a smaller set of clean images. The region growing method performed generally much better in regard to computational efficiency and segmentation correctness, especially for datasets of joints, and lumbar and cervical spine regions. The less efficient implicit snake method was able to additionally remove wrongly segmented skin tissue regions. This study presents a step towards efficient intra-operative segmentation of 3D fluoroscopy datasets, but there is room for improvement. Next, we plan to study model-based approaches for datasets from the knee and hip joint region, which would be thenceforth applied to all anatomical regions in our continuing development of an ideal segmentation procedure for 3D fluoroscopic images.

  5. A Prototype Micro-Angiographic Fluoroscope and Its Application in Animal Studies

    PubMed Central

    Wu, Ye; Rudin, Stephen; Bednarek, Daniel R.

    2011-01-01

    In order to satisfy the high resolution (3 to 10 cycles/mm) imaging requirements in neurovascular image-guided interventional (IGI) procedures, a micro-angiographic fluoroscope (MAF) is being developed to enable both rapid sequence angiography (15 fps) at high exposure levels (hundreds of μR/frame) as well as fluoroscopy at high frame rates (30 fps) and low exposure levels (5 to 20 μR/frame). The prototype MAF consists of a 350-μm-thick CsI(Tl) scintillator coupled by a 2:1 fiber-optical taper to an 18 mm diameter variable-gain light image intensifier with two-stage microchannel plate (MCP) viewed by a 12-bit, 1024x1024, 30 fps CCD camera with digital interface board. The optical set-up enables variation of effective pixel-size from 31 to 50 micron. The first frame lag of the MAF in fluoroscopic 30 fps mode (2:1 binning) was less than 0.8% at exposures of 5-23 μR/frame. MTF, NPS, and DQE in angiographic mode were measured for IEC standard spectrum RQA 5. At spatial frequencies of 4 and 10 cycles/mm the MTF was 14% and 1.5%, and the DQE was 12% and 1.2%, respectively, while the DQE(0) was 60%. Acquisition software was developed to acquire 15 fps angiography and 30 fps fluoroscopy for real-time dark field and flat field correction or real-time roadmapping. Images obtained with the MAF in small animal IGI procedures are demonstrated. The linearity versus x-ray intensity and MCP working range effects has been studied. We plan to expand the current 3.6 cm diameter field of view to 6 cm in the next model of the MAF. PMID:21311727

  6. Feasibility of low-dose digital pulsed video-fluoroscopic swallow exams (VFSE): effects on radiation dose and image quality.

    PubMed

    Weiss, Jakob; Notohamiprodjo, Mike; Neumaier, Klement; Li, Minglun; Flatz, Wilhelm; Nikolaou, Konstantin; Pomschar, Andreas

    2017-09-01

    Background Fluoroscopy is a frequently used examination in clinical routine without appropriate research evaluation latest hardware and software equipment. Purpose To evaluate the feasibility of low-dose pulsed video-fluoroscopic swallowing exams (pVFSE) to reduce dose exposure in patients with swallowing disorders compared to high-resolution radiograph examinations (hrVFSE) serving as standard of reference. Material and Methods A phantom study (Alderson-Rando Phantom, 60 thermoluminescent dosimeters [TLD]) was performed for dose measurements. Acquisition parameters were as follows: (i) pVFSE: 76.7 kV, 57 mA, 0.9 Cu mm, pulse rate/s 30; (ii) hrVFSE: 68.0 kV, 362 mA, 0.2 Cu mm, pictures 30/s. The dose area product (DAP) indicated by the detector system and the radiation dose derived from the TLD measurements were analyzed. In a patient study, image quality was assessed qualitatively (5-point Likert scale, 5 = hrVFSE; two independent readers) and quantitatively (SNR) in 35 patients who subsequently underwent contrast-enhanced pVFSE and hrVFSE. Results Phantom measurements showed a dose reduction per picture of factor 25 for pVFSE versus hrVFSE images (0.0025 mGy versus 0.062 mGy). The DAP (µGym(2)) was 28.0 versus 810.5 (pVFSE versus hrVFSE) for an average examination time of 30 s. Direct and scattered organ doses were significantly lower for pVFSE as compared to hrVFSE ( P < 0.05). Image quality was rated 3.9 ± 0.5 for pVFSE versus the hrVFSE standard; depiction of the contrast agent 4.8 ± 0.3; noise 3.6 ± 0.5 ( P < 0.05); SNR calculations revealed a relative decreased of 43.9% for pVFSE as compared to hrVFSE. Conclusion Pulsed VFSE is feasible, providing diagnostic image quality at a significant dose reduction as compared to hrVFSE.

  7. SU-E-P-15: Technique Factor Modulation and Reference Plane Air Kerma Rates in Response to Simulated Patient Thickness Variations for a Sample of Current Generation Fluoroscopes

    SciTech Connect

    Wunderle, K; Rakowski, J; Dong, F

    2015-06-15

    Purpose: To evaluate and compare approaches to technique factor modulation and air kerma rates in response to simulated patient thickness variations for four state-of-the-art and one previous-generation interventional fluoroscopes. Methods: A polymethyl methacrylate (PMMA) phantom was used as a tissue surrogate for the purposes of determining fluoroscopic reference plane air kerma rates, kVp, mA, and spectral filtration over a wide range of simulated tissue thicknesses. Data were acquired for each fluoroscopic and acquisition dose curve within a default abdomen or body imaging protocol. Results: The data obtained indicated vendor- and model-specific variations in the approach to technique factor modulation and reference plane air kerma rates across a range of tissue thicknesses. Some vendors have made hardware advances increasing the radiation output capabilities of their fluoroscopes; this was evident in the acquisition air kerma rates. However, in the imaging protocol evaluated, all of the state-of-the-art systems had relatively low air kerma rates in the fluoroscopic low-dose imaging mode as compared to the previous-generation unit. Each of the newest-generation systems also employ copper filtration in the selected protocol in the acquisition mode of imaging; this is a substantial benefit, reducing the skin entrance dose to the patient in the highest dose-rate mode of fluoroscope operation. Conclusion: Understanding how fluoroscopic technique factors are modulated provides insight into the vendor-specific image acquisition approach and provides opportunities to optimize the imaging protocols for clinical practice. The enhanced radiation output capabilities of some of the fluoroscopes may, under specific conditions, may be beneficial; however, these higher output capabilities also have the potential to lead to unnecessarily high dose rates. Therefore, all parties involved in imaging, including the clinical team, medical physicists, and imaging vendors, must work

  8. Radiation exposure contribution of the scout abdomen radiograph in common pediatric fluoroscopic procedures.

    PubMed

    Rao, Anil G; Simmons, Cephus E; Thacker, Paul G; Collins, Heather; Ritenour, E Russell; Hill, Jeanne G

    2016-08-01

    Contrast enema, voiding cystourethrography and upper gastrointestinal studies are the most common fluoroscopic procedures in children. Scout abdomen radiographs have been routinely obtained prior to fluoroscopy and add to the radiation exposure from these procedures. Elimination of unnecessary routine scout radiographs in select studies might significantly reduce radiation exposure to children and improve the overall benefit-to-risk ratio of these fluoroscopic procedures. To determine the radiation exposure contribution of the preliminary/scout abdomen radiographs with respect to the radiation exposure of the total procedure. We retrospectively collected demographic information and radiation exposure values of dose area product (in Gy-cm(2)) and entrance air kerma (in mGy) - initially for the scout abdomen radiographs done prior to fluoroscopy and subsequently the total procedural radiation values (the combined values of the scout radiograph and fluoroscopic radiation exposure) - in children who underwent contrast enemas, voiding cystourethrograms and upper gastrointestinal studies in a 4-month period. The radiation parameters, including fluoroscopy time, dose area product and entrance air kerma, were available in the log book maintained in the fluoroscopy suite. Fluoroscopy procedures were performed on a single fluoroscopy machine using four frames per second pulse rate and other radiation-minimizing techniques. Usage of the grid to obtain scout radiographs was also recorded. The proportion of radiation exposure from the scout radiograph relative to that of the total procedure was calculated by dividing the individual parameters of the scout to the total procedural values and multiplied by 100 to express these values as a percentage. We calculated mean, median and range and performed statistical analysis of the data. A total of 151 procedures performed on 71 males and 80 females qualified for the study. The age range of the patients was 2 days to 18 years, with

  9. Caustic soda ingestion in children under-5 years presenting for fluoroscopic examinations in an Academic Hospital in Ghana.

    PubMed

    Botwe, Benard Ohene; Anim-Sampong, Samuel; Sarkodie, Benjamin Dabo; Antwi, William K; Obeng-Nkansah, Jeannette; Ashong, Gabriel G N A

    2015-11-17

    Disastrous effects and lifelong complications, ranging from respiratory and gastrointestinal burns to death can result from caustic soda ingestion. Accidental and non-accidental ingestions occur in different age groups. However, it is very troubling to find ingestion of caustic soda a very common occurrence among children below 5 years since they do not have the developmental level required to independently weigh up risks and are also under parental and societal protections. This study was therefore planned to investigate the ingestions of caustic soda by these children for purposes of proposing measures to curb the problem. Descriptive survey was employed for this study. A 14-item, semi-structure questionnaire was purposively issued to 57 parents/guardians whose wards had ingested caustic soda. Data was analysed with SPSS V.20. Twenty-seven (47.4 %) children got access to the soda at storage, 1 (1.86 %) was administered accidentally by a sibling while 29 (50.9 %) ingested during soap preparation. In respect of the former, the majority got access because it was stored in soft drink and water bottles in their parents/guardians rooms or kitchen. For the later, the children got access to the left-over soda because the soap-makers failed to adhere to good storage and disposal practices. Storage of caustic soda in soft drink and water bottles in accessible places, and training of children to drink directly from bottles influence caustic soda ingestion in children under five. Non-compliance to good practices of storage and disposal of caustic soda during soap preparation increases exposure and access of children to caustic soda ingestion.

  10. Evaluation of methods to produce an image library for automatic patient model localization for dose mapping during fluoroscopically guided procedures

    NASA Astrophysics Data System (ADS)

    Kilian-Meneghin, Josh; Xiong, Z.; Rudin, S.; Oines, A.; Bednarek, D. R.

    2017-03-01

    The purpose of this work is to evaluate methods for producing a library of 2D-radiographic images to be correlated to clinical images obtained during a fluoroscopically-guided procedure for automated patient-model localization. The localization algorithm will be used to improve the accuracy of the skin-dose map superimposed on the 3D patient- model of the real-time Dose-Tracking-System (DTS). For the library, 2D images were generated from CT datasets of the SK-150 anthropomorphic phantom using two methods: Schmid's 3D-visualization tool and Plastimatch's digitally-reconstructed-radiograph (DRR) code. Those images, as well as a standard 2D-radiographic image, were correlated to a 2D-fluoroscopic image of a phantom, which represented the clinical-fluoroscopic image, using the Corr2 function in Matlab. The Corr2 function takes two images and outputs the relative correlation between them, which is fed into the localization algorithm. Higher correlation means better alignment of the 3D patient-model with the patient image. In this instance, it was determined that the localization algorithm will succeed when Corr2 returns a correlation of at least 50%. The 3D-visualization tool images returned 55-80% correlation relative to the fluoroscopic-image, which was comparable to the correlation for the radiograph. The DRR images returned 61-90% correlation, again comparable to the radiograph. Both methods prove to be sufficient for the localization algorithm and can be produced quickly; however, the DRR method produces more accurate grey-levels. Using the DRR code, a library at varying angles can be produced for the localization algorithm.

  11. Systematic fluoroscopic and electrical assessment of implantable cardioverter-defibrillator patients implanted with silicone-polyurethane copolymer (Optim™) coated leads.

    PubMed

    Forleo, Giovanni B; Di Biase, Luigi; Panattoni, Germana; Politano, Alessandro; Magliano, Giulia; Santini, Luca; Natale, Andrea; Romeo, Francesco

    2014-02-01

    Serious concerns have been recently raised about the reliability of the silicone-polyurethane copolymer (Optim™) lead insulation system. We sought to identify insulation defects and Optim-lead failures by systematic fluoroscopic and electrical assessment in a prospectively defined cohort of implantable cardioverter-defibrillator (ICD) patients. Between July 2007 and December 2011, 234 patients were implanted with 413 optim-coated leads as part of an ICD system at a single centre. Fluoroscopic screening with high-resolution cine-fluoroscopy at 30 frames per second was offered to all patients. In addition, the electrical integrity of all implanted leads was assessed. Durata, Riata ST Optim, and low-voltage Optim leads were implanted in 199, 26, and 188 cases, respectively. During a total follow-up of 10 036 lead-months, there were 7 Optim-lead failures (defined as electrical malfunction resulting in lead replacement) and 31 deaths; no cases of electrical noises were encountered. The overall incidence of lead failure was 1.2 vs. 0.3 per 100 lead-years, for high- and low-voltage leads, respectively (P = 0.1). One hundred fifty-one patients agreed to undergo fluoroscopy screening; none of the 264 analysed Optim leads were found to have any fluoroscopically visible structural defects after an average of 31 months post-implant. This study represents the first systematic screening of Optim-coated leads in a large unselected cohort of ICD patients. Over a 5-year period few lead failures were observed and normal fluoroscopic appearance was present in all patients.

  12. Fluoroscopically guided extraforaminal cervical nerve root blocks: analysis of epidural flow of the injectate with respect to needle tip position.

    PubMed

    Shipley, Kyle; Riew, K Daniel; Gilula, Louis A

    2014-02-01

    Study Design Retrospective evaluation of consecutively performed fluoroscopically guided cervical nerve root blocks. Objective To describe the incidence of injectate central epidural flow with respect to needle tip position during fluoroscopically guided extraforaminal cervical nerve root blocks (ECNRBs). Methods Between February 19, 2003 and June 11, 2003, 132 consecutive fluoroscopically guided ECNRBs performed with contrast media in the final injected material (injectate) were reviewed on 95 patients with average of 1.3 injections per patient. Fluoroscopic spot images documenting the procedure were obtained as part of standard quality assurance. An independent observer not directly involved in the procedures retrospectively reviewed the images, and the data were placed into a database. Image review was performed to determine optimal needle tip positioning for injectate epidural flow. Results Central epidural injectate flow was obtained in only 28.9% of injections with the needle tip lateral to midline of the lateral mass (zone 2). 83.8% of injectate went into epidural space when the needle tip was medial to midline of the lateral mass (zone 3). 100% of injectate flowed epidurally when the needle tip was medial to or at the medial cortex of the lateral mass (zone 4). There was no statistically significant difference with regards to central epidural flow and the needle tip position on lateral view. Conclusion To ensure central epidural flow with ECNRBs one must be prepared to pass the needle tip medial to midplane of the lateral mass or to medial cortex of the lateral mass. Approximately 16% of ECNRBs with needle tip medial to midline of the lateral mass did not flow into epidural space. One cannot claim a nerve block is an epidural block unless epidural flow of injectate is observed.

  13. Fluoroscopic tracking of multiple implanted fiducial markers using multiple object tracking.

    PubMed

    Tang, Xiaoli; Sharp, Greg C; Jiang, Steve B

    2007-07-21

    When treating mobile tumors using techniques such as beam gating or beam tracking, precise localization of tumor position is required, which is often realized by fluoroscopically tracking implanted fiducial markers. Multiple markers placed inside or near a tumor are often preferred to a single marker for the sake of accuracy. In this work, we propose a marker tracking system that can track multiple markers simultaneously, without confusing them, and that is also robust enough to continue tracking even when the markers are moving behind bony anatomy. The integrated radiotherapy imaging system (IRIS), developed at the Massachusetts General Hospital (MGH), was used to take fluoroscopy videos for marker tracking. The tracking system integrates marker detection with a multiple object tracking process, inspired by the multiple hypothesis marker tracking (MHT) process. It also utilizes breathing pattern information to help tracking. Four criteria are used to identify tracking failure, and when tracking failure occurs, the system can immediately inform the user. (In the clinical environment, the system would immediately disable the treatment beam.) In this paper, two liver patients with implanted fiducial markers were studied, and the studies were performed retrospectively to assess the effectiveness of the new tracking system. For both patients, LAT and AP fluoroscopic videos were studied. In order to better test the proposed tracking system, artificial markers were added around the real markers to disturb the tracking of the real markers. The performance of the proposed system was compared to that of a conventional tracking system (one that did not use multiple object tracking). The performance of the new system was also investigated with and without consideration of the breathing pattern information. We found that the conventional tracking system can easily miss tracking markers in the presence of artificial markers, and it cannot detect the tracking failures. On the

  14. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading.

    PubMed

    Centeno, Christopher J; Elliott, James; Elkins, Whitney L; Freeman, Michael

    2005-01-01

    Several authors have postulated that cervical instability is a major cause of traumatic spinal pain. The purpose of this prospective case series study (n = 6) was to determine if proliferant injections have an effect on cervical translation as measured by a blinded reader. This study was a prospective case series. Study participants were selected from patients seen for the primary complaint of Motor Vehicle Collision related neck pain in a private sub-specialty pain clinic. Flexion and extension views were obtained by standard radiographs taken with a C-Arm fluoroscope under Valium sedation. Patients with more than 2.7 mm of absolute cervical translation and at least 50% reduction of cervical and referred pain with a two day rigid cervical immobilization test were admitted into the study. Participants underwent 3 prolotherapy injections at all sites that demonstrated translation. The difference in means between pre-test and post-test measurements (flexion translation, extension translation, and pain VAS scores) were assessed by a Wilcoxon signed ranks test (alpha = 0.05). The mean post-test VAS score (M= 3.83, SD=2.3, t=2.889) was significantly less (p=0.04) than the mean pre-test VAS score (M=5.75, SD=1.94). The correlation between difference in mean extension at C2-3 and C5-6 and difference in mean extension was significant (rho=0.89, p=0.02 and rho=0.85, p=0.03 respectively). Difference in mean flexion at C3-4 and C4-5 was significantly correlated with difference in mean flexion (rho=0.88, p=0.02 and rho=0.941, p <0.01 respectively). The results of this study demonstrate statistically significant correlations between proliferant injections, a reduction of both cervical flexion and extension translation, as well as a reduction in pain VAS score. Since patients with traumatic cervical instability have few viable treatment options other than surgical fusion, cervical proliferant injections under C-Arm fluoroscope may be a viable treatment option.

  15. Fluoroscopic tracking of multiple implanted fiducial markers using multiple object tracking

    NASA Astrophysics Data System (ADS)

    Tang, Xiaoli; Sharp, Greg C.; Jiang, Steve B.

    2007-07-01

    When treating mobile tumors using techniques such as beam gating or beam tracking, precise localization of tumor position is required, which is often realized by fluoroscopically tracking implanted fiducial markers. Multiple markers placed inside or near a tumor are often preferred to a single marker for the sake of accuracy. In this work, we propose a marker tracking system that can track multiple markers simultaneously, without confusing them, and that is also robust enough to continue tracking even when the markers are moving behind bony anatomy. The integrated radiotherapy imaging system (IRIS), developed at the Massachusetts General Hospital (MGH), was used to take fluoroscopy videos for marker tracking. The tracking system integrates marker detection with a multiple object tracking process, inspired by the multiple hypothesis marker tracking (MHT) process. It also utilizes breathing pattern information to help tracking. Four criteria are used to identify tracking failure, and when tracking failure occurs, the system can immediately inform the user. (In the clinical environment, the system would immediately disable the treatment beam.) In this paper, two liver patients with implanted fiducial markers were studied, and the studies were performed retrospectively to assess the effectiveness of the new tracking system. For both patients, LAT and AP fluoroscopic videos were studied. In order to better test the proposed tracking system, artificial markers were added around the real markers to disturb the tracking of the real markers. The performance of the proposed system was compared to that of a conventional tracking system (one that did not use multiple object tracking). The performance of the new system was also investigated with and without consideration of the breathing pattern information. We found that the conventional tracking system can easily miss tracking markers in the presence of artificial markers, and it cannot detect the tracking failures. On the

  16. Non-fluoroscopic catheter visualization using MediGuide™ technology: experience from the first 600 procedures.

    PubMed

    Sommer, P; Richter, S; Hindricks, G; Rolf, S

    2014-09-01

    A novel cardiovascular navigation system known as MediGuide™ (MG) which allows non-fluoroscopic catheter tracking over a background of pre-recorded cine loops was recently introduced. This system allows significant reduction of fluoroscopy exposure which is one of the potentially harmful aspects of today's electrophysiological procedures such as ablations or device implantations. We provide a summary of recently published studies related to this new technological platform and describe our experience from the first 600 MG procedures at our institution.After reviewing the currently available publications in the field of MG-supported EP procedures, we describe the workflows for (1) ablation of supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia using MG-enabled diagnostic and ablation catheters, as well as (2) implant of cardiac resynchronization therapy (CRT) devices using sensor-equipped delivery tools including sheaths, sub-selectors, and guidewires.As shown in several studies [5-9], MG procedures resulted in similar efficacy as conventional cases but with a significant reduction in fluoroscopy time and dose. In particular, for SVT ablations, the median fluoroscopy time using the MG technology was 0.5 ± 1.4 min compared to 10.2 ± 9.6 min in conventional fluoroscopic settings. Similar reductions were demonstrated for AF ablation procedures from 25 min in conventional settings with electroanatomical mapping systems and live x-ray to 4.6 min with the addition of the MG technology. Recently, it was demonstrated that the application of MG for CRT device implants could successfully result in a median fluoroscopy time of 2.6 min for LV lead deployment.In summary, the first measurable clinical impact of the MG technology on a daily clinical routine is the reduction of fluoroscopy time and radiation exposure for various EP indications. These beneficial effects were achieved without negative consequences on procedural

  17. X-ray dose reduction through adaptive exposure in fluoroscopic imaging.

    PubMed

    Burion, Steve; Funk, Tobias

    2011-09-11

    X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a significant concern, particularly in pediatric applications. Pediatrics procedures are in general much more complex than those performed on adults and thus are on average four to eight times longer. Furthermore, children can undergo up to 10 fluoroscopic procedures by the age of 10, and have been shown to have a three-fold higher risk of developing fatal cancer throughout their life than the general population. We have shown that radiation dose can be significantly reduced in adult cardiac procedures by using our scanning beam digital x-ray (SBDX) system-- a fluoroscopic imaging system that employs an inverse imaging geometry (Figure 1, Movie 1 and Figure 2). Instead of a single focal spot and an extended detector as used in conventional systems, our approach utilizes an extended X-ray source with multiple focal spots focused on a small detector. Our X-ray source consists of a scanning electron beam sequentially illuminating up to 9,000 focal spot positions. Each focal spot projects a small portion of the imaging volume onto the detector. In contrast to a conventional system where the final image is directly projected onto the detector, the SBDX uses a dedicated algorithm to reconstruct the final image from the 9,000 detector images. For pediatric applications, dose savings with the SBDX system are expected to be smaller than in adult procedures. However, the SBDX system allows for additional dose savings by implementing an electronic adaptive exposure technique. Key to this method is the multi-beam scanning technique of the SBDX system: rather than exposing every part of the image with the same radiation dose, we can dynamically vary the exposure depending on the opacity of the region exposed. Therefore, we can significantly reduce exposure in radiolucent areas and maintain exposure in more opaque regions. In our

  18. A Repeat Look at Repeating Patterns

    ERIC Educational Resources Information Center

    Markworth, Kimberly A.

    2016-01-01

    A "repeating pattern" is a cyclical repetition of an identifiable core. Children in the primary grades usually begin pattern work with fairly simple patterns, such as AB, ABC, or ABB patterns. The unique letters represent unique elements, whereas the sequence of letters represents the core that is repeated. Based on color, shape,…

  19. Pediatric patient and staff dose measurements in barium meal fluoroscopic procedures

    NASA Astrophysics Data System (ADS)

    Filipov, D.; Schelin, H. R.; Denyak, V.; Paschuk, S. A.; Porto, L. E.; Ledesma, J. A.; Nascimento, E. X.; Legnani, A.; Andrade, M. E. A.; Khoury, H. J.

    2015-11-01

    This study investigates patient and staff dose measurements in pediatric barium meal series fluoroscopic procedures. It aims to analyze radiographic techniques, measure the air kerma-area product (PKA), and estimate the staff's eye lens, thyroid and hands equivalent doses. The procedures of 41 patients were studied, and PKA values were calculated using LiF:Mg,Ti thermoluminescent dosimeters (TLDs) positioned at the center of the patient's upper chest. Furthermore, LiF:Mg,Cu,P TLDs were used to estimate the equivalent doses. The results showed a discrepancy in the radiographic techniques when compared to the European Commission recommendations. Half of the results of the analyzed literature presented lower PKA and dose reference level values than the present study. The staff's equivalent doses strongly depends on the distance from the beam. A 55-cm distance can be considered satisfactory. However, a distance decrease of ~20% leads to, at least, two times higher equivalent doses. For eye lenses this dose is significantly greater than the annual limit set by the International Commission on Radiological Protection. In addition, the occupational doses were found to be much higher than in the literature. Changing the used radiographic techniques to the ones recommended by the European Communities, it is expected to achieve lower PKA values ​​and occupational doses.

  20. Salpingitis Isthmica Nodosa: Technical Success and Outcome of Fluoroscopic Transcervical Fallopian Tube Recanalization

    SciTech Connect

    Houston, J. Graeme; Machan, Lindsay S.

    1998-01-15

    Purpose: To evaluate the technical success and outcome of fallopian tube recanalization (FTR) in salpingitis isthmica nodosa (SIN). Methods: SIN is a well-recognized pathological condition affecting the proximal fallopian tube and is associated with infertility and ectopic pregnancy. We reviewed the presentations, films, and case records of all patients attending for FTR for infertility from 1990 to 1994. Technical success and total, intrauterine, and ectopic pregnancy rates at follow-up were determined. Results: SIN was observed in 22 of 349 (6%) patients. FTR was attempted in 34 tubes in these 22 patients. Technical success was achieved in 23 of 34 (68%) tubes affected by SIN. In 5 of the 11 failed recanalizations, failure was due to distal obstruction. At least one tube was patent on selective postprocedural salpingography in 17 of 22 (77%) patients. There were no recorded perforations or complications. At follow-up (mean 14 months), total, intrauterine, and ectopic pregnancy rates were 23%, 18%, and 4.5%, respectively. Conclusion: FTR in SIN is technically successful and, compared with previously reported results in unselected infertility patients, is associated with only a slightly less favorable intrauterine pregnancy rate and a comparable ectopic pregnancy rate. The findings of SIN at FTR should not discourage attempted fluoroscopic transcervical recanalization.

  1. Fluoroscopically Guided Transcervical Fallopian Tube Recanalization of Post-Sterilization Reversal Mid-Tubal Obstructions

    SciTech Connect

    Houston, J. Graeme; Anderson, David; Mills, John; Harrold, Anthony

    2000-03-15

    Purpose: To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery.Methods: From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion. Cases of FTR in mid-tubal occlusion were included in this study. Technical success (defined as complete tubal patency) using a standard guidewire and hydrophilic glidewire, the number of patients with at least one patent tube, and the intrauterine and ectopic pregnancy rates were determined.Results: Twenty-six infertile patients with previous sterilization reversal underwent HSG. Eight of 26 (31%) patients (mean age 32 years, range 23-37 years), had attempted FTR for mid-tubal occlusion at the site of surgical anastomosis. Fourteen tubes were attempted as there were two previous salpingectomies. Technical success was achieved in eight of 14 (57%) tubes attempted, resulting in five of eight (62%) patients having at least one patent tube. At follow-up (mean 18 months, range 12-28 months) in these five patients there was one intrauterine pregnancy. There were no ectopic pregnancies.Conclusions: FTR in mid-tubal obstruction in infertile patients following sterilization reversal surgery is technically feasible and may result in intrauterine pregnancy. In this small group there was a lower technical success rate and lower pregnancy rate than in unselected proximal tubal occlusion.

  2. A novel fluoroscopic-assisted balloon thrombectomy technique for thrombosed hemodialysis prosthetic grafts [corrected].

    PubMed

    Kakkos, Stavros K; Haddad, Joseph A; Haddad, Georges K

    2010-01-01

    Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts. Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc). Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%. Our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.

  3. Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance.

    PubMed

    Pedicelli, A; Rollo, M; Piano, M; Grattacaso, G; Colosimo, C; Bonomo, L

    2009-10-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive treatment for symptomatic vertebral compression fractures (VCFs). The aim of this study was to assess the effectiveness, complications and progress of results of PVP optimized in terms of technique, costs, time and strategic protocol after 3 years of procedures performed under fluoroscopic guidance alone. We treated 250 VCFs in 120 consecutive patients after assessing clinical and radiological indications. The effectiveness of the procedure was determined by statistical analysis of numerical scores for pain, mobility and drug consumption before and after treatment. No major complications and only three minor complications occurred. Clinically relevant improved mobility and reduction of pain and analgesics were observed, with overall significant results (p<0.0001) in all patients at 24 h after PVP and in 83 available patients at 6 months. A total of five asymptomatic refractures of cemented vertebrae and 14 new symptomatic vertebral fractures at different levels were observed between 1 and 10 months after the procedure. PVP is a safe, rapid, effective and costeffective therapy for VCFs, requiring only brief hospital admission and with long-lasting clinical results, when performed under good-quality radiological guidance, when correct indications are respected and when it is associated with rehabilitation therapy in the follow-up. It is a valid alternative to conservative therapy, which is burdened by high healthcare costs and often requires long-term immobilisation of frail and elderly patients at risk of clinical complications.

  4. Calculating the peak skin dose resulting from fluoroscopically guided interventions. Part I: Methods.

    PubMed

    Jones, A Kyle; Pasciak, Alexander S

    2011-11-15

    While direct measurement of the peak skin dose resulting from a fluoroscopically-guided procedure is possible, the decision must be made a priori at additional cost and time. It is most often the case that the need for accurate knowledge of the peak skin dose is realized only after a procedure has been completed, or after a suspected reaction has been discovered. Part I of this review article discusses methods for calculating the peak skin dose across a range of clinical scenarios. In some cases, a wealth of data are available, while in other cases few data are available and additional data must be measured in order to estimate the peak skin dose. Data may be gathered from a dose report, the DICOM headers of images, or from staff and physician interviews. After data are gathered, specific steps must be followed to convert dose metrics, such as the reference point air kerma (K(a,r)) or the kerma area product (KAP), into peak skin dose. These steps require knowledge of other related factors, such as the f-factor and the backscatter factor, tables of which are provided in this manuscript. Sources of error and the impact of these errors on the accuracy of the final estimate of the peak skin dose are discussed.

  5. X-ray characterization of CMOS imaging detector with high resolution for fluoroscopic imaging application

    NASA Astrophysics Data System (ADS)

    Cha, Bo Kyung; Kim, Cho Rong; Jeon, Seongchae; Kim, Ryun Kyung; Seo, Chang-Woo; Yang, Keedong; Heo, Duchang; Lee, Tae-Bum; Shin, Min-Seok; Kim, Jong-Boo; Kwon, Oh-Kyung

    2013-12-01

    This paper introduces complementary metal-oxide semiconductor (CMOS) active pixel sensor (APS)-based X-ray imaging detectors with high spatial resolution for medical imaging application. In this study, our proposed X-ray CMOS imaging sensor has been fabricated by using a 0.35 μm 1 Poly 4 Metal CMOS process. The pixel size is 100 μm×100 μm and the pixel array format is 24×96 pixels, which provide a field-of-view (FOV) of 9.6 mm×2.4 mm. The 14.3-bit extend counting analog-to digital converter (ADC) with built-in binning mode was used to reduce the area and simultaneously improve the image resolution. Both thallium-doped CsI (CsI:Tl) and Gd2O2S:Tb scintillator screens were used as converters for incident X-rays to visible light photons. The optical property and X-ray imaging characterization such as X-ray to light response as a function of incident X-ray exposure dose, spatial resolution and X-ray images of objects were measured under different X-ray energy conditions. The measured results suggest that our developed CMOS-based X-ray imaging detector has the potential for fluoroscopic imaging and cone-beam computed tomography (CBCT) imaging applications.

  6. Real-time respiratory phase matching between 2D fluoroscopic images and 3D CT images for precise percutaneous lung biopsy.

    PubMed

    Weon, Chijun; Kim, Mina; Park, Chang Min; Ra, Jong Beom

    2017-08-20

    A 3D CT image is used along with real-time 2D fluoroscopic images in the state-of-the-art cone-beam CT system to guide percutaneous lung biopsy (PLB). To improve the guiding accuracy by compensating for respiratory motion, we propose an algorithm for real-time matching of 2D fluoroscopic images to multiple 3D CT images of different respiratory phases that is robust to the small movement and deformation due to cardiac motion. Based on the transformations obtained from non-rigid registration between two 3D CT images acquired at expiratory and inspiratory phases, we first generate sequential 3D CT images (or a 4D CT image) and the corresponding 2D digitally reconstructed radiographs (DRRs) of vessels. We then determine 3D CT images corresponding to each real-time 2D fluoroscopic image, by matching the 2D fluoroscopic image to a 2D DRR. Quantitative evaluations performed with 20 clinical datasets show that registration errors of anatomical features between a 2D fluoroscopic image and its matched 2D DRR are less than 3mm on average. Registration errors of a target lesion are determined to be roughly 3mm on average for 10 datasets. We propose a real-time matching algorithm to compensate for respiratory motion between a 2D fluoroscopic image and 3D CT images of the lung, regardless of cardiac motion, based on a newly improved matching measure. The proposed algorithm can improve the accuracy of a guiding system for the PLB by providing 3D images precisely registered to 2D fluoroscopic images in real-time, without time-consuming respiratory gated or cardiac gated CT images. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Comparison of a fluoroscopic 3-dimensional imaging system and conventional CT in detection of pars fractures in the cadaveric lumbar spine.

    PubMed

    Kepler, Christopher K; Pavlov, Helene; Herzog, Richard J; Rawlins, Bernard A; Endo, Yoshimi; Green, Daniel W

    2012-12-01

    Cadaveric Study. To compare a fluoroscopic imaging system with computed tomography (CT) and radiographs in detection of spondylolysis and radiation exposure in a cadaver model. Lumbar spondylolysis is defined as a defect or fracture of the pars interarticularis and occurs with or without anterior spondylolisthesis. CT scan is the gold standard imaging study for spondylolysis but is limited by the supine position, which may cause reduction of anterolisthesis and by ionizing radiation, which limits the frequency of follow-up scans. Thirteen intact cadaveric lumbar spine segments with 26 pars were randomized to be left intact or to undergo simulated fracture using a 1.3 mm oscillating microsurgical saw. Fifteen pars underwent simulated fracture and 11 pars were left intact. Lumbar spine segments were imaged using plain radiographs, multiplanar fluoroscopic imaging, and conventional CT scan. The images were interpreted by 3 observers blinded to the number and location of defects. Radiation exposure and doses were recorded from all imaging units. Average radiation doses were 0.0025 mSv for each radiograph, 0.23 mSv (low dose) and 0.47 mSv (high dose) for fluoroscopic imaging, and 1.5 mSv for conventional CT imaging (pediatric dose setting). Evaluation of radiographs for spondylolysis had sensitivity of 98% and specificity of 97%. Evaluation using low-dose fluoroscopic images, high-dose fluoroscopic images, and CT scan images correctly identified the status of all pars based on multiplanar images; sensitivity and specificity were 100%. Kappa analysis demonstrated a value of 0.89 for radiographic interpretation indicating excellent agreement. Kappa values describing agreement for image interpretation for fluoroscopic imaging and CT scan were equal to 1.0, representing perfect agreement. Three-dimensional fluoroscopic imaging provides comparable diagnostic imaging with CT scan in an experimental cadaveric model of spondylolysis using up to 85% less radiation than

  8. Repeated Testing Produces Superior Transfer of Learning Relative to Repeated Studying

    ERIC Educational Resources Information Center

    Butler, Andrew C.

    2010-01-01

    The present research investigated whether test-enhanced learning can be used to promote transfer. More specifically, 4 experiments examined how repeated testing and repeated studying affected retention and transfer of facts and concepts. Subjects studied prose passages and then either repeatedly restudied or took tests on the material. One week…

  9. Optimizing radiation use during fluoroscopic procedures: a quality and safety improvement project.

    PubMed

    Duncan, James R; Street, Mandie; Strother, Marshall; Picus, Daniel

    2013-11-01

    The ionizing radiation used during fluoroscopically guided medical interventions carries risk. The teams performing these procedures seek to minimize those risks while preserving each procedure's benefits. This report describes a data-driven optimization strategy. Manual and automated data capture systems were used to collect a series of different metrics, including fluoroscopy time, kerma area product, and reference point air kerma, from both adult and pediatric interventional radiologic procedures. Tools from statistical process control were used to identify opportunities for improvement and assess which changes led to improvement. Initial efforts focused on creating a system capable of reliably capturing fluoroscopy time from all interventional radiologic procedures. Ongoing data analysis and feedback to frontline teams led to the development of a manual workflow that reliably captured fluoroscopy time. Data capture was later supplemented by automatic capture of electronic records. This process exploited the standardized format (DICOM Structured Reporting) that newer fluoroscopy units use to record the radiation metrics. Data analysis found marked differences between the imaging protocols used for adults and children. Revision of the adult protocols led to a stable twofold reduction in average exposure per adult procedure. Analysis of balancing measures found no impact on workflow. A systematic approach to improving radiation use during procedures led to a substantial and sustained reduction in risk with no reduction in benefits. Data were readily captured by both manual and automated processes. Concepts from cognitive psychology and information theory provided a theoretical basis for both data analysis and improvement opportunities. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. Incidence and management of oesophageal ruptures following fluoroscopic balloon dilatation in children with benign strictures.

    PubMed

    Zhou, Wei-Zhong; Song, Ho-Young; Park, Jung-Hoon; Shin, Ji Hoon; Kim, Jin Hyoung; Cho, Young Chul; Kim, Pyeong Hwa; Kim, Seong-Chul

    2017-01-01

    The purpose of this study is to investigate the incidence and management of oesophageal ruptures following fluoroscopic balloon dilatation (FBD) in children with benign oesophageal strictures. Sixty-two children with benign oesophageal strictures underwent FBDs. Oesophageal rupture was categorized as intramural (type 1), transmural (type 2), or transmural with free leakage (type 3). The possible risk factors for oesophageal ruptures were analyzed. One hundred and twenty-nine FBDs were performed in these patients. The oesophageal rupture rate was 17.1 % (22/129). The majority (21/22) of ruptures were type 1 and type 2, both were treated conservatively. Only one patient had a type 3 rupture and underwent oesophagoesophagostomy. The patient gender, age, and the length and cause of the stricture showed no significant effect on the rupture (P > 0.05). However, for the patients ≤2 years old, the initial balloon with a diameter ≥10 mm showed a higher oesophageal rupture rate than those <10 mm during the first session (P = 0.03). Although the oesophageal rupture rate in children was 17.1 %, the type 3 rupture rate was 0.8 %, which usually requires aggressive treatment. For children ≤2 years old, the initial balloon diameter should be <10 mm in the first session for decreasing the risk of oesophageal rupture. • The oesophageal rupture rate following balloon dilatation in children was 17.1 %. • The incidence of transmural rupture with free leakage is very low. • Only transmural rupture with free leakage needs aggressive treatment. • For children ≤2 years, the initial balloon diameter should be <10 mm.

  11. Upper ankle joint space detection on low contrast intraoperative fluoroscopic C-arm projections

    NASA Astrophysics Data System (ADS)

    Thomas, Sarina; Schnetzke, Marc; Brehler, Michael; Swartman, Benedict; Vetter, Sven; Franke, Jochen; Grützner, Paul A.; Meinzer, Hans-Peter; Nolden, Marco

    2017-03-01

    Intraoperative mobile C-arm fluoroscopy is widely used for interventional verification in trauma surgery, high flexibility combined with low cost being the main advantages of the method. However, the lack of global device-to- patient orientation is challenging, when comparing the acquired data to other intrapatient datasets. In upper ankle joint fracture reduction accompanied with an unstable syndesmosis, a comparison to the unfractured contralateral site is helpful for verification of the reduction result. To reduce dose and operation time, our approach aims at the comparison of single projections of the unfractured ankle with volumetric images of the reduced fracture. For precise assessment, a pre-alignment of both datasets is a crucial step. We propose a contour extraction pipeline to estimate the joint space location for a prealignment of fluoroscopic C-arm projections containing the upper ankle joint. A quadtree-based hierarchical variance comparison extracts potential feature points and a Hough transform is applied to identify bone shaft lines together with the tibiotalar joint space. By using this information we can define the coarse orientation of the projections independent from the ankle pose during acquisition in order to align those images to the volume of the fractured ankle. The proposed method was evaluated on thirteen cadaveric datasets consisting of 100 projections each with manually adjusted image planes by three trauma surgeons. The results show that the method can be used to detect the joint space orientation. The correlation between angle deviation and anatomical projection direction gives valuable input on the acquisition direction for future clinical experiments.

  12. Improved-resolution real-time skin-dose mapping for interventional fluoroscopic procedures

    NASA Astrophysics Data System (ADS)

    Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2014-03-01

    We have developed a dose-tracking system (DTS) that provides a real-time display of the skin-dose distribution on a 3D patient graphic during fluoroscopic procedures. Radiation dose to individual points on the skin is calculated using exposure and geometry parameters from the digital bus on a Toshiba C-arm unit. To accurately define the distribution of dose, it is necessary to use a high-resolution patient graphic consisting of a large number of elements. In the original DTS version, the patient graphics were obtained from a library of population body scans which consisted of larger-sized triangular elements resulting in poor congruence between the graphic points and the x-ray beam boundary. To improve the resolution without impacting real-time performance, the number of calculations must be reduced and so we created software-designed human models and modified the DTS to read the graphic as a list of vertices of the triangular elements such that common vertices of adjacent triangles are listed once. Dose is calculated for each vertex point once instead of the number of times that a given vertex appears in multiple triangles. By reformatting the graphic file, we were able to subdivide the triangular elements by a factor of 64 times with an increase in the file size of only 1.3 times. This allows a much greater number of smaller triangular elements and improves resolution of the patient graphic without compromising the real-time performance of the DTS and also gives a smoother graphic display for better visualization of the dose distribution.

  13. Improved-Resolution, Real-Time Skin-Dose Mapping for Interventional Fluoroscopic Procedures

    PubMed Central

    Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2014-01-01

    We have developed a dose-tracking system (DTS) that provides a real-time display of the skin-dose distribution on a 3D patient graphic during fluoroscopic procedures. Radiation dose to individual points on the skin is calculated using exposure and geometry parameters from the digital bus on a Toshiba C-arm unit. To accurately define the distribution of dose, it is necessary to use a high-resolution patient graphic consisting of a large number of elements. In the original DTS version, the patient graphics were obtained from a library of population body scans which consisted of larger-sized triangular elements resulting in poor congruence between the graphic points and the x-ray beam boundary. To improve the resolution without impacting real-time performance, the number of calculations must be reduced and so we created software-designed human models and modified the DTS to read the graphic as a list of vertices of the triangular elements such that common vertices of adjacent triangles are listed once. Dose is calculated for each vertex point once instead of the number of times that a given vertex appears in multiple triangles. By reformatting the graphic file, we were able to subdivide the triangular elements by a factor of 64 times with an increase in the file size of only 1.3 times. This allows a much greater number of smaller triangular elements and improves resolution of the patient graphic without compromising the real-time performance of the DTS and also gives a smoother graphic display for better visualization of the dose distribution. PMID:25177446

  14. Automatic monitoring of localized skin dose with fluoroscopic and interventional procedures.

    PubMed

    Khodadadegan, Yasaman; Zhang, Muhong; Pavlicek, William; Paden, Robert G; Chong, Brian; Schueler, Beth A; Fetterly, Kenneth A; Langer, Steve G; Wu, Teresa

    2011-08-01

    This software tool locates and computes the intensity of radiation skin dose resulting from fluoroscopically guided interventional procedures. It is comprised of multiple modules. Using standardized body specific geometric values, a software module defines a set of male and female patients arbitarily positioned on a fluoroscopy table. Simulated X-ray angiographic (XA) equipment includes XRII and digital detectors with or without bi-plane configurations and left and right facing tables. Skin dose estimates are localized by computing the exposure to each 0.01 × 0.01 m(2) on the surface of a patient irradiated by the X-ray beam. Digital Imaging and Communications in Medicine (DICOM) Structured Report Dose data sent to a modular dosimetry database automatically extracts the 11 XA tags necessary for peak skin dose computation. Skin dose calculation software uses these tags (gantry angles, air kerma at the patient entrance reference point, etc.) and applies appropriate corrections of exposure and beam location based on each irradiation event (fluoroscopy and acquistions). A physicist screen records the initial validation of the accuracy, patient and equipment geometry, DICOM compliance, exposure output calibration, backscatter factor, and table and pad attenuation once per system. A technologist screen specifies patient positioning, patient height and weight, and physician user. Peak skin dose is computed and localized; additionally, fluoroscopy duration and kerma area product values are electronically recorded and sent to the XA database. This approach fully addresses current limitations in meeting accreditation criteria, eliminates the need for paper logs at a XA console, and provides a method where automated ALARA montoring is possible including email and pager alerts.

  15. A Study of Occupational Radiation Dosimetry During Fluoroscopically Guided Simulated Urological Surgery in the Lithotomy Position.

    PubMed

    Horsburgh, Ben A; Higgins, Mike

    2016-12-01

    To quantify through environmental audit the radiation dose that urologists receive during surgery in the lithotomy position, and to quantify the dose reduction achieved by altering exposure techniques and personal protective equipment use. Simulated surgery in the lithotomy position using an anthropomorphic phantom as a patient and a SimMan(®) mannequin as the surgeon. Pulsed fluoroscopy, focus-to-skin distance (FSD), collimation, and addition of a lead shield at the table end were individually and collectively introduced after a control study. Scattered X-ray dose rates to the simulated surgeon's eye, thyroid, trunk, external genitalia, and leg were measured with each of the technique adjustments. The absorbed dose in air at the phantom skin was measured throughout. Results were compared to discover surgeon dose rates with technique alteration. Increasing FSD leads to a rise in surgeon eye dose, and table end lead protection increases the patient skin dose. Use of all the dose-reduction techniques together reduces the dose to the patient, and a surgeon's trunk dose is decreased by 95%, external genitalia dose by 99%, and leg dose by 97%. Sitting to perform fluoroscopically guided surgery in the lithotomy position increases surgeon dose by a median value of 17%, with the external genitalia dose increased by 78% compared with the standing position. This study describes effective methods of dose reduction that are easy to instigate. The resulting reduction in radiation dose during urology procedures meets the requirements of international guidelines and legislation. This change in practice improves patient care and reduces risk to urologists from occupational exposure to radiation. By combining all of the dose-reduction techniques, urologists should never reach the threshold for deterministic radiation effects to their eyes during their career, and they will have a significantly lower chance of stochastic risks such as cancer.

  16. Comparison measurements of DQE for two flat panel detectors: fluoroscopic detector vs. cone beam CT detector

    NASA Astrophysics Data System (ADS)

    Betancourt Benítez, Ricardo; Ning, Ruola; Conover, David

    2006-03-01

    The physical performance of two flat panel detectors (FPD) has been evaluated using a standard x-ray beam quality set by IEC, namely RQA5. The FPDs evaluated in this study are based on an amorphous silicon photodiode array that is coupled to a thallium-doped Cesium Iodide scintillator and to a thin film transistor (TFT) array. One detector is the PaxScan 2520 that is designed for fluoro imaging, and has a small dynamic range and a large image lag. The other detector is the PaxScan 4030CB that is designed for cone beam CT, and has a large dynamic range (>16-bit), a reduced image lag and many imaging modes. Varian Medical Systems manufactured both detectors. The linearity of the FPDs was investigated by using an ionization chamber and aluminum filtration in order to obtain the beam quality. Since the FPDs are used in fluoroscopic mode, image lag of the FPD was measured in order to investigate its effect on this study, especially its effect on DQE. The spatial resolution of the FPDs was determined by obtaining the pre-sampling modulation transfer function for each detector. A sharp edge was used in accordance to IEC 62220-1. Next, the Normalized Noise Power Spectrum (NNPS) was calculated for various exposures levels at RQA5 radiation quality. Finally, the DQE of each FPD was obtained with a modified version of the international standard set by IEC 62220-1. The results show that the physical performance in DQE and MTF of the PaxScan 4030CB is superior to that of PaxScan2520.

  17. Preoperative templating before spinal fusion using a fluoroscopic multiplanar imaging system is as accurate as CT scan and uses substantially less radiation.

    PubMed

    Kepler, Christopher K; Pavlov, Helene; Kim, Han J; Green, Daniel W; Rawlins, Bernard A

    2012-12-01

    Many surgeons utilize preoperative multiplanar imaging for surgical planning before fusion surgery using pedicle screw instrumentation. Computed tomographic (CT) scan is often used but limited by non-weight-bearing images and high-ionizing radiation. The purpose of this study was to compare pedicle length and width measurements using a multiplanar fluoroscopic imaging system and CT with gross measurements to validate the accuracy of multiplanar fluoroscopic imaging and compare relative radiation exposure between techniques. Thirteen intact cadaveric lumbar spine segments were imaged using multiplanar fluoroscopic imaging and conventional CT scan using a low-dose pediatric protocol. At each level and each imaging modality, the 26 pedicles were measured digitally for width and pedicle screw length in accordance with typical presurgical planning procedures. All images were independently measured by 3 observers. After measurement, the specimens were sectioned using a microsurgical saw to facilitate anatomic measurements using calipers. Measurements of the multiplanar fluoroscopic imaging and CT were compared with direct anatomic measurements to quantitate and compare measurement accuracy of CT and fluoroscopic imaging. At the time of image acquisition, radiation exposure from each modality was quantified to allow for comparison of radiation exposures. CT and multiplanar fluoroscopy had similar agreement with gross measurements with respect to pedicle width and length, with κ values for comparison of CT and fluoroscopy with gross measurements falling between 0.61 and 0.73. Both modalities underestimated pedicle width (by 1.9 mm for both modalities) and length (5.5 mm for CT, 6.6 mm for fluoroscopy). Interobserver reliability was higher for fluoroscopy versus CT. High-dose fluoroscopic imaging used 31% of the radiation exposure for CT. Multiplanar fluoroscopic imaging provides comparable diagnostic preoperative planning to CT scan in an experimental cadaveric model. The

  18. Real-Time Verification of a High-Dose-Rate Iridium 192 Source Position Using a Modified C-Arm Fluoroscope.

    PubMed

    Nose, Takayuki; Chatani, Masashi; Otani, Yuki; Teshima, Teruki; Kumita, Shinichirou

    2017-03-15

    High-dose-rate (HDR) brachytherapy misdeliveries can occur at any institution, and they can cause disastrous results. Even a patient's death has been reported. Misdeliveries could be avoided with real-time verification methods. In 1996, we developed a modified C-arm fluoroscopic verification of an HDR Iridium 192 source position prevent these misdeliveries. This method provided excellent image quality sufficient to detect errors, and it has been in clinical use at our institutions for 20 years. The purpose of the current study is to introduce the mechanisms and validity of our straightforward C-arm fluoroscopic verification method. Conventional X-ray fluoroscopic images are degraded by spurious signals and quantum noise from Iridium 192 photons, which make source verification impractical. To improve image quality, we quadrupled the C-arm fluoroscopic X-ray dose per pulse. The pulse rate was reduced by a factor of 4 to keep the average exposure compliant with Japanese medical regulations. The images were then displayed with quarter-frame rates. Sufficient quality was obtained to enable observation of the source position relative to both the applicators and the anatomy. With this method, 2 errors were detected among 2031 treatment sessions for 370 patients within a 6-year period. With the use of a modified C-arm fluoroscopic verification method, treatment errors that were otherwise overlooked were detected in real time. This method should be given consideration for widespread use. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Real-time image-processing algorithm for markerless tumour tracking using X-ray fluoroscopic imaging.

    PubMed

    Mori, S

    2014-05-01

    To ensure accuracy in respiratory-gating treatment, X-ray fluoroscopic imaging is used to detect tumour position in real time. Detection accuracy is strongly dependent on image quality, particularly positional differences between the patient and treatment couch. We developed a new algorithm to improve the quality of images obtained in X-ray fluoroscopic imaging and report the preliminary results. Two oblique X-ray fluoroscopic images were acquired using a dynamic flat panel detector (DFPD) for two patients with lung cancer. The weighting factor was applied to the DFPD image in respective columns, because most anatomical structures, as well as the treatment couch and port cover edge, were aligned in the superior-inferior direction when the patient lay on the treatment couch. The weighting factors for the respective columns were varied until the standard deviation of the pixel values within the image region was minimized. Once the weighting factors were calculated, the quality of the DFPD image was improved by applying the factors to multiframe images. Applying the image-processing algorithm produced substantial improvement in the quality of images, and the image contrast was increased. The treatment couch and irradiation port edge, which were not related to a patient's position, were removed. The average image-processing time was 1.1 ms, showing that this fast image processing can be applied to real-time tumour-tracking systems. These findings indicate that this image-processing algorithm improves the image quality in patients with lung cancer and successfully removes objects not related to the patient. Our image-processing algorithm might be useful in improving gated-treatment accuracy.

  20. Real-time image-processing algorithm for markerless tumour tracking using X-ray fluoroscopic imaging

    PubMed Central

    2014-01-01

    Objective: To ensure accuracy in respiratory-gating treatment, X-ray fluoroscopic imaging is used to detect tumour position in real time. Detection accuracy is strongly dependent on image quality, particularly positional differences between the patient and treatment couch. We developed a new algorithm to improve the quality of images obtained in X-ray fluoroscopic imaging and report the preliminary results. Methods: Two oblique X-ray fluoroscopic images were acquired using a dynamic flat panel detector (DFPD) for two patients with lung cancer. The weighting factor was applied to the DFPD image in respective columns, because most anatomical structures, as well as the treatment couch and port cover edge, were aligned in the superior–inferior direction when the patient lay on the treatment couch. The weighting factors for the respective columns were varied until the standard deviation of the pixel values within the image region was minimized. Once the weighting factors were calculated, the quality of the DFPD image was improved by applying the factors to multiframe images. Results: Applying the image-processing algorithm produced substantial improvement in the quality of images, and the image contrast was increased. The treatment couch and irradiation port edge, which were not related to a patient's position, were removed. The average image-processing time was 1.1 ms, showing that this fast image processing can be applied to real-time tumour-tracking systems. Conclusion: These findings indicate that this image-processing algorithm improves the image quality in patients with lung cancer and successfully removes objects not related to the patient. Advances in knowledge: Our image-processing algorithm might be useful in improving gated-treatment accuracy. PMID:24661056

  1. Computer vision-based diameter maps to study fluoroscopic recordings of small intestinal motility from conscious experimental animals.

    PubMed

    Ramírez, I; Pantrigo, J J; Montemayor, A S; López-Pérez, A E; Martín-Fontelles, M I; Brookes, S J H; Abalo, R

    2017-08-01

    When available, fluoroscopic recordings are a relatively cheap, non-invasive and technically straightforward way to study gastrointestinal motility. Spatiotemporal maps have been used to characterize motility of intestinal preparations in vitro, or in anesthetized animals in vivo. Here, a new automated computer-based method was used to construct spatiotemporal motility maps from fluoroscopic recordings obtained in conscious rats. Conscious, non-fasted, adult, male Wistar rats (n=8) received intragastric administration of barium contrast, and 1-2 hours later, when several loops of the small intestine were well-defined, a 2 minutes-fluoroscopic recording was obtained. Spatiotemporal diameter maps (Dmaps) were automatically calculated from the recordings. Three recordings were also manually analyzed for comparison. Frequency analysis was performed in order to calculate relevant motility parameters. In each conscious rat, a stable recording (17-20 seconds) was analyzed. The Dmaps manually and automatically obtained from the same recording were comparable, but the automated process was faster and provided higher resolution. Two frequencies of motor activity dominated; lower frequency contractions (15.2±0.9 cpm) had an amplitude approximately five times greater than higher frequency events (32.8±0.7 cpm). The automated method developed here needed little investigator input, provided high-resolution results with short computing times, and automatically compensated for breathing and other small movements, allowing recordings to be made without anesthesia. Although slow and/or infrequent events could not be detected in the short recording periods analyzed to date (17-20 seconds), this novel system enhances the analysis of in vivo motility in conscious animals. © 2017 John Wiley & Sons Ltd.

  2. SU-D-209-01: Can Fluoroscopic Air-Kerma Rates Be Reliably Measured with Solid-State Meters?

    SciTech Connect

    Feng, C; Thai, L; Wagner, L; Ozus, B

    2016-06-15

    Purpose: Ionization chambers remain the standard for calibration of air-kerma rate measuring devices. Despite their strong energy-dependent response, solid state radiation detectors are increasingly used, primarily due to their efficiency in making standardized measurements. To test the reliability of these devices in measuring air-kerma rates, we compared ion chambers measurements with solid-state measurements for various mobile fluoroscopes operated at different beam qualities and air-kerma rates. Methods: Six mobile fluoroscopes (GE OEC models 9800 and 9900) were used to generate test beams. Using various field sizes and dose rate controls, copper attenuators and a lead attenuator were placed at the image receptor in varying combinations to generate a range of air-kerma rates. Air-kerma rates at 30 centimeters from the image receptors were measured using two 6-cm{sup 3} ion chambers with electrometers (Radcal, models 1015 and 9015) and two with solid state detectors (Unfors Xi and Raysafe X2). No error messages occurred during measurements. However, about two months later, one solid-state device stopped working and was replaced by the manufacturer. Two out of six mobile fluoroscopic units were retested with the replacement unit. Results: Generally, solid state and ionization chambers agreed favorably well, with two exceptions. Before replacement of the detector, the Xi meter when set in the “RF High” mode deviated from ion chamber readings by factors of 2 and 10 with no message indicating error in measurement. When set in the “RF Low” mode, readings were within −4% to +3%. The replacement Xi detector displayed messages alerting the user when settings were not compatible with air-kerma rates. Conclusion: Air-kerma rates can be measured favorably well using solid-state devices, but users must be aware of the possibility that readings can be grossly in error with no discernible indication for the deviation.

  3. Radiofrequency ablation for treatment for osteoid osteoma of the scapula using a new three-dimensional fluoroscopic navigation system.

    PubMed

    Okada, Kiyoshi; Myoui, Akira; Hashimoto, Nobuyuki; Takenaka, Satoshi; Moritomo, Hisao; Murase, Tsuyoshi; Yoshikawa, Hideki

    2014-02-01

    Osteoid osteoma is a relatively common benign skeletal tumor. The traditional standard treatment has been surgical resection of the nidus. Recently, computed tomography (CT)-guided radiofrequency ablation (RFA) has gained favor as a more precise alternative due to potentially less bone destruction. However, CT-guided RFA is limited in treatment for osteoid osteoma involving complex anatomic structures such as cervical spine, pelvis, or scapula because of difficulty in approach and proximity to neurovascular structures. To solve this problem, we investigated RFA using a new real-time three-dimensional fluoroscopic navigation system. We report its technical procedure and use in a rare case of osteoid osteoma of the scapula.

  4. Fluoroscopically guided anterior atlantoaxial transarticular screws: a feasibility and trajectory study using CT-based simulation software.

    PubMed

    Padua, Mary R A; Yeom, Jin S; Lee, So Y; Lee, So M; Kim, Ho-Joong; Chang, Bong-Soon; Lee, Choon-Ki; Riew, K Daniel

    2013-11-01

    Anterior transarticular screw (ATAS) fixation has been suggested as a viable alternative to posterior stabilization. However, we are not aware of previous reports attempting to establish the usefulness of specific fluoroscopic landmark-guided trajectories in the use of ATAS, and we could find no reference to it in a computerized search using MEDLINE. To determine the anatomic feasibility of ATAS placement using defined fluoroscopic landmarks to guide screw trajectory. Evaluation using three-dimensional screw insertion simulation software and 1.0-mm-interval computed tomographic scans. Computed tomographic scans of 100 patients including 50 men and 50 women. Incidence of violation of the vertebral artery groove of C1 and C2, the spinal canal, and the atlanto-occipital joint and screw lengths and lengths of C1 and C2 purchase. Four screw trajectories were determined: promontory screw (PS), single central facet (CF) screw, and medial (MF) and lateral (LF) double facet screws. Placement of a 4.0-mm screw was simulated using defined fluoroscopic landmarks for each trajectory. The previously mentioned outcome measures were evaluated and compared for the four trajectories. This study was not supported by any financial sources, and there is no topic-specific potential conflict of interest with this study. No violation of the C1 or C2 vertebral artery groove or of the spinal canal was observed for any of the screw types. Screw lengths and the length of C2 purchase were by far the longest for PS (40.4±2.8 and 25.7±2.1 mm, respectively; p<.001 in all post hoc comparisons). The length of C1 purchase was longer for CF (16.4±2.3 mm) and LF (15.8±1.6 mm) than PS (14.7±2.0 mm) and MF (14.6±2.4 mm) (p≤.001, respectively). There was no atlanto-occipital joint violation if the length of C1 purchase was set at 12 mm for CF and LF and at 10 mm for PS and MF. Our results suggest that it may be possible to place ATASs without violating the vertebral artery groove, spinal canal

  5. H-reflex latency and nerve root tension sign correlation in fluoroscopically guided, contrast-confirmed, translaminar lumbar epidural steroid-bupivacaine injections.

    PubMed

    Stretanski, Michael F

    2004-09-01

    To examine the correlation between physical examination parameters, commonly referred to as "nerve root tension signs," and H-reflex latency measurements both pre- and postepidural steroid-bupivacaine (Marcaine) injection, and to propose mechanisms of pain alleviation. Prospective observational, with H-reflex latency measurement and physical examination at baseline and at 10 minutes postinjection. Physical medicine and rehabilitation practice, outpatient surgical center, and community setting. Ten consecutively recruited patients (6 women, 4 men; age range, 40-71 y) with clinical radiculopathy and compatible magnetic resonance imaging findings, who were unaware of the outcome measures. Patients received a fluoroscopically guided, contrast-confirmed, paramedian translaminar lumbar epidural injection of 120 mg of methylprednisolone acetate (80 mg/mL) and 2.0 mL of .25% preservative-free Marcaine. Seated slump testing (SST), straight-leg raising (SLR), and H-reflex latency were measured bilaterally both pre- and postinjection. Differences were measured by using the paired t test in an A-B design. All SST of the affected (injected) side improved from pre- to postinjection, with 3 patients reporting discordant hamstring pain and 7 reporting no pain. SLR ability increased by an average of 29 degrees +/-12 degrees, corresponding to an average relative increase of 54% on the affected side. A statistically significant difference was found (Student t test, P=.02) between pre and post H-reflex latency on the affected side but not when comparing changes between affected and unaffected sides (Student t test, P=0.6). Significant improvements in SST and SLR result from low volume epidural injection of Marcaine, with questionable prolongation of the H-reflex to the gastrocnemius-soleus complex on the affected side.

  6. SU-E-J-126: Generation of Fluoroscopic 3D Images Using Single X-Ray Projections on Realistic Modified XCAT Phantom Data.

    PubMed

    Mishra, P; Li, R; St James, S; Yue, Y; Mak, R; Berbeco, R; Lewis, J

    2012-06-01

    To simulate the process of generating fluoroscopic 3D treatment images from 4DCT and measured 2D x-ray projections using a realistic modified XCAT phantom based on measured patient 3D tumor trajectories. First, the existing XCAT phantom is adapted to incorporate measured patient lung tumor trajectories. Realistic diaphragm and chest wall motion are automatically generated based on input tumor motion and position, producing synchronized, realistic motion in the phantom. Based on 4DCT generated with the XCAT phantom, we derive patient-specific motion models that are used to generate 3D fluoroscopic images. Patient-specific models are created in two steps: first, the displacement vector fields (DVFs) are obtained through deformable image registration of each phase of 4DCT with respect to a reference image (typically peak-exhale). Each phase is registered to the reference image to obtain (n-1) DVFs. Second, the most salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). Since PCA is a linear decomposition method, all the DVFs can be represented as linear combinations of eigenvectors. Fluoroscopic 3D images are obtained using the projection image to determine optimal weights for the eigenvectors. These weights are determined through iterative optimization of a cost function relating the projection image to the 3D image via the PCA lung motion model and a projection operator. Constructing fluoroscopic 3D images is thus reduced to finding optimal weights for the eigenvectors. Fluoroscopic 3D treatment images were generated using the modified XCAT phantom. The average relative error of the reconstructed image over 30 sec is 0.0457 HU and the standard deviation is 0.0063. The XCAT phantom was modified to produce realistic images by incorporating patient tumor trajectories. The modified XCAT phantom can be used to simulate the process of generating fluoroscopic 3D treatment images from 4DCT and 2D x

  7. Minimally Invasive Robotic Versus Open Fluoroscopic-guided Spinal Instrumented Fusions: A Randomized Controlled Trial.

    PubMed

    Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2017-03-15

    A prospective randomized clinical trial. To compare the impact of robotic guidance in a minimally invasive spine surgery (MIS) to a fluoroscopy-guided open approach in lumbar fusions. MIS requires a protracted learning curve and excessively exposes the patient and surgical team to harmful radiation. Robotic-guidance has been shown to improve accuracy and radiation in most studies, but there is conflicting prospective data. Patients indicated to undergo a 1 or 2 level spinal fusion were randomized between robotic-guided MIS (RO) and fluoroscopic-guided open surgery (FA). Patient demographics and outcomes were recorded. Thirty patients were recruited to each arm. Average age was 66.7 years, 71.5% were females, and average body mass index was 25.2. Thirty-five levels were instrumented with 130 pedicle screws in RO versus 40 levels with 140 screws in FA, or 4.3 and 4.7 screws per surgery, respectively. Use of fluoroscopy was 3.5 versus 13.3 seconds in the RO and FA respectively (P < 0.001). C-arm output in mSv was 0.13 versus 0.27 in the RO and FA respectively (P = 0.015). By thermoluminescent dosimeters, the average per-screw radiation in the RO arm was 37.5% of that in the FA arm, demonstrating a mean reduction of 62.5% in use of radiation. There was no difference in the improvement in Visual Analog Scale scores for back and leg or the Oswestry Disability Index. All screws were accurate in RO whereas two screws breached (>2 mm and >4 mm) in FA (P = 0.500). One proximal facet violation occurred in the study, it was in FA (P = 1.000). The average distance from the proximal facets was 5.8 versus 4.6 mm in the RO and FA respectively (P < 0.001). The average length of stay was 6.8 versus 9.4 days in RO compared with FA (P = 0.020). MIS using robotic-guidance significantly reduced radiation exposure and length of stay. Patient outcomes were not affected by the surgical technique. 1.

  8. Investigation of first ray mobility during gait by kinematic fluoroscopic imaging-a novel method

    PubMed Central

    2012-01-01

    Background It is often suggested that sagittal instability at the first tarso-metatarsal joint level is a primary factor for hallux valgus and that sagittal instability increases with the progression of the deformity. The assessment of the degree of vertical instability is usually made by clinical evaluation while any measurements mostly refer to a static assessment of medial ray mobility (i.e. the plantar/dorsal flexion in the sagittal plane). Testing methods currently available cannot attribute the degree of mobility to the corresponding anatomical joints making up the medial column of the foot. The aim of this study was to develop a technique which allows for a quantification of the in-vivo sagittal mobility of the joints of the medial foot column during the roll-over process under full weight bearing. Methods Mobility of first ray bones was investigated by dynamic distortion-free fluoroscopy (25 frames/s) of 14 healthy volunteers and 8 patients with manifested clinical instability of the first ray. A CAD-based evaluation method allowed the determination of mobility and relative displacements and rotations of the first ray bones within the sagittal plane during the stance phase of gait. Results Total flexion of the first ray was found to be 13.63 (SD 6.14) mm with the healthy volunteers and 13.06 (SD 8.01) mm with the patients (resolution: 0.245 mm/pixel). The dorsiflexion angle was 5.27 (SD 2.34) degrees in the healthy volunteers and increased to 5.56 (SD 3.37) degrees in the patients. Maximum rotations were found at the naviculo-cuneiform joints and least at the first tarso-metatarsal joint level in both groups. Conclusions Dynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait. A significant difference in first ray flexion and angular rotation between the patients and healthy volunteers however could not be found. PMID:22316084

  9. Evaluation of the microangiographic fluoroscope (MAF) using generalized system performance metrics

    SciTech Connect

    Jain, Amit; Bednarek, Daniel R.; Rudin, Stephen

    2013-03-15

    Purpose: The performance of a newly developed, high resolution, microangiographic fluoroscope (MAF) (35 {mu}m pixel pitch and 300 {mu}m thick CsI phosphor) was evaluated using a generalized linear system analysis and compared with that of a standard amorphous Si thin film transistor flat panel detector (FPD) (194 {mu}m pixel pitch and 600 {mu}m thick CsI phosphor). The linear system metrics such as modulation transfer function (MTF), noise power spectrum, and detection quantum efficiency (DQE) are commonly used to gauge the intrinsic detector performance in the detector plane. However, these linear system metrics do not provide information about the image receptor performance in a real system since they do not include the effects of other parameters such as focal spot distribution, scatter radiation, and geometric unsharpness, which may compromise detector performance characteristics. Use of generalized linear system metrics [generalized modulation transfer function (GMTF), generalized normalized noise power spectrum (GNNPS), and generalized detection quantum efficiency (GDQE)] that include these effects gives a more meaningful, complete, and appropriate evaluation of detector performance as part of the imaging system. Methods: A uniform head equivalent phantom was used to simulate realistic clinical parameters and x-ray spectra. The detector MTFs were measured using the slanted edge method and the focal spot MTFs were measured using a pinhole assembly. The scatter MTF was simulated and the scatter fraction was measured for a head-equivalent phantom. The generalized system metrics were calculated for different combinations of three choices of focal spots and three different magnifications with two different air-gaps. The performance of the MAF was also illustrated using stent images obtained with different focal spots under similar conditions. Results: Results for the generalized metrics provide a quantitative description of the performance of the imaging system

  10. SU-C-209-02: 3D Fluoroscopic Image Generation From Patient-Specific 4DCBCT-Based Motion Models Derived From Clinical Patient Images

    SciTech Connect

    Dhou, S; Cai, W; Hurwitz, M; Williams, C; Lewis, J

    2016-06-15

    Purpose: We develop a method to generate time varying volumetric images (3D fluoroscopic images) using patient-specific motion models derived from four-dimensional cone-beam CT (4DCBCT). Methods: Motion models are derived by selecting one 4DCBCT phase as a reference image, and registering the remaining images to it. Principal component analysis (PCA) is performed on the resultant displacement vector fields (DVFs) to create a reduced set of PCA eigenvectors that capture the majority of respiratory motion. 3D fluoroscopic images are generated by optimizing the weights of the PCA eigenvectors iteratively through comparison of measured cone-beam projections and simulated projections generated from the motion model. This method was applied to images from five lung-cancer patients. The spatial accuracy of this method is evaluated by comparing landmark positions in the 3D fluoroscopic images to manually defined ground truth positions in the patient cone-beam projections. Results: 4DCBCT motion models were shown to accurately generate 3D fluoroscopic images when the patient cone-beam projections contained clearly visible structures moving with respiration (e.g., the diaphragm). When no moving anatomical structure was clearly visible in the projections, the 3D fluoroscopic images generated did not capture breathing deformations, and reverted to the reference image. For the subset of 3D fluoroscopic images generated from projections with visibly moving anatomy, the average tumor localization error and the 95th percentile were 1.6 mm and 3.1 mm respectively. Conclusion: This study showed that 4DCBCT-based 3D fluoroscopic images can accurately capture respiratory deformations in a patient dataset, so long as the cone-beam projections used contain visible structures that move with respiration. For clinical implementation of 3D fluoroscopic imaging for treatment verification, an imaging field of view (FOV) that contains visible structures moving with respiration should be

  11. Percutaneous transhepatic drainage of inaccessible abdominal abscesses following abdominal surgery under real-time CT-fluoroscopic guidance.

    PubMed

    Yamakado, Koichiro; Takaki, Haruyuki; Nakatsuka, Atsuhiro; Kashima, Masataka; Uraki, Junji; Yamanaka, Takashi; Takeda, Kan

    2010-02-01

    This study evaluated the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6-9.5 cm (mean, 6.7 +/- 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications in abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 +/- 9.2 min (range, 12-41 min). All abscesses were drained. They shrank immediately after catheter placement. In conclusions, this transhepatic approach under real-time CT fluoroscopic guidance is a safe, feasible, and useful technique for use of drainage of inaccessible abdominal abscesses.

  12. Simulation center training as a means to improve resident performance in percutaneous noncontinuous CT-guided fluoroscopic procedures with dose reduction.

    PubMed

    Mendiratta-Lala, Mishal; Williams, Todd R; Mendiratta, Vivek; Ahmed, Hafeez; Bonnett, John W

    2015-04-01

    The purpose of this study was to evaluate the effectiveness of a multifaceted simulation-based resident training for CT-guided fluoroscopic procedures by measuring procedural and technical skills, radiation dose, and procedure times before and after simulation training. A prospective analysis included 40 radiology residents and eight staff radiologists. Residents took an online pretest to assess baseline procedural knowledge. Second-through fourth-year residents' baseline technical skills with a procedural phantom were evaluated. First-through third-year residents then underwent formal didactic and simulation-based procedural and technical training with one of two interventional radiologists and followed the training with 1 month of supervised phantom-based practice. Thereafter, residents underwent final written and practical examinations. The practical examination included essential items from a 20-point checklist, including site and side marking, consent, time-out, and sterile technique along with a technical skills portion assessing pedal steps, radiation dose, needle redirects, and procedure time. The results indicated statistically significant improvement in procedural and technical skills after simulation training. For residents, the median number of pedal steps decreased by three (p=0.001), median dose decreased by 15.4 mGy (p<0.001), median procedure time decreased by 4.0 minutes (p<0.001), median number of needle redirects decreased by 1.0 (p=0.005), and median number of 20-point checklist items successfully completed increased by three (p<0.001). The results suggest that procedural skills can be acquired and improved by simulation-based training of residents, regardless of experience. CT simulation training decreases procedural time, decreases radiation dose, and improves resident efficiency and confidence, which may transfer to clinical practice with improved patient care and safety.

  13. Mechanical Anisotropy of Ankyrin Repeats

    PubMed Central

    Lee, Whasil; Zeng, Xiancheng; Rotolo, Kristina; Yang, Ming; Schofield, Christopher J.; Bennett, Vann; Yang, Weitao; Marszalek, Piotr E.

    2012-01-01

    Red blood cells are frequently deformed and their cytoskeletal proteins such as spectrin and ankyrin-R are repeatedly subjected to mechanical forces. While the mechanics of spectrin was thoroughly investigated in vitro and in vivo, little is known about the mechanical behavior of ankyrin-R. In this study, we combine coarse-grained steered molecular dynamics simulations and atomic force spectroscopy to examine the mechanical response of ankyrin repeats (ARs) in a model synthetic AR protein NI6C, and in the D34 fragment of native ankyrin-R when these proteins are subjected to various stretching geometry conditions. Our steered molecular dynamics results, supported by AFM measurements, reveal an unusual mechanical anisotropy of ARs: their mechanical stability is greater when their unfolding is forced to propagate from the N-terminus toward the C-terminus (repeats unfold at ∼60 pN), as compared to the unfolding in the opposite direction (unfolding force ∼ 30 pN). This anisotropy is also reflected in the complex refolding behavior of ARs. The origin of this unfolding and refolding anisotropy is in the various numbers of native contacts that are broken and formed at the interfaces between neighboring repeats depending on the unfolding/refolding propagation directions. Finally, we discuss how these complex mechanical properties of ARs in D34 may affect its behavior in vivo. PMID:22404934

  14. 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

  15. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

    PubMed Central

    Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

    2015-01-01

    Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient

  16. A CMOS-based high resolution fluoroscope (HRF) detector prototype with 49.5 μm pixels for use in endovascular image guided interventions (EIGI).

    PubMed

    Russ, M; Shankar, A; Setlur Nagesh, S V; Ionita, C N; Bednarek, D R; Rudin, S

    2017-02-11

    X-ray detectors to meet the high-resolution requirements for endovascular image-guided interventions (EIGIs) are being developed and evaluated. A new 49.5-micron pixel prototype detector is being investigated and compared to the current suite of high-resolution fluoroscopic (HRF) detectors. This detector featuring a 300-micron thick CsI(Tl) scintillator, and low electronic noise CMOS readout is designated the HRF-CMOS50. To compare the abilities of this detector with other existing high resolution detectors, a standard performance metric analysis was applied, including the determination of the modulation transfer function (MTF), noise power spectra (NPS), noise equivalent quanta (NEQ), and detective quantum efficiency (DQE) for a range of energies and exposure levels. The advantage of the smaller pixel size and reduced blurring due to the thin phosphor was exemplified when the MTF of the HRF-CMOS50 was compared to the other high resolution detectors, which utilize larger pixels, other optical designs or thicker scintillators. However, the thinner scintillator has the disadvantage of a lower quantum detective efficiency (QDE) for higher diagnostic x-ray energies. The performance of the detector as part of an imaging chain was examined by employing the generalized metrics GMTF, GNEQ, and GDQE, taking standard focal spot size and clinical imaging parameters into consideration. As expected, the disparaging effects of focal spot unsharpness, exacerbated by increasing magnification, degraded the higher-frequency performance of the HRF-CMOS50, while increasing scatter fraction diminished low-frequency performance. Nevertheless, the HRF-CMOS50 brings improved resolution capabilities for EIGIs, but would require increased sensitivity and dynamic range for future clinical application.

  17. A CMOS-based high-resolution fluoroscope (HRF) detector prototype with 49.5μm pixels for use in endovascular image guided interventions (EIGI)

    NASA Astrophysics Data System (ADS)

    Russ, M.; Shankar, A.; Setlur Nagesh, S. V.; Ionita, C. N.; Bednarek, D. R.; Rudin, S.

    2017-03-01

    X-ray detectors to meet the high-resolution requirements for endovascular image-guided interventions (EIGIs) are being developed and evaluated. A new 49.5-micron pixel prototype detector is being investigated and compared to the current suite of high-resolution fluoroscopic (HRF) detectors. This detector featuring a 300-micron thick CsI(Tl) scintillator, and low electronic noise CMOS readout is designated the HRF- CMOS50. To compare the abilities of this detector with other existing high resolution detectors, a standard performance metric analysis was applied, including the determination of the modulation transfer function (MTF), noise power spectra (NPS), noise equivalent quanta (NEQ), and detective quantum efficiency (DQE) for a range of energies and exposure levels. The advantage of the smaller pixel size and reduced blurring due to the thin phosphor was exemplified when the MTF of the HRF-CMOS50 was compared to the other high resolution detectors, which utilize larger pixels, other optical designs or thicker scintillators. However, the thinner scintillator has the disadvantage of a lower quantum detective efficiency (QDE) for higher diagnostic x-ray energies. The performance of the detector as part of an imaging chain was examined by employing the generalized metrics GMTF, GNEQ, and GDQE, taking standard focal spot size and clinical imaging parameters into consideration. As expected, the disparaging effects of focal spot unsharpness, exacerbated by increasing magnification, degraded the higher-frequency performance of the HRF-CMOS50, while increasing scatter fraction diminished low-frequency performance. Nevertheless, the HRF-CMOS50 brings improved resolution capabilities for EIGIs, but would require increased sensitivity and dynamic range for future clinical application.

  18. Fluoroscopic guide to an ideal implant position for Sapien XT and CoreValve during a valve-in-valve procedure.

    PubMed

    Bapat, Vinnie N; Attia, Rizwan Q; Condemi, Fortunata; Visagan, Ravi; Guthrie, Maya; Sunni, Shelina; Thomas, Martyn

    2013-11-01

    This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position. VIV procedures are being increasingly performed with substantial experience acquired in treating degenerated SHV in the aortic position with Sapien/Sapien XT (Edwards Lifesciences Ltd., Irvine, California) and CoreValve/Evolute (Medtronic Inc., Minneapolis, Minnesota) valves. Although less invasive than conventional surgery, securing the THV in an optimal position within the SHV determines the success of this novel treatment. For VIV implantation, we selected appropriate Sapien XT and CoreValve/Evolute sizes depending on the internal diameter of the SHV. Implantation was performed in vitro. In case of the Sapien XT valve, it was deployed 4 to 5 mm below the sewing ring of the SHV, whereas the CoreValve/Evolute was deployed 5 mm below the level of the sewing ring. Photographs and fluoroscopic images of the various VIV combinations were obtained in side profile to study the ideal position and end-on profile to study the circularity of the THV. Fluoroscopic images obtained in side profile highlighted the differences in various VIV combinations, as all SHV are unique in their fluoroscopic appearances. Also, all THV implants in various VIV combinations achieved a nearly circular shape. To achieve an optimal result when considering VIV, it is important to be familiar with the structure and fluoroscopic appearances of the failed SHV, the THV used, and their combination. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Solid-state fluoroscopic imager for high-resolution angiography: Physical characteristics of an 8 cm×8 cm experimental prototype

    PubMed Central

    Vedantham, Srinivasan; Karellas, Andrew; Suryanarayanan, Sankararaman; Onishi, Steven K.

    2008-01-01

    In this paper, the performance of an 8 cm×8 cm three-side buttable charge-coupled device (CCD)-based imager specially designed for high-resolution fluoroscopy and operating in fluoroscopic (30 frames/second) mode is presented in terms of the presampling modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). The 8 cm×8 cm CCD imager is coupled to a 450 μm thick CsI:Tl scintillator by nondemagnifying (straight, 1:1) fiberoptics. The CCD imager has a fundamental pixel pitch of 39 μm and incorporates an optically opaque interline (data) channel. The CCD imager was operated at 156 μm pixel pitch by binning 4×4 adjacent pixels prior to readout. The fluoroscopic image lag was measured and accounted for in the DQE estimate to provide lag-corrected DQE. The measured limiting spatial resolution at 10% presampling MTF with the imager operated at 156 μm pixel pitch (Nyquist sampling limit: 3.21 cy/mm) was 3.6 cy/mm. In the pulsed fluoroscopic mode, the first-frame image lag was less than 0.9%. The lag-corrected DQE(0) of ~0.62 was achieved even at a low fluoroscopic exposure rate of 1 μR/frame. Grid phantom measurements indicate no appreciable distortion. Results from DQE and image lag measurements at fluoroscopic exposure rates combined with the high spatial resolution observed from the MTF suggest that this type of imager or its variants may be a potential candidate for high-resolution neuro-interventional imaging, cardiovascular imaging, pediatric angiography, and small animal imaging. Since the CCD is three-side buttable, four such CCD modules can be joined to form a 2×2 matrix providing a field of view of 16 cm×16 cm. PMID:15259649

  20. Google Glass as an Alternative to Standard Fluoroscopic Visualization for Percutaneous Fixation of Hand Fractures: A Pilot Study.

    PubMed

    Chimenti, Peter C; Mitten, David J

    2015-08-01

    This pilot study investigated the feasibility of Google Glass to assist visualization of fluoroscopic images during percutaneous pinning of hand fractures. Cadavers were used to compare total time to pin each fracture and total number of radiographs per fracture from a mini C-arm. A FluoroScan monitor was used for radiographic visualization compared to projecting the images in the Google Glass display. All outcome measures significantly improved for proximal phalanx fractures (127 versus 86 seconds, p = 0.017; 5.3 versus 2.2 images, p = 0.003), and fewer images were obtained during fixation of metacarpal fractures using Google Glass compared with traditional techniques (6.4 versus 3.6, p < 0.001). Typical FluoroScan monitor placement may require the surgeon to alter focus away from the operative field, whereas Google Glass allows constant attention directed toward the operative field.

  1. Optimization of multi-image pose recovery of fluoroscope tracking (FTRAC) fiducial in an image-guided femoroplasty system

    NASA Astrophysics Data System (ADS)

    Liu, Wen P.; Armand, Mehran; Otake, Yoshito; Taylor, Russell H.

    2011-03-01

    Percutaneous femoroplasty [1], or femoral bone augmentation, is a prospective alternative treatment for reducing the risk of fracture in patients with severe osteoporosis. We are developing a surgical robotics system that will assist orthopaedic surgeons in planning and performing a patient-specific, augmentation of the femur with bone cement. This collaborative project, sponsored by the National Institutes of Health (NIH), has been the topic of previous publications [2],[3] from our group. This paper presents modifications to the pose recovery of a fluoroscope tracking (FTRAC) fiducial during our process of 2D/3D registration of X-ray intraoperative images to preoperative CT data. We show improved automata of the initial pose estimation as well as lower projection errors with the advent of a multiimage pose optimization step.

  2. Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

    PubMed Central

    Yu, Robinson K.; Ghodadra, Anish; Agarwal, Vikas

    2016-01-01

    Background Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. Methods Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate. Results Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P<0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both. Conclusions An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. PMID:28097241

  3. Guidewire path tracking and segmentation in 2D fluoroscopic time series using device paths from previous frames

    NASA Astrophysics Data System (ADS)

    Wagner, Martin G.; Strother, Charles M.; Mistretta, Charles A.

    2016-03-01

    Recent efforts to perform a 3D reconstruction of interventional devices such as guidewires from monoplane and biplane fluoroscopic images require the segmentation of the exact device path in the respective 2D projection images. The segmentation of the device in low dose fluoroscopy images can be challenging since noise and motion artifacts degrade the image quality. Additionally, extracting the device path from the segmented region may result in ambiguous results due to overlapping device parts or discontinuities in the device segmentation. The purpose of this work is to present a novel guidewire tracking and segmentation algorithm, which segments the device region based on three different features based on a ridge detection filter, noise reduction for curvilinear structures as well as an a priori probability map. The features are calculated from background subtracted as well as unsubtracted fluoroscopic images. The device path extraction is based on a topology preserving thinning algorithm followed by a path search, which minimizes a cost function based on distance and directional difference between adjacent segments as well as the similarity to the device path extracted from the previous frame. The quantitative evaluation was performed using 7 data sets acquired from a canine study. Device shapes with different complexities are compared to semi-automatic segmentations. An average segmentation accuracy of 0.50 0.41 mm was achieved where each point along the device was compared to the point on the reference device centerline with the same distance to the device tip. In all cases the device path could be resolved correctly, which would allow a more accurate and reliable reconstruction of the 3D path of the device.

  4. Design considerations for a new high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS)

    NASA Astrophysics Data System (ADS)

    Loughran, Brendan; Swetadri Vasan, S. N.; Singh, Vivek; Ionita, Ciprian N.; Jain, Amit; Bednarek, Daniel R.; Titus, Albert H.; Rudin, Stephen

    2013-03-01

    The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.

  5. Evaluation of intracranial aneurysm coil embolization in phantoms and patients using a high resolution microangiographic fluoroscope (MAF)

    NASA Astrophysics Data System (ADS)

    Ionita, Ciprian N.; Jain, Amit; Loughran, Brendan; Swetadri Vasan, S. N.; Bednarek, Daniel R.; Levy, Elad; Siddiqui, Adnan H.; Snyder, Kenneth V.; Hopkins, L. N.; Rudin, Stephen

    2012-03-01

    Intracranial aneurysm (IA) embolization using Gugliemi Detachable Coils (GDC) under x-ray fluoroscopic guidance is one of the most important neuro-vascular interventions. Coil deposition accuracy is key and could benefit substantially from higher resolution imagers such as the micro-angiographic fluoroscope (MAF). The effect of MAF guidance improvement over the use of standard Flat Panels (FP) is challenging to assess for such a complex procedure. We propose and investigate a new metric, inter-frame cross-correlation sensitivity (CCS), to compare detector performance for such procedures. Pixel (P) and histogram (H) CCS's were calculated as one minus the cross-correlation coefficients between pixel values and histograms for the region of interest at successive procedure steps. IA treatment using GDC's was simulated using an anthropomorphic head phantom which includes an aneurysm. GDC's were deposited in steps of 3 cm and the procedure was imaged with a FP and the MAF. To measure sensitivity to detect progress of the procedure by change in images of successive steps, an ROI was selected over the aneurysm location and pixel-value and histogram changes were calculated after each step. For the FP, after 4 steps, the H and P CCSs between successive steps were practically zero, indicating that there were no significant changes in the observed images. For the MAF, H and P CCSs were greater than zero even after 10 steps (30 cm GDC), indicating observable changes. Further, the proposed quantification method was applied for evaluation of seven patients imaged using the MAF, yielding similar results (H and P CCSs greater than zero after the last GDC deposition). The proposed metric indicates that the MAF can offer better guidance during such procedures.

  6. Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016).

    PubMed

    Livet, Véronique; Pillard, Paul; Goy-Thollot, Isabelle; Maleca, David; Cabon, Quentin; Remy, Denise; Fau, Didier; Viguier, Éric; Pouzot, Céline; Carozzo, Claude; Cachon, Thibaut

    2016-09-30

    The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats (P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in

  7. Design considerations for a new, high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS).

    PubMed

    Loughran, Brendan; Swetadri Vasan, S N; Singh, Vivek; Ionita, Ciprian N; Jain, Amit; Bednarek, Daniel R; Titus, Albert; Rudin, Stephen

    2013-03-06

    The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.

  8. A comparison of six software packages for evaluation of solid lung nodules using semi-automated volumetry: what is the minimum increase in size to detect growth in repeated CT examinations.

    PubMed

    de Hoop, Bartjan; Gietema, Hester; van Ginneken, Bram; Zanen, Pieter; Groenewegen, Gerard; Prokop, Mathias

    2009-04-01

    We compared interexamination variability of CT lung nodule volumetry with six currently available semi-automated software packages to determine the minimum change needed to detect the growth of solid lung nodules. We had ethics committee approval. To simulate a follow-up examination with zero growth, we performed two low-dose unenhanced CT scans in 20 patients referred for pulmonary metastases. Between examinations, patients got off and on the table. Volumes of all pulmonary nodules were determined on both examinations using six nodule evaluation software packages. Variability (upper limit of the 95% confidence interval of the Bland-Altman plot) was calculated for nodules for which segmentation was visually rated as adequate. We evaluated 214 nodules (mean diameter 10.9 mm, range 3.3 mm-30.0 mm). Software packages provided adequate segmentation in 71% to 86% of nodules (p < 0.001). In case of adequate segmentation, variability in volumetry between scans ranged from 16.4% to 22.3% for the various software packages. Variability with five to six software packages was significantly less for nodules >or=8 mm in diameter (range 12.9%-17.1%) than for nodules <8 mm (range 18.5%-25.6%). Segmented volumes of each package were compared to each of the other packages. Systematic volume differences were detected in 11/15 comparisons. This hampers comparison of nodule volumes between software packages.

  9. Repeating the Past

    NASA Astrophysics Data System (ADS)

    Moore, John W.

    1998-05-01

    As part of the celebration of the Journal 's 75th year, we are scanning each Journal issue from 25, 50, and 74 years ago. Many of the ideas and practices described are so similar to present-day "innovations" that George Santayana's adage (1) "Those who cannot remember the past are condemned to repeat it" comes to mind. But perhaps "condemned" is too strong - sometimes it may be valuable to repeat something that was done long ago. One example comes from the earliest days of the Division of Chemical Education and of the Journal.

  10. Slit Wheel Repeatability

    NASA Astrophysics Data System (ADS)

    DiFelice, Audrey

    2013-10-01

    Test the repeatibility of the slit wheel by taking a sequence of comparison lamp spectra with grating G230MB {2697} and the three smallest long slits {52X0.2, 52X0.1, and 52X0.05}. This is a clone of Cycle 20 Program 13140.

  11. Slit Wheel Repeatability

    NASA Astrophysics Data System (ADS)

    Long, Chris

    2011-10-01

    Test the repeatibility of the slit wheel by taking a sequence of comparison lamp spectra with grating G230MB {2697} and the three smallest long slits {52X0.2, 52X0.1, and 52X0.05}. This is a clone of Cycle 18 Program 12410.

  12. Slit Wheel Repeatability

    NASA Astrophysics Data System (ADS)

    DiFelice, Audrey

    2012-10-01

    Test the repeatibility of the slit wheel by taking a sequence of comparison lamp spectra with grating G230MB {2697} and the three smallest long slits {52X0.2, 52X0.1, and 52X0.05}. This is a clone of Cycle 19 Program 12771.

  13. A repeat cross-sectional study examining the equitable impact of nutritional standards for school lunches in England in 2008 on the diets of 4-7y olds across the socio-economic spectrum.

    PubMed

    Spence, Suzanne; Matthews, John N S; White, Martin; Adamson, Ashley J

    2014-10-24

    The 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children's nutrient intake at lunchtime and in total diet by level of deprivation. We conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children's diets. 368 and 624 children participated in 2003-4 and 2008-9 respectively. At lunchtime, between 2003-4 and 2008-9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008-9 compared with 2003-4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation. By 2008-9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant

  14. Leaded eyeglasses substantially reduce radiation exposure of the surgeon's eyes during acquisition of typical fluoroscopic views of the hip and pelvis.

    PubMed

    Burns, Sean; Thornton, Raymond; Dauer, Lawrence T; Quinn, Brian; Miodownik, Daniel; Hak, David J

    2013-07-17

    Despite recommendations to do so, few orthopaedists wear leaded glasses when performing operative fluoroscopy. Radiation exposure to the ocular lens causes cataracts, and regulatory limits for maximum annual occupational exposure to the eye continue to be revised downward. Using anthropomorphic patient and surgeon phantoms, radiation dose at the surgeon phantom's lens was measured with and without leaded glasses during fluoroscopic acquisition of sixteen common pelvic and hip views. The magnitude of lens dose reduction from leaded glasses was calculated by dividing the unprotected dose by the dose measured behind leaded glasses. On average, the use of leaded glasses reduced radiation to the surgeon phantom's eye by tenfold, a 90% reduction in dose. However, there was widespread variation in the amount of radiation that reached the phantom surgeon's eye among the various radiographic projections we studied. Without leaded glasses, the dose measured at the surgeon's lens varied more than 250-fold among these sixteen different views. In addition to protecting the surgeon's eye from the deleterious effects of radiation, the use of leaded glasses could permit an orthopaedist to perform fluoroscopic views on up to ten times more patients before reaching the annual dose limit of 20 mSv of radiation to the eye recommended by the International Commission on Radiological Protection. Personal safety and adherence to limits of occupational radiation exposure should compel orthopaedists to wear leaded glasses for fluoroscopic procedures if other protective barriers are not in use. Leaded glasses are a powerful tool for reducing the orthopaedic surgeon's lens exposure to radiation during acquisition of common intraoperative fluoroscopic views.

  15. The influence of injecting an epidural contrast agent into the sacral canal on the fluoroscopic visibility of bony landmarks for sacroiliac screw fixation: a feasibility study.

    PubMed

    Mendel, Thomas; Radetzki, Florian; Schwan, Stefan; Hofmann, Gunther Olaf; Goehre, Felix

    2015-02-01

    In sacroiliac screw fixation of unstable pelvic injuries in geriatric patients, poor bone quality often obscures important bony landmarks in fluoroscopic images. The authors analyzed the feasibility of injecting a transhiatal contrast agent (CA) into the sacral canal to improve fluoroscopic visualization in the sacral epidural space. Eight fresh cadaveric whole-body specimens from human donors whose mean age at the time of death was 78 years (range 69-87 years) were used. First, to identify bony landmarks without CA enhancement, the authors acquired fluoroscopy images of the native sacral canal, using lateral, inlet, and outlet projections. Through puncture of the sacral hiatus, 8-10 ml of CA was injected into the epidural space. Fluoroscopy images were then acquired in the standard pelvic views to identify the bony landmarks. To assess the effect of the CA enhancement, visibility of the landmarks was assessed before and after CA injection. Each identified landmark was scored as 1, and summative landmark scores of up to 10 were determined for each specimen. The cadaveric specimens were representative of bone structures in the geriatric population. In all specimens, epidural CA injection enhanced the fluoroscopic visualization of the sacral canal and of the S-1 foramina. The enhancement increased the total bony landmark score from 5.9 (range 4-8) without CA injection to 8.1 (range 6-10) after CA injection. Considering only intrasacral landmarks, the score was increased from 1.5 to 3. Injection of a transhiatal epidural CA improves fluoroscopic imaging of the sacral canal and of the neural foramina. Hence, this technique could be applied to help the surgeon identify anatomical landmarks during sacroiliac screw fixation in geriatric patients.

  16. Initial Experience with Computed Tomography and Fluoroscopically Guided Placement of Push-Type Gastrostomy Tubes Using a Rupture-Free Balloon Catheter

    SciTech Connect

    Fujita, Takeshi Tanabe, Masahiro; Yamatogi, Shigenari; Shimizu, Kensaku; Matsunaga, Naofumi

    2011-06-15

    The purpose of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy placement of push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance. A total of 35 patients (23 men and 12 women; age range 57-93 years [mean 71.7]) underwent percutaneous CT and fluoroscopically guided gastrostomy placement of a push-type gastrostomy tube using an RFB catheter between April 2005 and July 2008. Technical success, procedure duration, and complications were analyzed. Percutaneous radiologic gastrostomy placement was considered technically successful in all patients. The median procedure time was 39 {+-} 13 (SD) min (range 24-78). The average follow-up time interval was 103 days (range 7-812). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up period. The investigators conclude that percutaneous CT and fluoroscopically guided gastrostomy placement with push-type tubes using an RFB catheter is a safe and effective means of gastric feeding when performed by radiologists.

  17. The telomere repeat motif of basal Metazoa.

    PubMed

    Traut, Walther; Szczepanowski, Monika; Vítková, Magda; Opitz, Christian; Marec, Frantisek; Zrzavý, Jan

    2007-01-01

    In most eukaryotes the telomeres consist of short DNA tandem repeats and associated proteins. Telomeric repeats are added to the chromosome ends by telomerase, a specialized reverse transcriptase. We examined telomerase activity and telomere repeat sequences in representatives of basal metazoan groups. Our results show that the 'vertebrate' telomere motif (TTAGGG)( n ) is present in all basal metazoan groups, i.e. sponges, Cnidaria, Ctenophora, and Placozoa, and also in the unicellular metazoan sister group, the Choanozoa. Thus it can be considered the ancestral telomere repeat motif of Metazoa. It has been conserved from the metazoan radiation in most animal phylogenetic lineages, and replaced by other motifs-according to our present knowledge-only in two major lineages, Arthropoda and Nematoda.

  18. Duct Leakage Repeatability Testing

    SciTech Connect

    Walker, Iain; Sherman, Max

    2014-01-01

    Duct leakage often needs to be measured to demonstrate compliance with requirements or to determine energy or Indoor Air Quality (IAQ) impacts. Testing is often done using standards such as ASTM E1554 (ASTM 2013) or California Title 24 (California Energy Commission 2013 & 2013b), but there are several choices of methods available within the accepted standards. Determining which method to use or not use requires an evaluation of those methods in the context of the particular needs. Three factors that are important considerations are the cost of the measurement, the accuracy of the measurement and the repeatability of the measurement. The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards.

  19. Accumulate repeat accumulate codes

    NASA Technical Reports Server (NTRS)

    Abbasfar, Aliazam; Divsalar, Dariush; Yao, Kung

    2004-01-01

    In this paper we propose an innovative channel coding scheme called 'Accumulate Repeat Accumulate codes' (ARA). This class of codes can be viewed as serial turbo-like codes, or as a subclass of Low Density Parity Check (LDPC) codes, thus belief propagation can be used for iterative decoding of ARA codes on a graph. The structure of encoder for this class can be viewed as precoded Repeat Accumulate (RA) code or as precoded Irregular Repeat Accumulate (IRA) code, where simply an accumulator is chosen as a precoder. Thus ARA codes have simple, and very fast encoder structure when they representing LDPC codes. Based on density evolution for LDPC codes through some examples for ARA codes, we show that for maximum variable node degree 5 a minimum bit SNR as low as 0.08 dB from channel capacity for rate 1/2 can be achieved as the block size goes to infinity. Thus based on fixed low maximum variable node degree, its threshold outperforms not only the RA and IRA codes but also the best known LDPC codes with the dame maximum node degree. Furthermore by puncturing the accumulators any desired high rate codes close to code rate 1 can be obtained with thresholds that stay close to the channel capacity thresholds uniformly. Iterative decoding simulation results are provided. The ARA codes also have projected graph or protograph representation that allows for high speed decoder implementation.

  20. Efficacy and safety of repeated oral sucrose for repeated procedural pain in neonates: A systematic review.

    PubMed

    Gao, Haixia; Gao, Honglian; Xu, Guihua; Li, Mei; Du, Shizheng; Li, Fang; Zhang, Hua; Wang, Danwen

    2016-10-01

    Although sucrose is most extensively examined for its analgesia effect on a single procedural pain, neonates in neonatal intensive care units can be exposed to numerous painful procedures every day requiring multiple doses of sucrose. Some experiments have been performed to examine the efficacy and safety of repeated sucrose administration for repeated procedural pain; however, a systematic review of this topic has not yet been carried out. To identify and assess the evidence demonstrating the efficacy and safety of repeated sucrose for repeated procedural pain in neonates. A systematic review was conducted using the Cochrane methodology. Pubmed, Cochrane Library, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CBMdisc, CNKI, VIP, and Wanfang databases were searched through December 2015. All related abstracts were reviewed and the full texts of relevant articles were studied. Randomized controlled trials (RCTs) were included. Risk of bias was assessed for RCTs using quality critical appraisal criteria recommended by Cochrane Handbook. A standardised data form was used to extract information. Eight RCTs met our inclusion criteria. Different study designs were used in the included RCTs, which did not allow us to carry out a meta-analysis. The findings from this review indicated that repeated sucrose was effective in reducing both behavioral pain response and composite pain scores during repeated procedural pain. However, as for physiological pain response, one trial found less variability in physiological pain response for term neonates in the sucrose group than the sterile water group, while two trials demonstrated repeated sucrose was inefficacious for preterm neonates. Regarding the clinical outcomes, no study reported adverse effects related to the repeated sucrose administration. Regarding the neurobehavioral development, two trials reported repeated sucrose for repeated procedural pain would not lead to poor neurologic

  1. Two-tuohy needle and catheter technique for fluoroscopically guided percutaneous drainage of spinal epidural abscess: a case report.

    PubMed

    Perez-Toro, Marco R; Burton, Allen W; Hamid, Basem; Koyyalagunta, Dhanalakshmi

    2009-04-01

    The incidence of spinal epidural abscess has increased in the past decades. Traditionally, management was based on surgical decompression. More recent studies have shown conservative management has successful outcomes in selected patients. We present a case, in which an elderly woman presented with new onset radicular pain and mild leukocytosis more than a week after a complicated revision of an intrathecal catheter in place for management of chronic axial low back pain. Magentic resonance imaging (MRI) revealed a posterior epidural abscess from T12 to L2. Two Touhy needles were placed in the epidural space with fluoroscopic guidance for drainage of the abscess. A catheter was then advanced into the epidural space for irrigation with saline and an antibiotic solution. Intravenous antibiotics were continued for a total of 6 weeks. Radicular pain resolved immediately post-procedure. Serial MRIs also showed decreasing size of the abscess. Posterior spinal epidural abscesses may be successfully treated by way of the two Touhy needle and catheter technique for drainage and irrigation. This procedure should be reserved for patients that present with no neurological deficits or deemed nonsurgical candidates. Patients should continue on prolonged intravenous antibiotics and be monitored closely for clinical deterioration and undergo serial follow-up MRIs.

  2. Closed reduction and fluoroscopic-assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats.

    PubMed

    Boekhout-Ta, Christina L; Kim, Stanley E; Cross, Alan R; Evans, Richard; Pozzi, Antonio

    2017-01-01

    To report complications and clinical outcome of dogs and cats that underwent fluoroscopic-assisted percutaneous pinning (FAPP) of physeal fractures. Retrospective study. Client-owned dogs (n = 37) and cats (n = 4). Records (August 2007-August 2014) of physeal fractures treated with FAPP in 3 hospitals were evaluated. Data collected included signalment, fracture characteristics (etiology, location, duration, Salter-Harris classification, preoperative and postoperative displacement), surgical information (implant size, surgical duration), and outcome assessment information (functional outcome, radiographic outcome, and complications). The majority of animals (92%) were classified as full functional outcome. No significant predictors of functional outcome were identified. The overall complication rate was 15% (n = 6). Elective pin removal rate was 41% (n = 17). Goniometry and limb circumference measurements of the affected and contralateral limbs were not significantly different in dogs for which measurements were obtained. Seventeen of 18 animals (16 dogs, 2 cats) measured had bone length changes on follow-up radiographs. FAPP is associated with an excellent functional outcome in a narrow selection of fracture configurations, specifically those with minimal displacement and for which anatomical alignment can be achieved with closed reduction. © 2016 The American College of Veterinary Surgeons.

  3. Development of a 3D CT-scanner using a cone beam and video-fluoroscopic system.

    PubMed

    Endo, M; Yoshida, K; Kamagata, N; Satoh, K; Okazaki, T; Hattori, Y; Kobayashi, S; Jimbo, M; Kusakabe, M; Tateno, Y

    1998-01-01

    We describe the design and implementation of a system that acquires three-dimensional (3D) data of high-contrast objects such as bone, lung, and blood vessels (enhanced by contrast agent). This 3D computed tomography (CT) system is based on a cone beam and video-fluoroscopic system and yields data that is amenable to 3D image processing. An X-ray tube and a large area two-dimensional detector were mounted on a single frame and rotated around objects in 12 seconds. The large area detector consisted of a fluorescent plate and a charge coupled device (CCD) video camera. While the X-ray tube was rotated around the object, a pulsed X-ray was generated (30 pulses per second) and 360 projected images were collected in a 12-second scan. A 256 x 256 x 256 matrix image was reconstructed using a high-speed parallel processor. Reconstruction required approximately 6 minutes. Two volunteers underwent scans of the head or chest. High-contrast objects such as bronchial, vascular, and mediastinal structures in the thorax, or bones and air cavities in the head were delineated in a "real" 3D format. Our 3D CT-scanner appears to produce data useful for clinical imaging and 3D image processing.

  4. Suitability of resin-coated photographic paper for skin dose measurement during fluoroscopically-guided X-ray procedures.

    PubMed

    Guibelalde, E; González, L; Vañó, E

    2004-10-01

    The need for mapping skin doses during fluoroscopically-guided X-ray procedures has been described by a number of institutions and experts. Different large photographic or X-ray films placed on the patient's skin have been found to be useful for recording doses up to 1.0-2.0 Gy - depending on the film - and up to 15 Gy using radiochromic films. Though the upper limit of the film sensitivity is seldom exceeded during interventional procedures, the main disadvantage of the X-ray films is still the excessive sensitivity for long, high dose procedures. Radiochromic films show poor definition for doses below 0.5 Gy and are expensive. The goal of the present paper is to analyse the possibilities of using common resin-coated photographic paper for this purpose. Sensitometric curves obtained with different paper types processed in conventional X-ray film automatic processors demonstrate that some of them can be used with better results than X-ray films at a very low cost. Doses from about 10 mGy to near 3.0 Gy can be measured with good accuracy using a variety of glossy photographic papers.

  5. Repeatability of Cryogenic Multilayer Insulation

    NASA Technical Reports Server (NTRS)

    Johnson, W. L.; Vanderlaan, M.; Wood, J. J.; Rhys, N. O.; Guo, W.; Van Sciver, S.; Chato, D. J.

    2017-01-01

    Due to the variety of requirements across aerospace platforms, and one off projects, the repeatability of cryogenic multilayer insulation has never been fully established. The objective of this test program is to provide a more basic understanding of the thermal performance repeatability of MLI systems that are applicable to large scale tanks. There are several different types of repeatability that can be accounted for: these include repeatability between multiple identical blankets, repeatability of installation of the same blanket, and repeatability of a test apparatus. The focus of the work in this report is on the first two types of repeatability. Statistically, repeatability can mean many different things. In simplest form, it refers to the range of performance that a population exhibits and the average of the population. However, as more and more identical components are made (i.e. the population of concern grows), the simple range morphs into a standard deviation from an average performance. Initial repeatability testing on MLI blankets has been completed at Florida State University. Repeatability of five GRC provided coupons with 25 layers was shown to be +/- 8.4 whereas repeatability of repeatedly installing a single coupon was shown to be +/- 8.0. A second group of 10 coupons have been fabricated by Yetispace and tested by Florida State University, through the first 4 tests, the repeatability has been shown to be +/- 16. Based on detailed statistical analysis, the data has been shown to be statistically significant.

  6. Duct Leakage Repeatability Testing

    SciTech Connect

    Walker, Iain; Sherman, Max

    2014-08-01

    The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques for duct leakage using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards. The three duct leak measurement methods assessed in this report are the two duct pressurization methods that are commonly used by many practitioners and the DeltaQ technique. These are methods B, C and A, respectively of the ASTM E1554 standard. Although it would be useful to evaluate other duct leak test methods, this study focused on those test methods that are commonly used and are required in various test standards, such as BPI (2010), RESNET (2014), ASHRAE 62.2 (2013), California Title 24 (CEC 2012), DOE Weatherization and many other energy efficiency programs.

  7. 78 FR 65594 - Vehicular Repeaters

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... changes, and on whether current mobile repeater filter technologies can support reduced frequency... feasibility of adapting SAW filters, or other filter technology, for mobile repeater use. We particularly... mobile repeaters by public safety licensees on certain frequencies in the VHF band. DATES:...

  8. Repeat Customer Success in Extension

    ERIC Educational Resources Information Center

    Bess, Melissa M.; Traub, Sarah M.

    2013-01-01

    Four multi-session research-based programs were offered by two Extension specialist in one rural Missouri county. Eleven participants who came to multiple Extension programs could be called "repeat customers." Based on the total number of participants for all four programs, 25% could be deemed as repeat customers. Repeat customers had…

  9. Repeat Customer Success in Extension

    ERIC Educational Resources Information Center

    Bess, Melissa M.; Traub, Sarah M.

    2013-01-01

    Four multi-session research-based programs were offered by two Extension specialist in one rural Missouri county. Eleven participants who came to multiple Extension programs could be called "repeat customers." Based on the total number of participants for all four programs, 25% could be deemed as repeat customers. Repeat customers had…

  10. Training Distal Locking Screw Insertion Skills to Novice Trainees: A Comparison Between Fluoroscopic- and Electromagnetic-Guided Techniques.

    PubMed

    Leroux, Timothy; Khoshbin, Amir; Nousiainen, Markku T

    2015-10-01

    To compare the effect fluoroscopy or electromagnetic (EM) guidance has on the learning of locking screw insertion in tibial nails in surgical novices. A randomized, prospective, controlled trial was conducted involving 18 surgical trainees with no prior experience inserting locking screws in intramedullary nails. After a training session using fluoroscopy, participants underwent a pretest using fluoroscopic guidance. Participants were then randomized into either the fluoroscopy or EM group and were further trained using their respective technique. Post, retention, and transfer tests were conducted. Outcomes included task completion, drill attempts, screw changes, and radiation time. Intragroup comparisons revealed that the EM group used significantly less drill attempts during the post and retention tests compared with the pretest (P = 0.016 and P = 0.016, respectively). Intergroup comparisons revealed that the EM group was (1) more likely to complete the task during the retention test (P = 0.043) and (2) had significantly less radiation time during the post and retention tests (P = 0.002 and P = 0.003, respectively). Radiation time in the EM group during the transfer test increased to a level equal to what the fluoroscopy group used during the post and retention tests (P = 0.71 and P = 0.92, respectively). No other significant between-group differences occurred. EM guidance may be safely used to assist in the training of surgical novices in the skill of distal locking screw insertion. Not only does this technology significantly improve the ability to complete the task and decrease radiation use but also it does so without compromising skill acquisition. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  11. Three-dimensional kinematic estimation of mobile-bearing total knee arthroplasty from x-ray fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Yamazaki, Takaharu; Futai, Kazuma; Tomita, Tetsuya; Sato, Yoshinobu; Yoshikawa, Hideki; Tamura, Shinichi; Sugamoto, Kazuomi

    2011-03-01

    To achieve 3D kinematic analysis of total knee arthroplasty (TKA), 2D/3D registration techniques, which use X-ray fluoroscopic images and computer-aided design (CAD) model of the knee implant, have attracted attention in recent years. These techniques could provide information regarding the movement of radiopaque femoral and tibial components but could not provide information of radiolucent polyethylene insert, because the insert silhouette on X-ray image did not appear clearly. Therefore, it was difficult to obtain 3D kinemaitcs of polyethylene insert, particularly mobile-bearing insert that move on the tibial component. This study presents a technique and the accuracy for 3D kinematic analysis of mobile-bearing insert in TKA using X-ray fluoroscopy, and finally performs clinical applications. For a 3D pose estimation technique of the mobile-bearing insert in TKA using X-ray fluoroscopy, tantalum beads and CAD model with its beads are utilized, and the 3D pose of the insert model is estimated using a feature-based 2D/3D registration technique. In order to validate the accuracy of the present technique, experiments including computer simulation test were performed. The results showed the pose estimation accuracy was sufficient for analyzing mobile-bearing TKA kinematics (the RMS error: about 1.0 mm, 1.0 degree). In the clinical applications, seven patients with mobile-bearing TKA in deep knee bending motion were studied and analyzed. Consequently, present technique enables us to better understand mobile-bearing TKA kinematics, and this type of evaluation was thought to be helpful for improving implant design and optimizing TKA surgical techniques.

  12. Incorporating Corrections for the Head-Holder and Compensation Filter when Calculating Skin Dose during Fluoroscopically-Guided Interventions

    PubMed Central

    Vijayan, Sarath; Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2015-01-01

    The skin dose tracking system (DTS) that we developed provides a color-coded illustration of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures for immediate feedback to the interventionist. To improve the accuracy of dose calculation, we now have incorporated two additional important corrections (1) for the holder used to immobilize the head in neuro-interventions and (2) for the built-in compensation filters used for beam equalization. Both devices have been modeled in the DTS software so that beam intensity corrections can be made. The head-holder is modeled as two concentric hemi-cylindrical surfaces such that the path length between those surfaces can be determined for rays to individual points on the skin surface. The head-holder on the imaging system we used was measured to attenuate the primary x-rays by 10 to 20% for normal incidence, and up to 40% at non-normal incidence. In addition, three compensation filters of different shape are built into the collimator apparatus and were measured to have attenuation factors ranging from 58% to 99%, depending on kVp and beam filtration. These filters can translate and rotate in the beam and their motion is tracked by the DTS using the digital signal from the imaging system. When it is determined that a ray to a given point on the skin passes through the compensation filter, the appropriate attenuation correction is applied. These corrections have been successfully incorporated in the DTS software to provide a more accurate determination of skin dose. PMID:26819488

  13. Comparison of fully automated and semi-automated biopsy needles for lung biopsy under CT fluoroscopic guidance

    PubMed Central

    Yoshimatsu, R; Yamagami, T; Tanaka, O; Miura, H; Tanaka, T; Suzuki, T; Nishimura, T

    2012-01-01

    Objective The aim of this study was to compare two different automated biopsy needles, a fully automated biopsy needle (Monopty; Bard, Covington, GA) and a semi-automated biopsy needle (Temno; Bauer Medical, Clearwater, FL), for lung biopsy. Methods 50 consecutive percutaneous lung biopsies using the Monopty needle between June 2006 and January 2007 and 66 consecutive lung biopsies for 1 nodule in each session using the Temno needle between February 2007 and August 2008 were performed under CT fluoroscopic guidance followed by histopathological evaluation. Results In 42/50 lung biopsies performed with the Monopty needle and 54/66 lung biopsies performed with the Temno needle, the final diagnosis was confirmed by independent surgical pathological findings or clinical follow-up. Sufficient samples for histopathological evaluation were obtained in all 50 (100%) biopsies using the Monopty needle and in 55 (83.3%) of the 66 biopsies using the Temno needle (p<0.01). Accurate diagnosis was achieved in 41 (97.6%) of 42 biopsies using the Monopty needle and in 45 (83.3%) of 54 biopsies using the Temno needle (p=0.04). Biopsy-induced complications were pneumothorax, haemoptysis and haemothorax in 44.0%, 10.0% and 6.0% of biopsies, respectively, using the Monopty needle and in 48.3%, 8.3% and 3.3%, respectively, using the Temno needle. Conclusion There is a possibility that a fully automated biopsy needle such as the Monopty is more useful for CT scan-guided lung biopsy than semi-automated biopsy needles. PMID:21828150

  14. MO-F-CAMPUS-I-01: A System for Automatically Calculating Organ and Effective Dose for Fluoroscopically-Guided Procedures

    SciTech Connect

    Xiong, Z; Vijayan, S; Rana, V; Rudin, S; Bednarek, D

    2015-06-15

    Purpose: A system was developed that automatically calculates the organ and effective dose for individual fluoroscopically-guided procedures using a log of the clinical exposure parameters. Methods: We have previously developed a dose tracking system (DTS) to provide a real-time color-coded 3D- mapping of skin dose. This software produces a log file of all geometry and exposure parameters for every x-ray pulse during a procedure. The data in the log files is input into PCXMC, a Monte Carlo program that calculates organ and effective dose for projections and exposure parameters set by the user. We developed a MATLAB program to read data from the log files produced by the DTS and to automatically generate the definition files in the format used by PCXMC. The processing is done at the end of a procedure after all exposures are completed. Since there are thousands of exposure pulses with various parameters for fluoroscopy, DA and DSA and at various projections, the data for exposures with similar parameters is grouped prior to entry into PCXMC to reduce the number of Monte Carlo calculations that need to be performed. Results: The software developed automatically transfers data from the DTS log file to PCXMC and runs the program for each grouping of exposure pulses. When the dose from all exposure events are calculated, the doses for each organ and all effective doses are summed to obtain procedure totals. For a complicated interventional procedure, the calculations can be completed on a PC without manual intervention in less than 30 minutes depending on the level of data grouping. Conclusion: This system allows organ dose to be calculated for individual procedures for every patient without tedious calculations or data entry so that estimates of stochastic risk can be obtained in addition to the deterministic risk estimate provided by the DTS. Partial support from NIH grant R01EB002873 and Toshiba Medical Systems Corp.

  15. Incorporating corrections for the head-holder and compensation filter when calculating skin dose during fluoroscopically guided interventions

    NASA Astrophysics Data System (ADS)

    Vijayan, Sarath; Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2015-03-01

    The skin dose tracking system (DTS) that we developed provides a color-coded illustration of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures for immediate feedback to the interventionist. To improve the accuracy of dose calculation, we now have incorporated two additional important corrections (1) for the holder used to immobilize the head in neuro-interventions and (2) for the built-in compensation filters used for beam equalization. Both devices have been modeled in the DTS software so that beam intensity corrections can be made. The head-holder is modeled as two concentric hemi-cylindrical surfaces such that the path length between those surfaces can be determined for rays to individual points on the skin surface. The head-holder on the imaging system we used was measured to attenuate the primary x-rays by 10 to 20% for normal incidence, and up to 40% at non-normal incidence. In addition, three compensation filters of different shape are built into the collimator apparatus and were measured to have attenuation factors ranging from 58% to 99%, depending on kVp and beam filtration. These filters can translate and rotate in the beam and their motion is tracked by the DTS using the digital signal from the imaging system. When it is determined that a ray to a given point on the skin passes through the compensation filter, the appropriate attenuation correction is applied. These corrections have been successfully incorporated in the DTS software to provide a more accurate determination of skin dose.

  16. Region-of-interest micro-angiographic fluoroscope detector used in aneurysm and artery stenosis diagnoses and treatment

    NASA Astrophysics Data System (ADS)

    Wang, Weiyuan; Ionita, Ciprian; Huang, Ying; Qu, Bin; Panse, Ashish; Jain, Amit; Bednarek, Daniel R.; Rudin, Stephen

    2012-03-01

    Due to the need for high-resolution angiographic and interventional vascular imaging, a Micro-Angiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer, which was attached to the C-arm of a clinical angiographic unit at a local hospital. The MAF detector provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 μm thick CsI phosphor, a dual stage micro-channel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 μm effective square pixels with 12 bit depth. The changer allows the MAF region-of-interest (ROI) detector to be inserted in front of the Image Intensifier (II) when higher resolution is needed during angiographic or interventional vascular imaging procedures, e.g. endovascular stent deployment. The CAPIDS was developed and implemented using Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF including: fluoroscopy, roadmapping, radiography, and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular image-guided interventions (EIGI) for diagnosing and treating artery stenoses and aneurysms using self-expanding endovascular stents and coils in fifteen patient cases, which have demonstrated benefits of using the ROI detector. The visualization of the fine detail of the endovascular devices and the vessels generally gave the clinicians confidence on performing neurovascular interventions and in some instances contributed to improved interventions.

  17. Verification of the performance accuracy of a real-time skin-dose tracking system for interventional fluoroscopic procedures

    NASA Astrophysics Data System (ADS)

    Bednarek, Daniel R.; Barbarits, Jeffery; Rana, Vijay K.; Nagaraja, Srikanta P.; Josan, Madhur S.; Rudin, Stephen

    2011-03-01

    A tracking system has been developed to provide real-time feedback of skin dose and dose rate during interventional fluoroscopic procedures. The dose tracking system (DTS) calculates the radiation dose rate to the patient's skin using the exposure technique parameters and exposure geometry obtained from the x-ray imaging system digital network (Toshiba Infinix) and presents the cumulative results in a color mapping on a 3D graphic of the patient. We performed a number of tests to verify the accuracy of the dose representation of this system. These tests included comparison of system-calculated dose-rate values with ionization-chamber (6 cc PTW) measured values with change in kVp, beam filter, field size, source-to-skin distance and beam angulation. To simulate a cardiac catheterization procedure, the ionization chamber was also placed at various positions on an Alderson Rando torso phantom and the dose agreement compared for a range of projection angles with the heart at isocenter. To assess the accuracy of the dose distribution representation, Gafchromic film (XR-RV3, ISP) was exposed with the beam at different locations. The DTS and film distributions were compared and excellent visual agreement was obtained within the cm-sized surface elements used for the patient graphic. The dose (rate) values agreed within about 10% for the range of variables tested. Correction factors could be applied to obtain even closer agreement since the variable values are known in real-time. The DTS provides skin-dose values and dose mapping with sufficient accuracy for use in monitoring diagnostic and interventional x-ray procedures.

  18. Large or small bore, push or pull: a comparison of three classes of percutaneous fluoroscopic gastrostomy catheters.

    PubMed

    Kuo, Yuo-Chen; Shlansky-Goldberg, Richard D; Mondschein, Jeffrey I; Stavropoulos, S William; Patel, Aalpen A; Solomon, Jeffrey A; Soulen, Michael C; Kwak, Andrew; Itkin, Maxim; Chittams, Jesse L; Trerotola, Scott O

    2008-04-01

    To compare the tube performance and complication rates of small-bore, large-bore push-type, and large-bore pull-type gastrostomy catheters. A total of 160 patients (74 men, 86 women; mean age, 66.9 years, range, 22-95 y) underwent percutaneous fluoroscopic gastrostomy placement between January 2004 and March 2006. Choice of catheter was based on the preference of the attending radiologist. Data were collected retrospectively with institutional review board approval. Radiology reports provided information on the catheter, indication for gastrostomy, technical success, and immediate outcome. Chart review provided data on medical history, postprocedural complications, progress to feeding goal, and clinical outcomes. Statistical analysis was performed to compare the three classes of gastrostomy catheters. All 160 catheters were placed successfully. Patients who received small-bore catheters (14 F; n = 88) had significantly more tube complications (17% vs 5.6%) and were less likely to meet their feeding goal (P = .035) compared with patients with large-bore catheters (20 F; n = 72). No difference was observed in terms of major or minor complications. Large-bore push-type (n = 14) and pull-type catheters (n = 58) were similar in terms of complication rates. Patients who received large-bore push-type catheters achieved their feeding goals in significantly less time than those with large-bore pull-type catheters (average, 3.8 days vs 6.0 days; P = .04). Patients who received small-bore gastrostomy catheters are significantly more prone to tube dysfunction. Large-bore catheters should be preferentially used, with push-type catheters performing better with regard to the time to achieve feeding goal.

  19. Changes in length of the plantar aponeurosis during the stance phase of gait--an in vivo dynamic fluoroscopic study.

    PubMed

    Fessel, G; Jacob, H A C; Wyss, Ch; Mittlmeier, Th; Müller-Gerbl, M; Büttner, A

    2014-12-01

    In locomotion, ligaments and muscles have been recognized to support the arch of the foot. However, it remains unclear to what extent the passive and active structures of the lower extremity support the longitudinal arch of the foot during walking. In this study, the mechanical function of the plantar aponeurosis (PA) is investigated by elongation measurements in vivo during the stance phase of gait, in combination with measurements of the mechanical properties of the PA in vitro. Fluoroscopy was used to measure the dynamic changes in PA length and the angular motion of the metatarsophalangeal joint of the first ray, measured during the stance phase (StPh) in 11 feet. Simultaneously, ground forces were measured. Additionally, four cadaver feet delivered topographic information relating to the PA, and three autopsy specimens of PA served to determine the in vitro mechanical properties of PA. The present study revealed a non-significant peak average PA shortening of 0.48% at about 32.5% StPh, followed by a significant average peak elongation of 3.6% at 77.5% StPh. This average peak elongation of 3.6% corresponds to a force of 292N, as estimated by mechanical testing of the autopsy PA specimens. Considering the maximum peak elongation measured in one volunteer of 4.8% at 76% StPh, a peak PA load of 488N might be expected. Hence, with an average body weight of 751N, as allocated to the 11 investigated feet, this maximum peak force would correspond to about 0.65×body weight. As far as we are aware, this is the first report on a dynamic fluoroscopic study of the PA in gait with an appreciable number of feet (11 feet). In conclusion, muscles contribute to support of the longitudinal arch of the foot and can possibly relax the PA during gait. The 'windlass effect' for support of the arch in this context is therefore questionable.

  20. Reducing patient radiation dosage during pediatric SVT ablations using an "ALARA" radiation reduction protocol in the modern fluoroscopic era.

    PubMed

    Gellis, Laura A; Ceresnak, Scott R; Gates, Gregory J; Nappo, Lynn; Pass, Robert H

    2013-06-01

    Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA--As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m(2) (range 0.72- 1.94 m(2)). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym(2) (range 38.2-3,172 uGym(2)); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications. An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  1. Therapeutics development for triplet repeat expansion diseases.

    PubMed

    Di Prospero, Nicholas A; Fischbeck, Kenneth H

    2005-10-01

    The underlying genetic mutations for many inherited neurodegenerative disorders have been identified in recent years. One frequent type of mutation is trinucleotide repeat expansion. Depending on the location of the repeat expansion, the mutation might result in a loss of function of the disease gene, a toxic gain of function or both. Disease gene identification has led to the development of model systems for investigating disease mechanisms and evaluating treatments. Examination of experimental findings reveals similarities in disease mechanisms as well as possibilities for treatment.

  2. RepeatsDB: a database of tandem repeat protein structures

    PubMed Central

    Di Domenico, Tomás; Potenza, Emilio; Walsh, Ian; Gonzalo Parra, R.; Giollo, Manuel; Minervini, Giovanni; Piovesan, Damiano; Ihsan, Awais; Ferrari, Carlo; Kajava, Andrey V.; Tosatto, Silvio C.E.

    2014-01-01

    RepeatsDB (http://repeatsdb.bio.unipd.it/) is a database of annotated tandem repeat protein structures. Tandem repeats pose a difficult problem for the analysis of protein structures, as the underlying sequence can be highly degenerate. Several repeat types haven been studied over the years, but their annotation was done in a case-by-case basis, thus making large-scale analysis difficult. We developed RepeatsDB to fill this gap. Using state-of-the-art repeat detection methods and manual curation, we systematically annotated the Protein Data Bank, predicting 10 745 repeat structures. In all, 2797 structures were classified according to a recently proposed classification schema, which was expanded to accommodate new findings. In addition, detailed annotations were performed in a subset of 321 proteins. These annotations feature information on start and end positions for the repeat regions and units. RepeatsDB is an ongoing effort to systematically classify and annotate structural protein repeats in a consistent way. It provides users with the possibility to access and download high-quality datasets either interactively or programmatically through web services. PMID:24311564

  3. Some characteristics of repeated sickness absence

    PubMed Central

    Ferguson, David

    1972-01-01

    Ferguson, D. (1972).Brit. J. industr. Med.,29, 420-431. Some characteristics of repeated sickness absence. Several studies have shown that frequency of absence attributed to sickness is not distributed randomly but tends to follow the negative binomial distribution, and this has been taken to support the concept of `proneness' to such absence. Thus, the distribution of sickness absence resembles that of minor injury at work demonstrated over 50 years ago. Because the investigation of proneness to absence does not appear to have been reported by others in Australia, the opportunity was taken, during a wider study of health among telegraphists in a large communications undertaking, to analyse some characteristics of repeated sickness absence. The records of medically certified and uncertified sickness absence of all 769 telegraphists continuously employed in all State capitals over a two-and-a-half-year period were compared with those of 411 clerks and 415 mechanics and, in Sydney, 380 mail sorters and 80 of their supervisors. All telegraphists in Sydney, Melbourne, and Brisbane, and all mail sorters in Sydney, who were available and willing were later medically examined. From their absence pattern repeaters (employees who had had eight or more certified absences in two and a half years) were separated into three types based on a presumptive origin in chance, recurrent disease and symptomatic non-specific disorder. The observed distribution of individual frequency of certified absence over the full two-and-a-half-year period of study followed that expected from the univariate negative binomial, using maximum likelihood estimators, rather than the poisson distribution, in three of the four occupational groups in Sydney. Limited correlational and bivariate analysis supported the interpretation of proneness ascribed to the univariate fit. In the two groups studied, frequency of uncertified absence could not be fitted by the negative binomial, although the numbers of

  4. SU-E-I-42: Normalized Embryo/fetus Doses for Fluoroscopically Guided Pacemaker Implantation Procedures Calculated Using a Monte Carlo Technique

    SciTech Connect

    Damilakis, J; Stratakis, J; Solomou, G

    2014-06-01

    Purpose: It is well known that pacemaker implantation is sometimes needed in pregnant patients with symptomatic bradycardia. To our knowledge, there is no reported experience regarding radiation doses to the unborn child resulting from fluoroscopy during pacemaker implantation. The purpose of the current study was to develop a method for estimating embryo/fetus dose from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all trimesters of gestation. Methods: The Monte Carlo N-Particle (MCNP) radiation transport code was employed in this study. Three mathematical anthropomorphic phantoms representing the average pregnant patient at the first, second and third trimesters of gestation were generated using Bodybuilder software (White Rock science, White Rock, NM). The normalized embryo/fetus dose from the posteroanterior (PA), the 30° left-anterior oblique (LAO) and the 30° right-anterior oblique (RAO) projections were calculated for a wide range of kVp (50–120 kVp) and total filtration values (2.5–9.0 mm Al). Results: The results consist of radiation doses normalized to a) entrance skin dose (ESD) and b) dose area product (DAP) so that the dose to the unborn child from any fluoroscopic technique and x-ray device used can be calculated. ESD normalized doses ranged from 0.008 (PA, first trimester) to 2.519 μGy/mGy (RAO, third trimester). DAP normalized doses ranged from 0.051 (PA, first trimester) to 12.852 μGy/Gycm2 (RAO, third trimester). Conclusion: Embryo/fetus doses from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all stages of gestation can be estimated using the method developed in this study. This study was supported by the Greek Ministry of Education and Religious Affairs, General Secretariat for Research and Technology, Operational Program ‘Education and Lifelong Learning’, ARISTIA (Research project: CONCERT)

  5. Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter.

    PubMed

    Blockhaus, Christian; Schmidt, Jan; Kurt, Muhammed; Clasen, Lukas; Brinkmeyer, Christoph; Katsianos, Efstratios; Müller, Patrick; Gerguri, Shqipe; Kelm, Malte; Shin, Dong-In; Makimoto, Hisaki

    2016-05-25

    Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with atrial fibrillation (AF). With increasing numbers of PVI procedures, demand arises to reduce the cumulative fluoroscopic radiation exposure for both the physician and the patient. New technologies are emerging to address this issue. Here, we report our first experiences with a new fluoroscopy integrating technology in addition to a current 3D-mapping system. The new fluoroscopy integrating system (FIS) with 3D-mapping was used prospectively in 15 patients with AF. Control PVI cases (n = 37) were collected retrospectively as a complete series. Total procedure time (skin to skin), fluoroscopic time, and dose-area-product (DAP) data were analyzed. All PVI procedures were performed by one experienced physician using a commercially available circular multipolar irrigated ablation catheter. All PVI procedures were successfully undertaken without major complications. Baseline characteristics of the two groups showed no significant differences. In the group using the FIS, the fluoroscopic time and DAP were significantly reduced from 571 ± 187 seconds versus 1011 ± 527 seconds (P = 0.0029) and 4342 ± 2073 cGycm(2) versus 6208 ± 3314 cGycm(2) (P = 0.049), respectively. Mean procedure time was not significantly affected and was 114 ± 31 minutes versus 104 ± 24 minutes (P = 0.23) by the FIS.The use of the new FIS with the current 3D-mapping system enables a significant reduction of the total fluoroscopy time and DAP compared to the previous combination of 3D-mapping system plus normal fluoroscopy during PVI utilizing a circular multipolar irrigated ablation catheter. However, the concomitant total procedure time is not affected. Thus, the new system reduces the radiation exposure for both the physicians and patients.

  6. Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions

    PubMed Central

    Yoshimatsu, R; Miura, H; Yamada, K; Takahata, A; Matsumoto, T; Hasebe, T

    2013-01-01

    Objective: The goal of our study was to evaluate the diagnostic performance of percutaneous lung biopsy under CT-fluoroscopic guidance for ground-glass opacity (GGO) lesions. Methods: 85 percutaneous needle lung biopsies were performed in 73 patients. Specimens were obtained by core biopsy utilising an automated cutting needle and were evaluated histologically. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Results: Rates of adequate specimens obtained and of precise diagnosis by needle biopsy were 92.9% (79/85) and 90.6% (77/85) of evaluated lung lesions, respectively. Precise diagnosis was achieved in 87.1% (27/31) of lesions ≤10 mm in diameter, 90.0% (36/40) of lesions >10 mm to ≤20 mm and 100.0% (14/14) of lesions >20 mm. Precision in diagnosing GGO lesions according to the GGO component was 73.9% (17/23) for pure GGO lesions and 96.8% (60/62) for part-solid GGO lesions. Obtaining a precise diagnosis did not differ significantly according to the lesion size (p=0.3840), but differences were significant according to the GGO component (p=0.0047). Malignancy was accurately diagnosed in 35 of 36 malignant lesions for which surgery was later performed. The specific cell type determined from specimens obtained by needle biopsy was exactly the same as the final histological diagnosis obtained after surgery in 20 lesions. Conclusion: Tissue-core lung biopsy under CT-fluoroscopic guidance for a GGO lesion provides a high degree of diagnostic accuracy but is less reliable for determining the specific cell type. Advances in knowledge: Percutaneous lung biopsy under CT-fluoroscopic guidance for GGO is useful in differentiating malignancy. PMID:23385998

  7. Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children.

    PubMed

    Shah, Sweta; Desouches, Stephane L; Lowe, Lisa H; Kasraie, Nima; Reading, Brenton

    2015-02-01

    Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training. The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies. A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test. During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively. Implementation of a competency check-off for radiology resident trainees can reduce average radiation

  8. A small-signal approach to temporal modulation transfer functions with exposure-rate dependence and its application to fluoroscopic detective quantum efficiency.

    PubMed

    Friedman, S N; Cunningham, I A

    2009-08-01

    The detective quantum efficiency (DQE) is a metric widely used in radiography to quantify system performance and as a surrogate measure of patient "dose efficiency." It has been applied previously to fluoroscopic systems with the introduction of a temporal correction factor. Calculation of this correction factor relies on measurements of the temporal modulation transfer function (MTF). However, the temporal MTF is often exposure-rate dependent, violating a necessary Fourier linearity requirement. The authors show that a Fourier analysis is appropriate for fluoroscopic systems if a "small-signal" approach is used. Using a semitransparent edge, a lag-corrected DQE is described and measured for an x-ray image intensifier-based fluoroscopic system under continuous (non-pulsed) exposure conditions. It was found that results were equivalent for both rising and falling-edge profiles independent of edge attenuation when effective attenuation was in the range of 0.1-0.6. This suggests that this range is appropriate for measuring the small-signal temporal MTF. In general, lag was greatest at low exposure rates. It was also found that results obtained using a falling-edge profile with a radiopaque edge were equivalent to the small-signal results for the test system. If this result is found to be true generally, it removes the need for the small-signal approach. Lag-corrected DQE values were validated by comparison with radiographic DQE values obtained using very long exposures under the same conditions. Lag was observed to inflate DQE measurements by up to 50% when ignored.

  9. Repeated episodes of endosulfan poisoning.

    PubMed

    Dewan, Aruna; Bhatnagar, Vijay K; Mathur, Murli L; Chakma, Tapas; Kashyap, Rekha; Sadhu, Harsiddha G; Sinha, Sukesh N; Saiyed, Habibullah N

    2004-01-01

    A number of families in a rural area of Jabalpur District (Madhya Pradesh), India, were affected by repeated episodes of convulsive illness over a period of three weeks. The aim of this investigation was to determine the cause of the illness. The investigation included a house-to-house survey, interviews of affected families, discussions with treating physicians, and examination of hospital records. Endosulfan poisoning was suspected as many villagers were using empty pesticide containers for food storage. To confirm this, our team collected blood and food samples, which were transported to the laboratory and analyzed with GC-ECD. Thirty-six persons of all age groups had illness of varying severity over a period of three weeks. In the first week, due to superstitions and lack of treatment, three children died. In the second week, symptomatic treatment of affected persons in a district hospital led to recovery but recurrence of convulsive episodes occurred after the return home. In the third week, 10 people were again hospitalized in a teaching hospital. Investigations carried out in this hospital ruled out infective etiology but no facilities were available for chemical analysis. All persons responded to symptomatic treatment. The blood and food samples analyzed by our team showed presence of endosulfan, which was confirmed by GCMS. One of the food items (Laddu) prepared from wheat flour was found to contain 676 ppm of alpha-endosulfan. Contamination of wheat grains or flour with endosulfan and its consumption over a period of time was the most likely cause of repeated episodes of convulsions, but the exact reason for this contamination could not be determined. This report highlights the unsafe disposal of pesticide containers by illiterate farm workers, superstitions leading to delay in treatment, and susceptibility of children to endosulfan.

  10. Learning in repeated visual search

    PubMed Central

    Hout, Michael C.; Goldinger, Stephen D.

    2014-01-01

    Visual search (e.g., finding a specific object in an array of other objects) is performed most effectively when people are able to ignore distracting nontargets. In repeated search, however, incidental learning of object identities may facilitate performance. In three experiments, with over 1,100 participants, we examined the extent to which search could be facilitated by object memory and by memory for spatial layouts. Participants searched for new targets (real-world, nameable objects) embedded among repeated distractors. To make the task more challenging, some participants performed search for multiple targets, increasing demands on visual working memory (WM). Following search, memory for search distractors was assessed using a surprise two-alternative forced choice recognition memory test with semantically matched foils. Search performance was facilitated by distractor object learning and by spatial memory; it was most robust when object identity was consistently tied to spatial locations and weakest (or absent) when object identities were inconsistent across trials. Incidental memory for distractors was better among participants who searched under high WM load, relative to low WM load. These results were observed when visual search included exhaustive-search trials (Experiment 1) or when all trials were self-terminating (Experiment 2). In Experiment 3, stimulus exposure was equated across WM load groups by presenting objects in a single-object stream; recognition accuracy was similar to that in Experiments 1 and 2. Together, the results suggest that people incidentally generate memory for nontarget objects encountered during search and that such memory can facilitate search performance. PMID:20601709

  11. Influence of Flat-Panel Fluoroscopic Equipment Variables on Cardiac Radiation Doses

    SciTech Connect

    Nickoloff, Edward L. Lu Zhengfeng; Dutta, Ajoy; So, James; Balter, Stephen; Moses, Jeffrey

    2007-04-15

    Purpose. To assess the influence of physician-selectable equipment variables on the potential radiation dose reductions during cardiac catheterization examinations using modern imaging equipment. Materials. A modern bi-plane angiography unit with flat-panel image receptors was used. Patients were simulated with 15-30 cm of acrylic plastic. The variables studied were: patient thickness, fluoroscopy pulse rates, record mode frame rates, image receptor field-of-view (FoV), automatic dose control (ADC) mode, SID/SSD geometry setting, automatic collimation, automatic positioning, and others. Results. Patient radiation doses double for every additional 3.5-4.5 cm of soft tissue. The dose is directly related to the imaging frame rate; a decrease from 30 pps to 15 pps reduces the dose by about 50%. The dose is related to [(FoV){sup -N}] where 2.0 < N < 3.0. Suboptimal positioning of the patient can nearly double the dose. The ADC system provides three selections that can vary the radiation level by 50%. For pediatric studies (2-5 years old), the selection of equipment variables can result in entrance radiation doses that range between 6 and 60 cGy for diagnostic cases and between 15 and 140 cGy for interventional cases. For adult studies, the equipment variables can produce entrance radiation doses that range between 13 and 130 cGy for diagnostic cases and between 30 and 400 cGy for interventional cases. Conclusions. Overall dose reductions of 70-90% can be achieved with pediatric patients and about 90% with adult patients solely through optimal selection of equipment variables.

  12. Influence of flat-panel fluoroscopic equipment variables on cardiac radiation doses.

    PubMed

    Nickoloff, Edward L; Lu, Zheng Feng; Dutta, Ajoy; So, James; Balter, Stephen; Moses, Jeffrey

    2007-01-01

    To assess the influence of physician-selectable equipment variables on the potential radiation dose reductions during cardiac catheterization examinations using modern imaging equipment. A modern bi-plane angiography unit with flat-panel image receptors was used. Patients were simulated with 15-30 cm of acrylic plastic. The variables studied were: patient thickness, fluoroscopy pulse rates, record mode frame rates, image receptor field-of-view (FoV), automatic dose control (ADC) mode, SID/SSD geometry setting, automatic collimation, automatic positioning, and others. Patient radiation doses double for every additional 3.5-4.5 cm of soft tissue. The dose is directly related to the imaging frame rate; a decrease from 30 pps to 15 pps reduces the dose by about 50%. The dose is related to [(FoV)(-N )] where 2.0 < N < 3.0. Suboptimal positioning of the patient can nearly double the dose. The ADC system provides three selections that can vary the radiation level by 50%. For pediatric studies (2-5 years old), the selection of equipment variables can result in entrance radiation doses that range between 6 and 60 cGy for diagnostic cases and between 15 and 140 cGy for interventional cases. For adult studies, the equipment variables can produce entrance radiation doses that range between 13 and 130 cGy for diagnostic cases and between 30 and 400 cGy for interventional cases. Overall dose reductions of 70-90% can be achieved with pediatric patients and about 90% with adult patients solely through optimal selection of equipment variables.

  13. Repeat Pregnancy among Urban Adolescents: Sociodemographic, Family, and Health Factors.

    ERIC Educational Resources Information Center

    Coard, Stephanie Irby; Nitz, Katherine; Felice, Marianne E.

    2000-01-01

    Examines sociodemographic, family, and health factors associated with repeat pregnancy in a clinical sample of urban, first-time mothers. Results indicate that postpartum contraceptive method was associated with repeat pregnancy at year one; contraceptive use, maternal age, history of miscarriages, and postpartum contraceptive method were…

  14. Intrinsic unsharpness and approximate repeatability of quantum measurements

    NASA Astrophysics Data System (ADS)

    Carmeli, Claudio; Heinonen, Teiko; Toigo, Alessandro

    2007-02-01

    The intrinsic unsharpness of a quantum observable is studied by introducing the notion of resolution width. This quantification of accuracy is shown to be closely connected with the possibility of making approximately repeatable measurements. As a case study, the intrinsic unsharpness and approximate repeatability of position and momentum measurements are examined in detail.

  15. Preschool Children's Memory for Repeated Changes in the Lunch Routine.

    ERIC Educational Resources Information Center

    Krackow, Elisa

    An experiment examined the possibilities that: (1) repeated deviations in a routine event become fused into the general event representation (GER) for that event; and (2) when deviations go unreported, it is because they have been forgotten. Preschool children were interviewed to get their script reports before and after repeated deviations in the…

  16. Impact of Inclusion or Exclusion of Repeaters on Test Equating

    ERIC Educational Resources Information Center

    Puhan, Gautam

    2011-01-01

    This study examined the effect of including or excluding repeaters on the equating process and results. New forms of two tests were equated to their respective old forms using either all examinees or only the first timer examinees in the new form sample. Results showed that for both tests used in this study, including or excluding repeaters in the…

  17. History Never Repeats Itself

    ERIC Educational Resources Information Center

    Burawoy, Michael

    2009-01-01

    In his presidential address Jess Gilbert examines two democratic experiments of the United States Department of Agriculture (USDA) during the New Deal: first, county planning that coordinated federal programs through citizen committees, and second, land redistribution to landless southern farmers, including a small number of black sharecroppers…

  18. History Never Repeats Itself

    ERIC Educational Resources Information Center

    Burawoy, Michael

    2009-01-01

    In his presidential address Jess Gilbert examines two democratic experiments of the United States Department of Agriculture (USDA) during the New Deal: first, county planning that coordinated federal programs through citizen committees, and second, land redistribution to landless southern farmers, including a small number of black sharecroppers…

  19. In vivo kinematic study of the tarsal joints complex based on fluoroscopic 3D-2D registration technique.

    PubMed

    Chen Wang, M D; Geng, Xiang; Wang, Shaobai; Xin Ma, M D; Xu Wang, M D; Jiazhang Huang, M D; Chao Zhang, M D; Li Chen, M S; Yang, Junsheng; Wang, Kan

    2016-09-01

    The tarsal bones articulate with each other and demonstrate complicated kinematic characteristics. The in vivo motions of these tarsal joints during normal gait are still unclear. Seven healthy subjects were recruited and fourteen feet in total were tested in the current study. Three dimensional models of the tarsal bones were first created using CT scanning. Corresponding local 3D coordinate systems of each tarsal bone was subsequently established for 6DOF motion decompositions. The fluoroscopy system captured the lateral fluoroscopic images of the targeted tarsal region whilst the subject was walking. Seven key pose images during the stance phase were selected and 3D to 2D bone model registrations were performed on each image to determine joint positions. The 6DOF motions of each tarsal joint during gait were then obtained by connecting these positions together. The TNJ (talo-navicular joint) exhibited the largest ROMs (range of motion) on all rotational directions with 7.39±2.75°of dorsi/plantarflexion, 21.12±4.68°of inversion/eversion, and 16.11±4.44°of internal/external rotation. From heel strike to midstance, the TNJ, STJ (subtalar joint), and CCJ (calcaneao-cuboid joint) were associated with 5.97°, 5.04°, and 3.93°of dorsiflexion; 15.46°, 8.21°, and 5.82°of eversion; and 9.75°, 7.6°, and 4.99°of external rotation, respectively. Likewise, from midstance to heel off, the TNJ, STJ, and CCJ were associated with 6.39, 6.19°, and 4.47°of plantarflexion; 18.57°, 11.86°, and 6.32°of inversion and 13.95°, 9.66°, and 7.58°of internal rotation, respectively. In conclusion, among the tarsal joints, the TNJ exhibited the greatest rotational mobility. Synchronous and homodromous rotational motions were detected for TNJ, STJ, and CCJ during the stance phase.

  20. Simulation-based educational curriculum for fluoroscopically guided lumbar puncture improves operator confidence and reduces patient dose.

    PubMed

    Faulkner, Austin R; Bourgeois, Austin C; Bradley, Yong C; Hudson, Kathleen B; Heidel, R Eric; Pasciak, Alexander S

    2015-05-01

    Fluoroscopically guided lumbar puncture (FGLP) is a commonly performed procedure with increased success rates relative to bedside technique. However, FGLP also exposes both patient and staff to ionizing radiation. The purpose of this study was to determine if the use of a simulation-based FGLP training program using an original, inexpensive lumbar spine phantom could improve operator confidence and efficiency, while also reducing patient dose. A didactic and simulation-based FGLP curriculum was designed, including a 1-hour lecture and hands-on training with a lumbar spine phantom prototype developed at our institution. Six incoming post-graduate year 2 (PGY-2) radiology residents completed a short survey before taking the course, and each resident practiced 20 simulated FGLPs using the phantom before their first clinical procedure. Data from the 114 lumbar punctures (LPs) performed by the six trained residents (prospective cohort) were compared to data from 514 LPs performed by 17 residents who did not receive simulation-based training (retrospective cohort). Fluoroscopy time (FT), FGLP success rate, and indication were compared. There was a statistically significant reduction in average FT for the 114 procedures performed by the prospective study cohort compared to the 514 procedures performed by the retrospective cohort. This held true for all procedures in aggregate, LPs for myelography, and all procedures performed for a diagnostic indication. Aggregate FT for the prospective group (0.87 ± 0.68 minutes) was significantly lower compared to the retrospective group (1.09 ± 0.65 minutes) and resulted in a 25% reduction in average FT (P = .002). There was no statistically significant difference in the number of failed FGLPs between the two groups. Our simulation-based FGLP curriculum resulted in improved operator confidence and reduced FT. These changes suggest that resident procedure efficiency was improved, whereas patient dose was reduced. The FGLP training

  1. A Comparison of First Time and Repeat Rural DUI Offenders.

    PubMed

    Dickson, Megan F; Wasarhaley, Nesa E; Webster, J Matthew

    The purpose of the current study was to examine whether the differences found between first time and repeat rural DUI offenders were the same as those found previously in urban samples. A total of 118 rural DUI offenders were interviewed, approximately half (51.7%) of which were repeat offenders. Although demographic and mental health characteristics were similar across the two groups, repeat offenders reported more extensive substance use and criminal histories. Results suggest that the pattern of differences between rural first time and repeat DUI offenders may be different from the pattern found in prior urban-based studies. Treatment implications are discussed.

  2. A Comparison of First Time and Repeat Rural DUI Offenders

    PubMed Central

    Dickson, Megan F.; Wasarhaley, Nesa E.; Webster, J. Matthew

    2015-01-01

    The purpose of the current study was to examine whether the differences found between first time and repeat rural DUI offenders were the same as those found previously in urban samples. A total of 118 rural DUI offenders were interviewed, approximately half (51.7%) of which were repeat offenders. Although demographic and mental health characteristics were similar across the two groups, repeat offenders reported more extensive substance use and criminal histories. Results suggest that the pattern of differences between rural first time and repeat DUI offenders may be different from the pattern found in prior urban-based studies. Treatment implications are discussed. PMID:26225118

  3. Supplementation of bone marrow aspirate-derived platelet-rich plasma for treating radiation-induced ulcer after cardiac fluoroscopic procedures: A preliminary report

    PubMed Central

    Nishimoto, Soh; Fukuda, Kenji; Kawai, Kenichiro; Fujiwara, Toshihiro; Tsumano, Tomoko; Fujita, Kazutoshi; Kakibuchi, Masao

    2012-01-01

    Background: The frequency of encountering radiodermatitis caused by X-ray fluoroscopic procedures for ischaemic heart disease is increasing. In severe cases, devastating ulcers with pain, for which conservative therapy is ineffective, emerge. Radiation-induced ulcers are notorious for being difficult to treat. Simple skin grafting often fails because of the poor state of the wound bed. A vascularized flap is a very good option. However, the non-adherence of the well-vascularized flap with the irradiated wound bed is frequently experienced. Aim: To ameliorate the irradiated wound bed, bone marrow-derived platelet-rich plasma (bm-PRP) was delivered during the surgery. Materials and Methods: Four patients with severe cutaneous radiation injury accompanied by unbearable pain after multiple fluoroscopic procedures for ischaemic heart disease were treated. Wide excision of the lesion and coverage with a skin flap supplemented with bm-PRP injection was performed. Results: All patients obtained wound closure and were relieved from pain. No complication concerning the bone marrow aspiration and delivery of bm-PRP was observed. Conclusions: Supplementation of bm-PRP can be an option without major complications, time, and cost to improve the surgical outcome for irradiated wounds. PMID:22754164

  4. Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only.

    PubMed

    Greif, Martin; Lange, Philipp; Näbauer, Michael; Schwarz, Florian; Becker, Christoph; Schmitz, Christoph; Pohl, Tilmann; D'Anastasi, Melvin; Boekstegers, Peter; Massberg, Steffen; Kupatt, Christian

    2014-05-01

    To assess the feasibility of transcatheter aortic valve implantation (TAVI; Medtronic CoreValve and Edwards SAPIEN XT) under local anaesthesia with only mild analgesic medication and fluoroscopic guidance. 461 patients underwent TAVI under local anaesthesia with lidocaine. The procedure was performed successfully in 459 of the cases. All patients were also treated with piritramide, metoclopramide hydrochloride and 62 mg dimenhydrinate. Monitoring consisted of a six-electrode, virtual 12-lead ECG, pulse oximetry, and invasive arterial pressure measurement. There was no continuous surveillance by an anaesthesiologist. There was no need for conversion to general anaesthesia except in four patients who required cardiopulmonary resuscitation. Conscious sedation with intravenous administration of midazolam for agitation or inotropic medication for prolonged hypotension was necessary in only seven of the 461 patients. The combined safety end point according to the Valve Academic Research Consortium consensus document was reached in 12.6%. Our results show that TAVI performed under local anaesthesia with only mild analgesic medication and under fluoroscopic guidance is feasible, with good outcome comparable to published data.

  5. Percutaneous drainage of psoas and iliopsoas muscle abscesses with a one-step technique under real-time computed tomography fluoroscopic guidance.

    PubMed

    Kinoshita, Mitsuhiro; Takao, Shoichiro; Takechi, Katsuya; Takeda, Yoshitsugu; Miyamoto, Kanako; Yamanaka, Moriaki; Akagawa, Yoko; Iwamoto, Seiji; Osaki, Kyosuke; Tani, Hayato; Ohnishi, Norio; Shirono, Ryozo

    2016-01-01

    To evaluate the utility and safety of drainage catheter installation for psoas/iliopsoas muscle abscesses using a one-step technique under the guidance of real-time computed tomography (CT) fluoroscopy. Ten psoas or iliopsoas muscle abscesses in 7 patients that were treated with percutaneous drainage were included in this study. All drainage procedures were carried out using a one-step technique under real-time CT fluoroscopic guidance. The drainage catheter insertion was performed successfully with the one-step technique in all lesions. Improvements in the patients' symptoms and blood test results were seen after the drainage procedure in all cases. In addition, postoperative CT scans demonstrated that the abscesses had reduced in size or disappeared in all but one patient, who was transferred to another institution while the drainage catheter was still in place. No major complications were seen in any case. The one-step procedure is simple to perform. The percutaneous drainage of psoas or iliopsoas muscle abscesses with the one-step technique under real-time CT fluoroscopic guidance is accurate and safe. Moreover, compared with the two-step technique the one-step procedure results in a shorter drainage procedure and exposes the patient and operator to lower amounts of radiation. J. Med. Invest. 63: 323-327, August, 2016.

  6. Survey of simple sequence repeats in woodland strawberry (Fragaria vesca).

    PubMed

    Guan, L; Huang, J F; Feng, G Q; Wang, X W; Wang, Y; Chen, B Y; Qiao, Y S

    2013-07-30

    The use of simple sequence repeats (SSRs), or microsatellites, as genetic markers has become popular due to their abundance and variation in length among individuals. In this study, we investigated linkage groups (LGs) in the woodland strawberry (Fragaria vesca) and demonstrated variation in the abundances, densities, and relative densities of mononucleotide, dinucleotide, and trinucleotide repeats. Mononucleotide, dinucleotide, and trinucleotide repeats were more common than longer repeats in all LGs examined. Perfect SSRs were the predominant SSR type found and their abundance was extremely stable among LGs and chloroplasts. Abundances of mononucleotide, dinucleotide, and trinucleotide repeats were positively correlated with LG size, whereas those of tetranucleotide and hexanucleotide SSRs were not. Generally, in each LG, the abundance, relative abundance, relative density, and the proportion of each unique SSR all declined rapidly as the repeated unit increased. Furthermore, the lengths and frequencies of SSRs varied among different LGs.

  7. Technique of, and complications attributable to, repeated hyperosmotic blood-brain barrier disruption in dogs.

    PubMed

    Culver, B; Inzana, K; Jones, J; Troy, G; Kroll, R; Culver, B; Jortner, B

    1998-11-01

    To design a repeatable technique for reversible, hyperosmotic blood-brain barrier disruption (BBBD) in dogs and evaluate clinical effects of multiple BBBD. 10 healthy adult dogs. Using fluoroscopic guidance, an arterial catheter was directed into the internal carotid artery via the femoral artery of 10 dogs. Blood-brain barrier disruption was achieved in 5 dogs, using intracarotid infusion of mannitol. Five control dogs received only saline solution. After recovery, dogs were monitored for clinical signs of disease before a second, nonsurvival procedure was performed 2 to 3 weeks later. BBBD was estimated, using computed tomographic (CT) densitometry values, as well as Evan's blue dye staining on necropsy specimens. Seven dogs completed the entire study. Two treatment dogs were lost after the first infusion because of deteriorating neurologic function attributed to CNS edema and increased intracranial pressure. One control dog was lost because of vessel wall damage during catheterization. The remaining dogs had only transient neurologic, ocular, and vasculature injuries. Successful BBBD was documented in all treated dogs by use of CT and Evan's blue dye evaluation. Repeated catheterization of the internal carotid artery and disruption of the blood- brain barrier is possible in dogs. Refinement of this technique would be useful not only for improved delivery of chemotherapeutic agents in patients with brain tumors, but also would allow further investigation of new treatments involving genetically engineered retroviruses and monoclonal antibodies.

  8. Nifty Nines and Repeating Decimals

    ERIC Educational Resources Information Center

    Brown, Scott A.

    2016-01-01

    The traditional technique for converting repeating decimals to common fractions can be found in nearly every algebra textbook that has been published, as well as in many precalculus texts. However, students generally encounter repeating decimal numerals earlier than high school when they study rational numbers in prealgebra classes. Therefore, how…

  9. Nifty Nines and Repeating Decimals

    ERIC Educational Resources Information Center

    Brown, Scott A.

    2016-01-01

    The traditional technique for converting repeating decimals to common fractions can be found in nearly every algebra textbook that has been published, as well as in many precalculus texts. However, students generally encounter repeating decimal numerals earlier than high school when they study rational numbers in prealgebra classes. Therefore, how…

  10. Repeated Prescribed Burning in Aspen

    Treesearch

    Donald A. Perala

    1974-01-01

    Infrequent burning weather, low flammability of the aspen-hardwood association, and prolific sprouting and seeding of shrubs and hardwoods made repeated dormant season burning a poor tool to convert good site aspen to conifers. Repeat fall burns for wildlife habitat maintenance is workable if species composition changes are not important.

  11. All-photonic quantum repeaters

    NASA Astrophysics Data System (ADS)

    Azuma, Koji; Tamaki, Kiyoshi; Lo, Hoi-Kwong

    2015-04-01

    Quantum communication holds promise for unconditionally secure transmission of secret messages and faithful transfer of unknown quantum states. Photons appear to be the medium of choice for quantum communication. Owing to photon losses, robust quantum communication over long lossy channels requires quantum repeaters. It is widely believed that a necessary and highly demanding requirement for quantum repeaters is the existence of matter quantum memories. Here we show that such a requirement is, in fact, unnecessary by introducing the concept of all-photonic quantum repeaters based on flying qubits. In particular, we present a protocol based on photonic cluster-state machine guns and a loss-tolerant measurement equipped with local high-speed active feedforwards. We show that, with such all-photonic quantum repeaters, the communication efficiency scales polynomially with the channel distance. Our result paves a new route towards quantum repeaters with efficient single-photon sources rather than matter quantum memories.

  12. All-photonic quantum repeaters

    PubMed Central

    Azuma, Koji; Tamaki, Kiyoshi; Lo, Hoi-Kwong

    2015-01-01

    Quantum communication holds promise for unconditionally secure transmission of secret messages and faithful transfer of unknown quantum states. Photons appear to be the medium of choice for quantum communication. Owing to photon losses, robust quantum communication over long lossy channels requires quantum repeaters. It is widely believed that a necessary and highly demanding requirement for quantum repeaters is the existence of matter quantum memories. Here we show that such a requirement is, in fact, unnecessary by introducing the concept of all-photonic quantum repeaters based on flying qubits. In particular, we present a protocol based on photonic cluster-state machine guns and a loss-tolerant measurement equipped with local high-speed active feedforwards. We show that, with such all-photonic quantum repeaters, the communication efficiency scales polynomially with the channel distance. Our result paves a new route towards quantum repeaters with efficient single-photon sources rather than matter quantum memories. PMID:25873153

  13. All-photonic quantum repeaters.

    PubMed

    Azuma, Koji; Tamaki, Kiyoshi; Lo, Hoi-Kwong

    2015-04-15

    Quantum communication holds promise for unconditionally secure transmission of secret messages and faithful transfer of unknown quantum states. Photons appear to be the medium of choice for quantum communication. Owing to photon losses, robust quantum communication over long lossy channels requires quantum repeaters. It is widely believed that a necessary and highly demanding requirement for quantum repeaters is the existence of matter quantum memories. Here we show that such a requirement is, in fact, unnecessary by introducing the concept of all-photonic quantum repeaters based on flying qubits. In particular, we present a protocol based on photonic cluster-state machine guns and a loss-tolerant measurement equipped with local high-speed active feedforwards. We show that, with such all-photonic quantum repeaters, the communication efficiency scales polynomially with the channel distance. Our result paves a new route towards quantum repeaters with efficient single-photon sources rather than matter quantum memories.

  14. Triggering of repeating earthquakes in central California

    USGS Publications Warehouse

    Wu, Chunquan; Gomberg, Joan; Ben-Naim, Eli; Johnson, Paul

    2014-01-01

    Dynamic stresses carried by transient seismic waves have been found capable of triggering earthquakes instantly in various tectonic settings. Delayed triggering may be even more common, but the mechanisms are not well understood. Catalogs of repeating earthquakes, earthquakes that recur repeatedly at the same location, provide ideal data sets to test the effects of transient dynamic perturbations on the timing of earthquake occurrence. Here we employ a catalog of 165 families containing ~2500 total repeating earthquakes to test whether dynamic perturbations from local, regional, and teleseismic earthquakes change recurrence intervals. The distance to the earthquake generating the perturbing waves is a proxy for the relative potential contributions of static and dynamic deformations, because static deformations decay more rapidly with distance. Clear changes followed the nearby 2004 Mw6 Parkfield earthquake, so we study only repeaters prior to its origin time. We apply a Monte Carlo approach to compare the observed number of shortened recurrence intervals following dynamic perturbations with the distribution of this number estimated for randomized perturbation times. We examine the comparison for a series of dynamic stress peak amplitude and distance thresholds. The results suggest a weak correlation between dynamic perturbations in excess of ~20 kPa and shortened recurrence intervals, for both nearby and remote perturbations.

  15. Repeat abortions in New York City, 2010.

    PubMed

    Toprani, Amita; Cadwell, Betsy L; Li, Wenhui; Sackoff, Judith; Greene, Carolyn; Begier, Elizabeth

    2015-06-01

    This study aims to describe factors associated with the number of past abortions obtained by New York City (NYC) abortion patients in 2010. We calculated rates of first and repeat abortion by age, race/ethnicity, and neighborhood-level poverty and the mean number of self-reported past abortions by age, race/ethnicity, neighborhood-level poverty, number of living children, education, payment method, marital status, and nativity. We used negative binomial regression to predict number of past abortions by patient characteristics. Of the 76,614 abortions reported for NYC residents in 2010, 57% were repeat abortions. Repeat abortions comprised >50% of total abortions among the majority of sociodemographic groups we examined. Overall, mean number of past abortions was 1.3. Mean number of past abortions was higher for women aged 30-34 years (1.77), women with ≥5 children (2.50), and black non-Hispanic women (1.52). After multivariable regression, age, race/ethnicity, and number of children were the strongest predictors of number of past abortions. This analysis demonstrates that, although socioeconomic disparities exist, all abortion patients are at high risk for repeat unintended pregnancy and abortion.

  16. Human adaptation to repeated cold immersions.

    PubMed Central

    Golden, F S; Tipton, M J

    1988-01-01

    1. The present investigation was designed to examine human adaptation to intermittent severe cold exposure and to assess the effect of exercise on any adaptation obtained. 2. Sixteen subjects were divided into two equal groups. Each subject performed ten head-out immersions; two into thermoneutral water which was then cooled until they shivered vigorously, and eight into water at 15 degrees C for 40 min. During the majority of the 15 degrees C immersions, one group (dynamic group) exercised whilst the other (static group) rested. 3. Results showed that both groups responded to repeated cold immersions with a reduction in their initial responses to cold. The time course of these reductions varied, however, between responses. 4. Only the static group developed a reduced metabolic response to prolonged resting immersion. 5. It is concluded that repeated resting exposure to cold was the more effective way of producing an adaptation. The performance of exercise during repeated exposure to cold prevented the development of an adaptive reduction in the metabolic response to cold during a subsequent resting immersion. In addition, many of the adaptations obtained during repeated resting exposure were overridden or masked during a subsequent exercising immersion. PMID:3411500

  17. Ear examination

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/003340.htm Ear examination To use the sharing features on this page, ... ear References King EF, Couch ME. History, physical examination, and the preoperative evaluation. In: Flint PW, Haughey ...

  18. Repeated suicide attempts.

    PubMed

    Mynatt, S

    2000-12-01

    Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.

  19. Feature-based respiratory motion tracking in native fluoroscopic sequences for dynamic roadmaps during minimally invasive procedures in the thorax and abdomen

    NASA Astrophysics Data System (ADS)

    Wagner, Martin G.; Laeseke, Paul F.; Schubert, Tilman; Slagowski, Jordan M.; Speidel, Michael A.; Mistretta, Charles A.

    2017-03-01

    Fluoroscopic image guidance for minimally invasive procedures in the thorax and abdomen suffers from respiratory and cardiac motion, which can cause severe subtraction artifacts and inaccurate image guidance. This work proposes novel techniques for respiratory motion tracking in native fluoroscopic images as well as a model based estimation of vessel deformation. This would allow compensation for respiratory motion during the procedure and therefore simplify the workflow for minimally invasive procedures such as liver embolization. The method first establishes dynamic motion models for both the contrast-enhanced vasculature and curvilinear background features based on a native (non-contrast) and a contrast-enhanced image sequence acquired prior to device manipulation, under free breathing conditions. The model of vascular motion is generated by applying the diffeomorphic demons algorithm to an automatic segmentation of the subtraction sequence. The model of curvilinear background features is based on feature tracking in the native sequence. The two models establish the relationship between the respiratory state, which is inferred from curvilinear background features, and the vascular morphology during that same respiratory state. During subsequent fluoroscopy, curvilinear feature detection is applied to determine the appropriate vessel mask to display. The result is a dynamic motioncompensated vessel mask superimposed on the fluoroscopic image. Quantitative evaluation of the proposed methods was performed using a digital 4D CT-phantom (XCAT), which provides realistic human anatomy including sophisticated respiratory and cardiac motion models. Four groups of datasets were generated, where different parameters (cycle length, maximum diaphragm motion and maximum chest expansion) were modified within each image sequence. Each group contains 4 datasets consisting of the initial native and contrast enhanced sequences as well as a sequence, where the respiratory motion is

  20. An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

    PubMed Central

    Neve, Leon; Orchard, John; Gibbs, Nathan; van Mechelen, Willem; Verhagen, Evert; Sesel, Ken; Burgess, Ian; Hines, Brett

    2010-01-01

    Background Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2). These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI) or computed tomography (CT), even though this treatment scenario has not been adequately studied for this last diagnosis. Objectives To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain. Study design Retrospective case series. Methods Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N. Results 153 patients were eligible for the study (Group D: 93/Group N: 60). Eventually 110 patients responded (Group D: 67/Group N: 43). Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the long term. A larger proportion however, indicated that the injection had certainly improved their symptoms in the short term, but noted that the effects were non-lasting (Group D: 28%/Group N: 30%). Two patients were certain the injections had actually worsened their symptoms. No significant differences in characteristics and outcomes between Group D and Group N were noted. Conclusions Outcomes of this study suggest fluoroscopically

  1. Repeat Lumbar Punctures in Infants with Meningitis in the Neonatal Intensive Care Unit

    PubMed Central

    Greenberg, Rachel G.; Benjamin, Daniel K.; Cohen-Wolkowiez, Michael; Clark, Reese H.; Cotten, C. Michael; Laughon, Matthew; Smith, P. Brian

    2010-01-01

    Objective The purpose of this study is to examine the results of repeat lumbar puncture in infants with initial positive cerebrospinal fluid (CSF) cultures in order to determine the clinical characteristics and outcomes of infants with repeat positive cultures. Study Design Cohort study of infants with an initial positive CSF culture undergoing repeat lumbar puncture between 1997 and 2004 at 150 neonatal intensive care units managed by the Pediatrix Medical group. We compared the clinical outcomes of infants with repeat positive cultures and infants with repeat negative cultures. Result We identified 118 infants with repeat CSF cultures. Of these, 26 infants had repeat positive cultures. A higher proportion with repeat positive cultures died compared to those with repeat negative cultures, 6/23 (26%) vs. 6/81 (7%), respectively (p=0.02). Conclusion Among infants with a positive CSF culture, a repeat positive CSF culture is common. The presence of a second positive culture is associated with increased mortality. PMID:21164430

  2. Quantum repeaters: fundamental and future

    NASA Astrophysics Data System (ADS)

    Li, Yue; Hua, Sha; Liu, Yu; Ye, Jun; Zhou, Quan

    2007-04-01

    An overview of the Quantum Repeater techniques based on Entanglement Distillation and Swapping is provided. Beginning with a brief history and the basic concepts of the quantum repeaters, the article primarily focuses on the communication model based on the quantum repeater techniques, which mainly consists of two fundamental modules --- the Entanglement Distillation module and the Swapping module. The realizations of Entanglement Distillation are discussed, including the Bernstein's Procrustean method, the Entanglement Concentration and the CNOT-purification method, etc. The schemes of implementing Swapping, which include the Swapping based on Bell-state measurement and the Swapping in Cavity QED, are also introduced. Then a comparison between these realizations and evaluations on them are presented. At last, the article discusses the experimental schemes of quantum repeaters at present, documents some remaining problems and emerging trends in this field.

  3. Repeatability in redundant manipulator systems

    NASA Astrophysics Data System (ADS)

    Mukherjee, Ranjan

    1994-02-01

    Terrestrial manipulators with more DOF than the dimension of the workspace and space manipulators with as many manipulator DOF as the dimension of the workspace are both redundant systems. An interesting problem of such redundant systems has been the repeatability problem due to the presence of nonholonomic constraints. We show, contrary to the existing belief, that integrability of the nonholonomic constraints is not a necessary condition for the repeatability of the configuration variables. There exist certain trajectories in the independent configuration variable space that are like 'holonomic loops' along which the redundant manipulators exhibit repeatable motion. We present a simple method based on optimization techniques for designing repeatable trajectories for free-flying space manipulators and terrestrial manipulators under pseudoinverse control.

  4. Protein Repeats from First Principles.

    PubMed

    Turjanski, Pablo; Parra, R Gonzalo; Espada, Rocío; Becher, Verónica; Ferreiro, Diego U

    2016-04-05

    Some natural proteins display recurrent structural patterns. Despite being highly similar at the tertiary structure level, repeating patterns within a single repeat protein can be extremely variable at the sequence level. We use a mathematical definition of a repetition and investigate the occurrences of these in sequences of different protein families. We found that long stretches of perfect repetitions are infrequent in individual natural proteins, even for those which are known to fold into structures of recurrent structural motifs. We found that natural repeat proteins are indeed repetitive in their families, exhibiting abundant stretches of 6 amino acids or longer that are perfect repetitions in the reference family. We provide a systematic quantification for this repetitiveness. We show that this form of repetitiveness is not exclusive of repeat proteins, but also occurs in globular domains. A by-product of this work is a fast quantification of the likelihood of a protein to belong to a family.

  5. Protein Repeats from First Principles

    PubMed Central

    Turjanski, Pablo; Parra, R. Gonzalo; Espada, Rocío; Becher, Verónica; Ferreiro, Diego U.

    2016-01-01

    Some natural proteins display recurrent structural patterns. Despite being highly similar at the tertiary structure level, repeating patterns within a single repeat protein can be extremely variable at the sequence level. We use a mathematical definition of a repetition and investigate the occurrences of these in sequences of different protein families. We found that long stretches of perfect repetitions are infrequent in individual natural proteins, even for those which are known to fold into structures of recurrent structural motifs. We found that natural repeat proteins are indeed repetitive in their families, exhibiting abundant stretches of 6 amino acids or longer that are perfect repetitions in the reference family. We provide a systematic quantification for this repetitiveness. We show that this form of repetitiveness is not exclusive of repeat proteins, but also occurs in globular domains. A by-product of this work is a fast quantification of the likelihood of a protein to belong to a family. PMID:27044676

  6. Nanospring behaviour of ankyrin repeats.

    PubMed

    Lee, Gwangrog; Abdi, Khadar; Jiang, Yong; Michaely, Peter; Bennett, Vann; Marszalek, Piotr E

    2006-03-09

    Ankyrin repeats are an amino-acid motif believed to function in protein recognition; they are present in tandem copies in diverse proteins in nearly all phyla. Ankyrin repeats contain antiparallel alpha-helices that can stack to form a superhelical spiral. Visual inspection of the extrapolated structure of 24 ankyrin-R repeats indicates the possibility of spring-like behaviour of the putative superhelix. Moreover, stacks of 17-29 ankyrin repeats in the cytoplasmic domains of transient receptor potential (TRP) channels have been identified as candidates for a spring that gates mechanoreceptors in hair cells as well as in Drosophila bristles. Here we report that tandem ankyrin repeats exhibit tertiary-structure-based elasticity and behave as a linear and fully reversible spring in single-molecule measurements by atomic force microscopy. We also observe an unexpected ability of unfolded repeats to generate force during refolding, and report the first direct measurement of the refolding force of a protein domain. Thus, we show that one of the most common amino-acid motifs has spring properties that could be important in mechanotransduction and in the design of nanodevices.

  7. Stability of dental waxes following repeated heatings.

    PubMed

    Kotsiomiti, E; McCabe, J F

    1995-02-01

    The flow and strength properties of dental waxes were examined following excessive and repeated heatings of the materials. For one product, the flow at 40 +/- 0.5 degrees C was reduced by 25.3% following heating above 200 degrees C. A decrease of the elastic modulus at 20 +/- 1 degree C by approximately 66% was observed in some cases after the heating temperature had been increased to 300 degrees C. Property variations were related to compositional changes, which were investigated by infrared spectoscopy and thermal analysis. Exposure of dental waxes to temperatures higher than 200 degrees C, particularly if it is repeated, may affect the composition and properties, resulting in inferior materials.

  8. Learning with repeated-game strategies.

    PubMed

    Ioannou, Christos A; Romero, Julian

    2014-01-01

    We use the self-tuning Experience Weighted Attraction model with repeated-game strategies as a computer testbed to examine the relative frequency, speed of convergence and progression of a set of repeated-game strategies in four symmetric 2 × 2 games: Prisoner's Dilemma, Battle of the Sexes, Stag-Hunt, and Chicken. In the Prisoner's Dilemma game, we find that the strategy with the most occurrences is the "Grim-Trigger." In the Battle of the Sexes game, a cooperative pair that alternates between the two pure-strategy Nash equilibria emerges as the one with the most occurrences. In the Stag-Hunt and Chicken games, the "Win-Stay, Lose-Shift" and "Grim-Trigger" strategies are the ones with the most occurrences. Overall, the pairs that converged quickly ended up at the cooperative outcomes, whereas the ones that were extremely slow to reach convergence ended up at non-cooperative outcomes.

  9. Overcoming fixation with repeated memory suppression.

    PubMed

    Angello, Genna; Storm, Benjamin C; Smith, Steven M

    2015-01-01

    Fixation (blocks to memories or ideas) can be alleviated not only by encouraging productive work towards a solution, but, as the present experiments show, by reducing counterproductive work. Two experiments examined relief from fixation in a word-fragment completion task. Blockers, orthographically similar negative primes (e.g., ANALOGY), blocked solutions to word fragments (e.g., A_L_ _GY) in both experiments. After priming, but before the fragment completion test, participants repeatedly suppressed half of the blockers using the Think/No-Think paradigm, which results in memory inhibition. Inhibiting blockers did not alleviate fixation in Experiment 1 when conscious recollection of negative primes was not encouraged on the fragment completion test. In Experiment 2, however, when participants were encouraged to remember negative primes at fragment completion, relief from fixation was observed. Repeated suppression may nullify fixation effects, and promote creative thinking, particularly when fixation is caused by conscious recollection of counterproductive information.

  10. Percutaneous Cervical Vertebroplasty in a MultifunctionalImage-Guided Therapy Suite: Hybrid Lateral Approach to C1 andC4 Under CT and Fluoroscopic Guidance

    SciTech Connect

    Huegli, R.W. Schaeren, S.; Jacob, A.L.; Martin, J.B.; Wetzel, S.G.

    2005-06-15

    A 76-year-old patient suffering from two painful osteolytic metastases in C1 and C4 underwent percutaneous vertebroplasty by a hybrid technique in a multi-functional image-guided therapy suite (MIGTS). Two trocars were first placed into the respective bodies of C1 and C4 under fluoroscopic computed tomography guidance using a lateral approach. Thereafter, the patient was transferred on a moving table to the digital subtraction angiography unit in the same room for implant injection. Good pain relief was achieved by this minimally invasive procedure without complications. A hybrid approach for vertebroplasty in a MIGTS appears to be safe and feasible and might be indicated in selected cases for difficult accessible lesions.

  11. Peripheral Insertion of a Central Venous Access Device Under Fluoroscopic Guidance Using a Peripherally Accessed System (PAS) Port in the Forearm

    SciTech Connect

    Hata, Yasuhiro; Morita, Sojiro; Morita, Yoshitaka; Awatani, Toshihide; Takasaki, Motohiro; Horimi, Tadashi; Ozawa, Zen

    1998-05-15

    Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

  12. Integration of kerma-area product and cumulative air kerma determination into a skin dose tracking system for fluoroscopic imaging procedures

    NASA Astrophysics Data System (ADS)

    Vijayan, Sarath; Shankar, Alok; Rudin, Stephen; Bednarek, Daniel R.

    2016-03-01

    The skin dose tracking system (DTS) that we developed provides a color-coded mapping of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures in real time. The DTS has now been modified to also calculate the kerma area product (KAP) and cumulative air kerma (CAK) for fluoroscopic interventions using data obtained in real-time from the digital bus on a Toshiba Infinix system. KAP is the integral of air kerma over the beam area and is typically measured with a large-area transmission ionization chamber incorporated into the collimator assembly. In this software, KAP is automatically determined for each x-ray pulse as the product of the air kerma/ mAs from a calibration file for the given kVp and beam filtration times the mAs per pulse times the length and width of the beam times a field nonuniformity correction factor. Field nonuniformity is primarily the result of the heel effect and the correction factor was determined from the beam profile measured using radio-chromic film. Dividing the KAP by the beam area at the interventional reference point provides the area averaged CAK. The KAP and CAK per x-ray pulse are summed after each pulse to obtain the total procedure values in real-time. The calculated KAP and CAK were compared to the values displayed by the fluoroscopy machine with excellent agreement. The DTS now is able to automatically calculate both KAP and CAK without the need for measurement by an add-on transmission ionization chamber.

  13. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience.

    PubMed

    Fairley, Sarah L; Lucking, Andrew J; McEntegart, Margaret; Shaukat, Aadil; Smith, David; Chase, Alexander; Hanratty, Colm G; Spratt, James C; Walsh, Simon J

    2016-12-01

    Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary percutaneous coronary intervention (PCI). Procedural success is influenced by disease complexity, calcific burden and patient characteristics but has substantially improved with the implementation of novel hybrid strategies. However, vascular-access related complications remain a cause of morbidity and mortality. This study aimed to assess the effectiveness of fluoroscopic-guided femoral arterial puncture to minimise this risk during CTO PCI. Standardised data were retrospectively collected from four high-volume UK CTO centres between September 2011 and November 2013. Demographic, clinical and procedural data (vascular access site, sheath size, anticoagulation use) was collated. The anatomical location of the femoral puncture in relation to the femoral bifurcation, femoral head position and inferior epigastric artery were recorded. Adverse events related to vascular access were documented. A total of 528 patients were included (676 femoral punctures) with the majority being male (n=432, 81.8%). Large sheaths (8F) were used in 81.2% of cases. Fluoroscopy-enabled punctures were made in the 'safe zone' in over > 93% of cases. Vascular closure devices (VCD) were used in 88.3% of cases. The adverse event rate per puncture was 0.89%. This study demonstrates an extremely low incidence of vascular-access complications in CTO PCI when fluoroscopic guidance is used to obtain femoral arterial access by default radial operators. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  14. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial

    PubMed Central

    Casella, Michela; Dello Russo, Antonio; Pelargonio, Gemma; Del Greco, Maurizio; Zingarini, Gianluca; Piacenti, Marcello; Di Cori, Andrea; Casula, Victor; Marini, Massimiliano; Pizzamiglio, Francesca; Zucchetti, Martina; Riva, Stefania; Russo, Eleonora; Narducci, Maria Lucia; Soldati, Ezio; Panchetti, Luca; Startari, Umberto; Bencardino, Gianluigi; Perna, Francesco; Santangeli, Pasquale; Di Biase, Luigi; Cichocki, Fabrizio; Fattore, Giovanni; Bongiorni, Mariagrazia; Picano, Eugenio; Natale, Andrea; Tondo, Claudio

    2016-01-01

    Aims Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure. Methods and results We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTM navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0–0.08 vs. 8.87 mSv, iqr 3.67–22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0–12 vs. 859 s, iqr 545–1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs. Conclusion This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy. Trial registration clinicaltrials.gov Identifier: NCT01132274. PMID:26559916

  15. Percutaneous antegrade scaphoid screw placement: a feasibility and accuracy analysis of a novel electromagnetic navigation technique versus a standard fluoroscopic method.

    PubMed

    Hoffmann, M; Reinsch, O D; Petersen, J P; Schröder, M; Priemel, M; Spiro, A S; Rueger, J M; Yarar, S

    2015-03-01

    Central screw positioning in the scaphoid provides biomechanical advantages. A prospective randomized study of six fluoroscopically guided and six electromagnetically navigated screw (ENS) placements was performed on human cadavers. Accuracy of screw position was determined. Intraoperative fluoroscopy exposure times, readjustments of drilling directions, complete restarts and complications were documented. The ENS method provided a mean time benefit of 7.34 min compared with the standard method and the mean screw length ratio (SLR coronar: ENS 0.96 ± 0.04 mm, SFF: 0.92 ± 0.04 mm, P = 0.065; SLR sagittal: ENS 0.98 ± 0.02 mm, SFF: 0.91 ± 0.04 mm, P = 0.009) and the screw axis deviation angle (AD coronar: ENS 3.33 ± 2.34°, SFF: 10.33 ± 2.58°, P = 0.002; AD sagittal: ENS 2.83 ± 0.98°, SFF: 11.00 ± 6.16°, P = 0.002) were lower. Using the electromagnetic navigation procedure no drilling readjustments or restarts were required, no cortical breach occurred. Compared with the standard fluoroscopic technique, the ENS method used in this study showed higher accuracy, less complications, required less operation and radiation exposure time. Copyright © 2014 John Wiley & Sons, Ltd.

  16. PILOT STUDY TO ASSESS MEAL PROGRESSION THROUGH THE GASTROINTESTINAL TRACT OF HABITUATED DOGS DETERMINED BY FLUOROSCOPIC IMAGING WITHOUT SEDATION OR PHYSICAL RESTRAINT.

    PubMed

    Wrigglesworth, David J; Bailey, Michael Q; Colyer, Alison; Hughes, Kevin R

    2016-11-01

    A limiting factor of radiographic contrast studies is the requirement for restraint of the animal in order to reduce movement artifacts. To demonstrate that gastrointestinal transit can be analyzed by a barium meal in nonsedated and unrestrained dogs, a pilot study of six adult Labrador retriever dogs was undertaken. Study subjects were selected by convenience sampling from an available population of Labrador dogs and were trained to stand motionless during radiographic fluoroscopy. Following a meal containing 7% w/w powdered barium sulfate, radiographic images were generated using a digital fluoroscope C-arm, at intervals of 5, 15, and 30 min, and at 1, 2, 3, 4, 5, 6, 7, and 8 h. A qualitative assessment of fill density using a 5-point scale was made for the stomach, small intestine, and ascending, transverse, and descending regions of the colon at each timepoint. Gastric emptying half-time occurred between 1 and 2 h postmeal. Mean fill density of the small intestine increased from 15 min postmeal and reached a peak at 3 h postmeal. Mean fill density of the proximal large intestine mirrored that of the small intestine. The distal large intestine remained empty for the first 2 h postmeal, then increased between hours 2 and 5 postmeal, and was subsequently at maximum fill density from hour 6 postmeal onwards. Fluoroscopic observation of a barium contrast meal provided an effective indication of the amount and progression of ingested food through the various regions of the gastrointestinal tract in habituated, fully conscious dogs. © 2016 American College of Veterinary Radiology.

  17. Threshold contrast detail detectability measurement of the fluoroscopic image quality of a dynamic solid-state digital x-ray image detector.

    PubMed

    Davies, A G; Cowen, A R; Kengyelics, S M; Bury, R F; Bruijns, T J

    2001-01-01

    Solid-state digital x-ray imaging detectors of flat-panel construction will play an increasingly important role in future medical imaging facilities. Solid-state detectors that will support both dynamic (including fluoroscopic) and radiographic image recording are under active development. The image quality of an experimental solid-state digital x-ray image detector operating in a continuous fluoroscopy mode has been investigated. The threshold contrast detail detectability (TCDD) technique was used to compare the fluoroscopic imaging performance of an experimental dynamic solid-state digital x-ray image detector with that of a reference image intensifier television (IITV) fluoroscopy system. The reference system incorporated Plumbicon TV. Results were presented as a threshold detection index, or H(T)(A), curves. Measurements were made over a range of mean entrance air kerma (EAK) rates typically used in conventional IITV fluoroscopy. At the upper and mid EAK rate range (440 and 220 nGy/s) the solid-state detector outperformed the reference IITV fluoroscopy system as measured by TCDD performance. At the lowest measured EAK rate (104 nGy/s), the solid-state detector produces slightly inferior TCDD performance compared with the reference system. Although not statistically significant at this EAK rate, the difference will increase as EAK is lowered further. Overall the TCDD results and early clinical experiences support the proposition that a current design of dynamic solid-state detector produces image quality competitive with that of modern IITV fluoroscopy systems. These findings encourage the development of compact and versatile universal x-ray imaging systems based upon solid-state detector technology to support R & F and vascular/interventional applications.

  18. The value of physical examination in the diagnosis of hip osteoarthritis.

    PubMed

    Chong, Timothy; Don, Darren W; Kao, Ming-Chih; Wong, Dexter; Mitra, Raj

    2013-01-01

    To compare the sensitivity of physical examination (internal rotation of the hip) with radiographs (using the Kellgren-Lawrence grading scale) in the diagnosis of clinically significant hip osteoarthritis. Case Series, Retrospective chart review of hip pain patients that underwent fluoroscopically guided hip steroid and anesthetic injections. 10 patients with hip pain patients seen at an academic outpatient center over a 2 year period were analyzed. Fluoroscopically guided hip steroid and anesthetic injection. Pain relief and change in VAS pain score after intra-articular hip steroid and lidocaine injection was the main outcome measure. Based on Fisher's exact test, there was no association between severity of radiographic hip arthritis and pain relief with intra-articular anesthetic/steroid injection (p=0.45). Physical examination (provocative hip internal rotation) however was associated with a significant decrease in VAS pain score after intra-articular lidocaine and corticosteroid hip injection (p=0.022). Simple hip radiographs alone are not sufficient to diagnose clinically significant hip osteoarthritis. Physical examination (hip internal rotation) was found to be more accurate than simple radiographs in the diagnosis of clinically significant hip osteoarthritis. Radiographs seem to best utilized when they are an extension of the physical examination and patient history.

  19. Repeatability study of replicate crash tests: A signal analysis approach.

    PubMed

    Seppi, Jeremy; Toczyski, Jacek; Crandall, Jeff R; Kerrigan, Jason

    2017-10-03

    To provide an objective basis on which to evaluate the repeatability of vehicle crash test methods, a recently developed signal analysis method was used to evaluate correlation of sensor time history data between replicate vehicle crash tests. The goal of this study was to evaluate the repeatability of rollover crash tests performed with the Dynamic Rollover Test System (DRoTS) relative to other vehicle crash test methods. Test data from DRoTS tests, deceleration rollover sled (DRS) tests, frontal crash tests, frontal offset crash tests, small overlap crash tests, small overlap impact (SOI) crash tests, and oblique crash tests were obtained from the literature and publicly available databases (the NHTSA vehicle database and the Insurance Institute for Highway Safety TechData) to examine crash test repeatability. Signal analysis of the DRoTS tests showed that force and deformation time histories had good to excellent repeatability, whereas vehicle kinematics showed only fair repeatability due to the vehicle mounting method for one pair of tests and slightly dissimilar mass properties (2.2%) in a second pair of tests. Relative to the DRS, the DRoTS tests showed very similar or higher levels of repeatability in nearly all vehicle kinematic data signals with the exception of global X' (road direction of travel) velocity and displacement due to the functionality of the DRoTS fixture. Based on the average overall scoring metric of the dominant acceleration, DRoTS was found to be as repeatable as all other crash tests analyzed. Vertical force measures showed good repeatability and were on par with frontal crash barrier forces. Dynamic deformation measures showed good to excellent repeatability as opposed to poor repeatability seen in SOI and oblique deformation measures. Using the signal analysis method as outlined in this article, the DRoTS was shown to have the same or better repeatability of crash test methods used in government regulatory and consumer evaluation test

  20. Generation of Repeater F Waves in Healthy Subjects.

    PubMed

    Chroni, Elisabeth; Veltsista, Dimitra; Papapaulou, Chris; Trachani, Eftychia

    2017-05-01

    F waves identical in latency, size, and shape, known as repeater F waves, have been observed occasionally in normal motor conduction recordings. The purpose of this study was to examine the occurrence and characteristics of repeater F waves in healthy subjects under different testing conditions, aiming to selectively excite lower and higher threshold motor fibers. Sessions of 40 traces were recorded from the ulnar nerve in 12 volunteers, applying/using supramaximal, submaximal stimuli (intensity able to elicit 30% and 60% of the maximum compound muscle action potential amplitude), and a collision technique. Repeater F waves were identified and their numbers and relative frequency were estimated. For this purpose, a custom-designed software program was developed, to avoid misjudgments of simple visual inspection. Repeater occurrence was significantly higher using 30% submaximal intensity compared with the standard supramaximal stimulation. There was an inverse significant association between repeater index and overall F wave quantity. Repeaters' latency, amplitude, and duration measurements were within the ranges of the nonrepeaters. We herein showed that in healthy subjects the presence of repeater F waves might increase, when stimulation conditions other than standard single, supramaximal impulses were used. The frequency of repeaters was dependent on the overall F wave persistence, but there was no evidence to support a relationship with the type of motoneurons that was preferentially stimulated.

  1. Limitations on quantum key repeaters

    NASA Astrophysics Data System (ADS)

    Bäuml, Stefan; Christandl, Matthias; Horodecki, Karol; Winter, Andreas

    2015-04-01

    A major application of quantum communication is the distribution of entangled particles for use in quantum key distribution. Owing to noise in the communication line, quantum key distribution is, in practice, limited to a distance of a few hundred kilometres, and can only be extended to longer distances by use of a quantum repeater, a device that performs entanglement distillation and quantum teleportation. The existence of noisy entangled states that are undistillable but nevertheless useful for quantum key distribution raises the question of the feasibility of a quantum key repeater, which would work beyond the limits of entanglement distillation, hence possibly tolerating higher noise levels than existing protocols. Here we exhibit fundamental limits on such a device in the form of bounds on the rate at which it may extract secure key. As a consequence, we give examples of states suitable for quantum key distribution but unsuitable for the most general quantum key repeater protocol.

  2. Limitations on quantum key repeaters.

    PubMed

    Bäuml, Stefan; Christandl, Matthias; Horodecki, Karol; Winter, Andreas

    2015-04-23

    A major application of quantum communication is the distribution of entangled particles for use in quantum key distribution. Owing to noise in the communication line, quantum key distribution is, in practice, limited to a distance of a few hundred kilometres, and can only be extended to longer distances by use of a quantum repeater, a device that performs entanglement distillation and quantum teleportation. The existence of noisy entangled states that are undistillable but nevertheless useful for quantum key distribution raises the question of the feasibility of a quantum key repeater, which would work beyond the limits of entanglement distillation, hence possibly tolerating higher noise levels than existing protocols. Here we exhibit fundamental limits on such a device in the form of bounds on the rate at which it may extract secure key. As a consequence, we give examples of states suitable for quantum key distribution but unsuitable for the most general quantum key repeater protocol.

  3. Repeated DNA in Pneumocystis carinii.

    PubMed Central

    Stringer, S L; Hong, S T; Giuntoli, D; Stringer, J R

    1991-01-01

    A 16-kb DNA fragment designated Rp3-1 and cloned from the genome of rat-derived Pneumocystis carinii was found to contain sequences that were repeated approximately 70 times per genome. The repeated sequences in Rp3-1 spanned at least 10.4 kb. Sequences in Rp3-1 were present on each of the 16 P. carinii chromosomes resolved by field inversion gel electrophoresis. Most of the P. carinii genomic sequences homologous to those in the Rp3-1 clone appeared to be as long as those in the Rp3-1 clone but were highly polymorphic with respect to restriction enzyme cleavage sites. The Rp3-1 DNA fragment appears to be a member of a family of large, degenerate, dispersed repeats. Images PMID:1677941

  4. Magnetars as soft gamma repeaters

    NASA Astrophysics Data System (ADS)

    O'Meara, Karen

    1999-05-01

    The source of non-periodic, repeating, gamma-ray bursts located within our galaxy and near supernova remnants has been a mystery. A new theory by Christopher Thompson and Robert Duncan, postulating the existence of young neutron stars with intense magnetic fields (1E14 Gauss or more) offers an explanation. The intense magnetic fields of these "magnetars" suffice to create the phenomena detected from soft gamma-ray repeaters. The poles of a magnetar are hot enough to emit steady, low level x-ray emissions. Stresses on the star's crust due to the drifting of the magnetic field through the superfluid core create seismic activity and "starquakes," which release enormous bursts of energy. Data collected from recent soft gamma-ray repeater bursts appear to be strong evidence in support of this exciting new theory.

  5. Hysteresis of magnetostructural transitions: Repeatable and non-repeatable processes

    NASA Astrophysics Data System (ADS)

    Provenzano, Virgil; Della Torre, Edward; Bennett, Lawrence H.; ElBidweihy, Hatem

    2014-02-01

    The Gd5Ge2Si2 alloy and the off-stoichiometric Ni50Mn35In15 Heusler alloy belong to a special class of metallic materials that exhibit first-order magnetostructural transitions near room temperature. The magnetic properties of this class of materials have been extensively studied due to their interesting magnetic behavior and their potential for a number of technological applications such as refrigerants for near-room-temperature magnetic refrigeration. The thermally driven first-order transitions in these materials can be field-induced in the reverse order by applying a strong enough field. The field-induced transitions are typically accompanied by the presence of large magnetic hysteresis, the characteristics of which are a complicated function of temperature, field, and magneto-thermal history. In this study we show that the virgin curve, the major loop, and sequentially measured MH loops are the results of both repeatable and non-repeatable processes, in which the starting magnetostructural state, prior to the cycling of field, plays a major role. Using the Gd5Ge2Si2 and Ni50Mn35In15 alloys, as model materials, we show that a starting single phase state results in fully repeatable processes and large magnetic hysteresis, whereas a mixed phase starting state results in non-repeatable processes and smaller hysteresis.

  6. Do Twelfths Terminate or Repeat?

    ERIC Educational Resources Information Center

    Ambrose, Rebecca; Burnison, Erica

    2015-01-01

    When finding the decimal equivalent of a fraction with 12 in the denominator, will it terminate or repeat? This question came from a seventh grader in author Erica Burnison's class as the student was pondering a poster generated by one of her classmates. Not only was the question intriguing, but it also affirmed the belief in the power of…

  7. Do Twelfths Terminate or Repeat?

    ERIC Educational Resources Information Center

    Ambrose, Rebecca; Burnison, Erica

    2015-01-01

    When finding the decimal equivalent of a fraction with 12 in the denominator, will it terminate or repeat? This question came from a seventh grader in author Erica Burnison's class as the student was pondering a poster generated by one of her classmates. Not only was the question intriguing, but it also affirmed the belief in the power of…

  8. Pentapeptide Repeat Proteins and Cyanobacteria

    SciTech Connect

    Buchko, Garry W.

    2009-10-16

    Cyanobacteria are unique in many ways and one unusual feature is the presence of a suite of proteins that contain at least one domain with a minimum of eight tandem repeated five-residues (Rfr) of the general consensus sequence A[N/D]LXX. The function of such pentapeptide repeat proteins (PRPs) are still unknown, however, their prevalence in cyanobacteria suggests that they may play some role in the unique biological activities of cyanobacteria. As part of an inter-disciplinary Membrane Biology Grand Challenge at the Environmental Molecular Sciences Laboratory (Pacific Northwest National Laboratory) and Washington University in St. Louis, the genome of Cyanothece 51142 was sequenced and its molecular biology studied with relation to circadian rhythms. The genome of Cyanothece encodes for 35 proteins that contain at least one PRP domain. These proteins range in size from 105 (Cce_3102) to 930 (Cce_2929) kDa with the PRP domains ranging in predicted size from 12 (Cce_1545) to 62 (cce_3979) tandem pentapeptide repeats. Transcriptomic studies with 29 out of the 35 genes showed that at least three of the PRPs in Cyanothece 51142 (cce_0029, cce_3083, and cce_3272) oscillated with repeated periods of light and dark, further supporting a biological function for PRPs. Using X-ray diffraction crystallography, the structure for two pentapeptide repeat proteins from Cyanothece 51142 were determined, cce_1272 (aka Rfr32) and cce_4529 (aka Rfr23). Analysis of their molecular structures suggests that all PRP may share the same structural motif, a novel type of right-handed quadrilateral β-helix, or Rfr-fold, reminiscent of a square tower with four distinct faces. Each pentapeptide repeat occupies one face of the Rfr-fold with four consecutive pentapeptide repeats completing a coil that, in turn, stack upon each other to form “protein skyscrapers”. Details of the structural features of the Rfr-fold are reviewed here together with a discussion for the possible role of end

  9. Dominant short repeated sequences in bacterial genomes.

    PubMed

    Avershina, Ekaterina; Rudi, Knut

    2015-03-01

    We use a novel multidimensional searching approach to present the first exhaustive search for all possible repeated sequences in 166 genomes selected to cover the bacterial domain. We found an overrepresentation of repeated sequences in all but one of the genomes. The most prevalent repeats by far were related to interspaced short palindromic repeats (CRISPRs)—conferring bacterial adaptive immunity. We identified a deep branching clade of thermophilic Firmicutes containing the highest number of CRISPR repeats. We also identified a high prevalence of tandem repeated heptamers. In addition, we identified GC-rich repeats that could potentially be involved in recombination events. Finally, we identified repeats in a 16322 amino acid mega protein (involved in biofilm formation) and inverted repeats flanking miniature transposable elements (MITEs). In conclusion, the exhaustive search for repeated sequences identified new elements and distribution of these, which has implications for understanding both the ecology and evolution of bacteria.

  10. Observations of Soft Gamma Repeaters

    NASA Technical Reports Server (NTRS)

    Kouveliotou, Chryssa

    2004-01-01

    Magnetars (Soft Gamma Repeaters and Anomalous X-ray Pulsars) are a subclass of neutron stars characterized by their recurrent X-ray bursts. While in an active (bursting) state (lasting anywhere between days and years), they are emit&ng hundreds of predominantly soft (kT=30 kev), short (0.1-100 ms long) events. Their quiescent source x-ray light ewes exhibit puhlions rotational period rate changes (spin-down) indicate that their magnetic fields are extremely high, of the order of 10^14- 10^l5 G. Such high B-field objects, dubbed "magnetars", had been predicted to exist in 1992, but the first concrete observational evidence were obtained in 1998 for two of these sources. I will discuss here the history of Soft Gamma Repeaters, and their spectral, timing and flux characteristics both in the persistent and their burst emission.

  11. SU-E-I-28: Development of Graphic Patient Models for a Real-Time Skin Dose Tracking System (DTS) for Fluoroscopic Interventional Procedures.

    PubMed

    Rana, V; Bednarek, D; Wu, J; Rudin, S

    2012-06-01

    To develop a library of graphic human models that closely match patients undergoing interventional fluoroscopic procedures in order to obtain an accurate estimate of their skin dose. A dose tracking system (DTS) has been developed that calculates the dose to the patient's skin in real time during fluoroscopic procedures based on a graphical simulation of the x-ray system and the patient. The calculation is performed using a lookup table containing values of mGy per mAs at a reference point and inverse-square correction using the distance from the source to individual points on the skin. For proper inverse-square correction, the external shape of the graphic should closely match that of the patient. We are in the process of developing a library of 3D human graphic models categorized as a function of basic body type, sex, height and weight. Two different open- source software applications are being used to develop graphic models with varying weights and heights, to 'morph' the shapes for body type and to 'pose' them for proper positioning on the table. The DTS software is being designed such that the most appropriate body graphic can be automatically selected based on input of several basic patient dimensional metrics. A series of male and female body graphic models have been developed which vary in weight and height. Matching pairs have been constructed with arms at the side and over the head to simulate the usual placement in cardiac procedures. The error in skin dose calculation due to inverse-square correction is expected to be below 5% if the graphic can match the position of the patient's skin surface within 1 cm. A library of categorized body shapes should allow close matching of the graphic to the patient shape allowing more accurate determination of skin dose with the DTS. Support for this work was provided in part by NIH grants R43FD0158401, R44FD0158402, R01EB002873 and R01EB008425, and by Toshiba Medical Systems Corporation. © 2012 American Association

  12. A repeating fast radio burst.

    PubMed

    Spitler, L G; Scholz, P; Hessels, J W T; Bogdanov, S; Brazier, A; Camilo, F; Chatterjee, S; Cordes, J M; Crawford, F; Deneva, J; Ferdman, R D; Freire, P C C; Kaspi, V M; Lazarus, P; Lynch, R; Madsen, E C; McLaughlin, M A; Patel, C; Ransom, S M; Seymour, A; Stairs, I H; Stappers, B W; van Leeuwen, J; Zhu, W W

    2016-03-10

    Fast radio bursts are millisecond-duration astronomical radio pulses of unknown physical origin that appear to come from extragalactic distances. Previous follow-up observations have failed to find additional bursts at the same dispersion measure (that is, the integrated column density of free electrons between source and telescope) and sky position as the original detections. The apparent non-repeating nature of these bursts has led to the suggestion that they originate in cataclysmic events. Here we report observations of ten additional bursts from the direction of the fast radio burst FRB 121102. These bursts have dispersion measures and sky positions consistent with the original burst. This unambiguously identifies FRB 121102 as repeating and demonstrates that its source survives the energetic events that cause the bursts. Additionally, the bursts from FRB 121102 show a wide range of spectral shapes that appear to be predominantly intrinsic to the source and which vary on timescales of minutes or less. Although there may be multiple physical origins for the population of fast radio bursts, these repeat bursts with high dispersion measure and variable spectra specifically seen from the direction of FRB 121102 support an origin in a young, highly magnetized, extragalactic neutron star.

  13. A repeating fast radio burst

    NASA Astrophysics Data System (ADS)

    Spitler, L. G.; Scholz, P.; Hessels, J. W. T.; Bogdanov, S.; Brazier, A.; Camilo, F.; Chatterjee, S.; Cordes, J. M.; Crawford, F.; Deneva, J.; Ferdman, R. D.; Freire, P. C. C.; Kaspi, V. M.; Lazarus, P.; Lynch, R.; Madsen, E. C.; McLaughlin, M. A.; Patel, C.; Ransom, S. M.; Seymour, A.; Stairs, I. H.; Stappers, B. W.; van Leeuwen, J.; Zhu, W. W.

    2016-03-01

    Fast radio bursts are millisecond-duration astronomical radio pulses of unknown physical origin that appear to come from extragalactic distances. Previous follow-up observations have failed to find additional bursts at the same dispersion measure (that is, the integrated column density of free electrons between source and telescope) and sky position as the original detections. The apparent non-repeating nature of these bursts has led to the suggestion that they originate in cataclysmic events. Here we report observations of ten additional bursts from the direction of the fast radio burst FRB 121102. These bursts have dispersion measures and sky positions consistent with the original burst. This unambiguously identifies FRB 121102 as repeating and demonstrates that its source survives the energetic events that cause the bursts. Additionally, the bursts from FRB 121102 show a wide range of spectral shapes that appear to be predominantly intrinsic to the source and which vary on timescales of minutes or less. Although there may be multiple physical origins for the population of fast radio bursts, these repeat bursts with high dispersion measure and variable spectra specifically seen from the direction of FRB 121102 support an origin in a young, highly magnetized, extragalactic neutron star.

  14. Accuracy and repeatability of quantitative fluoroscopy for the measurement of sagittal plane translation and finite centre of rotation in the lumbar spine.

    PubMed

    Breen, Alexander; Breen, Alan

    2016-07-01

    Quantitative fluoroscopy (QF) was developed to measure intervertebral mechanics in vivo and has been found to have high repeatability and accuracy for the measurement of intervertebral rotations. However, sagittal plane translation and finite centre of rotation (FCR) are potential measures of stability but have not yet been fully validated for current QF. This study investigated the repeatability and accuracy of QF for measuring these variables. Repeatability was assessed from L2-S1 in 20 human volunteers. Accuracy was investigated using 10 consecutive measurements from each of two pairs of linked and instrumented dry human vertebrae as reference; one which tilted without translation and one which translated without tilt. The results found intra- and inter-observer repeatability for translation to be 1.1mm or less (SEM) with fair to substantial reliability (ICC 0.533-0.998). Intra-observer repeatability of FCR location for inter-vertebral rotations of 5° and above ranged from 1.5mm to 1.8mm (SEM) with moderate to substantial reliability (ICC 0.626-0.988). Inter-observer repeatability for FCR ranged from 1.2mm to 5.7mm, also with moderate to substantial reliability (ICC 0.621-0.878). Reliability was substantial (ICC>0.81) for 10/16 measures for translation and 5/8 for FCR location. Accuracy for translation was 0.1mm (fixed centre) and 2.2mm (moveable centre), with an FCR error of 0.3mm(x) and 0.4mm(y) (fixed centre). This technology was found to have a high level of accuracy and with a few exceptions, moderate to substantial repeatability for the measurement of translation and FCR from fluoroscopic motion sequences.

  15. The effect of repeated testing vs repeated practice on skills learning in undergraduate dental education.

    PubMed

    Sennhenn-Kirchner, S; Goerlich, Y; Kirchner, B; Notbohm, M; Schiekirka, S; Simmenroth, A; Raupach, T

    2017-01-24

    Recent studies in undergraduate medical education have demonstrated the advantage of repeated testing over repeated practice with regard to knowledge and skills retention. The aim of this study was to investigate whether this "testing effect" also applies to skills retention in undergraduate dental education. In this prospective, randomised controlled trial, fourth-year dental students at Göttingen University Medical Centre participated in a training session on surgical suturing in winter term 2014/2015. Following this, they were either assigned to two sessions of additional skills training (group A) or two sessions of skills assessment with feedback (group B). These sessions were spaced over a period of 4 weeks. Skills retention was assessed in a summative objective structured clinical examination (OSCE) at the end of term, that is 6 months after the initial teaching session. A total of 32 students completed the study. With regard to suturing, OSCE performance was significantly better in group B than group A (81.9±13.1% vs 63.0±15.4%; P=0.001; Cohen's d=1.33). There was no significant OSCE performance difference in the two groups with regard to other learning objectives that were addressed in the end-of-term examination. Thus, the group difference was specific to suturing skills. This is the first study to demonstrate that in dental education, repeated testing produces more favourable skills retention than repeated practice. Test-enhanced learning might be a viable concept for skills retention in undergraduate dentistry education. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Repeatability and Reproducibility of Virtual Subjective Refraction.

    PubMed

    Perches, Sara; Collados, M Victoria; Ares, Jorge

    2016-10-01

    To establish the repeatability and reproducibility of a virtual refraction process using simulated retinal images. With simulation software, aberrated images corresponding with each step of the refraction process were calculated following the typical protocol of conventional subjective refraction. Fifty external examiners judged simulated retinal images until the best sphero-cylindrical refraction and the best visual acuity were achieved starting from the aberrometry data of three patients. Data analyses were performed to assess repeatability and reproducibility of the virtual refraction as a function of pupil size and aberrometric profile of different patients. SD values achieved in three components of refraction (M, J0, and J45) are lower than 0.25D in repeatability analysis. Regarding reproducibility, we found SD values lower than 0.25D in the most cases. When the results of virtual refraction with different pupil diameters (4 and 6 mm) were compared, the mean of differences (MoD) obtained were not clinically significant (less than 0.25D). Only one of the aberrometry profiles with high uncorrected astigmatism shows poor results for the M component in reproducibility and pupil size dependence analysis. In all cases, vision achieved was better than 0 logMAR. A comparison between the compensation obtained with virtual and conventional subjective refraction was made as an example of this application, showing good quality retinal images in both processes. The present study shows that virtual refraction has similar levels of precision as conventional subjective refraction. Moreover, virtual refraction has also shown that when high low order astigmatism is present, the refraction result is less precise and highly dependent on pupil size.

  17. Dose reduction in fluoroscopic interventions using a combination of a region of interest (ROI) x-ray attenuator and spatially different, temporally variable temporal filtering

    NASA Astrophysics Data System (ADS)

    Swetadri Vasan, S. N.; Pope, Liza; Ionita, Ciprian N.; Titus, A. H.; Bednarek, D. R.; Rudin, S.

    2013-03-01

    A novel dose reduction technique for fluoroscopic interventions involving a combination of a material x-ray region of interest (ROI) attenuator and spatially different, temporally variable ROI temporal recursive filter, was used to guide the catheter to the ROI in three live animal studies, two involving rabbits and one involving a sheep. In the two rabbit studies presented , a catheter was guided to the entrance of the carotid artery. With the added ROI attenuator the image under the high attenuation region is very noisy. By using temporal filtering with a filter weight of 0.6 on previous frames, the noise is reduced. In the sheep study the catheter was guided to the descending aorta of the animal. The sheep offered a relatively higher attenuation to the incident x-rays and thus a higher temporal filter weight of 0.8 on previous frames was used during the procedure to reduce the noise to levels acceptable by the interventionalist. The image sequences from both studies show that significant dose reduction of 5-6 times can be achieved with acceptable image quality outside the ROI by using the above mentioned technique. Even though the temporal filter weighting outside the ROI is higher, the consequent lag does not prevent perception of catheter movement.

  18. The Prognostic Value of Enhanced-MRI and Fluoroscopic Factors for Predicting the Effects of Transforaminal Steroid Injections on Lumbosacral Radiating Pain

    PubMed Central

    2016-01-01

    Objective To investigate the predictive value of enhanced-magnetic resonance imaging (MRI) and fluoroscopic factors regarding the effects of transforaminal epidural steroid injections (TFESIs) in low back pain (LBP) patients with lumbosacral radiating pain. Methods A total of 51 patients who had LBP with radiating pain were recruited between January 2011 and December 2012. The patient data were classified into the two groups ‘favorable group’ and ‘non-favorable group’ after 2 weeks of follow-up results. The favorable group was defined as those with a 50%, or more, reduction of pain severity according to the visual analogue scale (VAS) for back or leg pain. The clinical and radiological data were collected for univariate and multivariate analyses to determine the predictors of the effectiveness of TFESIs between the two groups. Results According to the back or the leg favorable-VAS group, the univariate analysis revealed that the corticosteroid approach for the enhanced nerve root, the proportion of the proximal flow, and the contrast dispersion of epidurography are respectively statistically significant relative to the other factors. Lastly, the multiple logistic regression analysis showed a significant association between the corticosteroid approach and the enhanced nerve root in the favorable VAS group. Conclusion Among the variables, MRI showed that the corticosteroid approach for the enhanced target root is the most important prognostic factor in the predicting of the clinical parameters of the favorable TFESIs group. PMID:28119838

  19. Fluoroscopic-guided radiofrequency ablation of the basivertebral nerve: application and analysis with multiple imaging modalities in an ovine model (Invited Paper)

    NASA Astrophysics Data System (ADS)

    Bergeron, Jeffrey A.; Eskey, Cliff J.; Attawia, Mohammed; Patel, Samit J.; Ryan, Thomas P.; Pellegrino, Richard; Sutton, Jeffrey; Crombie, John; Paul, B. T.; Hoopes, P. J.

    2005-04-01

    Pathologic involvement of the basivertebral nerve, an intraosseous vertebral nerve found in humans and most mammalian species, may play a role in some forms of back pain. This study was designed to assess the feasibility and effects of the percutaneous delivery of radiofrequency (RF) energy to thermally ablate the basivertebral nerve in the lumbar vertebrae of mature sheep. Using fluoroscopic guidance, a RF bipolar device was placed and a thermal dose delivered to lumbar vertebral bodies in sheep. Post-treatment assessment included multiple magnetic resonance imaging (MRI) techniques and computed tomography (CT). These data were analyzed and correlated to histopathology and morphometry findings to describe the cellular and boney structural changes resulting from the treatment. Imaging modalities MRI and CT can be implemented to non-invasively describe treatment region and volume, marrow cellular effects, and bone density alterations immediately following RF treatment and during convalescence. Such imaging can be utilized to assess treatment effects and refine the thermal dose to vertebral body volume ratio used in treatment planning. This information will be used to improve the therapeutic ratio and develop a treatment protocol for human applications.

  20. Type of interventional pain procedure, body weight, and presence of spinal pathology are determinants of the level of radiation exposure for fluoroscopically guided pain procedures.

    PubMed

    Hanu-Cernat, Dalvina E; Duarte, Rui; Raphael, Jon H; Mutagi, Hirachand; Kapur, Sandeep; Senthil, Latha

    2012-07-01

    In the recent years new technology has led to the development of a bewildering array of imaging procedures. Yet, conventional radiography remains one of the most used tools to diagnose and to aid procedural interventions. Fluoroscopy guidance facilitates targeted drug delivery or radiofrequency directly to the area of pathology, a benefit that has to be balanced against the risks of radiation exposure. In this prospective observational survey of routine practice, dose area product (DAP) and screening time (ST) were recorded in 127 consecutive patients undergoing fluoroscopically guided spinal procedures along with other probable measures of potentially greater radiation exposure such as weight, type of spinal pathology, the ease of recognition of the anatomical landmarks, and the radiographic quality of the image in terms of contrast and graininess. The mean ST was 34±27 seconds (range, 3 to 218 seconds), the mean DAP was 1.18±1.08 Gy cm(2) (range, 0.023 to 6.82 seconds). A correlation between weight and DAP was confirmed (r=0.230, P<0.05, Spearman's correlation coefficient). Patients with spinal pathology (n=33) had higher radiation exposure than those without (DAP median=0.85, U=978.00, P<0.005, r=-0.28, Mann-Whitney test). The DAP values obtained compare favourably with the recommended doses for radiographs and other procedures, although they generally exceed the values for a chest X-ray.

  1. Comparison of fluoroscopic Guided Transforaminal Epidural Injections of Steroid and Local Anaesthetic with Conservative Management in Patients with Chronic Lumbar Radiculopathies

    PubMed Central

    Mehta, Nandita; Salaria, Misbah; Salaria, A. Q.

    2017-01-01

    Background: Chronic lumbar radiculopathy is a common medical problem and the treatment modalities used over years have been many ranging from conservative or symptomatic management to open decompression surgery. This study was aimed at to compare two modalities of treatment, i.e., conservative and lumbar transforaminal epidural steroid injections (TFESIs). Materials and Methods: A total of 120 patients of American Society of Anesthesiology class - (a healthy patient or a patient with mild systemic disease) were randomized to two groups. Group C (n = 60) were managed conservatively with bed rest, analgesics, and physiotherapy. Group T (n = 60) received lumbar TFESIs with methylprednisolone 40 mg with 2 ml bupivacaine (0.5%). Measurements using visual analog scale (VAS) were taken before treatment and at various time intervals after the start of treatment. Results: There was no statistically significant difference regarding the demographic characteristics of both groups. The VAS scores were less and statistically significant in Group T after 30 min postinjection, at the 2nd week and after 1 month. Recovery rate of straight leg raise test was found to be 98% in those treated with TFESI. The Group T had significantly better patient satisfaction score and additionally there was drug dose intake reduction before and after the treatment. Conclusion: Patients treated with fluoroscopic-guided TFESI have better pain relief, quality-of-life, and less analgesic requirement than those managed conservatively. PMID:28298750

  2. A Novel Foam Contrast Agent Suitable for Fluoroscopic Interventional Procedure: Comparative Study of Physical Properties and Experimental Intervention in Animal Model.

    PubMed

    Hwang, Jin Ho; Park, Hong Suk; Seo, Soowon; Choo, In Wook; Do, Young Soo; Choo, Sung Wook; Shin, Sung Wook; Park, Kwang Bo; Cho, Sung Ki; Hyun, Dongho; Lim, Sooyoun

    2015-01-01

    In fluoroscopic contrast study for interventional procedure, liquid contrast agent may be diluted in body fluid, losing its contrast effect. We developed a novel contrast agent of "foam state" to maintain contrast effect for enough time and performed a comparative study of physical properties and its usefulness in experimental intervention in animal model. The mean size of microbubble of foam contrast was 13.8 ± 3.6 µm. The viscosity was 201.0 ± 0.624 cP (centipoise) and the specific gravity was 0.616. The foam decayed slowly and it had 97.5 minutes of half-life. In terms of the sustainability in a slow flow environment, foam contrast washed out much more slowly than a conventional contrast. In experimental colonic stent placement, foam contrast revealed significantly better results than conventional contrast in procedure time, total amount of contrast usage, and the number of injections (p < 0.05). Our foam contrast has high viscosity and low specific gravity and maintains foam state for a sufficient time. Foam contrast with these properties was useful in experimental intervention in animal model. We anticipate that foam contrast may be applied to various kinds of interventional procedures.

  3. Establishment of trigger levels to steer the follow-up of radiation effects in patients undergoing fluoroscopically-guided interventional procedures in Belgium.

    PubMed

    Struelens, L; Bacher, K; Bosmans, H; Bleeser, F; Hoornaert, M T; Malchair, F; Balter, S

    2014-12-01

    The accumulated dose to the skin of the patient during fluoroscopically-guided procedures can exceed the thresholds for tissue reactions. In practice, interventionalists have no direct information about the local procedure-related skin doses in their patient, causing suboptimal or delayed treatment. In current study, the accumulated Kerma-Area-Product (KAP) values were registered, as well as the reference air kerma (Ka,r) values, if available, for almost 200 cases undergoing seven different procedures. A sheet filled with 50 thermoluminescent dosemeters was wrapped around each patient to measure the peak skin dose. In a significant part of the Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedures, chemo-embolizations of the liver and cerebral embolizations, the threshold values for deterministic skin damage (2 Gy) were attained. Trigger values in terms of KAP, corresponding to a peak skin dose of 2 Gy, were determined. In general, our results comply reasonably well with the values proposed in the NCRP 168 report, with a KAP value of 425 Gy cm² and a Ka,r value of 3 Gy, corresponding to a peak skin dose of 3 Gy. Only for the TIPSS procedure a considerably lower value of 2 Gy was obtained at the published Ka,r and for the RF ablations we obtained a considerably lower value of 250 Gy cm² in terms of KAP.

  4. Dose Reduction in Fluoroscopic Interventions Using a Combination of a Region of Interest (ROI) X-Ray Attenuator and Spatially-Different, Temporally-Variable Temporal Filtering.

    PubMed

    Vasan, S N Swetadri; Pope, Liza; Ionita, Ciprian N; Titus, A H; Bednarek, D R; Rudin, S

    2013-03-06

    A novel dose reduction technique for fluoroscopic interventions involving a combination of a material x-ray region of interest (ROI) attenuator and spatially different, temporally variable ROI temporal recursive filter, was used to guide the catheter to the ROI in three live animal studies, two involving rabbits and one involving a sheep. In the two rabbit studies presented, a catheter was guided to the entrance of the carotid artery. With the added ROI attenuator the image under the high attenuation region is very noisy. By using temporal filtering with a filter weight of 0.6 on previous frames, the noise is reduced. In the sheep study the catheter was guided to the descending aorta of the animal. The sheep offered a relatively higher attenuation to the incident x-rays and thus a higher temporal filter weight of 0.8 on previous frames was used during the procedure to reduce the noise to levels acceptable by the interventionalist. The image sequences from both studies show that significant dose reduction of 5-6 times can be achieved with acceptable image quality outside the ROI by using the above mentioned technique. Even though the temporal filter weighting outside the ROI is higher, the consequent lag does not prevent perception of catheter movement.

  5. Dose Reduction in Fluoroscopic Interventions Using a Combination of a Region of Interest (ROI) X-Ray Attenuator and Spatially-Different, Temporally-Variable Temporal Filtering

    PubMed Central

    Vasan, S.N Swetadri; Pope, Liza; Ionita, Ciprian N.; Titus, A.H.; Bednarek, D.R; Rudin, S.

    2013-01-01

    A novel dose reduction technique for fluoroscopic interventions involving a combination of a material x-ray region of interest (ROI) attenuator and spatially different, temporally variable ROI temporal recursive filter, was used to guide the catheter to the ROI in three live animal studies, two involving rabbits and one involving a sheep. In the two rabbit studies presented, a catheter was guided to the entrance of the carotid artery. With the added ROI attenuator the image under the high attenuation region is very noisy. By using temporal filtering with a filter weight of 0.6 on previous frames, the noise is reduced. In the sheep study the catheter was guided to the descending aorta of the animal. The sheep offered a relatively higher attenuation to the incident x-rays and thus a higher temporal filter weight of 0.8 on previous frames was used during the procedure to reduce the noise to levels acceptable by the interventionalist. The image sequences from both studies show that significant dose reduction of 5–6 times can be achieved with acceptable image quality outside the ROI by using the above mentioned technique. Even though the temporal filter weighting outside the ROI is higher, the consequent lag does not prevent perception of catheter movement. PMID:24817800

  6. Adverse childhood experiences and repeat induced abortion.

    PubMed

    Bleil, Maria E; Adler, Nancy E; Pasch, Lauri A; Sternfeld, Barbara; Reijo-Pera, Renee A; Cedars, Marcelle I

    2011-02-01

    The objective of the study was to characterize the backgrounds of women who have repeat abortions. In a cross-sectional study of 259 women (mean age, 35.2 ± 5.6 years), the relation between adverse experiences in childhood and risk of having 2 or more abortions vs 0 or 1 abortion was examined. Self-reported adverse events occurring between the ages of 0 and 12 years were summed. Independent of confounding factors, women who experienced more abuse, personal safety, and total adverse events in childhood were more likely to have 2 or more abortions vs 0 abortions (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.15-5.71; OR, 2.74; 95% CI, 1.29-5.82; and OR, 1.59; 95% CI, 1.21-2.09, respectively) and vs 1 abortion (OR, 5.83; 95% CI, 1.71-19.89; OR, 2.23; 95% CI, 1.03-4.81; and OR, 1.37; 95% CI, 1.04-1.81, respectively). Women who experienced more family disruption events in childhood were more likely to have 2 or more abortions vs 0 abortions (OR, 1.75; 95% CI, 1.14-2.69) but not vs 1 abortion (OR, 1.16; 95% CI, 0.79-1.70). Women who have repeat abortions are more likely to have experienced childhood adversity than those having 0 or 1 abortion. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. Learning with repeated-game strategies

    PubMed Central

    Ioannou, Christos A.; Romero, Julian

    2014-01-01

    We use the self-tuning Experience Weighted Attraction model with repeated-game strategies as a computer testbed to examine the relative frequency, speed of convergence and progression of a set of repeated-game strategies in four symmetric 2 × 2 games: Prisoner's Dilemma, Battle of the Sexes, Stag-Hunt, and Chicken. In the Prisoner's Dilemma game, we find that the strategy with the most occurrences is the “Grim-Trigger.” In the Battle of the Sexes game, a cooperative pair that alternates between the two pure-strategy Nash equilibria emerges as the one with the most occurrences. In the Stag-Hunt and Chicken games, the “Win-Stay, Lose-Shift” and “Grim-Trigger” strategies are the ones with the most occurrences. Overall, the pairs that converged quickly ended up at the cooperative outcomes, whereas the ones that were extremely slow to reach convergence ended up at non-cooperative outcomes. PMID:25126053

  8. WE-G-207-06: 3D Fluoroscopic Image Generation From Patient-Specific 4DCBCT-Based Motion Models Derived From Physical Phantom and Clinical Patient Images

    SciTech Connect

    Dhou, S; Cai, W; Hurwitz, M; Rottmann, J; Myronakis, M; Cifter, F; Berbeco, R; Lewis, J; Williams, C; Mishra, P; Ionascu, D

    2015-06-15

    Purpose: Respiratory-correlated cone-beam CT (4DCBCT) images acquired immediately prior to treatment have the potential to represent patient motion patterns and anatomy during treatment, including both intra- and inter-fractional changes. We develop a method to generate patient-specific motion models based on 4DCBCT images acquired with existing clinical equipment and used to generate time varying volumetric images (3D fluoroscopic images) representing motion during treatment delivery. Methods: Motion models are derived by deformably registering each 4DCBCT phase to a reference phase, and performing principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated by optimizing the resulting PCA coefficients iteratively through comparison of the cone-beam projections simulating kV treatment imaging and digitally reconstructed radiographs generated from the motion model. Patient and physical phantom datasets are used to evaluate the method in terms of tumor localization error compared to manually defined ground truth positions. Results: 4DCBCT-based motion models were derived and used to generate 3D fluoroscopic images at treatment time. For the patient datasets, the average tumor localization error and the 95th percentile were 1.57 and 3.13 respectively in subsets of four patient datasets. For the physical phantom datasets, the average tumor localization error and the 95th percentile were 1.14 and 2.78 respectively in two datasets. 4DCBCT motion models are shown to perform well in the context of generating 3D fluoroscopic images due to their ability to reproduce anatomical changes at treatment time. Conclusion: This study showed the feasibility of deriving 4DCBCT-based motion models and using them to generate 3D fluoroscopic images at treatment time in real clinical settings. 4DCBCT-based motion models were found to account for the 3D non-rigid motion of the patient anatomy during treatment and have the potential

  9. Accumulate Repeat Accumulate Coded Modulation

    NASA Technical Reports Server (NTRS)

    Abbasfar, Aliazam; Divsalar, Dariush; Yao, Kung

    2004-01-01

    In this paper we propose an innovative coded modulation scheme called 'Accumulate Repeat Accumulate Coded Modulation' (ARA coded modulation). This class of codes can be viewed as serial turbo-like codes, or as a subclass of Low Density Parity Check (LDPC) codes that are combined with high level modulation. Thus at the decoder belief propagation can be used for iterative decoding of ARA coded modulation on a graph, provided a demapper transforms the received in-phase and quadrature samples to reliability of the bits.

  10. Repeated swim stress alters brain benzodiazepine receptors measured in vivo

    SciTech Connect

    Weizman, R.; Weizman, A.; Kook, K.A.; Vocci, F.; Deutsch, S.I.; Paul, S.M.

    1989-06-01

    The effects of repeated swim stress on brain benzodiazepine receptors were examined in the mouse using both an in vivo and in vitro binding method. Specific in vivo binding of (/sup 3/H)Ro15-1788 to benzodiazepine receptors was decreased in the hippocampus, cerebral cortex, hypothalamus, midbrain and striatum after repeated swim stress (7 consecutive days of daily swim stress) when compared to nonstressed mice. In vivo benzodiazepine receptor binding was unaltered after repeated swim stress in the cerebellum and pons medulla. The stress-induced reduction in in vivo benzodiazepine receptor binding did not appear to be due to altered cerebral blood flow or to an alteration in benzodiazepine metabolism or biodistribution because there was no difference in (14C)iodoantipyrine distribution or whole brain concentrations of clonazepam after repeated swim stress. Saturation binding experiments revealed a change in both apparent maximal binding capacity and affinity after repeated swim stress. Moreover, a reduction in clonazepam's anticonvulsant potency was also observed after repeated swim stress (an increase in the ED50 dose for protection against pentylenetetrazol-induced seizures), although there was no difference in pentylenetetrazol-induced seizure threshold between the two groups. In contrast to the results obtained in vivo, no change in benzodiazepine receptor binding kinetics was observed using the in vitro binding method. These data suggest that environmental stress can alter the binding parameters of the benzodiazepine receptor and that the in vivo and in vitro binding methods can yield substantially different results.

  11. The meaning of sampling density in multiple repeat prostate biopsies

    PubMed Central

    Čapoun, Otakar; Minárik, Ivo; Kýr, Michal; Hanuš, Tomáš; Babjuk, Marek; Sobotka, Roman

    2016-01-01

    Introduction Extended transrectal ultrasound-guided prostate biopsy is a state-of-the-art tool for prostate cancer detection. Nevertheless, approximately 1/3 of cancers are missed when using this method and repeat biopsy sessions are often required. The aim of this study was to investigate how sampling density (a compound variable reflecting the number of biopsy cores and prostate volume) impacts on detection rate in multiple repeat TRUS-biopsies. Material and methods A total of 1007 consecutive patients undergoing their 1st, 2nd, 3rd and any further repeat prostate biopsies were included. The relationship between sampling density and other clinical variables (age, prostate-specific antigen level, free/total PSA ratio, digital rectal examination, number of previous biopsies) and cancer detection rate were assessed by interaction analysis. Results There were 562 primary re-biopsies, 267 second re-biopsies and 178 third and further re-biopsies included in the study. Detection rate was 25.4%, 25.8% and 25.3%, respectively. Interaction of sampling density with age was demonstrated in patients undergoing their first repeat biopsy (but not further re-biopsies). No interaction was observed with other variables investigated. Conclusions A more extensive prostate sampling leads to a higher cancer detection rate on repeat prostate biopsies, as shown previously. However, this effect seems to be particularly pronounced in men younger than 65 years undergoing their first repeat prostate biopsy. PMID:28127449

  12. Crowding by a repeating pattern

    PubMed Central

    Rosen, Sarah; Pelli, Denis G.

    2015-01-01

    Theinability to recognize a peripheral target among flankers is called crowding. For a foveal target, crowding can be distinguished from overlap masking by its sparing of detection, linear scaling with eccentricity, and invariance with target size.Crowding depends on the proximity and similarity of the flankers to the target. Flankers that are far from or dissimilar to the target do not crowd it. On a gray page, text whose neighboring letters have different colors, alternately black and white, has enough dissimilarity that it might escape crowding. Since reading speed is normally limited by crowding, escape from crowding should allow faster reading. Yet reading speed is unchanged (Chung & Mansfield, 2009). Why? A recent vernier study found that using alternating-color flankers produces strong crowding (Manassi, Sayim, & Herzog, 2012). Might that effect occur with letters and reading? Critical spacing is the minimum center-to-center target–flanker spacing needed to correctly identify the target. We measure it for a target letter surrounded by several equidistant flanker letters of the same polarity, opposite polarity, or mixed polarity: alternately white and black. We find strong crowding in the alternating condition, even though each flanker letter is beyond its own critical spacing (as measured in a separate condition). Thus a periodic repeating pattern can produce crowding even when the individual elements do not. Further, in all conditions we find that, once a periodic pattern repeats (two cycles), further repetition does not affect critical spacing of the innermost flanker. PMID:26024457

  13. Crowding by a repeating pattern.

    PubMed

    Rosen, Sarah; Pelli, Denis G

    2015-01-01

    Theinability to recognize a peripheral target among flankers is called crowding. For a foveal target, crowding can be distinguished from overlap masking by its sparing of detection, linear scaling with eccentricity, and invariance with target size.Crowding depends on the proximity and similarity of the flankers to the target. Flankers that are far from or dissimilar to the target do not crowd it. On a gray page, text whose neighboring letters have different colors, alternately black and white, has enough dissimilarity that it might escape crowding. Since reading speed is normally limited by crowding, escape from crowding should allow faster reading. Yet reading speed is unchanged (Chung & Mansfield, 2009). Why? A recent vernier study found that using alternating-color flankers produces strong crowding (Manassi, Sayim, & Herzog, 2012). Might that effect occur with letters and reading? Critical spacing is the minimum center-to-center target-flanker spacing needed to correctly identify the target. We measure it for a target letter surrounded by several equidistant flanker letters of the same polarity, opposite polarity, or mixed polarity: alternately white and black. We find strong crowding in the alternating condition, even though each flanker letter is beyond its own critical spacing (as measured in a separate condition). Thus a periodic repeating pattern can produce crowding even when the individual elements do not. Further, in all conditions we find that, once a periodic pattern repeats (two cycles), further repetition does not affect critical spacing of the innermost flanker.

  14. Repeatedly Reactivated Memories Become More Resistant to Hippocampal Damage

    ERIC Educational Resources Information Center

    Lehmann, Hugo; McNamara, Kathryn C.

    2011-01-01

    We examined whether repeated reactivations of a context memory would prevent the typical amnesic effects of post-training damage to the hippocampus (HPC). Rats were given a single contextual fear-conditioning session followed by 10 reactivations, involving a brief return to the conditioning context (no shock). Subsequently, the rats received sham…

  15. Repeated Reading Intervention Effects in Kindergartners with Partial Letter Knowledge

    ERIC Educational Resources Information Center

    van Gorp, Karly; Segers, Eliane; Verhoeven, Ludo

    2014-01-01

    The direct, transfer and retention effects of a repeated reading intervention study of single CVC (consonant in the onset and a vowel and consonant in the rime) words in kindergartners with partial letter knowledge were examined. A total of 26 second-year kindergartners participated in this study. Participants were divided over two feedback…

  16. Physiological responses to repeated transportation of gestating Brahman cows

    USDA-ARS?s Scientific Manuscript database

    The transportation process acts as a stressor with adverse effects on animal health and performance. The purpose of this study was to examine physiological responses to repeated transportation of gestating Brahman cows, previously classified as mature cows, into temperament groups of calm, moderate,...

  17. Repeatedly Reactivated Memories Become More Resistant to Hippocampal Damage

    ERIC Educational Resources Information Center

    Lehmann, Hugo; McNamara, Kathryn C.

    2011-01-01

    We examined whether repeated reactivations of a context memory would prevent the typical amnesic effects of post-training damage to the hippocampus (HPC). Rats were given a single contextual fear-conditioning session followed by 10 reactivations, involving a brief return to the conditioning context (no shock). Subsequently, the rats received sham…

  18. Repeated Reading Intervention Effects in Kindergartners with Partial Letter Knowledge

    ERIC Educational Resources Information Center

    van Gorp, Karly; Segers, Eliane; Verhoeven, Ludo

    2014-01-01

    The direct, transfer and retention effects of a repeated reading intervention study of single CVC (consonant in the onset and a vowel and consonant in the rime) words in kindergartners with partial letter knowledge were examined. A total of 26 second-year kindergartners participated in this study. Participants were divided over two feedback…

  19. CDC Vital Signs: Preventing Repeat Teen Births

    MedlinePlus

    ... file Error processing SSI file Preventing Repeat Teen Births Recommend on Facebook Tweet Share Compartir On this ... Too many teens, ages 15–19, have repeat births. Nearly 1 in 5 births to teens, ages ...

  20. Repeated Reading. What Works Clearinghouse Intervention Report

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2014

    2014-01-01

    "Repeated reading" is an academic practice that aims to increase oral reading fluency. "Repeated reading" can be used with students who have developed initial word reading skills but demonstrate inadequate reading fluency for their grade level. During "repeated reading," a student sits in a quiet location with a…

  1. Evolution of Protein Domain Repeats in Metazoa

    PubMed Central

    Schüler, Andreas; Bornberg-Bauer, Erich

    2016-01-01

    Repeats are ubiquitous elements of proteins and they play important roles for cellular function and during evolution. Repeats are, however, also notoriously difficult to capture computationally and large scale studies so far had difficulties in linking genetic causes, structural properties and evolutionary trajectories of protein repeats. Here we apply recently developed methods for repeat detection and analysis to a large dataset comprising over hundred metazoan genomes. We find that repeats in larger protein families experience generally very few insertions or deletions (indels) of repeat units but there is also a significant fraction of noteworthy volatile outliers with very high indel rates. Analysis of structural data indicates that repeats with an open structure and independently folding units are more volatile and more likely to be intrinsically disordered. Such disordered repeats are also significantly enriched in sites with a high functional potential such as linear motifs. Furthermore, the most volatile repeats have a high sequence similarity between their units. Since many volatile repeats also show signs of recombination, we conclude they are often shaped by concerted evolution. Intriguingly, many of these conserved yet volatile repeats are involved in host-pathogen interactions where they might foster fast but subtle adaptation in biological arms races. Key Words: protein evolution, domain rearrangements, protein repeats, concerted evolution. PMID:27671125

  2. Two-dimensional quantum repeaters

    NASA Astrophysics Data System (ADS)

    Wallnöfer, J.; Zwerger, M.; Muschik, C.; Sangouard, N.; Dür, W.

    2016-11-01

    The endeavor to develop quantum networks gave rise to a rapidly developing field with far-reaching applications such as secure communication and the realization of distributed computing tasks. This ultimately calls for the creation of flexible multiuser structures that allow for quantum communication between arbitrary pairs of parties in the network and facilitate also multiuser applications. To address this challenge, we propose a two-dimensional quantum repeater architecture to establish long-distance entanglement shared between multiple communication partners in the presence of channel noise and imperfect local control operations. The scheme is based on the creation of self-similar multiqubit entanglement structures at growing scale, where variants of entanglement swapping and multiparty entanglement purification are combined to create high-fidelity entangled states. We show how such networks can be implemented using trapped ions in cavities.

  3. Linear Synchronous Motor Repeatability Tests

    SciTech Connect

    Ward, C.R.

    2002-10-18

    A cart system using linear synchronous motors was being considered for the Plutonium Immobilization Plant (PIP). One of the applications in the PIP was the movement of a stack of furnace trays, filled with the waste form (pucks) from a stacking/unstacking station to several bottom loaded furnaces. A system was ordered to perform this function in the PIP Ceramic Prototype Test Facility (CPTF). This system was installed and started up in SRTC prior to being installed in the CPTF. The PIP was suspended and then canceled after the linear synchronous motor system was started up. This system was used to determine repeatability of a linear synchronous motor cart system for the Modern Pit Facility.

  4. Repeated recall and PKMζ maintain fear memories in juvenile rats.

    PubMed

    Oliver, Chicora F; Kabitzke, Patricia; Serrano, Peter; Egan, Laura J; Barr, Gordon A; Shair, Harry N; Wiedenmayer, Christoph

    2016-12-01

    We examined the neural substrates of fear memory formation and maintenance when repeated recall was used to prevent forgetting in young animals. In contrast to adult rats, juveniles failed to show contextual fear responses at 4 d post-fear conditioning. Reconsolidation sessions 3 and 6 d after conditioning restored contextual fear responses in juveniles 7 d after initial training. In juveniles that received reconsolidation sessions, protein kinase M zeta (PKMζ) increased in the amygdala, but not in the hippocampus. These data suggest that repeated reminders and increased PKMζ maintain fear responses in juvenile animals that otherwise would not exhibit this behavior.

  5. Repeat instability: mechanisms of dynamic mutations.

    PubMed

    Pearson, Christopher E; Nichol Edamura, Kerrie; Cleary, John D

    2005-10-01

    Disease-causing repeat instability is an important and unique form of mutation that is linked to more than 40 neurological, neurodegenerative and neuromuscular disorders. DNA repeat expansion mutations are dynamic and ongoing within tissues and across generations. The patterns of inherited and tissue-specific instability are determined by both gene-specific cis-elements and trans-acting DNA metabolic proteins. Repeat instability probably involves the formation of unusual DNA structures during DNA replication, repair and recombination. Experimental advances towards explaining the mechanisms of repeat instability have broadened our understanding of this mutational process. They have revealed surprising ways in which metabolic pathways can drive or protect from repeat instability.

  6. Do the gaps in the ligamentum flavum in the cervical spine translate into dural punctures? An analysis of 4,396 fluoroscopic interlaminar epidural injections.

    PubMed

    Manchikanti, Laxmaiah; Malla, Yogesh; Cash, Kimberly A; Pampati, Vidyasagar

    2015-01-01

    Cervical interlaminar epidural injections are performed frequently in managing chronic neck and upper extremity pain, although less commonly than lumbar interlaminar epidural injections. Recently, the US Food and Drug Administration warnings and safeguards to prevent neurologic complications. These were developed by the Multi-Society Pain Workgroup have taken center stage for all types of epidural injections, including cervical interlaminar epidural injections. The recommendations of safeguards to prevent neurologic complications after epidural steroid injections include that cervical interlaminar epidural injections must be performed utilizing fluoroscopy with anteroposterior, lateral, or oblique views with injection of contrast medium and that entry be limited to the C7-T1 epidural space or occasionally the C6-C7 with requirements for magnetic resonance imaging assessment of the epidural space. To assess the incidence of dural puncture associated with fluoroscopically directed cervical interlaminar epidural injections. A retrospective assessment of patients undergoing cervical interlaminar epidural injections from January 2013 through February 2015. A private interventional pain management practice; a specialty referral center in the United States. The data were collected for 4,396 consecutive cervical interlaminar epidural injections performed from January 2013 through February 2015. The procedures were all performed under fluoroscopic visualization under posteroanterior view with contrast medium injection with lateral view confirmation when indicated. The procedures were performed by one of 2 physicians; the dural puncture and subsequent postoperative complications with level of epidural entry were determined. The outcome was assessment of dural puncture. A review of multiple manuscripts showed that defects in the ligamentum flavum may extend to as much as 100% of the population. However, it also has been shown that among the levels with a gap, the location of

  7. Unfolding a linker between helical repeats.

    PubMed

    Ortiz, Vanessa; Nielsen, Steven O; Klein, Michael L; Discher, Dennis E

    2005-06-10

    In many multi-repeat proteins, linkers between repeats have little secondary structure and place few constraints on folding or unfolding. However, the large family of spectrin-like proteins, including alpha-actinin, spectrin, and dystrophin, share three-helix bundle, spectrin repeats that appear in crystal structures to be linked by long helices. All of these proteins are regularly subjected to mechanical stress. Recent single molecule atomic force microscopy (AFM) experiments demonstrate not only forced unfolding but also simultaneous unfolding of tandem repeats at finite frequency, which suggests that the contiguous helix between spectrin repeats can propagate a cooperative helix-to-coil transition. Here, we address what happens atomistically to the linker under stress by steered molecular dynamics simulations of tandem spectrin repeats in explicit water. The results for alpha-actinin repeats reveal rate-dependent pathways, with one pathway showing that the linker between repeats unfolds, which may explain the single-repeat unfolding pathway observed in AFM experiments. A second pathway preserves the structural integrity of the linker, which explains the tandem-repeat unfolding event. Unfolding of the linker begins with a splay distortion of proximal loops away from hydrophobic contacts with the linker. This is followed by linker destabilization and unwinding with increased hydration of the backbone. The end result is an unfolded helix that mechanically decouples tandem repeats. Molecularly detailed insights obtained here aid in understanding the mechanical coupling of domain stability in spectrin family proteins.

  8. Updates in the real-time Dose Tracking System (DTS) to improve the accuracy in calculating the radiation dose to the patients skin during fluoroscopic procedures.

    PubMed

    Rana, Vijay K; Rudin, Stephen; Bednarek, Daniel R

    2013-03-06

    We have developed a dose-tracking system (DTS) to manage the risk of deterministic skin effects to the patient during fluoroscopic image-guided interventional cardiac procedures. The DTS calculates the radiation dose to the patient's skin in real-time by acquiring exposure parameters and imaging-system geometry from the digital bus on a Toshiba C-arm unit and displays the cumulative dose values as a color map on a 3D graphic of the patient for immediate feedback to the interventionalist. Several recent updates have been made to the software to improve its function and performance. Whereas the older system needed manual input of pulse rate for dose-rate calculation and used the CPU clock with its potential latency to monitor exposure duration, each x-ray pulse is now individually processed to determine the skin-dose increment and to automatically measure the pulse rate. We also added a correction for the table pad which was found to reduce the beam intensity to the patient for under-table projections by an additional 5-12% over that of the table alone at 80 kVp for the x-ray filters on the Toshiba system. Furthermore, mismatch between the DTS graphic and the patient skin can result in inaccuracies in dose calculation because of inaccurate inverse-square-distance calculation. Therefore, a means for quantitative adjustment of the patient-graphic-model position and a parameterized patient-graphic library have been developed to allow the graphic to more closely match the patient. These changes provide more accurate estimation of the skin-dose which is critical for managing patient radiation risk.

  9. Quantitative comparison using Generalized Relative Object Detectability (G-ROD) metrics of an amorphous selenium detector with high resolution Microangiographic Fluoroscopes (MAF) and standard flat panel detectors (FPD).

    PubMed

    Russ, M; Shankar, A; Jain, A; Setlur Nagesh, S V; Ionita, C N; Scott, C; Karim, K S; Bednarek, D R; Rudin, S

    2016-02-27

    A novel amorphous selenium (a-Se) direct detector with CMOS readout has been designed, and relative detector performance investigated. The detector features include a 25μm pixel pitch, and 1000μm thick a-Se layer operating at 10V/μm bias field. A simulated detector DQE was determined, and used in comparative calculations of the Relative Object Detectability (ROD) family of prewhitening matched-filter (PWMF) observer and non-prewhitening matched filter (NPWMF) observer model metrics to gauge a-Se detector performance against existing high resolution micro-angiographic fluoroscopic (MAF) detectors and a standard flat panel detector (FPD). The PWMF-ROD or ROD metric compares two x-ray imaging detectors in their relative abilities in imaging a given object by taking the integral over spatial frequencies of the Fourier transform of the detector DQE weighted by an object function, divided by the comparable integral for a different detector. The generalized-ROD (G-ROD) metric incorporates clinically relevant parameters (focal-spot size, magnification, and scatter) to show the degradation in imaging performance for detectors that are part of an imaging chain. Preliminary ROD calculations using simulated spheres as the object predicted superior imaging performance by the a-Se detector as compared to existing detectors. New PWMF-G-ROD and NPWMF-G-ROD results still indicate better performance by the a-Se detector in an imaging chain over all sphere sizes for various focal spot sizes and magnifications, although a-Se performance advantages were degraded by focal spot blurring. Nevertheless, the a-Se technology has great potential to provide breakthrough abilities such as visualization of fine details including of neuro-vascular perforator vessels and of small vascular devices.

  10. Quantitative comparison using generalized relative object detectability (G-ROD) metrics of an amorphous selenium detector with high resolution microangiographic fluoroscopes (MAF) and standard flat panel detectors (FPD)

    NASA Astrophysics Data System (ADS)

    Russ, M.; Shankar, A.; Jain, A.; Setlur Nagesh, S. V.; Ionita, C. N.; Scott, C.; Karim, K. S.; Bednarek, D. R.; Rudin, S.

    2016-03-01

    A novel amorphous selenium (a-Se) direct detector with CMOS readout has been designed, and relative detector performance investigated. The detector features include a 25μm pixel pitch, and 1000μm thick a-Se layer operating at 10V/μm bias field. A simulated detector DQE was determined, and used in comparative calculations of the Relative Object Detectability (ROD) family of prewhitening matched-filter (PWMF) observer and non-pre-whitening matched filter (NPWMF) observer model metrics to gauge a-Se detector performance against existing high resolution micro-angiographic fluoroscopic (MAF) detectors and a standard flat panel detector (FPD). The PWMF-ROD or ROD metric compares two x-ray imaging detectors in their relative abilities in imaging a given object by taking the integral over spatial frequencies of the Fourier transform of the detector DQE weighted by an object function, divided by the comparable integral for a different detector. The generalized-ROD (G-ROD) metric incorporates clinically relevant parameters (focal- spot size, magnification, and scatter) to show the degradation in imaging performance for detectors that are part of an imaging chain. Preliminary ROD calculations using simulated spheres as the object predicted superior imaging performance by the a-Se detector as compared to existing detectors. New PWMF-G-ROD and NPWMF-G-ROD results still indicate better performance by the a-Se detector in an imaging chain over all sphere sizes for various focal spot sizes and magnifications, although a-Se performance advantages were degraded by focal spot blurring. Nevertheless, the a-Se technology has great potential to provide break- through abilities such as visualization of fine details including of neuro-vascular perforator vessels and of small vascular devices.

  11. Updates in the real-time Dose Tracking System (DTS) to improve the accuracy in calculating the radiation dose to the patients skin during fluoroscopic procedures

    PubMed Central

    Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2013-01-01

    We have developed a dose-tracking system (DTS) to manage the risk of deterministic skin effects to the patient during fluoroscopic image-guided interventional cardiac procedures. The DTS calculates the radiation dose to the patient’s skin in real-time by acquiring exposure parameters and imaging-system geometry from the digital bus on a Toshiba C-arm unit and displays the cumulative dose values as a color map on a 3D graphic of the patient for immediate feedback to the interventionalist. Several recent updates have been made to the software to improve its function and performance. Whereas the older system needed manual input of pulse rate for dose-rate calculation and used the CPU clock with its potential latency to monitor exposure duration, each x-ray pulse is now individually processed to determine the skin-dose increment and to automatically measure the pulse rate. We also added a correction for the table pad which was found to reduce the beam intensity to the patient for under-table projections by an additional 5–12% over that of the table alone at 80 kVp for the x-ray filters on the Toshiba system. Furthermore, mismatch between the DTS graphic and the patient skin can result in inaccuracies in dose calculation because of inaccurate inverse-square-distance calculation. Therefore, a means for quantitative adjustment of the patient-graphic-model position and a parameterized patient-graphic library have been developed to allow the graphic to more closely match the patient. These changes provide more accurate estimation of the skin-dose which is critical for managing patient radiation risk. PMID:24817801

  12. Safety and Feasibility of a Minimally Fluoroscopic Approach for Ventricular Tachycardia Ablation in Patients With Structural Heart Disease: Influence of the Ventricular Tachycardia Substrate.

    PubMed

    Cano, Óscar; Andrés, Ana; Osca, Joaquín; Alonso, Pau; Sancho-Tello, María-José; Olagüe, José; Martínez-Dolz, Luis

    2016-02-01

    We sought to evaluate the safety and feasibility of a minimally fluoroscopic approach using the CARTOUNIVU module during scar-related ventricular tachycardia (VT) ablation. Consecutive patients with structural heart disease undergoing VT ablation using the CARTOUNIVU module were prospectively included and classified depending on their VT substrate: (1) ischemic VT (IVT) and (2) nonischemic VT and depending on the presence of an epicardial access. Radiation exposure parameters and major and minor procedure-related complications were registered. A near-zero fluoroscopy exposure was defined as those procedures with an effective dose ≤1 mSv. A total of 44 VT ablation procedures were performed in 41 patients (22 IVT and 19 nonischemic VT). The use of the CARTOUNIVU module resulted in low levels of radiation exposure: median total fluoroscopy time and effective dose of 6.08 (1.51-12.36) minutes and 2.15 (0.58-8.22) mSv, respectively. Patients with IVT had lower radiation exposure than patients with nonischemic VT (total fluoroscopy time, 2.53 [1.22-11.22] versus 8.51 [5.55-17.34] minutes; P=0.016). Epicardial access was associated with significantly higher levels of radiation exposure. Complications occurred in 4.9% patients, none of them being related to the use of the image integration tool. A near-zero fluoroscopy ablation could be performed in 14 of 44 procedures (32%), 43% of IVT procedures, and 50% of procedures with endocardial access only. The use of the CARTOUNIVU module during scar-related VT ablation resulted in low levels of radiation exposure. A near-zero fluoroscopy approach can be achieved in up to half of the procedures, especially in IVT patients with endocardial ablation. © 2016 American Heart Association, Inc.

  13. LabVIEW Graphical User Interface for a New High Sensitivity, High Resolution Micro-Angio-Fluoroscopic and ROI-CBCT System.

    PubMed

    Keleshis, C; Ionita, Cn; Yadava, G; Patel, V; Bednarek, Dr; Hoffmann, Kr; Verevkin, A; Rudin, S

    2008-01-01

    A graphical user interface based on LabVIEW software was developed to enable clinical evaluation of a new High-Sensitivity Micro-Angio-Fluoroscopic (HSMAF) system for real-time acquisition, display and rapid frame transfer of high-resolution region-of-interest images. The HSMAF detector consists of a CsI(Tl) phosphor, a light image intensifier (LII), and a fiber-optic taper coupled to a progressive scan, frame-transfer, charged-coupled device (CCD) camera which provides real-time 12 bit, 1k × 1k images capable of greater than 10 lp/mm resolution. Images can be captured in continuous or triggered mode, and the camera can be programmed by a computer using Camera Link serial communication. A graphical user interface was developed to control the camera modes such as gain and pixel binning as well as to acquire, store, display, and process the images. The program, written in LabVIEW, has the following capabilities: camera initialization, synchronized image acquisition with the x-ray pulses, roadmap and digital subtraction angiography acquisition (DSA), flat field correction, brightness and contrast control, last frame hold in fluoroscopy, looped playback of the acquired images in angiography, recursive temporal filtering and LII gain control. Frame rates can be up to 30 fps in full-resolution mode. The user friendly implementation of the interface along with the high framerate acquisition and display for this unique high-resolution detector should provide angiographers and interventionalists with a new capability for visualizing details of small vessels and endovascular devices such as stents and hence enable more accurate diagnoses and image guided interventions. (Support: NIH Grants R01NS43924, R01EB002873).

  14. High prevalence of insulation failure with externalized cables in St. Jude Medical Riata family ICD leads: fluoroscopic grading scale and correlation to extracted leads.

    PubMed

    Parvathaneni, Sunthosh V; Ellis, Christopher R; Rottman, Jeffrey N

    2012-08-01

    Inside-out abrasion with externalization of sensing ring or high-voltage cables in St Jude Medical Riata implantable cardioverter-defibrillator leads has been reported. The prevalence of extruded cables, rate of electrical abnormalities, and predictors of failure in Riata leads are unknown. To estimate the incidence of lead failure in the St Jude Medical Riata implantable cardioverter-defibrillator leads and to propose a standard for the fluoroscopic assessment of insulation breakdown. Patients undergoing cine-fluoroscopy on Riata implantable cardioverter-defibrillator leads at our institution before January 25, 2012, were included (n = 87). Leads were graded as types 0-3 (0 = normal, 1 = abnormal conductor spacing, 2 ≤1 cm cable extrusion, 3 = >1 cm length extrusion). Comparison to extracted leads (n = 15) was documented. Device interrogation data were used for electrical analysis. The mean time from implant was 5.9 ± 3.45 years. Structural lead failure with externalized cables was seen in 33.3% (29 of 87) of the patients. Thirty-one percent (9 of 29) of the leads with exposed cables showed electrical failure, and 29.7% (19 of 64) of the leads with normal electrical data contained externalized cables. Time from implant ≥5 years predicted structural lead failure (P < 0.05). X-ray grade compared with extracted leads demonstrated a sensitivity and specificity of 86% and 100%, respectively. Cine-fluoroscopy using a simple scale correlated with the structural integrity of extracted Riata leads. A high percentage of leads with extrusion showed electrical failure. Leads ≥5 years from implant showed a high rate of externalized cables. A large independent multicenter study to determine the prevalence and clinical sequelae of Riata lead failures is warranted. Copyright © 2012 Heart Rhythm Society. All rights reserved.

  15. Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery.

    PubMed

    Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

    2017-08-01

    Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS's navigation system overcoming the earlier version's issues, aiming to move the RAFS system into a surgical environment. The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about [Formula: see text] (phantom) and [Formula: see text] (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error [Formula: see text], [Formula: see text]. Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.

  16. The Micro-Angiographic Fluoroscope (MAF) in High Definition (HD) Mode for Improved Contrast-to-Noise Ratio and Resolution in Fluoroscopy and Roadmapping.

    PubMed

    Panse, Ashish; Ionita, C N; Wang, W; Natarajan, S K; Jain, A; Bednarek, D R; Rudin, S

    2010-10-30

    During image guided interventional procedures, superior resolution and image quality is critically important. Operating the MAF in the new High Definition (HD) fluoroscopy mode provides high resolution and increased contrast-to-noise ratio. The MAF has a CCD camera and a 300 micron cesium iodide x-ray convertor phosphor coupled to a light image intensifier (LII) through a fiber-optic taper. The MAF captures 1024 × 1024 pixels with an effective pixel size of 35 microns, and is capable of real-time imaging at 30 fps. The HD mode uses the advantages of higher exposure along with a small focal spot effectively improving the contrast-to-noise ratio (CNR) and the spatial resolution. The Control Acquisition Processing and Image Display System (CAPIDS) software for the MAF controls the LII gain. The interventionalist can select either fluoroscopic or angiographic modes using the two standard foot pedals. When improved image quality is needed and the angiography footpedal is used for HD mode, the x-ray machine will operate at a preset higher exposure rate using a small focal spot, while the CAPIDS will automatically adjust the LII gain to achieve proper image brightness. HD mode fluoroscopy and roadmapping are thus achieved conveniently during the interventional procedure. For CNR and resolution evaluation we used a bar phantom with images taken in HD mode with both the MAF and a Flat Panel Detector (FPD). It was seen that the FPD could not resolve more than 2.8 lp/mm whereas the MAF could resolve more than 5 lp/mm. The CNR of the MAF was better than that of the FPD by 60% at lower frequencies and by 600% at the Nyquist frequency of the FPD. The HD mode has become the preferred mode during animal model interventions because it enables detailed features of endovascular devices such as stent struts to be visualized clearly for the first time. Clinical testing of the MAF in HD mode is imminent.

  17. Investigation on effect of image lag in fluoroscopic images obtained with a dynamic flat-panel detector (FPD) on accuracy of target tracking in radiotherapy.

    PubMed

    Tanaka, Rie; Ichikawa, Katsuhiro; Mori, Shinichiro; Dobashi, Suguru; Kumagai, Motoki; Kawashima, Hiroki; Minohara, Shinichi; Sanada, Sigeru

    2010-01-01

    Real-time tumor tracking in external radiotherapy can be achieved by diagnostic (kV) X-ray imaging with a dynamic flat-panel detector (FPD). The purpose of this study was to address image lag in target tracking and its influence on the accuracy of tumor tracking. Fluoroscopic images were obtained using a direct type of dynamic FPD. Image lag properties were measured without test devices according to IEC 62220-1. Modulation transfer function (MTF) and profile curves were measured on the edges of a moving tungsten plate at movement rate of 10 and 20 mm/s, covering lung tumor movement of normal breathing. A lung tumor and metal sphere with blurred edge due to image lag was simulated using the results and then superimposed on breathing chest radiographs of a patient. The moving target with and without image lag was traced using a template-matching technique. In the results, the image lag for the first frame after X-ray cutoff was 2.0% and decreased to less than 0.1% in the fifth frame. In the measurement of profile curves on the edges of static and moving tungsten material plates, the effect of image lag was seen as blurred edges of the plate. The blurred edges of a moving target were indicated as reduction of MTF. However, the target could be traced within an error of ± 5 mm. The results indicated that there was no effect of image lag on target tracking in usual breathing speed in a radiotherapy situation.

  18. A Semiparametric Bayesian Model for Repeatedly Repeated Binary Outcomes

    PubMed Central

    Quintana, Fernando A.; Müller, Peter; Rosner, Gary L.; Relling, Mary V.

    2009-01-01

    Summary We discuss the analysis of data from single nucleotide polymorphism (SNP) arrays comparing tumor and normal tissues. The data consist of sequences of indicators for loss of heterozygosity (LOH) and involve three nested levels of repetition: chromosomes for a given patient, regions within chromosomes, and SNPs nested within regions. We propose to analyze these data using a semiparametric model for multi-level repeated binary data. At the top level of the hierarchy we assume a sampling model for the observed binary LOH sequences that arises from a partial exchangeability argument. This implies a mixture of Markov chains model. The mixture is defined with respect to the Markov transition probabilities. We assume a nonparametric prior for the random mixing measure. The resulting model takes the form of a semiparametric random effects model with the matrix of transition probabilities being the random effects. The model includes appropriate dependence assumptions for the two remaining levels of the hierarchy, i.e., for regions within chromosomes and for chromosomes within patient. We use the model to identify regions of increased LOH in a dataset coming from a study of treatment-related leukemia in children with an initial cancer diagnostic. The model successfully identifies the desired regions and performs well compared to other available alternatives. PMID:19746193

  19. Synthesized Speech Intelligibility and Early Preschool-Age Children: Comparing Accuracy for Single-Word Repetition with Repeated Exposure

    ERIC Educational Resources Information Center

    Pinkoski-Ball, Carrie L.; Reichle, Joe; Munson, Benjamin

    2012-01-01

    Purpose: This investigation examined the effect of repeated exposure to novel and repeated spoken words in typical environments on the intelligibility of 2 synthesized voices and human recorded speech in preschools. Method: Eighteen preschoolers listened to and repeated single words presented in human-recorded speech, DECtalk Paul, and AT&T Voice…

  20. Synthesized Speech Intelligibility and Early Preschool-Age Children: Comparing Accuracy for Single-Word Repetition with Repeated Exposure

    ERIC Educational Resources Information Center

    Pinkoski-Ball, Carrie L.; Reichle, Joe; Munson, Benjamin

    2012-01-01

    Purpose: This investigation examined the effect of repeated exposure to novel and repeated spoken words in typical environments on the intelligibility of 2 synthesized voices and human recorded speech in preschools. Method: Eighteen preschoolers listened to and repeated single words presented in human-recorded speech, DECtalk Paul, and AT&T Voice…

  1. Trinucleotide repeats at the FRAXF locus: Frequency and distribution in the general population

    SciTech Connect

    Holden, J.J.A.; Walker, M.

    1996-08-09

    FRAXF the third X-chromosomal fragile site to be cloned, has been shown to harbor a polymorphic compound triplet array: (GC-CGTC){sub n} (GCC){sub n}. Expansion and methylation of the GCC-repeat and the neighboring CpG-rich region result in chromosomal fragility. DNAs from 500 anonymous consecutive newborn males were examined to determine the incidence of various repeat numbers. The range of repeats was from 10-38, with the most common alleles having 14 (52.7%), 12 (16.6%), 21 (9.0%), and 22 (5.2%) triplets. Based on the distribution of repeat numbers, we suggest that the 21-repeat allele resulted from hairpin formation involving 7 GCC-repeats in a 14-repeat allele, accompanied by polymerase slippage. Examination of dinucleotide repeats near the FRAXF repeat will be important in testing this hypothesis. Since the clinical phenotype, if any, of FRAXF is unknown, this database will also be valuable for comparisons with repeat numbers in individuals from special populations. 20 refs., 1 fig., 1 tab.

  2. Isolated traumatic gallbladder rupture: US findings and the role of repeat US in diagnosis.

    PubMed

    Akay, Hatice Ozturkmen; Senturk, Senem; Cigdem, M Kemal; Bayrak, Aylin H; Ozdemir, Erdal

    2008-06-01

    We represent the US findings of isolated gallbladder rupture caused by blunt abdominal trauma in a 13-year-old boy. At the initial US examination, although a pericholecystic fluid collection was observed, the mildly collapsed gallbladder was regarded as a contracted gallbladder. Even though the patient was haemodynamically stable, repeat US examination after 24 h revealed gallbladder perforation. In haemodynamically stable trauma patients repeated US examinations can be useful and are strongly recommended.

  3. Patient and staff radiation doses from early radiological examinations (1899-1902).

    PubMed

    Kotre, C J; Little, B G

    2006-10-01

    A source of data on radiographic and fluoroscopic examinations, including radiographic technique factors, was used in conjunction with information about cold-cathode X-ray apparatus to estimate patient and staff radiation doses for the years 1899 to 1902 at the Forth Banks Infirmary, Newcastle-upon-Tyne. Physical evidence from representative apparatus of the period was used with a beam spectral simulation program to characterize the X-ray beam, and information about the electrical supply waveform was produced by experimental operation of a contemporary induction coil. Results are given in terms of skin entrance dose, and these are compared with modern values. An estimate of the annual dose received by the radiographer known to have carried out all of the examinations within this period is also given.

  4. Modeling Repeatedly Flaring δ Sunspots.

    PubMed

    Chatterjee, Piyali; Hansteen, Viggo; Carlsson, Mats

    2016-03-11

    Active regions (ARs) appearing on the surface of the Sun are classified into α, β, γ, and δ by the rules of the Mount Wilson Observatory, California on the basis of their topological complexity. Amongst these, the δ sunspots are known to be superactive and produce the most x-ray flares. Here, we present results from a simulation of the Sun by mimicking the upper layers and the corona, but starting at a more primitive stage than any earlier treatment. We find that this initial state consisting of only a thin subphotospheric magnetic sheet breaks into multiple flux tubes which evolve into a colliding-merging system of spots of opposite polarity upon surface emergence, similar to those often seen on the Sun. The simulation goes on to produce many exotic δ sunspot associated phenomena: repeated flaring in the range of typical solar flare energy release and ejective helical flux ropes with embedded cool-dense plasma filaments resembling solar coronal mass ejections.

  5. Modeling Repeatedly Flaring δ Sunspots

    NASA Astrophysics Data System (ADS)

    Chatterjee, Piyali; Hansteen, Viggo; Carlsson, Mats

    2016-03-01

    Active regions (ARs) appearing on the surface of the Sun are classified into α , β , γ , and δ by the rules of the Mount Wilson Observatory, California on the basis of their topological complexity. Amongst these, the δ sunspots are known to be superactive and produce the most x-ray flares. Here, we present results from a simulation of the Sun by mimicking the upper layers and the corona, but starting at a more primitive stage than any earlier treatment. We find that this initial state consisting of only a thin subphotospheric magnetic sheet breaks into multiple flux tubes which evolve into a colliding-merging system of spots of opposite polarity upon surface emergence, similar to those often seen on the Sun. The simulation goes on to produce many exotic δ sunspot associated phenomena: repeated flaring in the range of typical solar flare energy release and ejective helical flux ropes with embedded cool-dense plasma filaments resembling solar coronal mass ejections.

  6. Trinucleotide Repeats: A Structural Perspective

    PubMed Central

    Almeida, Bruno; Fernandes, Sara; Abreu, Isabel A.; Macedo-Ribeiro, Sandra

    2013-01-01

    Trinucleotide repeat (TNR) expansions are present in a wide range of genes involved in several neurological disorders, being directly involved in the molecular mechanisms underlying pathogenesis through modulation of gene expression and/or the function of the RNA or protein it encodes. Structural and functional information on the role of TNR sequences in RNA and protein is crucial to understand the effect of TNR expansions in neurodegeneration. Therefore, this review intends to provide to the reader a structural and functional view of TNR and encoded homopeptide expansions, with a particular emphasis on polyQ expansions and its role at inducing the self-assembly, aggregation and functional alterations of the carrier protein, which culminates in neuronal toxicity and cell death. Detail will be given to the Machado-Joseph Disease-causative and polyQ-containing protein, ataxin-3, providing clues for the impact of polyQ expansion and its flanking regions in the modulation of ataxin-3 molecular interactions, function, and aggregation. PMID:23801983

  7. Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

    PubMed

    Casutt, Alessio; Prella, Maura; Beigelman-Aubry, Catherine; Fitting, Jean-William; Nicod, Laurent; Koutsokera, Angela; Lovis, Alban

    2015-07-01

    Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. TRDB—The Tandem Repeats Database

    PubMed Central

    Gelfand, Yevgeniy; Rodriguez, Alfredo; Benson, Gary

    2007-01-01

    Tandem repeats in DNA have been under intensive study for many years, first, as a consequence of their usefulness as genomic markers and DNA fingerprints and more recently as their role in human disease and regulatory processes has become apparent. The Tandem Repeats Database (TRDB) is a public repository of information on tandem repeats in genomic DNA. It contains a variety of tools for repeat analysis, including the Tandem Repeats Finder program, query and filtering capabilities, repeat clustering, polymorphism prediction, PCR primer selection, data visualization and data download in a variety of formats. In addition, TRDB serves as a centralized research workbench. It provides user storage space and permits collaborators to privately share their data and analysis. TRDB is available at . PMID:17175540

  9. The Bangla clubfoot tool: a repeatability study.

    PubMed

    Evans, Angela Margaret; Perveen, Roksana; Ford-Powell, Vikki A; Barker, Simon

    2014-01-01

    'Walk for Life' (WFL) is the sustainable clubfoot program in Bangladesh, where there are many challenges in implementing the Ponseti technique in a poor and highly populated country. The relapsing tendency of congenital clubfoot deformity means that initial results may well differ from those of the medium and longer term. Over 10000 children with16668 clubfeet have been treated by WFL since its inception in 2009. Such a large project provides both the need to evaluate each individual child's case, and also the opportunity to evaluate the wider WFL program results. Such systematic review requires a measure that is sufficiently robust, yet contextually practical, hence the aim of this work was to develop a tool for this purpose, and to report the examiner reliability. The Bangla clubfoot tool was largely developed from components of existing validated clubfoot assessment measures, and adapted for local use. Three areas of examination are included: parent satisfaction, gait, clinical examination of the clubfoot. A same-subject repeated measures study design was used to assess the intra-rater reliability of a local WFL physiotherapist, and a visiting WFL volunteer. The inter-rater reliability was also assessed, which is relevant for other examiners and other clubfoot projects undertaking evaluation of medium and longer term results. The reliability study was conducted in 37 children who had commenced treatment for congenital clubfoot deformity using Ponseti method within the previous two years. The mean age of the children was 2.6 years, with gender 28 male: 9 female. The intra-rater reliability results [ICCs (95% CI)] were: 0.87 (0.76 - 0.93) for the local WFL examiner, and 0.82 (0.64 - 0.91) for the visiting examiner. Inter-rater reliability results [ICCs (95% CI)] were: 0.92 (0.88 - 0.96). Hence the tool showed very good intra-rater and inter-rater reliability, rendering it suitable for use. The Bangla clubfoot tool has been developed to suit the context of the

  10. The Bangla clubfoot tool: a repeatability study

    PubMed Central

    2014-01-01

    Background ‘Walk for Life’ (WFL) is the sustainable clubfoot program in Bangladesh, where there are many challenges in implementing the Ponseti technique in a poor and highly populated country. The relapsing tendency of congenital clubfoot deformity means that initial results may well differ from those of the medium and longer term. Over 10000 children with16668 clubfeet have been treated by WFL since its inception in 2009. Such a large project provides both the need to evaluate each individual child’s case, and also the opportunity to evaluate the wider WFL program results. Such systematic review requires a measure that is sufficiently robust, yet contextually practical, hence the aim of this work was to develop a tool for this purpose, and to report the examiner reliability. Methods The Bangla clubfoot tool was largely developed from components of existing validated clubfoot assessment measures, and adapted for local use. Three areas of examination are included: parent satisfaction, gait, clinical examination of the clubfoot. A same-subject repeated measures study design was used to assess the intra-rater reliability of a local WFL physiotherapist, and a visiting WFL volunteer. The inter-rater reliability was also assessed, which is relevant for other examiners and other clubfoot projects undertaking evaluation of medium and longer term results. Results The reliability study was conducted in 37 children who had commenced treatment for congenital clubfoot deformity using Ponseti method within the previous two years. The mean age of the children was 2.6 years, with gender 28 male: 9 female. The intra-rater reliability results [ICCs (95% CI)] were: 0.87 (0.76 – 0.93) for the local WFL examiner, and 0.82 (0.64 – 0.91) for the visiting examiner. Inter-rater reliability results [ICCs (95% CI)] were: 0.92 (0.88 – 0.96). Hence the tool showed very good intra-rater and inter-rater reliability, rendering it suitable for use. Conclusions The Bangla clubfoot tool

  11. The Effects of Repeated Readings on Student Performance in the Corrective Reading Program.

    ERIC Educational Resources Information Center

    Steventon, Candace E.; Fredrick, Laura D.

    2003-01-01

    Examines the effects of adding a repeated reading intervention in the context of the "Corrective Reading Decoding Strategies B2" program on the oral reading fluency of three alternative middle school students for practiced and nonpracticed passages. Concludes that the repeated reading had positive effects for practiced passages but not…

  12. Variables Associated with Repeated Suicide Attempt in a Criminal Justice Population

    ERIC Educational Resources Information Center

    Hakansson, Anders; Bradvik, Louise; Schlyter, Frans; Berglund, Mats

    2011-01-01

    The aim of this study was to identify factors associated with repeated suicide attempts among criminal justice clients examined for substance abuse using the Addiction Severity Index. Among suicide attempters (n = 1,404), repeaters (two or more attempts, n = 770) were compared to nonrepeaters. In logistic regression, repetition was associated with…

  13. Children's Conceptions of Bullying and Repeated Conventional Transgressions: Moral, Conventional, Structuring and Personal-Choice Reasoning

    ERIC Educational Resources Information Center

    Thornberg, Robert; Thornberg, Ulrika Birberg; Alamaa, Rebecca; Daud, Noor

    2016-01-01

    This study examined 307 elementary school children's judgements and reasoning about bullying and other repeated transgressions when school rules regulating these transgressions have been removed in hypothetical school situations. As expected, children judged bullying (repeated moral transgressions) as wrong independently of rules and as more wrong…

  14. What Children Recall about a Repeated Event When One Instance Is Different from the Others

    ERIC Educational Resources Information Center

    Connolly, Deborah A.; Gordon, Heidi M.; Woiwod, Dayna M.; Price, Heather L.

    2016-01-01

    This research examined whether a memorable and unexpected change (deviation details) presented during 1 instance of a repeated event facilitated children's memory for that instance and whether a repeated event facilitated children's memory for deviation details. In Experiments 1 and 2, 8-year-olds (N = 167) watched 1 or 4 live magic shows.…

  15. Variables Associated with Repeated Suicide Attempt in a Criminal Justice Population

    ERIC Educational Resources Information Center

    Hakansson, Anders; Bradvik, Louise; Schlyter, Frans; Berglund, Mats

    2011-01-01

    The aim of this study was to identify factors associated with repeated suicide attempts among criminal justice clients examined for substance abuse using the Addiction Severity Index. Among suicide attempters (n = 1,404), repeaters (two or more attempts, n = 770) were compared to nonrepeaters. In logistic regression, repetition was associated with…

  16. Variability in Muscle Damage after Eccentric Exercise and the Repeated Bout Effect

    ERIC Educational Resources Information Center

    Chen, Trevor C.

    2006-01-01

    The first purpose of this study was to determine a possible explanation for the variability in the response to eccentric exercise by having participants repeat the same exercise 1 year apart. The second purpose was to examine whether initial injury in response to eccentric exercise was associated with the extent of the repeated bout effect (RBE).…

  17. Variability in Muscle Damage after Eccentric Exercise and the Repeated Bout Effect

    ERIC Educational Resources Information Center

    Chen, Trevor C.

    2006-01-01

    The first purpose of this study was to determine a possible explanation for the variability in the response to eccentric exercise by having participants repeat the same exercise 1 year apart. The second purpose was to examine whether initial injury in response to eccentric exercise was associated with the extent of the repeated bout effect (RBE).…

  18. What Children Recall about a Repeated Event When One Instance Is Different from the Others

    ERIC Educational Resources Information Center

    Connolly, Deborah A.; Gordon, Heidi M.; Woiwod, Dayna M.; Price, Heather L.

    2016-01-01

    This research examined whether a memorable and unexpected change (deviation details) presented during 1 instance of a repeated event facilitated children's memory for that instance and whether a repeated event facilitated children's memory for deviation details. In Experiments 1 and 2, 8-year-olds (N = 167) watched 1 or 4 live magic shows.…

  19. Short Tandem Repeat DNA Internet Database

    National Institute of Standards and Technology Data Gateway

    SRD 130 Short Tandem Repeat DNA Internet Database (Web, free access)   Short Tandem Repeat DNA Internet Database is intended to benefit research and application of short tandem repeat DNA markers for human identity testing. Facts and sequence information on each STR system, population data, commonly used multiplex STR systems, PCR primers and conditions, and a review of various technologies for analysis of STR alleles have been included.

  20. Understanding and identifying amino acid repeats

    PubMed Central

    Nijveen, Harm

    2014-01-01

    Amino acid repeats (AARs) are abundant in protein sequences. They have particular roles in protein function and evolution. Simple repeat patterns generated by DNA slippage tend to introduce length variations and point mutations in repeat regions. Loss of normal and gain of abnormal function owing to their variable length are potential risks leading to diseases. Repeats with complex patterns mostly refer to the functional domain repeats, such as the well-known leucine-rich repeat and WD repeat, which are frequently involved in protein–protein interaction. They are mainly derived from internal gene duplication events and stabilized by ‘gate-keeper’ residues, which play crucial roles in preventing inter-domain aggregation. AARs are widely distributed in different proteomes across a variety of taxonomic ranges, and especially abundant in eukaryotic proteins. However, their specific evolutionary and functional scenarios are still poorly understood. Identifying AARs in protein sequences is the first step for the further investigation of their biological function and evolutionary mechanism. In principle, this is an NP-hard problem, as most of the repeat fragments are shaped by a series of sophisticated evolutionary events and become latent periodical patterns. It is not possible to define a uniform criterion for detecting and verifying various repeat patterns. Instead, different algorithms based on different strategies have been developed to cope with different repeat patterns. In this review, we attempt to describe the amino acid repeat-detection algorithms currently available and compare their strategies based on an in-depth analysis of the biological significance of protein repeats. PMID:23418055

  1. Visual Scan Adaptation During Repeated Visual Search

    DTIC Science & Technology

    2010-01-01

    repeated distractor –target configurations both require environmental stability. For stable distractor – target configurations, Chun and Jiang (1998) have...demon- strated search time savings from repeating distractor –target configurations, and Song and Jiang (2005) demonstrated that as little as 25% of the...search environment (i.e., two distractor locations and the target location out of 12 total locations per trial) repeated from trial to trial resulted

  2. Repeat Concussions in the National Football League

    PubMed Central

    Casson, Ira R.; Viano, David C.; Powell, John W.; Pellman, Elliot J.

    2011-01-01

    Background: Repeat concussion is an important issue in the National Football League (NFL). An initial description of repeat injuries was published for 6 years (1996-2001). Hypothesis: The characteristics and frequency of repeat concussion in the NFL have not changed in the subsequent 6 years (2002-2007). Study Design: Case control. Methods: From 1996 to 2007, concussions were reported using a standardized form documenting signs and symptoms, loss of consciousness and medical action taken. Data on repeat concussions were analyzed for the 12 years and compared between the 2 periods. Results: In 2002-2007, 152 players had repeat concussions (vs 160 in 1996-2001); 44 had 3+ head injuries (vs 52). The positions most often associated with repeat concussion in 2002-2007 were the defensive secondary, kick unit, running back, and linebacker. The odds for repeat concussion were elevated for wide receivers, tight ends, and linebackers but lower than in the earlier period. During 2002-2007, over half of players with repeat concussion were removed from play, and fewer immediately returned (vs 1996-2001). The average duration between concussions was 1.25 years for 2002-2007 and 1.65 years for the 12-year period. Over 12 years, 7.6% of all repeat concussions occurred within 2 weeks of the prior concussion. Conclusions: The defensive secondary, kick unit, running back, and linebacker have the highest incidence of repeat concussion. During 2002-2007, more than half of players with repeat concussion were removed from play, and only a fraction immediately returned. Although concussion was managed more conservatively by team physicians in the recent 6 years, repeat concussions occurred at similar rates during both periods. PMID:23015986

  3. Repeat concussions in the national football league.

    PubMed

    Casson, Ira R; Viano, David C; Powell, John W; Pellman, Elliot J

    2011-01-01

    Repeat concussion is an important issue in the National Football League (NFL). An initial description of repeat injuries was published for 6 years (1996-2001). The characteristics and frequency of repeat concussion in the NFL have not changed in the subsequent 6 years (2002-2007). Case control. From 1996 to 2007, concussions were reported using a standardized form documenting signs and symptoms, loss of consciousness and medical action taken. Data on repeat concussions were analyzed for the 12 years and compared between the 2 periods. In 2002-2007, 152 players had repeat concussions (vs 160 in 1996-2001); 44 had 3+ head injuries (vs 52). The positions most often associated with repeat concussion in 2002-2007 were the defensive secondary, kick unit, running back, and linebacker. The odds for repeat concussion were elevated for wide receivers, tight ends, and linebackers but lower than in the earlier period. During 2002-2007, over half of players with repeat concussion were removed from play, and fewer immediately returned (vs 1996-2001). The average duration between concussions was 1.25 years for 2002-2007 and 1.65 years for the 12-year period. Over 12 years, 7.6% of all repeat concussions occurred within 2 weeks of the prior concussion. The defensive secondary, kick unit, running back, and linebacker have the highest incidence of repeat concussion. During 2002-2007, more than half of players with repeat concussion were removed from play, and only a fraction immediately returned. Although concussion was managed more conservatively by team physicians in the recent 6 years, repeat concussions occurred at similar rates during both periods.

  4. Lambda Exonuclease Digestion of CGG Trinucleotide Repeats

    PubMed Central

    Conroy, R.S.; Koretsky, A.P.; Moreland, J.

    2011-01-01

    Fragile X syndrome and other triplet repeat diseases are characterized by an elongation of a repeating DNA triplet. The ensemble-averaged lambda exonuclease digestion rate of different substrates, including one with an elongated FMR1 gene containing 120 CGG repeats, was measured using absorption and fluorescence spectroscopy. Using magnetic tweezers sequence-dependent digestion rates and pausing was measured for individual lambda exonucleases. Within the triplet repeats a lower average and narrower distribution of rates and a higher frequency of pausing was observed. PMID:19562332

  5. An improved selective-repeat ARQ strategy

    NASA Astrophysics Data System (ADS)

    Weldon, E. J., Jr.

    1982-03-01

    ARQ is the term used for an automatic system which provides error correction by utilizing a constant ratio code and a closed loop to request retransmission of mutilated characters. A selective repeat strategy was described by Stuart (1963). In a selective-repeat ARQ system, blocks are numbered and ACKed (acknowledged) or NACKed by number. Practical selective-repeat ARQ procedures fall far short of channel capacity when the error probability is high. The present investigation is concerned with a new selective-repeat ARQ strategy, which is shown to be superior, with respect to its throughput, to earlier techniques.

  6. Identifying tandem Ankyrin repeats in protein structures.

    PubMed

    Chakrabarty, Broto; Parekh, Nita

    2014-12-30

    Tandem repetition of structural motifs in proteins is frequently observed across all forms of life. Topology of repeating unit and its frequency of occurrence are associated to a wide range of structural and functional roles in diverse proteins, and defects in repeat proteins have been associated with a number of diseases. It is thus desirable to accurately identify specific repeat type and its copy number. Weak evolutionary constraints on repeat units and insertions/deletions between them make their identification difficult at the sequence level and structure based approaches are desired. The proposed graph spectral approach is based on protein structure represented as a graph for detecting one of the most frequently observed structural repeats, Ankyrin repeat. It has been shown in a large number of studies that 3-dimensional topology of a protein structure is well captured by a graph, making it possible to analyze a complex protein structure as a mathematical entity. In this study we show that eigen spectra profile of a protein structure graph exhibits a unique repetitive profile for contiguous repeating units enabling the detection of the repeat region and the repeat type. The proposed approach uses a non-redundant set of 58 Ankyrin proteins to define rules for the detection of Ankyrin repeat motifs. It is evaluated on a set of 370 proteins comprising 125 known Ankyrin proteins and remaining non-solenoid proteins and the prediction compared with UniProt annotation, sequence-based approach, RADAR, and structure-based approach, ConSole. To show the efficacy of the approach, we analyzed the complete PDB structural database and identified 641 previously unrecognized Ankyrin repeat proteins. We observe a unique eigen spectra profile for different repeat types and show that the method can be easily extended to detect other repeat types. It is implemented as a web server, AnkPred. It is freely available at 'bioinf.iiit.ac.in/AnkPred'. AnkPred provides an elegant and

  7. Acute versus repeated chocolate exposure: effects on intake and cravings in restrained and unrestrained eaters.

    PubMed

    Coelho, Jennifer S; Nederkoorn, Chantal; Jansen, Anita

    2014-04-01

    The cue-reactivity model, which is based on conditioning processes, posits that repeated food exposure (in the absence of consumption) should decrease cue reactivity. To examine whether repeated chocolate exposure attenuates cravings and intake, relative to those exposed to an acute cue, a 2 (repeated vs acute cue) × 2 (restrained vs unrestrained eaters) design was employed. Fifty female participants were recruited. Repeated exposure reduced cravings in unrestrained eaters (relative to acute exposure), but increased cravings in restrained eaters. An interaction between restraint and exposure emerged on intake, such that restrained eaters ate less after acute exposure than did unrestrained eaters.

  8. Witness recall across repeated interviews in a case of repeated abuse.

    PubMed

    Brubacher, Sonja P; La Rooy, David

    2014-02-01

    In this illustrative case study we examine the three forensic interviews of a girl who experienced repeated sexual abuse from ages 7 to 11. She disclosed the abuse after watching a serialized television show that contained a storyline similar to her own experience. This triggered an investigation that ended in successful prosecution of the offender. Because this case involved abuse that was repeated on a weekly basis for 4 years we thus investigated the degree to which the child's narrative reflected specific episodes or generic accounts, and both the interviewer's and child's attempts to elicit and provide, respectively, specific details across the 3 interviews collected in a 1 month period. Across the 3 interviews, the child's account was largely generic, yet on a number of occasions she provided details specific to individual incidents (episodic leads) that could have been probed further. As predicted: earlier interviews were characterized more by episodic than generic prompts and the reverse was true for the third interview; the child often responded using the same style of language (episodic or generic) as the interviewer; and open questions yielded narrative information. We discuss the importance of adopting children's words to specify occurrences, and the potential benefits of permitting generic recall in investigative interviews on children's ability to provide episodic leads. Despite the fact that the testimony was characterized by generic information about what usually happened, rather than specific episodic details about individual occurrences, this case resulted in successful prosecution.

  9. Context dependency of trait repeatability and its relevance for management and conservation of fish populations.

    PubMed

    Killen, S S; Adriaenssens, B; Marras, S; Claireaux, G; Cooke, S J

    2016-01-01

    Repeatability of behavioural and physiological traits is increasingly a focus for animal researchers, for which fish have become important models. Almost all of this work has been done in the context of evolutionary ecology, with few explicit attempts to apply repeatability and context dependency of trait variation toward understanding conservation-related issues. Here, we review work examining the degree to which repeatability of traits (such as boldness, swimming performance, metabolic rate and stress responsiveness) is context dependent. We review methods for quantifying repeatability (distinguishing between within-context and across-context repeatability) and confounding factors that may be especially problematic when attempting to measure repeatability in wild fish. Environmental factors such temperature, food availability, oxygen availability, hypercapnia, flow regime and pollutants all appear to alter trait repeatability in fishes. This suggests that anthropogenic environmental change could alter evolutionary trajectories by changing which individuals achieve the greatest fitness in a given set of conditions. Gaining a greater understanding of these effects will be crucial for our ability to forecast the effects of gradual environmental change, such as climate change and ocean acidification, the study of which is currently limited by our ability to examine trait changes over relatively short time scales. Also discussed are situations in which recent advances in technologies associated with electronic tags (biotelemetry and biologging) and respirometry will help to facilitate increased quantification of repeatability for physiological and integrative traits, which so far lag behind measures of repeatability of behavioural traits.

  10. Context dependency of trait repeatability and its relevance for management and conservation of fish populations

    PubMed Central

    Killen, S. S.; Adriaenssens, B.; Marras, S.; Claireaux, G.; Cooke, S. J.

    2016-01-01

    Repeatability of behavioural and physiological traits is increasingly a focus for animal researchers, for which fish have become important models. Almost all of this work has been done in the context of evolutionary ecology, with few explicit attempts to apply repeatability and context dependency of trait variation toward understanding conservation-related issues. Here, we review work examining the degree to which repeatability of traits (such as boldness, swimming performance, metabolic rate and stress responsiveness) is context dependent. We review methods for quantifying repeatability (distinguishing between within-context and across-context repeatability) and confounding factors that may be especially problematic when attempting to measure repeatability in wild fish. Environmental factors such temperature, food availability, oxygen availability, hypercapnia, flow regime and pollutants all appear to alter trait repeatability in fishes. This suggests that anthropogenic environmental change could alter evolutionary trajectories by changing which individuals achieve the greatest fitness in a given set of conditions. Gaining a greater understanding of these effects will be crucial for our ability to forecast the effects of gradual environmental change, such as climate change and ocean acidification, the study of which is currently limited by our ability to examine trait changes over relatively short time scales. Also discussed are situations in which recent advances in technologies associated with electronic tags (biotelemetry and biologging) and respirometry will help to facilitate increased quantification of repeatability for physiological and integrative traits, which so far lag behind measures of repeatability of behavioural traits. PMID:27382470

  11. A theoretical and experimental evaluation of the microangiographic fluoroscope: A high-resolution region-of-interest x-ray imager

    SciTech Connect

    Jain, Amit; Bednarek, D. R.; Ionita, Ciprian; Rudin, S.

    2011-07-15

    Purpose: The increasing need for better image quality and high spatial resolution for successful endovascular image-guided interventions (EIGIs) and the inherent limitations of the state-of-the-art detectors provide motivation to develop a detector system tailored to the specific, demanding requirements of neurointerventional applications.Method: A microangiographic fluoroscope (MAF) was developed to serve as a high-resolution, region-of-interest (ROI) x-ray imaging detector in conjunction with large lower-resolution full field-of-view (FOV) state-of-the-art x-ray detectors. The newly developed MAF is an indirect x-ray imaging detector capable of providing real-time images (30 frames per second) with high-resolution, high sensitivity, no lag and low instrumentation noise. It consists of a CCD camera coupled to a Gen 2 dual-stage microchannel plate light image intensifier (LII) through a fiber-optic taper. A 300 {mu}m thick CsI(Tl) phosphor serving as the front end is coupled to the LII. The LII is the key component of the MAF and the large variable gain provided by it enables the MAF to operate as a quantum-noise-limited detector for both fluoroscopy and angiography. Results: The linear cascade model was used to predict the theoretical performance of the MAF, and the theoretical prediction showed close agreement with experimental findings. Linear system metrics such as MTF and DQE were used to gauge the detector performance up to 10 cycles/mm. The measured zero frequency DQE(0) was 0.55 for an RQA5 spectrum. A total of 21 stages were identified for the whole imaging chain and each stage was characterized individually. Conclusions: The linear cascade model analysis provides insight into the imaging chain and may be useful for further development of the MAF detector. The preclinical testing of the prototype detector in animal procedures is showing encouraging results and points to the potential for significant impact on EIGIs when used in conjunction with a state

  12. Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study.

    PubMed

    Schoene, Katharina; Rolf, Sascha; Schloma, Denis; John, Silke; Arya, Arash; Dinov, Borislav; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard; Sommer, Philipp

    2015-07-01

    Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter. We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P < 0.001). This resulted in a significant reduction in radiation dose in patients randomized to NFCT [17.4 (IQR 11; 206.6) cGy cm(2)] vs. the CONV group [418.4 (IQR 277; 812.2) cGy cm(2)] (P < 0.001). There were no significant differences in procedure duration between the NFCT group [49.5 (IQR 37; 65) min] when compared with the CONV group [33.5 (IQR 26.3; 55.5) min] (P = 0.053). No adverse events were recorded. Freedom from atrial flutter at 6 months of follow-up was 19/20 (95%) in the NFCT and 18/20 (90%) in the CONV group (n.s.). In this first prospective randomized study, by comparing NFCT with standard fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use. Published on behalf of the European Society of Cardiology. All rights reserved. © The

  13. SU-E-I-22: Dependence On Calibration Phantom and Field Area of the Conversion Factor Used to Calculate Skin Dose During Neuro-Interventional Fluoroscopic Procedures

    SciTech Connect

    Rana, V K; Vijayan, S; Rudin, S R; Bednarek, D R

    2014-06-01

    Purpose: To determine the appropriate calibration factor to use when calculating skin dose with our real-time dose-tracking system (DTS) during neuro-interventional fluoroscopic procedures by evaluating the difference in backscatter from different phantoms and as a function of entrance-skin field area. Methods: We developed a dose-tracking system to calculate and graphically display the cumulative skin-dose distribution in real time. To calibrate the DTS for neuro-interventional procedures, a phantom is needed that closely approximates the scattering properties of the head. We compared the x-ray backscatter from eight phantoms: 20-cm-thick solid water, 16-cm diameter water-filled container, 16-cm CTDI phantom, modified-ANSI head phantom, 20-cm-thick PMMA, Kyoto-Kagaku PBU- 50 head, Phantom-Labs SK-150 head, and RSD RS-240T head. The phantoms were placed on the patient table with the entrance surface at 15 cm tube-side from the isocenter of a Toshiba Infinix C-arm, and the entrance-skin exposure was measured with a calibrated 6-cc PTW ionization chamber. The measurement included primary radiation, backscatter from the phantom and forward scatter from the table and pad. The variation in entrance-skin exposure was also measured as a function of the skin-entrance area for a 30x30 cm by 20-cm-thick PMMA phantom and the SK-150 head phantom using four different added beam filters. Results: The entranceskin exposure values measured for eight different phantoms differed by up to 12%, while the ratio of entrance exposure of all phantoms relative to solid water showed less than 3% variation with kVp. The change in entrance-skin exposure with entrance-skin area was found to differ for the SK-150 head compared to the 20-cm PMMA phantom and the variation with field area was dependent on the added beam filtration. Conclusion: To accurately calculate skin dose for neuro-interventional procedures with the DTS, the phantom for calibration should be carefully chosen since different

  14. SU-C-210-04: Considerable Pancreatic Tumor Motion During Breath-Hold Measured Using Intratumoral Fiducials On Fluoroscopic Movies

    SciTech Connect

    Lens, E; Horst, A van der; Versteijne, E; Tienhoven, G van; Bel, A

    2015-06-15

    Purpose: Using a breath hold (BH) technique during radiotherapy of pancreatic tumors is expected to reduce intra-fractional motion. The aim of this study was to evaluate the tumor motion during BH. Methods: In this pilot study, we included 8 consecutive pancreatic cancer patients. All had 2– 4 intratumoral gold fiducials. Patients were asked to perform 3 consecutive 30-second end-inhale BHs on day 5, 10 and 15 of their three-week treatment. During BH, airflow through a mouthpiece was measured using a spirometer. Any inadvertent flow of air during BH was monitored for all patients. We measured tumor motion on lateral fluoroscopic movies (57 in total) made during BH. In each movie the fiducials as a group were tracked over time in superior-inferior (SI) and anterior-posterior (AP) direction using 2-D image correlation between consecutive frames. We determined for each patient the range of intra-BH motion over all movies; we also determined the absolute means and standard deviations (SDs) for the entire patient group. Additionally, we investigated the relation between inadvertent airflow during BH and the intra-BH motion. Results: We found intra-BH tumor motion of up to 12.5 mm (range, 1.0–12.5 mm) in SI direction and up to 8.0 mm (range, 1.0–8.0 mm) in AP direction. The absolute mean motion over the patient population was 4.7 (SD: 3.0) mm and 2.8 (SD: 1.2) mm in the SI and AP direction, respectively. Patients were able to perform stable consecutive BHs; during only 20% of the movies we found very small airflows (≤ 65 ml). These were mostly stepwise in nature and could not explain the continuous tumor motions we observed. Conclusion: We found substantial (up to 12.5 mm) pancreatic tumor motion during BHs. We found minimal inadvertent airflow, seen only during a minority of BHs, and this did not explain the obtained results. This work was supported by the foundation Bergh in het Zadel through the Dutch Cancer Society (KWF Kankerbestrijding) project No. UVA 2011-5271.

  15. Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

    PubMed Central

    Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A.; Pampati, Vidyasagar; Datta, Sukdeb

    2012-01-01

    Study Design: A randomized, active control, double-blind trial. Objective: To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome. Summary of Background Data: There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome. Methods: This active control randomized study included 140 patients with 70 patients in each group. Group I received 0.5% lidocaine, 10 mL; Group II received 9 mL of 0.5% lidocaine mixed with 1 mL of 6 mg of nonparticulate betamethasone. The multiple outcome measures included the numeric rating scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as at least 50% improvement in pain and Oswestry Disability Index scores. Patients with a positive response to the first 2 procedures with at least 3 weeks of relief were considered to be successful. All others were considered as failures. Results: Overall in Group I, 53% and 47% of the patients and in Group II, 59% and 58% of the patients, showed significant improvement with reduction in pain scores and disability index at 12 months and 24 months. In contrast, in the successful groups, significant pain relief and improvement in function were observed in 70% and 62% of Group I at one and 2 years; in 75% and 69% of Group II at one and 2 years. The results in the successful group showed that at the end of the first year patients experienced approximately 38 weeks of relief and at the end of 2 years Group I had 62 weeks and Group II had 68 weeks of relief. Overall total relief for 2 years was 48 weeks in Group I and 54 weeks in Group II. The average procedures in the successful groups were at 4 in one year and 6 at

  16. Comparative studies of the CAG repeats in the spinocerebellar ataxia type 1 (SCA1) gene.

    PubMed

    Limprasert, P; Nouri, N; Nopparatana, C; Deininger, P L; Keats, B J

    1997-09-19

    The CAG repeat tract at the autosomal dominant spinocerebellar ataxia type 1 (SCA1) locus was analyzed in SCA1 families and French-Acadian, African-American, Caucasian, Greenland Inuit, and Thai populations. The normal alleles had 9-37 repeats, whereas disease alleles contained 44-64 repeats. The CAG repeat tract contained one or two CAT interruptions in 44 of 47 normal human chromosomes and in all five chimpanzees examined. In contrast, no CAT interruptions were found in Old World monkeys or expanded human alleles. The number and positions of CAT interruptions may be important in stabilizing CAG repeat tracts in normal chromosomes. At least five codons occupy the region corresponding to the polyglutamine tract at the SCA1 locus in mice, rats, and other rodents. They comprise three or four CCN (coding for proline) in addition to one or two CAG repeats.

  17. Repeats, longevity and the sources of mtDNA deletions: evidence from “deletional spectra”

    PubMed Central

    Guo, Xinhong; Popadin, Konstantin Yu.; Markuzon, Natalya; Orlov, Yuriy L.; Kraytsberg, Yevgenya; Krishnan, Kim. J.; Zsurka, Gabor; Turnbull, Douglas M.; Kunz, Wolfram S.; Khrapko, Konstantin

    2010-01-01

    Perfect direct repeats and, in particular, the prominent 13-bp repeat, are thought to cause mitochondrial DNA (mtDNA) deletions, which have been associated with the aging process. Accordingly, individuals lacking the 13-bp repeat are highly prevalent among centenarians and the number of repeats negatively correlates with mammalian longevity. However, detailed examination of the distribution of mtDNA deletions challenges the role of the 13-bp repeat and other perfect repeats in generating mtDNA deletions. Instead, deletions appear to depend on long and stable, albeit imperfect, duplexes between distant mtDNA segments. Furthermore, significant dissimilarities in breakpoint distributions suggest that multiple mechanisms are involved in creating mtDNA deletions. PMID:20591530

  18. All repeats are not equal: a module-based approach to guide repeat protein design.

    PubMed

    Sawyer, Nicholas; Chen, Jieming; Regan, Lynne

    2013-05-27

    Repeat proteins composed of tandem arrays of a short structural motif often mediate protein-protein interactions. Past efforts to design repeat protein-based molecular recognition tools have focused on the creation of templates from the consensus of individual repeats, regardless of their natural context. Such an approach assumes that all repeats are essentially equivalent. In this study, we present the results of a "module-based" approach in which modules composed of tandem repeats are aligned to identify repeat-specific features. Using this approach to analyze tetratricopeptide repeat modules that contain three tandem repeats (3TPRs), we identify two classes of 3TPR modules with distinct structural signatures that are correlated with different sets of functional residues. Our analyses also reveal a high degree of correlation between positions across the entire ligand-binding surface, indicative of a coordinated, coevolving binding surface. Extension of our analyses to different repeat protein modules reveals more examples of repeat-specific features, especially in armadillo repeat modules. In summary, the module-based analyses that we present effectively capture key repeat-specific features that will be important to include in future repeat protein design templates.

  19. Repeatability of sonographic measurements in clubfeet.

    PubMed

    Aurell, Y; Adlercreutz, C; Andriesse, H; Jonsson, K

    2004-10-01

    To assess the intra- and interobserver agreement of ultrasound assessment of clubfoot patho-anatomy in early childhood. Seventeen clubfeet in 12 children were sequentially scanned by 2 examiners and repeat assessments were carried out independently. Three well-defined imaging planes were chosen to evaluate navicular displacement: the medial malleolus-navicular (MM-N) distance, soft tissue thickness, talar deformity and the calcaneo-cuboid (C-C) distance. Intra- and interobserver agreement was analysed using Cohen's kappa for the discrete variables and by Bland-Altman's graphic technique for measurements. Kappa values for intra-observer agreement were 0.82 for navicular displacement, 0.93 for "talar head pointing laterally", and 0.70 for medial deviation of the talar neck. The corresponding interobserver kappa values were 0.70, 0.68, and 0.36. The mean difference between the two observers for the MM-N distance was 0.42 +/- 3.0 mm and for the soft tissue thickness 0.35 +/- 2.0 mm; the C-C distance showed a mean interobserver distance of 0.0 +/- 2.8 mm. The imaging planes used to study the talo-navicular and calcaneo-cuboid relationships are reproducible and relatively easy to learn. Intra- and interobserver assessments were acceptable for MM-N distance, soft tissue thickness, navicular displacement and "talar head pointing laterally", but questionable for the C-C distance and medial deviation of the talar neck.

  20. Autonomy facilitates repeated maximum force productions.

    PubMed

    Iwatsuki, Takehiro; Abdollahipour, Reza; Psotta, Rudolf; Lewthwaite, Rebecca; Wulf, Gabriele

    2017-08-30

    Performer autonomy (or self-control) has consistently been shown to enhance motor learning, and it can also provide immediate benefits for motor performance. Autonomy is also a key variable in the OPTIMAL theory of motor learning (Wulf & Lewthwaite, 2016). It is assumed to contribute to enhanced expectancies and goal-action coupling, affecting performance effectiveness and efficiency. The purpose of the present study was to examine whether providing autonomy support by giving performers choices would enhance their ability to maintain maximum force levels. Participants were asked to repeatedly produce maximum forces using a hand dynamometer. After 2 initial trials with the dominant and non-dominant hand, stratified randomization was used to assign participants with the same average maximum force to one of two groups, choice or yoked control groups. Choice group participants were able to choose the order of hands (dominant, non-dominant) on the remaining trials (3 per hand). For control group participants, hand order was determined by choice-group counterparts. Maximum forces decreased significantly across trials in the control group, whereas choice group participants were able to maintain the maximum forces produced on the first trial. We interpret these findings as evidence that performer autonomy promotes movement efficiency. The results are in line with the view that autonomy facilitates the coupling of goals and actions (Wulf & Lewthwaite, 2016). Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Trinucleotide repeats associated with human disease.

    PubMed Central

    Mitas, M

    1997-01-01

    Triplet repeat expansion diseases (TREDs) are characterized by the coincidence of disease manifestation with amplification of d(CAG. CTG), d(CGG.CCG) or d(GAA.TTC) repeats contained within specific genes. Amplification of triplet repeats continues in offspring of affected individuals, which generally results in progressive severity of the disease and/or an earlier age of onset, phenomena clinically referred to as 'anticipation'. Recent biophysical and biochemical studies reveal that five of the six [d(CGG)n, d(CCG)n, (CAG)n, d(CTG)n and d(GAA)n] complementary sequences that are associated with human disease form stable hairpin structures. Although the triplet repeat sequences d(GAC)n and d(GTC)n also form hairpins, repeats of the double-stranded forms of these sequences are conspicuously absent from DNA sequence databases and are not anticipated to be associated with human disease. With the exception of d(GAG)n and d(GTG)n, the remaining triplet repeat sequences are unlikely to form hairpin structures at physiological salt and temperature. The details of hairpin structures containing trinucleotide repeats are summarized and discussed with respect to potential mechanisms of triplet repeat expansion and d(CGG.CCG) n methylation/demethylation. PMID:9171073

  2. Nasal PMN response to repeated challenge with endotoxin in healthy volunteers**

    EPA Science Inventory

    Abstract Rationale: We have employed nasal challenge with Iipopolysaccharid (lPS) followed by nasal lavage (NU to experimentally induce and examine upper airway inflammation in human volunteers.It is unclear however whether adaptation within individuals occurs following repeated ...

  3. Children's Cognitive Maps of Large-Scale Spaces: Effects of Exploration, Direction, and Repeated Experience.

    ERIC Educational Resources Information Center

    Herman, James F.

    1980-01-01

    Three experiments were conducted to examine the particular aspects of repeated experiences in a large-scale environment on the development of children's cognitive maps. Subjects were kindergartners and third graders. (MP)

  4. Nasal PMN response to repeated challenge with endotoxin in healthy volunteers**

    EPA Science Inventory

    Abstract Rationale: We have employed nasal challenge with Iipopolysaccharid (lPS) followed by nasal lavage (NU to experimentally induce and examine upper airway inflammation in human volunteers.It is unclear however whether adaptation within individuals occurs following repeated ...

  5. Measurements of the modulation transfer function, normalized noise power spectrum and detective quantum efficiency for two flat panel detectors: a fluoroscopic and a cone beam computer tomography flat panel detectors.

    PubMed

    Benítez, Ricardo Betancourt; Ning, Ruola; Conover, David; Liu, Shaohua

    2009-01-01

    The physical performance of two Flat Panel Detectors has been evaluated. The first Flat Panel Detector is for Fluoroscopic applications, Varian PaxScan 2520, and the second is for Cone Beam Computer Tomography applications, Varian PaxScan 4030CB. First, the spectrum of the X-ray source was measured. Second, the linearity of the detectors was investigated by using an ionization chamber and the average ADU values of the detectors. Third, the temporal resolution was characterized by evaluating their image lag. Fourth, their spatial resolution was characterized by the pre-sampling Modulation Transfer Function. Fifth, the Normalized Noise Power Spectrum was calculated for various exposures levels. Finally, the Detective Quantum Efficiency was obtained as a function of spatial frequency and entrance exposure. The results illustrate that the physical performance in Detective Quantum Efficiency and Normalized Noise Power Spectrum of the Cone Beam Computer Tomography detector is superior to that of the fluoroscopic detector whereas the latter detector has a higher spatial resolution as demonstrated by larger values of its Modulation Transfer Function at large spatial frequencies.

  6. [Repeated head injury during judo practice].

    PubMed

    Fujiwara, Kazue

    2014-01-01

    Mild traumatic brain injuries, if repeated, can cause permanent brain damage, or even death. I examined five published documents(three judicial decisions, one official injury report, and one book)to analyze incidents in which high school students who, while practicing judo, experienced acute subdural hematoma(ASDH)with grave outcomes, despite the fact that they had been examined by neurosurgeons. The five students, first-grade boy and girl of junior high school and two first-grade boys and one second-grade girl of senior high school, were hit on the head during extracurricular judo practice and were taken to the neurosurgery department of different hospitals. They were all novices or unskilled players. The initial diagnoses were ASDH in three cases, concussion in one, and headache in one. Although the surgeons, except in one case, prohibited the students from returning to play, the juveniles resumed judo practice soon. Some of them complained of continued headaches, but they kept practicing. Between 17 and 82 days after the first injury, they received the fateful hits to their heads, and they were brought to the emergency rooms. MRI and CT revealed ASDH in all;two of them died, and the other three remain in persistent vegetative state. Neurosurgeons should take the initiative to prevent severe brain injury of young athletes through collaborations with the athletes themselves, fellow athletes, family members, coaches, teachers, athletic directors, and other physicians. They should pay close attention to headaches and other signs and symptoms of concussion and prohibit the athletes from returning to play until they are confirmed to be symptom free for recommended periods, insisting that safety comes first.

  7. Reward modulation of contextual cueing: Repeated context overshadows repeated target location.

    PubMed

    Sharifian, Fariba; Contier, Oliver; Preuschhof, Claudia; Pollmann, Stefan

    2017-08-07

    Contextual cueing can be enhanced by reward. However, there is a debate if reward is associated with the repeated target-distractor configurations or with the repeated target locations that occur in both repeated and new displays. Based on neuroimaging evidence, we hypothesized that reward becomes associated with the target location only in new displays, but not in repeated displays, where the repeated target location is overshadowed by the more salient repeated target-distractor configuration. To test this hypothesis, we varied the reward value associated with the same target location in repeated and new displays. The results confirmed the overshadowing hypothesis in that search facilitation in repeated target-distractor configurations was modulated by the variable value associated with the target location. This effect was observed mainly in early learning.

  8. A Comparison of DWI Repeaters and Non-repeaters Who Attended a Level I Rehabilitation Program.

    ERIC Educational Resources Information Center

    Landrum, James W.; Windham, Gerald O.

    1981-01-01

    Compares behavioral and demographic characteristics of drunk drivers with repeated arrests and drivers not having repeated arrests, after attending an alcohol education program. Previous public drunkeness and previous drunk driving arrests were strong predictors of repeat arrests and were judged useful in screening offenders for rehabilitation…

  9. A Comparison of DWI Repeaters and Non-repeaters Who Attended a Level I Rehabilitation Program.

    ERIC Educational Resources Information Center

    Landrum, James W.; Windham, Gerald O.

    1981-01-01

    Compares behavioral and demographic characteristics of drunk drivers with repeated arrests and drivers not having repeated arrests, after attending an alcohol education program. Previous public drunkeness and previous drunk driving arrests were strong predictors of repeat arrests and were judged useful in screening offenders for rehabilitation…

  10. Protein binding to expanded telomere repeats in Tetrahymena thermophila.

    PubMed

    McGuire, Jennifer M; Gana, Joyce Ache; Petcherskaia, Marina; Kirk, Karen E

    2003-01-01

    The ends of eukaryotic chromosomes are protected by DNA-protein structures called telomeres. Telomeric DNA is highly conserved, usually consisting of long tracts of a repeating G-rich sequence. Tetrahymena thermophila telomeric DNA consists of alternating blocks of GGGG and TT sequences (i.e. a G4T2 repeat sequence). We examined the relative importance of the guanine and thymine elements of the repeat sequence in promoting in vitro binding by T. thermophila proteins. We identified single- and, for the first time, double-stranded telomere binding activities from a crude T. thermophila protein extract and tested the binding of these activities to altered telomere repeat sequences. All deletions or substitutions made to the guanine element virtually abolished binding, indicating that four G's are essential for recognition by the binding activity. However, G's alone are not sufficient for efficient binding, as elimination of the thymine element dramatically reduced binding. By contrast, substantial expansion of the thymine element was well tolerated, even though one such change, G4T4, is lethal in vivo. We tested up to a four-fold expansion of the thymine element and found that highly efficient binding was still achieved. These results suggest a minimal recognition sequence for T. thermophila proteins, with the T element providing an important spacer between essential G elements.

  11. Metazoan evolution of the armadillo repeat superfamily.

    PubMed

    Gul, Ismail Sahin; Hulpiau, Paco; Saeys, Yvan; van Roy, Frans

    2017-02-01

    The superfamily of armadillo repeat proteins is a fascinating archetype of modular-binding proteins involved in various fundamental cellular processes, including cell-cell adhesion, cytoskeletal organization, nuclear import, and molecular signaling. Despite their diverse functions, they all share tandem armadillo (ARM) repeats, which stack together to form a conserved three-dimensional structure. This superhelical armadillo structure enables them to interact with distinct partners by wrapping around them. Despite the important functional roles of this superfamily, a comprehensive analysis of the composition, classification, and phylogeny of this protein superfamily has not been reported. Furthermore, relatively little is known about a subset of ARM proteins, and some of the current annotations of armadillo repeats are incomplete or incorrect, often due to high similarity with HEAT repeats. We identified the entire armadillo repeat superfamily repertoire in the human genome, annotated each armadillo repeat, and performed an extensive evolutionary analysis of the armadillo repeat proteins in both metazoan and premetazoan species. Phylogenetic analyses of the superfamily classified them into several discrete branches with members showing significant sequence homology, and often also related functions. Interestingly, the phylogenetic structure of the superfamily revealed that about 30 % of the members predate metazoans and represent an ancient subset, which is gradually evolving to acquire complex and highly diverse functions.

  12. Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy.

    PubMed

    Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Matsumoto, Tomohiro; Kakizawa, Hideaki; Toyoda, Naoyuki; Hasebe, Terumitsu; Awai, Kazuo

    2014-05-01

    This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. • CT-guided needle biopsy is a well-established diagnostic technique. • Touch imprint cytological evaluation on site is helpful in improving quality of CT-guided biopsy. • The rate of diagnosing malignant lymphoma specifically with cytological examination is relatively low. • The rate of specific diagnosis of benign lesion in musculoskeletal regions is low.

  13. Relationship of social support and social burden to repeated breast cancer screening in the women's health initiative.

    PubMed

    Messina, Catherine R; Lane, Dorothy S; Glanz, Karen; West, Delia Smith; Taylor, Vicky; Frishman, William; Powell, Lynda

    2004-11-01

    Direct and interactive effects of social support, social burden (caregiving, negative life events, and social strain), education, and income on repeated use of breast cancer screening among a large (N=55,278), national sample of postmenopausal women participating in the Women's Health Initiative observational study were examined. Repeated screening decreased as emotional/informational support and positive social interactions decreased (ps<.01). Repeated mammography decreased with frequent caregiving (p<.01). Less social strain reduced the frequency of repeated breast self-examinations (BSEs; ps<.01), but frequent caregiving and more negative life events increased repeated use of BSE (ps<.01). Interactive effects suggested that emotional/informational but not tangible support is associated with repeated mammography and clinical breast examinations (ps<.01) and may be particularly important among low-income older women, especially those burdened by caregiving.

  14. Extreme variability in the Xp:Yp pseudoautosomal telomere revealed by telomere variant repeat mapping

    SciTech Connect

    Baird, D.M.; Jeffreys A.J.; Royle, N.J.

    1994-09-01

    The presence of telomere variant repeat units in the proximal regions of human telomeres has been demonstrated but the distribution of these repeats and the extent of allelic variation has not been examined. We have developed a PCR based system to assay the distribution of standard (TTAGGG) and variant (TGAGGG, TCAGGG) repeats at the proximal end of the Xp:Yp telomere repeat array. The 1 kb of DNA immediately adjacent to this telomere exhibits a high level of base substitutional polymorphism. In individuals heterozygous for a flanking polymorphism, allele specific primers have been designed to discriminate between the alleles and, in conjunction with a primer complementary to either TTAGGG, TGAGGG or TCAGGG repeats, to determine the distribution of telomere and variant repeat units at the proximal end of an individual telomere. Among the 41 Xp:Yp telomeres mapped to date only 5 are identical and composed solely of (TTAGGG) repeats at the proximal end. The remaining 36 mapped telomeres are all different, although a subset show similarities and are found in association with the same flanking DNA haplotype, suggesting a common ancestry. The telomere variant repeat mapping technique can be used to examine the turnover of these sequences in human populations and in somatic tissues and tumors.

  15. Immigration, local dispersal limitation, and the repeatability of community composition under neutral and niche dynamics.

    PubMed

    Ai, Dexiecuo; Desjardins-Proulx, Philippe; Chu, Chengjin; Wang, Gang

    2012-01-01

    Repeatability of community composition has been a critical aspect for community structure, which is closely associated with community stability, predictability, conservation biology and ecological restoration. It has been shown that both immigration and local dispersal limitation can affect the community composition in both neutral and niche model. Hence, we use a spatially explicit individual-based model to investigate the potential influence of immigration rate and strength of local dispersal limitation on repeatability in both neutral and niche models. Similarity measures are used to quantify repeatability. We examine the repeatability of community composition among replicate communities (which means the same community repeats many times), and between niche and neutral replicate communities. We find the correlation between repeatability and immigration rate is positive in the neutral model and an inverted unimodal in the niche model. The correlation between repeatability and local dispersal distance is positive in the niche model and negative in the neutral model. High repeatability between niche communities and neutral communities is observed with high immigration rates or when high local dispersal distance appears in the niche model or low local dispersal distance in the neutral model. Our results show that repeatability of community composition is not only dependent on the types of community models (niche vs. neutrality) but also strongly determined by immigration rates and local dispersal limitation.

  16. Examining the Forces That Guide Teaching Decisions

    ERIC Educational Resources Information Center

    Griffith, Robin; Massey, Dixie; Atkinson, Terry S.

    2013-01-01

    This study of two successful first grade teachers examines the forces that guide their instructional decisions. Findings reveal the complexities of forces that influence the moment-to-moment decisions made by these teachers. Teachers repeatedly attempted to balance their desires to be student-centered while addressing state standards and…

  17. Source Parameters for Repeating Earthquakes along the Middle America Trench

    NASA Astrophysics Data System (ADS)

    Bilek, S. L.; Phillips, W. S.; Walter, J. I.; Peng, Z.; Schwartz, S. Y.; Brudzinski, M. R.; Yao, D.

    2015-12-01

    Repeating earthquakes, with their similar locations and similar waveforms, are often thought to represent slip along the same patch of fault. Analysis of these earthquake clusters can provide useful information about the nature of the fault and earthquake interaction. Here we focus on sequences of repeating earthquakes along both the Nicoya Peninsula, Costa Rica and along the Oaxaca segment of Mexico, as both megathrust faults have been well instrumented in recent years with local seismic networks able to record the small magnitude earthquakes. These regions have also experienced large megathrust earthquakes as well as non-volcanic tremor and slow slip, suggesting a complex fault system that allows a wide spectrum of slip. We can use source characteristics of the repeating earthquakes to probe this fault complexity. Along the Nicoya Peninsula, there are over 370 repeating earthquakes (M 0.5-3.3) in the 3 months following the 2012 Mw 7.6 megathrust earthquake grouped into 55 distinct clusters. Along Oaxaca, the earthquake clusters or swarms (M 1.5-5.5) span a wider spatial and temporal range. For our source parameter calculations, we form narrow-frequency band envelopes for pairs of earthquakes within the earthquake clusters to compute spectral ratios for each pair. We determine seismic moment, corner frequency, and earthquake stress drop for each earthquake from these spectral ratios. We compare the source parameters for events within the clusters to examine temporal variations and compare between clusters to explore spatial variations that could be linked to other slip heterogeneity. Preliminary results for the Nicoya region suggest nearly identical stress drop for repeating events within clusters located near the 2012 mainshock, and more variability in stress drops for earthquakes in clusters located updip and to the northwest of the mainshock.

  18. Timing of repeat colonoscopy: disparity between guidelines and endoscopists' recommendation.

    PubMed

    Krist, Alex H; Jones, Resa M; Woolf, Steven H; Woessner, Sarah E; Merenstein, Daniel; Kerns, J William; Foliaco, Walter; Jackson, Paul

    2007-12-01

    Colonoscopy possesses the highest sensitivity of available screening tests for colorectal cancer and polyps, but it also carries risks. Appropriate intervals for repeating colonoscopy are important to ensure that the benefits of screening and surveillance are not offset by harms. The study objective was to examine whether endoscopists' recommendations for repeat colonoscopy, as communicated to primary care clinicians after the procedure, adhered to published guidelines. Analysts abstracted medical records at ten primary care practices in Virginia and Maryland in 2006. The records of a random sample of men and women (300 per practice) aged 50 to 70 years were reviewed. The sample included patients who had a colonoscopy and a written report from an endoscopist, and who lacked designated risk factors. The main outcome was concordance between endoscopists' recommendations and published guidelines regarding repeat colonoscopy. Of 3000 charts reviewed, 1282 (42.7%) included records of a colonoscopy and 1021 (34%) included an endoscopist's report. In 64.9% of communications, the endoscopist specified when retesting should occur. Recommendations were consistent with contemporaneous guidelines in only 39.2% of cases and with current guidelines in 36.7% of cases. The adjusted mean number of years in which repeat colonoscopy was recommended was 7.8 years following normal colonoscopy and 5.8 years and 4.4 years, respectively, when hyperplastic polyps or 1-2 small adenomatous polyps were found. Endoscopists often recommended repeat colonoscopy at shorter intervals than are advised either by current guidelines or by guidelines in effect at the time of the procedure. Endoscopists' communications to primary care clinicians often lacked contextual information that might explain these discrepancies. Unless appropriate caveats apply, adhering to endoscopists' recommendations may incur unnecessary harms and costs.

  19. Practical use of the repeating patterns in mask writing

    NASA Astrophysics Data System (ADS)

    Shoji, Masahiro; Inoue, Tadao; Yamabe, Masaki

    2010-03-01

    In May 2006, the Mask Design, Drawing, and Inspection Technology Research Department (Mask D2I) at the Association of Super-Advanced Electronics Technologies (ASET) launched a 4-year program for reducing mask manufacturing cost and TAT by concurrent optimization of MDP, mask writing, and mask inspection. As one of the tasks being pursued at the Mask Design Data Technology Research Laboratory, we have evaluated the effect of reducing the drawing shot counts by utilizing the repeating patterns, and showed positive impact on mask making by using CP drawing. During the past four years, we have developed a software to extract repeating patterns from fractured OPCed mask data which can be used to minimize the shot counts. In this evaluation, we have used an actual device production data obtained from the member companies of MaskD2I. To the extraction software we added new functions for extracting common repeating patterns from a set of multiple masks, and studied how this step can reduce the counts in comparison to the shot counts required during the conventional mask writing techniques. We have also developed software that uses the extraction result of repeating patterns and prepares drawing-data for the MCC/CP drawing system, which has been developed at the Mask Writing Equipment Technology Research Laboratory. With this software, we have simulated EB proximity effect on CP writing and examined how it affect the shot count reduction where CP shots with large CD errors are to be divided into VSB shots. In this paper, we will report the evaluation result of the practical application of repeating patterns in mask writing with this software.

  20. Repeatability and agreement in the measurement of horizontal fusional vergences.

    PubMed

    Antona, B; Barrio, A; Barra, F; Gonzalez, E; Sanchez, I

    2008-09-01

    This study was designed to determine the repeatability of fusional vergence ranges measured using the rotary prisms in the phoropter and in free space using the prism bar. The level of agreement between the two methods was also investigated. In two separate sessions, negative and positive fusional vergence ranges (NFV and PFV, respectively) were measured at distance and near in 61 young adults (mean age 19.74, S.D. 2.5 years) who were unfamiliar with the methods used. Base-in and base-out blur, break and recovery points were sequentially determined. Both sets of measurements were obtained by the same examiner. At each distance, NFV was determined first and then PFV. The repeatability of the tests and agreement between measurements made with the phoropter rotary prisms and the prism bar were estimated by the Bland and Altman method. For both the phoropter rotary prisms and prism bar, NFV measurements showed better repeatability than PFV at both near and distance. Mean differences recorded for the NFV break and recovery points were non-significant (under 0.5Delta), while those observed for PFV were generally greater than 2Delta. When agreement between the two tests was assessed, it was found that break points were higher when determined using the phoropter rotary prisms, while recovery points were generally higher for the prism bar method. In clinical terms, according to the expected values of the NFV and PFV, agreement between the two techniques can be described as fair, because although mean differences were never greater than 5.5Delta, 95% agreement intervals were as wide as +/-8.00Delta for NFV and +/-13.19Delta for PFV. The two methods used to measure fusional vergences showed fairly good inter-session repeatability for measuring NFV but repeatability was reduced for PFV measurements. The level of agreement observed between the two methods was such that their interchangeable use in clinical practice is not recommended.

  1. Epigenetics and Triplet-Repeat Neurological Diseases.

    PubMed

    Nageshwaran, Sathiji; Festenstein, Richard

    2015-01-01

    The term "junk DNA" has been reconsidered following the delineation of the functional significance of repetitive DNA regions. Typically associated with centromeres and telomeres, DNA repeats are found in nearly all organisms throughout their genomes. Repetitive regions are frequently heterochromatinized resulting in silencing of intrinsic and nearby genes. However, this is not a uniform rule, with several genes known to require such an environment to permit transcription. Repetitive regions frequently exist as dinucleotide, trinucleotide, and tetranucleotide repeats. The association between repetitive regions and disease was emphasized following the discovery of abnormal trinucleotide repeats underlying spinal and bulbar muscular atrophy (Kennedy's disease) and fragile X syndrome of mental retardation (FRAXA) in 1991. In this review, we provide a brief overview of epigenetic mechanisms and then focus on several diseases caused by DNA triplet-repeat expansions, which exhibit diverse epigenetic effects. It is clear that the emerging field of epigenetics is already generating novel potential therapeutic avenues for this group of largely incurable diseases.

  2. DNA Triplet Repeat Expansion and Mismatch Repair

    PubMed Central

    Iyer, Ravi R.; Pluciennik, Anna; Napierala, Marek; Wells, Robert D.

    2016-01-01

    DNA mismatch repair is a conserved antimutagenic pathway that maintains genomic stability through rectification of DNA replication errors and attenuation of chromosomal rearrangements. Paradoxically, mutagenic action of mismatch repair has been implicated as a cause of triplet repeat expansions that cause neurological diseases such as Huntington disease and myotonic dystrophy. This mutagenic process requires the mismatch recognition factor MutSβ and the MutLα (and/or possibly MutLγ) endonuclease, and is thought to be triggered by the transient formation of unusual DNA structures within the expanded triplet repeat element. This review summarizes the current knowledge of DNA mismatch repair involvement in triplet repeat expansion, which encompasses in vitro biochemical findings, cellular studies, and various in vivo transgenic animal model experiments. We present current mechanistic hypotheses regarding mismatch repair protein function in mediating triplet repeat expansions and discuss potential therapeutic approaches targeting the mismatch repair pathway. PMID:25580529

  3. Newly arisen DNA repeats in primate phylogeny.

    PubMed

    Ryan, S C; Dugaiczyk, A

    1989-12-01

    We discovered the presence of an Alu and an Xba repetitive DNA element within introns 4 and 7, respectively, of the human alpha-fetoprotein (AFP) gene; these elements are absent from the same gene in the gorilla. The Alu element is flanked by 12-base-pair direct repeats, AGGATGTTGTGG ... (Alu) ... AGGATGTTGTGG, which presumably arose by way of duplication of the intronic target site AGGATGTTGTGG at the time of the Alu insertion. In the gorilla, only a single copy of the unoccupied target site is present, which is identical to the terminal repeat flanking the human Alu element. There are two copies of an Xba repeat in the human AFP gene, apparently the only two in the genome. Xba1 and Xba2, located within introns 8 and 7, respectively, differ from each other at 3 of 303 positions. Xba1 is referred to as the old (ancestral) repeat because it lacks direct repeats. The new (derived) Xba2 is flanked by direct repeats, TTTCTTTTT ... (Xba) ... TTTCTTCTT, and is thought to have arisen as a result of transposition of Xba1. The ancestral Xba1 and a single copy of the Xba2 target site are present at orthologous positions in the gorilla, but the new Xba2 is absent. We conclude that the Alu and Xba DNA repeats emerged in the human genome at a time postdating the human-gorilla divergence and became established as genetic novelties in the human lineage. We submit that the chronology of divergence of primate lines of evolution can be correlated with the timing of insertion of new DNA repeats into the genomes of those primates.

  4. Cumulative Effect of Repeated Brief Cerebral Ischemia

    DTIC Science & Technology

    1993-05-31

    KL, Pohost GM and Conger KA, Correlating EEG and Lactate Kinetics During Repeated Brief Cerebral Ischemia, Proceedings of the American Heart Association 1993...Cornelating EEG and Lactate Kinetics During Repeated Brief Cerebral Ischemia, Proceedings of the American Heart Association 1993. 4) HP Hetherington...thes Bernhard Foundation. ass- 134 󈧑&.1 n5. 9# American Heart Association 026085 66th Scientific Sessions Abstract Form Medical Research Nursing

  5. Repeat radiosurgery for cerebral arteriovenous malformations.

    PubMed

    Awad, Ahmed J; Walcott, Brian P; Stapleton, Christopher J; Ding, Dale; Leed, Cheng-Chia; Loeffler, Jay S

    2015-06-01

    We perform a systematic review of repeat radiosurgery for cerebral arteriovenous malformations (AVM) with an emphasis on lesion obliteration rates and complications. Radiosurgery is an accepted treatment modality for AVM located in eloquent cortex or deep brain structures. For residual or persistent lesions, repeat radiosurgery can be considered if sufficient time has passed to allow for a full appreciation of treatment effects, usually at least 3years. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. References for this review were identified by searches of MEDLINE, Web of Science and Google Scholar databases. A total of 14 studies comprising 733 patients met the review criteria and were included. For series that reported target dose at both first and repeat treatments, the weighted means were 19.42Gy and 19.06Gy, respectively. The mean and median obliteration rate for the repeat radiosurgery treatments were 61% (95% confidence interval 51.9-71.7%) and 61.5%, respectively. The median follow up following radiosurgery ranged from 19.5 to 80months. Time to complete obliteration after the repeat treatment ranged from 21 to 40.8months. The most common complications of repeat radiosurgery for AVM included hemorrhage (7.6%) and radiation-induced changes (7.4%). Repeat radiosurgery can be used to treat incompletely obliterated AVM with an obliteration rate of 61%. Complications are related to treatment effect latency (hemorrhage risk) as well as radiation-induced changes. Repeat radiosurgery can be performed at 3 years following the initial treatment, allowing for full realization of effects from the initial treatment prior to commencing therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Repeat radiosurgery for cerebral arteriovenous malformations

    PubMed Central

    Stapleton, Christopher J.; Ding, Dale; Leed, Cheng-Chia; Loeffler, Jay S.

    2015-01-01

    We perform a systematic review of repeated radiosurgery for cerebral arteriovenous malformations (AVM) with an emphasis on lesion obliteration rates and complications. Radiosurgery is an accepted treatment modality for AVM located in eloquent cortex or deep brain structures. For residual or persistent lesions, repeated radiosurgery can be considered if sufficient time has passed to allow for a full appreciation of treatment effects, usually at least 3 years. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. References for this review were identified by searches of MEDLINE, Web of Science and Google Scholar databases. A total of 14 studies comprising 733 patients met the review criteria and were included. For series that reported target dose at both first and repeat treatments, the weighted means were 19.42 Gy and 19.06 Gy, respectively. The mean and median obliteration rate for the repeat radiosurgery treatments were 61% (95% confidence interval 51.9–71.7%) and 61.5%, respectively. The median follow up following radiosurgery ranged from 19.5 to 80 months. Time to complete obliteration after the repeat treatment ranged from 21 to 40.8 months. The most common complications of repeated radiosurgery for AVM included hemorrhage (7.6%) and radiation-induced changes (7.4%). Repeat radiosurgery can be used to treat incompletely obliterated AVM with an obliteration rate of 61%. Complications are related to treatment effect latency (hemorrhage risk) as well as radiation-induced changes. Repeat radiosurgery can be performed at three years following the initial treatment, allowing for full realization of effects from the initial treatment prior to commencing therapy. PMID:25913746

  7. Security of Quantum Repeater Network Operation

    DTIC Science & Technology

    2016-10-03

    can disrupt operation of the network. Our work produced a first-of-its-kind taxonomy of potential attacks on quantum repeater network operations...behaving node, or a small number of them, can disrupt operation of the network. Our work produced a first-of-its-kind taxonomy of potential attacks on...created a taxonomy of possible attacks on repeater nodes, published in SENT 2015 (Suzuki & Van Meter, 2015). We modeled our taxonomy after security

  8. Monitoring plant phenology using digital repeat photography.

    PubMed

    Crimmins, Michael A; Crimmins, Theresa M

    2008-06-01

    Repeated observations of plant phenology have been shown to be important indicators of global change. However, capturing the exact date of key events requires daily observations during the growing season, making phenologic observations relatively labor intensive and costly to collect. One alternative to daily observations for capturing the dates of key phenologic events is repeat photography. In this study, we explored the utility of repeat digital photography for monitoring phenologic events in plants. We provide an illustration of this approach and its utility by placing observations made using repeat digital imagery in context with local meteorologic and edaphic variables. We found that repeat photography provides a reliable, consistent measurement of phenophase. In addition, digital photography offers advantages in that it can be mathematically manipulated to detect and enhance patterns; it can classify objects; and digital photographs can be archived for future analysis. In this study, an estimate of greenness and counts of individual flowers were extracted by way of mathematic algorithms from the photo time series. These metrics were interpreted using meteorologic measurements collected at the study site. We conclude that repeat photography, coupled with site-specific meteorologic measurements, could greatly enhance our understanding environmental triggers of phenologic events. In addition, the methods described could easily be adopted by citizen scientists and the general public as well as professionals in the field.

  9. Digital repeat analysis; setup and operation.

    PubMed

    Nol, J; Isouard, G; Mirecki, J

    2006-06-01

    Since the emergence of digital imaging, there have been questions about the necessity of continuing reject analysis programs in imaging departments to evaluate performance and quality. As a marketing strategy, most suppliers of digital technology focus on the supremacy of the technology and its ability to reduce the number of repeats, resulting in less radiation doses given to patients and increased productivity in the department. On the other hand, quality assurance radiographers and radiologists believe that repeats are mainly related to positioning skills, and repeat analysis is the main tool to plan training needs to up-skill radiographers. A comparative study between conventional and digital imaging was undertaken to compare outcomes and evaluate the need for reject analysis. However, digital technology still being at its early development stages, setting a credible reject analysis program became the major task of the study. It took the department, with the help of the suppliers of the computed radiography reader and the picture archiving and communication system, over 2 years of software enhancement to build a reliable digital repeat analysis system. The results were supportive of both philosophies; the number of repeats as a result of exposure factors was reduced dramatically; however, the percentage of repeats as a result of positioning skills was slightly on the increase for the simple reason that some rejects in the conventional system qualifying for both exposure and positioning errors were classified as exposure error. The ability of digitally adjusting dark or light images reclassified some of those images as positioning errors.

  10. Remarkable selective constraints on exonic dinucleotide repeats.

    PubMed

    Haasl, Ryan J; Payseur, Bret A

    2014-09-01

    Long dinucleotide repeats found in exons present a substantial mutational hazard: mutations at these loci occur often and generate frameshifts. Here, we provide clear and compelling evidence that exonic dinucleotides experience strong selective constraint. In humans, only 18 exonic dinucleotides have repeat lengths greater than six, which contrasts sharply with the genome-wide distribution of dinucleotides. We genotyped each of these dinucleotides in 200 humans from eight 1000 Genomes Project populations and found a near-absence of polymorphism. More remarkably, divergence data demonstrate that repeat lengths have been conserved across the primate phylogeny in spite of what is likely considerable mutational pressure. Coalescent simulations show that even a very low mutation rate at these loci fails to explain the anomalous patterns of polymorphism and divergence. Our data support two related selective constraints on the evolution of exonic dinucleotides: a short-term intolerance for any change to repeat length and a long-term prevention of increases to repeat length. In general, our results implicate purifying selection as the force that eliminates new, deleterious mutants at exonic dinucleotides. We briefly discuss the evolution of the longest exonic dinucleotide in the human genome--a 10 x CA repeat in fibroblast growth factor receptor-like 1 (FGFRL1)--that should possess a considerably greater mutation rate than any other exonic dinucleotide and therefore generate a large number of deleterious variants. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.

  11. Dynamic combinatorial libraries of artificial repeat proteins.

    PubMed

    Eisenberg, Margarita; Shumacher, Inbal; Cohen-Luria, Rivka; Ashkenasy, Gonen

    2013-06-15

    Repeat proteins are found in almost all cellular systems, where they are involved in diverse molecular recognition processes. Recent studies have suggested that de novo designed repeat proteins may serve as universal binders, and might potentially be used as practical alternative to antibodies. We describe here a novel chemical methodology for producing small libraries of repeat proteins, and screening in parallel the ligand binding of library members. The first stage of this research involved the total synthesis of a consensus-based three-repeat tetratricopeptide (TPR) protein (~14 kDa), via sequential attachment of the respective peptides. Despite the effectiveness of the synthesis and ligation steps, this method was found to be too demanding for the production of proteins containing variable number of repeats. Additionally, the analysis of binding of the individual proteins was time consuming. Therefore, we designed and prepared novel dynamic combinatorial libraries (DCLs), and show that their equilibration can facilitate the formation of TPR proteins containing up to eight repeating units. Interestingly, equilibration of the library building blocks in the presence of the biologically relevant ligands, Hsp90 and Hsp70, induced their oligomerization into forming more of the proteins with large recognition surfaces. We suggest that this work presents a novel simple and rapid tool for the simultaneous screening of protein mixtures with variable binding surfaces, and for identifying new binders for ligands of interest.

  12. Directly repeated sequences associated with pathogenic mitochondrial DNA deletions.

    PubMed Central

    Johns, D R; Rutledge, S L; Stine, O C; Hurko, O

    1989-01-01

    We determined the nucleotide sequences of junctional regions associated with large deletions of mitochondrial DNA found in four unrelated individuals with a phenotype of chronic progressive external ophthalmoplegia. In each patient, the deletion breakpoint occurred within a directly repeated sequence of 13-18 base pairs, present in different regions of the normal mitochondrial genome-separated by 4.5-7.7 kilobases. In two patients, the deletions were identical. When all four repeated sequences are compared, a consensus sequence of 11 nucleotides emerges, similar to putative recombination signals, suggesting the involvement of a recombinational event. Partially deleted and normal mitochondrial DNAs were found in all tissues examined, but in very different proportions, indicating that these mutations originated before the primary cell layers diverged. Images PMID:2813377

  13. Repeated Names, Overt Pronouns, and Null Pronouns in Spanish

    PubMed Central

    Lezama, Carlos Gelormini; Almor, Amit

    2010-01-01

    In two self-paced, sentence-by-sentence reading experiments we examined the difference in the processing of Spanish discourses with repeated names, overt pronouns, and null pronouns in emphatic and non-emphatic contexts. In Experiment 1, repeated names and overt pronouns caused a processing delay when they referred to salient antecedents in non-emphatic contexts. In Experiment 2, both processing delays were eliminated when an emphatic cleft-structure was used. The processing delay caused by overt pronouns referring to salient antecedents in non-emphatic contexts in Spanish contrasts with previous findings in Chinese, where null and overt pronouns elicited similar reading times. We explain both our Spanish findings and the Chinese findings in a unified framework based on the notion of balance between processing cost and discourse function in line with the Informational Load Hypothesis. PMID:21552376

  14. The Student Volunteer Army: a 'repeat emergent' emergency response organisation.

    PubMed

    Carlton, Sally; Mills, Colleen E

    2017-01-17

    This paper seeks to contribute to understanding of the factors associated with an effective emergent emergency response organisation and to provide new insights into this understudied area. It examines, through an analysis of a range of textual resources, the emergence and re-emergence of the Student Volunteer Army (SVA) during the devastating earthquakes in Canterbury, New Zealand, in 2010-11. This evaluation is conducted in relation to the four key features of an effective emergency response organisation: adaptability; direction; leadership; and communication. In addition, the paper aims to further understanding of 'emergency entrepreneurship' and thus of the values and strategies that underpin social entrepreneur organisations in times of normalcy. The paper concludes that the unique position of the SVA as a 'repeat emergent' emergency response organisation enabled it to innovate continually and to improve repeatedly its systems, relationships, and image, such that it exhibited features common to emergent and established emergency response organisations.

  15. Item repetition in short-term memory: Ranschburg repeated.

    PubMed

    Henson, R N

    1998-09-01

    In serial recall from short-term memory, repeated items are recalled well when close together (repetition facilitation), but not when far apart (repetition inhibition; the Ranschburg effect). These effects were re-examined with a new scoring scheme that addresses the possibility that repetitions are distinct tokens in memory. Repetition facilitation and repetition inhibition proved robust, and were shown to interact with the temporal grouping of items (Experiment 1), which affected the probability of detecting repetition (Experiments 2A and 2B). It is argued that detection of a repetition is necessary for repetition facilitation, attributable to the tagging of immediate repetition, whereas the failure to detect or remember a repetition results in repetition inhibition, attributable to an automatic suppression of previous responses and a bias against guessing repeated items (Experiment 3). The findings are discussed in relation to models of short-term memory and the phenomenon of repetition blindness.

  16. Proliferating cell nuclear antigen prevents trinucleotide repeat expansions by promoting repeat deletion and hairpin removal

    PubMed Central

    Beaver, Jill M.; Lai, Yanhao; Rolle, Shantell J.; Liu, Yuan

    2017-01-01

    DNA base lesions and base excision repair (BER) within trinucleotide repeat (TNR) tracts modulate repeat instability through the coordination among the key BER enzymes DNA polymerase β, flap endonuclease 1 (FEN1) and DNA ligase I (LIG I). However, it remains unknown whether BER cofactors can also alter TNR stability. In this study, we discovered that proliferating cell nuclear antigen (PCNA), a cofactor of BER, promoted CAG repeat deletion and removal of a CAG repeat hairpin during BER in a duplex CAG repeat tract and CAG hairpin loop, respectively. We showed that PCNA stimulated LIG I activity on a nick across a small template loop during BER in a duplex (CAG)20 repeat tract promoting small repeat deletions. Surprisingly, we found that during BER in a hairpin loop, PCNA promoted reannealing of the upstream flap of a double-flap intermediate, thereby facilitating the formation of a downstream flap and stimulating FEN1 cleavage activity and hairpin removal. Our results indicate that PCNA plays a critical role in preventing CAG repeat expansions by modulating the structures of dynamic DNA via cooperation with BER enzymes. We provide the first evidence that PCNA prevents CAG repeat expansions during BER by promoting CAG repeat deletion and removal of a TNR hairpin. PMID:27793507

  17. Microevolution of pandemic Vibrio parahaemolyticus assessed by the number of repeat units in short sequence tandem repeat regions.

    PubMed

    García, Katherine; Gavilán, Ronnie G; Höfle, Manfred G; Martínez-Urtaza, Jaime; Espejo, Romilio T

    2012-01-01

    The emergence of the pandemic strain Vibrio parahaemolyticus O3:K6 in 1996 caused a large increase of diarrhea outbreaks related to seafood consumption in Southeast Asia, and later worldwide. Isolates of this strain constitutes a clonal complex, and their effectual differentiation is possible by comparison of their variable number tandem repeats (VNTRs). The differentiation of the isolates by the differences in VNTRs will allow inferring the population dynamics and microevolution of this strain but this requires knowing the rate and mechanism of VNTRs' variation. Our study of mutants obtained after serial cultivation of clones showed that mutation rates of the six VNTRs examined are on the order of 10(-4) mutant per generation and that difference increases by stepwise addition of single mutations. The single stepwise mutation (SSM) was deduced because mutants with 1, 2, 3, or more repeat unit deletions or insertions follow a geometric distribution. Plausible phylogenetic trees are obtained when, according to SSM, the genetic distance between clusters with different number of repeats is assessed by the absolute differences in repeats. Using this approach, mutants originated from different isolates of pandemic V. parahaemolyticus after serial cultivation are clustered with their parental isolates. Additionally, isolates of pandemic V. parahaemolyticus from Southeast Asia, Tokyo, and northern and southern Chile are clustered according their geographical origin. The deepest split in these four populations is observed between the Tokyo and southern Chile populations. We conclude that proper phylogenetic relations and successful tracing of pandemic V. parahaemolyticus requires measuring the differences between isolates by the absolute number of repeats in the VNTRs considered.

  18. A Case of Conjunctival Amyloidosis with Repeated Subconjunctival Hemorrhage

    PubMed Central

    Ando, Takaaki; Saito, Mamiko; Tawada, Ayako; Yotsukura, Jiro; Yamamoto, Shuichi

    2017-01-01

    Conjunctival amyloidosis is a very rare disease, and its presence may be a sign of systemic amyloidosis. We present our ocular and systemic findings in a patient with conjunctival amyloidosis. A 43-year-old man had repeated subconjunctival hemorrhages (SCHs) for two years and was referred to the Chiba University Hospital. He had comprehensive ophthalmological and systemic examinations to determine the cause of the SCHs. His visual acuities were 1.2 OU, and the intraocular pressures were 13-14 mmHg OU. Magnetic resonance imaging was normal. Initially, the SCH was the only abnormality. After 3 months, the SCH had partially cleared, and a pink mass was detected in the superior area of the subconjunctiva. Partial biopsy and histopathological examinations showed a greenish birefringence and dichroism under polarized light illumination. The birefringence was located in amyloid fibers. Immunofixation electrophoresis detected λ-light chain abnormality in the ocular biopsy specimen but systemic examinations did not find any lesions. Multiple myeloma was ruled out, and the patient is being followed closely to detect any early signs of systemic amyloidosis. Because repeated SCHs might be initial signs of systemic amyloidosis, patients with conjunctival amyloidosis should be comprehensively examined for systemic amyloidosis because of its poor life prognosis. PMID:28326212

  19. Automated genotyping of dinucleotide repeat markers

    SciTech Connect

    Perlin, M.W.; Hoffman, E.P. |

    1994-09-01

    The dinucleotide repeats (i.e., microsatellites) such as CA-repeats are a highly polymorphic, highly abundant class of PCR-amplifiable markers that have greatly streamlined genetic mapping experimentation. It is expected that over 30,000 such markers (including tri- and tetranucleotide repeats) will be characterized for routine use in the next few years. Since only size determination, and not sequencing, is required to determine alleles, in principle, dinucleotide repeat genotyping is easily performed on electrophoretic gels, and can be automated using DNA sequencers. Unfortunately, PCR stuttering with these markers generates not one band for each allele, but a pattern of bands. Since closely spaced alleles must be disambiguated by human scoring, this poses a key obstacle to full automation. We have developed methods that overcome this obstacle. Our model is that the observed data is generated by arithmetic superposition (i.e., convolution) of multiple allele patterns. By quantitatively measuring the size of each component band, and exploiting the unique stutter pattern associated with each marker, closely spaced alleles can be deconvolved; this unambiguously reconstructs the {open_quotes}true{close_quotes} allele bands, with stutter artifact removed. We used this approach in a system for automated diagnosis of (X-linked) Duchenne muscular dystrophy; four multiplexed CA-repeats within the dystrophin gene were assayed on a DNA sequencer. Our method accurately detected small variations in gel migration that shifted the allele size estimate. In 167 nonmutated alleles, 89% (149/167) showed no size variation, 9% (15/167) showed 1 bp variation, and 2% (3/167) showed 2 bp variation. We are currently developing a library of dinucleotide repeat patterns; together with our deconvolution methods, this library will enable fully automated genotyping of dinucleotide repeats from sizing data.

  20. Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: A Report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council

    SciTech Connect

    Rauch, Phillip; Lin, Pei-Jan Paul; Balter, Stephen; Fukuda, Atsushi; Goode, Allen; Hartwell, Gary; LaFrance, Terry; Nickoloff, Edward; Shepard, Jeff; Strauss, Keith

    2012-05-15

    Task Group 125 (TG 125) was charged with investigating the functionality of fluoroscopic automatic dose rate and image quality control logic in modern angiographic systems, paying specific attention to the spectral shaping filters and variations in the selected radiologic imaging parameters. The task group was also charged with describing the operational aspects of the imaging equipment for the purpose of assisting the clinical medical physicist with clinical set-up and performance evaluation. Although there are clear distinctions between the fluoroscopic operation of an angiographic system and its acquisition modes (digital cine, digital angiography, digital subtraction angiography, etc.), the scope of this work was limited to the fluoroscopic operation of the systems studied. The use of spectral shaping filters in cardiovascular and interventional angiography equipment has been shown to reduce patient dose. If the imaging control algorithm were programmed to work in conjunction with the selected spectral filter, and if the generator parameters were optimized for the selected filter, then image quality could also be improved. Although assessment of image quality was not included as part of this report, it was recognized that for fluoroscopic imaging the parameters that influence radiation output, differential absorption, and patient dose are also the same parameters that influence image quality. Therefore, this report will utilize the terminology ''automatic dose rate and image quality'' (ADRIQ) when describing the control logic in modern interventional angiographic systems and, where relevant, will describe the influence of controlled parameters on the subsequent image quality. A total of 22 angiography units were investigated by the task group and of these one each was chosen as representative of the equipment manufactured by GE Healthcare, Philips Medical Systems, Shimadzu Medical USA, and Siemens Medical Systems. All equipment, for which measurement data were