Biomedical subjects
B R Line
Publications and source records attributed to B R Line.
Scintigraphic studies of inflammation in diffuse lung disease.
67Ga lung scintigraphy is an established means to assess alveolar inflammation in a wide variety of diffuse lung diseases. It can be used to monitor the extent and activity of the alveolitis during the course of the disease and as a follow-up evaluation to therapy. Although the mechanism of 67Ga localization is not established firmly, the isotope appears to act as a tracer for disturbed protein and cellular fluxes within the interstitium and alveolar spaces. The radiolabeled aerosol study may also be applied to the study of these fluxes as a reflection of inflammation and injury. Although Tc-DTPA clearance studies are highly sensitive to lung injury, they may be too nonspecific to separate lung injury from other physiologic processes effectively.
Nuclear medicine information management systems.
There are good arguments for considering a computer system to improve timeliness and quality of patient care, enhance the format of clinical reports, and strengthen management controls for the containment of health care costs. A nuclear medicine information management system serves to fill these needs. Receptionists access the system to schedule patient studies, log patient data, and generate examination records. Secretaries transcribe and print clinical reports. Film library staff locate patient films and keep track of borrowed studies. Technologists produce study work sheets, record quality assurance information, and process the examination results. Staff preparing radiopharmaceuticals use the system to receive and inventory tracer stocks, track preparation and dispensing activities, and to keep records for external review. Clinicians use it to look up old study results and record their study impressions. Managers access statistical reports, billing information, and resource utilization data. This review describes an information management system as implemented in a nuclear medicine clinic. Software applications for patient scheduling, radiopharmacy, film management, report generation, quality assurance, and inventory control are described as implemented on a variety of academic and commercial systems. Hardware architectures and the issues surrounding system specification and installation are explored.
Regional ventilatory clearance by xenon scintigraphy: a critical evaluation of two estimation procedures.
Estimates of ventilatory clearance are usually made by inspecting xenon washout images. Quantitative computer procedures have been described that produce regional clearance rates, yet their accuracy is not well established. We define a mathematical model for scintigraphic ventilation data based on 96 clinical studies, and with this model we test the accuracy of two procedures used to estimate ventilatory clearance. The least-squares curve-fitting technique for both washin and washout data has the same accuracy as a modified Stewart-Hamilton method (A/H) that uses washout data alone. Both procedures demonstrate relative errors of less than 5% and coefficients of variation of 10-20% when regions with equilibrium count rates of 3 cps and clearance times between 10 and 90 sec are examined. Because the A/H procedure is preferred for its simplicity and speed, we analyze two of its main sources of error: early washin/washout termination and background activity. To measure regional ventilation by the A/H procedure, we recommend: (a) washin and washout periods at least three times the largest clearance time of clinical interest; b) a regional equilibrium count rate of at least 3cps; and c) a 25- to 50-sec average of the equilibrium count rate.
Gallium scans for staging small cell lung cancer.
The high incidence of gallium 67 accumulation in lung cencer has made radioistope scanning with this agent useful in identifying the extent of cancer locally. However, we investigated the usefulness of whole-body gallium 67 scanning, compared with physical examination, bone, liver and brain scans, and bone marrow aspirate and biopsy, in detecting metastases outside the chest in 47 patients with small cell lung cancer. In each case whole-body scanning with gallium 67 was inferior to the other methods used to detect extrathoracic tumor deposits.
Cells, collagen and idiopathic pulmonary fibrosis.
Explore the source record for details and available documents.
Gallium-67 citrate scanning in the staging of idiopathic pulmonary fibrosis: Correlation and physiologic and morphologic features and bronchoalveolar lavage.
Idiopathic pulmonary fibrosis is a fatal disorder characterized by interstitial fibrosis and parenchymal inflammation. Current concepts of this disease suggest that the inflammation precedes and probably induces the fibrotic state. To evaluate the extent and relative activity of the inflammatory process, we scanned patients with idiopathic pulmonary fibrosis using gallium-67, a radionuclide known to concentrate in regions of inflammation. To quantify the amount of isotope in the lung parenchyma, the 67Ga-index was developed, a parameter derived from estimates of the size of regional pulmonary uptake, the uptake intensity, and its texture. Evaluation of 67Ga scans in 30 patients with idiopathic pulmonary fibrosis and 19 control subjects demonstrated that the 67Ga-index in the group with idiopathic pulmonary fibrosis was significantly higher (P less than 0.001) than that in the control group. When compared with lung biopsy morphologic studies in 22 patients with idiopathic pulmonary fibrosis, the 67Ga-index correlated with the degree of interstitial cellularity (P less than 0.05) and the degree of alveolar cellularity (P less than 0.005). When compared with cellular analysis of bronchoalveolar lavage fluid in 17 patients with idiopathic pulmonary fibrosis, the 67Ga-index correlated with the differential percentage of neutrophils (P less than 0.05), but not lymphocytes, eosinophils, or macrophages. These studies indicate that 67Ga accumulates in the lungs of patients with idiopathic pulmonary fibrosis and is probably associated with the active inflammatory state. The associations of the 67Ga-index with morphologic features and bronchoalveolar lavage analysis suggest that quantitative evaluation of these scans may be useful in staging the activity of idiopathic pulmonary fibrosis and following responses to therapy.
Ejection fraction by count rate from gated images.
Left-ventricular (LV) ejection fraction (EF) was determined from ECG-gated images of the cardiac blood pool, by computing the relative change in net LV counts occurring in these images during systole. EFs obtained with this method gave satisfactory interobserver agreement in 20 studies reviewed by three independent observers (average r = 0.95) and also compared favorably with EFs obtained by contrast ventriculography in 39 patients (r = 0.92). The technique appears suitable for use in the evaluation of systolic function in patients with heart disease.
Scanning for soft-tissue amyloid.
Explore the source record for details and available documents.
[Gallium 67 citrate scintigraphy. II. Clinical aspects].
Explore the source record for details and available documents.
[Gallium-67 scintigraphy: I. Metabolism].
Explore the source record for details and available documents.
Idiopathic pulmonary fibrosis. Clinical, histologic, radiographic, physiologic, scintigraphic, cytologic, and biochemical aspects.
Idiopathic pulmonary fibrosis is a fatal disorder that starts as an alveolitis and progresses to interstitial fibrosis. Correlative morphologic, physiologic, and biochemical studies in 29 patients have shown that the inflammatory process in best followed by serial bronchoalveolar lavage and 67 Ga citrate scanning, and the fibrotic process is best followed by quantitation of the exercise-induced drop in arterial oxygen tension per unit of oxygen consumed. Although biopsies in idiopathic pulmonary fibrosis seem to show increased amounts of fibrotic tissue, biochemical studies suggest that the disease is probably one of collagen rearrangement rather than collagen increase. Perhaps becasue of this, peripheral lymphocytes of these patients recognize collagen as "non-self" and, when exposed to it in vitro, produce lymphokines and cell lysis. The fibrotic process is probably irreversible, but the inflammatory and immune processes that cause it may be amenable to therapy if diagnosed early.