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Biomedical subjects

J A Seibert

Publications and source records attributed to J A Seibert.

18 recordsLinked to original sources

Differential effect of recombinant tissue plasminogen activator-induced thrombolysis in the central nervous system and systemic arteries.

Recombinant tissue plasminogen activator (rTPA) has been more effective in inducing thrombolysis in laboratory studies of intracranial thrombosis than clinical studies of systemic or coronary thrombosis would indicate. To evaluate this discrepancy, 21 rabbits were subjected to embolic occlusion of the right internal carotid artery (ICA) by retrograde injection of a tin-tagged, 2-hour-old autologous clot through the external carotid artery with angiographic monitoring in the same manner as in a previously reported model. The emboli lodged intracranially at the bifurcation of the ICA in 10 animals and in the cervical ICA in 11 animals. Digital subtraction angiography confirmed total occlusion of the ICA in all animals. Treatment started one-half hour after embolization and consisted of a bolus of 0.5 mg/kg of rTPA followed by an infusion of 1 mg/kg/h for 2 hours. All of the animals with intracranial emboli and 6 of the animals with cervical emboli were treated intravenously. The remaining 5 animals with cervical emboli were treated by intracarotid infusion of the same dose of rTPA. In the intravenously treated group, serial digital subtraction angiography documented thrombolysis in 9 of the 10 animals with intracranial emboli and only 1 of the 6 with cervical emboli. Thrombolysis occurred in 4 of the 5 rabbits with cervical emboli treated with intracarotid rTPA. Intravenous rTPA therapy produced a significantly (P less than 0.01) higher rate of thrombolysis in intracranial as compared to cervical thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Orthogonal electrode catheter array for mapping of endocardial focal site of ventricular activation.

Precise location of the endocardial site of origin of ventricular tachycardia may facilitate surgical and catheter ablation of this arrhythmia. The endocardial catheter mapping technique can locate the site of ventricular tachycardia within 4-8 cm2 of the earliest site recorded by the catheter. This report describes an orthogonal electrode catheter array (OECA) for mapping and radiofrequency ablation (RFA) of endocardial focal site of origin of a plunge electrode paced model of ventricular activation in dogs. The OECA is an 8 F five pole catheter with four peripheral electrodes and one central electrode (total surface area 0.8 cm2. In eight mongrel dogs, mapping was performed by arbitrarily dividing the left ventricle (LV) into four segments. Each segment was mapped with OECA to find the earliest segment. Bipolar and unipolar electrograms were obtained. The plunge electrode (not visible on fluoroscopy) site was identified by the earliest wave front arrival times of -30 msec or earlier at two or more electrodes (unipolar electrograms) with reference to the earliest recorded surface ECG (I, AVF, and V1). Validation of the proximity of the five electrodes of the OECA to the plunge electrode was performed by digital radiography and RFA. Pathological examination was performed to document the proximity of the OECA to the plunge electrode and also for the width, depth, and microscopic changes of the ablation. To find the segment with the earliest LV activation a total of 10 +/- 3 (mean +/- SD) positions were mapped. Mean arrival times at the two earlier electrodes were -39 +/- 4 msec and -35 +/- 3 msec. Digital radiography showed the plunge electrode to be within the area covered by all five electrodes in all eight dogs. The plunge electrode was within 1 cm2 area of the region of RFA in all eight dogs. The width and depth of ablation were 5 +/- 3.5 and 7 +/- 3.5 mm, respectively. Microscopic changes revealed coagulative necrosis, hemorrhage, and inflammatory changes in all RFAs. In conclusion, the OECA can map the endocardial focal site of origin of paced ventricular activation within 1 cm2 area in a canine model. RFA from the OECA can cause discrete ablations representing all five electrodes or cross-shaped ablation connecting central electrode to all four peripheral electrodes. This catheter holds promise for extending surgical and clinical catheter ablation procedures.

Animals

Exposure rates in high-level-control fluoroscopy for image enhancement.

High-level fluoroscopic boost options that exceed conventional exposure limits are available as a means of reducing quantum mottle during angiography. Federal law does not specify exposure limits for such high-level controls but requires specific means of activation to safeguard against inadvertent use. The American Association of Physicists in Medicine recently recommended that high-level exposure rates not exceed 2.58 mC/kg/min (10R/min). At six institution surveyed, maximum exposure rates ranged from 5.42 to 24 mC/kg/min (21-93 R/min). Activation of high-level capability varied from a simple foot switch to a keyed interlock requiring a second operator to engage. There appears to be no industry coherence in high-level control exposure limits as yet, although the Center for Devices and Radiological Health recently initiated an investigatory program.

Environmental Exposure

Internal densitometric gating for digital subtraction angiography.

Motion artifacts create a severe problem in digital subtraction angiography (DSA) studies. Periodic motion can be eliminated by "gating," matching a precontrast mask with a postcontrast image at the same phase position in the cycle. Electrocardiogram (EKG) signals are used in cardiac DSA for this purpose. An alternate method relies on the generation of a density-time curve dependent on the attenuation changes of anatomical motion. A densitometric window placed at an appropriate location records the variation, from which individual images are tagged with phase position information encoded as delay time. Results are similar to the EKG gating method for cardiac DSA when using an appropriate window location. Periodic motion caused by superimposed respiration can be suppressed by tracking diaphragm or other object attenuation changes with the same algorithms. Using these techniques permits the nonarbitrary matching of mask and contrast images without physiologic monitoring. The techniques are straightforward and relatively easy to implement on systems designed for rapid digital imaging.

Angiography

Partial splenic embolization guided by blood flow measurements.

The author used blood flow measurements to guide partial splenic embolization procedures in five patients. The measurements were obtained by time density analysis of contrast medium injections in the splenic artery using digital subtraction angiographic techniques and modified software. The blood flow measurements demonstrated blood flow changes occurring as a result of the embolization. The embolization procedures continued until the blood flow in the splenic artery had been reduced to 50% of its original value. The blood flow measurements appear to predict the amount of parenchymal reduction achieved by embolization and show promise as a method of monitoring these procedures.

Adult

Evaluation of recombinant tissue plasminogen activator in embolic stroke.

In an effort to determine the value of tissue-type plasminogen activator (TPA) in the treatment of embolic stroke, 17 rabbits were subjected to a model of embolic stroke in which 2-hour-old, tin-impregnated, autologous clots were embolized to the bifurcation of the internal carotid artery at the circle of Willis via retrograde injection into the cannulated external carotid artery. High-resolution digital subtraction radiography was used to localize clots intracranially at the carotid bifurcation. Circulation through the internal carotid artery and intracranial vessels was monitored with serial digital subtraction angiography before and after embolization and during treatment. Disappearance of the tin marker on the digital subtraction radiograph indicated dissolution of clot and was associated with reestablishment of circulation on the digital subtraction angiogram. Experimental animals were treated with human-specific recombinant TPA 30 minutes, 2 hours, or 4 hours after clot embolization. TPA was administered as an intravenous bolus of 0.5 mg/kg followed by an infusion of 1 mg/kg/h for 2 hours. Digital subtraction angiograms were performed every 30 minutes. All clots dissolved, and cerebral circulation was reestablished within 120 minutes of treatment. In control animals treated with saline, embolized clots were stable, and the internal carotid artery remained occluded. At the completion of each study, the animal was perfused with freshly prepared, buffered 2,3,5-triphenyltetrazolium chloride (TTC) for demarcation of cerebral infarction. Control animals demonstrated infarction of 50 +/- 3.6% of the ipsilateral cerebral hemisphere, with an infarct weight of 2.1 +/- 0.2 g.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Scattered energy deposition under shielding.

Monte Carlo methods are used to generate line spread functions describing dose distributions at a variety of depths within a homogeneous water phantom. The line spread function data are convolved with a step function that represents the edge of a primary radiation field. The dosimetric information beyond the edge of the field is reported in the form of tissue-air ratios for three different beam spectra in the diagnostic energy range.

Models, Structural

Digital angiographic quantification of blood flow dynamics in embolic stroke treated with tissue-type plasminogen activator.

Computer analysis of digital subtraction angiography (DSA) was utilized to quantify the effectiveness of tissue-type plasminogen activator (TPA) in a rabbit cerebroembolic stroke model. Fourteen animals underwent cannulation of the facial artery and a preembolus angiogram. Autologous blood clots were then injected, and occlusion of the internal carotid artery at the circle of Willis was documented with repeat angiogram. The experimental group received a 1-mg/kg intravenous infusion of TPA via a femoral catheter for 90 minutes. A control group received an equivalent volume of saline. Follow-up angiograms were performed every 15 minutes. The TPA-treated animals showed progressive improvement in flow through previously occluded vessels. Time-density curves of the contrast material over the middle cerebral artery trunk and brain parenchyma were generated. The best integrated curves for the two groups were compared at 30 minutes after occlusion and 90 minutes after treatment. Animals were then observed for 24 hours and their neurological status was documented. Premortem infusion of either Evans blue dye or neutral red dye was performed and the integrity of the blood-brain barrier and tissue perfusion were assessed by video planometry. Significant improvements were noted by DSA, and Evans blue and neutral red dye studies in animals treated with TPA.

Animals

Improved fluoroscopic and cine-radiographic display with pulsed exposures and progressive TV scanning.

In fluoroscopic image display, moving objects lose resolution because of continuous x-ray exposure and interlaced TV scanning. Significant improvements can be obtained with progressive TV scanning synchronized to short x-ray pulses occurring at a rate of 30 Hz. Modification of the x-ray generator and addition of a progressive-scan TV camera coupled with a scan converter (progressive to interlaced) allows one to maintain fluoroscopy radiation levels, prevent image refresh flicker, and use existing low bandwidth interlaced monitors for optimum image quality.

Animals

Videodensitometric quantitation of stenosis: in vitro and in vivo validation.

Percentage of stenosis of a vascular lumen was quantitated using a digital subtraction angiography system with videodensitometric analysis. To validate the algorithm and methods, we used precisely drilled Lucite rods of three inner diameters and various reduced diameters to give known luminal reduction. Both in vitro and in vivo results of stenosis measurements resulted in an excellent correlation between actual and measured values (correlation coefficient greater than 0.9 for all trials). Consistent underestimation of stenosis of about 5% was attributed to the various image degradations inherent with the imaging procedure and equipment. Errors were greatest with midrange stenoses and less at the extremes of the lesion values. An insufficient signal-to-noise ratio was caused by low photon flux and/or low contrast material concentration and overlying vasculature filled with contrast material. Overall, the videodensitometric technique is accurate, easy to implement, objective, and relatively free of errors associated with the geometric/edge detection method.

Absorptiometry, Photon

Removal of image intensifier veiling glare by mathematical deconvolution techniques.

X-ray images acquired with an image intensifier detector system suffer from veiling glare, a low-frequency degradation described by a point spread function (PSF). The PSF has two experimentally determined parameters unique to a given image intensifier. This information is utilized to deconvolve the degradation from digitally acquired images. Results demonstrate a significant increase in contrast ratio of high-contrast objects after deconvolution and image restoration.

Animals

Characterization of the point spread function and modulation transfer function of scattered radiation using a digital imaging system.

A digital radiographic system was used to measure the distribution of scattered x radiation from uniform slabs of Lucite at various thicknesses. Using collimation and air gap techniques, [primary + scatter] images and primary images were digitally acquired, and subtracted to obtain scatter images. The scatter distributions measured using small circular apertures were computer fit to an analytical function, representing the circular aperture function convolved with a modified Gaussian point spread function (PSF). On the basis of goodness of fit criterion, the proposed Gaussian function is a very good model for the scatter PSF. The measured scatter PSF's are reported for various Lucite thicknesses. Using the PSF's, the modulation transfer functions are calculated, and this spatial frequency information may have value in analytical scatter removal techniques, grid design, and air gap optimization.

Computers

Monte Carlo simulation of the scattered radiation distribution in diagnostic radiology.

Monte Carlo techniques were employed to evaluate the point spread function (PSF) of scattered radiation in diagnostic radiology. The Monte Carlo procedure is described and shown to compare well with Monte Carlo scatter analysis of other authors. The intensity and distribution of the PSF are described independently. The effects of object thickness, air gap, and beam spectra are examined. An analytic derivation of the scatter PSF is presented in a companion article, and the Monte Carlo results discussed herein are used for comparison.

Biophysical Phenomena

An analytical model of the scattered radiation distribution in diagnostic radiology.

A simple scatter model is used to analytically derive the point spread function (PSF) for scattered radiation in diagnostic radiology. The resulting equation is a function of four physical parameters; object thickness, object-to-detector distance (air gap), and the linear attenuation coefficients for both primary and scatter radiation. Though the model is based upon single scattering, it is shown that by reducing the scatter attenuation coefficient the analytic model compares well to the multiple scattering PSF determined using Monte Carlo analysis.

Biophysical Phenomena

X-ray scatter removal by deconvolution.

The distribution of scattered x rays detected in a two-dimensional projection radiograph at diagnostic x-ray energies is measured as a function of field size and object thickness at a fixed x-ray potential and air gap. An image intensifier-TV based imaging system is used for image acquisition, manipulation, and analysis. A scatter point spread function (PSF) with an assumed linear, spatially invariant response is modeled as a modified Gaussian distribution, and is characterized by two parameters describing the width of the distribution and the fraction of scattered events detected. The PSF parameters are determined from analysis of images obtained with radio-opaque lead disks centrally placed on the source side of a homogeneous phantom. Analytical methods are used to convert the PSF into the frequency domain. Numerical inversion provides an inverse filter that operates on frequency transformed, scatter degraded images. Resultant inverse transformed images demonstrate the nonarbitrary removal of scatter, increased radiographic contrast, and improved quantitative accuracy. The use of the deconvolution method appears to be clinically applicable to a variety of digital projection images.

Computer Simulation

Analysis and correction of imperfections in the image intensifier-TV-digitizer imaging chain.

Image intensifier-television-video digitizer (IITVD) systems are commonly used for digital planar image acquisition in radiology. However, the well-known distortions inherent in these systems limit their utility in research and in some clinical applications where quantitatively correct images are required. Software correction techniques have been implemented which restore both the spatial and grey scale quantitative integrity, allowing IITVD systems to be used as analytical research tools. Previously reported and novel correction techniques were used to reduce veiling glare, pincushion distortion, dc bias, and residual shading effects. The results indicate that excellent quantitative integrity can be achieved when these straightforward artifact reduction techniques are employed.

Analog-Digital Conversion

On-line monitoring of sequential blood flow reduction during splenic embolization.

Partial embolization of the spleen has been well established for the treatment of hypersplenism. A weakness of the technique is the lack of an objective method to quantitate the flow reduction during the procedure. The video dilution technique (VDT) has earlier been used to measure blood flow in regional arteries using video cassette replay. By adapting the VDT concept of relative flow to digital subtraction angiography, it is possible to calculate the flow reduction instantly following each injection of embolic material. We present a case of partial splenic embolization where the flow in the splenic artery was reduced to a predetermined level of 50 per cent of baseline flow. The clinical results were excellent. By observing the clinical results of partial embolization, terminated at different levels of flow reduction, it will be possible to optimize the results and prevent overembolization.

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