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Stephen W Smith

Publications and source records attributed to Stephen W Smith.

At least 19 recordsLinked to original sources
PubMed2004

Outcome of low-risk patients discharged home after a normal cardiac troponin I.

Patients with symptoms suggestive of, but at low risk for, acute coronary syndrome (ACS), who have a negative electrocardiogram (EKG) and a single normal troponin I at 6-9 h after symptom onset are frequently discharged from our Emergency Department (ED). We sought to determine their rate of adverse cardiac events at 30 days (ACE-30), defined as cardiac death or myocardial infarction (MI), by chart review, telephone interview, or county death records. Of 663 patients, data were available for 588 (89%). Mean age was 48 years; 59% were male. There were 390 patients (66%) who complained of chest pain. Previous coronary artery disease (CAD) was reported in 145 patients (25%). Two patients (0.34%) had ACE-30, both with non-ST elevation MI. There were no cases of cardiac death. None of the patients died in Hennepin County within 30 days. At our institution, low-risk patients with symptoms suggestive of ACS who are discharged home after a normal cTnI drawn 6-9 h after symptom onset have a very low incidence of cardiac events at 30 days.

Angina, Unstable↗
PubMed2004

Feasibility study: real-time 3-D ultrasound imaging of the brain.

We tested the feasibility of real-time, 3-D ultrasound (US) imaging in the brain. The 3-D scanner uses a matrix phased-array transducer of 512 transmit channels and 256 receive channels operating at 2.5 MHz with a 15-mm diameter footprint. The real-time system scans a 65 degrees pyramid, producing up to 30 volumetric scans per second, and features up to five image planes as well as 3-D rendering, 3-D pulsed-wave and color Doppler. In a human subject, the real-time 3-D scans produced simultaneous transcranial horizontal (axial), coronal and sagittal image planes and real-time volume-rendered images of the gross anatomy of the brain. In a transcranial sheep model, we obtained real-time 3-D color flow Doppler scans and perfusion images using bolus injection of contrast agents into the internal carotid artery.

Animals↗
PubMed2004

Integrated catheter for 3-D intracardiac echocardiography and ultrasound ablation.

A catheter device with integrated ultrasound imaging array and ultrasound ablation transducer is introduced. This device has been designed for use in interventional cardiac procedures in which the cardiac anatomy is first imaged using real-time three-dimensional (3-D) ultrasound, then ablated to treat arrhythmias. The imaging array includes 112 elements operating at 5.4 MHz arranged in a 2-D matrix. Individual elements have a bandwidth of 21% and an insertion loss of 80 dB. The array has an azimuth resolution of 12 degrees and an elevation resolution of 8.7 degrees. The ablation transducer is a concentric piezoelectric transducer PZT-4 ring (outside diameter (O.D.), 4.5 mm, inside diameter (I.D.), 3.1 mm) operating at 10 MHz that surrounds the imaging array. It can produce a spatial-peak, temporal-average intensity up to 16 W/cm2. The entire device fits into a 9 Fr lumen with a 14 Fr tip to accommodate the ablation ring. With this device we have imaged, in realtime 3-D, a variety of targets including wire phantoms, fixed sheep hearts, and fresh bovine tissue. The ablation ring has been used to heat tissue-mimicking rubber 14 degrees C, as well as create lesions in fresh bovine tissue.

Animals↗
PubMed2004

A miniaturized catheter 2-D array for real-time, 3-D intracardiac echocardiography.

The design, fabrication, and characterization of a 112 channel, 5 MHz, two-dimensional (2-D) array transducer constructed on a six layer flexible polyimide interconnect circuit is described. The transducer was mounted in a 7 Fr (2.33 mm outside diameter) catheter for use in real-time intracardiac volumetric imaging. Two transducers were constructed: one with a single silver epoxy matching layer and the other without a matching layer. The center frequency and -6 dB fractional bandwidth of the transducer with a matching layer were 4.9 MHz and 31%, respectively. The 50 omega pitch-catch insertion loss was 80 dB, and the typical interelement crosstalk was -30 dB. The final element yield was greater than 97% for both transducers. The transducers were used to acquire real-time, 3-D images in an in vivo sheep model. We present in vivo images of cardiac anatomy obtained from within the coronary sinus, including the left and right atria, aorta, coronary arteries, and pulmonary veins. We also present images showing the manipulation of a separate electrophysiological catheter into the coronary sinus.

Animals↗
PubMed2004

Two dimensional arrays for real time 3D intravascular ultrasound.

We have previously described 2D arrays operating at up to 10.0 MHz consisting of several thousand elements for transthoracic cardiac imaging and over a hundred elements for intracardiac imaging using 7 Fr to 12 Fr catheters. We have begun to explore forward viewing real time 3D phased array intravascular ultrasound, which may require imaging depths of a few centimeters to look down the axis of a vessel to view vulnerable atherosclerotic plaque. We used a noncoaxial based cable technology that allowed 100 signal wires to be placed inside a4.8 French IVUS lumen with an inner diameter of 1.3 mm. We pursued two different fabrication technologies for the building of the transducers. Each transducer was constructed in the forward viewing configuration to allow simultaneous real time B-scans, C-scans and volumetric rendering of vessels and vascular stents distal to the catheter tip. In order to obtain the desired penetration depth, each transducer was constructed to operate at 10.0 MHz. The first method included an ordered array of 11 x 11 = 121 elements. In order to conform to the round aperture of the IVUS lumen, the comers were cut off, resulting in a total of 97 signal channels. Real time images include a 4 mm diameter vessel in a tissue mimicking phantom, an expanded stent and a stent in an excised sheep aorta. The second method is based upon a laser dicing technique that cuts the individual elements in a random pattern. This resulted in 61 signal channels. Real time 3D images of the AIUM test object were made with this transducer.

Animals↗
PubMed2004

Real-time rectilinear 3-D ultrasound using receive mode multiplexing.

In previous work, we developed two generations of a real-time rectilinear volumetric scanner operating at 5 MHz for abdominal, breast, or vascular imaging using a Mills cross two-dimensional (2-D) array and a rectilinear periodic 2-D array. To improve spatial resolution performance and sensitivity, we developed a new design using 4:1 receive mode multiplexing. With 4:1 multiplexing, the new 65,000 element 2-D array has 4 x 256 = 1024 receivers so that 256 receivers can be used on any image line. The two major benefits of using receive mode multiplexing are an increase in receive sensitivity due to a greater number of receive elements, and a decrease in grating lobe and clutter levels due to increased receive element density. Theoretical simulations and analysis show an increase of about 13 dB in sensitivity compared to our previous work. With these encouraging results, a new 65,000 element 5-MHz, 2-D array having 1024 receivers and 169 transmitters was prototyped. In addition, the multiplexer and control circuitry were designed, built, and interfaced with both the transducer and volumetric scanner. Images of tissue-mimicking phantoms and in vivo targets were obtained. Using a spherical cyst phantom, experimental results showed a +12 dB improvement in signal-to-noise ratio and a +6 dB improvement in contrast compared to our previous work.

Adult↗
PubMed2003

Dual lumen transducer probes for real-time 3-D interventional cardiac ultrasound.

We have developed dual lumen probes incorporating a forward-viewing matrix array transducer with an integrated working lumen for delivery of tools in real-time 3-D (RT3-D) interventional echocardiography. The probes are of 14 Fr and 22 Fr sizes, with 112 channel 2-D arrays operating at 5 MHz. We obtained images of cardiac anatomy and simultaneous interventional device delivery with an in vivo sheep model, including: manipulation of a 0.36-mm diameter guidewire into the coronary sinus, guidance of a transseptal puncture using a 1.2-mm diameter Brockenbrough needle, and guidance of a right ventricular biopsy using 3 Fr biopsy forceps. We have also incorporated the 22 Fr probe within a 6-mm surgical trocar to obtain apical four-chamber ultrasound (US) scans from a subcostal position. Combining the imaging catheter with a working lumen in a single device may simplify cardiac interventional procedures by allowing clinicians to easily visualize cardiac structures and simultaneously direct interventional tools in a RT3-D image.

Animals↗
PubMed2002

Real-time rectilinear volumetric imaging using a periodic array.

Current real-time phased array volumetric scanners use a 2-D array to scan a pyramidal volume comprised of many sector scans stacked in the elevation direction. This scan format is primarily useful for cardiac imaging to avoid interference from the ribs. However, a real-time rectilinear volumetric scan with a wider field-of-view (FOV) close to the transducer could prove more useful for abdominal, breast or vascular imaging. In our previous work, a 94 x 94 Mills cross array operating at 5 MHz was fabricated, and the first real-time rectilinear volumetric images were made using a 2-D array and the Duke real-time 3-D scanner. The FOV for the Mills cross was 30 x 8 x 60 mm. Despite reasonable success with the Mills cross array, the array had limitations of poor off-axis sensitivity and a smaller FOV in one direction. To overcome these limitations, a new rectilinear array containing over 65,500 elements was developed with a periodic geometry to increase the FOV to 30 mm x 30 mm x 60 mm and improve the off-axis sensitivity. Images of tissue-mimicking phantoms and the carotid artery in vivo were obtained. In addition, spectral and color flow Doppler results from a pulsatile flow phantom were obtained.

Cardiac Volume↗
PubMed2002

Feasibility study of real-time three-dimensional intracardiac echocardiography for guidance of interventional electrophysiology.

The authors tested the feasibility of real-time three-dimensional intracardiac echocardiography for guidance of interventional electrophysiological studies. The three-dimensional scanner uses a matrix array ultrasound transducer of 64 channels operating at 5 MHz in a 12 Fr catheter. The system features real-time three-dimensional image rendering and produces up to 60 volumetric scans per second. Using an open-chest sheep model, real-time three-dimensional images of anatomic landmarks were obtained, including the pulmonary veins and coronary sinus, which are of value in electrophysiological procedures. In vivo radio frequency ablation procedures in the right ventricle were also monitored, which yielded lesions of high image contrast.

Animals↗
PubMed2002

Conflict resolution and peer mediation in middle schools: extending the process and outcome knowledge base.

Many professional educators are implementing school-based prevention focused on conflict resolution (CR) and peer mediation (PM). The authors conducted research on CR-PM in 3 middle schools. Specifically, they surveyed teachers and students, tracked disciplinary incidents across school years, collected mediation data, and compared mediators with a matched sample to determine attitudinal change as a result of PM training and experience. The authors also surveyed peer mediators and disputants about program satisfaction, as well as peer mediators and their parents about the generalization of PM skills. The authors conclude with implications for developing future CR programs, including a focus on mediation-process evaluation as well as schoolwide outcome measures and the use of peer mediation training as an intervention for students at risk.

Adolescent↗
PubMed2002

Real-time rectilinear volumetric imaging.

Current real-time volumetric scanners use a 2-D array to scan a pyramidal volume consisting of many sector scans stacked in the elevation direction. This scan format is primarily useful for cardiac imaging to avoid interference from the ribs. However, a real-time rectilinear volumetric scan with a wider field of view close to the transducer could prove more useful for abdominal, breast, or vascular imaging. In previous work, computer simulations of very sparse array transducer designs in a rectilinear volumetric scanner demonstrated that a Mills cross array showed the best overall performance given current system constraints. Consequently, a 94 x 94 Mills cross array including 372 active channels operating at 5 MHz has been developed on a flexible circuit interconnect. In addition, the beam former delay software and scan converter display software of the Duke volumetric scanner were modified to achieve real-time rectilinear volumetric scanning consisting of a 30-mm x 8-mm x 60-mm scan at a rate of 47 volumes/s. Real-time rectilinear volumetric images were obtained of tissue-mimicking phantoms, showing a spatial resolution of 1 to 2 mm. Images of carotid arteries in normal subjects demonstrated tissue penetration to 6 cm.

Cardiac Volume↗
PubMed2002

Intracardiac catheter 2-D arrays on a silicon substrate.

The design, fabrication, and characterization of a 7 MHz, two-dimensional (2-D) array transducer built on a silicon substrate is described. The array fits inside a 9-French (2.9 mm O.D.) catheter for use in real-time intracardiac volumetric imaging. The -6 dB fractional bandwidth of the transducer is 30%, the 50 ohm pitch-catch insertion loss is 78 dB, and the interelement crosstalk is -25 dB. Real-time volumetric images in phantoms and in-vitro images of a sheep heart have been acquired yielding measured spatial resolution of 2 mm at a depth of 1 cm. The cardiac structures imaged include ventricular chambers, interventricular septum, mitral and tricuspid valves and real-time 3-D rendered volumes of the tricuspid valve in the open and closed position.

Animals↗