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High-resolution CT of the wrist: initial experience with scaphoid disorders and surgical fusions.

We performed high-resolution CT scans on 30 wrists in 27 patients with either previous surgical intercarpal fusion or known or suspected scaphoid abnormalities. Most examinations used the same protocol: contiguous 1.5-mm axial sections parallel to the long axis of the body of the scaphoid, small reconstruction circle, and bone reconstruction algorithm. Fifteen patients were evaluated for union of previous surgical carpal fusions; eight patients were evaluated for healing of scaphoid fractures; and the other four patients had miscellaneous disorders, including a midcarpal dislocation with a scaphoid fracture. High-resolution CT clearly showed whether the carpal fusions were united. In addition, metallic fixation devices were easy to locate and did not significantly degrade image quality. Osseous union of healing scaphoid fractures was reliably assessed. We conclude that high-resolution CT of the wrist is a useful method for evaluating surgical carpal fusions and various disorders of the scaphoid.

Arthrodesis

Multimedic system for telepathology and interdisciplinary councils between doctors and various hospitals.

At present, the exchange of information between clinicians and pathologists are limited to mail, telefax and telephone. The bi-directional video communication using at least two digitized phone lines (ISDN) is an additional medium for video-conference and for image exchange. The MECOM system (Medical Communication) has been set up in the department of pathology of Aixla-Chapelle Hospital (Germany) and has routinely used for two years between 4 local hospitals. Now it is mainly used for staff discussions between pathologists and practitioners involved in different oncological fields. Mecom can transmit any kind of high resolution images (x rays films, scanner images, histologic slides...) which are useful or necessary during medical staff discussions. This system requires only two phone lines to be operative. However it can turn on up to twelve parallel ISDN lines which allow to transmit 768 kbytes/sec. It manages the SG3, HVQ and H320 compression algorithms and allows the transmission of still images at a resolution varying from 256/240 to 512/480 pixels. Mecom is a modulable system which adapts to the needs. It has the following advantages. Emergency inter-disciplinary conferences. Real time images, discussion between a pathologist and an expert to confirm histo-pathological diagnosis. Abolition of distances. That is specially useful or necessary in countries with low medical population and poor transportation network.

Computer Communication Networks

Deblurring of 3-dimensional patterns of evoked rat cerebellar cortical activity: a study using voltage-sensitive dyes and optical sectioning.

One of the benefits of imaging neuronal activity is the capability of resolving spatial patterns in the x-y plane. With optical sectioning microscopy, the 3-dimensional (3-D) structure may also be studied without physical deformation by serially moving the focal plane of the microscope through the volume of interest along the focal axis. However, each image is blurred by contributions from neighboring planes. This degradation is most severe for low numerical aperture lenses and large amounts of defocus. In this study, an image restoration method using the optical properties of an aberration-free, defocused optical system has been developed for improving optical signals from voltage-sensitive dyes. Deblurring based on the optical transfer function (OTF) of the system was applied on two test sets of serially sectioned images: (1) fluorescent beads and (2) in vivo rat cerebellar cortex stained with the voltage-sensitive dye RH795. This method was shown to reduce significantly the out-of-focus contribution to the images, improving the spatial resolution not only in the x-y plane, but also the z axis. The algorithms were then applied to optical signals obtained by stimulation of the cerebellar surface. Optical signals having a distinct beam-like pattern were evoked and recorded over depths ranging from 0 to 300 microns prior to deblurring. Application of the deblurring algorithm reduced the depth of cerebellar cortex over which the optical signals were observed. In agreement, field potential recordings of the evoked parallel fiber volley and post-synaptic components were restricted to a narrow range of depths similar to the deblurred optical images. Removal of out-of-focus information is an essential step in the serial sectioning of central nervous system structures for neuronal imaging and 3-D reconstruction.

Algorithms

Protein design by optimization of a sequence-structure quality function.

An automated procedure for protein design by optimization of a sequence-structure quality has been developed. The method selects a statistically optimal sequence for a particular structure, on the assumption that such a protein will adopt the desired structure. We present two optimization algorithms: one provides an exact optimization while the other uses a combinatorial technique for comparatively rapid results. Both are suitable for massively parallel computers. A prototype system was used to design sequences which should adopt the four-helix bundle conformation of myohemerythrin. These appear satisfactory to secondary structure and profile analysis. Detailed inspection reveals that the sequences are generally plausible but, as expected, lack some specific structural features. The design parameters provide some insight into the general determinants of protein structure.

Algorithms

PR interval behavior during exercise: implications for physiological pacemakers.

The relationship between heart rate response and the dynamic changes in the PR interval was assessed in 631 patients undergoing routine cardiac exercise tests for a variety of clinical indications. Patients were stratified into four subsets: nonmedicated normals (n = 437), patients on beta-antagonist agents (n = 118), those on antiarrhythmic agents alone (n = 61) and those with a clinical diagnosis of advanced (New York Heart Association [NYHA] Class III or IV) congestive heart failure. All patients were in stable sinus rhythm throughout the test. PR intervals were measured at rest, at mid-exercise and at peak exercise. Mean PR intervals shortened to a statistically significant degree in most subgroups. This effect was predominantly observed in the earlier stages of exercise. In patients with advanced heart failure, there was no statistically significant shortening of exercise PR intervals later in exercise, demonstrating a parallel with their relatively blunted heart rate response. These changes in exercise PR intervals suggest that implanted pacemaker algorithms may be constructed to maximize hemodynamic benefit in patients requiring physiological pacemakers.

Adolescent

[Quality assurance of inpatient care--exemplified by surgery].

Internal quality assurance is natural for hospital physicians. External quality control is undertaken in cooperation with medical societies and sponsors-partly on voluntary basis. Despite considerable efforts in optimizing treatment procedures by classification of injuries and tumor stages, algorithms and tightly scheduled practical medical training, further control mechanisms are demanded; the economic drive is evident. In parallel to the introduction of quality control for services with a case-based flat rate, an interstructural result quality is desired. Hospital certification procedures are no longer utopian. The physician's duty for continuing medical education, which is set down in the professional code, has to be proven. The development of guidelines by scientific societies may help but is in need of a corrective. The medical chambers may play a particular role in this connection. Even if mechanisms of quality assurance differ, it is in the patient's interest that there must be no difference between ambulant and hospital care.

Cost Control

Cone-beam SPECT with a tilted detector.

In this article we report on the TOMOCONIC project for cerebral SPECT using cone-beam collimators. First, we describe our experimental set-up. The cone-beam collimator improves both spatial resolution and sensitivity. We tilt the detector to center the focal point rotation plane on the region to reconstruct. Then, to minimize cone-beam artefacts, we use the Grangeat algorithm for image reconstruction. We describe here how it can be generated to this tilted acquisition geometry. Finally, we present our first experimental results and a comparison with parallel-beam SPECT. The improvement ratio on transverse spatial resolution is 1.5. We conclude with our first clinical images.

Algorithms

Rapid three-dimensional treatment planning: I. Ray-tracing approach to primary component dose calculations.

Algorithms for fully three-dimensional divergent-beam radiotherapy treatment planning have been developed to achieve very high sampling of dose in heterogeneous (inhomogeneous density) tissue throughout an arbitrarily oriented patient volume, in clinically acceptable times of calculation. Dose is calculated at points along numerous rays which sample each beam. To display the dose distribution, the calculated dose values for each beam are interpolated onto rectilinear grids of (arbitrary) parallel planes, scaled for beam weight and finally merged with the weighted dose contributions of other beams. In this paper we describe and demonstrate the algorithm for the primary component of the three-dimensional photon dose distribution delivered to a patient.

Clinical Trials as Topic

A key by which the toad's visual system gets access to the domain of prey.

Searching for principles that allow toads to distinguish between prey and nonprey, we wondered how the toad's prey-catching activity measured as R differs in response to changes in significant configurational stimulus features. Elongated shapes moving worm-like in the direction of their longer axes are preferred prey dummies; but a toad is not a worm detector, and a worm is not the unique prey-catching releaser. Considering the frequency distributions of R values, we show that the release of prey catching is in a specific manner sensitive to the relation between the extensions of an object parallel (xl1) and perpendicular (xl2) to its direction of movement. It is the xl1 and xl2 features-relating algorithm that provides the key (instruction) by which the toad's visual system gets access to the domain of potential prey in terms of configurational cues. This, within behaviorally relevant limits, largely invariant algorithm also holds for segmented stimuli. Further investigations show that this principle of object discrimination is not due to experimental procedures but emerges as a species-common property, of which different toad species take advantage in a species-specific manner. Neurobiological correlates are discussed.

Animals

Conductance catheter measurements of left ventricular volume in the intact dog: parallel conductance is independent of left ventricular size.

OBJECTIVE: It has recently been suggested that conductance catheter parallel conductance (alpha Vc) is a function of left ventricular volume. To confirm this, alpha Vc was measured in this study over a wide range of steady state volumes. In addition, conductance derived volumes were compared to those obtained by radionuclide angiography to determine if the conductance catheter can be used to measure absolute left ventricular volume accurately in the intact dog heart. METHODS: Seven dogs were anaesthetised and instrumented with left ventricular conductance and pressure tip catheters, a flow through rho cuvette to continually measure blood resistance, a thermodilution catheter, and a venous catheter for volume infusion/withdrawal. Conductance and angiographic data were acquired at 8(SD 1) variably loaded states. Parallel conductance was measured twice at each state using a saline dilution technique and a new non-linear algorithm that allows variability in the observations of both maximum and minimum conductance volumes. RESULTS: The mean value of alpha Vc was 89.1(18.0) ml (71.8 to 111.3 ml) with a mean within-animal coefficient of variation of 7.3(3.4)%. Multiple linear regression using dummy variables to account for the large interanimal variability did not reveal any relationship between alpha Vc and either maximum or minimum left ventricular volume. Furthermore, no difference was found when alpha Vc values measured at the lowest and highest loading levels in each dog were compared. Linear regression showed good agreement between conductance and radionuclide derived end diastolic volumes (slope = 0.94, R = 0.9, p < 0.001). CONCLUSIONS: While alpha Vc varies between animals, it remains constant within any given animal over a broad range of left ventricular volumes. Thus the conductance catheter can provide reliable absolute left ventricular volume measurements under steady state conditions.

Animals

A multiple projection method for digital tomosynthesis.

A new method of optimized efficiency for the retrospective reconstruction of tomograms is presented. The method has been developed for use with isocentric fluoroscopic units and is capable of performing digital tomosynthesis of anatomical planes of user selected orientation and distance from the isocenter. Optimization of efficiency has been achieved by segmenting the reconstruction process into discrete transformations that are specific to groups of pixels, rather than performing pixel by pixel operations. These involve a number of projections of the acquired image matrices as well as parallel translations and summing. Application of this method has resulted in a significant reduction of computing time. The proposed algorithm has been experimentally tested on a radiotherapy simulator unit with the use of a phantom and the obtained results are reported and discussed.

Algorithms

A reflectance photometer with a square photodiode array detector for use on multilayer dry-film slides.

This semiautomated prototype reflectance photometer measures reflected light from multilayer dry-film slides. The instrument makes use of a square photodiode array detector, a Hewlett-Packard desktop computer, and a modified mechanical transport mechanism from an Ektachem DT60 analyzer. When 2 microL of serum is placed on a dry-film slide, a colored spot is formed. The slide is automatically transported to an incubation area and then to the photometer area. There the spot is illuminated with dual tungsten lamps, and the reflected light passes through an interference filter, where it is focused on a square photodiode array containing 10,000 individual detectors. The analog signal from each detector is digitized and transmitted to a computer for calculation of the percentage of reflectance. I used a series of algorithms to locate the spot, estimate spot area, correct for minor variations in sample volume, and compute the average reflectance from a central spot area. To evaluate the instrument's performance, I ran parallel glucose determinations in the Beckman Astra; results correlated well. The small sample size along with no dead sample volume makes the system useful for small sample volumes.

Algorithms

Sequencing of megabase plus DNA by hybridization: theory of the method.

A mismatch-free hybridization of oligonucleotides containing from 11 to 20 monomers to unknown DNA represents, in essence, a sequencing of a complementary target. Realizing this, we have used probability calculations and, in part, computer simulations to estimate the types and numbers of oligonucleotides that would have to be synthesized in order to sequence a megabase plus segment of DNA. We estimate that 95,000 specific mixes of 11-mers, mainly of the 5'(A,T,C,G)(A,T,C,G)N8(A,T,C,G)3' type, hybridized consecutively to dot blots of cloned genomic DNA fragments would provide primary data for the sequence assembly. An optimal mixture of representative libraries in M13 vector, having inserts of (i) 7 kb, (ii) 0.5 kb genomic fragments randomly ligated in up to 10-kb inserts, and (iii) tandem "jumping" fragments 100 kb apart in the genome, will be needed. To sequence each million base pairs of DNA, one would need hybridization data from about 2100 separate hybridization sample dots. Inevitable gaps and uncertainties in alignment of sequenced fragments arising from nonrandom or repetitive sequence organization of complex genomes and difficulties in cloning "poisonous" sequences in Escherichia coli, inherent to large sequencing by any method, have been considered and minimized by choice of libraries and number of subclones used for hybridization. Because it is based on simpler biochemical procedures, our method is inherently easier to automate than existing sequencing methods. The sequence can be derived from simple primary data only by extensive computing. Phased experimental tests and computer simulations increasing in complexity are needed before accurate estimates can be made in terms of cost and speed of sequencing by the new approach. Nevertheless, sequencing by hybridization should show advantages over existing methods because of the inherent redundancy and parallelism in its data gathering.

Algorithms

A software-controlled EKG simulator.

This design allows generation of a wide range of waveforms from subaudio to ultrasonic directly via software. Waveforms may be calculated on the fly by suitable algorithms or produced from previously created lookup tables. The heart of the design is a fast 16-bit processor which directly executes the Forth programming language. A simple R/2R digital-to-analog converter is coupled to a parallel output port to produce the desired waveforms. This device has been used to generate realistic-appearing normal and abnormal EKG tracings in the lab.

Algorithms

Using a neural network to identify potential HLA-DR1 binding sites within proteins.

The presentation by antigen-presenting cells of immunodominant peptide segments in association with major histocompatibility complex (MHC) encoded proteins is fundamental to the efficacy of a specific immune response. One approach used to identify immunodominant segments within proteins has involved the development of predictive algorithms which utilize amino acid sequence data to identify structural characteristics or motifs associated with in vivo antigenicity. The parallel-computing technique termed 'neural networking' has recently been shown to be remarkably efficient at addressing the problem of pattern recognition and can be applied to predict protein secondary structure attributes directly from amino acid sequence data. In order to examine the potential of a neural network to generalize peptide structural features related to binding within class II MHC-encoded proteins, we have trained a neural network to determine whether or not any given amino acid of a protein is part of a peptide segment capable of binding to HLA-DR1. We report that a neural network trained on a data base consisting of peptide segments known to bind to HLA-DR1 is able to generalize features relating to HLA-DR1-binding capacity (r = 0.17 and p = 0.0001).

Amino Acid Sequence

Standard forms of dentition and mandible for applications in rotational panoramic radiography.

Mathematical expressions describing the average form and size of the dentition and the mandible are presented. These expressions should be of value in applications of panoramic radiography when reference to an average standard jaw form is of interest. Data were collected from axial radiographs of 35 males and 35 females of three ethnic groups: Mexican-Americans, black Americans and American and Scandinavian Caucasians. Curves were traced on the axial radiographs representing the dentition and the mandible and points along these curves digitized. Mathematical expressions were established using advanced algorithms for orthogonal polynomial curve fitting, i.e. perpendicular distances to the curved dentition and mandible were minimized rather than distances parallel to the y-axis in an arbitrarily chosen coordinate system. The standard deviations around the polynomials defining the average curves are demonstrated and expressions for calculating the continuously varying standard deviations are given.

Dentition

Conditions for electron tomographic data acquisition.

The conventional algorithms employed in electron microscope tomography require that the series of images obtained from different orientations of the specimen each represent a parallel orthographic projection under uniform magnification. Electron microscope optics can produce distortions in images that may affect the accuracy of a tomographic reconstruction. These distortions result in images with differential rotation and magnification of regions of a thick or highly tilted specimen located at different distances with respect to the plane of focus. The distortions increase in magnitude and may significantly affect the accuracy of the tomographic data when images are acquired under current center misalignment or non-eucentric positioning of the specimen. An additional source of error can be introduced if the condenser lenses are adjusted to compensate for the intensity attenuation due to the increased beam path length as the specimen is tilted. The change in beam crossover position due to adjustment of the condensers alters the beam divergence and may introduce systematic changes in magnification over the tilt series. The process of alignment of the tilt series will propagate these errors to more central regions of the image. In most cases, with proper consideration, it is possible to minimize these errors to levels where they will have negligible effects on the resolution of the tomographic reconstruction.

Algorithms

Real-time 3D dose calculation and display: a tool for plan optimization.

PURPOSE: Both human and computer optimization of treatment plans have advantages; humans are much better at global pattern recognition, and computers are much better at detailed calculations. A major impediment to human optimization of treatment plans by manipulation of beam parameters is the long time required for feedback to the operator on the effectiveness of a change in beam parameters. Our goal was to create a real-time dose calculation and display system that provides the planner with immediate (fraction of a second) feedback with displays of three-dimensional (3D) isodose surfaces, digitally reconstructed radiographs (DRRs), dose-volume histograms, and/or a figure of merit (FOM) (i.e., a single value plan score function). This will allow the experienced treatment planner to optimize a plan by adjusting beam parameters based on a direct indication of plan effectiveness, the FOM value, and to use 3D display of target, critical organs, DRRs, and isodose contours to guide changes aimed at improving the FOM value. METHODS AND MATERIALS: We use computer platforms that contain easily utilized parallel processors and very tight coupling between calculation and display. We ported code running on a network of two workstations and an array of transputers to a single multiprocessor workstation. Our current high-performance graphics workstation contains four 150-MHz processors that can be readily used in a shared-memory multithreaded calculation. RESULTS: When a 10 x 10-cm beam is moved, using an 8-mm dose grid, the full 3D dose matrix is recalculated using a Bentley-Milan-type dose calculation algorithm, and the 3D dose surface display is then updated, all in < 0.1s. A 64 x 64-pixel DRR calculation can be performed in < 0.1 s. Other features, such as automated aperture calculation, are still required to make real-time feedback practical for clinical use. CONCLUSION: We demonstrate that real-time plan optimization using general purpose multiprocessor workstations is a practical goal. Parallel processing technology provides this capability for 3D planning systems, and when combined with objective plan ranking algorithms should prove effective for optimizing 3D conformal radiation therapy. Compared to our earlier transputer work, multiprocessor workstations are more easily programmed, making software development costs more reasonable compared with uniprocessor development costs. How the dose calculation is partitioned into parallel tasks on a multiprocessor work station can make a significant difference in performance. Shared-memory multiprocessor workstations are our first choice for future work, because they require minimum programming effort and continue to be driven to higher performance by competition in the workstation arena.

Computer Graphics