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[A knowledge-based system for the interpretation of pelvimetric findings].

Digital Image Intensifier Radiography (DIR) as well as Nuclear Magnetic Resonance Tomography (NMR) using an especially developed imaging routine for pelvimetry are suitable tools for the assessment of the anatomical conditions when mechanical problems are supposed to occur during birth (cephalopelvic disproportion, breech presentation). A concept for an optimised evaluation procedure of these imaging techniques has been developed, including: a more elaborate measuring protocol, easily and precisely executable due to appropriate software packages being implemented in the diagnostic units, calculation of obstetrically relevant parameters not deriving immediately from the imaging procedures. This is possible by means of multiple regression analysis of a data base from 467 evaluated female pelvis computed tomograms, calculation of intrapelvic soft tissue place requirements by means of correlative analysis of female computed tomograms and weight-/height-index, empirical determination of cut off values in borderline pelvi-fetometric constellations evaluating 190 births by means of logistic regression of the according pelvic-fetometric data. The calculations necessary to obtain all these parameters are implemented in a software package which also contains an algorithm for the general characterisation of an individual pelvis. Thus, a rather sophisticated knowledge base for pelvic assessment becomes easily accessible.

Adult↗
PubMed1989

[The value of computed tomography in monitoring the preoperative chemotherapy of osteosarcoma].

Computed tomography was performed in 45 patients with osteosarcomas before and after preoperative chemotherapy. Changes of bone alterations, intramedullary tumour spread and the size of soft tissue masses are computer tomographic criteria for tumour response after chemotherapy. The computed tomography decision of responder or non-responder was correct in 37/45 patients. In comparison with conventional x-rays CT was superior. CT is a reliable method for preoperative extension diagnosis and for the decision-marking for limb-saving operations.

Adolescent↗
PubMed1983

Computed tomography of tuberculous osteomyelitis of the pubis.

Computed tomographic findings in a case of isolated pubic tuberculous osteomyelitis with an associated tuberculous soft tissue abscess are described. Computed tomographic findings include local bony erosion and destruction, as well as an associated peripherally enhancing soft tissue mass.

Humans↗
PubMed1984

CT of benign soft-tissue masses of the extremities.

The computed tomographic (CT) scans and medical records of 35 patients with proven benign soft-tissue masses of the extremities were reviewed to assess the contribution of CT in the evaluation of such masses. CT demonstrated the mass in all 35 cases and was able to provide a specific diagnosis in 28 (80%); 25 prospectively, three retrospectively. Correct diagnoses made using CT included hematomas (five), synovial cysts (seven), myositis ossificans (six), fatty tumors (four), aneurysms (three), pseudoaneurysms (two), schwannoma (one), and abscess (one). The CT appearance of a hematoma depends on its age. Synovial cysts are near-water-density masses, often associated with a small joint effusion. Myositis ossificans can be differentiated from parosteal osteosarcoma by virtue of its characteristic zonal ossification. Lipomas are recognized on noncontrast scans by the characteristic low attenuation of fat, while aneurysms and pseudoaneurysms are best diagnosed on postcontrast scans. In seven cases (20%) a specific diagnosis could not be made on the basis of the CT scan. However, in these cases CT delineated the extent of the mass and demonstrated its relation to surrounding structures; this anatomic information was helpful in planning surgical excision or percutaneous biopsy. The authors conclude that CT is a valuable noninvasive imaging method for the evaluation of soft-tissue masses of the extremities.

Adolescent↗
PubMed1996

Aspergillus sinusitis: clinical aspects and treatment outcomes.

Seventy-two cases of Aspergillus sinusitis were analyzed during a period of 14 years from January 1980 through October 1993. There were 60 cases of primary type and 12 cases of secondary type. The maxillary and ethmoid sinuses were most commonly affected in both primary and secondary types. The sphenoid sinus was commonly involved in secondary type. Fourteen (23%) cases of primary type and 4 (33%) cases of secondary type demonstrated sinus wall destruction on computed tomography or magnetic resonance images. Seventy percent of primary type and all cases of secondary type showed focal or diffuse areas of increased attenuation in the soft tissue mass on computed tomography scans. Sixteen cases assessed by magnetic resonance imaging showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities on T2-weighted images. Fifty-nine (98%) of 60 cases of primary type were noninvasive, and 1 was invasive. In secondary type, 10 (83%) of 12 patients had noninvasive disease. The most common coexisting disease in secondary aspergillosis was diabetes mellitus. Thickened mucosa with necrotic brownish green material, which was the most common finding in both types, was found in 33 patients with primary type and in 5 with secondary type. Surgery was performed in most cases, among which 4 patients received chemotherapy after surgery with amphotericin B with or without flucytosine. All patients were cured without recurrence during a mean follow-up period of 13 months.

Adolescent↗
PubMed2000

The filmless radiology reading room: a survey of established picture archiving and communication system sites.

The purpose of this study was to survey radiologists experienced in soft-copy diagnosis using computer workstations about their current reading room environment, their impressions of the efficacy of their reading room design, and their recommendations based on their experience for improvement of the soft-copy reading environment. Surveys were obtained from radiologists at seven sites representing three major picture archiving and communication system (PACS) vendors throughout the world that have had extensive experience with soft-copy interpretation of radiology studies. The radiologists filled out a detailed survey, which was designed to assess their current reading room environment and to provide them with the opportunity to make suggestions about improvement of the PACS reading rooms. The survey data were entered into a database and results were correlated with multiple parameters, including experience with PACS, types of modalities interpreted on the system, and number of years of experience in radiology. The factors judged to be most important in promoting radiologist productivity were room lighting, monitor number, and monitor brightness. Almost all of the radiologists indicated that their lighting source was from overhead rather than indirect or portable light sources. Approximately half indicated they had the capability of dimming the brightness of the overhead lighting. Most radiologists indicated that they were able to adjust room temperature but that they did not have individual temperature controls at their workstations. The radiologists indicated that the most troublesome sources of noise included background noise, other radiologists, and clinicians much more than noise from computer monitors, technologists, or patients. Most radiologists did not have chairs that could recline or arm rests. Most did have wheels and the capability to swivel, both of which were judged important. The majority of chairs also had lumbar support, which was also seen to be important. Radiologists commonly adjusted room lighting and their reading chair, but rarely adjusted room temperature or monitor brightness. The median number of hours spent at the workstation before taken a "break" was 1.5. Common recommendations to improve the room layout included compartmentalization of the reading room and availability of the hospital/radiology information system at each workstation. The survey data suggest several areas of potential improvement based on radiologists' experience. Optimization of soft-copy reading room design is likely to result in decreased fatigue and increased productivity.

Attitude of Health Personnel↗
PubMed1989

Giant bone island. Computed tomography findings.

Although bone island is a well-known benign skeletal entity, it may stimulate an aggressive bone forming neoplasm when it is large. Spiculated margin intermingling with thickened trabeculae together with the lack of bone destruction and soft tissue mass on computed tomography scan is diagnostic.

Adult↗
PubMed1989

Evaluation of thyroid calcification using computed radiography with image plate.

The value of lateral magnification soft x-ray roentgenography using a Computed Radiography (CR) system was studied. ROC curve analysis revealed that a CR system has virtually the same, or a better ability than a screen-film system for detecting thyroid calcification. According to our criteria the CR system an accuracy rate of 77.1% in malignant/benign diagnosis was obtained.

Calcinosis↗
PubMed1999

A graphical object display improves anesthesiologists' performance on a simulated diagnostic task.

OBJECTIVE: This study tests the hypothesis that a graphical object display (a data display consisting of meaningful shapes) will affect the ability of anesthesiologists to perform a diagnostic task rapidly and correctly. The diagnostic tasks studied were recognition and differentiation of five etiologies of shock--anaphylaxis, bradycardia, myocardial ischemia, hypovolemia, pulmonary embolus. METHODS: Data sets consisting of HR, Systemic Arterial BP, Pulmonary Arterial BP, CVP, and Cardiac Output were generated for five shock states and five non-shock states. The resulting 10 data sets were presented on a computer monitor to study subjects twice (first in an alpha-numeric format and then in the object format) for a total of twenty decision screens. Subjects used soft-buttons on a computer touch-screen monitor to: a) advance to the next display; b) differentiate a non-shock state from a shock state; and, c) select the etiology of shock state represented by the display (Figure 2). Data collection was automatic, using the internal clock and memory of the computer. RESULTS: Eleven anesthesiologists participated in this study. They completed a total of 3060 diagnostic decisions, half with each display format. Performance measures were time to decision and diagnostic accuracy. The object display improved no-shock recognition by 1.0 second and shock etiology determination by 1.4 seconds (p < 0.05). The object display also significantly improved accuracy for shock recognition by 1.4% and etiology determination by 4.1% (p < 0.05). Testing was completed in a time interval of <45 min per 10 trials. CONCLUSIONS: The primary finding of this study was that anesthesiologists using the object display format committed significantly fewer diagnostic errors when interpreting physiologic data. In addition, both the recognition of no-shock and the diagnosis of shock etiology were completed more rapidly when the object display was used. The major limitation of this initial trial is the simplicity of the test. Future investigation of the impact of the display on clinical decision making will require more realistic clinical scenarios with partial or full simulation to better understand the potential clinical impact.

Anesthesiology↗
PubMed2005

Intraosseous neurilemmoma of L2 vertebra--a case report.

Intraosseous neurilemmoma (schwannoma) is a rare bone tumor with incidence less than 0.2% of all primary bone tumors. It is a benign neoplasm arising from the schwann cells of the nerve sheath. When they occur, they are usually found in the mandible. This paper reports an unusual occurrence of intraosseous neurilemmoma in L2 vertebral body. This patient presented with complaints of backache and progressively increasing weakness in both lower limbs. Roetengenograms showed an osteolytic lesion of L2 vertebra localized in the left half of the body and pedicle. Computed tomograph revealed a large soft tissue component of the tumor mass with thecal sac compression. A computed tomograph assisted needle biopsy revealed the tumor to be neurilemmoma. Subsequently, during decompression, it was possible to shell out tumor from surrounding tissues. Remaining tumor was curettedfrom bone and the cavity packed with autograft. The recovery was uneventful with incorporation of graft. The aim of this article is to highlight intraosseous neurilemmoma as a possible differential diagnosis in bony tumors. Intraosseous neurilemmoma of lumbar vertebrae is an extremely rare occurrence and till date only four cases are reported in English literature.

Adult↗
PubMed1980

Soft-tissue anatomy within the spinal canal as seen on computed tomography.

The CT appearance of the vascular, ligamentous, and neural tissues in the spinal canal was studied in 50 patients and 5 cadavers. In some patients, iodinated contrast medium was first injected into the ascending lumbar veins, nucleus pulposus, or theca. Positive identification of spinal soft tissues on the CT image was made by reference to cadaver dissections. The spinal cord, nerves, root sheaths, retrovertebral plexus, epidural and basivertebral veins, posterior longitudinal ligament and ligamentum flavum, intervertebral disks, and vertebral arteries can be demonstrated by CT, indicating its value in the diagnosis of disease of the cord, disk, and epidural space.

Contrast Media↗
PubMed1980

Orbital trauma and computed tomography.

Because computed tomography visualizes most soft tissues, foreign bodies, and bone details, it is an important supplement to conventional radiography in evaluating orbital trauma. A series of eight cases is presented to demonstrate the value of computed tomography. Several special techniques that enhance the usefulness of computed tomographic scanning are described.

Eye Diseases↗
PubMed2000

Specific elements of a new hemodynamics display improves the performance of anesthesiologists.

OBJECTIVE: We tested the hypothesis that a monitoring display proposed by Blike et al. improves the performance of anesthesiologists. We measured the performance of anesthesiologists using the new display and compared it to their performance with a traditional display. We studied three different displays on how they affected recognition and differentiation of five etiologies of shock-anaphylaxis, bradycardia, hypovolemia, ischemia and pulmonary embolus. METHODS: The participants monitored heart rate, systemic arterial and pulmonary blood pressure, central venous pressure, and cardiac output during five shock states and five non-shock states. The resulting 10 data sets made up ten decision screens, which we presented randomly on a computer monitor to the subjects in one of three different formats (a Single Sensor Single Indicator (SSSI) Numeric display; an Object display; and an Object Minus Shapes display). Subjects used soft-buttons on a computer touch-screen monitor to: a) advance to the next display; b) differentiate a non-shock state from a shock state; and, c) select the etiology of shock state represented by the display (Figure 4). The internal clock and memory of the computer made the collection of data automatic. RESULTS: The subjects recognized a problem more rapidly with the help of a graphical "pointer on a reference scale" in both Object displays, but their accuracy had not improved in comparison to the SSSI Numeric display. The shape of the Object display improved performance of etiology determination compared to the Object Minus Shapes display and SSSI Numeric display. Testing (10 trials) was completed in less than 45 minutes. CONCLUSIONS: The new display with "emergent features" can improve the diagnostic performance of clinicians.

Anesthesiology↗
PubMed1987

Application of magnetic resonance imaging and computerized tomography as an adjunct to the surgical management of soft tissue sarcomas.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans of 53 evaluable patients with biopsy-proven soft tissue sarcomas were reviewed and compared with operative results to ascertain the accuracy for each imaging modality to predict resectability. Location of soft part sarcomas included: abdomino-pelvic (3), retroperitoneal (7), extremity (35), and other anatomic sites (8). MRI was observed to have greater accuracy than CT to preoperatively predict resectability (96.2% vs. 75.5%, respectively, p = 0.0034) following three-dimensional, multiplanar evaluation. Further, MRI was judged to have superior sensitivity to CT (95.6% vs. 73.3%, respectively, p = 0.006) and equivalent specificity (100% vs. 87.5%, respectively, p = 0.125). MRI represents a sophisticated diagnostic imaging technique to differentiate normal tissue from soft tissue sarcomas with superior contrast resolution in multiplanar imaging. MRI is considered to be the imaging modality of choice for these tumors with the advantage of not exposing the patient to ionizing irradiation or intravenous contrast agents to delineate contiguous structures.

Adolescent↗
PubMed1991

Three-dimensional upper airway computed tomography in obstructive sleep apnea. A prospective study in patients treated by uvulopalatopharyngoplasty.

The success of uvulopalatopharyngoplasty in treating obstructive sleep apnea varies considerably. Some of this variability may be accounted for by differences in the site of upper airway narrowing. To determine whether preoperative awake upper airway and soft tissue volumes predict the response to uvulopalatopharyngoplasty, preoperative awake computed tomograms (CT) of the upper airway were performed on 60 consecutive patients with symptomatic obstructive sleep apnea. Tracings were made from the CT scans of upper airway, tongue, and soft palate. Computer software was used to determine the cross-sectional area and volume of the upper airway, tongue, and soft palate. Patients underwent overnight polysomnograms before and 3 months after uvulopalatopharyngoplasty. Tongue volume was larger (p less than 0.02) and both upper airway to tongue volume (p less than 0.0005) and oropharynx to soft palate volume ratios (p less than 0.01) were smaller in obese patients. A good response to uvulopalatopharyngoplasty as defined by a postoperative apnea index of less than 5 apneas/h or a reduction in apnea index greater than or equal to 50% was seen in 50 patients (83%). Patients who had a good response had a smaller oropharyngeal cross-sectional area (p less than 0.01), a smaller upper airway volume (p less than 0.05), a smaller upper airway to tongue volume ratio (p less than 0.01), and a smaller oropharynx to soft palate volume ratio (p less than 0.05). Obese patients with obstructive sleep apnea have larger tongues and smaller upper airways relative to tongue and soft palate size. Patients with smaller upper airways, particularly relative to tongue and soft palate size, have a good response to uvulopalatopharyngoplasty.

Computer Graphics↗
PubMed1998

Accuracy of cephalometric and video imaging program Dentofacial Planner Plus in orthognathic surgical planning.

The prediction of profile changes after surgery poses a problem due to the variability of the soft tissue and the differences in soft-tissue translations relative to osseous changes. This study examined the accuracy of computer predictions of such soft-tissue changes. Twenty-five patients with mandibular retrognathia were examined before and after orthognathic surgery. Changes in soft-tissue reference points were correlated to translations of hard-tissue references in the sagittal and vertical planes, and the measurements from these patients were compared to results predicted in preoperative planning by the cephalometric and video imaging program Dentofacial Planner. In surgical treatment involving advancement of the mandible, the mean operative advancement of the osseous pogonion was 6.06 mm. The corresponding movements of soft-tissue references, expressed as percentages relative to the movement of the osseous pogonion in the sagittal plane, were 98.4% for the soft-tissue pogonion, 93.6% for the soft-tissue menton, and 49.0% for the soft-tissue labrale inferior. The same measurements were carried out in the vertical plane and the changes in soft-tissue references were compared to those predicted in preoperative planning using the Dentofacial Planner. The predicted images were perceived as agreeing with the actual image most frequently in the lip and nasal area, while the highest degree of error was seen in the submental region. An overall predictability of more than 80% can be attained by planning mandibular advancement operations for correction of mandibular retrognathia using the Dentofacial Planner.

Adult↗
PubMed2005

Standardization for image characteristics in telemammography using genetic and nonlinear algorithms.

As the soft copy reading and computer assisted diagnosis (CAD) in mammography become more and more important, the standardization of digital images becomes paramount. Telemammography and telemedicine requires the standardization for image characteristics, such as image resolution, bit-depth and intensity response. Soft copy reading and CAD in mammography are both dependent on the characteristics of the source of the digital data, either direct digital mammography or digitized screen-film mammography. An algorithm developed on images from one database may not perform well as on images from another database (with a different digitization). In this paper, we describe two methods based on a genetic algorithm and a nonlinear algorithm for standardization of digitized and digital mammography. The proposed standardization techniques are based on geometric and intensity transformations that are discovered using a set of calibration images. A set of transformation algorithm is used to search for the best standardization.

Algorithms↗