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Quantification of global and regional renal blood flow with electron beam computed tomography.

Alterations in renal blood flow distribution may occur in a variety of pathophysiologic situations; however, quantification of global and regional renal blood flows has been limited because of the lack of reliable, noninvasive techniques. To determine the feasibility of flow measurements with electron-beam computed tomography (EBCT), six anesthetized dogs were scanned by EBCT during basal conditions, after renal vasodilation, and at recovery. Flow (mL/min/cm3 tissue) was calculated from EBCT-derived time-density curves using three different algorithms and compared with simultaneously obtained electromagnetic flow (EMF) probe measurements after indexing to EBCT-derived renal volume. EBCT-determined flow correlated well with EMF measurements regardless of the algorithm used. An algorithm using the area under the time-density curve was concluded to be the most suitable for calculation of renal blood flow; it correlated with EMF as EBCT flow = 44.5 + 1.05 EMF (r = 0.885, SEE = 31.2 mL/min, P < .0001). Consistent overestimation of flow by EBCT resulted probably from retention of contrast media in the renal parenchyma. EMF showed an increase of 20 +/- 10% in renal blood flow after vasodilation. EBCT-derived global, cortical, and medullary flows increased by 33.8 +/- 10.3%, 24.8 +/- 17.8%, and 99.0 +/- 73.8%, respectively. In conclusion, EBCT was found feasible for credible quantitation of renal blood flow in the physiologic range studied.

Algorithms

Accelerated learning by active example selection.

Much previous work on training multilayer neural networks has attempted to speed up the backpropagation algorithm using more sophisticated weight modification rules, whereby all the given training examples are used in a random or predetermined sequence. In this paper we investigate an alternative approach in which the learning proceeds on an increasing number of selected training examples, starting with a small training set. We derive a measure of criticality of examples and present an incremental learning algorithm that uses this measure to select a critical subset of given examples for solving the particular task. Our experimental results suggest that the method can significantly improve training speed and generalization performance in many real applications of neural networks. This method can be used in conjunction with other variations of gradient descent algorithms.

Algorithms

Comparative analysis of arterial oxygen saturations during exercise by pulse oximetry, photometric measurements, and calculation procedures.

Pulse oximetry allows non-invasive monitoring of arterial oxygen saturation (SO2). To study the validity of pulse oximetry, comparative measurements were performed. During exhaustion limited exercise SO2-values measured by pulse oximetry (SO2puls), calculated SO2-values (algorithms of Kelman, Severinghaus, and Siggaard-Andersen--SO2calc), and as "golden standard" photometric measured SO2-values (SO2meas) were compared. Fourteen triathletes performed a stepwise cycling exercise test in the supine position. SO2calc was determined on the basis of capillary actual blood gas values. SO2puls was measured continuously with a finger probe attached to the second finger. The SO2puls- and SO2calc-values differed from the SO2meas-values (p less than 0.05); however, the differences were of no clinical relevance. Performing linear regression analysis, only SO2puls correlated significantly (r = 0.47, p less than 0.001) with SO2meas. Pulse oximetry is able to replace invasive measurements of arterial oxygen saturation in athletes. It is superior to SO2-calculations and permits reliable, valid and non-invasive continuous monitoring of SO2.

Adult

Response force titration for the assessment of the neuromuscular toxicity of 2,5-hexanedione in rats.

A silent, non-moving glass lever combined with strain gauges and mounted in an operant chamber measured the vertical isometric force exerted by the forepaw of rats. Every weekday the rats were subjected to a force titration schedule consisting of a sequence of discrete trials signalled by a lever light. The required force, above which a water reinforcement is delivered, was regulated by a generalized bisection algorithm. A stable force level which the rat was able to attain at 50% of the trials was quickly reached in each session by this algorithm. This technique was used to measure the neuromuscular performance decrement due to repeated 2,5-hexanedione treatment (250 and 500 mg/kg/day per os). The results were compared with fore- and hindlimb grip strength measurements on the same animals. This experiment showed that the force titration technique is able to distinguish between motivational and true force decrements, a distinction which cannot be made by the grip strength technique.

Analysis of Variance

[Concept of the mean stopping power and the mean electron energy in electron dosimetry].

In consideration of the variations of the values E,Er,EH and Ew of the energy spectrum of electrons at the measuring point in case of a given energy on the surface Eo and in the depth t of a phantom with a low Z-number, the authors present the practical realisation of a conception allowing to determine by one single conversion curve Sw,1 (Er) the energy-dose of rapid electrons in water Dw, at least within the spectrum of Eo = 5 to 42 MeV and Er = 2.2 to 42 MeV, from the cavity ion dose Jc measured absolutely or by means of a calibrated electron chamber. Sw,1 (Er) is the relative unrestricted mass collision stopping power as a function of the mean rest energy Er at the measuring point. Er can be calculated in a simple manner from Eo and t and coincides almost perfectly with the most probable energy Ew of measured electron spectra. The authors present an algorithm for the calculation of the true mean electron energy E from Eo and t with a good coincidence with the values of measured electron spectra. It is shown that, contrary to the curve with one parameter Sw,1 (Er), a relation of Sw,1 to E leads to a series of curves with two parameters Sw,1 (Eo, t). The method using a relation of Sw,1 to Er which offers the advantage of a simple practical application and good precision is presented as "conception of the mean stopping power in electron dosimetry".

Electrons

An algorithmic approach to diagnosis of hypoglycemia.

An algorithm has been devised to facilitate the diagnostic approach to the causes of hypoglycemia. This systematic approach enables the physician to reach the final diagnosis in a logical way without subjecting the child to unnecessary and possibly hazardous investigations. The algorithm is based on the following measurements as required by each patient: concentrations of blood glucose, lactate, ketone bodies, and glucose-regulating hormones. These measurements are performed with the patient in the fasting state and after loading tests (glycerol and galactose) as needed. If indicated, an enzymatic test is performed to establish the final diagnosis. Eighteen children aged 1 month to 7 years who had persistent or recurrent hypoglycemia have been examined according to this algorithm. The correct diagnosis was arrived at in 17 patients. The diagnosis was not reached in one neonate who had glucose-6-phosphatase deficiency and initially did not have lactic acidosis; once lactic acidosis developed, his illness fitted perfectly into the algorithm.

Algorithms

MR quantification of cerebral ventricular volume using a semiautomated algorithm.

PURPOSE: A semiautomated border identification algorithm, insensitive to user bias, is evaluated for accuracy and speed in the measurement of ventricular volumes from three-dimensional MR images. METHODS: A three-dimensional gradient-echo technique was implemented on a Signa clinical imaging system. Data from phantoms and patients were analyzed for volume using a segmentation algorithm designed with: 1) correction for partial volume averaging; 2) insensitivity to user bias; and 3) speed. Accuracy, precision, and intra- and interobserver variability were determined. RESULTS: Average error for phantom studies was 4% to 6%, or 1 to 2 cc across the volumes, which ranged from normal to mild hydrocephalus (< 60 cc). Patient studies showed intra- and interobserver error of 2.3% and 7.8%, respectively. The correction for partial volume averaging resulted in a threefold decrease in error. Data were acquired and reconstructed within 7 minutes. Experienced radiologists required less than 15 minutes to perform each analysis. CONCLUSIONS: This algorithm allows accurate measurement of ventricular volumes in an efficient, minimally supervised manner.

Adult

Accuracy and precision of the CellForm-Human automated sperm morphometry instrument.

OBJECTIVE: To evaluate the accuracy and precision of the CellForm-Human (CFH) automated sperm morphometry instrument (Motion Analysis Corp., Santa Rosa, CA). SETTING: Clinical and research andrology and in vitro fertilization laboratories. PATIENTS: Individuals undergoing semen evaluation and infertility work-up. RESULTS: Coefficients of variation for repeated measures of the same sperm were 1%. Coefficients of variation of normal sperm measurements were 7.4% to 12.8%, depending on the measure. Of the objects recognized as sperm by the instrument, 6.8% were debris; hence, the sperm recognition algorithms need improvement. Mean values for all CFH measures of normal sperm from specimens clinically classified as having predominantly normal, tapered, or amorphous sperm were not different; hence, the morphometry of normal sperm from normal specimens was similar to normal sperm from specimens with two different abnormalities. The instrument classified sperm as abnormal if their length or width fell outside a critical range of values recommended by the World Health Organization. Using this method, manual and CFH classification agreed unambiguously 60% of the time. When disagreement occurred, length or width marginally exceeded the range by no more than 0.1 microns. In these cases, the technician classified sperm as normal 25% of the time and classified them as abnormal 6% of the time. Because this disagreement between methods is well below the resolution of manual methods, the overall accuracy of CFH was 91% for cell type classification. CONCLUSION: At its present stage of development, the CFH instrument exceeds the accuracy and precision of most manual approaches. With improvements in sperm recognition and type classification algorithms, it could significantly improve the reliability of morphology assays in clinical and research laboratories.

Equipment Design

Peak flow records in asthma: evaluation of an algorithm for interpretation of patterns.

The clinical value of serial measurements of peak expiratory flow (PEF) in asthma is well established, but the analysis of the PEF records is not standardized. We developed an algorithm for interpretation of PEF, based upon the characteristic features of chronic airflow limitation, and retrospectively analysed the PEF of fifty outpatients affected by non-seasonal asthma. For each patient we correlated the developed indices of evolution of PEF with, respectively, the severity of asthma (evaluated in terms of consumption of drugs), forced expiratory volume in one second and with the trend of the indices over several months. The developed indices were well correlated with the severity score and to a lesser extent to other investigated parameters. These results seem to provide a useful approach to a computerized evaluation of the results of PEF monitoring.

Adolescent

Measurements of ultrasonic fields with optical diffraction tomography.

This article describes a light diffraction technique that allows a measurement of ultrasonic pressure and phase in the cross-section of an ultrasonic beam. The light diffraction measurements are based on the Raman-Nath model of ultrasonic continuous-wave light diffraction. The diffracted light intensity can be expressed as an integration of sound pressure along the light path. This integration is analogous to the integration of the absorption coefficient in x-ray tomography. Tomography algorithms can be employed on the light measurement data to calculate the pressure and phase in a measuring plane perpendicular to the ultrasound propagation vector. The reconstruction of the measurement plane is done with an implementation of an algebraic reconstruction technique (ART). Satisfactory results are obtained with 10 projections. The measurement method is applicable up to Raman-Nath parameter values of 2.3. The experimental results are compared to miniature PVDF hydrophone measurements.

Algorithms

Echocardiographic design of a multicenter investigation of free-living elderly subjects: the Cardiovascular Health Study.

The Framingham study has shown by M-mode echocardiography that left ventricular hypertrophy is a powerful, independent predictor for the development of coronary heart disease and that increased left atrial dimension has been associated with an increased risk of stroke. No previous population-based study has evaluated the risk factor correlates and predictive value for coronary heart disease and stroke of two-dimensional and Doppler, as well as M-mode, echocardiography. The Cardiovascular Health Study is a multi-year prospective epidemiologic study of 5201 men and women older than 65 recruited from four geographic sites in the United States. The main objectives of incorporating echocardiography were to determine whether echocardiographic indices, or changes in these indices, are (1) correlated with traditional risk factors for coronary heart disease and stroke; and (2) independent predictors of morbidity and mortality for coronary heart disease and stroke. Echocardiographic measurements of interest include those related to global and segmental left ventricular systolic and diastolic structure and function and left atrial size. For each subject, a baseline echocardiogram was recorded in super-VHS tape using a standard protocol and equipment. All studies were sent to a reading center where images were digitized and measurements were made using customized computer algorithms. Calculated data and images were stored on optical disks to facilitate retrieval and future comparisons in longitudinal studies. A second echocardiogram is scheduled in year 7, with a goal of determining whether changes in cardiac anatomy or function over a 5-year period are important predictors of morbidity or mortality from coronary heart disease and stroke. Quality control measures included standardized training of echocardiography technicians and readers, technician observation by a trained echocardiographer, periodic blind duplicate readings with reader review sessions, phantom studies, and quality control adults.

Allied Health Personnel

A simulation of emission and transmission noise propagation in cardiac SPECT imaging with nonuniform attenuation correction.

Transmission computed tomography provides information needed for nonuniform attenuation correction of cardiac single photon emission computed tomography (SPECT). Nonuniform attenuation correction is accomplished using an iterative ML-EM algorithm and a projection-backprojection operation that incorporates attenuation factors measured from the reconstructed transmission map. The precision and accuracy of the attenuation corrected emission reconstruction is a function of emission and transmission statistics. This paper presents an error propagation analysis that uses a mathematical cardiac chest phantom to simulate various combinations of total emission counts C and transmission flux I0 under ideal imaging conditions (without geometric response distortion and without scatter). The spatial average, spatial variance, and accuracy measures for a 4 x 4 pixel region in the heart are tabulated after 30 iterations of the ML-EM algorithm. The confidence intervals for these measures were determined from 1000 realizations of reconstructions from projections randomly generated with the same transmission and emission statistics. It can be shown empirically from the simulation results that the spatial %rms uncertainty for the simulated cardiac region has a simple expression: %rms2 = K1/C+K2/I0(2)+B2 where K1 and K2 are least-square estimates based on the simulation results, and B is the measured spatial %rms uncertainty for the simulation at infinite statistics. For a transmission incident flux of 1500 events per projection bin of 0.712 cm and typical clinical emission events totaling 1 x 10(5), the spatial %rms uncertainty is approximately 14%. At clinical transmission and emission statistics, the statistical noise in the simulated attenuation-corrected reconstructions are dominated by the emission statistics.

Algorithms

3D PET using a conventional multislice tomograph without septa.

A conventional multislice positron emission tomography scanner was modified to operate without interplane septa to evaluate its performance in collecting and reconstructing data in a three-dimensional (3D) format, thereby significantly increasing system sensitivity. A 3D filtered backprojection algorithm was implemented and tested, using both computer simulations and phantom measurements. No artifacts were apparent in the test images, although the algorithm was shown to lead to a 11% degradation in transaxial resolution in the outer planes. Following septa removal, sensitivity was found to increase by a factor of 7 with an increase in scatter fraction from 16 to 41%. Axial resolution degraded from 6.9 to 7.7 mm full width at half maximum at the center of the field of view. The maximum count rate without septa was 2.4 x 10(5) cps, at a concentration of 0.4 microCi/ml, compared with 1.3 x 10(5) cps at 1.5 microCi/ml with septa. Brain studies were performed with volunteers using 18F-fluorodeoxyglucose, 18F-fluorodopa, and H2 15O to compare noise-equivalent count rates and qualitatively assess image quality over a wide range of imaging conditions.

Algorithms

A noninvasive technique for detecting hypernasal speech using a nonlinear operator.

Speakers with a defective velopharyngeal mechanism produce speech with inappropriate nasal resonance (hypernasal speech). It is of clinical interest to detect hypernasality as it is indicative of an anatomical, neurological, or peripheral nervous system problem. There are various clinical techniques used to determine hypernasality. The current techniques are physically invasive or intrusive to some extent. A preferred approach for detecting hypernasality, would be noninvasive to maximize patient comfort and naturalness of speaking. In this study, a noninvasive technique based on the Teager Energy operator is proposed. Utilizing a property of the Teager Energy operator and a model for normal and nasalized speech, a significant difference between the Teager Energy profile for lowpass and bandpass filtered nasalized speech is shown. This difference is shown to be nonexistent for normal speech. A classification algorithm is formulated that detects the presence of hypernasality using a measure of the difference in the Teager Energy profiles. The classification algorithm was evaluated using a native English speaker population producing front (/i/) and mid (/A/) vowels. Results show that the presence of hypernasality in speech can be reliably detected using the proposed classification algorithm.

Algorithms

Bayesian decision making based on measurements containing errors.

The paper presents a Bayesian approach to the construction of diagnostic and prognostic algorithms, based on the use of several diagnostic factors (tests) in combination. With this approach, the simultaneous use of dichotomous, discrete, categoric, and continuous factors is easy and the resulting algorithms are more efficient than those of other known methods. Moreover, each factor value that is available for use is assumed to represent an estimate (the result of an imperfect measurement) of some (unknown) true value. The proposed method of accounting for measurement errors is advantageous as regards efficiency for users of the algorithm (physicians) if the accuracy of the factor-measurement techniques at their disposal differs from that of the constructor of the algorithm (the scientist). The approach is illustrated by an example, and possible error models and methods of collecting statistical data are discussed.

Algorithms

A geometric algorithm for medical image correlations.

An automatic image correlation algorithm is discussed for the cranial region which is based on the geometric properties of the second moment tensor associated with a volume. The second moment tensor of two identical volumes represented in two different coordinate frames is evaluated to obtain the set of translations, rotations, and anisotropic scaling operators which relate the two coordinate frames. The theory is presented along with a discussion of quantitative error analysis to measure the usefulness of such an algorithm in the clinical setting.

Algorithms

Temperature field estimation using electrical impedance profiling methods. I. Reconstruction algorithm and simulated results.

Algorithmic methods for estimating complete temperature fields during hyperthermia treatments based on surface and internal electrical measurements are presented. The techniques utilized draw upon impedance imaging concepts, but rather than limit the measurements to positions on the body surface, internal impedance recording sites are allowed. Theoretical simulations show that this strategy improves the reconstructed image in the target region when either internal measurement locations are added to a given number of external recording sites or some external measurement locations are replaced by internal recording positions. The algorithms developed are tested on a set of problems with increasing levels of complexity. The culmination of these investigations is a complete simulation of a hyperthermia treatment and reconstruction of a thermal image for a body cross-section of an actual cancer patient. The results of this work suggest that the surface plus internal measurement approach holds some promise as a method for estimating temperature distributions during hyperthermia treatments. However, the simulations while promising are idealizations in that they are two-dimensional with modest levels of additive noise. In a companion paper, we explore the viability of this approach in several laboratory phantom experiments which include both static and heat-induced transient electrical property profiles.

Algorithms

Image analysis techniques for automatic evaluation of two-dimensional electrophoresis.

Techniques for automatic analysis of two-dimensional electrophoresis gels by computer-aided image analysis are described. Original gels or photographic films are scanned using a laser scanner and the files are transferred to a microcomputer. The program package first performs a compression and preevaluation of the files. Spot identification and quantification is performed by the chain code algorithm after appropriate zooming and cutting. Labeling facilitates spot identification and quantification in numerical and graphical (pseudocolor) representation on peripheral devices for camera ready output. Interpolation between measured basepoints is performed by cubic spline algorithms which are automatically switched on and off, depending on the need by the program. High speed analysis and graphic representation is achieved using fast Assembler language routines rather than high level languages. One-dimensional gels can be analyzed using the same software. Spot matching between parallel two-dimensional gels has not yet been implemented.

Electrophoresis, Gel, Two-Dimensional