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Reconstruction of the electrocardiogram during heart surgery.

Electrocardiograms (ECG) recorded during arrhythmia surgery are used for identification of arrhythmias of different morphology. However, the interpretation of an intraoperative ECG is difficult because some leads cannot be recorded and the signals of the remaining leads often differ from those of a preoperative recording because of the sternotomy. Therefore, a method for reconstruction of a complete intraoperative ECG, which resembles a preoperatively recorded ECG, was studied in 24 patients undergoing heart surgery. The reconstruction method involves calculating coefficients for a transformation matrix, using a preoperative ECG recording and a first intraoperative ECG recording. Once this matrix has been established, further intraoperative recordings can be transformed into an ECG which strongly resembles a preoperative ECG. The correlation between reconstructed intraoperative leads and the corresponding preoperative leads was high in the leads Vx and Vy (median correlation coefficient 0.98 and 0.97) and slightly smaller in lead Vz (0.94). Further studies will prove if the method can be useful in arrhythmia surgery.

Aged↗

Improvement of 3D acquisition and visualization in MRI.

Three-dimensional (3D) visualization techniques are becoming an ever more important aid in the interpretation of tomographic data. Up to now, however, they have not received widespread use in MRI, because both acquisition and visualization techniques have been inadequate. In this paper we describe new 3D acquisition techniques which can acquire up to 128 slices with a resolution of 256 x 256 pixels in from 8 to 20 min. These techniques produce 3D data sets with excellent contrast and few motion artifacts, which are very well suited for 3D visualization techniques. For the visualization we investigate several rendering techniques, describe some improvements and compare their results. We found that there is no single method which renders all objects equally well. We show which shading method is best suited for different objects and why the other methods fail. Our studies suggest that in a 3D view with several objects each object should be rendered with a separate shading method. In so doing, 3D views can be generated which look like the real human anatomy.

Data Display↗

A data adaptive reprojection technique for MR angiography.

Inability to detect vessel overlap and vascular loops can compromise the interpretation of magnetic resonance angiograms. A data-adaptive ray tracing (DART) technique was developed to produce the appropriate variations in signal intensity at points of vessel overlap in order to simulate the standard angiographic representation of vessels. In this technique a threshold is utilized to identify vessels in the image slices composing a 3D angiographic data set. A mask, which defines regions slightly larger than the vessel boundaries, is obtained by blurring the vessel information surviving the initial threshold. This mask is converted to binary form prior to multiplication by the original angiographic data set. Following application of an additional threshold to the masked data, line integrals through the regions defined by the mask are performed to obtain an angiographic signal proportional to the integrated vessel signal as in conventional angiography. This integrated reprojection is then uniquely combined with a maximum intensity pixel (MIP) reprojection to produce the final DART image. The application of the DART technique to 2D time-of-flight and 3D phase-contrast angiograms successfully enabled the identification of over-lapping vessels and vascular loops. DART was also found to produce less vessel narrowing than the MIP technique.

Algorithms↗

Mast cell fixation and staining in image analysis.

Modern image analysers automatically perform densitometric measurements and elaborate digital images. Elaboration however is subject to operator interpretation and often eliminates precious information from the areas of interest. For this reason, it was appropriate to find a staining method which would overcome this drawback and, in the case of mast cell histochemistry, limit staining to granule content. The following current staining techniques were tested: Toluidine Blue in buffered solution (solut. a) and in 0.003% alcoholic solution (solut. b) and alcoholic Astra Blue, pH 0.2 Densitometric analysis was performed on both 5 microns and semithin sections of mouse tongue fixed in Isotonic formaldehyde-acetic acid (IFAA). Digital images were obtained using 630 nm and 546 nm wavelengths for Toluidine Blue and 610 nm for Astra Blue. Direct comparison between the two Toluidine Blue solutions revealed that more pixels were captured by the 5 microns sections stained with solut. a, whilst the opposite occurred in semithin sections. Both dyes introduced a certain amount of error due to the orthochromatic component of the nucleus and cytoplasmic basophily, which had to be eliminated through image elaboration. Because of its subjective nature, this operation may in turn lead to further errors. The choice of Astra Blue as an alternative to Toluidine Blue in densitometric analysis of mastocytes is based on its property to restrict staining to the granules of mast cells. A comparison between Astra Blue and the two Toluidine Blue solutions showed that, at all transmission levels, preparations stained with Astra Blue captured more pixels than those stained with Toluidine Blue. Consequently our results suggest that the most suitable technique for densitometric image analysis is fixation of mast cells in IFAA followed with Astra Blue.

Animals↗

Quantitative histological analysis of the human sinoatrial node during growth and aging.

BACKGROUND: Fibrosis or fatty infiltration of the human sinoatrial (SA) node is generally believed to represent replacement of the SA nodal cells by connective tissue. Quantitative analysis, however, has not been performed precisely to validate the interpretation of such histological changes. METHODS AND RESULTS: The actual volume of the SA node and its components were calculated according to the sum of the pixel number representing the colors of SA nodal cells and connective tissue in serial sections using a digital color image analyzer. Average volume occupied by the total SA nodal cells in adolescents and adults (n = 7) was 3.55 +/- 0.45 mm3, which was 2.4 times greater than that in infants (n = 3). The rate of increase was smaller than that of the total SA node (4.2 times, 16.68 +/- 2.56 mm3 in adolescents and adults). The considerable discrepancy in the growth ratio between the SA nodal cells and the total SA node resulted from an increase in the volume of connective tissue (7.4 times). In the elderly (n = 9), the volume of total SA node and SA nodal cells actually decreased (13.10 +/- 1.85 mm3 and 2.18 +/- 0.44 mm3), whereas that of fibrous connective tissue remained unchanged. Constant DNA ploidy patterns of SA nodal cells determined by cytofluorometry indicated that SA nodal cells never synthesize DNA during growth. CONCLUSIONS: Until adulthood, the actual volume of SA nodal cells does not decrease, although the increase in volume ratio of the interstitial tissue to the total SA node has merely given a false impression of involution of SA nodal cells. Atrophy of SA nodal cells, however, occurs during aging together with reduction of the SA node and/or infiltration of fatty tissue.

Adolescent↗

Polyaxonal amacrine cells of rabbit retina: PA2, PA3, and PA4 cells. Light and electron microscopic studies with a functional interpretation.

Polyaxonal (PA) amacrine cells are a new class of amacrine cell bearing one to six branching, axon-like processes that emerge from the cell body or dendritic trees within 50 microns of the cell body. These slender processes of uniform caliber branch at right angles and in many respects closely resemble the axons of Golgi type II cells found elsewhere in the brain. Of the four types of polyaxonal amacrine cell that we have recognized in rabbit retina, two have been described previously in brief communications. One of these, the PA1 amacrine cell with its interstitially displaced cell body, located in the inner plexiform layer (IPL), has been analyzed extensively in two preceding reports. This paper concerns PA2, PA3, and PA4 amacrine cells. Type 2 polyaxonal (PA2) amacrine cells, identified in Golgi preparations of whole-mounted rabbit retinas, have smaller cell bodies (9-14 microns) than the other three types and these are always displaced to the ganglion cell layer (GCL) or the inner border of the inner plexiform layer (IPL). The dendritic fields of PA2 cells are also smaller than those of other PA amacrine cells, and most of their sparse dendritic branching is narrowly stratified at the border of strata (S) 4 and 5. Some members of this more heterogeneous amacrine cell "type" are bistratified, however, and more highly branched with terminal branches rising to end in S1. PA2 amacrine cells bear a scattering of small dendritic spines and may also exhibit complex dendritic appendages arising at the ends of terminal branches in proximal regions of the dendritic tree. PA2 cells emit one to three axons from the proximal dendritic tree, and about half of the cells bear a single axon. Type 3 polyaxonal (PA3) amacrine cells resemble PA1 cells in the large size of their cells bodies (11-16 microns) and dendritic fields, but differ from the latter in placement of cell bodies, which is in the GCL, and dendritic and axonal stratification, which is multistratified, ranging from S4 to S1, with a concentration in S3 or S4 and a variable contribution to S1. PA3 cells differ from PA1 cells in several other respects, including dendritic branching which occurs at higher frequency and is biased toward temporal retina, and in characteristic bristling dendritic spines, clustered in the intermediate regions of the dendritic tree, that are longer, more variable in appearance and more tightly clustered than the small, uniform spines of PA1 cells that are clustered on proximal dendrites.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Ocular↗

The MELANIE project: from a biopsy to automatic protein map interpretation by computer.

The goals of the MELANIE project are to determine if disease-associated patterns can be detected in high resolution two-dimensional polyacrylamide gel electrophoresis (HR 2D-PAGE) images and if a diagnosis can be established automatically by computer. The ELSIE/MELANIE system is a set of computer programs which automatically detect, quantify, and compare protein spots shown on HR 2D-PAGE images. Classification programs help the physician to find disease-associated patterns from a given set of two-dimensional gel electrophoresis images and to form diagnostic rules. Prototype expert systems that use these rules to establish a diagnosis from new HR 2D-PAGE images have been developed. They successfully diagnosed cirrhosis of the liver and were able to distinguish a variety of cancer types from biopsies known to be cancerous.

Biopsy↗

Superimposing two-dimensional gels to study genetic variation in malaria parasites.

Two-dimensional polyacrylamide gel electrophoresis is a valuable tool for studying genetic variation in the human malaria parasite, Plasmodium falciparum. It involves examining the position of protein spots in gel produced from different isolates. Some spots have been seen to vary, while others have had a constant position in all isolates so far examined. These invariant spots provide a reference frame to compare variations in other spots. This paper discusses the usefulness of digital image handling, warping and superimposition in a personal computer environment. Rather than produce a fully automatic interpretation system, we show how the computer may be used as a tool for manipulating gel images, although interpretation of the gels' features remains with the human expert. Autoradiographs are scanned on a desktop scanner, and the images in digital form can be displayed on a monitor attached to a personal computer. The coordinates of the invariant spots on each of several gels are identified by the user. Each of the gels is then warped so that the invariant spots of all the gels coincide as closely as possible. The variable spots are then examined. We have used both affine warping transformations, which match the invariant spots as closely as possible, and thin plate spline transformations, which match them exactly. Colour superimposition proved a useful way of examining the gels.

Animals↗

Quantitative morphology for biologists and computer scientists: I. Computer-aided tutorial for biological stereology (version 1.0).

This paper describes a computer-aided tutorial for biological stereology. Stereology, a type of quantitative morphology, includes a collection of statistical methods that quantify the structural compartments that can be viewed in sections with light and electron microscopy. These methods provide volume, surface, length, shape, and number data, and help define the quantitative relationships among the structural compartments of biological hierarchies. Hierarchies, which connect structural data ranging in size from molecules to organs, serve as a central core to which the data of biological databases can be linked. The tutorial focuses on two objectives. It provides the user primarily interested in using quantitative morphology databases with background information, and offers a set of state-of-the-art tools to researchers wishing to use these methods in the laboratory. The main topics of the tutorial include: introduction to quantitative morphology, symbols/terms, data types, sampling, hierarchies, data interpretation, and utilities. The tutorial runs under the MS-DOS operating system and requires at least an IBM PC AT (or compatible), a color monitor (EGA, VGA), 540 KB of RAM, and 3 MB of hard disk space.

Animals↗

Oral diagnostic reporting and synchronized image filing using magneto-optical disks.

An experimental radiologic reporting system has been developed and tested. The rewritable and compact magneto-optical disk (MOD) is applied to storing medical images with oral diagnostic reports of these radiologic images. The disk is 5.25 inches in diameter, has 600 MB memory capacity, is erasable, light and compact. Advantages are simultaneous recording of radiologic images and their oral reports by radiologists, and application to circulation of media inside the hospital as well as to filing of medical images. The MOD has a multimedia function of communication and filing. When medical images are taken and stored, oral interpretation by radiologists can be simultaneously added. Physicians can get information of the images and their reports by oral speech at the same time in front of computer workstation. Furthermore, integration of a voice recognition capability is now being undertaken.

Image Processing, Computer-Assisted↗

New approach to interpretation of technetium-99m pyrophosphate scintigraphy in detection of acute myocardial infarction: clinical assessment of diagnostic accuracy.

A modified classification for interpreting technetium-99m pyrophosphate scintigrams defines the 2+ diffuse pattern of tracer uptake as equlvocal rather than positive for acute myocardial infarction. Results of scintigraphy using this classification were compared with results of standard diagnostic tests for myocardial infarction in 235 patients admitted to a coronary care unit with acute chest pain. Of 81 patients with acute transmural infarction by standard clinical, electrocardiographic and serum enzyme criteria, 76 had a positive, 5 an equivocal and none a negative scintigram. Of 18 with acute nontransmural infarction by standard criteria, 7 had a positive, 9 an equivocal and 2 a negative scintigram. This it was uncommon for a patient with acute myocardial infarction, transmural or nontransmural, to have a definitely negative technetium-99m pyrophosphate study. Ten patients had equivocal evidence of infarction by standard criteria. Of the remaining 126 patients with no evidence of acute myocardial infarction by standard criteria, 87 had a negative, 35 an equivocal and 4 a definitely positive scintigram. Thus the definitely positive scintigraphic pattern was relatively highly specific for acute myocardial infarction. If the 2+ pattern had been considered positive, the specificity of the technique would have been greatly decreased. Computer processing strengthened observer certainty of the visual impression but changed the scintigraphic evaluation in only eight cases. Thus, use of an equivocal pattern renders technetium-99m pyrophosphate imaging both an extremely sensitive and specific method for detecting acute myocardial infarction.

Acute Disease↗

Initial results for automated computational modeling of patient-specific electromagnetic hyperthermia.

Developments in finite-difference time-domain (FD-TD) computational modeling of Maxwell's equations, super-computer technology, and computed tomography (CT) imagery open the possibility of accurate numerical simulation of electromagnetic (EM) wave interactions with specific, complex, biological tissue structures. One application of this technology is in the area of treatment planning for EM hyperthermia. In this paper, we report the first highly automated CT image segmentation and interpolation scheme applied to model patient-specific EM hyperthermia. This novel system is based on sophisticated tools from the artificial intelligence, computer vision, and computer graphics disciplines. It permits CT-based patient-specific hyperthermia models to be constructed without tedious manual contouring on digitizing pads or CRT screens. The system permits in principle near real-time assistance in hyperthermia treatment planning. We apply this system to interpret actual patient CT data, reconstructing a 3-D model of the human thigh from a collection of 29 serial CT images at 10 mm intervals. Then, using FD-TD, we obtain 2-D and 3-D models of EM hyperthermia of this thigh due to a waveguide applicator. We find that different results are obtained from the 2-D and 3-D models, and conclude that full 3-D tissue models are required for future clinical usage.

Computer Simulation↗

Computer-aided interpretation and quantification of angular periodontal bone defects on dental radiographs.

Capabilities of human observers to detect and describe small bone defects objectively are limited. Digital image processing can provide a useful contribution to the diagnostic process. This paper describes the evaluation of a computer-aided procedure for the interpretation and quantification of angular periodontal bone defects on dental radiographs. The computer-aided procedure was able to rank series of artificial periodontal bone lesions as accurate as experienced clinicians. Comparison of data from clinical inspection of lesions during surgery and quantitative results of the digitized procedure shows that the latter produced reliable information on the lesions size. Reproducibility is satisfactory. It was concluded that computer-aided detection and description of periodontal bone defects decreases the interobserver variability in general and the time-dependent variability in repeated assessments of a single observer.

Alveolar Bone Loss↗

A three-dimensional display for cardiac activation mapping.

A three-dimensional display is described that allows activation sequences from the epicardium and endocardium to be shown simultaneously on the same image. Three electrode arrays (epicardial sock, left ventricular balloon, right ventricular balloon) are represented in a three-dimensional perspective by an array of dots that are intensified when activated. This arrangement requires fewer calculations and is easier to interpret than sliced-isochronal maps but cannot represent a complete heart cycle in one image. The three-dimensional display eliminates the distortion caused by two-dimensional diagrams and facilitates activation correlation between electrode arrays. A standard, low cost microcomputer has been used to implement the activation display.

Arrhythmias, Cardiac↗

Subperiosteal resorption: effect of full-frame image compression of hand radiographs on diagnostic accuracy.

Image compression is essential to handle a large volume of digital images, including computed tomographic, magnetic resonance, computed radiographic, and digitized images in a digital radiology operation. Developed during the past few years, full-frame bit allocation performed with the cosine transform technique has been proved to be an excellent irreversible image compression method. This article describes the effect, on the accuracy of diagnosis of subperiosteal resorption, of using the hardware compression module to produce hand radiographs. Receiver operating characteristic analysis of the interpretation of 71 radiographs by five observers demonstrated that there is no statistically significant difference in diagnostic accuracy between the original radiographs and compressed and reconstructed images obtained with a compression ratio as high as 20:1.

Bone Resorption↗

Short fixation-shock freezing and freeze-drying versus chemical fixation and dehydration: computer assisted image analysis of morphological variables and immunogold labeling density on pituitary secretory granules.

We have performed a computer assisted image analysis evaluation of the effects of two preparation protocols on morphological variables and immunolabeling density of secretory granules using rat adenohypophysis as a model. Glutaraldehyde (GA) fixation for 2 hr and chemical dehydration was compared with short GA fixation (15 min) followed by cryofixation and freeze-drying (CF-FD). The 2 hr GA fixed specimens showed spherical nuclei and secretory granules regardless of their size, contrasting with the more irregularly shaped nuclei and secretory granules after short GA-CF-FD. In the latter group of specimens a correlation could be found between smaller nuclear areas and more irregular shapes. The differences in morphological variables between the two preparation protocols might be due to a better protein stabilization and a reduced collapse of macromolecules after the 2 hr GA fixation, strengthened by the chemical dehydration. The specific immunolabeling with antiserum to growth hormone was much greater but more varied after short time GA-CF-FD than after long GA fixation. Epon surface topography over the granule area also differed: smooth after short time GA-CF-FD and furrowed after long GA fixation. Our results, demonstrating important differences in morphological parameters and immunolabeling density between two common preparation protocols, seem critical for more reliable interpretation in quantitative immunoelectron microscopy. We also emphasize the need for computer assisted image analysis and measurements in immunoelectron microscopy to ensure objective evaluations.

Animals↗

Evaluation of PACS in ultrasonography.

We review our experience with a picture archiving and communication system to replace film in the ultrasound section of a clinical radiology department. The system includes three ultrasound units connected by a fiberoptic network via acquisition nodes to a central data management system, workstation, and optical jukebox. The system handles 80% of sonographic studies in the department. Image production, interpretation, storage, and retrieval are evaluated. Despite limitations, a picture archiving and communication system can be integrated into a functioning ultrasound section of an active radiology department with minimal disruption and promising results.

Computer Systems↗

[Acoustic rhinometry: the bat principle of the nose].

All cross-sectional areas of the upper airway can be measured by an acoustic signal using the acoustic reflection technique, or acoustic rhinometry. The plane of the cross-sectional areas measured was determined in nasal models. The isotemporal layers were found to be nearly parallel to the nasal valve. The acoustically measured cross-sectional areas correlated with the cross-sectional areas of cuts from nasal models. After digitizing these cuts, a CAD software calculates cross-sectional areas in all orientations and at all distances. The difference between the measured and calculated cross-sectional areas is up to 3% in the nasal cavity and up to 17% in the nasopharynx. The hypothesis that the cross-sectional areas measured lie nearly parallel to the nasal valve was confirmed. The normal rhinometric curve shows the minimal cross-sectional area (I-notch) to lie at the nasal isthmus. The second narrowest segment of the nasal cavity lies at the head of the inferior concha and septal concha (C-notch). Characteristic examples of patients with turbinate hypertrophy, choanal atresia, enlarged adenoids, and septal deviations are presented. Acoustic rhinometric curves can only be interpreted in combination with the rhinoscopic findings because different pathological conditions can produce similar curves. Recording of reliable and reproducible data by acoustic rhinometry demands that the connection between the rhinometer and the nose does not distort the valve area. When we used two different nose pieces (1.2 and 1.5 cm outer diameter) the cross-sectional areas in the anterior third of the nose of only 28% of the patients was measured correctly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoids↗