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PubMed1997

KAMEDIN: a telemedicine system for computer supported cooperative work and remote image analysis in radiology.

The software system KAMEDIN (Kooperatives Arbeiten und MEdizinische Diagnostik auf Innovativen Netzen) is a multimedia telemedicine system for exchange, cooperative diagnostics, and remote analysis of digital medical image data. It provides components for visualisation, processing, and synchronised audio-visual discussion of medical images. Techniques of computer supported cooperative work (CSCW) synchronise user interactions during a teleconference. Visibility of both local and remote cursor on the conference workstations facilitates telepointing and reinforces the conference partner's telepresence. Audio communication during teleconferences is supported by an integrated audio component. Furthermore, brain tissue segmentation with artificial neural networks can be performed on an external supercomputer as a remote image analysis procedure. KAMEDIN is designed as a low cost CSCW tool for ISDN based telecommunication. However it can be used on any TCP/IP supporting network. In a field test, KAMEDIN was installed in 15 clinics and medical departments to validate the systems' usability. The telemedicine system KAMEDIN has been developed, tested, and evaluated within a research project sponsored by German Telekom.

Humans↗

PubMed2006

A comparison of reconstruction algorithms for C-arm mammography tomosynthesis.

Digital tomosynthesis is an imaging technique to produce a tomographic image from a series of angular digital images in a manner similar to conventional focal plane tomography. Unlike film focal plane tomography, the acquisition of the data in a C-arm geometry causes the image receptor to be positioned at various angles to the reconstruction tomogram. The digital nature of the data allows for input images to be combined into the desired plane with the flexibility of generating tomograms of many separate planes from a single set of input data. Angular datasets were obtained of a low contrast detectability (LCD) phantom and cadaver breast utilizing a Lorad stereotactic biopsy unit with a coupled source and digital detector in a C-arm configuration. Datasets of 9 and 41 low-dose projections were collected over a 30 degrees angular range. Tomographic images were reconstructed using a Backprojection (BP) algorithm, an Iterative Subtraction (IS) algorithm that allows the partial subtraction of out-of-focus planes, and an Algebraic Reconstruction (AR) algorithm. These were compared with single view digital radiographs. The methods' effectiveness at enhancing visibility of an obscured LCD phantom was quantified in terms of the Signal to Noise Ratio (SNR), and Signal to Background Ratio (SBR), all normalized to the metric value for the single projection image. The methods' effectiveness at removing ghosting artifacts in a cadaver breast was quantified in terms of the Artifact Spread Function (ASF). The technology proved effective at partially removing out of focus structures and enhancing SNR and SBR. The normalized SNR was highest at 4.85 for the obscured LCD phantom, using nine projections and IS algorithm. The normalized SBR was highest at 23.2 for the obscured LCD phantom, using 41 projections and an AR algorithm. The highest normalized metric values occurred with the obscured phantom. This supports the assertion that the greatest value of tomosynthesis is in imaging fibroglandular breasts. The ASF performance was best with the AR technique and nine projections.

Algorithms↗

PubMed2005

[Research methods in dentistry. 8. Methods for longitudinally detecting differences in bone density: digital subtraction radiography].

Subtraction radiography has been developed in 1934 by the Dutch radiologist B. Ziedses des Plantes. The technique is based on the subtraction of two radiographic images. As a result, only the differences remain visible, and structures which have been unaltered in between both exposures, are suppressed. The technique was introduced also in dental radiology in the eighties in the last century. Since then, many studies have been performed showing the benefit of this technique in dental diagnosis. A requirement for reliable results is that the two radiographs which are used for the subtraction have equal brightness and contrast, as well as a completely identical projective geometry. Since radiographic images can be acquired digitally, methods have been developed to make density and contrast equal for both images used for the subtraction process even after the images have been taken, using dedicated software programs. The projection geometry of two images can be made identical in this way as well. Because of this, the technique can also be applied in general dental practice.

Bone Density↗

PubMed1980

Semantic priming in nonproductive schizophrenia.

A group of 10 nonproductive schizophrenics (i.e., not experiencing hallucinations, delusions, or mood swings) was compared with a group of 10 nonpsychotic alcoholics, matched on visual acuity and reading level, in a primed word identification task. Subsets of three target words were projected onto a series of screens constructed in such a way that an increasing random proportion of the words' features were made visible. The prime was the category to which the target words belonged; the target words represented one of four levels of goodness-of-membership in the primed category. On the whole, identification thresholds in the two groups were not significantly different. However, although the alcoholics' thresholds increased rapidly as goodness-of-membership decreased, this trend was not significant in the schizophrenic group. When the target words were poor members of the primed category, the schizophrenics' thresholds were significantly lower than the alcoholics'. Such results are consistent with Feigenberg's characterization of schizophrenia as a disturbance in the process of probabilistic prognosis.

Alcoholism↗

PubMed2004

Doing criticism in 'symbiotic niceness': a study of palliative care nurses' talk.

This paper examines how palliative care nurses do criticism of other professionals in talk within settings for care of the dying (two hospices and one general hospital). Strategies for the production of moral identities include the use of direct criticism, indirect criticism and quoted speech, hence 'inverted comma criticism'. Criticism is done through the construction and reconstruction of 'atrocity stories'. Atrocity stories are used as a medium by nurses to express their opinions and feelings about doctors who might have behaved insensitively. At the same time, it allows doctors to redeem themselves. The analysis of talk reveals that the voices of absent patients are reactivated and co-opted into the nurses' talk. The stories serve to produce an image of nurses as caring, morally responsible patient advocates and loyal characters to their medical colleagues. Through the analysis of talk, the communication skills and strategies for the maintenance of interactional order are made visible and displayed. Skills for the production of the palliative care team work are also made visible. Emotional labour is analysed as a project for the production of particular kinds of niceness which in turn require particular types of emotional labour. This paper argues that educators should aim to identify and make conscious use of nurses' own available interactional skills, and focus on valuable cultural (rules of decorum) and material resources (the disease process) which are readily available and accessible for nurses, as a starting point in communication training. The theory of an account of co-production of niceness which benefits each other, hence, symbiotic niceness, reveals that being nice to each other can be rewarding and therapeutic in that it helps to smooth, distance and ameliorate problems occurring in the reality of palliative care nurses' and their patients' life-worlds.

Anecdotes as Topic↗

PubMed2003

Three-dimensional display modes for CT colonography: conventional 3D virtual colonoscopy versus unfolded cube projection.

The authors compared a conventional two-directional three-dimensional (3D) display for computed tomography (CT) colonography with an alternative method they developed on the basis of time efficiency and surface visibility. With the conventional technique, 3D ante- and retrograde cine loops were obtained (hereafter, conventional 3D). With the alternative method, six projections were obtained at 90 degrees viewing angles (unfolded cube display). Mean evaluation time per patient with the conventional 3D display was significantly longer than that with the unfolded cube display. With the conventional 3D method, 93.8% of the colon surface came into view; with the unfolded cube method, 99.5% of the colon surface came into view. Sensitivity and specificity were not significantly different between the two methods. Agreements between observers were kappa = 0.605 for conventional 3D display and kappa = 0.692 for unfolded cube display. Consequently, the latter method enhances the 3D endoluminal display with improved time efficiency and higher surface visibility.

Colonography, Computed Tomographic↗

PubMed2006

Priming of depth-rotated objects depends on attention and part changes.

Three priming experiments investigated the role of attention and view changes when common objects were rotated in depth. Objects were shown in prime-probe trial pairs. Experiment 1 extended findings by Stankiewicz, Hummel, and Cooper (1998) showing that attended objects primed themselves in the same but not in a reflected view, whereas ignored objects only primed themselves in the same view. In Experiment 2, depth-rotations produced changes in the visible part structure between prime and probe view of an object. Priming after depth-rotation was more reduced for attended objects than for ignored objects. Experiment 3 showed that other depth rotations that did not change the perceived part structure revealed a priming pattern similar to that in Experiment 1, with equivalent reduction in priming for attended and ignored objects. These data indicate that recognition of attended objects is mediated by a part-based (analytic) representation together with a view-based (holistic) representation, whereas ignored images are recognized in a strictly view-dependent fashion.

Attention↗

PubMed2006

Interprofessional collaboration with service users in the development of cancer services: the Cancer Partnership Project.

Patient and Public Involvement (PPI) is a cornerstone of UK National Health Service (NHS) policy. The Cancer Partnership Project (CPP) is the leading national PPI initiative in cancer care. The CPP espouses a "partnership" model, with a "Partnership Group" - collaborative service improvement groups formed of NHS staff and service users - in each of 34 cancer networks in England. These groups aim to enable service users to influence local cancer service development and thereby improve the effectiveness of services. We interviewed 59 cancer service users and NHS staff in a reflective evaluation of CPP. Groups were active and visible in 30 networks, their main activities being: providing an accessible source of consumer opinion; prolific networking and representation; patient information and communication projects; and lobbying for service improvements. The groups exhibited some significant tensions. The motivations of professional staff varied markedly, and "obligatory" involvement as part of a person's job was counter-productive when not coupled with a "personal" belief in the value of PPI. Other controversial areas were the disclosure by patients' of personal health and treatment experiences, and emotional attachment to the group. It was concluded that partnership groups represent a useful PPI model, but more attention generally should be paid to the complexities of PPI and timescales required for meaningful cultural change.

Adult↗

PubMed2001

The antiviral drug docosanol as a treatment for Kaposi's sarcoma lesions in HIV type 1-infected patients: a pilot clinical study.

Docosanol inhibits a broad spectrum of lipid-enveloped viruses in vitro including HSV-1, HSV-2, VZV, CMV, HHV-6, and HIV-1. These observations led us to conduct a pilot clinical study with docosanol 10% cream as a topical treatment for Kaposi's sarcoma (KS) in HIV-1-infected patients. In this open-label study 28 cutaneous KS lesions in 10 HIV-1-infected patients were treated topically five times daily for 4 weeks with evaluation of lesion characteristics of area, edema, and color. All patients elected to enroll in an extended treatment protocol and continued to treat for up to 35 weeks. Within 28 days, 2 of 10 patients exhibited a partial response based on standardized criteria exhibiting 74 to 83% reductions in total target lesion areas. With extended treatment, a partial response was exhibited in two additional patients where total target lesion area was reduced by 52% in one patient and target lesions in another patient that had been large, swollen, and painful at study initiation were no longer visible. No patient experienced disease progression or signs of visceral disease. The average percent decrease in lesion area for all target lesions was 20% (p < 0.01). A patient's response to therapy appeared to be independent of anti-HIV regimen, HIV viral load, or previous KS treatments. These results suggest that docosanol merits further investigation as a potential topical therapy in the treatment of AIDS-associated Kaposi's sarcoma lesions.

AIDS-Related Opportunistic Infections↗

PubMed1991

Fatal incidents involving pickup trucks in Alabama.

Death or injury resulting from crashes involving light trucks (ie, pickup trucks) is a significant problem. Data show that fatal crashes and occupant fatalities involving light trucks have steadily increased since 1983. This project describes vehicle crashes involving passengers riding in the beds of pickup trucks. Actual crashes were identified through the Fatal Accident Reporting System (FARS) of the National Highway Traffic Safety Administration. The 40 incidents studied involved 204 pickup truck passengers. Of these, 45 were killed, 107 sustained visible injuries or were carried from the scene, 6 had bruises and abrasions, and 2 had no visible injury but were briefly unconscious or had a documented complaint of pain. The risk of death among pickup truck passengers who were fully ejected from the vehicle was nearly six times that of passengers not fully ejected. Correspondingly, the risk of ejection from the truck was 26.7 times greater among occupants riding in the bed than occupants riding in the cab.

Accidents, Traffic↗

PubMed1997

Strategic planning with multitype libraries in the community: a model with extra funding as the main goal.

Medical libraries are discovering that ongoing collaboration in fundraising with other types of community libraries is mutually beneficial. Such partnerships may lead to joint grants, increase library visibility and access to decision makers, allow participation in community information networks, and provide leverage in additional fundraising projects. These partnerships have the potential to raise the profile of libraries. The accompanying community recognition for the parent organization may create a positive image, draw patients to the health center, and position the library and institution for future success in fundraising. Within institutions, development officers may become allies, mentors, and beneficiaries of the medical librarian's efforts. For a planned approach to community outreach with extra funding as the major objective, busy medical library administrators need guidelines. Standard participative techniques were applied to strategic planning by Indianapolis libraries to help achieve successful community outreach and to write joint statements of mission, vision, goals, and objectives.

Community-Institutional Relations↗

PubMed1997

Periapical radiographic techniques during endodontic diagnosis and treatment.

The objective of this article is to describe various radiographic projections which can be used during endodontic therapy. Changes to the angulation of the X-ray beam in relation to the teeth and film can help diagnosis and treatment by producing images which provide additional information not always visible on radiographs taken with standard angulations. For example, changes in angulation can be useful to determine the number and curvature of roots and canals, to identify superimposed roots and to distinguish between anatomical landmarks and apical pathology. Although use of such techniques increases the diagnostic yield of films, it must be appreciated that such views lead to images that are less distinct because of inherent image distortion. Nevertheless, use of the various techniques during endodontics can provide substantial benefit for clinicians in their daily practice.

Dental Pulp Cavity↗

PubMed1994

[Adipose pad of the external sub-malleolar fossa. Anatomy and value in liposuction of the lower limbs].

The existence of an adipose formation under the skin of the lateral part of the ankle is constant in both sexes. It is more important in the female ankle. No anatomical study has been made before, except for an illustration in Sarrafian's Treatise of Anatomy, where it is described as a "fat pad of the prelateral malleolar fossa", whereas no actual description is provided in the text. Therefore, there exists no international anatomical definition (PNA) of this constant superficial formation, and we propose to adopt Sarrafian's definition (in French: C.A.S.M.E.). This fat pad is located directly under the lateral malleola, just before the projection of the extensor digitorum brevis muscle. The prelateral malleolar fat pad is spontaneously visible, as a redundant tissue, on the side of all adult female ankles. The present study includes anatomical dissections of seven ankles of fresh cadavers. Its surgical interest resides in the fact that it may affect the results of liposuction of the lower extremities, because it could be mistaken for a chronic oedema resulting from surgery. In ankle liposuction, it will be advisable to perform an additional liposuction of this fat pad, with a syringe, to improve results. Therefore it is important to perform a systematic examination of this fat pad and to note its clinical characteristics before and after surgery in all cases of liposuctions of all parts of the lower extremities.

Adipose Tissue↗

PubMed1995

Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study.

OBJECTIVE: To test systematically if spinal manipulative treatments (SMT) and the audible release associated with SMT cause activation of spinal muscles. DESIGN: Experimental pilot study. SETTING: Human Performance Laboratory, The University of Calgary. PARTICIPANTS: One male and one female asymptomatic volunteer. INTERVENTION: Slow and fast SMTs to the left transverse process of thoracic vertebrae using a reinforced hypothenar contact. The treatment forces were directed in a posterior-to-anterior direction with the subjects in a prone position. MAIN OUTCOME MEASURES: Forces applied by the chiropractor during SMT. Measurements of the audible release using skin-mounted accelerometers. Electromyographical activity of selected spinal muscles. RESULTS: Electromyographical (EMG) activity was observed consistently 50-100 msec after the onset of each of the fast SMTs, whether the treatment resulted in an audible release or not; for slow SMTs, there was never any visible electromyographical activity of the target muscles, whether the treatment resulted in an audible release or not. CONCLUSION: The results of this study suggest that fast treatment thrusts elicit muscle activation, whereas slow force application does not. The timing of the onset of the EMG response suggests that activation may be produced by a reflex response originating in the muscle spindles. It also appears that the audible release does not (by itself) evoke muscle activation or a joint proprioceptive reflex response as has been speculated in the literature.

Adult↗

PubMedDate not supplied

[Perceptions of mental patients' sexuality by nurses].

This research aimed at identifying the social representations of nursing professionals expressed in situations in which the sexuality of mentally-ill people constitutes a visible fact in psychiatric institutions. The technical and methodological resource for data collection, based on projective procedures, was denominated Investigation Technique in Daily Situations--ITDS. This instrument consisted of sixteen boards with graphic reproductions of these professionals' daily actions, from which six were selected for the analysis of the mentally-ill person's sexuality. Seventeen nurses working in psychiatric hospitals in Ribeirão Preto composed the sample. Their discoursive manifestation showed their denials of the mentally-ill person's sexuality, which restrained it as a deviation, misbehavior and disease. By doing so, they take a distant position with repressive or defensive attitudes. This position reveals the strategy adopted in relation to such knowledge and power, following the determinations of their professional code by meeting institutional and social expectations.

Humans↗

PubMed2006

Intrinsic uniformity requirements for pinhole SPECT.

UNLABELLED: Pinhole SPECT is a fully 3-dimensional tomography technique. Uniformity requirements for gamma-cameras have been studied for 2-dimensional SPECT performed with parallel-hole collimators. This study investigated reconstruction artifacts in pinhole SPECT arising from intrinsic uniformity defects of the gamma-camera in the case of a pinhole aperture (5 mm) and a rotation radius (10 cm) suitable for human studies. METHODS: A cylindric phantom was filled with water and 99mTc. The count density in the pinhole SPECT projections largely exceeded the density that would be expected in human studies. Two-dimensional gaussian-shaped positive uniformity defects of various heights and various full widths at half maximum were simulated at 5 locations on the 64 projections. All these sets of projections were reconstructed using an iterative 3-dimensional ordered-subset expectation maximization (OSEM) algorithm tailored to the pinhole geometry. The influence of the number of OSEM iterations (2, 5, or 8 for 8 subsets) was also investigated. The height of the ring artifacts generated by the uniformity defects was measured on the reconstructed transverse slices and was compared with the noise in the noncorrupted slices. The uniformity defects were also generated on a 30-megacount flood image from the camera. These images were inspected visually, and the National Electrical Manufacturers Association (NEMA) differential and integral uniformities were calculated. RESULTS: Defects centered on the line corresponding to the orthogonal projection of the camera axis of rotation onto the detector plane generated artifacts whose magnitude-to-noise ratio exceeded 1% when the defect height was larger than 5%-10%, depending on the defect full width at half maximum. These defects were clearly visible on the slices and the flood images. Defects located elsewhere on the camera detector generated ring artifacts of magnitude-to-noise ratio smaller than 1%. They were visually observable both on the reconstructed slices and on the flood images for defect heights larger than 5%. The increase in the number of OSEM iterations conducted to a decrease in the artifact magnitude-to-noise ratio. CONCLUSION: Although hardly visible on the flood images and only slightly increasing the NEMA differential or integral uniformity, a detector uniformity defect of 3% height is able to generate a visible artifact on the reconstructed transverse slices. The study was conducted on a relatively high-count pinhole SPECT acquisition. Considering that far fewer counts would accumulate in clinical practice, any camera that fulfils these uniformity requirements should not lead to the presence of visible uniformity artifacts in the reconstructed slices.

Artifacts↗

PubMed2006

Three-dimensional fast-recovery fast spin-echo MRCP: comparison with two-dimensional single-shot fast spin-echo techniques.

PURPOSE: To retrospectively evaluate the technical quality of and the visibility of the biliary tree and pancreatic duct on magnetic resonance (MR) cholangiopancreatographic (MRCP) images obtained with a single-breath-hold three-dimensional (3D) fast-recovery fast spin-echo (FRFSE) sequence in comparison with conventional two-dimensional (2D) single-shot fast spin-echo (SSFSE) thin-section and thick-slab sequences. MATERIALS AND METHODS: Institutional review board approval was obtained; informed consent was not required for this HIPAA-compliant study. MRCP was performed at 1.5 T in 53 consecutive patients (25 men and 28 women, aged 23-84 years). A single-breath-hold volume acquisition was performed by using the 3D FRFSE sequence and the conventional 2D SSFSE sequences. Two radiologists graded studies obtained with each sequence in a blinded fashion, and the paired Student t test was used to assess differences in technical quality, visibility of eight individual ductal segments of the biliary tree and pancreatic duct, and number of ductal segments visualized per patient. RESULTS: Studies obtained with 3D FRFSE were of significantly higher technical quality than those obtained with thin-section 2D SSFSE (P < .02 for both readers). The 3D FRFSE maximum intensity projection reconstruction and 2D SSFSE thick-slab sequence proved statistically equivalent with regard to the overall visibility of the biliary tree and pancreatic duct and the number of ductal segments visualized per patient. In comparison with 2D SSFSE thin-section imaging, however, 3D FRFSE imaging produced an improved overall duct segment visibility grade of 0.45 on a three-point visibility scale (P < .001), with a corresponding average per-patient improvement of 1.9 out of eight possible fully visualized duct segments (P < .001). CONCLUSION: The 3D FRFSE sequence shows promise for improved visibility of the pancreatic duct and biliary tree, compared with the conventional 2D SSFSE thin-section and thick-slab approach, while permitting the entire MRCP examination to be performed in a single breath hold.

Adult↗

PubMed1999

[Contribution of high-resolution volume computed tomography (HRVCT) for the exploration of diffuse pulmonary infiltrative disorders].

AIM: To assess high-resolution volume computed tomography (HRVCT) for the investigation of diffuse pulmonary infiltrative disorders. PATIENTS AND METHODS: Thirty patients with diffuse interstitial disease (idiopathic fibrosis n = 7, silicosis n = 4, asbestosis n = 5, sarcoidosis n = 7, histiocytosis n = 2, lymphangitis carcinomatosa n = 2, tuberculosis n = 1, bronchiolitis obliterans n = 1) were explored using high-resolution computed tomography (HRCT) and HRVCT. All diagnoses were proven by fiberscopy, bronchoalveolar lavage and respiratory function tests and/or lung biopsy. The HRVCT protocol consisted of spiral tomography using 10 mm slices. Data were processed with a Windows Advantage workstation (GE Milwaukee). Two readers compared multiprojection volume reconstruction (MPVR) using maximal intensity projection (MIP) and minimal intensity projection (MINIP) displays with millimetric HRCT slices acquired at the same volume. RESULTS: Micronodules were detected better with HRVCT than with HRCT. MIP mode enabled better distinction between nodules and vessels. MINIP mode enabled better detection of cysts in the pulmonary parenchyma than HRCT. The honeycomb aspect of pulmonary fibrosis was differentiated better than super-infected central-lobar emphysema. MINIP mode enabled detection of ground glass opacities which were not visible on HRCT. Certain anomalies were however detected only on HRCT. HRVCT was very sensitive to movement effects which altered image quality, particularly in the MINIP mode. CONCLUSION: HRVCT is a new and promising approach for investigating diffuse pulmonary infiltrative disorders.

Adult↗