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Computer-monitored radionuclide tracking of three-dimensional mandibular movements. Part I: theoretical approach.

A new technique for the three-dimensional recording of a person's mandibular movement is described. A small and harmless radioactive source is fixed on the patient's skin at the point of interest or sealed in a tooth cavity. Using the proper collimation, the motion of the point source is recorded via a gamma camera and minicomputer. Long-term storage on a magnetic device offers playback, slow motion facilities, and data analysis through the use of sophisticated computer languages. Simultaneous recordings using two cameras, or postsynchronization of two different views of an experiment, enable the three-dimensional restitution of mandibular movements. Superimposition of a grid of radioactive spots spaced at measured intervals during the recording permits a straightforward calibration of the patient's motion. Multiple sources in a single experiment may be recorded to describe the displacement of several points of interest. This method, derived from nuclear medicine techniques, offers a powerful tool of general interest for the tracking of dynamic events in many fields of dentistry such as temporomandibular joint dysfunction and prosthetic restorative techniques. Further considerations on our experimental settings and results will be published in part II.

Analog-Digital Conversion

Sorting efficiency.

Computers and the tasks they perform are becoming increasingly important in medicine. It behooves medical personnel to become familiar with some computer functions so that they may be in a better position to demand and evaluate a given implementation. One very basic computer task is sorting information. Some general principles of computing efficiency are discussed, as well as the standard "O" notation. A simple sort, bubblesort, is discussed and analyzed. A second elementary sort, insertionsort, is considered in relation to its more sophisticated descendant, shellsort. The most efficient in-memory sort, quicksort (and its various descendants), is likewise examined, and the advantages and disadvantages of each variant are discussed in some detail, as well as methods that may enhance speed and resource utilization. Finally, mergesort, which is used in sorting large files resident in mass-storage devices, is discussed, along with its particular advantages.

Algorithms

A proposal of an off-line PACS based on a personal database.

Problems with picture archiving and communication systems (PACS) are focused and an off-line PACS of practical value is proposed in this paper. This system is based on the personal database where each patient has his/her own recording medium. This medium files all medical information as well as images of value, and is carried with a patient through hospital. Advantages over the conventional or on-line PACS communicating through a network are discussed and a possibility of practical use is analysed showing a prototype system. The biggest advantage of this system is quick and easy access to the images of concern and a small amount of cost for initial investment. It is also pointed out that the format of the data recording on the disk has to be standardized so that this system could be used for a medical care system over a wide area.

Computer Systems

Analog and digital computer theory.

Analog signals abound in the natural world. With appropriate transducers these signals can be converted to continuous voltages and can be displayed, transmitted, stored, or copied. They can be processed by analog computers, the simplest of which is an audio amplifier. With analog signals, however, there can be errors because of signals loss, interference, and noise. Binary digital signals permit only two values, either 0 ('off' or 'low') or 1 ('on' or 'high'). These signals are much less susceptible to transmission problems. Binary signals are commonly organized into 8-bit groups which can represent 256 different numbers or meanings. These data can be transmitted in either serial or parallel fashion at high rates of speed. Analog-to-digital converters permit analog signals to be transformed to digital signals. A computer consists of the memory, the processor, and the input/output devices. Memory includes the fastest registers, the very fast core memory, the peripheral storage devices such as diskettes and disks, and the very slow peripheral devices such as magnetic tape. The processor can only load and store numbers in memory, add two numbers, test a number, and provide input and output. The program counter indicates the next computer instruction to be performed. Input/output devices allow communication with the outside world and may assume many forms. A computer by itself can do nothing. A program or series of instructions is required. The most simplistic program language is assembler or machine language. Most programming is done in more sophisticated languages, however.(ABSTRACT TRUNCATED AT 250 WORDS)

Analog-Digital Conversion

CD-ROM source data uploaded to the operating and storage devices of an IBM 3090 mainframe through a PC terminal.

A powerful method of processing MEDLINE and CINAHL source data uploaded to the IBM 3090 mainframe computer through an IBM/PC is described. Data are first downloaded from the CD-ROM's PC devices to floppy disks. These disks then are uploaded to the mainframe computer through an IBM/PC equipped with WordPerfect text editor and computer network connection (SONNGATE). Before downloading, keywords specifying the information to be accessed are typed at the FIND prompt of the CD-ROM station. The resulting abstracts are downloaded into a file called DOWNLOAD.DOC. The floppy disks containing the information are simply carried to an IBM/PC which has a terminal emulation (TELNET) connection to the university-wide computer network (SONNET) at the Ohio State University Academic Computing Services (OSU ACS). The WordPerfect (5.1) processes and saves the text into DOS format. Using the File Transfer Protocol (FTP, 130,000 bytes/s) of SONNET, the entire text containing the information obtained through the MEDLINE and CINAHL search is transferred to the remote mainframe computer for further processing. At this point, abstracts in the specified area are ready for immediate access and multiple retrieval by any PC having network switch or dial-in connection after the USER ID, PASSWORD and ACCOUNT NUMBER are specified by the user. The system provides the user an on-line, very powerful and quick method of searching for words specifying: diseases, agents, experimental methods, animals, authors, and journals in the research area downloaded. The user can also copy the TItles, AUthors and SOurce with optional parts of abstracts into papers under edition. This arrangement serves the special demands of a research laboratory by handling MEDLINE and CINAHL source data resulting after a search is performed with keywords specified for ongoing projects. Since the Ohio State University has a centrally founded mainframe system, the data upload, storage and mainframe operations are free.

CD-ROM

Data acquisition and analysis system for intracellular neuronal signals.

A comprehensive system for the acquisition and analysis of neurophysiological data is described, with a focus on intracellular data. The software comprising the system will evaluate a number of neuronal signals, including intracellular as well as extracellular recordings from neurons, evoked potentials and computer simulation data. Significant enhancements enable sampling at high resolution (50 kHz throughput to disk; +/- 15 bit or 96 db), concurrent with extensive on-line analysis capabilities and display. Modifications of existing software and development of new types of input and output devices and analysis can be incorporated as needed, using a binary digital database as the primary storage for the experimental signals and device-independent graphics.

Cell Communication

Portable chest radiography in intensive care: a comparison of computed and conventional radiography.

A prospective study was performed comparing computed and conventional radiography for the detection and visibility of cardiovascular devices in intensive care unit patients. Computed images were obtained using a commercially available 2K x 2K, 12-bit storage phosphor plate system. Image sets from 50 patients were assessed independently by three observers. A significant difference between the types of image was found for the detection of mediastinal drainage tubes and prosthetic valves. Computed images allowed greater confidence in the identification of courses and tips of lines. This advantage was most marked with edge-enhanced computed images.

Adult

Some ways of measurement unification in testing ECG analysers on the basis of test signals normalized according to amplitude/parameters and medical indications.

An urgency of test method development for testing the automated ECG analysers is substantiated; a generalized measurement algorithm used in measuring devices testing is discussed with interpretation as applied to ECG analysers. A general measurement scheme in analyser testing is given, tasks to create test ECG signals and develop methods and means for storage, reproduction and transfer of ECG signals to ECG analysers are advanced. A method to create, organize, store and reproduce the ECG signal data bank with the use of measuring and computing complex (MCC) is developed. A device for ECG signal reproduction and transfer (a generator) is made, with its structural diagram, work principles and main technological (metrological) characteristics shown.

Algorithms

The effect of scatter reduction on the signal-to-noise ratio in computed radiography.

Signal-to-noise ratio (SNR) in computed radiography (CR) was assessed by using the computerized image data from storage phosphor radiographs in a modification of the Rose model. A multiple pencil-beam (MPB) imaging device, a conventional 1:12 grid, and an air gap of 90 cm were compared in terms of improvement of the signal-to-noise ratio caused by the reduction of scatter. The MPB device showed better SNRs by a factor of 1.25 compared to the grid and air gap which were approximately equal to each other. This is related to its superiority in scatter control, which has also been shown previously. Air gap screening has not been very popular because of geometrical problems, but in scatter reduction it is still comparable to today's grid technology. The optimization of image information content in CR is briefly discussed.

Radiographic Image Enhancement

Clinical application of a magneto-optical disk image filing system/image save and carry (ISAC) system.

We propose the utilization of portable magneto optical disks for image filing. The main problems in PACS are the need for a high-speed local area network (LAN) and a large mass storage device. An image filing system--image save and carry (ISAC)--is one solution for these problems in present PACS and requires minimal additional hardware and cost for the installation. Whenever a patient is examined, the clerk carries the medical record and the ISAC magneto-optical disk for recording image data, and after inspection records the image data into the magneto-optical disk. We investigated the number of image retrievals done for inpatients and outpatients in 1988 at our radiation therapy department. The data storage requirements were on the average 18.5 MB for outpatients and 173.9 MB for inpatients. An ISAC display console needs also an easy-to-use man/machine interface for specifying images and image display characteristics in order to realize the ISAC system.

Computer Systems

Combination of multiple pencil-beam imaging to computed storage phosphor radiography: a new method.

Computed radiography (CR) with storage phosphors offers a wide dynamic range and improved sensitivity compared to film-screen technology. CR was combined in this study with a prototype multiple pencil-beam (MPB) imaging device which has been shown to be very effective in scatter reduction. The combination was analyzed and compared to the standard technique of grid screening in two ways: a free-response ROC (FROC) analysis was first performed followed by a blinded test arrangement for visual analysis of image quality in a series of computed radiography of the lumbar spine by both the MPB and grid modalities. The results of the FROC study showed a statistically significant (P less than or equal to 0.01) improvement in signal detection. The MPB-CR images of the lumbar spine had more contrast but also a slightly mottled or grainy appearance. Image quality was found good but contrast processing was criticized because it seemed to result in a too steep display of contrast in MPB imaging. This should be avoidable by changing the image processing parameters.

Adult

The microcomputer in the dental office: a new diagnostic aid.

The first computer applications in the dental office were based upon standard accountancy procedures. Recently, more and more computer applications have become available to meet the specific requirements of dental practice. This implies not only business procedures, but also facilities to store patient records in the system and retrieve them easily. Another development concerns the automatic calculation of diagnostic data such as those provided in cephalometric analysis. Furthermore, growth and surgical results in the craniofacial area can be predicted by computerized extrapolation. Computers have been useful in obtaining the patient's anamnestic data objectively and for the making of decisions based on such data. Computer-aided instruction systems have been developed for undergraduate students to bridge the gap between textbook and patient interaction without the risks inherent in the latter. Radiology will undergo substantial changes as a result of the application of electronic imaging devices instead of the conventional radiographic films. Computer-assisted electronic imaging will enable image processing, image enhancement, pattern recognition and data transmission for consultation and storage purposes. Image processing techniques will increase image quality whilst still allowing low-dose systems. Standardization of software and system configuration and the development of 'user friendly' programs is the major concern for the near future.

Computer-Assisted Instruction

A model for capacity planning of a comprehensive integrated information system for hospitals and clinics.

Appropriate system sizing is essential to ensuring a reasonable computer response time for end users. A model is discussed that describes the type and number of interactions between user terminals and printers and the central processor for a comprehensive, integrated medical information system. The system modeled includes support to inpatient and outpatient order entry and results reporting for clinical services; registration; admission, disposition, and transfer; patient appointing; pharmacy, clinical laboratory, and radiology; medical record management; and electronic messages. Originally developed for use in benchmark testing of comprehensive systems designed for military hospitals and clinics, the model has been generalized to be applicable to other systems and settings. Results are presented for a routine busy day in a 200-bed teaching hospital providing extensive outpatient services, and a large free-standing clinic. The model results can be applied to several facets of system planning, including sizing of the central processor and communications network, determining the optimal number of storage devices and user devices, and fine tuning the user interface.

Ambulatory Care Information Systems

CD-ROM. A new advance in medical information retrieval.

The massive production of medical information is being met by new technologies for storing and retrieving knowledge. Recent years have witnessed the maturation of time-sharing information utilities into a full-blown industry. In medicine these services have provided bibliographic information but have recently expanded to full-text availability of journals and books. Now optical storage technology, most conspicuously the compact disk read only memory (CD-ROM), provides similar massive information storage and retrieval affordable to microcomputer users. Such devices might replace many of the functions of time-sharing.

Computers

Neurobiological approach to computing devices.

According to the old metaphor of classical cybernetics the brain can be considered as a computer. Newer theoretical endeavours reverse the question and ask: what could neurobiology offer to engineers of near-future generation computer systems? Three not completely disjoint abstract functions of the nervous system, namely pattern formation, pattern recognition and action, can be treated in a unified conceptual framework. Storage and retrieval mechanisms of information are connected to fault-tolerant, adaptive parallel structures. "Learning" and "plastic behaviour" are interpreted in terms of the theory of non-linear dynamic systems. As neural development and plasticity can be approached by deterministic models superimposed by random influence, noise might also have a positive role to play during the operation of technical computing devices. Molecular computation is discussed in relation to eventual hardware realization of "neurobiology-based" computers.

Cybernetics

A TV system for image recording and processing in conventional transmission electron microscopy.

An image processing system for a CTEM is described which is particularly suited for the imaging of radiation-sensitive objects. It consists of an image intensifier device for single electron counting, a digital storage unit and a video recorder for intermediate storage of low-dose image series. During on-line operation the information can be transferred to a computer for further processing. The output can be transferred onto a second digital storage unit and observed on a monitor. The influence on the DQE of the pulse height distribution of the single electron video signals and of a multiple counting are eliminated by means of special electronic components. Various modes of operation and application possibilities of the image processing system are discussed.

Computers

Absorption-edge fluoroscopy using a three-spectrum technique.

We have recently reported on a 1-kVp, two-filter image subtraction method for visualizing low concentrations of elements like iodine which have K-shell absorption edges in the diagnostic x-ray energy range. However, in the application of this technique to human thyroid imaging, superimposed images due to variations in tissue and bone thickness presented serious difficulties. In this paper, a technique is described for implementing a 3-kVp, three-filter approach. Using carefully chosen spectra and logarithmic image processing, images are produced which are compatible with our previously described two-stage storage-tube subtraction device. Proper manipulation of the resulting difference images results in a final absorption-edge image in which only the element of interest is visualized, with unwanted background images suppressed. Computer calculations are presented to illustrate the relative sizes of difference signals arising from the element of interest and from tissue and bone backgrounds. Phantom studies using iodine concentrations as small as 1 mg/cm2, with variations of 10 cm of tissue and 2 g/cm2 of bone, suggest that the theory is sound and that, with straightforward apparatus modifications, images of good quality should be possible.

Fluoroscopy

An image processing/stereological analysis system for transmission electron microscopy.

This study examines the feasibility of combining computer image digitization, image enhancement, and point counting stereological techniques to quantify video images from transmission electron microscopes (TEM). The essential hardware consists of an IBM PC/AT, a Matrox imaging board, a digitizing tablet, a high resolution black and white monitor, and a portable mass storage device. In addition a video camera must be mounted to the TEM. The software is written in three modules which have numerous routines for image acquisition, enhancement, and quantification. Quantification is achieved by selecting an electronic lattice and superimposing it on the cell image. A cursor is moved on the lattice (via the digitizing tablet) and the points are entered into a spreadsheet. One of the major limitations of the system was the reduced resolution inherent in the current hardware. However, sampling experiments showed that one could compensate for the reduced resolution by increasing the magnification of the digitized images, and the stereological values from digitized images compared favorably to those from electron micrographs. Furthermore, the system proved advantageous by eliminating the usual darkroom work, and in enhancing low contrast tissue. In spite of several hardware limitations, the concept of quantifying computer digitized TEM images appears promising.

Animals