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The oxygen status algorithm: a computer program for calculating and displaying pH and blood gas data.

Input parameters for the program are the arterial pH, pCO2, and pO2 (measured by a blood gas analyzer), oxygen saturation, carboxy-, met-, and total hemoglobin (measured by a multi-wavelength spectrometer), supplemented by patient age, sex, temperature, inspired oxygen fraction, fraction of fetal hemoglobin, and ambient pressure. Output parameters are the inspired and alveolar oxygen partial pressures, pH,pCO2 and pO2 referring to the actual patient temperature, estimated shunt fraction, half-saturation tension, estimated 2,3-diphosphoglycerate concentration, oxygen content and oxygen capacity, extracellular base excess, and plasma bicarbonate concentration. Three parameters related to the blood oxygen availability are calculated: the oxygen extraction tension, concentration of extractable oxygen, and oxygen compensation factor. Calculations of the 'reverse' type may also be performed so that the effect of therapeutic measures on the oxygen status or the acid-base status can be predicted. The user may choose among several different units of measurement and two different conventions for symbols. The results are presented in a data display screen comprising all quantities together with age, sex, and temperature adjusted reference values. The program generates a 'laboratory diagnosis' of the oxygen status and the acid-base status and three graphs illustrating the oxygen status and the acid-base status of the patient: the oxygen graph, the acid-base chart and the blood gas map. A printed summary in one A4 page including a graphical display can be produced with an Epson or HP Laser compatible printer. The program is primarily intended for routine laboratories with a blood gas analyzer combined with a multi-wavelength spectrometer. Calculating the derived quantities may enhance the usefulness of the analyzers and improve patient care. The program may also be used as a teaching aid in acid-base and respiratory physiology. The program requires an IBM PC, XT, AT or similar compatible computer running under DOS version 2.11 or later. A VGA color monitor is preferred, but the program also supports EGA, CGA, and Hercules monitors. The program will be freely available at the cost of a discette and mailing expenses by courtesy of Radiometer Medical A/S, Emdrupvej 72, DK-2400 Copenhagen NV, Denmark (valid through 1991). A simplified algorithm for a programmable pocket calculator avoiding iterative calculations is given as an Appendix.

2,3-Diphosphoglycerate

Circadian and ultradian rhythms in blood glucose and plasma insulin of healthy adults.

The circadian and ultradian variations of blood glucose and plasma insulin have been characterized individually and as a group phenomenon in five healthy young adults studied while adhering as closely as possible to their usual routine of sleep, activity, meal content and timing. Three complementary methods were used to analyze the data: displaying raw data as a function of time; cosinor method according to Nelson and Halberg; and time series analyses as proposed by De Prins and Malbecq. The subjects were studied in the laboratory and their life routine were controlled, but very close to that of their habitual routine. They had mainly ultradian rhythms of blood glucose (mainly about 6 hr) and circadian rhythms of immunoreactive insulin (I.R.I.). Blood glucose ultradian rhythms seem to be mainly but not exclusively mealtime dependent, while I.R.I. circadian rhythms appear to be primarily endogenous in origin. Therefore, the role played by insulin in the control of blood glucose levels seems to be programmed on a circadian basis rather than by a time independent feedback phenomenon as postulated by the conventional homeostatic hypothesis. The advantage of this chronophysiologic approach is to consider circadian rhythms of both I.R.I. and insulin effectiveness as an adaptive phenomenon able to maintain blood sugar changes in the ultradian domain of rhythms.

Activity Cycles

A data acquisition, display and plotting program for the IBM PC.

A program, AQ, has been developed to perform analog-to-digital (A/D) conversions on IBM PC products using the Data Translation DT2801-A or DT2801 boards. This program provides support for all of the triggered and continuous A/D modes of these boards. Additional subroutines for management of data files and display of acquired data have also been developed. These programs have been written so that a minimum number of keystrokes are required for their operation. Parameter files are used to simplify reconfiguration of this program for various data acquisition tasks.

Analog-Digital Conversion

The development of a third generation system for entering microbiology data into a clinical laboratory information system.

Increased demands on technologists' time and the desire to have electronic storage of patient information have led to numerous computer-based efforts to manage microbiology data. Our approach to the design of a new microbiology subsystem has been to maximize the functionality without requiring unusual input devices. DEC VT100-compatible terminals are used for data entry and display. Data are displayed taking advantage of such features of these terminals as reverse video, highlighting, and scroll windowing. Numerous single-key instructions for invoking functions and changing cursor positions have been implemented to minimize keystrokes and to anticipate the entry sequences of the technologists. A program that allows the quick location and display of specimens and results is also included in the package.

Clinical Laboratory Information Systems

Statistical analysis and graphical display of multivariate data on the Macintosh.

Two Macintosh programs written for multivariate data analysis and multivariate data graphical display are presented. MacMul includes principal component analysis (PCA), correspondence analysis (CA) and multiple correspondence analysis (MCA), with a complete, original and unified set of numerical aids to interpretation. GraphMu is designed for drawing collections of elementary graphics (curves, maps, graphical models) thus allowing comparisons between variables, individuals, and principal axes planes of multivariate methods. Both programs are self-documented applications and make full use of the user-oriented graphical interface of the Macintosh to simplify the process of analysing data sets. An example is described to show the results obtained on a small ecological data set.

Algorithms

Three-dimensional display of data obtained by single photon emission computed tomography.

Three-dimensional display of radioactive distributions has been achieved using data generated by single photon emission computed tomography (SPECT). Computer techniques for constructing images are presented and the special problems associated with manipulating SPECT data are reviewed. The potential role of three-dimensional imaging in nuclear medicine is discussed and SPECT studies from several illustrative cases are presented.

Adult

Phase plane (volume to volume-time function loop) display of data from radionuclide ventriculography obtained by single cardiac probe system.

To assess the left ventricular (LV) performance more sensitively, a new display method of phase plane (PP), displaying volume and volume-time function (dV/dt) in a single image, was applied to radionuclide ventriculography obtained by a single cardiac probe system. The sampling interval was 10 msec and the data acquisition time was 60 sec. The LV volume curve was smoothed by fitting a fourth order polynomial curve of Fourier's analysis. Then the dV/dt was calculated. In this single image PP display, the width of the horizontal axis indicates relative LV volume, and the height of the vertical axis indicates dV/dt. The direction of the rotation of this loop is clockwise. We classified 126 patients with various heart diseases into seven groups, according to the configuration of the loop. The most interesting finding was that the distortion of the loop during diastole was frequently seen in patients with hypertension and angina pectoris, whereas their ejection fraction was within normal limits. We concluded that the single image PP display is a sensitive method for assessing the abnormality of the LV function, not only by evaluating the conventional parameters, but also by analyzing the configuration of the volume to volume-time function loop.

Adult

SQUID: a program for the analysis and display of data from crystallography and molecular dynamics.

SQUID is a flexible computer program that allows the analysis and display of molecular coordinates from crystallography, NMR, and molecular dynamics. The program can also display two-dimensional and three-dimensional data using many graph types, as well as perform array processing of data with numerous intrinsic functions. Graphics are based on the use of "move" and "draw" instructions, allowing easy development of new device drivers, including vector plotters.

Computer Graphics

Optimization of techniques in screening CT of the sinuses.

The number of screening examinations of the sinuses performed with CT has markedly increased owing to the widespread and increasing use of endoscopic sinonasal surgery. We reviewed scans from 500 patients who had screening CT examinations of the sinuses for preendoscopic evaluation of inflammatory sinonasal disease to better define an optimal imaging protocol. Three aspects of direct coronal imaging of the paranasal sinuses were investigated: (1) preparation of the patient prior to the examination; (2) technical factors of the CT study, including positioning of the patient, optimal coronal angle, slice thickness, and CT exposure factors; and (3) data display. Our experience indicates that pretreatment of the patient with maximal medical therapy enables the best preendoscopic definition of anatomy, disease pattern, and nonreversible disease component for the treating surgeon. CT technical factors are optimized with scanning in the prone position with thin (3-mm) sections obtained through the anterior paranasal sinuses. This allows optimal visualization of the ostiomeatal unit. The remaining posterior portions of the sinuses are adequately imaged with thicker slices (5 mm). The coronal scan angle used is less critical. Exposure factors (mAs) can be reduced dramatically without image compromise. Data display is optimized when the bone algorithm is used to acquire the data and with image display at intermediate window center and width level. Use of the techniques outlined in this article results in a cost-effective yet diagnostic scan of the sinuses with decreased radiation exposure to the patient.

Cost-Benefit Analysis

Interactive display of volumetric data by Fast Fourier Projection.

This article describes a new algorithm for reprojection of volumetric data, called Fast Fourier Projection (FFP), which is one to two orders of magnitude faster than conventional methods such as ray casting. The theoretical basis of the new method is developed in a unified mathematical framework encompassing slice imaging and conventional volumetric reprojection methods. Software implementation is discussed in detail. The article closes with an account of experience with a prototype FFP implementation, and applications of the technique in medical visualization.

Algorithms

Three-dimensional volumetric display of CT data: effect of scan parameters upon image quality.

Of the many steps involved in producing high quality three-dimensional (3D) images of CT data, the data acquisition step is of greatest consequence. The principle of "garbage in, garbage out" applies to 3D imaging--bad scanning technique produces equally bad 3D images. We present a formal study of the effect of two basic scanning parameters, slice thickness and slice spacing, on image quality. Three standard test objects were studied using variable CT scanning parameters. The objects chosen were a bone phantom, a cadaver femur with a simulated 5 mm fracture gap, and a cadaver femur with a simulated 1 mm fracture gap. Each object was scanned at three collimations: 8, 4, and 2 mm. For each collimation, four sets of scans were performed using four slice intervals: 8, 4, 3, and 2 mm. The bone phantom was scanned in two positions: oriented perpendicular to the scanning plane and oriented 45 degrees from the scanning plane. Three-dimensional images of the resulting 48 sets of data were produced using volumetric rendering. Blind review of the resultant 48 data sets was performed by three reviewers rating five factors for each image. The images resulting from scans with thin collimation and small table increments proved to rate the highest in all areas. The data obtained using 2 mm slice intervals proved to rate the highest in perceived image quality. Three millimeter slice spacing with 4 mm collimation, which clinically provides a good compromise between image quality and acquisition time and dose, also produced good perceived image quality. The studies with 8 mm slice intervals provided the least detail and introduced the worst inaccuracies and artifacts and were not suitable for clinical use. Statistical analysis demonstrated that slice interval (i.e., table incrementation) was of primary importance and slice collimation was of secondary, although significant, importance in determining perceived 3D image quality.

Data Display