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[Quantitative sacroiliac joint scintigraphy? (author's transl)].

Methodological aspects and clinical value of digital sacroiliac joint scintigraphy area are described. Preinformation of the observer affects the value of the uptake ratios significantly. A data processing is presented which reduces this effect. Nevertheless there is insufficient discrimination between normal persons and patients with acute inflammation. Routine bone scanning can therefore not be used to exclude "inflammatory changes".

Adult

Scene segmentation techniques for the analysis of routine bone marrow smears from acute lymphoblastic leukemia patients.

Automated analysis of lymphoblast cell morphology is being evaluated as a basis for predicting the response to therapy of patients with acute lymphoblastic leukemia. A new technique of scene segmentation particularly applicable to the "cluttered" images of cells in routine bone marrow smears is described. Morphologic characteristics of lymphoblasts found in bone marrow smears made at time of diagnosis were measured by an automated, interactive image-processing system using the new scene segmentation technique. These characteristics, on a patient by patient basis, are being compared to remission length and survival data to develop and test new prognostic methods.

Autoanalysis

[Postural scintimyelography of the cervical spine (author's transl)].

This study discusses the clinical validity of 101 postural scintimyelograms as a screening method for cervical myelopathy. The RIHSA or Ytterbium isotope-examination are not an extra burden to the patient if the radiopharmacon is introduced into the dural sac following Queckenstedt's test. If there is a normal rise and fall of CSF pressure after bilateral jugular compression and postural scintimyelography is judged normal as well, a cervical subarachnoid obstruction may be excluded. If both examinations yield pathological results an obstructive process in the cervical spinal canal is made certain; and in cases of spondylotic myelopathy a positive contrast myelogrpahy may thus be superfluous. If the results of these two examinations are contradictory then further neuroradiolocal studies are indicated.

Cerebrospinal Fluid

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

Image processing in pathology.

The present study is an effort to ally biopsies to well defined groups of diseases by means of automatic analysis of liver cell nuclei. The results obtained should support the morphologic differential diagnosis of liver diseases. A total of 78 liver biopsies from patients with obstructive jaundice, chronic hepatitis, acute viral hepatitis or with alcoholic liver injury were investigated. Performing automatic analysis of the microscopic pictures 95% of the equatorial sectioned liver cell nuclei are correctly recognized.

Cell Nucleus

Experimental infarct sizing using computer processing and a three-dimensional model.

A method for noninvasive sizing of myocardial infarction, in which data from technetium-99m stannous pyrophosphate scintigrams and a three-dimensional model were used, was tested on experimental, acute anterior infarcts in dogs. The results indicate that the method does size experimental anterior infarcts accurately, but further testing will be necessary to assess the capabilities of the technique for sizing other types of infarcts.

Animals

An automated method of differential red blood cell classification with application to the diagnosis of anemia.

A method of automated red cell analysis suitable for the rapid classification of large numbers of red cells from individual blood specimens has been developed, and preliminarily tested on normal bloods and clinically proven cases of anemias and red cell disorders. According to this method digital image processing techniques provide several features relating to shape and internal central pallor configurations of red cells. These features are used with a fully automated decision logic to rapidly provide a quantitative "red cell differential" analysis, a report of the percentage subpopulations of recognized categories of red cells. For each subpopulation, measurements of mean cell area, mean cell hemoglobin content and mean cell hemoglobin density are provided. The nine types of red cell disorders studied with this method were: (a) iron deficiency anemia, (b) the anemia of chronic disease, (c) beta-thalassemia trait, (d) sickle cell anemia, (e) hemoglobin C disease, (f) intravascular hemolysis, (g) hereditary elliptocytosis, (h) hereditary spherocytosis, and (i) megaloblastic anemia due to folic acid deficiency. Preliminary indications are that the red cell differential is useful in distinguishing between these conditions.

Anemia

Fully automatic computer-assisted pancreas imaging.

Good pancreas imaging is difficult to achieve even if a computer is applied. The special computer program proposed here was developed to optimize the results and to minimize the operator interaction with the data processing system.

Computers

The role of the digital computer in pediatric cardiology.

A digital computer system is described which allows the real-time processing of all physiological signals obtained during a heart catheterization procedure and which makes all relevant results and informations available immediately during the investigation. In addition, special electronic units and programs have been developed in our institution for the automated extraction of morphological criteria from biplane angiocardiograms. Thereby right and left ventricular volume, shape and contraction pattern can be quantitated and used to characterize the performance of the heart as muscle and pump in physical terms. Recently, complete digital processing of videoangiocardiograms has been achieved in a stroboscopic mode, each videofield in real time. Application of image enhancement, subtraction, integration and restoration techniques leads to a fundamentally improved angiocardiographic image quality for a given amount of injected contrast material. Based on eight years of experience with digital computer application in pediatric cardiology, computer technologies are considered likely to become the method of choice in the future.

Angiocardiography

133Xe regional lung perfusion and ventilation study with the computer-assisted gamma-camera.

A new method of studying regional lung functions using 133Xe and the computer-assisted scintillation camera is described. The method and the computer processing give details of the distribution of 133Xe during perfusion and ventilation and also measures of lung function. Some cases are described in detail, and the clinical significance of the method was confirmed in 45 cases.

Adult

A general purpose computerized display and analysis system for image processing in nuclear medicine.

In this work a general purpose image processor is described, which takes into account the special features and the various requirements for analysing images in nuclear medicine. A new approach for system structure involving encoding and representing medical images is given. This encoder, which is part of the image processor, is efficient especially for long-term storage and for certain pattern recognition in medical imaging. In this processor a statistical package is incorporated for collecting medical statistics using the acquired patient data. This information is used together with the encoder for an automated diagnostic system.

Computers

Towards computer analysis of pulmonary infiltration.

A feasibility study is described to provide quantitative texture measures to distinguish between normal lung, alveolar infiltrates and interstitial infiltrates. Advanced computer imaging technology and decision making processes were applied to distinguish between these textural patterns. The results, based on computer extracted quantitative measures, show an excellent separation of the three classes considered with 95% accuracy in the training phase and 90% accuracy in the testing phase.

Diagnosis, Computer-Assisted

Bayesian statistics: a guided tour.

An overview of Bayesian statistical decision theory is presented in the tutorial spirit. A section on fundamental principles is followed by selected applications of the Bayesian approach to parameter estimation, pattern recognition, image processing, computer-aided medical diagnosis, optimal diagnostic test selection, and radiotherapy treatment planning.

Decision Making

[Electronic data processing in the clinical nuclear medicine].

Computer techniques as introduced into clinical nuclear-medicine 12 years ago, were first exclusively used for scintigraphic purposes. Through the development of a comprehensive pilot system for nuclear medical data processing on the basis of two Siemens Process control computers it could be demonstrated, that besides of scintigraphy there are also other important fields for computer application, e.g. in function diagnostics and therapy planning.

Bayes Theorem

Fundamental study of automatic cytoscreening for uterine cancer. IV. Sample requirements for CYBEST and simulation test of cell dispersion.

The preparation of samples with good cell dispersion and without cell overlapping is a particularly important problem, whether for image processing systems or for flow systems. Simulation tests were carried out to estimate a cell density with good cell dispersion and a minimum number of overlapping cells. A little less than 50 cells per mm2 was disclosed to show a condition of sufficient cell dispersion. By microscopical observation and counting of the malignant cells using ten cases of uterine cervical carcinoma, it was found that in most instances over 50 malignant cells were contained in 20,000 to 40,000 cells on the smears. When the cell density is approximately 50 per mm2, the scanning area of the CYBEST of 40 X 20 mm may contain up to 40,000 cells. The probability that such a number of cells contains malignant cells is extremely high, in fact, nearly 100 per cent. By field tests, it was experimentally confirmed that these cell densities are very adequate for the function of the CYBEST.

Autoanalysis

[Use of a process computer in nuclear medicine].

The picture processing of scintigrammes (scintillation scanner and scintillation camera) has become possible only by use of process calculators. In the processing of individual static pictures by means of mathematical filtration methods, underground subtraction and formation of classes the perceptibility of details is improved. The evaluation of dynamic photographs of the scintillation camera (to 10 pictures/s) presumes the genuine time working of a process calculator. Out of the sequel of pictures the temporary course of activity in marked picture regions (organs, parts of organs) can be calculated as function curve. Using a small computer system KRS 4,200 (Robotron) in the Radiological Clinic of the Leipzig Karl-Marx-University the temporary and logical course of measuring is regulated in nuclear-medical measuring places. Acceptance and processing of the measuring values is performed by 5 working places in genuine time work. Furthermore, organizational tasks of the course of work are treated by computer.

Computers

Patient data acquisition.

Patient data are acquired in three ways: by direct interrogation; physiological measurements; and analysis of specimens, signals, and images. When computers are used to acquire information from the patient directly, difficulties arise from the lack of standardized patient medical history, the complexities of natural language processing, and the problems of man/machine communication (patient with computer terminal, and physician with computer-generated history). A great variety of data input devices have been used for the acquisition of the patient medical history. Most have been extensively used in multiphasic health testing programs, and this experience is freely drawn upon in this paper.

Computers