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Airway dimensions measured from micro-computed tomography and high-resolution computed tomography.

Volume averaging results in both over- and underestimation of airway dimensions when they are measured by high-resolution computed tomography (HRCT). The current authors calibrated computerised measurements of airway dimensions from HRCT against a novel three-dimensional micro-computed tomography (CT) standard, which has a 50-fold greater resolution, as well as against traditional morphometry. Inflation-fixed porcine lung cubes were scanned by HRCT and micro-CT. A total of 59 lumen area (Ai), 30 wall area (A(aw)) and 11 lumen volume (Vi) measurements were made. Ai was measured from the cut surface of 11 airways by morphometry. Airways in scanned images were matched using branching points. After calibration, the errors of Ai, A(aw) and Vi HRCT measurements were determined. The current authors found a systematic, size-dependent underestimation of Ai and overestimation of A(aw) from HRCT measurements. This was used to calibrate an HRCT measurement algorithm. The 95% limits of agreement of subsequent measurements were +/-3.2 mm2 for Ai, +/-4.3 mm2 for A(aw), and +/-11.2 mm3 for Vi with no systematic error. Morphometric measurements agreed with micro-CT (+/-2.5 mm2) without systematic error. In conclusion, micro-computed tomography image data from inflation-fixed airways can be used as calibration standards for three-dimensional lumen volume measurements from high-resolution computed tomography, while morphometry is acceptable for two-dimensional measurements. The image dataset could be used to validate other developmental three-dimensional segmentation algorithms.

Animals↗

Insulin algorithms in the self-management of insulin-dependent diabetes: the interactive 'Apple Juice' program.

The 'Apple Juice' program is an interactive diabetes self-management program which runs on a lap-top Macintosh Powerbook 100 computer. The dose-by-dose insulin advisory program was initially designed for children with insulin-dependent (type 1) diabetes mellitus. It utilizes several different insulin algorithms, measurement formulae, and compensation factors for meals, activity, medication and the dawn phenomenon. It was developed to assist the individual with diabetes and/or care providers, in determining specific insulin dosage recommendations throughout a 24 h period. Information technology functions include, but are not limited to automated record keeping, data recall, event reminders, data trend/pattern analyses and education. This paper highlights issues, observations and recommendations surrounding the use of the current version of the software, along with a detailed description of the insulin algorithms and measurement formulae applied successfully with the author's daughter over a six year period.

Algorithms↗

Image processing on Macintosh II: a practical boundary finding algorithm for biomedical measurement.

With increasing research interest in displaying and analyzing biomedical images, a practical personal computer based off-line image processing software would be useful. This paper describes the implementation of an image processing work station on a Macintosh II which features a novel edge detection capability useful for biomedical measurement. The boundary finding algorithm is coded in Turbo Pascal, and operates at a speed comfortable for interactive operation. Depending on the complexity of the problem, it usually takes less than a minute for the measurement of an image. The edge detection algorithm has an built-in edge detector with decision-making capability, and can be efficiently controlled by a mouse. In this way, the local accuracy of an automatic edge detection operator, and the global accuracy of the human eye (through manual control of a mouse) are combined.

Algorithms↗

Detection of ferricyanide as a probe for the effect of hematocrit in whole blood biosensors.

Measurement of the concentration of an analyte in whole blood can be influenced by a range of factors; the red cell content or hematocrit (Hct) of the sample, the distribution and rate of movement of analyte between red cells and plasma, the amount of protein in solution, the viscosity of the sample and fouling of the sensor. The effect of the red cells is the major factor that must be taken into account. Using the analyte molality rather than the analyte molarity, the theoretical response for a range of analytes which are found in plasma and in the red cells can be calculated. For an analyte which is found in plasma alone, the effect of hematocrit is significant, with a bias of -1% per %Hct; if the analyte can freely and rapidly diffuse between the red cells and plasma, this bias is reduced to zero. Using ferrocyanide as a model analyte, the effects of fouling and reduced sample viscosity were measured to be -0.2% per %Hct, giving an overall bias of -1.2% per %Hct, a level of bias which is not clinically acceptable. This bias can be negated by measuring the hematocrit separately and incorporating it into the measurement algorithm. Such a correction is essential for the correct measurement of the concentration of an analyte in whole blood.

Biosensing Techniques↗

Virtual 10-20 measurement on MR images for inter-modal linking of transcranial and tomographic neuroimaging methods.

It is important to create a link between stereotaxic coordinates and head-surface-based positioning systems in order to share data between tomographic and transcranial brain mapping studies. In our previous studies, we established the probabilistic correspondence of the international 10-20 positions to the standard stereotaxic coordinate systems and made a reference database. However, its expansion required the physical marking of the 10-20 positions and the subsequent acquisition of MR images. To avoid such tedious procedures, we developed a virtual 10-20 measurement algorithm that can be applied to re-analyze any structural MR image that covers the whole head. As in the physical 10-20 measurements, with the reference points given, the algorithm automatically determines each 10-20 position step by step. Using the virtual 10-20 measurement method, we re-analyzed the MR images of 17 healthy subjects for whom we had determined 10-20 positions by physical marking in our previous study. The acquired 10-20 positions were normalized to the Montreal Neurological Institute (MNI) stereotactic coordinates and compared with the positions previously determined by physical measurements. 10-20 positions determined using the virtual and physical methods were roughly consistent. Average standard deviations for virtual and physical methods were 7.7 mm and 9.0 mm, respectively. There was a systematic shift in the virtual method, likely due to the absence of hair interference. We corrected the shift with affine transformation. The virtual 10-20 measurement method proved to be an effective alternative to physical marking. This method will serve as an essential tool for expanding the reference database and will further strengthen the link between tomographic and transcranial brain mapping methods.

Adult↗

Failure of the circulatory system limits exercise performance in patients with systemic sclerosis.

OBJECTIVE: To determine the mechanisms for exercise impairment in symptomatic patients with systemic sclerosis (SSc) using breath-by-breath expired-gas analysis with incremental exercise testing. DESIGN: Prospective, open trial. PATIENTS AND METHODS: Fifteen consecutive patients with SSc seen at the Medical University Hospital (a tertiary referral center) with complaints of exercise intolerance underwent pulmonary function testing (spirometry, helium dilution lung volumes, and diffusing capacity of carbon monoxide) and incremental exercise testing on a cycle ergometer measuring oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (R), oxygen saturation, blood pressure, and heart rate (HR). Values for oxygen uptake at anaerobic threshold (VO2AT) were derived graphically by blinded clinicians experienced in exercise testing, and the results were averaged. Ventilatory reserve and oxygen pulse were calculated from measured values, and all data were subjected to analysis by standard clinical algorithms. MEASUREMENTS AND MAIN RESULTS: Of 15 patients studied, 14 had either restrictive lung disease or normal results of spirometry on pulmonary function testing. One patient with a history of tobacco use had evidence of airways obstruction. Three patients were unable to exercise maximally (as determined by maximum respiratory exchange ratio [Rmax] greater than 1.09 or maximum heart rate [HRmax] greater than 85% predicted), and exercise testing was terminated in one with Mobitz type II atrioventricular block. The following data (mean +/- SEM) were obtained from 11 maximally exercising patients: VO2max 795 +/- 75 mL oxygen (O2)/min, R 1.34 +/- 0.05, VO2AT/VO2max predicted 0.21 +/- 0.02, O2 pulse 5.1 +/- 0.4 mL O2/beat, ventilatory reserve 0.52 +/- 0.06, and tidal volume/forced vital capacity ratio 0.46 +/- 0.02. Of the 11 patients completing breath-by-breath expired-gas analysis, all had circulatory impairment to exercise, as determined by low O2 pulse and low VO2 at anaerobic threshold, and circulatory impairment was limiting in 9 of 11 patients. Of those nine patients, four had evidence of impaired gas exchange compatible with pulmonary vascular disease. Arterial oxygen desaturation occurred in 2 of 11 patients. CONCLUSION: Circulatory impairment to exercise is common in SSc patients with exercise intolerance. Restrictive lung disease, although also common, does not limit exercise tolerance in patients capable of maximal effort.

Adult↗

How large is the optic disc? Systematic errors in fundus cameras and topographers.

PURPOSE: To determine whether or not there are systematic differences in the areas of optic discs as measured by different machines using different measurement algorithms and whether racial or gender differences exist in optic disc area measurements. METHODS: We examined the results of twenty-three published studies on the size of normal optic discs of various patient populations. Studies differed in the type of instrument and method used to measure optic disc area, and the number, age, race and gender of subjects examined. Noticing that different machines exhibited statistically significant systematic differences in optic disc sizes of comparable populations, we computed a "normalization" factor for each machine based on these mean differences. Applying this normalization factor to the results, we then re-examined the differences between racial and gender groups. RESULTS: By comparing the results of mean optic disc areas of different racial groups made with different machines, and normalizing results according to those of the Zeiss fundus camera, we found the normalization factors for the following machines to be, Zeiss fundus camera: 1 (by definition), Rodenstock Optic Disc Analyzer (RODA): 1.51, Topcon fundus camera: 1.04, Heidelberg Retina Tomograph (HRT): 1.15 and TopSS scanning laser ophthalmoscope: 1.29. That is, to bring the results of area measurements made with a RODA machine in line with those made with a Zeiss fundus camera, one should multiply the former by the factor 1.51. Using the normalized results, we confirmed the findings of previous authors that the optic disc areas of black subjects were statistically significantly larger than those of white subjects (n-weighted mean effect = 0.556 +/- 0.142 S.E., n = 5). Further, the meta-analysis of various racial populations from five studies shows that males have significantly larger discs than females (n-weighted mean effect = 0.151 +/- .055 S.E., n = 9). CONCLUSION: Different machines and techniques give different results when populations of similar racial composition are measured. We recommend applying the above normalizing factors when comparing studies that employ different instruments.

Adolescent↗

How blurry is that border? An investigation into algorithmic reproduction of skin lesion border cut-off.

This paper describes an approach to algorithmically measuring the second of the ABCD criteria [Stolz W, Braun-Falco O, Bilek P, Landthaler M, Cognetta AB. Color atlas of dermatoscopy. Oxford: Blackwell Science Ltd, 1994], border cut-off. The method measures the lightness gradient of the lesion at the boundary. Gradients are assigned to "blurry" or "sharp cut-off" on the basis of a threshold obtained by comparing dermatologists' opinions with the algorithm. The algorithm appears to correlate quite well with dermatologists' opinions, although several concerns are apparent, especially the distribution of the image set. This algorithm presents a first step at measuring border cut-off and eventually, reproducing the ABCD criteria [Stolz W, Braun-Falco O, Bilek P, Landthaler M, Cognetta AB. Color atlas of dermatoscopy. Oxford: Blackwell Science Ltd, 1994].

Algorithms↗

Reevaluation of color constancy algorithm performance.

The relative performance of color constancy algorithms is evaluated. We highlight some problems with previous algorithm evaluation and define more appropriate testing procedures. We discuss how best to measure algorithm accuracy on a single image as well as suitable methods for summarizing errors over a set of images. We also discuss how the relative performance of two or more algorithms should best be compared, and we define an experimental framework for testing algorithms. We reevaluate the performance of six color constancy algorithms using the procedures that we set out and show that this leads to a significant change in the conclusions that we draw about relative algorithm performance as compared with those from previous work.

Journal Article↗

Measurement of thermal effects on the optical properties of prostate tissue at wavelengths of 1,064 and 633 nm.

BACKGROUND AND OBJECTIVE: The extent of thermal injury during laser prostatectomy is dependent on the light distribution in laser-irradiated tissue. As tissue is irradiated, the optical properties change as a function of temperature due to an alteration of molecular and cellular structure. The purpose of the present study was to determine how the exposure of both fresh and previously frozen canine prostate tissue to elevated temperatures affects the optical properties. STUDY DESIGN/MATERIALS AND METHODS: Optical properties were measured by using a double integrating sphere spectrophotometer with an inverse adding-doubling algorithm. Measurements were made at two wavelengths (1,064 nm and 633 nm) on samples heated in a waterbath in 5 degree-10 degree increments for 10 min through a 50 degrees C temperature range. RESULTS: Upon coagulation, the absorption coefficient of fresh tissue decreased from the baseline measurement for both wavelengths (0.027 +/- 0.003 to 0.019 +/- 0.002 for lambda = 1,064 nm; 0.073 +/- 0.007 to 0.061 +/- 0.006 for lambda = 633 nm). However, the scattering coefficient increased sharply from the baseline measurement following coagulation (3.06 +/- 0.26 to 6.05 +/- 0.29 for lambda = 1,064 nm; 4.89 +/- 0.23 to 7.22 +/- 0.30 for lambda = 633 nm). Thermal coagulation occurred during exposure to temperatures between 60 degrees C and 70 degrees C. CONCLUSION: Data obtained in this study indicate that thermal coagulation of tissue alters the optical properties. The extent to which these changes occur was found to be dependent on wavelength and freshness of tissue. These results are significant because they suggest how thermally induced changes in the optical properties may limit the depth of light penetration in tissue thus compromising treatment.

Algorithms↗

Fully automated system for three-dimensional bronchial morphology analysis using volumetric multidetector computed tomography of the chest.

Recent advancements in computed tomography (CT) have enabled quantitative assessment of severity and progression of large airway damage in chronic pulmonary disease. The advent of fast multidetector computed tomography scanning has allowed the acquisition of rapid, low-dose 3D volumetric pulmonary scans that depict the bronchial tree in great detail. Volumetric CT allows quantitative indices of bronchial airway morphology to be calculated, including airway diameters, wall thicknesses, wall area, airway segment lengths, airway taper indices, and airway branching patterns. However, the complexity and size of the bronchial tree render manual measurement methods impractical and inaccurate. We have developed an integrated software package utilizing a new measurement algorithm termed mirror-image Gaussian fit that enables the user to perform automated bronchial segmentation, measurement, and database archiving of the bronchial morphology in high resolution and volumetric CT scans and also allows 3D localization, visualization, and registration.

Algorithms↗

A systematic and effective supervised learning mechanism based on Jacobian rank deficiency.

Most neural network applications rely on the fundamental approximation property of feedforward networks. Supervised learning is a means of implementing this approximate mapping. In a realistic problem setting, a mechanism is needed to devise this learning process based on available data, which encompasses choosing an appropriate set of parameters in order to avoid overfitting, using an efficient learning algorithm measured by computation and memory complexities, ensuring the accuracy of the training procedures as measured by the training error, and testing and cross-validation for generalization. We develop a comprehensive supervised learning algorithm to address these issues. The algorithm combines training and pruning into one procedure by utilizing a common observation of Jacobian rank deficiency in feedforward networks. The algorithm not only reduces the training time and overall complexity but also achieves training accuracy and generalization capabilities comparable to more standard approaches. Extensive simulation results are provided to demonstrate the effectiveness of the algorithm.

Algorithms↗

Novel approach for anterior chamber angle analysis: anterior chamber angle detection with edge measurement and identification algorithm (ACADEMIA).

OBJECTIVE: To describe a novel approach to measuring anterior chamber angle dimensions and configurations. METHODS: Sixty-nine images were selected randomly from the ultrasound biomicroscopic image database to develop the algorithm. Thirty images were selected for further analyses. The value of each pixel of the 8-bit grayscale ultrasound biomicroscopic images was quantized into 0 (black) or 1 (white), and the edge points outlining the angle were detected and fitted with straight lines. The dimensions and profiles of anterior chamber angles were then measured. RESULTS: The algorithm failed to identify the edge points correctly in 8 (11.6%) of 69 images because of strong background noise. Three basic types of angle configuration were identified based on the derived angle profiles: constant, increasing, and decreasing, which corresponded to flat, bowed forward, and bowed backward iris contours, respectively. The angle measurements demonstrated high correlation with trabecular-iris angle and angle opening distance 500 (calculated as the distance from the corneal endothelium to the anterior iris surface perpendicular to a line drawn at 500 mum from the scleral spur). The strongest association was found between the averaged angle derived from the angle profile and the angle opening distance 500 (r = 0.91). CONCLUSION: The proposed algorithm has high correlations with angle opening distance and trabecular-iris angle with the added advantages of being fully automated, reproducible, and able to capture the characteristic angle configurations. However, good-quality ultrasound biomicroscopic images with high signal-to-noise ratio are required to identify the edge points correctly.

Algorithms↗

Implementation of pencil kernel and depth penetration algorithms for treatment planning of proton beams.

The implementation of two algorithms for calculating dose distributions for radiation therapy treatment planning of intermediate energy proton beams is described. A pencil kernel algorithm and a depth penetration algorithm have been incorporated into a commercial three dimensional treatment planning system (Helax-TMS, Helax AB, Sweden) to allow conformal planning techniques using irregularly shaped fields, proton range modulation, range modification and dose calculation for non-coplanar beams. The pencil kernel algorithm is developed from the Fermi Eyges formalism and Molière multiple-scattering theory with range straggling corrections applied. The depth penetration algorithm is based on the energy loss in the continuous slowing down approximation with simple correction factors applied to the beam penumbra region and has been implemented for fast, interactive treatment planning. Modelling of the effects of air gaps and range modifying device thickness and position are implicit to both algorithms. Measured and calculated dose values are compared for a therapeutic proton beam in both homogeneous and heterogeneous phantoms of varying complexity. Both algorithms model the beam penumbra as a function of depth in a homogeneous phantom with acceptable accuracy. Results show that the pencil kernel algorithm is required for modelling the dose perturbation effects from scattering in heterogeneous media.

Algorithms↗

A feasibility study to investigate the use of thin-plate splines to account for prostate deformation.

Image registration is an important step in the radiotherapy treatment planning process. It provides a method of fusing different types of diagnostic imaging information. One such application is to combine magnetic resonance spectroscopic images (MRSI) of the prostate with anatomical MRI and/or computed tomography images that are routinely used in the radiation treatment planning of prostate cancer. MRSI provides in vivo information related to the underlying metabolic activity of tissues, and can be related to the presence of cancer. However, the inflated endorectal coil required during MRS imaging poses a potential problem by deforming the prostate when it is filled with approximately 100 cm3 of air during image acquisition. This pushes the prostate superiorly/anteriorly, deforming the prostate and consequently the spectroscopic imaging data in a nonlinear manner. In this application, the coil-deformed MRS images are warped back to a non-deformed state, using a single data set. A nonlinear warping algorithm is presented to achieve this. Results indicate that the algorithm attains an accuracy of 97% (4 cm3 difference) when reproducing the total prostate volume compared to a Radiation Oncologist defined prostate volume. This difference is slightly smaller than the measured intra-operator variance of +/-1.5 cm3 (deflated coil) and the measured algorithm variance of +/-1.0 cm3. Additionally, intraprostatic nodules were used to assess the accuracy of the warping algorithm in regions inside the prostate. While choosing anatomical tie points along the external prostate surface, analysis of the nodules revealed the algorithm accuracy reduced to 63-93%.

Feasibility Studies↗

Correlation between carotid area calcifications and periodontitis: a retrospective study of digital panoramic radiographic findings in pretreatment cancer patients.

OBJECTIVES: The objective of this study was to examine the prevalence of carotid area calcifications retrospectively detected on digital panoramic radiographs of pretreatment cancer subjects, and to correlate the finding of such calcifications with radiographic evidence of periodontal bone loss in the same subjects. STUDY DESIGN: Digital panoramic radiographs of 201 subjects were evaluated for calcifications projected in the carotid artery bifurcation area as well as for alveolar bone loss as a result of periodontal disease. Inclusion criteria were unobscured carotid artery bifurcation regions bilaterally and sufficient index teeth present with a definable cemento-enamel junction and alveolar crest. Radiographs were independently observed for carotid area calcifications and for periodontal status. Image enhancements permitted for detection of calcifications projected in the carotid area included window/level, inverse, and emboss. Periodontal measurements were made on index teeth using proprietary imaging software and a mouse-driven measurement algorithm. A 3-factor analysis of variance was performed with 3 between-subjects comparisons. Percentage of bone loss was the dependent variable. Independent variables were age, subject sex, and the presence or absence of carotid area calcifications. RESULTS: Differences measured in percentage of bone loss between sexes were not statistically significant. While bone loss did increase with age, comparison of the mean bone loss of each age category revealed no statistical significance. There was a highly significant correlation between carotid artery area calcifications visible on panoramic radiographs and percent alveolar bone loss. Radiographs showing unilateral and bilateral calcifications had a mean percent bone loss of 24.2% +/- 12.6% and 25.7% +/- 13.0% respectively, compared to those with no calcification at 10.4% +/- 9.9%. CONCLUSIONS: Nearly 1 in 4 subjects in this study evidenced calcifications projected in the carotid bifurcation region. The finding of such calcifications was significantly related to the calculated percentage of alveolar bone loss.

Age Factors↗

Automated variable weighting in k-means type clustering.

This paper proposes a k-means type clustering algorithm that can automatically calculate variable weights. A new step is introduced to the k-means clustering process to iteratively update variable weights based on the current partition of data and a formula for weight calculation is proposed. The convergency theorem of the new clustering process is given. The variable weights produced by the algorithm measure the importance of variables in clustering and can be used in variable selection in data mining applications where large and complex real data are often involved. Experimental results on both synthetic and real data have shown that the new algorithm outperformed the standard k-means type algorithms in recovering clusters in data.

Algorithms↗

Accurate portal dose measurement with a fluoroscopic electronic portal imaging device (EPID) for open and wedged beams and dynamic multileaf collimation.

Measuring portal dose with an electronic portal imaging device (EPID) in external beam radiotherapy can be used to perform routine dosimetric quality control checks on linear accelerators and to verify treatments (in vivo dosimetry). An accurate method to measure portal dose images (PDIs) with a commercially available fluoroscopic EPID has been developed. The method accounts for (i) the optical 'cross talk' within the EPID structure, (ii) the spatially nonuniform EPID response and (iii) the nonlinearity of the EPID response. The method is based on a deconvolution algorithm. Measurement of the required input data is straightforward. The observed nonlinearity of the EPID response was largely due to the somewhat outdated EPID electronics. Nonlinearity corrections for more modern systems are expected to be smaller. The accuracy of the method was assessed by comparing PDIs measured with the EPID with PDIs measured with a scanning ionization chamber in a miniphantom, located at the same position as the fluorescent screen. For irradiations in open, wedged and intensity modulated 25 MV photon beams (produced with dynamic multileaf collimation) EPID and ionization chamber measurements agreed to within 1% (1 SD).

Fluoroscopy↗