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PubMed1998

[Progress in diagnostic imaging of the thorax (CT, MRI, intervention)--significance and value for the surgeon].

Among radiological diagnostical procedures, the conventional chest X-ray has retained its significance as a screening investigation up to the present. Digital imaging does not reveal any advantages. Due to its higher resolution the CT scan, particularly the spiral CT scan, has markedly increased radiological possibilities, thus influencing surgical oncology significantly. Tumor invasion of the mediastinum, heart, and thoracic wall has become detectable, as well as enlarged lymph nodes and metastases. CT angiography permits a better assessment of large vessels by aortic rupture or dissection and pulmonary embolism, to name a few. MRI is inferior to CT scan in this respect, displaying a slight advantage in terms of detecting tumor infiltration of the nerval plexus, i.e. pancoast syndrome.

Humans↗

PubMed2006

Factors that influence radiation dose in percutaneous coronary intervention.

AIM: To explore the factors that may influence the radiation dose imparted to the patient in PCI, and investigate whether the use of the latest digital X-ray system based on FP detector technology can have an impact on dose. MATERIALS AND METHOD: Demographic and clinical data such as number of lesions treated, number of stents placed, grade of tortuosity, and stage of occlusion, as well as use of double wire and double balloon technique, ostial stenting or bifurcation stenting, and presence of major complications were recorded, together with radiation parameters. RESULTS: The factors that increased patient radiation dose were (1) patient gender, as men exhibited higher doses than women; (2) complex lesion; (3) increasing number of stents; (4) position of stent; (5) grade of tortuosity; and (6) stage of occlusion. The FP digital system appeared to be settled in a lower-dose rate for fluoroscopy (a factor of 6) and higher for dose per frame in cine (a factor of 3) in comparison with the image intensifier (II) system. There was a marked reduction of DAP when the FP technology was introduced. CONCLUSION: More extensive studies should be performed in the future so as to further investigate the influence of the FP detector in IC.

Angioplasty, Balloon, Coronary↗

PubMed2004

Patient dosimetry during coronary interventions: a comprehensive analysis.

BACKGROUND: We performed a detailed analysis of patient radiation during coronary interventions, comparing dose measurements to established dose reference levels, assessing coronary artery doses, and estimating total radiation risk of fatal cancer. METHODS: We prospectively examined 281 patients who were subjected to 307 percutaneous coronary interventions. RESULTS: The mean kerma area product (KAP) per procedure was 82.1 +/- 47.9 Gy x cm2. Corresponding values for fluoroscopy and digital cineangiography were 28.3 +/- 25.5 Gy x cm2 and 53.8 +/- 35.5 Gy x cm2, respectively, and exposure times were 13.1 +/- 6.8 minutes (87%) and 2.0 +/- 1.5 minutes (13%), respectively. The right anterior oblique caudal and left anterior oblique cranial projections accounted for the highest amount of KAP (24.0% and 23.1%, respectively) compared with other projections. The maximum recorded skin-dose was 182 mGy. Performing a representative procedure on a phantom, the effective dose was 14.9 mSv. The mean coronary dose was 61.7 +/- 38.2 mGy, with a highest calculated dose of 220.1 mGy. The third quartile of KAP measurements was 105 Gy x cm2, the 95th percentile was 175 Gy x cm2, and the mean value of KAP measurements was 82 Gy x cm2. The total risk for the development of fatal cancer was calculated as 83 cases for every 100,000 patients subjected to coronary intervention. CONCLUSIONS: A detailed analysis of patient radiation during coronary interventions is presented. Coronary doses and total radiation risk of fatal cancer are also calculated, and a method for establishing dose reference level values is proposed.

Angioplasty, Balloon, Coronary↗

PubMed1996

A real-time reconstruction system for magnetic resonance imaging.

A digital-electronic reconstruction system for MRI has been designed and demonstrated. The system is capable of reconstructing a 128 x 128 pixel image from complex-valued data in approximately 8 ms (122 frames per second) or a 256 x 256 pixel image in 32 ms (30 frames per second) using the standard 2D FFT reconstruction algorithm. Real-time MR imaging can be obtained when this reconstruction system is coupled with fast continuous echo-planar type data acquisition. This provides the unique potential for real-time monitoring of interventional procedures or for rapid patient positioning. The real-time reconstruction system presented here consists of four main subsystems: an analog to digital converter, an interface memory, the Fourier processor, and the display processor. The basic design of this reconstruction system is presented along with results, demonstrating the capability of the system.

Analog-Digital Conversion↗

PubMed1992

[A case of congenital pulmonary varices].

Pulmonary varices are rare disorders (only 72 published cases), and are most often congenital in origin, asymptomatic and have a benign outcome. In some cases the appearance of varices is favoured by pulmonary venous hypertension which is most often related to mitral valve disease, or it is associated with other vascular or bronchial malformations. We present a new case of isolated pulmonary varices occurring in an asymptomatic young woman aged 20. The pulmonary radiological abnormality was confirmed using computed tomography which showed that the abnormality was both of vascular origin and of venous composition. Digital subtraction angiography during the venous phased confirmed the diagnosis. There was no associated cardiomyopathy, nor any bronchial or vascular malformation. No surgical intervention was taken, nor was there any clinical or radiological change observed during follow-up over one year. The diagnosis of pulmonary varices is an important one to make, particularly to avoid an unnecessary thoracotomy, but there should always be a systemic search for associated anomalies.

Adult↗

PubMed1994

Endovascular treatment of intracranial aneurysms.

OBJECTIVE: To examine the techniques, reported experiences, and advantages and disadvantages associated with the endovascular treatment of intracranial aneurysms. DESIGN: We review the endovascular techniques used for the treatment of intracranial aneurysms and the sequelae of subarachnoid hemorrhage, which have evolved during the past 10 years. MATERIAL AND METHODS: Two broad categories of endovascular therapy for intracranial aneurysms are described: occlusion of the parent artery and preservation of the parent artery by selective occlusion of the aneurysm with balloons or metallic coils. The Mayo protocol for testing tolerance of patients before permanent balloon occlusion of the parent artery is described, as are the types of aneurysms most amenable to this treatment. In addition, use of balloon angioplasty for cerebral vasospasm after subarachnoid hemorrhage is reviewed. RESULTS: Recent improvements in microcatheter technology have facilitated the safe navigation of percutaneously introduced catheters in the intracranial circulation and selective catheterization of intracranial aneurysms. Surgically difficult aneurysms are now being treated with endovascular techniques more frequently than in the past. Early results from animal experiments and human trials have shown that selective occlusion of aneurysms with metallic coils may have a role in the treatment of intracranial aneurysms. Balloon angioplasty of symptomatic cerebral vasospasm has demonstrated improvement in neurologic function in approximately 70% of patients. CONCLUSION: As technology continues to improve and as greater experience is obtained, interventional neuroradiologists will continue to have an increasingly important role in the treatment of intracranial aneurysms.

Angiography, Digital Subtraction↗

PubMed2005

Mobile eHealth interventions for obesity: a timely opportunity to leverage convergence trends.

Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes. This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer-assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model. Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.

Attitude to Health↗

PubMed2006

Voluntary incident reporting by anaesthetic trainees in an Australian hospital.

OBJECTIVE: To assess the reporting of critical incidents by anaesthetic trainees using personal digital assistants. The project also identified the reporting of 'near miss' incidents by anaesthetic trainees. DESIGN: Comparison of electronic incident reporting with retrospective case note review of cases in which no incident was reported. SETTING: A 400-bed university teaching hospital in Victoria. PARTICIPANTS: Fourteen accredited Australian and New Zealand College of Anaesthetists (ANZCA) registrars and their training supervisors. INTERVENTIONS: Registrars and supervisors underwent initial training for 1 hour and were provided with ongoing support. The cases and incidents reported to the database using the portable digital assistants were analysed. MAIN OUTCOME MEASURES: These were the total number of anaesthetics reported to the database; the number of incidents reported to the database; the outcome severity of incidents reported; and the number of incidents detected in the case note review that were not reported to the database. RESULTS: An incident was reported for 156 (3.5%) of 4441 anaesthetic procedures reported to the database. Of these incidents, 72 (46.2%) were 'near misses'. One incident was identified in a review of 208 case notes, which had no incidents reported electronically, and was not reported to the database electronically. This gives a reporting rate of 99.52% [95% confidence interval (CI) 96.9-100%]. CONCLUSIONS: ANZCA trainees in routine anaesthetic practice can reliably use mobile computing technology to report critical incidents and 'near miss' incident data.

Anesthesiology↗

PubMed1992

Myocardial perfusion and regression of coronary artery disease in patients on a regimen of intensive physical exercise and low fat diet.

This intervention program tested the applicability and effects of intensive physical exercise and a low fat diet on progression of coronary atherosclerotic lesions and stress-induced myocardial ischemia in patients with stable angina pectoris. Eighteen patients participated in this program for 1 year; they consumed a low fat, low cholesterol diet (less than 20 energy % fat, cholesterol less than 200 mg/day) and exercised for greater than 3 h/week. Change in coronary morphology was assessed by angiography and digital image processing; stress-induced myocardial ischemia was measured by thallium-201 scintigraphy. Results were compared with those in patients receiving "usual care." In the intervention group, significant regression of coronary atherosclerotic lesions was noted in 7 of the 18 patients; no change or progression was present in 11 patients. In patients receiving usual care, regression was detected in only 1, with no change or progression in 11 patients (different from intervention, p less than 0.05). There was a significant reduction in stress-induced myocardial ischemia, which was not limited to patients with regression of coronary atherosclerotic lesions. Thus, regular physical exercise and a low fat diet may retard progression of coronary artery disease; however, improvement of myocardial perfusion may be achieved independently from regression of stenotic lesions.

Angiography, Digital Subtraction↗

PubMed2006

Chiropractic manipulation affects the difference between arterial systolic blood pressures on the left and right in normotensive subjects.

OBJECTIVE: The purpose of this study is to determine whether chiropractic manipulation is associated with any measurable changes in the difference between the arterial blood pressures on the left and right before and after treatment in normotensive subjects. METHODS: A nonrandomized, matched pair, controlled clinical trial, with the treatment (manipulation) group and control (resting) group matched for age and sex, was performed in chiropractic student clinics in London, UK. The treatment group consisted of 35 new patients presenting to a single student chiropractor between the start of April 2003 and the end of August 2003. The control group consisted of 35 nonpatients matched for sex and age. The intervention was chiropractic manipulation. Preintervention and postintervention systolic and diastolic blood pressures were recorded in both arms through the use of a digital oscillometric sphygmomanometer. RESULTS: A significant difference was found between the pre- and posttreatment blood pressure differences for systolic pressures (P = .01), but no significant difference was found in either set of control data or the treatment diastolic values. A significant difference was also found between the treatment and control group's preintervention systolic differences (P = .002), but not between the groups at any other time. CONCLUSION: Chiropractic treatment appears to have an effect on the difference in systolic blood pressure between the arms, which is not shown in the control group or the diastolic treatment group values. This may be attributable to a difference between the 2 groups' preintervention systolic values; however, there was no significant difference between the 2 groups after intervention.

Adolescent↗

PubMed2000

Infrared scanning laser tomography of macular cysts.

OBJECTIVE: To perform three-dimensional, noninvasive, quantitative analysis of cystoid macular edema and macular cysts using infrared scanning laser tomography and to correlate findings with visual acuity (VA) as a basis for interventional studies. DESIGN: Cross-sectional, nonrandomized study. PARTICIPANTS: Seventeen patients (29-86 years of age) with macular cysts associated with a broad spectrum of diseases. INTERVENTION: Confocal infrared imaging with scanning laser tomography with the TopSS (790 nm) (Laser Diagnostic Technologies, San Diego, CA) with digitized images was used to perform three-dimensional, quantitative analysis of cysts in the central 5 degrees of the macula. MAIN OUTCOME MEASURES: Measurements of macular cyst number, area, volume, depth, slope, height of the surrounding macular elevation, and correlation with VA. RESULTS: Scanning laser tomography detected macular cysts in all patients. The number per patient ranged from 1 through 15. Cysts were accompanied by surrounding macular elevation in 16 patients (mean macular height, 216 microm). The area covered by cysts in the central 5 degrees was 0.087 to 0.969 mm2, and volume was 0.007 to 0.549 mm3. Visual acuity was significantly poorer in patients with greater cyst area (P = 0.0007), cyst volume (P = 0.0009), macular thickening (P = 0.0002), and cyst depth (P = 0.0013). Cyst number, average slope, and maximum slope, however, did not correlate significantly with VA. Grouping of macular cysts according to macular height and average cyst depth revealed that cysts in a more thickened retina were significantly deeper, had steeper slopes, and corresponded to worse VA. Macular height and average cyst depth were highly associated with each other, suggesting that in eyes with surrounding macular edema, cysts were deeper and may reflect more widespread tissue destruction. Individual confocal tomographic images provided additional information. Neither ophthalmoscopy nor fluorescein angiography delineated features such as retinal folds that suggested vitreous traction or changes in deeper layers that suggested occult choroidal new vessels. CONCLUSIONS: Infrared scanning laser tomography is a rapid and noninvasive imaging method that provides quantitative analysis of macular cysts in addition to qualitative information not seen clinically. Because poor VA is related to severe involvement of the central retina, scanning laser tomography could provide an objective outcome measure for interventional studies.

Adult↗

PubMed2004

Gadolinium-based magnetic resonance imaging contrast agents in interventional radiology.

Gadolinium-based agents are widely used in magnetic resonance imaging as contrast agents. These agents are radio-opaque enough for diagnostic imaging of the vascular tree by using digitally subtracted images as well as for imaging of the biliary system and the urinary tract. The recommended doses for gadolinium do not impair renal function or cause adverse reactions in patients with iodine sensitivity; thus patients with such conditions can safely undergo diagnostic angiography, either by MRI angiography or by catheterization using gadolinium as contrast agent, for diagnostic and therapeutic purposes.

Contrast Media↗

PubMed2006

Dose area product evaluations with Gafchromic XR-R films and a flat-bed scanner.

Gafchromic XR-R films are a useful tool to evaluate entrance skin dose in interventional radiology. Another dosimetric quantity of interest in diagnostic and interventional radiology is the dose area product (DAP). In this study, a method to evaluate DAP using Gafchromic XR-R films and a flat-bed scanner was developed and tested. Film samples were exposed to an x-ray beam of 80 kVp over a dose range of 0-10 Gy. DAP measurements with films were obtained from the digitalization of a film sample positioned over the x-ray beam window during the exposure. DAP values obtained with this method were compared for 23 cardiological interventional procedures with DAP values displayed by the equipment. The overall one-sigma dose measurement uncertainty depended on the absorbed dose, with values below 6% for doses above 1 Gy. A maximum discrepancy of 16% was found, which is of the order of the differences in the DAP measurements that may occur with different calibration procedures. Based on the results presented, after an accurate calibration procedure and a thorough inspection of the relationship between the actual dose and the direct measured quantity (net optical density or net pixel value variation), Gafchromic XR-R films can be used to assess the DAP.

Biophysical Phenomena↗

PubMed2001

Surveillance of peripheral arterial bypass grafts with three-dimensional MR angiography: comparison with digital subtraction angiography.

OBJECTIVE: The purpose of this study was to use contrast-enhanced three-dimensional MR angiography to assess the patency of peripheral arterial bypass grafts of the lower extremity. SUBJECTS AND METHODS: The study included 39 patients with 45 lower limb grafts. Twenty-eight were saphenous vein grafts, 13 were expanded polytetrafluoroethylene, and two were Dacron grafts. Digital subtraction angiography correlation was available for 30 patients (31 grafts). MR angiography was performed on a 1.5-T system with a multichannel quadrature phased array peripheral vascular coil. The scanning delay was determined with a test bolus technique, using half-time to maximum signal intensity in the graft. Arterial imaging was accomplished with two three-dimensional MR angiography acquisitions with gadopentetate dimeglumine administered using an automated injector. The pelvic and femoral arteries were imaged, the MR table was repositioned, and the lower limb arteries were imaged. The three-dimensional MR angiography sequence used the following parameters: TR/TE, 5.2/1.5 msec; inversion time, 28 msec; flip angle, 30 degrees. The proximal anastomosis, graft, and distal anastomosis were characterized as normal, stenosed, occluded, or ectatic or aneurysmatic. RESULTS: Sensitivity and specificity values for MR angiography regarding the assessment of grafts were 100% for 87 evaluable segments for which digital subtraction angiography correlation was available: stenosis (n = 10), occlusions (n = 9), ectasia or aneurysms (n = 8). Six segments could not be assessed because of the presence of intravascular stents or metallic clips. CONCLUSION: Contrast-enhanced three-dimensional MR angiography is well suited for the characterization of arterial grafts, for planning subsequent vascular interventions, and for excluding further lesions.

Aged↗

PubMed2004

Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction.

BACKGROUND: The pelvic floor muscles are active in normal erectile function. Therefore, it was hypothesised that weak pelvic floor muscles could be a cause of erectile dysfunction. AIMS: To compare the efficacy of pelvic floor muscle exercises and manometric biofeedback with lifestyle changes for men with erectile dysfunction. DESIGN OF STUDY: Randomised controlled trial. SETTING: The Somerset Nuffield Hospital, Taunton, United Kingdom. METHOD: Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78 years) were enrolled from a local urology clinic. Of these, 28 participants were randomised to an intervention group and engaged in pelvic floor exercises, as well as receiving biofeedback and suggestions for lifestyle changes. Twenty-seven controls were solely advised on lifestyle changes. Baseline, 3- and 6-month assessments were: erectile function domain of International Index of Erectile Function (IIEF), Partner's International Index of Erectile Function (PIIEF), Erectile Dysfunction-Effect on Quality of Life (ED-EQoL), anal manometry, digital anal measurements, and clinical assessment by an assessor blind to treatment allocation. After 3 months, the control group were transferred to the active arm. RESULTS: At 3 months, compared with controls, men in the intervention group showed significant mean increases in the erectile function domain of the IIEF (6.74 points, P = 0.004); anal pressure (44.16 cmH(2)O, P <0.001); and digital anal grades (1.5 grades, P <0.001). All showed further improvement in these outcomes at 6 months. Similar benefits were seen in men of the control arm after transfer to active treatment. A total of 22 (40.0%) participants attained normal function, 19 (34.5%) participants had improved erectile function, and 14 (25.5%) participants failed to improve. CONCLUSION: Pelvic floor muscle exercises and biofeedback are an effective treatment for men with erectile dysfunction.

Adult↗

PubMed2003

Digital analysis of choroidal neovascularisation in consecutive fluorescein angiograms for use in longitudinal clinical trials.

BACKGROUND/AIMS: To document the natural history and to assess the efficacy of interventional therapies in neovascular age related macular degeneration (AMD), an accurate and reproducible method is required for analysis of consecutive fluorescence angiograms. The development and evaluation of an image analysis software for this purpose is described here. It allows for the quantitative analysis of changes in CNV and/or leakage area over time. METHODS: In digitised angiograms, a mouse driven arrow was used to delineate the CNV border. The ratio of the CNV area to the square of the distance between two vessels was automatically calculated by pixel count to compensate for variation in image sizes at different examination times. These results were directly transferred and stored in a database. To assess reproducibility, CNV areas in 20 patients with occult and 20 patients with classic CNV were determined independently by two readers. RESULTS: There was only marginal variability between observers with this method: the mean deviation was 0.01 pixels for classic CNV (95% CI -0.17 to +0.15, SD 0.35) and 0.55 pixels for occult CNV (95% CI -1.06 to -0.04, SD 1.14). CONCLUSIONS: This practical PC based method allows for quantification of angiographic features such as CNV size in early frames and area of leakage in late frames. Limitations include non-readily defined borders in angiograms of poor image quality or indistinct borders of the hyperfluorescent areas of interest. The software is applicable to future clinical trials where the analysis of neovascular complex changes is required, for example, following therapeutic intervention.

Choroidal Neovascularization↗

PubMed2005

Capacity for direct attention in patients undergoing percutaneous coronary intervention: the effects of psychological distress.

Emphasis is placed on educating coronary heart disease patients about lifestyle choices to reduce the risk of further cardiovascular events, but little attention has been paid to the impact of attentional capacity on patients' learning. The purpose of this study is to identify and compare the capacity for direct attention and the effect of psychological distress during hospitalization and 6 weeks after percutaneous coronary intervention. Forty subjects, mean age of 63 years, 27 men and 13 women, completed components of the Wechsler Memory Test to measure direct attention, and the Profile of Mood States. There were significant differences in the Digit Span Test-backward, a measure of working memory (t=-2.79; p<0.009), and the Profile of Mood States total score, a measure of psychological distress (t=3.183; p<0.003), from hospitalization to 6 weeks post-percutaneous coronary intervention. Data demonstrate psychological distress and reduced capacity for direct attention during hospitalization indicating that hospital environments are suboptimal for learning.

Angioplasty, Balloon, Coronary↗

PubMed2001

Pseudomyasthenia resulting from a posterior carotid artery wall aneurysm: a novel presentation: case report.

OBJECTIVE AND IMPORTANCE: Painful oculomotor palsy can result from enlargement or rupture of intracranial aneurysms. The IIIrd cranial nerve dysfunction in this setting, whether partial or complete, is usually fixed or progressive and is sometimes reversible with surgery. We report an unusual oculomotor manifestation of a posterior carotid artery wall aneurysm, which mimicked ocular myasthenia gravis. CLINICAL PRESENTATION: A 47-year-old woman developed painless, intermittent, partial IIIrd cranial nerve palsy. She presented with isolated episodic left-sided ptosis, which initially suggested a metabolic or neuromuscular disorder. However, digital subtraction angiography revealed a left posterior carotid artery wall aneurysm, just proximal to the origin of the posterior communicating artery. INTERVENTION: The aneurysm was successfully clipped via a pterional craniotomy. During surgery, the aneurysm was observed to be compressing the oculomotor nerve. The patient's symptoms resolved after the operation. CONCLUSION: The variability of incomplete IIIrd cranial nerve deficits can present a diagnostic challenge, and the approach for patients with isolated IIIrd cranial nerve palsies remains controversial. Although intracranial aneurysms compressing the oculomotor nerve classically produce fixed or progressive IIIrd cranial nerve palsies with pupillary involvement, anatomic variations may result in atypical presentations. With the exception of patients who present with pupil-sparing but otherwise complete IIIrd cranial nerve palsy, clinicians should always consider an intracranial aneurysm when confronted with even subtle dysfunction of the oculomotor nerve.

Angiography, Digital Subtraction↗