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This is a two-phase study. The first phase assesses the use of portable 2D echocardiography for diagnostic studies in remote areas. The second phase examines the diagnostic capabilities of 2D "only" versus 2D echocardiography combined with M-mode.
A portable small-sized ID-01M X-ray dosimeter made by the Spektr Moscow Research Production Association to control general-purpose and special X-ray diagnostic units is described. Two plane-parallel ionization chambers are used as radiation detectors. The technical data of the dosimeter are presented.
OBJECTIVE: We sought to evaluate the diagnostic performance of a portable indirect flat-panel detector for low-dose imaging as compared with an asymmetric film-screen system in a pediatric intensive care unit. MATERIALS AND METHODS: A total of 120 neonates underwent chest radiographs using a portable flat-panel detector (digital speed 800) and an asymmetric film-screen system (400 speed). Four readers evaluated the detection of 11 anatomic and 5 pathologic landmarks and 4 support devices. Statistical analysis was performed using repeated analysis of variance. The level of statistical significance was P = 0.05. RESULTS: The detection of 4 anatomic/4 pathologic landmarks and 2 support devices was significantly better using the flat-panel detector as compared with the asymmetric film-screen system (P < 0.05). Another 8 anatomic and one pathologic landmarks were detected equally well or slightly better with the flat-panel detector (P > 0.05). CONCLUSIONS: The portable flat-panel detector offers the potential of a 50% dose reduction with equal or significantly better detection of clinically important structures.
A compact, rugged and portable fiber-optic evanescent-field laser sensor is developed for the detection of gaseous species in harsh environments such as volcano fumaroles or industrial combustion of glass furnaces. The sensor consists of an optical multi-mode fused silica fiber with jacket and cladding removed and the bare fiber core in direct contact with the surrounding molecules. The beam of a single-mode DFB diode laser with an emission wavelength centered at 1.5705 microm is coupled into the fiber. At the other end of the fiber an infrared detector is used to record the transmitted infrared laser light intensity. Due to the frustrated total reflection (FTR) and the attenuated total reflection (ATR) the laser intensity is attenuated when passing through the fiber. The FTR is related to a change of the index of refraction while the latter one is related to a change of the absorption coefficient. While tuning the DFB laser wavelength across absorption lines of molecules surrounding the fiber a spectral intensity profile is measured. Voigt functions are fitted to the recorded intensity profiles to estimate relative molecule concentrations. In this paper results from first field measurements at the volcano site 'Solfatara' in Italy are reported that use such a sensor device for simultaneous detection of H2S, CO2 and H2O directly in the gas stream of a volcano fumarole.
The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology.
Saliva and other types of oral samples can readily be used for noninvasive diagnosis of diseases of the oral cavity and systemic diseases. Following an introduction outlining the types of oral samples and the analytes that can be measured in these samples, a detailed description of a novel oral-based diagnostic system to detect multiple bacterial and/or viral pathogens is presented. A reasonably priced, portable, point-of-care diagnostic system should be available within five years.
The fiberoptic biosensor with tapered optical probes has been developed to perform rapid and sensitive fluoroimmunoassays. A number of assays for biologic analytes were developed using a laboratory breadboard device that employed a large, 514 nm argon ion laser. These assays, with limits of detection of 5-50 ng/ml for protein antigens, showed promise for clinical use because of their demonstrated lack of matrix effects from plasma, seru, or blood. However, such a large device was impractical for on-site diagnostics, so a new, portable, multichannel biosensor was developed. To test this new biosensor, which uses 635 nm laser diodes, the assays were converted to use the cyanine dye, Cy5. The detection antibodies were labeled with Cy5 and assays performed to detect the F1 antigen of Yersinia pestis and the protective antigen of Bacillus anthracis. The limit of detection was found to improve by a factor of 10 for each assay. The portable biosensor was then evaluated in a blind test containing F1 antigen spiked into 30 of 173 serum samples. One hundred percent detection was achieved for samples with 100 ng/ml or more F1 antigen, with a specificity of 88%.
OBJECTIVE: Our aim was to determine portable abdominal CT image quality and clinical content in a consecutive series of scans obtained in ICUs at a single center. MATERIALS AND METHODS: All helical portable abdominal CT scans obtained between June 1999 and December 2000 were reviewed by two observers. Image quality was assessed for feature detection and overall quality compared with the patients' contemporaneous stationary CT scans. Hospital records were used to determine patient demographics, scanning indications, and clinical impact and to verify portable CT findings when possible. RESULTS: One hundred twenty-two helical portable CT scans (47 contrast-enhanced) and 41 contemporaneous stationary CT scans in 107 patients were included. IV contrast material improved portable CT scan quality, but quality scores for portable CT scans were consistently lower than those for stationary CT scans, both with and without contrast material. Thirty-three conditions suspected before scanning were supported by findings on portable CT scans, which detected evidence of infection in 18 and hemorrhage in 16 cases and motivated seven laparotomies and six percutaneous drainage procedures. Thirty-three portable CT scans (27%) contributed to a change in patient treatment. Results of surgery or autopsy confirmed portable CT findings in 12 of 17 cases. CONCLUSION: Although image quality is inferior to conventional stationary CT, portable abdominal CT provides important diagnostic information without requiring patient transport outside the ICU. Radiologists should avoid overconfident interpretation of portable CT scans.
Echocardiography is an essential tool in the evaluation of patients with cardiac emergencies and chest trauma. The objective of our study was to establish the feasibility and diagnostic accuracy of a portable satellite transmission system in the assessment of cardiac emergencies for the real-time support of mass casualty and humanitarian relief efforts. Twelve patients with various degrees of cardiac structural disease identified by conventional inhospital transthoracic echocardiography were transported to a remote portable field hospital where transthoracic echocardiography was performed with a handheld echocardiographic device. Images were then relayed by a commercial satellite to a level III trauma center where they were interpreted in real time by a cardiologist. Remote studies were recorded at the field hospital before satellite transmission and again on download at the receiving facility. The remotely acquired studies before and after satellite transmission were compared with each other and subsequently compared with conventional hospital transthoracic echocardiograms for technical quality and diagnostic accuracy using a blinded, single-reader, side-by-side comparison. Excellent agreement was found between the recorded field-site and satellite-transmitted images with an overall average of 95% concordance. When the field data acquired with the handheld device and satellite transmission were compared with conventional inhospital echocardiography, a high degree of agreement was demonstrated in overall technical quality (83%) and assessments of left ventricular ejection fraction (100%), pericardial effusion (100%), and left ventricular size (92%). This study demonstrates the feasibility and diagnostic accuracy of remote, real-time echocardiography using satellite transmission for mass casualty triage or humanitarian relief efforts.
AIMS: To evaluate the diagnostic performance of a portable semi-quantitative whole blood immunoassay measuring soluble human fatty acid-binding protein [H-FABP] (CardioDetect) for the pre-hospital detection of myocardial infarction (MI). METHODS AND RESULTS: We enrolled prospectively 108 consecutive patients with acute ischemic type chest pain in whom the first medical care was delivered by a mobile intensive care unit (MICU). CTnI, myoglobin, CK-MB and CardioDetect were first assessed in the MICU before hospital admission using point-of-care assays and then cTnI was serially measured during the hospital stay. MI was defined as a positive cTnI in any sample over the first 24 h. The vast majority of the patients (77/108) were admitted <3 h of symptoms onset. Pre-hospital cTnI sample was normal in 96 patients (88.9%) of whom 43 had subsequent cTnI elevation. A positive H-FABP using the CardioDetect assay had a significantly better sensitivity than cTnI, myoglobin and CK-MB (87.3% vs 21.8%, 64.2% and 41.5%, respectively) to identify MI. The significant better sensitivity of the CardioDetect assay was also observed among patients who presented <3 h of symptom onset. The specificity of the CardioDetect assay was significantly better than that of myoglobin, irrespective of the time delay from symptom onset to measurement. In patients with normal pre-hospital cTnI and no ST-elevation (n=63), assessment based only on a positive H-FABP had 83.3% sensitivity, 93.3% specificity for the diagnosis of an evolving MI. CONCLUSION: Early assessment of H-FABP in patients presenting with chest pain improves the diagnosis of ongoing MI.
The international literature concerned with major depression prevalence has been growing rapidly, providing a wealth of new information about prevalence in different countries. In understanding and using these rates, analytically oriented epidemiologists, decision makers, and administrators, however, need to be aware of a set of interpretive difficulties. Experience suggests that international major depression prevalence comparisons should be treated with caution. The portability of major depression diagnostic criteria across countries requires further confirmation, and existing diagnostic interviews have technical vulnerabilities that may render international comparisons vulnerable to measurement bias.
In the majority of patients admitted to an Intensive Care Unit with acute respiratory failure (ARF), the aetiology for ARF is quite evident. In a minority of patients no obvious aetiology is apparent at presentation. In this group a previously unrecognized sleep-related breathing disorder (SRBD) may be the cause of the ARF. In spite of clinical suspicion SRBD remains infrequently diagnosed in ARF also because the technology necessary for this type of diagnosis (polysomnography) is usually unavailable in Intensive Care Units. The aim of this study was to evaluate the utility of portable polysomnography system (PSGp) in a group of patients with ARF of unclear aetiology and with a clinical suspicion of SRBD. We studied a selected group of 14 patients (eight males, six females) admitted to an Intermediate Intensive care unit with varying degree of acute respiratory failure. Mean (SD) age was 57 (13) years, pH 7.28 (0.04), PaO2 5.6 (0.7) kPa), PaO2 (8.8 (1.6) kPa), Body mass index 42.7 (9.6) kg m(-2). The patients had no history of skeletal, neuromuscular or cardiovascular disease. None of them had a history of overt chronic lung diseases or had obvious respiratory tract infections. They were submitted to cardiac and respiratory functional evaluation and to nightly PSGp (VITALOG HMS 5000, Respironics Inc., Redwood City, CA, U.S.A.) which was performed in an intermediate intensive care unit. Ten subjects had obstructive sleep apnoea-hypopnoea syndrome (OSAS), with mean respiratory disorder index h(-1) (RDI) 60.1 (25.9) [in five associated with obesity-hypoventilation syndrome (OHS)]; two had central sleep apnoea with mean RDI 45 (28.3) (one with hypothyroidism and one with cerebral multiple infarctions and right hemidiaphragmatic paralysis) and two had OHS with mean RDI 12.5 (3.5). Nocturnal hypoventilation was present in almost all patients. Continuous positive airway pressure (CPAP) was effective in three patients. Eight patients needed to be treated with BILEVEL (BiPAP, Respironics Inc.) airway positive pressure in timed or spontaneous/timed modes. Two patients required intubation and mechanical ventilatory treatment. In one patient with hypothyroidism was sufficient to institute hormonal therapy. Our study shows that acute respiratory failure due to SRBD is not exceptional in an Intermediate Intensive Care Unit and that if clinical suspicion is strong, portable polysomnography may yield diagnostic confirmation and help in establishing appropriate treatment and in avoiding the invasive ventilatory treatment.
The role of CT scanning in the diagnosis and management of craniomaxillofacial injuries is well documented. However, coexistent injuries, limitations on patient positioning, CT availability, or financial constraints may prevent or delay the diagnosis of significant orbital wall defects. Real-time ultrasound represents a safe, inexpensive, noninvasive, portable, and readily available diagnostic modality which has had a limited application in the diagnosis of orbital pathology. The objectives of this study were to define the role of orbital ultrasound in the assessment of the traumatized orbit and to provide correlation of pathology with CT imaging. Eighteen patients (16 males, 2 females) having sustained trauma to the orbitozygomatic region were assessed at a regional trauma center over a 6-month period. Each patient underwent an ultrasound examination of both orbits. Confirmatory CT scans (5-mm axial and 1.5-mm coronal orbital cuts) were then obtained for comparative assessment. Patients with open globe injuries, alteration of visual acuity, or life-threatening conditions were excluded from the study. The results of the study revealed a positive correlation between the ultrasound and CT findings in 17 (94 percent) of the patients. Ultrasound demonstrated satisfactory sensitivity (92 percent) and specificity (100 percent) and positive predictive value (100 percent) when compared with CT scanning. Soft-tissue herniation, orbital emphysema, and muscle entrapment were well visualized by means of real-time ultrasound. It is concluded that orbital ultrasound is an accurate diagnostic modality in the investigation of orbital trauma and correlates well with CT findings. A cost analysis will be presented, and details of the limitations and efficacy of orbital ultrasound will be discussed.
Although local area networks (LANs) are commonplace in hospital-based radiology departments today, wireless LANs are still relatively unknown and untried. A linked wireless reporting system was developed to improve work throughput and efficiency. It allows radiologists, physicians, and technologists to review current radiology reports and images and instantly compare them with reports and images from previous examinations. This reporting system also facilitates creation of teaching files quickly, easily, and accurately. It consists of a Digital Imaging and Communications in Medicine 3.0-based picture archiving and communication system (PACS), a diagnostic report server, and portable laptop computers. The PACS interfaces with magnetic resonance imagers, computed tomographic scanners, and computed radiography equipment. The same kind of functionality is achievable with a wireless LAN as with a wired LAN, with comparable bandwidth but with less cabling infrastructure required. This wireless system is presently incorporated into the operations of the emergency and radiology departments, with future plans calling for applications in operating rooms, outpatient departments, all hospital wards, and intensive care units. No major problems have been encountered with the system, which is in constant use and appears to be quite successful.
The aim of this study was to evaluate the accuracy of the portable coagulometer CoaguChek (Roche Diagnostics) as a prothrombin time (PT) monitor, and to correlate capillary blood results with those of three different routine methods used for monitoring oral anticoagulant therapy (OAT): capillary, plasma and whole blood samples. Three hospitals participated in the study with a total of 235 patients on OAT. The international normalized ratio (INR) results obtained with CoaguChek were compared with those obtained using each of the routine methods. The study presents a good correlation between the PT monitor and the three methods studied: r = 0.9745 (hospital A), r = 0.9283 (hospital B), r = 0.9136 (hospital C). A simplified concordance test of the methods results in a nine-field comparison table showing concordances of 87.2, 85.7 and 68.4%, respectively. The absolute difference (mean +/- SD) between laboratory A and CoaguChek INRs was 0.0571 +/- 0.2042, with values of 0.04286 +/- 0.3906 for laboratory B and 0.6986 +/- 0.6170 for laboratory C. These results confirm that CoaguChek could be used as a new method for oral anticoagulant monitoring, and is in best agreement with the capillary blood PT system.
Using data collected by Project Renewal's mobile medical services to homeless people in New York City, this paper discusses a tension between an emergency medicine model of outreach and that of primary care. In the former model, clinicians evaluate clients on the basis of presenting complaints and refer them, as necessary, for specialized treatment. The latter is a broader model of comprehensive outreach and/or treatment, where clinicians screen clients and assess them for various conditions offering ongoing evaluation and treatment on site. The model of outreach is applicable for some homeless clients, but the prevalence and overlap of physical complaints, infectious diseases, substance abuse, and psychiatric symptoms among homeless people in New York City has resulted in an evolution toward broader approaches to outreach in this population. Improvements in diagnostic testing and increasingly portable medical technology may make the mobile delivery of medical care to homeless persons increasingly feasible.
The vestibulo-ocular reflex (VOR) is most active at higher frequencies (> 2 Hz) during locomotion, in order to stabilize vision. Use of active head movements, monitored by a sensor on a head strap, is a new method of testing the horizontal and vertical VORs which utilizes this natural frequency range, and doesn't require a rotating chair. Specialized computer processing based on Fourier analysis is necessary to analyze head and eye signals, which can be erratic. Higher harmonics of these erratic movements are particularly useful for VOR testing, in the analogous sense that complex sound processing is necessary for speech processing in audition. Use of portable computers with VOR active head analysis can be done at the bedside, as a portable vestibular test. Sophisticated software can effectively substitute for rotating chair hardware, provided that physiological corrections are applied to actively-generated movements at higher frequencies. In summary, the resulting test is brief, comfortable to the patient, portable, and useful for diagnostic screening over the frequency range that is most active during common daily movements.
To extend the potentialities of sialography, we used roentgenography with direct multiple amplification of the image by Reis microfocal portable x-ray diagnostic device and analyzed this image by analog UAR-1 computer operating in a high-frequency harmonization mode. The basic feature of such roentgenography is spatial stratification of the object shadow simultaneously forming its spatial image. High-frequency harmonization of an x-ray image essentially improved its contrast, this permitting detection of small formations poorly shown on sialogram, the contours of these formations and relationships between them. A total of 85 patients were examined using this method. Analysis of the resultant sialograms showed that using this method it is possible to assess the status of small structures of the gland, detect the changes in the pharyngeal process of the parotid gland. Sialogram direct projection is no longer needed.