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[Endoscopic 3-D imaging--measuring biological surfaces].

The precise endoscopical measurement of topometrical structures of organs will overcome limitations in present minimal invasive surgery and lead to new operation techniques. This paper describes a research project concerning an endoscopical 3D-measurement system based on optical techniques. We will introduce prototype endoscopes for minimal invasive 3D-measurements and the applied photogrammetrical algorithms for acquiring the topometrical structures. The influence of major organ surface properties on the measurement will be discussed and first results will be presented.

Endoscopes↗

[The choice of the treatment procedure in complicated forms of gallstones].

The article is devoted to an assessment of results of treatment of patients with complicated forms of cholelithiasis. Results of the treatment with active surgical measures and use of the endoscopic surgery methods are compared. Advantages of using endoscopy in algorithm of diagnostic and medical measures are shown. Recommendations are given concerning the terms and consequence of using the endoscopic methods of treatment.

Acute Disease↗

Vessel motion measurement in real-time using movement detection at multiple regions of interest.

A vessel motion detection algorithm has been implemented for the measurement of multiple lymphatic chamber diameters via pre-recorded VHS tape (PAL, 25 Hz). The method differs significantly from previous attempts based on edge-detection, in that it employs center of mass of pixel brightness in the vessel wall based on a Kalman filtered image subtracted from a Kalman filtered background. The operation of the algorithm confirms that it is able to detect accurately the full constriction-relaxation cycle of the vessel and produce data that meets high standards of tolerance. The procedure is well suited for real-time measurement of lymphatic and blood vessel constrictions in vitro or in vivo at multiple sites so long as the object under measurement is sufficiently differentiated from its background.

Algorithms↗

Making the most of a patient's laboratory data: optimisation of signal-to-noise ratio.

All results in laboratory medicine are compared to some reference for interpretation. This reference may be a previous result from the same patient, a reference population--either healthy or diseased, or both--or a decision limit recommended by an expert group. The aim for the medical laboratory is to improve the signal-to-noise ratio by increasing the signal or reducing the noise. This presentation deals with the more general tools for reduction of the noise component, and focuses on biological within-subject variation, reference intervals and decision models. Regarding biological within-subject variation, the estimation of reference change value (RCV) as a yardstick for judging measured differences within the patient over time is an important tool. Here, only type 1 errors are usually applied, but type 2 errors should also be taken into consideration. Moreover, variance homogeneity is assumed for the application of RCV, but this assumption is not always fulfilled, and erroneous interpretations may be introduced. A tool for comparison of different and more complicated algorithms applied to serial measurements is computer simulation (e.g. on data from tumour markers). In order to reduce the noise component from reference intervals, partitioning according to relevant subgroups is a tool, and useful criteria for judging whether subgroups should be combined are reported. Geographical and racial differences may cause different reference distributions (e.g. plasma proteins), but it has been possible to establish common reference intervals for 25 common components in Caucasians in the five Nordic countries. Transformation of data and presentation of accumulated ranked values in rankit plots where Gaussian (or log-Gaussian) distributions show up as straight lines is a valuable tool for interpretation of the distributions and comparison of subgroups. In this way it is often possible to isolate a low-risk group which fits a log-Gaussian distribution. In case of thyroid autoantibodies the distributions look biphasic, even after all possible rule-out criteria have been exhausted, but a composite model makes it possible to extract a reference population from the mixture. The classical decision model is bimodal, reflecting an assumption of two independent but overlapping distributions, with a clear but unknown prevalence for the disease. When a decision limit (cut-off point) is applied, the percentages of false positive and false negative results will be determined, but the underlying prevalence is unchanged. In contrast to this, the unimodal distributions cover a continuum of probabilities for a certain disease (risk) and the decision limit is arbitrarily chosen. Thus, the disease or risk is defined by the measured component. Consequently, the decision limit directly defines the prevalence, and this limit can be different over time and geography as has been the case for cholesterol or glucose.

Journal Article↗

Volume of mastoid pneumatization: three-dimensional reconstruction with ultrahigh-resolution computed tomography.

The volume of the mastoid air cell system was measured in 69 patients with normal middle ears. All patients underwent axial ultrahigh-resolution computed tomography. Mastoid pneumatization was marked on each axial slice, and 3-dimensional reconstruction was performed. The volumes were measured with a volumetric algorithm. A polyethylene tubing phantom with a density similar to that of bone on computed tomography was devised. The polyethylene tubing was tied in a particular fashion so as to create interconnecting air spaces with a known volume. The phantom was scanned with the imaging parameters used for scanning the temporal bone. The air in the tubing was marked, and 3-dimensional reconstruction for the marked phantom air was performed. The volume of the interconnecting air spaces was measured and found to be identical to its known volume, thereby verifying the accuracy of the method used. The mean mastoid volume was 6.61 cm3. The smallest volume measured was 1.3 cm3, and the largest was 12.7 cm3. The importance of this technique lies in its high accuracy, ease of use, and ability to directly correlate mastoid size and clinical findings.

Adult↗

Automated, high-resolution micropipet aspiration reveals new insight into the physical properties of fluid membranes.

We describe recent advances in our experimental approach to examine the physical properties of biological and artificial membranes by automated micropipet aspiration. New instrumentation allows us to apply fast yet precise tension protocols to membranes while continuously recording the membrane deformation with high-speed videomicroscopy. Robust algorithms for subpixel geometric measurements track the displacements of membrane edges with resolution of a few nanometers and enable us to determine changes of the membrane area and enclosed volume of pipet-aspirated cells or vesicles with exceptional accuracy. Experimentation and data analysis are greatly facilitated by custom-written software whose basic design is described here as well. Example measurements demonstrate how this technique has significantly improved the amount and reliability of data obtained by various types of micropipet-aspiration experiments, allowing us to study interesting aspects of membrane behavior that have eluded earlier techniques.

Algorithms↗

A method for automatically interpreting mass spectra of 18O-labeled isotopic clusters.

16O/18O labeling is one differential proteomics technology among many that promises diagnostic and prognostic biomarkers of disease. Although the incorporation of 18O in the C-terminal carboxyl group during endoproteinase digestion in the presence of H2 18O makes the process of labeling facile, the ease and effectiveness of label incorporation have in some regards been outweighed by the difficulties in interpreting the resulting spectra. Complex isotope patterns result from the composition of unlabeled (18O(0)), singly labeled (18O(1)), and doubly labeled species (18O(2)) as well as contributions from the naturally occurring isotopes (e.g. 13C and 15N). Moreover because labeling is enzymatic, the number of 18O atoms incorporated can vary from peptide to peptide. Finally it is difficult to distinguish highly up-regulated from highly down-regulated or C-terminal peptides. We have developed an algorithm entitled regression analysis applied to mass spectrometry (RAAMS) that automatically, rapidly, and confidently interprets spectra of 18O-labeled peptides without requiring chemical composition information derived from product ion spectra. The algorithm is able to measure the effective 18O incorporation rate due to variable enzyme substrate specificity of the pseudosubstrate during the isotope exchange reaction and corrects for the 18O(0) abundance that remains in the labeled sample when using a two-step digestion/labeling procedure. We have also incorporated a method for distinguishing pure 18O(0) from pure 18O(2) peptides utilizing impure H2 18O. The algorithm operates on centroided peak lists and is therefore very fast: nine chromatograms of, on average, 1,168 spectra and containing, on average, 6,761 isotopic clusters were interpreted in, on average, 45 s per chromatogram. RAAMS is fast enough (average, 38 ms/spectrum) to allow the possibility of performing information-dependent MS/MS on a chromatographic time scale on species exceeding predetermined ratio thresholds. We describe in detail the operation of the algorithm and demonstrate its use on datasets with known and unknown ratios.

Algorithms↗

Comparison of SWAN and WISE menopausal status classification algorithms.

BACKGROUND: Classification of menopausal status is important for epidemiological and clinical studies as well as for clinicians treating midlife women. Most epidemiological studies, including the Study of Women's Health Across the Nation (SWAN), classify women based on self-reported bleeding history. METHODS: The Women's Ischemia Syndrome Evaluation (WISE) study developed an algorithm using menstrual and reproductive history and serum hormone levels to reproduce the menopausal status classifications assigned by the WISE hormone committee. We applied that algorithm to women participating in SWAN and examined characteristics of women with concordant and discordant SWAN and WISE classifications. RESULTS: Of the 3215 SWAN women with complete information at baseline (1995-1997), 2466 (76.7%) received concordant classifications (kappa = 0.52); at the fifth annual follow-up visit, of the 1623 women with complete information, 1154 (72.7%) received concordant classifications (kappa = 0.57). At each time point, we identified subgroups of women with discordant SWAN and WISE classifications. These subgroups, ordered by chronological age, showed increasing trends for menopausal symptoms and follicle-stimulating hormone (FSH) and a decreasing trend for estrogen (p < 0.001). CONCLUSIONS: The WISE algorithm is a useful tool for studies that have access to blood samples for hormone data unrelated to menstrual cycle phase, with or without an intact uterus, and no resources for adjudication. Future studies may want to combine aspects of the SWAN and WISE algorithms by adding hormonal measures to the series of bleeding questions in order to determine more precisely where women are in the perimenopausal continuum.

Adult↗

Mammographic x-ray spectra measured by Compton spectroscopy using a high resolution Schottky CdTe detector.

Analysis of x-ray spectra is important for quality assurance (QA) and quality control (QC) of radiographic systems. This is especially true for mammographic x-ray imaging systems which require low-contrast detectability. Under clinical conditions, the measurement of diagnostic x-ray spectra is difficult because of pulse pile-up due to the high fluence rate of incident x-ray photons. However, it is difficult to set a long source-to-detector distance to reduce the number of photons detected per unit time for mammographic x-ray units. Compton spectroscopy is a suitable tool to deal with this problem. Detection of 90-degrees scattered photons only, energy correction and reconstruction are easy using the Klein-Nishina formula. However, x-ray spectra measured by this method have lower energy resolution, because of the geometrical irradiation angle or electron movement in the scatterer. Moreover, spectra measured with a compound semiconductor detector, such as a high resolution Schottky CdTe detector like we used, are distorted by the detector response, which is based on detecting x-ray photon interactions and charge carrier trapping in the semiconductor crystal. While the distortion of spectra caused by the response can be easily corrected by applying a stripping procedure, it is very difficult to reconstruct the broad spectra measured by Compton spectroscopy as sharp spectra such as obtained when directly measured. Some complicated reconstruction algorithms have been reported to fit the shape of spectra obtained by the Compton spectroscopy to sharp standard spectra. However, for QA / QC of the radiographic system, it is not necessary to correct the spectra sharply if the spectral broadening is at a tolerable level and the properties of the broad spectra acquired by the Compton spectroscopy agree with those of the sharp spectra measured directly; i.e. evaluations are necessary only for estimation of spectral shape. In this paper, we compared attenuation curves calculated using Hubbell's attenuation coefficients to estimate the coincidence or difference of spectra measured by the Compton spectroscopy and directly measured in the primary beam. Our results showed that the attenuation curves acquired from the reconstructed spectra measured by the Compton spectroscopy agreed with that acquired from corrected spectra that were directly measured. Moreover, the attenuation curves acquired from the spectra actually measured by adding aluminum attenuators agreed with theoretically calculated curves.

Mammography↗

Evaluation of achievable registration accuracy of the femur during minimally invasive total hip replacement.

The aim of the paper was to investigate whether accurate, point-based registration of the intra-operative femur will be achieved within the context of minimally invasive surgery for total hip replacement. Computer tomography images, collected for pre-operative planning purposes, were used to simulate the intra-operative registration procedure using algorithms for various levels of measurement noise, different small areas of the femur available to the surgeon, and a limited number of collected data points (20-60). This helped with the choice of design variables to perform in vitro registration on a plastic bone model to validate the procedure, which included a multistart algorithm developed for intra-operative registration. The algorithm minimised the distance between the measured and image-derived surfaces and was able to cope with the presence of multiple local minima given sufficient computational effort, even with realistically large measurement noise. It was found that, if a small patch of the femur was used, accessible by a needle that could at times penetrate thin layers of soft tissue, errors in the order of 1.0 mm in translation and 0.5 degrees in rotation were achievable.

Algorithms↗

Quantification of diabetic maculopathy by digital imaging of the fundus.

Measurement of the extent of diabetic retinopathy is an essential part of assessing the efficacy of local or systemic treatment regimens. Current clinical studies use empirical grading of retinopathy which is performed by a trained observer using standard photographs. This method is relatively arbitrary, as well as time consuming and vulnerable to observer error. We have developed a digital fundus imaging system and image processing programs which provide objective, quantitative measures of macular oedema, retinal exudates, and microaneurysms in diabetic retinopathy. Using fluorescein angiograms, the degree of macular oedema is quantified both in terms of area of fundus involved and severity of oedema by analysis of the temporal changes in intensity of fluorescence. Fluorescein angiograms are also used for the detection and counting of microaneurysms, by a combination of shade correction, matched filtering, and shape algorithms. For detection and measurement of retinal exudates, a colour transparency projected through a red free filter is analysed using a combination of shade correction and thresholding techniques. The system described is in clinical use, and has potential for a wide variety of applications. With further development, digital analysis of fundus images should supercede the currently used manual semi-quantitative methods, providing faster, more accurate, objective quantitative results.

Aneurysm↗

Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population.

Large vessel peripheral arterial disease (LV-PAD) is a common condition that causes significant morbidity and disability. The authors evaluated the individual components of a comprehensive noninvasive vascular examination to identify the most sensitive and specific measurements for diagnosing LV-PAD. This cohort, initially screened between 1979 and 1981 in Rancho Bernardo, California, included 421 normal subjects and 63 subjects with LV-PAD. Segmental blood pressure ratios and flow velocities by Doppler ultrasound were used to define cases of LV-PAD. The sensitivity, specificity, positive predictive value, and negative predictive value of each individual component of the diagnostic algorithm were determined. Overall, measurements of posterior tibial flow showed the highest sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. In addition, an absent or non-recordable posterior tibial peak forward flow, occurring in 96% of all limbs with isolated posterior tibial disease, or an ankle ratio < or = 0.8 considered in parallel yielded a test with sensitivity of 89%, specificity of 99%, positive predictive value of 90%, negative predictive value of 99%, and overall accuracy of 98%. These results indicate that the vast majority of LV-PAD cases can be detected with a single measurement using a handheld Doppler flowmeter employed at the ankle.

Adult↗

Recursive direct phasing with reference-beam diffraction.

The reference-beam diffraction technique provides a practical way to measure a large number of triplet phases in a standard oscillating-crystal diffraction experiment for protein crystals. The triplet-phase data set from such reference-beam measurements contains a unique phase-occurrence pattern that leads to a new recursive phasing algorithm for the individual structure-factor phases. Application of the new algorithm is demonstrated for tetragonal lysozyme using 7360 triplet phases measured in a reference-beam experiment with a median phase discrepancy of 45 degrees. An electron-density map obtained using this phasing algorithm and the measured triplet phases shows good agreement with the known protein structure.

Algorithms↗

Experimental verification of cesium brachytherapy line source emission using a semiconductor detector.

Described is an experimental verification technique for cesium brachytherapy line source emission. The dose rate levels produced by a line source algorithm are compared with measurements taken around J-series stainless-steel sheathed cesium sources with a p-type semiconductor diode detector. Further study of isodensity contours is undertaken using a film dosimetry technique. The errors involved in using these techniques are assessed.

Algorithms↗

Monitoring odorous sulfur emissions using self-organizing maps for handling ion mobility spectrometry data.

Possibilities for monitoring emissions of reduced sulfur compounds in pulp and paper mills were investigated using ion mobility spectrometry (IMS) and a self-organizing map (SOM) algorithm. The reduced sulfur compounds measured were hydrogen sulfide (H2S), dimethyl sulfide (DMS), and methyl mercaptan (MM). Attention was paid to momentary concentrations because there is no monitoring device able to measure peak concentrations of reduced sulfur compounds under field conditions. These methods were evaluated by measuring the reduced sulfur compounds first in the laboratory and then at a process monitoring site at a pulp factory. The aim was to find out whether it would be possible to use the laboratory measurements to recognize the same reduced sulfur compounds at the monitoring site. Data collection was followed by analysis using the SOM algorithm and Sammon's mapping. The results showed that the IMS spectra of reduced sulfur compounds and their mixtures can be distinguished from each other by computationally intelligent methods and that the spectra from the process monitoring site corresponded with the laboratory measurements to a certain extent.

Air Pollutants↗

Automated estimation of initial and terminal contact timing using accelerometers; development and validation in transtibial amputees and controls.

The aim of this study was to develop and validate an automated accelerometry-based system for estimating initial contact (IC) and terminal contact (TC) timing information from walking patterns of healthy control subjects and transtibial amputees that can be used in daily life with minimal interference of researchers. Subjects were instrumented with two uniaxial accelerometers just below the knee while synchronized ground reaction force (GRF) recordings were used as reference measurements. An automated multiphase algorithm was developed to estimate the time of IC and TC in the acceleration signals of five healthy subjects and two transtibial amputees walking at different walking speeds. The accuracy of the detection algorithm in ten control subjects and eight transtibial amputees indicated mean errors ranging between 0.013 and 0.034 s for the TC and IC timing, with 95 % confidence interval of the individual step errors ranging between -0.062 and 0.115 s. Correlation coefficients between the estimated stance phase duration and GRF data were 0.98 and 0.97 for controls and amputees, respectively. We concluded that IC and TC can be accurately and easily measured using this system in both healthy subjects and transtibial amputees walking at different walking speeds. The system can be used in clinical situations or gait labs as well as during daily life.

Acceleration↗

Automated measurement of bulbar redness.

PURPOSE: To examine the relationship between physical image characteristics and the clinical grading of images of conjunctival redness and to develop an accurate and efficient predictor of clinical redness from the measurements of these images. METHODS: Seventy-two clinicians graded the appearance of 30 images of redness on a 100-point sliding scale with three referent images (at 25, 50, and 75 points) through a World Wide Web-based survey. Using software developed in a commercial computer program, each image was quantified in two ways: by the presence of blood vessel edges, based on the Canny edge-detection algorithm, and by a measure of overall redness, quantified by the relative magnitude of the redness component of each red-green-blue (RGB) pixel. Linear and nonlinear regressors and a Bayesian estimator were used to optimally combine the image characteristics to predict the clinical grades. RESULTS: The clinical judgments of the redness images were highly variable: The average grade range for each image was approximately 55 points, more than half the extent of the entire scale. The median clinical grade was chosen as the most reliable measure of "truth." The median grade was predicted by a weighted linear combination of the edgeness and redness features of each image. The strength of the predicted association was r = 0.976, exceeding the strength of association of all but one of the 72 individual clinicians. CONCLUSIONS: Clinical grading of redness images is highly variable. Despite this human variability, easily implemented image-analysis and statistical procedures were able to reliably predict median clinical grades of conjunctival redness.

Conjunctival Diseases↗

Shape calibration of a conformal ultrasound therapy array.

A conformal ultrasound phased array prototype with 96 elements was recently calibrated for electronic steering and focusing in a water tank. The procedure for calibrating the shape of this 2D therapy array consists of two steps. First, a least squares triangulation algorithm determines the element coordinates from a 21 x 21 grid of time delays. The triangulation algorithm also requires temperature measurements to compensate for variations in the speed of sound. Second, a Rayleigh-Sommerfeld formulation of the acoustic radiation integral is aligned to a second grid of measured pressure amplitudes in a least squares sense. This shape calibration procedure, which is applicable to a wide variety of ultrasound phased arrays, was tested on a square array panel consisting of 7- x 7-mm elements operating at 617 kHz. The simulated fields generated by an array of 96 equivalent elements are consistent with the measured data, even in the fine structure away from the primary focus and sidelobes. These two calibration steps are sufficient for the simulation model to predict successfully the pressure field generated by this conformal ultrasound phased array prototype.

Acoustics↗