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An algorithm for the interpretation of cardiopulmonary exercise tests.

We have developed and are using an algorithm for the interpretation of cardiopulmonary exercise tests that are performed in our Pulmonary Diagnostic Service Department. As its decision points, this algorithm uses routinely obtained measurements from the results of these exercise tests, such as VO2, VCO2, VE, SaO2, HR, and AT. Using the algorithm results in an objective determination of limitation to exercise and allows for the differentiation between pulmonary and cardiac or circulatory limitation. This straightforward technique for arriving at an interpretation of these tests has resulted in a more consistent approach to interpretation and an excellent teaching guide for physicians and technicians.

Algorithms

In vivo evaluation of a noninvasive method to measure the retinal thickness in primates.

To diagnose certain macular diseases earlier and monitor their therapy more sensitively, we are developing a noninvasive method to measure the retinal thickness. The new instrument, which is an extension of slit-lamp biomicroscopy, was used to obtain the data, which were analyzed with an algorithm to yield thickness measurements. The measurements performed in monkeys indicated that the retinal thickness can be visualized in a region extending from the optic disc to the fovea and that quantitative results can be obtained. The retinal thickness reproducibility was 6% for the same location on the same day, 15% for the same location on different days, and 12% for the same location in different eyes. The average retinal thickness in these areas was 335 microns, indicating that the reproducibility was between 20 and 50 microns. Measurements across the foveola illustrated that retinal thicknesses as low as 80 microns could be obtained.

Animals

Morphological measurement of the SEP using a dynamic time warping algorithm.

A dynamic time warping technique was created to align the components of digitally high-pass (300 Hz-2500 Hz) filtered somatosensory evoked potentials evoked by median nerve stimulation recorded with a bipolar cephalic montage. A cost function was assigned related to the amount of warping necessary to match a standard wave derived from 24 normal subjects. Its value ranged from 0.525 to 2.456 (mean 1.305 +/- 0.501). This contrasted with a mean of 5.089 +/- 4.277 (range 0.701-13.972) derived from 25 patients with definite (n = 24) or possible (n = 1) multiple sclerosis chosen on the basis of having few or no clinical abnormalities at the time of testing. Fourteen (56%) of the patients had cost functions that were 3 or more S.D.s above the normal mean as compared to 3 (12%) having prolonged latency of the N19 peak. When used in combination, the cost function and latency yielded 60% abnormalities; 5 times higher than latency measurement alone.

Adult

Automated determination of the magnitude and time delay ("phase") of the cardiac cycle dependent variation of myocardial ultrasonic integrated backscatter.

An algorithm for quantitative description of cardiac cycle dependent variation of integrated backscatter (cyclic variation) has been developed and is shown to be suitable for analysis of nonsinusoidal data typical of ultrasonic tissue characterization measurements from myocardium in vivo. The algorithm produces estimates of the magnitude of variation and of the time delay relative to the electrocardiographically recorded QRS-complex. To validate the algorithm, 246 integrated backscatter measurements were analyzed both manually and by the automated method. The magnitude and time delay estimates from the two methods correlated closely. With a separate set of data, the algorithm produced reasonable descriptions of the cyclic variation for 89 of 101 integrated backscatter measurements. Only modest computational power is required for effective implementation of this algorithm, facilitating inclusion of online automated analysis capabilities in quantitative ultrasonic tissue characterization systems.

Algorithms

A method of calculating peripheral dose distributions of photon beams below 10 MV.

The radiation dose outside the radiotherapy treatment field can be of clinical concern and, therefore, a method of accurately predicting the peripheral doses received by tissues would be beneficial. This paper describes a semiempirical method developed for calculating the peripheral dose received at points outside the collimated field edge for incident photon beams with energies below neutron production thresholds (less than 10 MV). The dependence of the peripheral dose upon depth, distance, field shape and size, azimuthal angle about the central axis, external contour variations, and tissue heterogeneities are accounted for by this calculation. Predictions by this algorithm are compared with measurements and it is shown that the method is capable of reproducing the measured peripheral dose values usually to within the statistical uncertainties of the data.

Algorithms

Noninvasive measurement of transmural gradients in myocardial strain with MR imaging.

A method is presented for performing high-resolution strain measurements by using magnetic resonance (MR) tagging. Multispectral radiofrequency pulses are used to produce tagging grids from which strain estimates are obtained with a resolution of 2 mm. A tag detection algorithm is presented that measures the center of a tag line with a precision that ranges from 0.1 to 0.2 mm over the systolic interval. With this method, a transmural gradient in the strain of a normal dog heart was detected.

Animals

Wideband external pulse recording during cuff deflation: a new technique for evaluation of the arterial pressure pulse and measurement of blood pressure.

Analysis of the external brachial pulse recorded during standard blood pressure cuff deflation with use of a transducer with a wide frequency response has revealed a reproducible pattern with three distinct components that we have labeled K1, K2, and K3. K1 is a low-amplitude, low-frequency signal that is present with cuff pressures above systolic pressure. K2 is a triphasic signal appearing at systolic pressure and disappearing at diastolic pressure, which approximately corresponds to the audible Korotkoff sound. K3 appears with cuff pressure between systolic and diastolic pressure and continues to be present below diastolic pressure. Intra-arterial pressure recordings made with a high-fidelity Millar catheter-tip manometer revealed K2 and K3 analogs. K3 resembles the intra-arterial pressure waveform and when calibrated according to the pulse pressure, noninvasive dK3/dt determinations correlated well with intra-arterial dP/dt measurements. The appearance/disappearance property of K2 was designated as the "K2 algorithm" and represents a new, objective noninvasive method for measurement of blood pressure. The K2 algorithm compares favorably with intra-arterial measurements, is more accurate than the auscultatory technique, and may be especially useful in clinical situations in which the auscultatory technique does not work well.

Adolescent

A two-dimensional pencil-beam algorithm for calculation of arc electron dose distributions.

A two-dimensional pencil-beam algorithm is presented for the calculation of arc electron dose distributions in any plane that is perpendicular to the axis of rotation. The dose distributions are calculated by modelling the arced beam as a single broad beam defined by the irradiated surface of the patient. The algorithm is two-dimensional in that the anatomical cross section of the patient and the skin collimators are assumed identical in parallel planes outside the plane of calculation. The broad beam is modelled as a collection of strip beams, each strip beam being characterised by its planar fluence, mean projected angular direction and a root-mean-square spread about the mean direction. Using these parameters, the dose distribution is calculated using pencil-beam theory. Examples of strip-beam parameters and resulting dose distributions for patient geometries are presented. Features of the algorithm, which include (1) incorporation of pencil-beam theory for the calculation of dose in heterogeneous tissue, (2) run times of only about twice that of comparable-sized fixed electron fields and (3) the input requirement of only a single depth dose and four off-axis dose profiles of measured data, make the algorithm practical for clinical use.

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

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

Automatic detection and measurement of EMG silent periods in masticatory muscles during chewing in man.

Silent periods are transient stops of muscle activity that are induced by mechanical or electrical stimulus. The current report describes a new algorithm which enables automatic detection and measurement of silent periods that occur in the EMG of human masticatory muscles during chewing efforts together with jaw positions in space at the occurrence of the silent periods. The EMG signal for detection of the silent period is modeled based on the observation of the EMG records induced from the jaw-closing muscles during chewing efforts in seven volunteer subjects. The algorithm for automatic detection and measurement of the EMG silent period has been applied successfully to real EMG data and the performance of the software was confirmed to be sufficiently reliable. The results of the analysis are stored in a biosignal database for possible clinical use.

Adult

Case studies on the effect of exercise and hot water submersion on intracardiac temperature and the performance of a pacemaker which varies pacing rate based on temperature.

The effectiveness of using blood temperature change as an indicator to automatically vary heart rate physiologically was evaluated in 3 patients implanted with Model Sensor Kelvin 500 (Cook Pacemaker Corporation, Leechburg, PA, USA) pacemakers. Each patient performed two block-randomized treadmill exercise tests: one while programmed for temperature-based, rate-modulated pacing and the other while programmed without rate modulation. In 1 pacemaker patient and 4 volunteers, heart rates were recorded during exposure to a hot water bath. Blood temperature measured at 10 sec intervals and pacing rate measured at 1 min intervals were telemetered to a diagnostic programmer and data collector for storage and transfer to a computer. Observation comments and ECG-derived heart rates were manually recorded. The temperature-based pacemaker was shown to respond promptly not only to physical exertion but also to emotionally caused stress and submersion in a hot bath. These events cause increased heart rate in the normal heart. Using a suitable algorithm to process the measurement of blood temperature, it was possible to produce appropriate pacing rates in paced patients.

Aged

Linking cortical structure and delirium in the elderly: insights from cohort study and shared genetic risk analysis.

BACKGROUND: This study aimed to assess the association between regional cortical changes measured via baseline magnetic resonance imaging (MRI) and the incidence of delirium. METHODS: Observational associations were assessed using a prospective cohort from the UK Biobank and an independent clinical cohort. The population-based study included participants aged 60 years or older who had undergone structural brain MRI since 2014. Regional cortical volume, mean thickness, and surface area were extracted based on the Desikan-Killiany cortical atlas. Delirium was defined using ICD-10 diagnostic codes. Additionally, preoperative brain MRI images from participants in another cohort were collected and automatically segmented using deep learning algorithms to obtain cortical measurements. Logistic analysis was performed to investigate the associations between cerebral cortical structure and delirium risk. Lastly, genome-wide association study data derived from the ENIGMA Consortium and FinnGen Biobank were utilized to conduct conditional/conjunctional false discovery rate (cond/conjFDR) analyses to identify shared genetic loci associated with cortical structures and delirium. RESULTS: This observational analysis included 31,890 participants from the UK Biobank and 152 participants from an independent cohort. In the UK Biobank cohort, decreased cortical thickness in the 17 regions was associated with a significantly increased risk of delirium. Similarly, a preoperative reduction in cortical volume in 7 regions was associated with an increased risk of delirium in the independent cohort. Besides, 100 single-nucleotide polymorphisms (SNPs) were identified as significantly associated with cortical structures when conditioned on delirium. Finally, colocalization analysis demonstrated that these pleiotropic risk loci modulated the expression of NT5C2, RGP1, CCDC25, TPM2, EEF1AKMT2, IQANK1 and LHPP in blood and brain tissues. CONCLUSION: Regional cortical atrophy is associated with an increased risk of delirium in the elderly. Brain MRI examinations may be beneficial for preoperative delirium risk assessment in elderly individuals undergoing elective surgery.

Humans

Optimal a posteriori time domain filter for average evoked potentials.

Evoked potentials measured with scalp electrodes are often described as a deterministic process corrupted by unrelated noise. The common procedure to determine the signal is to average N repetitive measurements. By obtaining additional information from the N measurements, signal detection can be improved. An algorithm that estimates the signal autocorrelation from N given measurements is proposed. The estimator is consistent and unbiased, and its variance tends to 0 as o(N). Two filters that are applied to the average response are introduced. Both depend on the estimation of the signal and the noise autocorrelations. One filter is based on the assumption that the average response is a stationary process. The second filter coefficients are obtained by minimizing the mean squared error (MSE) of an optimal filter of a nonstationary process applied on a single sweep. When a small number of sweeps are averaged, the stationary assumption is adequate, and the MSE of the stationary optimal filter is two to five times less than the MSE of the average response. When a large number of measurements are considered, the error in estimating the autocorrelations decreases. In this case, applying the optimal filter for a nonstationary process leads to a significant improvement in the signal estimation.

Algorithms

Should inhomogeneity corrections be applied during treatment planning of tangential breast irradiation?

Due to the inclusion of lung tissue in the treatment volume, some parts of the breast will get a higher dose during tangential breast irradiation because of the lower lung density. Data on the accuracy of dose calculation algorithms, investigated by phantom measurements, determinations of the geometry and density of the actual lung in the patient and the results of in vivo dose measurements, are presented. From this information it can be concluded that a lung correction varying between about 3% and 7% is needed but its magnitude is slightly overpredicted in a number of commercial treatment planning systems. Because this increase in dose is already in a high dose region, it is recommended that inhomogeneity corrections should be applied during tangential breast irradiation.

Algorithms

Calculation of dose profiles in homogeneous phantoms for irregular, partially attenuated, photon beams.

Measured and calculated dose profiles under partial attenuators which cover only part of the radiation beam are presented. The study was performed for x-ray beams generated with a 4-MV linear accelerator at a source-surface distance of 120 cm in a water phantom for lead attenuators of arbitrary shape but constant thickness. Dose correction factors, which are used to multiply the open beam data to predict doses under partial attenuators, depend strongly on attenuator parameters, such as its thickness, lateral dimensions, and distance from phantom or patient surface, in addition to depending on depths in the phantom. The dose correction factors are calculated with Clarkson sector integration techniques, and the results, in spite of the simplifying assumptions used in the algorithm, generally agree with measured data to within 3%. The calculational method therefore may be applied to general clinical situations in which partial attenuators are used.

Humans