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Diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging.

Magnetic resonance (MR) imaging with multiaxial cross sections has been used to improve the resolution of small, fine, and slender spinal roots to more precisely diagnose herniated intervertebral disc (HIVD), especially in cases of far lateral disc (FLD) herniation. However, false-negative results remain a problem because of the unsatisfactory resolution of these methods. We report the use of a volume visualization technique to generate three-dimensional (3D) images from multiaxial sections. In our study, 10 patients with FLD herniation each underwent MR imaging (method 1), 3D MR image reconstruction with single-axis cross-sections (method 2), and 3D MR image reconstruction with multiaxial cross sections (method 3). Final diagnoses were confirmed at surgery. The preoperative diagnosis matched the operative findings in five patients using method 1, six patients using method 2, and nine patients using method 3. In addition, the software developed for this application includes functions which simulate decompression of the spinal cord and roots. Therefore, this computer-aided diagnosis system using multiaxial cross sections is a useful tool for diagnosing HIVD and for training medical residents and students. This technique has three main advantages over conventional imaging modalities: 1) resolution of small, fine, or slender anatomic structures, which reduces the possibility of false-positive and false-negative image findings; 2) segmentation (disarticulation) of images; and 3) simulation of surgery.

Adult↗

[The application of computer imaging simulation in nose augmentation].

By measurement and analysis, the postoperative image was simulated in standard facial image of the saddle nose using computer imaging and the software developed by us. When the simulated image is accepted by both the surgeon and the patient, the computer gives data to instruct the operation. The authors described how to obtain the standard facial image and how to reduce error. The computer imaging simulation makes the cosmetic operation accurate, quantitative and imaged, and its applications will be broadened.

Adult↗

CAREN--Computer Assisted Rehabilitation Environment.

The CAREN project concerns the development of a virtual reality environment in which the agility of healthy subjects and patients can be tested in a variety of reproducible conditions. CAREN is made by customizing hardware and developing software to enable measurements of motion of a subject in detail as a response to a perturbation from the computer driven motion platform. After feeding the data in a human body model simulation, joint moments of force and muscle activation can be calculated. From the time patterns of these responses, inferences can be made concerning the motor programs the subjects launch. Any primary problem in a motor program, resulting in functional failure or inadequacy, can be identified down to the joint and muscle group. Secondary adaptations of patients to a limitation in the periphery (such as lack of muscle force) can be separated from the primary ones. Inadequacy of complete motor programs in children with movement disorders can be classified, recorded and related to progress that may occur. Especially the understanding of compensation strategies in patients may lead to a better therapeutic attitude. CAREN offers not only a test environment with means of almost unlimited exploratory behaviors for patients, but constitutes also a strong tool for motor control research.

Computer Graphics↗

Validation of an analytical expression for the absorbed dose from a spherical beta source geometry and its application to micrometastatic radionuclide therapy.

The purpose of this study was to validate an analytical expression for the absorbed-dose calculation from the spherical source of beta-emitting radionuclides and to apply it to micrometastases treated with radiolabeled monoclonal antibodies. The self-absorbed fractions from I-131 and P-32 uniform spherical sources were calculated using the analytical expression introduced by P. K. Leichner (J. Nucl. Med., 35: 1721-1729, 1994). The calculated absorbed fractions were compared with previously reported values and were found to be in reasonable agreement, with a maximum difference of 15% for smaller masses and a long-range beta emitter. The expression was subsequently applied to estimate the absorbed dose within spheroid models with nonuniform penetration of radiolabeled antibody. The corresponding absorbed dose for I-131 was compared with reported micro-thermoluminescence dosimeter measurements and found to be in good agreement. This work has independently substantiated the methodology outlined by Leichner and may be reliably incorporated into new software developments for radionuclide dosimetry treatment planning.

Beta Particles↗

Integration and visualization of multimodality brain data for language mapping.

A goal of the University of Washington Brain Project is to develop software tools for processing, integrating and visualizing multimodality language data obtained at the time of neurosurgery, both for surgical planning and for the study of language organization in the brain. Data from a single patient consist of four magnetic resonance-based image volumes, showing anatomy, veins, arteries and functional activation (fMRI). The data also include the location, on the exposed cortical surface, of sites that were electrically stimulated for the presence of language. These five sources are mapped to a common MR-based neuroanatomical model, then visualized to gain a qualitative appreciation of their relationships, prior to quantitative analysis. These procedures are described and illustrated, with emphasis on the visualization of fMRI activation, which may be deep in the brain, with respect to surface-based stimulation sites.

Anatomy, Cross-Sectional↗

[A method for continuous monitoring of total peripheral and pulmonary vascular resistance in high risk cardiac patients].

In this study we present a computer-assisted monitoring system ("Opserver") which allows a continuous registration of directly measured values: hear rate (HR), systolic, diastolic and mean arterial pressure (SAP, DAP, MAP): systolic, diastolic and mean pulmonary arterial pressure (PAPs, PAPd, PAPm), central venous pressure (CVP), mixed venous oxygen saturation (SvO2), pulse-oxymetrically measured oxygen saturation (SaO2), cardiac output (CO) and calculated haemodynamic parameters: cardiac index (CI), total peripheral vascular resistance (TPVR) and pulmonary vascular resistance (PVR). The basic principle of this on-line monitoring system is the registration of calculated parameters combining data of various devices by specially-developed software. The procedure is shown in several clinical examples. The advantages of this system are:--monitoring of critical haemodynamic responses in cardiac high-risk patients relating to induction and finishing of anaesthesia including in- and extubation, recovery from anaesthesia, operation and transport and--exact documentation of the data for the purpose of clinical studies. Based on continuous measurement, this monitoring system allows an optimum evaluation of cardiorespiratory acute incidents, thereby permitting a problem-oriented therapy in high-risk patients with vasoactive medication in the perioperative period and in the intensive care unit.

Anesthesia, General↗

DNA content by in situ fluorescence imaging and S-phase detection, with chromatin structure preserved.

OBJECTIVE: To test the feasibility of in situ DNA quantitation of adherent cells' nuclei by fluorescence imaging, preserving chromatin structure and to follow-up S phase, in relation to DNA content, in order to assess the precision of DNA measurements. STUDY DESIGN: Double labeling experiments involved total DNA staining with Hoechst 33342 and BrdU immunostaining (after either Br photolysis and DNA strand break labeling by terminal transferase or acid denaturation) to detect replicating DNA. An epifluorescence microscope was used, images captured with a CCD camera and quantitative total DNA measurements done in 12 bits with IPLab software. BrdU results were related to DNA content on an individual cell basis. Cell cycle analyses were run with Imastat software (developed in the laboratory) on Hoechst-stained cells and on double labeled cells. RESULTS: In cells progressing through the cycle, as assessed by BrdU, a corresponding increase in DNA content was measured. Early S differed from G1 (P < .05). Imastat analyses gave a CV for GI peak of 6-7%. CONCLUSION: Quantitative fluorescence imaging allows a sensitive determination of DNA content for adherent-cell nuclei in situ. Topologic analyses of nuclear components will be possible in relation to DNA content.

3T3 Cells↗

Virtual network computing: cross-platform remote display and collaboration software.

VNC (Virtual Network Computing) is a computer program written to address the problem of cross-platform remote desktop/application display. VNC uses a client/server model in which an image of the desktop of the server is transmitted to the client and displayed. The client collects mouse and keyboard input from the user and transmits them back to the server. The VNC client and server can run on Windows 95/98/NT, MacOS, and Unix (including Linux) operating systems. VNC is multi-user on Unix machines (any number of servers can be run are unrelated to the primary display of the computer), while it is effectively single-user on Macintosh and Windows machines (only one server can be run, displaying the contents of the primary display of the server). The VNC servers can be configured to allow more than one client to connect at one time, effectively allowing collaboration through the shared desktop. I describe the function of VNC, provide details of installation, describe how it achieves its goal, and evaluate the use of VNC for molecular modelling. VNC is an extremely useful tool for collaboration, instruction, software development, and debugging of graphical programs with remote users.

Chemistry↗

[Telemedicine: perspectives and multidisciplinary approach].

BACKGROUND: Telemedicine is use of the new computer-based communication technologies for medical purposes. It augments the exchange of scientific information, while its applications in the fields of patient care and medical education cover remote diagnosis and therapy as well as remote education and training. METHOD: This article reviews the development of telemedicine and its application to specialties such as anaesthesiology, dermatology, medicine, surgery and pathology at the University Hospital of Basle, Switzerland. RESULTS: Since 1980 the Department of Medicine has held multidisciplinary teleconferences for expert consultation and medical education. Since 1992 the Institute of Pathology has been linked to remote hospitals for real-time biopsy, and, since 1997, remote dermato-histopathological diagnosis has been performed in conjunction with a number of centres and practitioners. International academic teleconferences have been held in the field of surgery since 1986 and there is an interactive education programme via telemedicine in the field of anaesthesiology. The technology in use must be adapted to needs: since few practitioners are currently connected to the Internet, teleconferencing will still be the rule in the Department of Medicine. Remote diagnosis in dermatology and pathology requires high-resolution images transmitted by self-developed software via 64 Kb/s ISDN connection, while surgery works with ISDN teleconferencing at 384 Kb/s to ensure live transmission of surgical procedures with high-quality images. CONCLUSION: Our practice, based on several hundred cases, suggests that telemedicine is useful in simplifying and expanding access to remote interdisciplinary expertise, as well as improving medical education in a number of specialties. Telemedicine's multidisciplinary approach is to be recommended.

Humans↗

Computer-assisted quantitation of choroidal neovascularization for clinical trials.

PURPOSE: To develop a computer-assisted method for the quantitation of choroidal neovascularization (CNV) for the support of clinical trials. METHODS: Fluorescein angiographic images were selected from 5 patients enrolled in a clinical trial for which three follow-up visits were available. Thirty- and 600-second images were digitized at 1000 dots/in and registered (aligned) with polynomial warping algorithms. Custom-developed software allowed for coarse, automated identification of CNV. An easy-to-use graphical user interface facilitated supervision and refinement of the lesion boundaries by a skilled reader based on standard stereoscopic viewing of the fluorescein angiography study. Capabilities for boundary delineation in both early and late phases, and animation to allow for image correlation and evaluation of temporal changes in fluorescence of spatially corresponding pixels, were included. Two metrics for CNV characterization were generated. First, the lesion area based on the lesion boundaries was identified after supervision. Second, an integrated lesion intensity (ILI) reflecting the integrated, normalized lesion hyperfluorescence was calculated. RESULTS: Area and ILI measures were calculated for each of 5 patients for three or more visits. Facile supervision based on the stereoscopic angiogram permitted arbitrarily close concordance with CNV identification using standard methods. Changes in area and ILI measurements between visits correlated closely with clinically observed changes in each case. CONCLUSIONS: Interactive image processing permits efficient, accurate, computer-assisted CNV quantitation that may be useful for the support of clinical trials and preclinical studies.

Choroid↗

[Survivability and morphologic anomalies in higher plants wolffia arrhiza following exposure to heavy ions of the galactic space radiation].

Experimental data on the effects of spaceflight factors, space radiation in particular, on higher plant Wolffia arrhiza firstly exposed in the "Bioblock" assembly and measurements made by physical track detectors of heavy ions (HI) are presented. Death of individual Wolffia plants and morphologic anomalies were the basic evaluation criteria. The peculiar feature of this biological object consists in the possibility to reveal delayed effects after 1-2 months since space flight as Wolffia has a high rate of vegetative reproduction. German investigators through microscopic examination of track detectors performed identification of individual plants affected by HI. With specially developed software and a coordinate system of supposition of biolayers and track detectors with the accuracy of 1 micron, tracks and even separate sections of individual HI tracks were determined in biological objects. Thereafter each Wolffia plant hit by HI was examined and data were compared with other variants. As a result, correlation between Wolffia death rate and morphologic anomalies were determined at different times post flight and topography of HI tracks was found. It is hypothesized that morphological anomalies in Walffia were caused by direct hits of plant germs by heavy ions or close passage of particles.

Apoptosis↗

[Ultrasonic myocardial characterization. Application of an original method of acoustic quantification to analysis of healthy and hypertrophic interventricular septal myocardium].

Echocardiography does not provide objective tissue characterisation of sonified tissues. A recent advance has been the introduction of the radiofrequency signal. At present, its exploitation remains a research tool. The required material for quantification is still insufficiently robust and discriminative. The indices derived from histograms of grey scales are calculated by the majority of workers for regions of interest manually positioned in the image. This statistical method allows analysis of the average grey level but not of the architecture of the tissue examined. Tissue characterisation is, therefore, only a potential feature of echocardiography. The authors' approach consists in developing software applied to digital signal provided by the echograph and not directly by the transducer, as in the research based on the use of radiofrequency signals. This software allows characterisation of the texture by two statistical methods applied to signal processing: the histograms of the grey scales, the matrix of co-occurrence (assessing the make-up of the different grey scales in the region of interest). This tool of tissue characterisation is presented here in the studies of the interventricular septum in the parasternal long axis view. Two populations, one with healthy myocardium and the other with myocardial hypertrophy, have been studied. These two populations are differentiated in a significant manner by their respective values of parameters of myocardial texture characterisation in early diastole. Despite a number of methodological problems, this study confirms the hopes that it will be possible in the near future to obtain a quantitative "histological" definition of tissues by echocardiography.

Echocardiography↗

Leucite-reinforced glass ceramic inlays after six years: wear of luting composites.

Wear of luting composites is still an unsolved problem with adhesive inlays. However, only limited clinical research has been conducted regarding this phenomenon. This study evaluated the substance loss within the luting gap over a six-year period in vivo. In the course of a controlled prospective clinical study, 16 patients received 39 Class-II IPS Empress inlays. Variolink Low (Vivadent; n = 18) was used as conventional low-viscosity luting composite, the hybrid-type restorative resin composite Tetric (n = 21; Vivadent) was applied according to the ultrasonic insertion technique. The restorations were clinically assessed after 6, 12, 24, 36, 48 and 72 months and replicas were made. The contact-free occlusal areas of the replicas were scanned by use of a computer-controlled profilometer (Perthen S3P), the analysis of the data was computed using a newly developed software (Xpert for Windows 95) and statistically analyzed with non-parametric tests. After six months all restorations exhibited marginal ditching. The percentage of detectable luting gap abrasion increased between each recall appointment (32% after six months, 48% after 12 months, 46% after 24 months, 55% after 36 months, 59% after 48 months and 65% after 72 months). Except for the 48-months results, no significant difference between the materials used for luting was evident (p > 0.05). Between the width and the depth of the luting space a linear regression was computed. The quantitative evaluation clearly demonstrated that hopes of relevantly reduced wear of luting composites were not confirmed when using the higher filled luting material.

Adult↗

[Absorbed dose during helical acquisition CT. Effect of acquisition parameters].

PURPOSE: European directive 97/43 specifies that the dose delivered to the patient during a radiological procedure should be estimated. In order to prepare for implementation of this new regulation, we have studied the dose delivered during spiral CT acquisition. MATERIALS AND METHODS: We have studied the influence of slice thickness, pitch, tube voltage and intensity, and acquisition volume length. We present measurements for single and dual detector CT scanners. We used a pencil ionization chamber to measure air kerma. We measured absorbed dose in water with a waterproof ionization chamber set in a semi-customized phantom filled with water. Chambers were set on the rotation axis of the CT scanners. We studied the dose outside the acquisition volume. RESULTS: We quantified the influence of each parameter on the absorbed dose. We used our measurements to calculate the dose for different acquisition protocols. Also we evaluated the dose to organs distant from the acquisition area. CONCLUSION: This study is one step toward a systematic estimation of the dose delivered to patient during helical CT exams. To use these results in daily practice, we have to develop software using our measurements.

Equipment Design↗

A histological procedure to determine dental age.

Sclerosis of dentine has become one of the well established indicators of ageing and age determination. In this study a new technique was reported where a photomicrographic image of a cross section of sclerotic dentine was converted to a grey scale of 256 tones and then reduced to black and white and read by computer using specially developed software. A regression analysis was applied to a sample of 62 teeth (age range 17-84 years) and an age determination within an error limit of 11 years was obtained. Using a Neural Network software however the error was reduced to 8 years.

Adolescent↗

Swarm intelligence. A whole new way to think about business.

What do ants and bees have to do with business? A great deal, it turns out. Individually, social insects are only minimally intelligent, and their work together is largely self-organized and unsupervised. Yet collectively they're capable of finding highly efficient solutions to difficult problems and can adapt automatically to changing environments. Over the past 20 years, the authors and other researchers have developed rigorous mathematical models to describe this phenomenon, which has been dubbed "swarm intelligence," and they are now applying them to business. Their research has already helped several companies develop more efficient ways to schedule factory equipment, divide tasks among workers, organize people, and even plot strategy. Emulating the way ants find the shortest path to a new food supply, for example, has led researchers at Hewlett-Packard to develop software programs that can find the most efficient way to route phone traffic over a telecommunications network. South-west Airlines has used a similar model to efficiently route cargo. To allocate labor, honeybees appear to follow one simple but powerful rule--they seem to specialize in a particular activity unless they perceive an important need to perform another function. Using that model, researchers at Northwestern University have devised a system for painting trucks that can automatically adapt to changing conditions. In the future, the authors speculate, a company might structure its entire business using the principles of swarm intelligence. The result, they believe, would be the ultimate self-organizing enterprise--one that could adapt quickly and instinctively to fast-changing markets.

Commerce↗

Meta-modelling: the appropriate solution for a family of applications.

The aim of this paper is to present an appropriate framework able to generate models and to implement them, in the objective of computerizing a family of medico-technical reports. The accelerated rate of technical development makes it necessary to design computerized applications independently of data-processing technology. This apparent paradox is a quite real challenge which needs research and development software environments to support frameworks. In this article, we present a meta-model (i.e. a generic structure - supported by the Méta-Gen software tool) ) which is able to generate various models of medico-technical reports. These models in turn are able to generate various types of instances. This meta-model is a "Meta-medical record", it is constituted of basic concepts : " User Semantic Group " to which are attached a set of " sentence-type ", a set of several corpus of variables with a set of graphs ("navigators"). Five models (echocardiography for hospital "A", echocardiography for hospital "B", gastroscopy, fibercoloscopy A.E.P.). were already generated from this "Meta-Medical Record". A beginning of implementation in echocardiography report is presented here. The advantages are a very thorough personalization of the document for the user, and a greater independence of the design diagram from the technological platform.

Echocardiography↗

[Applications and advantages of a multimedia system for autopsies ].

This work evaluates the benefits and applications of computers and multimedia systems in post-mortem examination practice and, more in particular, in the definition of data collection protocols. We examined issues concerning the different aims of autopsy (e.g. diagnostic, scientific, educational, legal), and found that the pathologist's main duty is to acquire a large amount of data in the best possible way. However, despite the will to carry out detailed post-mortem examinations, many pathologic anatomy services face objective difficulties in doing so, especially due to understaffing, lack of time and high costs. The Institute for Pathologic Anatomy of the University of Genoa has developed software for data handling and for outcome reporting, a particularly important aspect in fetal-perinatal diagnosis. The system consists of a relational database in a client-server environment (Fourth Dimension) with two integrated parts. The first part, with unrestricted access, contains patients' personal data, including gender, age, time and date of death, hospital department of origin, person and department requiring the post-mortem examination, hour and time of autopsy, pathologist's name, and clinical diagnosis of death. Using a scanner, a copy of the autopsy application is also field, together with the patient's medical file and any diagnostic images useful to document the case history. The second part of the information system is accessible by pathologists only, and contains the autopsy report. This part is organized to balance two different needs: it allows sufficient space and freedom for autopsy description while providing guidelines for presentation of the report. The structure of the conventional autopsy protocol has been maintained, with subdivisions for all the organs and apparatuses according to topographic criteria. Before this part, a section is dedicated to external cadaver examination and anthropometric data; weight, shape, volume and texture are described for each organ, together with external and cut-surface features. A third section allows the examiner to report other observations not requested previously, while a final section is also provided for the epicrisis and for the formulation of the final diagnosis, the same as that reported in the first form. The database is coupled with an interactive system for collecting voice comments, thereby replacing the need for tape-recorders in the autopsy room. The user can recall a dictation window, dictate a text, check spelling and insert additional text. The database is also coupled to an image acquisition system, on the assumption that moving images allow a more faithful documentation of reality. Therefore, all rooms in which autopsies are carried out on fetuses or neonates have been equipped with a fixed camera linked to a monitor and a video-recorder. A PCB, used for image digitalization, recognizes up to 16,000,000 different colors. Guided by dedicated software, image files are transferred to a computer and then saved with the autoptic report. The database can be consulted and queried in two principle ways: by key words in the contents or main disease descriptions, or by individual words or phrases contained within the complete text of the reports. The present database system for autopsy reporting has proved itself useful in a pathological anatomy service. The combined presence of images and texts renders the system useful also as a research tool. By linking to a Web site dedicated to pathologic anatomy, it will be possible to display online rare cases involving diagnostic difficulties. The system offers great advantages for present and retrospective diagnostics, as well as for research and education purposes.

Archives↗