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PubMedDate not supplied

Performance analysis of a medical decision algorithm to mitigate spread of SARS due to interfacility patient transfers.

OBJECTIVE: To determine performance of a medical decision algorithm to mitigate spread of severe acute respiratory syndrome (SARS) from interfacility patient transfers during the Toronto SARS outbreak. METHODS: Records from the Provincial Transfer Authorization Centre and Toronto Public Health from April 1 to July 31, 2003, were linked using probabilistic methods. Authorization decision (transfer authorized or denied) and SARS status (probable case, suspect case, or patient under investigation for SARS; or non-SARS case) were obtained for linked records. Primary outcome was the number of patients where correct authorization decisions were made based on SARS status at the time of request. Secondary outcome was the number for whom, in retrospect, authorization decision was correct knowing final SARS status. Algorithm sensitivity, specificity, and predictive values were determined. RESULTS: There were 14,571 requests for transfer and 2,132 patients investigated for SARS during the study period. The algorithm authorized 14,551 and did not authorize 20 requests. Sensitivity and specificity to make appropriate authorization decisions at the time of request were 100% (95% confidence interval [CI], 77.2%-100%) and 99.95% (95% CI, 99.9-100%), respectively. Positive and negative predictive values were 65% (95% CI, 44.1%-85.9%) and 100% (95% CI, 98.4%-100%), respectively. Sensitivity and specificity, in retrospect, within ten days of the transfer request were 100% (95% CI, 80.6%-100%) and 99.97% (95% CI, 99.9%-100%), respectively. Positive and negative predictive values were 80% (95% CI, 62.5%-97.5%) and 100% (95% CI, 98.4%-100%), respectively. Seven of the 20 patients with nonauthorized requests were not known to have SARS at the time of request. Within ten days, three of seven were under investigation for, a suspect case of, or a probable case of SARS. CONCLUSIONS: The medical decision algorithm was highly sensitive and specific in correctly authorizing transfers. Despite its highly sensitive and specific algorithm, it did incorrectly deny authorization to a very small number of patients without SARS.

Algorithms↗

PubMedDate not supplied

Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting.

OBJECTIVE: To determine whether paramedics can safely use a spinal clearance algorithm to reduce unnecessary spinal immobilization (SI) in the out-of-hospital setting. METHODS: Paramedics were instructed in the use of a spinal clearance algorithm that prompted assessment of the trauma patient's 1) level of consciousness, 2) drug and/or alcohol use, 3) loss of consciousness during the event, 4) presence of spinal pain/tenderness, 5) presence of neurologic deficit, 6) concomitant serious injury, or 7) presence of pain with range of motion. The algorithm indicated that if any of the above were present, the patient should receive full SI, and if all of the above were negative, then SI could be withheld. Paramedics completed a tracking form that included the above and followed the patient to the emergency department (ED). Data were then gathered to determine the presence of spinal fracture, neurologic deficit, or a combination of the two. To compare the trends for SI, a retrospective medical incident report (MIR) review was conducted from the previous year. MIRs were selected based on the same criteria as those used for study inclusion. RESULTS: Two hundred eighty-one patients were included in the study, with 65% (n = 183) of them receiving SI. Two hundred ninety-three MIRs were included in the retrospective sample, with SI being provided 95% (n = 288) of the time. Comparison of these samples shows a 33% reduction in utilization of SI (95% confidence interval: 27.2%- 38.8%). CONCLUSION: An out-of-hospital spinal clearance algorithm administered by paramedics can reduce SI by one-third. Any application of a spinal clearance algorithm should be accompanied by rigorous medical supervision.

Adolescent↗

PubMed2005

An algorithm to construct genetically similar subsets of families with the use of self-reported ethnicity information.

We present a simple algorithm that uses self-reported ethnicity information, pedigree structure, and affection status to group families into genetically more homogeneous subsets. This algorithm should prove useful to researchers who wish to perform genetic analyses on more-homogeneous subsets when they suspect that ignoring heterogeneity could lead to false-positive results or loss of power. We applied our algorithm to the self-reported ethnicity information of 159 families from the Veterans Affairs Cooperative Study of schizophrenia. We compared these estimates of population membership with those obtained using the program structure in an analysis of 378 microsatellite markers. We found excellent concordance between family classifications determined using self-reported ethnicity information and our algorithm and those determined using genetic marker data and structure; 158 of the 159 families had concordant classifications. In addition, the degree of admixture estimated using our algorithm and self-reported ethnicity information correlated well with that predicted using the genotype information.

Algorithms↗

PubMed1992

Evaluation of a 3D reconstruction algorithm for multi-slice PET scanners.

A fully 3D reconstruction algorithm based on filtered backprojection was evaluated for the reconstruction of data obtained with multi-slice positron emission tomography (PET) scanners which have had the septa removed. This algorithm uses forward-projection through the reconstructed images of a 2D subset of the data to complete the 3D dataset thus satisfying the condition of shift invariance. This is followed by 3D filtered backprojection. Axial sampling was doubled by combining adjacent polar angles, thus improving reconstructed axial resolution. The algorithm was tested using real and simulated datasets and gave high quality reconstructions without artifacts over a wide range of imaging conditions. Events are placed accurately throughout the imaging volume as determined by measurements with a MRI/PET registration phantom. The forward-projection step leads to degradation in image resolution due to insufficient axial and transaxial sampling. This effect is amplified if multiple iterations of the algorithm are used, with little decrease in image noise. Changing the filter employed in the initial 2D reconstruction can be used to alter the noise and resolution characteristics of the 3D images. This algorithm has proved very robust at reconstructing 3D PET data and is relatively fast. Those small problems which exist can be attributed to detector sampling problems, especially in the axial direction, which is a consequence of the geometry of these scanners, which are designed primarily for 2D data acquisition.

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PubMed1994

Evaluation of task-oriented performance of several fully 3D PET reconstruction algorithms.

The relative performance of five fully 3D PET reconstruction algorithms is evaluated. The algorithms are a filtered backprojection (FBP) method and two variants each of the EM-ML and ART iterative methods. For each of the iterative methods, one variant makes use of voxels and the other makes use of 'blobs' (spherically symmetric functions smoothly decaying to zero at their boundaries) as basis functions in its discrete reconstruction model. The methods are evaluated from the point of view of the efficacy of the reconstructions produced by them for three typical medical tasks--estimation of the average activity inside specific regions of interest, detection of hot spots, and detection of cold spots. A free parameter is allowed in the description of each of the five algorithms; the parameters are determined by a training process during which a value of the free parameter is selected which (nearly) maximizes a technical figure of merit. Such training and the actual comparative evaluation is done by making use of randomly generated phantoms and their projection data. The methodology allows assignation of levels of statistical significance to claims of the relative superiority of one algorithm over another for a particular task. We find that using blobs as basis functions in the iterative algorithms is definitely advantageous over using voxels. This result has high statistical significance. (We also include a visual illustration of it.) Comparing FBP, EM-ML using blobs, and ART using blobs, we do not find a clear difference in the overall performance of the investigated variants of the methods. If anything, our results suggest that ART using blobs may be the most efficacious of the three.

Algorithms↗

PubMed1994

An algorithm for the fast registration of image sequences obtained with a scanning laser ophthalmoscope.

There is a need to quantify images of retinal pathology so that the natural progression and response to various forms of treatment such as laser therapy can be reliably monitored. The images obtained with a scanning laser ophthalmoscope are better than those from a traditional fundus camera, and the method of data collection leads naturally to digitization and quantitative techniques. However, during any angiographic sequence, there will inevitably be eye movement and it is essential that this be corrected for prior to the application of quantitative analysis. This article presents an algorithm (the smart localized binary correlation algorithm) for the automatic registration of fluorescein or indocyanine green angiograms which is based on localized correlation of binary templates in binary thresholded gradient images. The use of this algorithm decreases the calculation time up to 180 times when compared with the fastest applicable algorithm found in the literature. The algorithm only detects translational movement of the images but proves to be robust against rotational movement for the small angles (< 4 degrees) encountered in ophthalmic imaging. Registration accuracy is estimated to be +/- 2 pixels.

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PubMed1998

Iterative and analytical reconstruction algorithms for varying-focal-length cone-beam projections.

In single photon emission computed tomography (SPECT), a varying-focal-length cone-beam collimator can be used to reduce the truncation problem and to maintain sensitivity when imaging the organ of interest. The collimator is constructed so that the collimator holes focus to a circular symmetric, spatially varying, focal point function. The focal length increases radially from the shortest focal length at the centre to the longest focal length at the periphery of the collimator. This paper describes a 3D backprojection-filtering (BF) algorithm for this varying-focal-length cone-beam geometry. The proposed algorithm is compared to an iterative ML-EM (maximum likelihood-expectation maximization) algorithm. The 3D Hoffman brain phantom and Defrise phantom are used in computer simulations. Since the maximum tilt angle of the projection rays is small for most realistic imaging geometries, the proposed algorithm provides a good approximation. When a circular orbit is used, the BF algorithm gives an exact reconstruction of the central slice.

Algorithms↗

PubMed1998

An adaptive control algorithm for optimization of intensity modulated radiotherapy considering uncertainties in beam profiles, patient set-up and internal organ motion.

A new general beam optimization algorithm for inverse treatment planning is presented. It utilizes a new formulation of the probability to achieve complication-free tumour control. The new formulation explicitly describes the dependence of the treatment outcome on the incident fluence distribution, the patient geometry, the radiobiological properties of the patient and the fractionation schedule. In order to account for both measured and non-measured positioning uncertainties, the algorithm is based on a combination of dynamic and stochastic optimization techniques. Because of the difficulty in measuring all aspects of the intra- and interfractional variations in the patient geometry, such as internal organ displacements and deformations, these uncertainties are primarily accounted for in the treatment planning process by intensity modulation using stochastic optimization. The information about the deviations from the nominal fluence profiles and the nominal position of the patient relative to the beam that is obtained by portal imaging during treatment delivery, is used in a feedback loop to automatically adjust the profiles and the location of the patient for all subsequent treatments. Based on the treatment delivered in previous fractions, the algorithm furnishes optimal corrections for the remaining dose delivery both with regard to the fluence profile and its position relative to the patient. By dynamically refining the beam configuration from fraction to fraction, the algorithm generates an optimal sequence of treatments that very effectively reduces the influence of systematic and random set-up uncertainties to minimize and almost eliminate their overall effect on the treatment. Computer simulations have shown that the present algorithm leads to a significant increase in the probability of uncomplicated tumour control compared with the simple classical approach of adding fixed set-up margins to the internal target volume.

Algorithms↗

PubMed1998

An optimized leaf-setting algorithm for beam intensity modulation using dynamic multileaf collimators.

A leaf-setting algorithm is developed for generating arbitrary beam intensity profiles in discrete levels using dynamic multileaf collimators (DMLCs). The algorithm starts with the algebraic expression for the area under the beam profile. It is shown that the coefficients in this expression can be transformed into the specifications for the leaf-setting sequence. It is proven that the algorithm optimizes beam delivery time and total monitor units for the DMLC leaf setting for intensity modulated radiotherapy (IMRT). The algorithm is demonstrated to be applicable to both the 'step-and-shoot' and 'dynamic' type of beam delivery. The graphical interpretation and numerical implementation scheme of the algorithm is illustrated using a simplified example.

Algorithms↗

PubMed2002

Multichannel algorithm for fast 3D reconstruction.

Some recent medical imaging applications such as functional imaging (PET and SPECT) or interventional imaging (CT fluoroscopy) involve increasing amounts of data. In order to reduce the image reconstruction time, we develop a new fast 3D reconstruction algorithm based on a divide and conquer approach. The proposed multichannel algorithm performs an indirect frequential subband decomposition of the image f to be reconstructed (f = sigma fj) through the filtering of the projections Rf. The subband images fj are reconstructed on a downsampled grid without information suppression. In order to reduce the computation time, we do not backproject the null filtered projections and we downsample the number of projections according to the Shannon conditions associated with the subband image. Our algorithm is based on filtering and backprojection operators. Using the same algorithms for these basic operators, our approach is three and a half times faster than a classical FBP algorithm for a 2D image 512 x 512 and six times faster for a 3D image 32 x 512 x 512.

Algorithms↗

PubMed2002

Broadband ultrasound attenuation imaging: algorithm development and clinical assessment of a region growing technique.

This paper presents a computerized method for the selection of an irregular region of interest (ROI) in broadband ultrasound attenuation (BUA) images. A region growing algorithm searches an initial region in the posterior part of the calcaneus until the pixel with the lowest attenuation value is found; this is the starting seed. Then, the algorithm evaluates the values of the eight pixels neighbouring the starting seed. Pixels that have the closest value to the starting seed are accepted. This procedure is the first processing level. The procedure is repeated for the group of pixels neighbouring those accepted from the previous processing level. The algorithm ceases when the number of accepted pixels reaches a user-specified number. The clinical part of this study compares measurements of BUA at an automatic ROI implemented on a quantitative ultrasound imaging device, defined as the circular region of lowest attenuation in the posterior part of the calcaneus, and at irregular ROIs of various sizes generated by the algorithm developed in this study. The algorithm was applied to BUA images obtained from 24 post-menopausal women with hip fractures and 26 age-matched healthy female subjects. The use of the irregular ROI with a size of 2400 pixels is proposed because that region yielded better clinical results compared to irregular ROIs with different size and the circular automatic ROI.

Algorithms↗

PubMed2003

Segment-based dose optimization using a genetic algorithm.

Intensity modulated radiation therapy (IMRT) inverse planning is conventionally done in two steps. Firstly, the intensity maps of the treatment beams are optimized using a dose optimization algorithm. Each of them is then decomposed into a number of segments using a leaf-sequencing algorithm for delivery. An alternative approach is to pre-assign a fixed number of field apertures and optimize directly the shapes and weights of the apertures. While the latter approach has the advantage of eliminating the leaf-sequencing step, the optimization of aperture shapes is less straightforward than that of beamlet-based optimization because of the complex dependence of the dose on the field shapes, and their weights. In this work we report a genetic algorithm for segment-based optimization. Different from a gradient iterative approach or simulated annealing, the algorithm finds the optimum solution from a population of candidate plans. In this technique, each solution is encoded using three chromosomes: one for the position of the left-bank leaves of each segment, the second for the position of the right-bank and the third for the weights of the segments defined by the first two chromosomes. The convergence towards the optimum is realized by crossover and mutation operators that ensure proper exchange of information between the three chromosomes of all the solutions in the population. The algorithm is applied to a phantom and a prostate case and the results are compared with those obtained using beamlet-based optimization. The main conclusion drawn from this study is that the genetic optimization of segment shapes and weights can produce highly conformal dose distribution. In addition, our study also confirms previous findings that fewer segments are generally needed to generate plans that are comparable with the plans obtained using beamlet-based optimization. Thus the technique may have useful applications in facilitating IMRT treatment planning.

Algorithms↗

PubMed2003

Algorithm and performance of a clinical IMRT beam-angle optimization system.

This paper describes the algorithm and examines the performance of an intensity-modulated radiation therapy (IMRT) beam-angle optimization (BAO) system. In this algorithm successive sets of beam angles are selected from a set of predefined directions using a fast simulated annealing (FSA) algorithm. An IMRT beam-profile optimization is performed on each generated set of beams. The IMRT optimization is accelerated by using a fast dose calculation method that utilizes a precomputed dose kernel. A compact kernel is constructed for each of the predefined beams prior to starting the FSA algorithm. The IMRT optimizations during the BAO are then performed using these kernels in a fast dose calculation engine. This technique allows the IMRT optimization to be performed more than two orders of magnitude faster than a similar optimization that uses a convolution dose calculation engine. Any type of optimization criterion present in the IMRT system can be used in this BAO system. An objective function based on clinically-relevant dose-volume (DV) criteria is used in this study. This facilitates the comparison between a BAO plan and the corresponding plan produced by a planner since the latter is usually optimized using a DV-based objective function. A simple prostate case and a complex head-and-neck (HN) case were used to evaluate the usefulness and performance of this BAO method. For the prostate case we compared the BAO results for three, five and seven coplanar beams with those of the same number of equispaced coplanar beams. For the HN case we compare the BAO results for seven and nine non-coplanar beams with that for nine equispaced coplanar beams. In each case the BAO algorithm was allowed to search up to 1000 different sets of beams. The BAO for the prostate cases were finished in about 1-2 h on a moderate 400 MHz workstation while that for the head-and-neck cases were completed in 13-17 h on a 750 MHz machine. No a priori beam-selection criteria have been used in achieving this performance. In both the prostate and the head-and-neck cases, BAO is shown to provide improvements in plan quality over that of the equispaced beams. The use of DV-based objective function also allows us to study the dependence of the improvement of plan quality offered by BAO on the DV criteria used in the optimization. We found that BAO is especially useful for cases that require strong DV criteria. The main advantages of this BAO system are its speed and its direct link to a clinical IMRT system.

Algorithms↗

PubMed2003

A hybrid evolutionary algorithm for multi-objective anatomy-based dose optimization in high-dose-rate brachytherapy.

Multiple objectives must be considered in anatomy-based dose optimization for high-dose-rate brachytherapy and a large number of parameters must be optimized to satisfy often competing objectives. For objectives expressed solely in terms of dose variances, deterministic gradient-based algorithms can be applied and a weighted sum approach is able to produce a representative set of non-dominated solutions. As the number of objectives increases, or non-convex objectives are used, local minima can be present and deterministic or stochastic algorithms such as simulated annealing either cannot be used or are not efficient. In this case we employ a modified hybrid version of the multi-objective optimization algorithm NSGA-II. This, in combination with the deterministic optimization algorithm, produces a representative sample of the Pareto set. This algorithm can be used with any kind of objectives, including non-convex, and does not require artificial importance factors. A representation of the trade-off surface can be obtained with more than 1000 non-dominated solutions in 2-5 min. An analysis of the solutions provides information on the possibilities available using these objectives. Simple decision making tools allow the selection of a solution that provides a best fit for the clinical goals. We show an example with a prostate implant and compare results obtained by variance and dose-volume histogram (DVH) based objectives.

Algorithms↗

PubMed2003

An analytical image reconstruction algorithm to compensate for scattering angle broadening in Compton cameras.

Compton cameras have been developed for use in gamma-ray astronomy and nuclear medicine. Their defining merit is that they do not need collimators; however, on the demerit side, they need inversion procedures for image reconstruction, since a measured datum is proportional to the integration of incident gamma rays along a cone surface with the same Compton scattering angle. First, an iteration method was adopted for this task. Later, analytical methods were found under restricted conditions. Parra (2000 IEEE Trans. Nucl. Sci. 47 1543-50) deduced a purely analytical reconstruction algorithm for a complete set of scattering-projection data that include data at all the scattering angles. Tomitani and Hirasawa (2002 Phys. Med. Biol. 47 2129-45) found that by making a slight modification, Parra's algorithm could be extended to the scattering-projection data in limited scattering angles. However, their algorithm neglected the effects of practical problems that cause the degradation of spatial resolution. Sources of degradation were identified as noise in the energy signal of their front detector and the Doppler effect in the scattering process. In this paper, we first analyse the effects of these sources on the angular resolution of the scattering-projection data and then present a revised reconstruction algorithm in which these two factors are incorporated. Simulation studies on digital phantoms reveal that the algorithm can reconstruct images even when these two factors are included.

Algorithms↗

PubMed2004

Exact and approximate algorithms for helical cone-beam CT.

This paper concerns image reconstruction for helical x-ray transmission tomography (CT) with multi-row detectors. We introduce two approximate cone-beam (CB) filtered-backprojection (FBP) algorithms of the Feldkamp type, obtained by extending to three dimensions (3D) two recently proposed exact FBP algorithms for 2D fan-beam reconstruction. The new algorithms are similar to the standard Feldkamp-type FBP for helical CT. In particular, they can reconstruct each transaxial slice from data acquired along an arbitrary segment of helix, thereby efficiently exploiting the available data. In contrast to the standard Feldkamp-type algorithm, however, the redundancy weight is applied after filtering, allowing a more efficient numerical implementation. To partially alleviate the CB artefacts, which increase with increasing values of the helical pitch, a frequency-mixing method is proposed. This method reconstructs the high frequency components of the image using the longest possible segment of helix, whereas the low frequencies are reconstructed using a minimal, short-scan, segment of helix to minimize CB artefacts. The performance of the algorithms is illustrated using simulated data.

Algorithms↗

PubMed2004

A comparison of step-and-shoot leaf sequencing algorithms that eliminate tongue-and-groove effects.

The performances of three recently published leaf sequencing algorithms for step-and-shoot intensity-modulated radiation therapy delivery that eliminates tongue-and-groove underdosage are evaluated. Proofs are given to show that the algorithm of Que et al (2004 Phys. Med. Biol. 49 399-405) generates leaf sequences free of tongue-and-groove underdosage and interdigitation. However, the total beam-on times could be up to n times those of the sequences generated by the algorithms of Kamath et al (2004 Phys. Med. Biol. 49 N7-N19), which are optimal in beam-on time for unidirectional leaf movement under the same constraints, where n is the total number of involved leaf pairs. Using 19 clinical fluence matrices and 100000 randomly generated 15 x 15 matrices, the average monitor units and number of segments of the leaf sequences generated using the algorithm of Que et al are about two to four times those generated by the algorithm of Kamath et al.

Algorithms↗

PubMed2004

Inherent smoothness of intensity patterns for intensity modulated radiation therapy generated by simultaneous projection algorithms.

The efficient delivery of intensity modulated radiation therapy (IMRT) depends on finding optimized beam intensity patterns that produce dose distributions, which meet given constraints for the tumour as well as any critical organs to be spared. Many optimization algorithms that are used for beamlet-based inverse planning are susceptible to large variations of neighbouring intensities. Accurately delivering an intensity pattern with a large number of extrema can prove impossible given the mechanical limitations of standard multileaf collimator (MLC) delivery systems. In this study, we apply Cimmino's simultaneous projection algorithm to the beamlet-based inverse planning problem, modelled mathematically as a system of linear inequalities. We show that using this method allows us to arrive at a smoother intensity pattern. Including nonlinear terms in the simultaneous projection algorithm to deal with dose-volume histogram (DVH) constraints does not compromise this property from our experimental observation. The smoothness properties are compared with those from other optimization algorithms which include simulated annealing and the gradient descent method. The simultaneous property of these algorithms is ideally suited to parallel computing technologies.

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