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PubMed1987

Algorithms in radiology and medical imaging.

As a tool in clinical decision making, algorithms deserve careful consideration. The potential use or abuse of algorithms in rationing health care renders such consideration essential. In radiology and medical imaging, algorithms have been applied as teaching tools in the conference room setting. These teaching decision trees, however, may not be applicable in the clinical situation. If an algorithmic approach to clinical radiology is pursued, several issues should be considered. Specifically, the application, design, designer, economics, and universality of the algorithms must be addressed. As an alternative to the wide dissemination of clinical algorithms, the authors propose the development of consensus opinions among specialists and the promulgation of the principle of radiologist-consultant-decision maker. A decision team is preferable to a decision tree.

Algorithms↗

PubMed1987

Prospective evaluation of a sequential pacing and high-energy bidirectional shock algorithm for transvenous cardioversion in patients with ventricular tachycardia.

Rapid ventricular pacing alone or in combination with low- or intermediate-energy shocks has limited efficacy in cardioverting rapid ventricular tachycardia (VT) when delivered through two transvenous catheter electrodes. This prospective study determined the efficacy and safety of an algorithm that used a sequence of rapid ventricular pacing (RVP) and intermediate-energy (5 and 15 J) and high-energy (25J) single, bidirectional shocks delivered by two transvenous catheter electrodes in conjunction with a cutaneous electrode in patients with sustained VT. The bidirectional shock was simultaneously delivered over two electrical vectors via a common right ventricular apical cathode and tow anodes consisting of the superior vena caval catheter electrode and cutaneous patch. The electrical therapy delivered was determined by the cycle length of VT. Slow VT (cycle length greater than 300 msec) was sequentially treated by RVP followed by incremental bidirectional shocks of 5, 15, and 25 J. Rapid VT (cycle length less than 300 msec) was treated with no incremental bidirectional shocks of 15 and 25 J. VT was reinduced to determine reproducibility of the algorithm for episodes that were successfully terminated. For patients in whom the primary algorithm failed, a second algorithm was used that excluded 5 and 15 J shocks and went directly to a 25 J shock. VT was reinduced twice and the secondary algorithm was evaluated. Thus, reproducibility of termination of VT with the primary and secondary algorithm was examined. Fifty episodes of slow VT and 40 episodes of rapid VT were induced in 22 patients (mean left ventricular ejection fraction 31 +/- 14%). Six patients had rapid VT, nine patients had slow VT, and seven patients had both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

Routine use of a higher order interpolator and bone algorithm in thoracic CT.

OBJECTIVE: This study was designed to evaluate the utility of the routine use of high spatial frequency algorithms and higher order helical interpolators for imaging lung parenchyma during routine thoracic CT. SUBJECTS AND METHODS: We evaluated 50 consecutive patients undergoing clinically indicated thoracic CT using the same imaging parameters and scanner. The helical volume was reconstructed three separate times using standard and higher order (180 degrees linear with double-sided lobes) interpolators and standard and high spatial frequency (bone) algorithms. The images were photographed and given to five separate readers who were kept unaware of the interpolator and algorithm and who were asked to evaluate simultaneously each patient's three sets of images for best, in-between, and worst images of the lung interstitium, pathology, and normal anatomy. RESULTS: All five readers rated the standard interpolator and algorithm images as the worst (p < .01). All five readers consistently rated the double-sided lobe interpolator and bone algorithm images as the best (p < .01). CONCLUSION: A second reconstruction of routine thoracic helical CT data using higher order helical interpolators and a bone algorithm significantly improves interstitial detail of lung parenchyma and overall visualization of normal anatomy and pathologic processes.

Aged↗

PubMedDate not supplied

Evaluation of shading algorithms for surface display: depth information, surface orientation, colour and transparency.

When interpreting a shaded surface image the observer must infer a three-dimensional shape from a two-dimensional image. The principal monocular cues used in this process are surface orientation and apparent depth. Four shading algorithms were compared, ranging from pure depth to pure surface orientation with two intermediates. Eight observers assessed these algorithms using 40 sets of images showing test objects derived from emission computed axial tomograms, X-ray computed tomograms and simulated data. The results demonstrated a highly significant preference (p less than 0.01) for surface orientation over depth information for all observers and both imaging modalities. The coefficient of concordance showed that the observers were in good agreement as to the rank order of the algorithms, with significant agreement (p less than 0.05) for 37 of the 40 sets of images. The overall preferred algorithm was based on a local polynomial fitting procedure and contained primarily surface information. This shading algorithm was extended to include colour, which was used both as an arbitrary surface property to identify parts of a complex object and as a means of conveying temporal information. Further extension of the algorithm to the display of transparent surfaces was facilitated by an illumination model based on purely isotropic light. This enabled even irregular surfaces to be displayed as transparent objects, and was combined with opaque shading for displaying nested surfaces in nuclear magnetic resonance data.

Algorithms↗

PubMed1992

An annotated algorithm approach to clinical guideline development.

The Urinary Incontinence in Adults Guideline Panel facilitated the ready elucidation of its guideline's management recommendations through the use of an annotated algorithm approach. The algorithms created as part of this guideline differ from previous algorithms in two ways: (1) they employ systematic annotation to link explicitly the algorithms' recommendations to the literature, and (2) they contain patient counseling and decision nodes to depict the major preference-dependent decision or branch points in the algorithm. We believe that these two innovations can help ensure the clinical validity of guidelines' algorithms while preserving appropriate clinical flexibility and respecting patient preferences.

Algorithms↗

PubMed1991

Exploring a new best information algorithm for Iliad.

Iliad is a diagnostic expert system for internal medicine. One important feature that Iliad offers is the ability to analyze a particular patient case and to determine the most cost-effective method for pursuing the work-up. Iliad's current "best information" algorithm has not been previously validated and compared to other potential algorithms. Therefore, this paper presents a comparison of four new algorithms to the current algorithm. The basis for this comparison was eighteen "vignette" cases derived from real patient cases from the University of Utah Medical Center. The results indicated that the current algorithm can be significantly improved. More promising algorithms are suggested for future investigation.

Algorithms↗

PubMed1991

Stochastic simulation algorithms for query networks.

One of the barriers to using belief networks for medical information retrieval is the computational cost of reasoning as the networks become large. Stochastic simulation algorithms allow one to compute approximations of probability values in a reasonable amount of time. We previously examined the performance of five stochastic simulation algorithms applied to four simple belief networks networks and found that the Self-Importance algorithm performed well. In this paper, we examine how the same five algorithms perform when applied to a belief network derived from the cardiovascular subtree of the Medical Subject Headings (MeSH). Both the Likelihood Weighting and Self-Importance algorithms perform well when applied to the MeSH-derived network, suggesting that stochastic simulation algorithms may provide reasonable performance in medical information retrieval settings.

Algorithms↗

PubMed1991

Use of immunoglobulin heavy-chain and light-chain measurements in a multicenter trial to investigate monoclonal components: II. Classification by use of computer-based algorithms.

We describe a computer algorithm for classifying serum monoclonal proteins (MC) based on serum protein electrophoresis (SPE) and the automated measurement of kappa and lambda light chains and IgG, IgA, and IgM. We developed the algorithm by using a large database of unselected samples containing MC collected in a multicenter study. The performance of the algorithm was optimized by using iterative computational procedures and was tested on both the development database and on an independent set of MC-containing samples. With the development database, the algorithm correctly classified 50% and misassigned 2.5% of the MC. Where the MC were present in concentrations greater than 10 g/L, the rate of successful classification increased to 72% with 3% misclassification. When the algorithm was tested on a group of 101 MC-containing samples from an independent source, 67% were correctly classified and 8% misclassified, half of the latter being unusual IgD myelomas. We discuss the scope for the application of the algorithm in routine laboratory practice involving personal computer software.

Algorithms↗

PubMed1991

Algorithm to predict triple-vessel/left main coronary artery disease in patients without myocardial infarction. An international cross validation.

Logistic regression was applied to the clinical, risk factor, and exercise data of consecutive angiographic referrals without prior myocardial infarction to determine an algorithm predicting the probability of triple-vessel/left main coronary artery disease. These data were obtained from a total of 1,074 such subjects from patient populations at four centers (Cleveland Clinic Foundation, Cleveland, Ohio; Hungarian Institute of Cardiology, Budapest, Hungary; the university hospitals, Zurich and Basel, Switzerland; and the Veterans Administration Medical Center, Long Beach, Calif.) and used to derive four separate probability algorithms. Each algorithm is based on patient data from study samples at three of the four centers and consists of 272 logistic functions, which are related to linear combinations of 13 variables (age, sex, type of chest pain, systolic blood pressure, resting electrocardiogram, serum cholesterol, fasting blood sugar, achieved exercise work load, achieved heart rate, exercise-induced angina and hypotension, heart rate-adjusted resting ST depression, and exercise ST slope). The four algorithms were cross validated by testing them on the populations not involved in their derivation. The resulting probabilities in the four test groups were then compared with the angiographic findings of triple-vessel/left main coronary artery disease. The discriminatory power of all the algorithms was fair to good (area under receiver operating characteristic curve, 0.68, 0.75, 0.82, 0.85) in the test groups. The algorithm did not significantly underestimate or overestimate disease probability except in one center (Long Beach).(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

PubMed1989

[The use of a computer for the diagnosis of comatose states in diabetics (a differential diagnostic algorithm)].

An algorithm for differential diagnosis of comatose conditions in patients with diabetes mellitus has been devised. The algorithm is intended for the general practitioner and non-specialized department. The algorithm uses the minimum of the crucial signs of comatose conditions, ensuring their diagnosis under the conditions of any hospital. The algorithm can be applied to the recognition of the typical variants of comatose conditions in a "pure" form. The amount of algorithm steps is minimized. The program of differential diagnosis is written in the Fokal language and realized on the computer "Elektronika BK 0010". The program is run in the dialogue mode. The algorithm is used in clinical practice and in the training process, with its efficacy being independent of the professional skills of the user.

Algorithms↗

PubMed1989

Prediction of protein helices with a derivative of the strip-of-helix hydrophobicity algorithm.

The strip-of-helix hydrophobicity algorithm was devised to identify protein sequences which, when coiled as alpha or 3(10) helices, had one axial, hydrophobic strip and otherwise variably hydrophilic residues. The strip-of-helix hydrophobicity algorithm also ranked such sequences according to an index, the mean hydrophobicity of amino acids in the axial strip. This algorithm well predicted T cell-presented fragments of antigenic proteins. A derivative of this algorithm (the structural helices algorithm (SHA] was tested for the prediction of helices in crystallographically defined proteins. For the SHA, eight amino acid sequences, 2 cycles plus one amino acid in an alpha helix, with strip-of-helix hydrophobicity indices greater than 2.5, were selected with overlapping segments joined. These selections were terminated according to simple "capping rules," which took into account the roles of N-terminal Asn or Pro and C-terminal Gly in the stability of helices. In analyses of 35 crystallographically defined proteins with known alpha and 3(10) helices, the predictions with the SHA overlapped (had overlap indices x greater than or equal to 0.5) with 34% of known helices, touched (had overlap indices 0.5 greater than x greater than 0) or overlapped with 66% of known helices, or were neighboring (came within 6 residues) or touched or overlapped with 82% of known helices. At each level of judging the quality of prediction, the SHA was usually less sensitive (correct predictions/total number of known helices) and more efficient (correct predictions/total number of predictions) than the Chou-Fasman and Garnier-Robson methods. It was simpler in design and calculation. The chemical mechanisms underlying these algorithms appear to apply both to protein folding and to selection of T cell-presented antigenic sequences.

Algorithms↗

PubMed1994

[Development of clinical algorithms for quality assurance in management of multiple trauma].

Resuscitation and management of high-risk multiple trauma patients require a systematic and coordinated approach to diagnostic and therapeutic interventions. Clinical algorithms with branch chain decision logic can provide a clear and organized transformation of clinical standards for trauma care. Owing to their capability in formalization and standardization, algorithms define precisely the process of care and serve as a central interface within the system of quality assurance and quality control. The standardized document symbols and conventions for information processing according to ANSI/ISO/CCITT regulations are generally applied to the flowchart design of clinical algorithms. Special starting and ending point symbols make it possible to break down complex processes in several single interrelated algorithms. Inclusion of optional criteria checklists reduces the number of decision nodes and loops and minimizes the extent of a comprehensive algorithm. Clinical algorithms are an excellent tool for converting highly complex concepts of multiple trauma management into a logical, prioritized and systematic process of care.

Algorithms↗

PubMed1996

[Verification of accuracy of several algorithms to quantitate left ventricular regional wall motion: a study using cine MR imaging with myocardial tagging].

To verify the accuracy of several algorithms used to quantitate left ventricular (LV) regional wall motion, five volunteers were examined by cine MR imaging with presaturation myocardial tagging in short-axis and 4-chamber sections. Three algorithms for the wall motion analysis, radial, centerline, and originally developed "modified-Hildreth" methods, were applied to the cine MR images, and dissociation of the end-systolic position of the tags estimated by each algorithm from the true position was examined. The modified-Hildreth method was comparable in accuracy to the other methods for estimating end-systolic tag position. Significantly worse estimation of the tag position by the three algorithms occurred in the 4-chamber section compared with the short-axis section (p < 0.001, 0.005), indicating difficulties in the wall motion analysis of "long-axis" LV images. Among the algorithms, the centerline method showed the highest accuracy of the estimation in the 4-chamber section, and the modified-Hildreth method was the best in the short-axis section. In the 4-chamber section, correction of the position of end-diastolic and end-systolic images around the luminal centroids improved the estimation (p < 0.01, 0.05). Tagging cine MR imaging was proved to be useful for determining the most suitable algorithm for quantitative wall motion analysis of LV images obtained from conventional angiocardiography and other imaging modalities.

Adult↗

PubMed1996

A modified EM algorithm for estimation in generalized mixed models.

Application of the EM algorithm for estimation in the generalized mixed model has been largely unsuccessful because the E-step cannot be determined in most instances. The E-step computes the conditional expectation of the complete data log-likelihood and when the random effect distribution is normal, this expectation remains an intractable integral. The problem can be approached by numerical or analytic approximations; however, the computational burden imposed by numerical integration methods and the absence of an accurate analytic approximation have limited the use of the EM algorithm. In this paper, Laplace's method is adapted for analytic approximation within the E-step. The proposed algorithm is computationally straightforward and retains much of the conceptual simplicity of the conventional EM algorithm, although the usual convergence properties are not guaranteed. The proposed algorithm accommodates multiple random factors and random effect distributions besides the normal, e.g., the log-gamma distribution. Parameter estimates obtained for several data sets and through simulation show that this modified EM algorithm compares favorably with other generalized mixed model methods.

Algorithms↗

PubMed1984

Identification and estimation algorithm for stochastic neural system.

An algorithm for the estimation of stochastic processes in a neural system is presented. This process is defined here as the continuous stochastic process reflecting the dynamics of the neural system which has some inputs and generates output spike trains. The algorithm proposed here is to identify the system parameters and then estimate the stochastic process called neural system process here. These procedures carried out on the basis of the output spike trains which are supposed to be the data observed in the randomly missing way by the threshold time function in the neural system. The algorithm is constructed with the well-known Kalman filters and realizes the estimation of the neural system process by cooperating with the algorithm for the parameter estimation of the threshold time function presented previously (Nakao et al., 1983). The performance of the algorithm is examined by applying it to the various spike trains simulated by some artificial models and also to the neural spike trains recorded in cat's optic tract fibers. The results in these applications are thought to prove the effectiveness of the algorithm proposed here to some extent. Such attempts, we think, will serve to improve the characterizing and modelling techniques of the stochastic neural systems.

Animals↗

PubMed1978

Analysis of a cooperative stereo algorithm.

Marr and Poggio (1976) recently described a cooperative algorithm that solves the correspondence problem for stereopsis. This article uses a probabilistic technique to analyze the convergence of that algorithm, and derives the conditions governing the stability of the solution state. The actual results of applying the algorithm to random-dot stereograms are compared with the probabilistic analysis. A satisfactory mathematical analysis of the asymptotic behaviour of the algorithm is possible for a suitable choice of the parameter values and loading rules, and again the actual performance of the algorithm under these conditions is compared with the theoretical predictions. Finally, some problems raised by the analysis of this type of "cooperative" algorithm are briefly discussed.

Depth Perception↗

PubMed1994

Sensitivity and specificity of a dual-chamber arrhythmia recognition algorithm for implantable devices.

Present ventricular rate-based arrhythmia detection algorithms lack specificity. Using a training set of 109 endocardial electrogram recordings, a sensitive and specific dual-chamber arrhythmia recognition algorithm has been developed. The algorithm uses atrial and ventricular rates, irregularity, degree of beat-to-beat similarity, and measure of electrogram complex distinctiveness to arrive at a diagnostic conclusion. A test set of 121 endocardial electrogram recordings obtained during provocative electrophysiology studies was then used for blinded validation of the algorithm. In normal rhythm, 1:1 tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation, the percentages of sensitivity/specificity were, respectively, 100/99, 100/99, 80/99, 89/98, 91/97, 92/100, and 100/98. Although ventricular rate alone can usually distinguish normal rhythm, ventricular tachycardia, and ventricular fibrillation, it is confounded by atrial arrhythmias and 1:1 tachycardias. When tested on a database, a ventricular rate-only algorithm resulted in sensitivity/specificity of 100/65, 90/78, and 100/99%, respectively, for these three rhythms. Therefore, the dual-chamber algorithm based on both temporal and morphologic measures provides better distinction of normal rhythm and ventricular tachycardia than existing methods, without sacrificing sensitivity.

Arrhythmias, Cardiac↗

PubMed1979

Potential effect of self-care algorithms on the number of physician visits.

To assess the potential effect of self-care algorithms on the number of physician visits, actual visits from the Seattle Virus Watch were compared retrospectively with those recommended by clinical algorithms for common illnesses from the book, Take Care of Yourself, by Vickery and Fries. From a total of 3929 illnesses, records indicating the presence of the index symptom for eight algorithms were identified, determining whether the criteria for seeing a physician were met and whether a physician visit was recorded. The number of visits observed was compared to the number of visits recommended by the algorithms. Strict adherence would have increased the number of visits over that observed for five, remained the same for two, and decreased for one of the algorithms. These results indicate that adherence to some commonly promulgated self-care algorithms may increase rather than decrease the number of physician visits.

Activities of Daily Living↗