Lung Scan Research Articles

Cranial ultrasound image acquisition in a moving ambulance feasibility for pre-hospital EMS applications: A review of literature (P10-7.004)

<h3>Objective:</h3> Investigate available literature for the use of prehospital ultrasound for neurological indications. <h3>Background:</h3> Ultrasound is an invaluable resource for rapid diagnosis in the hospital setting. With the advent of handheld devices, it is an ideal imaging modality in the prehospital setting. It is affordable, easily placed on ambulances, and now within the scope of non-physician emergency medical providers. Data demonstrates that earlier intervention is key to improving patient outcomes with intracranial pathologies like hemorrhage. Ultrasound could play a vital role in the early detection and treatment of intracranial pathologies in the prehospital setting. <h3>Design/Methods:</h3> A systematic literature review was completed to find studies examining the role of point-of-care ultrasound in the prehospital setting for a neurological indication. Studies included those with human subjects that underwent ultrasound imaging. Imaging was completed by EMTs either in the field or while in transit to the hospital, by ambulance or helicopter. Studies where imaging was completed by someone other than an EMT in the field were excluded. <h3>Results:</h3> Ten studies met the inclusion criteria noted above. Only one demonstrated the use of ultrasound for a neurological indication. Nine studies showed EMTs were capable of providing consistent images in the field. One found lung scans acquired by EMTs inadequate. In all studies, images captured in the field were compared to repeat imaging by physicians in the hospital or standard hospital imaging modalities such as CT. Various methods were employed to educate EMTs on using and interpreting ultrasound, including lectures, pre and post-assessments, and ongoing education modules. <h3>Conclusions:</h3> Handheld ultrasound performed by EMTs in a moving ambulance is intuitive, accessible, and has been shown to be capable of providing consistent images. Further studies are needed to understand the potential application of ultrasound for neurological indications in the prehospital setting. <b>Disclosure:</b> Mr. Malinda has nothing to disclose. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Critical Care Medicine. The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Subject expert for thesis review with UNIVERSITY OF TECHNOLOGY . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Research participation in clinical trial funded by AHRQ with MEDSTAR HEALTH RESEARCH INSTITUTE . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker for CME event with Thomas Jefferson University . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Visiting Professor with University of Pittsburgh. Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities. Dr. Kapoor has nothing to disclose.

COVID-19 SECOND WAVE: EXPERIENCE OF CLINIC FOR LUNG DISEASE, UNIVERSITY CLINICAL CENTER TUZLA

The objective of this paper was to present basic clinical characteristics and outcomes of treating Covid 19 patients during the second wave of the pandemic. In the retrospective study for the period from September 2020 to February 2021 it was analyzed disease history data and radiological lung changes, time from the initial start of the disease until hospitalization, parameters of blood gas analysis, comorbidities, and the outcome. The research covered 409 patients, out of which 263 (64.3%) were males. Average age was 67.07± 12.44 years (min. 20; max. 93). A high comorbidities prevalence (82.9%) was noticed out of which arterial hypertension (69.2%), diabetes mellitus (37.7%) and obesity (24.7%). On the radiological lung scan the most noticed changes were consolidation (46.2%), “ground glass” (41.3%) and interstitial changes (13%). Bilateral lung infiltration was noticed in 91.9% of the patients. Average oxygen saturation was 84.29%±10.28% (min. 35; max. 98; med. 87%). In patients with unilateral lung infiltration, average oxygen saturation was 85.09%±8.60% (med. 89%, min.61% max 98%), while in patients with bilateral lung infiltration average was 84.22%±10.42% (med. 87%, min. 35%, max. 98%). From the total all patients’ death was noticed in 35.7% cases. Morbidity of patients with unilateral lung infiltration was 27.3% and in patients with unilateral infiltration 36.4%. Hospital admission in the first week of the disease indicates the severity of the clinical condition and can be a predictor of poor outcome. Bilateral pulmonary infiltration, obesity and diabetes mellitus are risk factors for high mortality.

Quantitative image analysis in COVID-19 acute respiratory distress syndrome: a cohort observational study.

Background Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury commonly associated with pneumonia, including coronavirus disease-19 (COVID-19). The resultant effect can be persistent lung damage, but its extent is not known. We used quantitative high resolution computed tomography (QHR-CT) lung scans to radiographically characterize the lung damage in COVID-19 ARDS (CARDS) survivors. Methods Patients with CARDS (N=20) underwent QHR-CT lung scans 60 to 90 days after initial diagnosis, while hospitalized at a long-term acute care hospital (LTACH). QHR-CT assessed for mixed disease (QMD), ground glass opacities (QGGO), consolidation (QCON) and normal lung tissue (QNL). QMD was correlated with respiratory support on admission, tracheostomy decannulation and supplementary oxygen need on discharge. Results Sixteen patients arrived with tracheostomy requiring invasive mechanical ventilation. Four patients arrived on nasal oxygen support. Of the patients included in this study 10 had the tracheostomy cannula removed, four remained on invasive ventilation, and two died. QHR-CT showed 45% QMD, 28.1% QGGO, 3.0% QCON and QNL=23.9%. Patients with mandatory mechanical ventilation had the highest proportion of QMD when compared to no mechanical ventilation. There was no correlation between QMD and tracheostomy decannulation or need for supplementary oxygen at discharge. Conclusions Our data shows severe ongoing lung injury in patients with CARDS, beyond what is usually expected in ARDS. In this severely ill population, the extent of mixed disease correlates with mechanical ventilation, signaling formation of interstitial lung disease. QHR-CT analysis can be useful in the post-acute setting to evaluate for interstitial changes in ARDS.

Point of Care Ultrasound (POCUS) Utilization and Barriers by Senior Emergency Medicine and Critical Care Residents at Two Teaching Referral Hospitals, Addis Ababa, Ethiopia.

POCUS has become an integral part of the practice of emergency medicine. POCUS is a highly focused, limited, goal-directed exam with the expressed purpose of answering selected questions used at the bedside for critically ill patients who are not stable. We aimed to assess POCUS utilization and barriers by senior-year emergency medicine and critical care residents at two tertiary academic and referral hospitals in Addis Ababa, Ethiopia. Methodology. A cross-sectional study was conducted from June 1 to August 30, 2022 in St Paul's Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital using an electronic survey of senior-year (second and third years) emergency medicine and critical care residents. Data were collected using Goggle form, exported to SPSS version 24, and then analyzed. Seventy-six residents out of 78 (97.4%) responded to the online survey. The mean age was 29.9 years with an SD of 2.87. Fifty-six residents (73.7%) were male and 45 (59.2%) were year 2 residents. Sixty-one (76.3%) had previous POCUS training. Fifty residents (82.0%) received training from the classroom. Twenty-seven residents (35.5%) rated their current level of knowledge as good for sterile transducer techniques, 28 (36.8%) rated fair for their knobology, and 27 (35.5%) rated very good for their transducer selection knowledge. Thirty-two (42.1%) rated very good about their ability to interpret IVC. 26 (34.2%) responded that they had good ability to interpret FAST/EFAST. Forty-nine (64.5%) residents claimed lack of an ultrasound machine followed by 33 (43.4%) lack of organized curriculum were the main barriers to POCUS utilization. Forty-two (55.3%) residents preferred to complete face-to-face teaching, while 33 (43.4%) preferred blended learning both face-to-face and online. POCUS is performed by the majority of EMCC residents. The most frequent scans performed by residents were FAST, IVC, and lung scans. Lack of ultrasound machine and organized curriculum was the main barrier to US utilization. Availability of equipment, face-to-face training, and having an organized curriculum are recommended by residents to improve their skills in the future.

Utility of 99mTc-MIBI myocardial perfusion imaging in the evaluation of cardiovascular complications in COVID-19 patients

The coronavirus disease is due to Acute Respiratory Syndrome Coronavirus2 (SARS-CoV-2). COVID-19 mainly affects the respiratory and immune systems and other organs like the cardiovascular and nervous systems, lungs, and kidneys (1). Several studies have reported COVID-19 patients with persistent symptoms for months after the initial phase. The most common symptoms are fatigue, headaches, cough, anosmia, arthralgia, and chest pain (2). Studies have shown this modality to diagnose, follow up, and evaluate response to treatment in chronic COVID-19 complications using 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT), pulmonary involvement with 99mTc-MAA perfusion lung scan, renal involvement with 99mTc-DTPA, and 99mTc-DMSA renal scintigraphy (3). Myocardial perfusion imaging with 99mTc-MIBI provides meaningful data to predict prognosis, risk of annual cardiac events, and evaluation of myocardium viability (4). Conventional SPECT Myocardial Perfusion Imaging (MPI) needs a viable metabolically active myocardial cell to extract the radiotracer. A review of articles shows that 99mTc-MIBI myocardial perfusion scintigraphy could be helpful in the timely acute myocardial infarction (MI) diagnosis and myocardial viability in COVID-19 patients. It is also beneficial in managing COVID-19 patients with heart failure by myocardial injury evaluation and choosing the best therapeutic choice, prognosis, and treatment response.

Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: a systematic review and meta-analysis of individual participant data

We aimed to assess the relationship between residual pulmonary vascular obstruction (RPVO) on planar lung scan after completion of at least 3 months of anticoagulant therapy for acute pulmonary embolism (PE) and the risk of recurrent venous thromboembolism (VTE) or death due to PE one year after treatment discontinuation. The systematic review was registered with the International Prospective Registry of Systematic Reviews (PROSPERO: CRD42017081080). The primary outcome measure was to generate a pooled estimate of the rate of recurrent VTE at one year in patient with RPVO diagnosed on planar lung scan after discontinuation of at least 3 months of anticoagulant treatment for an acute PE. Individual data were obtained for 809 patients. RPVO (ie, obstruction >0%) was found in 407 patients (50.3%) after a median of 6.6 months of anticoagulant therapy for a first acute PE. Recurrent VTE or death due to PE occurred in 114 patients (14.1%), for an annual risk of 6.4% (95% confidence interval, 4.7%-8.6%). Out of the 114 recurrent events, 63 occurred within one year after discontinuation of anticoagulant therapy corresponding to a risk of 8.1% (6.4%-9.8%) at 1 year. The risk of recurrent VTE at one year was 5.8% (4.4-7.2) in participants with RPVO <5%, vs 11.7% (9.5-13.8) in participants with RPVO ≥5%. RPVO is a significant predictor of the risk of recurrent venous thromboembolism. However, the risk of recurrent events remains too high in patients without residual perfusion defect for it to be used as a stand-alone test to decide on anticoagulation discontinuation.

Three Zone Scanning Protocol For Lung Ultrasound: An Anatomical Basis.

Lung ultrasound is rapidly gaining popularity based on point of care ease of use, diagnostic fidelity and lack of ionizing radiation. This was particularly notable at the beginning of the COVID-19 pandemic, where concerns of contamination of the x-ray department led to a reluctance to order frequent chest x-rays. Early COVID-19 lung involvement is of a bronchopneumonia, and patches of consolidation adjacent to the chest wall were easily detectable by ultrasound. A large number of proposed scanning protocols were advocated and are often complex and largely based on traditional stethoscope examination or access points on the chest wall rather than the underlying lung anatomy. A surgical understanding of lung anatomy and related surface anatomy has led us to develop a simplified three zone scanning protocol in 2013. The anterior zone corresponds to the upper lobe, and the posterior zone is divided between upper lobe and lower lobe. The relationship between lung lobes and the surface of the chest wall provides the anatomical basis for a simple three scanning zone lung ultrasound protocol.

Is the needle still needed? Relationship between laboratory features of pleural effusion and results of lung CT examinations in patients with pneumonia and lung cancer.

Thoracocentesis is an invasive procedure routinely performed in the diagnosis of causes for the presence of pathological fluid in the pleural cavity. In many patients, a computed tomography scanning (CT) is also performed to diagnose the cause of the presence of fluid in the pleural cavity. The diagnostic value of CT is particularly high in situations in which performing thoracocenthesis could be associated with an increased risk of complications. The aim other study was to assess the relationship between the objective radiological features and the results of laboratory tests of fluid collected by thoracocenthesis in patients with pneumo-nias (n=18) and lung cancer (n=35). The examined group consisted of the patients with pneumonia (n=18) and lung cancer (n=35) which resulted in the presence of fluid in the pleural cavity. In the patients thoracocentesis, CT lung scanning was also performed, according to the medical indications. Three scans with the greatest amount of fluid were identified, and the mean density of the fluid expressed in Hounsfield units was calculated within the area. These calculations were compared with the results of laboratory fluid tests. The maximum number of Hounsfield units (HU) was significantly lower in the group of lung cancer patients, compared to those diagnosed with pneumonia (74.3% sensi-tivity and 55.6% specificity). The pH of pleural fluid was significantly lower in patients with lung cancer, compared to those with pneumonia (74.3% sensitivity and 66.7% specificity). According to the results, radiological differentiation of pneumonia and lung cancer resulting in pleural effusion, to some extent is possible; however, the needle is still needed.

Analysis of lung scan imaging using deep multi‐task learning structure for Covid‐19 disease

AbstractCovid‐19 caused by the SARS‐CoV2 virus has become a pandemic all over the world. By growing in a number of cases, there is a need for clinical decision‐making system based on machine learning models. Most of the previous studies have examined only one task, while the detection and identification of infectious area are conducted simultaneously in the real world. Thus, the present study aims to propose a multi‐task model which can perform automatic classification‐segmentation for screening Covid‐19 pneumonia by using chest CT imaging. This model includes a common encoder for feature representation, one decoder for segmentation, and a multi‐layer perceptron for classification, respectively. The proposed model can evaluate three datasets, along with the effect of images size on the output of the model. The outputs were examined in both multi‐task and single‐task learning. The result indicates that the effect of multi‐task is significant in improving the results, which can increase the outputs of each task performance to 95.40% accuracy in classification and 95.40% in segmentation. Further, the model represented the highest results among the state‐of‐the‐art methods. The proposed model can be applied as a primary screening tool to help primary service staff in better referral of the suspected patients to specialists.

Opportunistic AI-enabled automated bone mineral density measurements in lung cancer screening and coronary calcium scoring CT scans are equivalent

Rationale and objectivesWe previously reported a novel manual method for measuring bone mineral density (BMD) in coronary artery calcium (CAC) scans and validated our method against Dual X-Ray Absorptiometry (DEXA). Furthermore, we have developed and validated an artificial intelligence (AI) based automated BMD (AutoBMD) measurement as an opportunistic add-on to CAC scans that recently received FDA approval. In this report, we present evidence of equivalency between AutoBMD measurements in cardiac vs lung CT scans. Materials and methodsAI models were trained using 132 cases with 7649 (3 mm) slices for CAC, and 37 cases with 21918 (0.5 mm) slices for lung scans. To validate AutoBMD against manual measurements, we used 6776 cases of BMD measured manually on CAC scans in the Multi-Ethnic Study of Atherosclerosis (MESA). We then used 165 additional cases from Harbor UCLA Lundquist Institute to compare AutoBMD in patients who underwent both cardiac and lung scans on the same day. ResultsMean±SD for age was 69 ± 9.4 years with 52.4% male. AutoBMD in lung and cardiac scans, and manual BMD in cardiac scans were 153.7 ± 43.9, 155.1 ± 44.4, and 163.6 ± 45.3 g/cm3, respectively (p = 0.09). Bland-Altman agreement analysis between AutoBMD lung and cardiac scans resulted in 1.37 g/cm3 mean differences. Pearson correlation coefficient between lung and cardiac AutoBMD was R2 = 0.95 (p < 0.0001). ConclusionOpportunistic BMD measurement using AutoBMD in CAC and lung cancer screening scans is promising and yields similar results. No extra radiation plus the high prevalence of asymptomatic osteoporosis makes AutoBMD an ideal screening tool for osteopenia and osteoporosis in CT scans done for other reasons.

COUNTERPOINT: Pulmonary Vascular Resistance 2.0— Shedding Light or Casting Shadows?

COUNTERPOINT: Pulmonary Vascular Resistance 2.0— Shedding Light or Casting Shadows?

Non-Invasive Assessment of Lung Water Content Using Chest Patch RF Sensors: A Computer Study Using NIH Patients CT Scan Database and AI Classification Algorithms

Chronic heart failure, pulmonary hypertension, acute respiratory distress syndrome (ARDS), coronavirus disease (COVID), and kidney failure are leading causes of death in the U.S. and across the globe. The cornerstone for managing these diseases is assessing patients’ volume fluid status in lungs. Available methods for measuring fluid accumulation in lungs are either expensive and invasive, thus unsuitable for continuous monitoring, or inaccurate and unreliable. With the recent COVID-19 epidemic, the development of a non-invasive, affordable, and accurate method for assessing lung water content in patients became utmost priority for controlling these widespread respiratory related diseases. In this paper, we propose a novel approach for non-invasive assessment of lung water content in patients. The assessment includes quantitative baseline assessment of fluid accumulation in lungs (normal, moderate edema, edema), as well as continuous monitoring of changes in lung water content. The proposed method is based on using a pair of chest patch radio frequency (RF) sensors and measuring the scattering parameters (S-parameters) of a 915-MHz signal transmitted into the body. To conduct an extensive computational study and validate our results, we utilize a National Institute of Health (NIH) database of computerized tomography (CT) scans of lungs in a diverse population of patients. An automatic workflow is proposed to convert CT scan images to three-dimensional lung objects in High-Frequency Simulation Software and obtain the S-parameters of the lungs at different water levels. Then a personalized machine learning model is developed to assess lung water status based on patient attributes and S-parameter measurements. Decision trees are chosen as our models for the superior accuracy and interpretability. Important patient attributes are identified for lung water assessment. A “cluster-then-predict” approach is adopted, where we cluster the patients based on their ages and fat thickness and train a decision tree for each cluster, resulting in simpler and more interpretable decision trees with improved accuracy. The developed machine learning models achieve areas under the receiver operating characteristic curve of 0.719 and 0.756 for 115 male and 119 female patients, respectively. These results suggest that the proposed “Chest Patch” RF sensors and machine learning models present a promising approach for non-invasive monitoring of patients with respiratory diseases.

Association of the Severity of Emphysema Based on HRCT Scoring System with Clinical Profile and Pulmonary Function Test Parameters: A Cross-sectional Study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is commonly observed in middle aged and elderly individuals. Dyspnoea, with or without expectoration, or isolated dyspnoea, is the primary respiratory symptom. Clinical signs, symptoms, and Pulmonary Function Tests (PFTs) are non specific. Chest radiography poorly correlates with disease severity and extent compared to clinical and functional impairment. High-Resolution Computed Tomography (HRCT) has been widely adopted to detect, characterise, and quantify emphysema. HRCT scoring is a useful radiological method for assessing emphysema severity in COPD patients and can provide prognostic information. Aim: To assess the severity of emphysema based on the HRCT scoring system and its association with clinical profile and PFTs. Materials and Methods: The present cross-sectional observational study was conducted in the Department of Radiodiagnosis at Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, New Delhi, India. It included 30 clinically diagnosed COPD patients referred for HRCT lung scans from November 1,2018, to March 31, 2020. HRCT assessment was performed at three levels: carina, 5 cm above carina, and 5 cm below carina. The severity of lung parenchyma was evaluated using the “Sakai Scoring Method.” The emphysema score was correlated with clinical profile (duration of illness, COPD severity, smoking, and pack-years smoked) and PFT parameters (FEV1, FEV1/FVC). Results: The mean age of the cases was 60±9.44 years. There was a strong positive linear correlation between the duration of illness (r=0.67, p=0.001) and COPD severity (r=0.452, p=0.02) with HRCT emphysema score. Significant correlation was found between HRCT emphysema score and pack-years smoked (r=0.558, p=0.004). The emphysema score showed an inverse correlation with FEV1 (r= -0.56, p=0.002) but no correlation with Forced Expiratory Volume 1 / Forced Vital Capacity (FEV1/FVC) (r= -0.16, p=0.430). Conclusion: The HRCT semi-quantitative scoring system is valuable for the initial assessment of disease severity and is significantly correlated with the PFT parameter FEV1.

Discussion

Discussion

Comparison of computed tomography in relation to ventilation perfusion scan in the diagnosis of pulmonary embolism

Abstract&#x0D; Introduction: Pulmonary embolism is still a challenge in diagnosis due to its variable and nonspecific symptoms. Computed tomography and ventilation/perfusion scanning are the modalities most commonly used in the diagnosis of pulmonary embolism, and both modalities have their advantages and disadvantages. One of the most important factors in the assessment and localization of pulmonary embolism is the diagnostic accuracy of these modalities, which serves to model different diagnostic strategies in the diagnosis of pulmonary embolism.&#x0D; Material and methods: The research was conducted as a review of professional literature available in scientific research databases. A selection of 20 professional papers was made, based on which an analysis was conducted and a database was formed. Criteria for inclusion in the research were scientific research papers that report on the sensitivity and specificity of diagnostic modalities of CT and V/P scanning as well as the results of diagnostic tests based on which the comparison of data from two modalities determined a diagnostically more accurate modality.&#x0D; Results: Sensitivity of 91.89% and specificity of 98.86% and diagnostic accuracy of 94.83% were determined in the case of computed tomography. Sensitivity of 90.58% and specificity of 98.33% and diagnostic accuracy of 96.43% were determined for the ventilation perfusion scanning method. We can conclude that the application of ventilation/perfusion scanning in the diagnosis of pulmonary embolism is a little more accurate compared to computed tomography.&#x0D; Conclusion: Ventilation/perfusion lung scanning will more accurately identify healthy individuals while on the other hand we can conclude that computed tomography is more accurate in diagnosing embolism in sick individuals. . Given that this difference between the two modalities is very small, the question is whether it is statistically significant at all. We can conclude that both diagnostic procedures have a high level of accuracy.

Rar liver tumour — epithelioid haemangioendothelioma: a case report

Abstract Epithelioid haemangioendothelioma (EHE) is a rare vascular soft tissue malignant tumour with unknown etiology; the estimated prevalence of EHE is less than one in 1 million. A 56-year-old man was admitted in our department due to pain in the right side of the abdomen lasting for two years and weight loss up to 10 kg. Since 2012, the patient underwent lung and abdominal CT scanning as well as biopsy, however the diagnosis was challenging. In 2015, repeated abdominal CT scanning and a liver core biopsy was performed. The epithelioid haemangioendothelioma was diagnosed based by histopathological examination with subsequent radiological and clinical correlation. Therefore, accurate histopathological examination with radiological and clinical correlation is essential in the diagnosis of epithelioid haemangioendothelioma.

Identifying the Effective Factors in the Death of Patients Receiving Convalescent Plasma

Background: Despite the fast spread of COVID-19 around the world, no definitive treatment has been found for the disease yet. Various drugs have been tried to reduce the mortality rate of the disease. In this regard, convalescent plasma therapy is a beneficial method to control the illness. Objective: This study aims to determine the outcomes of patients receiving this therapy in Bu-Ali Hospital, Qazvin, Iran. Methods: The present study is a case series of 60 samples. The samples were selected by purposive sampling method. The study was conducted after ethical approval and patients’ consent in 2020. The inclusion criteria were having a lung scan confirming the disease by an internist or infectious disease specialist, a positive PCR test, and a history of receiving plasma during treatment. Results: Out of 60 patients with COVID-19 who received convalescent plasma, 33 (55%) survived. The findings indicate that patients who received plasma and died were not significantly different from surviving patients regarding age, sex, underlying disease, and length of hospital stay (P&gt;0.05). However, there was a significant difference between the deceased and surviving patients regarding plasma receiving time (P=0.005). Conclusion: If the convalescent plasma therapy of patients starts closer to the time of admission, the effect of therapy on reducing patient mortality will be greater.

Performance and Feasibility of Therapeutic Vibrating Mesh Nebulizer for Ventilation Lung Scan

PurposeThis study aimed to evaluate the performance of a therapeutic vibrating mesh-type nebulizer for the pulmonary delivery of radioaerosols for lung scintigraphy in healthy subjects.MethodsSix healthy subjects (mean age of 28.7 ± 6.2 years) inhaled 2 mL Tc-99m diethylenetriaminepentaacetic acid and normal saline solution (20 mCi) via a therapeutic vibrating mesh-type nebulizer (DK010, DELBio, Taipei, Taiwan). The nebulizer’s mass median aerodynamic diameter was between 2.3 and 5.0 µm (3.47 ± 0.37 µm), and the nebulization rate was greater than 0.2 mL/min. Scintigraphy was performed to count radioaerosols in the regions of interest to determine the total and regional lung deposition and extrathoracic airway deposition of aerosols, penetration of aerosols, and radioactivity count balance (RCB).ResultsThe total lung depositions of aerosols were 21.2% ± 5.2% (% ex-valve dose), 27.4% ± 8.0% (% ex-device dose), and 13.8% ± 4.1% (% initial dose) in the nebulizer. The extrathoracic airway deposition was 4.8% ± 1.1%. The RCB was 5.4% ± 3.0%. The ratio of outer over inner lung deposition (O/I ratio, or penetration index) was 1.89 ± 0.55.ConclusionThe delivery efficiency and penetration of aerosols to the peripheral lung, which were achieved by the DELBio DK010 vibrating mesh-type nebulizer, were similar to the commercialized jet-type nebulizers dedicated for radioaerosol lung scintigraphy nebulizer. The therapeutic vibrating mesh-type nebulizer (DELBio DK010) is feasible for radionuclide lung ventilation scintigraphy.

Reduction in radioactive internal contamination by 99mTc among medical personnel in nuclear medicine facilities with the use of respiratory tract protection measures

The main objective of the present publication was to assess the reduction of internal radioactive contamination with 99mTc among medical personnel of nuclear medicine facilities using generally available respiratory tract protection systems. During the current research project, four respiratory tract protection systems were tested by estimation of 99mTc activity levels in blood samples collected from medical personnel. Medical staff were equipped with a disposable surgical mask, a half mask with gas absorbers, a half mask with aerosol absorbers and a half mask with gas absorbers with added Petryanov filter. The presented results indicate that wearing only a disposable surgical mask may significantly reduce radioactive internal contamination among medical personnel and improve their safety in the workplace. The best results of reduced 99mTc concentration in the blood were achieved by the use of a half mask with gas absorbers with added Pertryanov filters and a half mask with aerosol absorbers, where the reduction factors were estimated at 90% and 80%, respectively. Respiratory tract protection systems should become standard equipment for medical personnel performing ventilation–perfusion SPECT lung scans.

Dlung: Unsupervised Few-Shot Diffeomorphic Respiratory Motion Modeling.

Lung image registration plays an important role in lung analysis applications, such as respiratory motion modeling. Unsupervised learning-based image registration methods that can compute the deformation without the requirement of supervision attract much attention. However, it is noteworthy that they have two drawbacks: they do not handle the problem of limited data and do not guarantee diffeomorphic (topology-preserving) properties, especially when large deformation exists in lung scans. In this paper, we present an unsupervised few-shot learning-based diffeomorphic lung image registration, namely Dlung. We employ fine-tuning techniques to solve the problem of limited data and apply the scaling and squaring method to accomplish the diffeomorphic registration. Furthermore, atlas-based registration on spatio-temporal (4D) images is performed and thoroughly compared with baseline methods. Dlung achieves the highest accuracy with diffeomorphic properties. It constructs accurate and fast respiratory motion models with limited data. This research extends our knowledge of respiratory motion modeling.