Medical Diagnostic Imaging Research Articles

MEDICAL DIAGNOSTIC IMAGING SYSTEM, INFORMATION PROCESSING METHOD FOR MEDICAL DIAGNOSTIC IMAGING SYSTEM, ULTRASONIC IMAGING DIAGNOSTIC APPARATUS, AND OPERATION DEVICE

Provided is a medical diagnostic imaging system in which user information can be easily and efficiently moved (transferred) among a plurality of ultrasonic imaging diagnostic apparatuses. The medical diagnostic imaging system includes: a plurality of ultrasonic imaging diagnostic apparatuses each including a recording unit for recording user information registered by a user, the user information including work flow data for guiding at least an operation procedure of the ultrasonic imaging diagnostic apparatus, and execution means for executing this user information; and user information transfer means configured to be able to communicate with the ultrasonic imaging diagnostic apparatuses, for transferring the user information recorded on the recording means of a predetermined one of the ultrasonic imaging diagnostic apparatuses to the recording means of a different one of the ultrasonic imaging diagnostic apparatuses by way of a communication.

MEDICAL IMAGE DIAGNOSTIC DEVICE

A medical diagnostic imaging apparatus is provided that is capable of accurately tracking motions of a moving organ that moves periodically over a plurality of periods. The medical diagnostic imaging apparatus includes a matching computation unit for performing a matching computation between a template extracted containing a tracking point on one image and another image, and a template extracting unit for extracting, from the other image, a region correlated with the template as a template of the other image by the matching computation, whereby a movement of the tracking point is tracked based on the extracted template. The template extracting unit extracts, as a key template, a region containing one or more tracking points set on an image at least one time phase within a motion cycle of the moving organ. The matching computation unit performs the matching computation using the key template in the vicinity of the time phase at which the key template is extracted.

System of telesonography with synchronous teleconsultations and asynchronous telediagnoses (Togo)

Objectif. Concevoir un systeme de tele-expertise echographique, en temps reel et a bas prix, et de telediagnostic echographique en differe, entre un centre expert (CHU) et un site isole (hopitaux peripheriques et dispensaires). Materiels et methodes. Un systeme de communication via Internet transferant des videos echographiques et d’ambiance entre les deux sites permet une tele-expertise en temps reel, en presence d’un echographiste peu experimente sur le site isole. Si le site isole ne dispose pas d’echographiste, un operateur non initie realise une capture volumique par mouvements de tilt de ± 40 par rapport a la verticale avec une sonde echographique en deux dimensions (2D) en se servant d’une cartographie de localisation des fenetres acoustiques. Un programme de reconstruction tridimensionnelle (3D) original permet a l’expert de naviguer dans le volume d’image envoye par le centre isole pour un telediagnostic en differe. Resultats. Le systeme a ete teste entre le CHR Tsevie (Togo) et les CHU experts de Campus (Lome, Togo) et de Trousseau (Tours, France) avec une connexion Internet moyenne de 2 Mbps. Une tele-expertise en temps reel etait realisee a partir des videos echographiques de qualite tres satisfaisante acheminees avec un delai maximal de 1,5 s. Un telediagnostic echographique en differe etait aussi realise avec des resultats satisfaisants. Conclusion. Ce systeme de tele-echographie necessitant une infrastructure peu onereuse, et presentant des resultats preliminaires satisfaisants, constitue une methode de telemedecine, utilisable tant dans les pays developpes que dans les pays en developpement.

Natural convection cooling for LEU irradiated fuel plates

The important thermal hydraulic limiting phenomena were studied during the natural convection cooling of a proposed irradiated Low Enriched Uranium (LEU) plate’s target. The irradiated LEU targets are used for the production of the medical isotope Molybdenum-99 (Mo-99), whose decay product, Technetium-99 (Tc-99), is used in the majority of medical diagnostic imaging procedures. After finishing the stage of irradiation for the LEU targets, they reach a high level of radioactivity, so the direct handling and maneuvering for these targets at that time becomes quite difficult. The targets should stay for a period of time for decay and cooling either at the reactor core situation or at a special basket inside the reactor main pool. This parametric study was performed to verify the thermal–hydraulic limiting phenomena (Onset of Nucleate Boiling, Pulsed Boiling Power ration, Onset of Net Vapor Generation and Burn-out Power ratio) during the natural convection cooling against the different power ratio of the irradiated plate (plate decay power at the establishment of natural convection regime to the steady state plate operational full power during the irradiation). The study was performed at two different positions, namely inside the reactor core with a long chimney, and in a storage basket. Half load and full load were considered, and both of these possibilities were discussed and analyzed with considering different power ratios. All the limiting phenomena satisfy the safety margins except the ONBR. The ONBR requires certain conditions to satisfy the safety margin.

Unintended Consequences of Health Care Legislation

Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders.

Clinical outcome following pneumonectomy for management of chronic pyothorax in four cats

Pneumonectomy is the resection of all lung lobes from one side of the thorax. The clinical findings, treatment and outcome of four cases of feline chronic pyothorax managed with exploratory thoracotomy and pneumonectomy are reported. All cases were initially medically managed with thoracic drain placement and antibiosis. However, resolution was not achieved with medical therapy and diagnostic imaging findings consistent with an area of abscessation or marked lung lobe consolidation were identified, supporting a decision for surgical management. Surgical exploration was performed via median sternotomy and, on the basis of gross inspection, non-functional lung was removed. A left-sided pneumonectomy was performed in three cats and a right-sided pneumonectomy in one. All cases survived to discharge and an excellent quality of life was reported on long-term follow-up. Pneumonectomy appears to be well tolerated in the cat.

Chromosomal microarray testing influences medical management

PurposeChromosomal microarray (CMA) testing provides the highest diagnostic yield for clinical testing of patients with developmental delay (DD), intellectual disability (ID), multiple congenital anomalies (MCA), and autism spectrum disorders (ASD). Despite improved diagnostic yield and studies to support cost-effectiveness, concerns regarding the cost and reimbursement for CMA have been raised because it is perceived that CMA results do not influence medical management. MethodsWe conducted a retrospective chart review of CMA testing performed during a 12-month period on patients with DD/ID, ASD, and congenital anomalies to determine the proportion of cases where abnormal CMA results impacted recommendations for clinical action. ResultsAmong 1792 patients, 13.1% had clinically relevant results, either abnormal (n = 131; 7.3%) or variants of possible significance (VPS; n = 104; 5.8%). Abnormal variants generated a higher rate of recommendation for clinical action (54%) compared with VPS (34%; Fisher exact test, P = 0.01). CMA results influenced medical care by precipitating medical referrals, diagnostic imaging, or specific laboratory testing. ConclusionsFor all test indications, CMA results influenced medical management in a majority of patients with abnormal variants and a substantial proportion of those with VPS. These results support the use of CMA as a clinical diagnostic test that influences medical management for this patient population.

OpenITGLinkMUSiiC: A Standard Communications Protocol for Advanced Ultrasound Research

Ultrasound imaging is the most popular and safe diagnostic medical imaging modality. Over the past years, a considerable number of studies have been conducted on new medical ultrasound imaging modalities such as ultrasound-based elasticity imaging, photoacoustic imaging, thermal imaging, etc. Moreover, results of such advanced ultrasound research are readily integrated with Image Guided Therapy (IGT) systems due to the advantages of ultrasound imaging such as mobility and real-time data acquisition. For integrating two systems, a communication method between systems has to be devised. OpenIGTLink is a standardized TCP/IP-based protocol for the integration of medical imaging and IGT systems. However, OpenIGTLink is not sufficient for communicating between IGT and advanced ultrasound research systems, because OpenIGTLink does not define any message type for general ultrasound data and some results of ultrasound researching. In this paper, we propose an extension to OpenIGTLink, called OpenIGTLinkMUSiiC, by adding new message types and new network classes. Our new message types are designed for containing raw ultrasound data, advanced ultrasound modalities, and text-based control parameters. The network classes of OpenIGTLinkMUSiiC improve upon the performance of existing network classes by implementing a multithread architecture. Finally, we present two ultrasound research applications using OpenIGTLink-MUSiiC.

Approach to the Thyroid Cancer Patient with Bone Metastases

Thyroid cancer incidence has been increasing for decades in the United States (1, 2). There are known risk factors for thyroid cancer including female gender, advancing age, family history, and radiation exposure, but none of these can fully explain the changing pattern of this disease over such a short period of time. Much of the rise has been attributed to increased medical surveillance, diagnostic imaging, and ultrasound-guided fine-needle aspiration (FNA), but this probably does not explain the entire observed upsurge. With increased evaluation of patients in an asymptomatic stage, it might be expected that the highest rate of increase would be seen in tumors of less than 1.0 cm, but incidence has also been increasing for tumors of any size, especially tumors at least 4 cm among men and women and for distant metastases among men (3). The more frequent diagnosis of late stage disease has led to the rising occurrence of differentiated thyroid carcinoma and bone metastases, even as the initial presentation of disease. It is suspected that a combination of environmental factors, iodine deficiency, and genetic factors (i.e. BRAF mutations) may explain the rising incidence of differentiated thyroid cancer, particularly more aggressive, late stage disease (4, 5).

White Paper Report of the 2010 RAD-AID Conference on International Radiology for Developing Countries: Identifying Sustainable Strategies for Imaging Services in the Developing World

The 2010 RAD-AID Conference on International Radiology for Developing Countries was a multidisciplinary meeting to discuss data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services reduce health care quality. The theme of this year's conference was sustainability, with a focus on establishing and maintaining imaging services in resource-limited regions. Conference presenters and participants identified 4 important components of sustainability: (1) sustainable financing models for radiology development, (2) integration of radiology and public health, (3) sustainable clinical models and technology solutions for resource-limited regions, and (4) education and training of both developing and developed world health care personnel.

Development of a Gamma-Ray Process Tomography System for Hydrodynamic Characterisation of Multiphase Reactors

Gamma-ray computed tomography (CT) is a powerful non-invasive imaging technique for viewing an object in 2-D or 3-D cross-section images without the need to physically section it. The invention of CT technique revolutionised the field of medical diagnostic imaging because it provides more detailed and useful information than any previous non-invasive imaging technique. The method is increasingly used in industrial fields. This paper describes the development of a gamma-ray computed tomography system for imaging and visualising of industrial multiphase reactors. The theoretical aspects of CT scanner, the system configurations and the adopted algorithm for image reconstruction are discussed. Penetrating radiation from an isotopic gamma-ray source of Cs-137 and a bank of NaI(Tl) scintillation detectors in combination with a dedicated mechanical gantry set-up were used to construct the CT system. During scanning, the movement of the detector’s bank and rotation table is controlled by a LabView-based software. The software is also designed to control all associated nuclear electronics equipments and finally to acquire gamma-ray transmission data. The image reconstruction is performed by using Expectation-Maximisation (EM) and Alternating-Maximisation (AM) algorithms written in Visual-Fortran programming language. Several physical phantoms to simulate industrial multiphase process columns and reactors were scanned using this CT scanner. Some of the reconstructed images are presented in this paper.

WE‐B‐110‐02: Diagnostic Exposure Tracking in the Medical Record

The Electronic Medical Record (EMR) represents the collection of diagnostic tests and procedural test information related to an individual patientˈs history of care at a health center. In the context of medical diagnostic imaging, this relates to the access to imaging procedures, the written diagnoses from the imaging experts, and of increasing relevance and importance, the radiation dose reports for the procedures. The EMR is also emerging as the gateway for computerized order entry for imaging exams, in which the imaging history and accumulated radiation dose will be made available for the referring physician from various imaging procedures, such as interventional radiology and cardiology, computed tomography, and nuclear medicine. Integrating the Healthcare Enterprise (IHE) Radiation Exposure Monitoring (REM) profile specifies how information related to dose can be extracted from modalities that are compliant with the DICOM Radiation Dose Structured Report (RDSR). However, once the information is collected via the RDSR, appropriate steps must be taken to parse the data according to exam types, body area scanned, and dose metrics provided in order to apply conversion factors to estimate an effective dose for a procedure. Effective dose estimates can be considerably under or overestimated, depending on the modality, the patient size, machine calibration errors, and a host of issues that are under current investigation. In this presentation, a review of the various dose metrics for the modalities is discussed, as are current methods to calculate the effective dose. Ultimately, to post the dose information in the EMR, a dose‐management actor described by the IHE REM profile captures the pertinent dose information from each modality and study, parses the data and computes the effective dose according to defined conversion methods. Each individual dose report message transmitted to the EMR is stored in the patient dose report file defined by medical record number, which updates the dose index raw data (e.g., DAP in Interventional radiology, CTDIvol, DLP in CT), the calculated effective dose per procedure, and total cumulative effective dose for the patient.Learning objectives:1. Understand the various dose metrics produced by the imaging modalities.2. Determine how effective dose can be estimated for a given procedure with the dose index values provided by a modality.3. Understand limitations of effective dose calculations, the wide range of under/over estimates that can occur for a specific procedure, and the limitations of the total cumulative patient effective dose.

Biomarkers of DNA Damage: A Topic and Patent Review

The integrity of the human genome is threatened by DNA damaging agents, particularly ionizing radiation, which induces potentially lethal double strand breaks. Ionizing radiation is of particular concern given its increasing use in medical diagnostic imaging and given the risk of radiological attack or exposure from nuclear reactor accidents. As biological responses to DNA damage have been elucidated, numerous biomarkers have emerged to potentially serve as biodosimeters of radiation exposure and effects. A brief background on the need for biodosimeters of DNA damage and of the DNA damage response is included. DNA damage biomarkers have many possible applications, including monitoring patients and health care workers exposed in diagnostic imaging, monitoring effectiveness and recovery in patients receiving chemotherapy and/or radiation therapy to inform dosing and scheduling, and establishing individual exposure in populations exposed to a radiological hazard. Recent patents on biomarkers of DNA damage discussed in this review include: antibody based tests of proteins modified in response to DNA damage; RNA and protein marker profiles identified from analysis of genome-wide expression and metabolite screens; and genetic markers of damage sensitivity. Applications, advantages and limitations of each biomarker are discussed.

Decreasing Unnecessary Radiation Exposure for Children

Today there are several methods of medical diagnostic imaging. These include radiography (sometimes called x-rays), computed tomography (sometimes called CT scans), fluoroscopy, and nuclear medicine scans.

Pediatric Inflammatory Bowel Disease and Imaging‐related Radiation: Are We Increasing the Likelihood of Malignancy?

Increasing use of diagnostic radiography has led to concern about the malignant potential of ionizing radiation. We aimed to quantify the cumulative effective dose (CED) from diagnostic medical imaging in children with inflammatory bowel disease (IBD) and to identify which children are at greatest risk for high amounts of image-related radiation exposure. A retrospective chart review of pediatric IBD patients seen between January 1 and May 30, 2008 was conducted. The effective dose of radiation received from all of the radiology tests performed during the course of each patient's treatment was estimated using typical effective doses and our institution's computed tomography dose index. A CED ≥50 mSv was considered high. Complete records were available for 257 of 372 screened subjects. One hundred seventy-one had Crohn disease (CD) and 86 had ulcerative colitis (UC). The mean CED was 17.56 ± 15.91 mSv and was greater for children with CD than for those with UC (20.5 ± 17.5 vs 11.7 ± 9.9 mSv, P < 0.0001). Fifteen children (5.8%) had a CED ≥50 mSv, including 14 of 171 (8.2%) with CD and 1 of 86 (1.2%) with UC (P = 0.02). In children with CD, factors associated with high CED per multivariate analysis were any IBD-related surgery (odds ratio 42, 95% confidence interval 8-223, P < 0.0001) and platelet count (odds ratio 16, 95% confidence interval 1.5-175, P = 0.02). Although all doses of ionizing radiation have some malignancy-inducing potential, a small but important percentage of children with IBD are exposed to particularly high doses of ionizing radiation from diagnostic tests and procedures. Physicians caring for such patients must seek to limit radiation exposure whenever possible to lessen the lifetime risk of malignancy.

Application of Nanoparticles in Diagnostic Imaging via Ultrasonography

The effectiveness of an imaging technique not only depends on its ability to image quantitatively both morphological and physiological functions of the tissue, but also on the contrast agent used to communicate with biomolecules. Several types of contrast media are used in medical imaging and they can roughly be cataloged based on the imaging modalities where they are used. More importantly, the use of contrast agent withtheir size ranging in nanometer scale has become general practice in medical diagnosis. As the matter of fact, nanoparticles have fascinated scientist for over a century and are now heavily utilized in biomedical sciences and engineering as they are long known to communicate effectively with the biomolecules. Today these materials can be synthesized and modified with various chemical functional groups which allow them to be conjugated with antibodies, ligands, and drugs of interest and thus opening a wide range of potential applications in biotechnology, and more importantly in diagnostic medical imaging viaultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). These imaging modalities differ not only in resolution, but also in the instrumentation and the type of nanoparticle that can be employed as its assistant. Of these imaging techniques, ultrasound is one of the oldest imaging modalitywhich is still widely used to examine internal organs of the body and diagnose potential disease states such as cancer, plague, clots, and swelling. Various articles have been published over the period of years detailing the instrumentation and the applications of ultrasonography, but very few have emphasized the importance of particle size indeveloping a successful contrast agent for ultrasonography. Thus in the present review article we aim to present the basic principles involved in developing successful contrast agent for Ultrasound imaging. Furthermore, we have also discussed the experimental and physical aspects of various types of nanoparticles including its fabrication and design oftargeted contrast agents. Finally, we have cited some of the best biomedical and clinical applications of the developed nanoprobes and their use for Ultrasound imaging.

Whole mouse blood microRNA as biomarkers for exposure to 𝛄-rays and 56Fe ions

Purpose: Biomarkers of ionising radiation exposure are useful in a variety of scenarios, such as medical diagnostic imaging, occupational exposures, and spaceflight. This study investigates to what extent microRNA (miRNA) expression signatures in mouse peripheral blood can be used as biomarkers for exposures to radiation with low and high linear energy transfers.Materials and methods: Mice were irradiated with doses of 0.5, 1.5, or 5.0 Gy γ-rays (dose rate of 0.0136 Gy/s) or with doses of 0.1 or 0.5 Gy 56Fe ions (dose rate of 0.00208 Gy/s). Total RNA was isolated from whole blood at 6 h or 24 h after irradiation. Three animals per irradiation condition were used. Differentially expressed miRNA were determined by means of quantitative real-time polymerase chain reaction.Results: miRNA expression signatures were radiation type-specific and dose- and time-dependent. The differentially expressed miRNA were expressed in either one condition (71%) or multiple conditions (29%). Classifiers based on the differentially expressed miRNA predicted radiation type or dose with accuracies between 75% and 100%. Gene-ontology analyses show that miRNA induced by irradiation are involved in the control of several biological processes, such as mRNA transcription regulation, nucleic-acid metabolism, and development.Conclusion: miRNA signatures induced by ionising radiation in mouse blood are radiation type- and radiation dose-specific. These findings underline the complexity of the radiation response and the importance of miRNA in it.

Cervical vertebral canal endoscopy in the horse: Intra- and post operative observations

Despite modern medical diagnostic imaging, it is not possible to identify reliably the exact location of spinal cord compression in horses with cervical vertebral stenotic myelopathy (CVSM). Vertebral canal endoscopy has been successfully used in man and a technique for cervical vertebral canal endoscopy (CVCE) has been described in equine cadavers. To determine the feasibility and safety of CVCE in healthy mature horses. Six healthy mature horses were anaesthetised. A flexible videoendoscope was subsequently introduced via the atlanto-occipital space into the epidural space (epiduroscopy, Horses 1-3) or the subarachnoid space (myeloscopy, Horses 4-6) and advanced to the 8th cervical nerve. Neurological examinations were performed after surgery and lumbosacral cerebrospinal fluid (CSF) analysed in horses that had undergone myeloscopy. All procedures were completed successfully and all horses recovered from anaesthesia. Anatomical structures in the epidural space (including the dura mater, nerve roots, fat and blood vessels) and subarachnoid space (including the spinal cord, blood vessels, arachnoid trabeculations, nerve roots and the external branch of the accessory nerve) were identified. During epiduroscopy, a significant increase in mean arterial pressure was recognised, when repeated injections of electrolyte solution into the epidural space were performed. In one horse of the myeloscopy group, subarachnoid haemorrhage and air occurred, resulting in transient post operative ataxia and muscle fasciculations. No complications during or after myeloscopy were observed in the other horses. CSF analysis indicated mild inflammation on Day 7 with values approaching normal 21 days after surgery. Endoscopic examination of the epidural and subarachnoid space from the atlanto-occipital space to the 8th cervical nerve is possible and can be safely performed in healthy horses. Cervical vertebral canal endoscopy might allow accurate identification of the compression site in horses with CVSM and aid diagnosis of other lesions within the cervical vertebral canal.

Improvement of radiology services based on the process management approach

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements.

Use of Medical Imaging Procedures With Ionizing Radiation in Children

To determine population-based rates of the use of diagnostic imaging procedures with ionizing radiation in children, stratified by age and sex. Retrospective cohort analysis. All settings using imaging procedures with ionizing radiation. Individuals younger than 18 years, alive, and continuously enrolled in UnitedHealthcare between January 1, 2005, and December 31, 2007, in 5 large US health care markets. Number and type of diagnostic imaging procedures using ionizing radiation in children. A total of 355 088 children were identified; 436 711 imaging procedures using ionizing radiation were performed in 150 930 patients (42.5%). The highest rates of use were in children older than 10 years, with frequent use in infants younger than 2 years as well. Plain radiography accounted for 84.7% of imaging procedures performed. Computed tomographic scans-associated with substantially higher doses of radiation-were commonly used, accounting for 11.9% of all procedures during the study period. Overall, 7.9% of children received at least 1 computed tomographic scan and 3.5% received 2 or more, with computed tomographic scans of the head being the most frequent. Exposure to ionizing radiation from medical diagnostic imaging procedures may occur frequently among children. Efforts to optimize and ensure appropriate use of these procedures in the pediatric population should be encouraged.