Browsing by Subject "Tomography"

Now showing 1 - 5 of 5
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    Derivation of a screening tool to identify patients with right ventricular dysfunction or tricuspid regurgitation after negative computerized tomographic pulmonary angiography of the chest
    (University of Chicago Press Journals, 2015-03) Kline, Jeffrey A.; Russell, Frances M.; Lahm, Tim; Mastouri, Ronald A.; Department of Medicine, IU School of Medicine
    Many dyspneic patients who undergo computerized tomographic pulmonary angiography (CTPA) for presumed acute pulmonary embolism (PE) have no identified cause for their dyspnea yet have persistent symptoms, leading to more CTPA scanning. Right ventricular (RV) dysfunction or overload can signal treatable causes of dyspnea. We report the rate of isolated RV dysfunction or overload after negative CTPA and derive a clinical decision rule (CDR). We performed secondary analysis of a multicenter study of diagnostic accuracy for PE. Inclusion required persistent dyspnea and no PE. Echocardiography was ordered at clinician discretion. A characterization of isolated RV dysfunction or overload required normal left ventricular function and RV hypokinesis, or estimated RV systolic pressure of at least 40 mmHg. The CDR was derived from bivariate analysis of 97 candidate variables, followed by multivariate logistic regression. Of 647 patients, 431 had no PE and persistent dyspnea, and 184 (43%) of these 431 had echocardiography ordered. Of these, 64 patients (35% [95% confidence interval (CI): 28%-42%]) had isolated RV dysfunction or overload, and these patients were significantly more likely to have a repeat CTPA within 90 days (P = .02, [Formula: see text] test). From univariate analysis, 4 variables predicted isolated RV dysfunction: complete right bundle branch block, normal CTPA scan, active malignancy, and CTPA with infiltrate, the last negatively. Logistic regression found only normal CTPA scanning significant. The final rule (persistent dyspnea + normal CTPA scan) had a positive predictive value of 53% (95% CI: 37%-69%). We conclude that a simple CDR consisting of persistent dyspnea plus a normal CTPA scan predicts a high probability of isolated RV dysfunction or overload on echocardiography.
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    Differences in Prognostic Value of Myocardial Perfusion SPECT using High-Efficiency Solid-State Detector Between Men and Women in a Large International Multi-Center Study
    (American Heart Association, 2022) Tamarappoo, Balaji K.; Otaki, Yuka; Sharir, Tali; Hu, Lien-Hsin; Gransar, Heidi; Einstein, Andrew J.; Fish, Mathews B.; Ruddy, Terrence D.; Kaufmann, Philipp; Sinusas, Albert J.; Miller, Edward J.; Bateman, Timothy M.; Dorbala, Sharmila; Di Carli, Marcelo; Eisenberg, Evann; Liang, Joanna X.; Dey, Damini; Berman, Daniel S.; Slomka, Piotr J.; Medicine, School of Medicine
    Background: Semiquantitative assessment of stress myocardial perfusion defect has been shown to have greater prognostic value for prediction of major adverse cardiac events (MACE) in women compared with men in single-center studies with conventional single-photon emission computed tomography (SPECT) cameras. We evaluated sex-specific difference in the prognostic value of automated quantification of ischemic total perfusion defect (ITPD) and the interaction between sex and ITPD using high-efficiency SPECT cameras with solid-state detectors in an international multicenter imaging registry (REFINE SPECT [Registry of Fast Myocardial Perfusion Imaging With Next-Generation SPECT]). Methods: Rest and exercise or pharmacological stress SPECT myocardial perfusion imaging were performed in 17 833 patients from 5 centers. MACE was defined as the first occurrence of death or myocardial infarction. Total perfusion defect (TPD) at rest, stress, and ejection fraction were quantified automatically by software. ITPD was given by stressTPD-restTPD. Cox proportional hazards model was used to evaluate the association between ITPD versus MACE-free survival and expressed as a hazard ratio. Results: In 10614 men and 7219 women, with a median follow-up of 4.75 years (interquartile range, 3.7-6.1), there were 1709 MACE. In a multivariable Cox model, after adjusting for revascularization and other confounding variables, ITPD was associated with MACE (hazard ratio, 1.08 [95% CI, 1.05-1.1]; P<0.001). There was an interaction between ITPD and sex (P<0.001); predicted survival for ITPD<5% was worse among men compared to women, whereas survival among women was worse than men for ITPD≥5%, P<0.001. Conclusions: In the international, multicenter REFINE SPECT registry, moderate and severe ischemia as quantified by ITPD from high-efficiency SPECT is associated with a worse prognosis in women compared with men.
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    Monte Carlo Simulation to Study Propagation of Light through Biological Tissues
    (2012-09-20) Prabhu Verleker, Akshay; Berbari, Edward J.; Stantz, Keith; Yoshida, Ken
    Photoacoustic Imaging is a non-invasive optical imaging modality used to image biological tissues. In this method, a pulsating laser illuminates a region of tissues to be imaged, which then generates an acoustic wave due to thermal volume expansion. This wave is then sensed using an acoustic sensor such as a piezoelectric transducer and the resultant signal is converted into an imaging using the back projection algorithm. Since different types of tissues have different photo-acoustic properties, this imaging modality can be used for imaging different types of tissues and bodily organ systems. This study aims at quantifying the process of light conversion into the acoustic signal. Light travels through tissues and gets attenuated (scattered or absorbed) or reflected depending on the optical properties of the tissues. The process of light propagation through tissues is studied using Monte Carlo simulation software which predicts the propagation of light through tissues of various shapes and with different optical properties. This simulation gives the resultant energy distribution due to light absorption and scattering on a voxel by voxel basis. The Monte Carlo code alone is not sufficient to validate the photon propagation. The success of the Monte Carlo code depends on accurate prediction of the optical properties of the tissues. It also depends on accurately depicting tissue boundaries and thus the resolution of the imaging space. Hence, a validation algorithm has been designed so as to recover the optical properties of the tissues which are imaged and to successfully validate the simulation results. The accuracy of the validation code is studied for various optical properties and boundary conditions. The results are then compared and validated with real time images obtained from the photoacoustic scanner. The various parameters for the successful validation of Monte Carlo method are studied and presented. This study is then validated using the algorithm to study the conversion of light to sound. Thus it is a significant step in the quantification of the photoacoustic effect so as to accurately predict tissue properties.
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    Performance analysis of EM-MPM and K-means clustering in 3D ultrasound breast image segmentation
    (2013-05) Yang, Huanyi; Christopher, Lauren; Salama, Paul; Rizkalla, Maher E.; King, Brian
    Mammographic density is an important risk factor for breast cancer, detecting and screening at an early stage could help save lives. To analyze breast density distribution, a good segmentation algorithm is needed. In this thesis, we compared two popularly used segmentation algorithms, EM-MPM and K-means Clustering. We applied them on twenty cases of synthetic phantom ultrasound tomography (UST), and nine cases of clinical mammogram and UST images. From the synthetic phantom segmentation comparison we found that EM-MPM performs better than K-means Clustering on segmentation accuracy, because the segmentation result fits the ground truth data very well (with superior Tanimoto Coefficient and Parenchyma Percentage). The EM-MPM is able to use a Bayesian prior assumption, which takes advantage of the 3D structure and finds a better localized segmentation. EM-MPM performs significantly better for the highly dense tissue scattered within low density tissue and for volumes with low contrast between high and low density tissues. For the clinical mammogram, image segmentation comparison shows again that EM-MPM outperforms K-means Clustering since it identifies the dense tissue more clearly and accurately than K-means. The superior EM-MPM results shown in this study presents a promising future application to the density proportion and potential cancer risk evaluation.
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    Understanding mechanical environment changes and biological responses to canine retraction using t-loop
    (2015-05) Jiang, Feifei; Chen, Jie; Bajaj, Anil; El-Mounayri, Hazim; Katona, Thomas; Nauman, Eric
    Predictability of tooth displacement in response to specific orthodontic load system directly links to the quality and effectiveness of the treatment. The key questions are how the tooth’s environment changes in response to the orthodontic load and how the biological tissues respond clinically. The objectives of this study are to determine the mechanical environment (ME) changes and to quantify the biological tissues’ response. Eighteen (18) patients who needed maxillary bilateral canine retractions were involved in the study. A method was developed to quantify the 3D load systems on the canine, which allowed the treatment strategies to be customized in terms of orthodontic loading systems to meet either translation (TR) or controlled tipping (CT) requirement. Dental casts were made before and after each treatment interval, and the Cone Beam Computed Tomography (CBCT) scans were taken prior to and following the entire treatment for control of treatment strategy and post treatment evaluations. Finite element method (FEM) was applied to calculate the location of center of resistance (CRes) for tooth movement control. The location and variation of CRes were recorded and compared with previous studies. A quick CRes assessment method that locates CRes by calculating the centroid of the contact surface (CCS) and the centroid of the projection of root surface (CPCS) in certain direction was also tested and compared with the results from FEM. Customized T-loop spring, a kind of orthodontic appliance, was designed, fabricated, and calibrated on a load measuring system to ensure that the load met the clinician’s prescription. The treatment outcomes in terms of tooth displacement and root resorption characterized by the changes of tooth length and volume as well as the bone mineral density (BMD) represented by the Hounsfield units (HU) change were recorded and analyzed. The ME in terms of stress were also calculated by using FEM. Paired t-test and mixed model ANOVA methods were used to analyze the relationships between the mechanical inputs (quantified and customized load, and corresponding stress) and clinical outcomes (root resorption and BMD change). It was found that the overall root resorption is not significant for canine retraction, but apical root resorption does occur, meaning that orthodontic load is not a sufficient factor. Also, it was observed that HU distribution changed significantly in both root and alveolar bone. The maximum reduction was on the coronal level in the direction perpendicular to the direction of movement in root, and in the direction of the tooth movement at the coronal level in bone. In addition, it was determined that the locations of the CRes in the MD and BL directions were significantly different. The locations of the CRes of a human canine in MD and BL directions can be estimated by finding the CPCSs in the two directions. Finally, it was shown that the stress invariants can be used to characterize how the osteocytes feel when ME changes. The stress invariants in the alveolar bone are not significantly affected by different M/F. The higher bone modeling/remodeling activities along the direction of tooth movement may be related to the initial volumetric increase and decrease in the alveolar bone.