Biomedical subjects

A Glowinski

Publications and source records attributed to A Glowinski.

31 records · Page 2Linked to original sources

PubMed1998

[Real-time MRI with radial k-radial scanning technique for control of angiographic interventions].

PURPOSE: To test the feasibility of real-time MR controlled guidance of field-inhomogeneity catheters in vitro and in vivo as a first step to MR-guided angiographic interventions. METHODS: Applying a combination of radial scanning with the sliding window reconstruction technique, a frame rate of 23 low resolution images per second was achieved. Field inhomogeneity catheters were steered through a flow phantom and into the renal arteries of a pig. RESULTS: It was possible to visualize flow or, respectively, vessels and to depict catheter movements. This enabled real-time MR-guidance of the catheter into the renal arteries of the flow phantom and into those of the pig. CONCLUSIONS: The new technique yields a sufficiently high temporal resolution for MR-guidance of catheters through vessels.

Angiography↗

PubMed1998

Device visualization for interventional MRI using local magnetic fields: basic theory and its application to catheter visualization.

This paper addresses one of the major problems in Interventional magnetic resonance imaging (MRI): the visualization of interventional devices. For visualization locally induced magnetic fields are used, which disturb the homogeneity of the main magnetic field of the MR scanner. This results in signal loss in the vicinity of the device due to intravoxel dephasing, and leads to a disturbance of the phase image. The local fields are established by a low current in a closed copper loop along the device. This method will be introduced as a means for catheter visualization. The basic theory behind this method is presented. Simulations are performed to determine the effect of intravoxel dephasing, without interfering effects like susceptibility or radio-frequency artifacts. Scanned and simulated data is used to verify the theoretical consideration. Different configurations of wire loops are discussed and two types of catheter visualization scans are proposed. Results from a pig study show that this methods holds promise for intravascular interventions under MRI guidance.

Animals↗

PubMed1997

Catheter visualization using locally induced, actively controlled field inhomogeneities.

A new technique for visualization of interventional devices using MR is presented. A prototype catheter was equipped with a thin copper wire loop, leading from the proximal end to the tip and back. A small current (10-150 mA) through these two parts of a wire induces a local magnetic field along the catheter. Introduction of this catheter into the main magnetic field of the MR imager locally disturbs the homogeneity of the magnetic field. Image locations within the locally induced fields appear dark due to signal loss, and the extent of this effect can be varied during the procedure by simply adjusting the current. Different dedicated wire configurations allow visualization of the catheter in its whole length or in parts, i.e., with markers for balloons. Fast gradient echo sequences that provide a bright signal from inflowing blood are used for rapid imaging.

Animals↗

PubMed1997

[Catheter visualization in MR-tomography: initial experimental results with field-inhomogeneity catheters].

PURPOSE: To assess the feasibility of a new developed field inhomogeneity catheter for interventional MR imaging in vivo. MATERIALS AND METHODS: Three different prototypes of a field inhomogeneity catheter were investigated in 6 pigs. The catheters were introduced in Seldinger technique via the femoral vessels over a guide wire on an interventional MR system (Philips Gyroscan NT combined with a C-arm fluoroscopy unit [Philips BV 212]). Catheters were placed in veins and arteries. The catheter position was controlled by a fast gradient echo sequence (Turbo Field Echo [TEE]). RESULTS: Catheters were introduced over a guide wire without complications in all cases. Using the field inhomogeneity concept, catheters were easily visualised in the inferior vena cava and the aorta by the fast gradient echo technique on MR in all cases. Although aortic branches were successfully cannulated, the catheters were not displayed by the TFE technique due to the complex and tortuous anatomy. All animals survived the experiments without complications. CONCLUSION: MR guided visualization of a field inhomogeneity catheter is a simple concept which can be realised on each MR scanner and may allow intravascular MR guided interventions in future.

Animals↗

PubMed1997

[Flow direction-sensitive spin-echo MR angiography].

New blood pool contrast agents yield a significant shortening of T1 of blood. Consequently, the usual techniques of time-of-flight and phase-contrast angiographies cannot produce angiograms sensitive to one flow direction, even if saturation slabs are applied. It was our aim to test the hypothesis of displaying arterial and venous flow selectively with a specially designed spin echo sequence even after administration of contrast agents. Parallel slice selective 90-degree and 180-degree pulses were applied. The distance between slices could be varied. It was attempted to obtain MR angiographies that were flow sensitive for one direction only. We performed flow phantom studies without the use of contrast media and first in vivo experiments in pigs after administration of iron oxide particles. With our modified spin echo sequence unidirectional flow can be displayed, whereas stationary tissue is totally suppressed. There are no special demands for the hardware and no additional postprocessing needs to be performed. The locally off-centred 90-degree and 180-degree pulses are responsible for this. Exclusively, protons excited by the 90-degree pulse and flowing into the slice of the 180-degree pulse will be refocused and only such protons will give rise to signal in the images.

Animals↗

PubMed1997

[MR-guided biopsies with high-resolution ultrafast T2-weighted turbo spin-echo sequence LoLo: initial clinical experience].

PURPOSE: The feasibility of the "LoLo"-technique for MR guidance of biopsy procedures was tested. MATERIAL AND METHODS: MR-guided biopsies were performed on 10 patients employing a 1.5 T system. The "LoLo"-technique used is a single shot turbo spin echo technique. Only a small field of view is covered in order to yield images with a resolution of 1 mm2 in 600 ms. The orthogonal orientation of the slice selective radio frequency pulses to each other prevents foldover artifacts. RESULTS: No complications occurred. All biopsy procedures yielded sufficient material to diagnose the underlying disease. The "LoLo"-technique enabled good depiction of the needle tip in all cases. T2-weighted contrast typical for turbo spin echo images was observed. No foldover artifacts were detectable. CONCLUSION: MR-guided biopsies are possible with the "LoLo"technique. Compared to gradient echo sequences T2-weighting and smaller susceptibility artifacts proved to be advantageous.

Adult↗

PubMed1997

Interventional magnetic resonance. Initial clinical experience with a 1.5-tesla magnetic resonance system combined with c-arm fluoroscopy.

RATIONALE AND OBJECTIVES: The authors evaluate the feasibility of performing magnetic resonance (MR) procedures on a 1.5-tesla (T) system combined with conventional c-arm fluoroscopy. METHODS: A 1.5-T MR imaging system was combined with a conventional c-arm fluoroscopy unit in one room. The two systems were connected via a floating table top. Twenty-six interventional procedures (biopsies, MR-portography, percutaneous alcohol injection, laser ablation, fluid aspiration, and breast marking) were performed in 22 patients under MR, fluoroscopic control, or both. For MR guidance, fast gradient echo sequences were used, initiated from a panel at the front of the magnet. Images were displayed on an liquid crystal display screen positioned on the magnet. RESULTS: All MR-guided procedures were performed successfully without complications. The addition of c-arm fluoroscopy was useful for bone interventions and MR-portography. All diagnostic biopsies yielded sufficient amounts of tissue for histologic diagnosis. In breast lesions, the target identified on dynamic MR imaging was marked correctly in each case. In interstitial laser thermotherapy the laser effect could be visualized, and in percutaneous ethanol injection the distribution of the alcohol could be seen. Both imaging systems worked without image distortions and high-quality MR images were obtained. CONCLUSIONS: The combination of a 1.5-T MR imager with a c-arm fluoroscopy system seems to be a promising technical solution for performing interventional MR procedures.

Adult↗

PubMed1995

Integrating guidelines and the clinical record: the role of semantically constrained terminologies.

The extent to which protocols and guidelines will be used depends critically on how well they are integrated with existing medical records and each other. Effective integration requires consistent information structures and content, but if the union between components becomes too intimate it may restrict interaction with other applications. Such isolation leads to operational inefficiencies and can be financially unattractive. Systematic representation methods for protocols address part of the problem but are hampered by the unsuitability of existing medical terminologies; the effort required for bespoke development is prohibitive. Unifying and generalising terminological functions in a single "Terminology Server" that can support both construction of systems and their operational use promises to reduce development effort whilst allowing individual designers considerable independence. However, significant theoretical and practical questions remain about how far the problems of communication can be mitigated by a generalised, use-independent terminological system.

England↗

PubMed1993

Goals for concept representation in the GALEN project.

The GALEN project aims to develop language independent concept representation systems as the foundations for the next generation of multilingual coding systems. Traditional coding schemes have reached the limits of what can be maintained and managed, and a shift to formal compositional systems is now essential. GALEN is developing one such scheme and an associated concept model, together with criteria for their evaluation. It should provide the flexibility required to cope with the diversity amongst medical applications, whilst ensuring the coherence necessary for integration and re-use of terminologies.

Humans↗

PubMedDate not supplied

Visualization of MR-compatible catheters by electrically induced local field inhomogeneities: evaluation in vivo.

The purpose of this study was to assess the feasibility of a newly developed field inhomogeneity catheter for interventional MRI in vivo. Different prototypes of a field inhomogeneity catheter (pigtail and multipurpose configuration, balloon catheters) were investigated in pigs. The catheters were introduced in Seldinger technique via the femoral vessels over a guidewire on an interventional MR system (Philips Gyroscan NT combined with a C-arm fluoroscopy unit [Philips BV 212]). Catheters were placed in veins and arteries. The catheter position was controlled by a fast gradient-echo sequence (turbo field echo [TFE]). Catheters were introduced over a guidewire without complications in all cases. Using the field inhomogeneity concept, catheters were easily visualized in the inferior vena cava and the aorta by the fast gradient-echo technique on MR in all cases. Although aortic branches were successful cannulated, the catheters were not well displayed by the TFE technique due to the complex and tortuous anatomy. All animals survived the experiments without complications. MR-guided visualization of a field inhomogeneity catheter is a simple concept that can be realized on each MR scanner and may allow intravascular MR-guided interventions in future.

Animals↗

PubMedDate not supplied

MR-guided biopsy using a T2-weighted single-shot zoom imaging sequence (Local Look technique).

The purpose of this study was to demonstrate the utility of a T2-weighted single shot turbo spin-echo technique--the so-called "Local Look" (LoLo) and more recently renamed "Zoom Imaging" technique--for MR-guided percutaneous interventions. We performed 28 procedures on 22 patients using a 1.5-T system for MR guidance. All procedures were controlled with the LoLo technique, which acquires T2-weighted images in 600 msec. This is achieved by using a small field of view (250 x 125 mm) along with a maximum echo train length, the so-called "single shot method." To prevent backfolding artifacts, the 90 degrees and 180 degrees pulses were oriented orthogonally to each other. Because signal is created only in the region in which the pulses overlap, no backfolding can occur from outside this area. Half of the biopsies were additionally monitored using a fast gradient-echo sequence, which was compared with the LoLo technique. All of the procedures were technically successful, and there were no procedural complications. The LoLo technique produced images that had good contrast between the lesion and the needle artifact, and the artifact size was smaller than that produced by the gradient-echo technique. Subjective judgment of the ability to accurately delineate the needle tip indicated that the LoLo technique was either superior to (73%) or equal to (27%) the gradient-echo sequence in all cases. The LoLo technique is an accurate and effective method for MR guidance of percutaneous procedures, because it shows good lesion contrast and small needle artifacts. The additional use of a gradient-echo sequence during the procedure planning stage is advisable in more difficult cases, particularly when adjacent blood vessels are a concern. Monitoring of the needle tip is best performed with the LoLo technique.

Artifacts↗

PubMedDate not supplied

MR imaging-guided percutaneous nephrostomy and use of MR-compatible catheters in the nondilated porcine urinary tract.

PURPOSE: To investigate technique and practicability of MR-guided percutaneous nephrostomy (MRPCN) and to test magnetic resonance (MR)-compatible catheters inside the urinary tract. MATERIALS AND METHODS: In 10 healthy pigs, a percutaneous nephrostomy tube was placed into the nonobstructed pelvicaliceal system with use of exclusive MR guidance with a standard 1.5-T magnet. The urinary tract was visualized by intravenous injection of Gd-DTPA in combination with low-dose furosemide. The procedure was controlled with use of a T1-weighted turbo gradient-echo sequence in two orthogonal planes. The equipment for MRPCN included an 18-gauge MR-compatible puncture needle, a nitinol guide wire, and different 5-F MR catheters. RESULTS: In all 10 animals, the puncture needle was safely directed into the nondilated target calix. Slight deviations of the needle were detected on both MR image planes, which enabled immediate correction. This technique achieved a "first attempt" puncture of the targeted calix in each animal. MR images accurately demonstrated the dysprosium labelled tip of the different inserted catheters. It proved essential to inject a gadolinium-insaline solution via these catheters to preserve the endoluminal contrast enhancement as long as necessary. Balloon catheters were directed and inflated inside the ureter under exclusive MR guidance. Complications such as perforation and leakage were visualized by MR imaging. CONCLUSIONS: MRPCN is a promising technique for puncturing the pelvicaliceal system. The ability to successfully enter the urinary tract, even when it is nondilated, underscores the accuracy achievable with multiplanar MR imaging.

Animals↗

PubMedDate not supplied

Evaluating and validating very large knowledge-based systems.

Most knowledge-based systems for use in medicine have been developed in response to specific problems such as the diagnosis of abdominal or chest pain in an accident and emergency department, or the diagnosis and treatment of meningitis. There is a role for a general decision support system capable of answering queries about any aspect of medicine, particularly in primary care. However, evaluating such a knowledge base requires more elaborate methodology than a simple iterative test and refine cycle. At the design stage an adequate knowledge base structure is required to allow focused modification of the knowledge base when errors are discovered. During the prolonged evaluation cycle the partially formed knowledge base must be tested with such techniques as validation checks for consistency and completeness and examination of characteristics of problem-solving procedures. Finally a variety of criteria that represent the performance, robustness, flexibility, predictability, validity, coverage, relevance and congruity of the knowledge base are needed for a full description of the system's worth. Two case studies from the Oxford System of Medicine project are provided as examples of this philosophy: validating specific medical facts and comparing two methods for aggregating reasoning for and against a decision option.

Artificial Intelligence↗