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B C Penney

Publications and source records attributed to B C Penney.

At least 19 recordsLinked to original sources
PubMed2001

Exploring a chronic care model in a regional healthcare context.

The episodic acute care model of service delivery that consumes the majority of healthcare funding is inadequate to meet the needs of a society experiencing an increasing burden of chronic illness. This article describes, in a regional Canadian healthcare context, the application and preliminary evaluation of a model of chronic care delivery developed in a managed care environment in the United States. The strategic goals of this model are to empower clients by providing a redesigned service delivery environment that supports self-management; support care providers by developing clinical information systems and decision supports; and align community resources, policies and organization of care to support an informed, activated client and a proactive practice team.

Aged↗
PubMed1999

Attenuation compensation in 99mTc SPECT brain imaging: a comparison of the use of attenuation maps derived from transmission versus emission data in normal scans.

UNLABELLED: Brain SPECT imaging using 99mTc lipophilic tracers such as hexamethyl propyleneamine oxime (HMPAO) attempts to estimate cerebral, cerebellar and subcortical perfusion by assessing the relative amount of tracer uptake among these regions. Most commonly, comparison is made with cerebellar activity. Because the assessment of relative tracer uptake may be rendered inaccurate by photon attenuation by the nonuniform attenuation properties of the head, brain SPECT reconstructions have been compared using attenuation correction (AC) with various methods for estimating the attenuation map. METHODS: Patients underwent 99mTc-HMPAO brain SPECT with transmission line source AC hardware. In addition to the emission dataset, emission downscatter and transmission datasets were acquired. Iterative reconstructions using three different attenuation maps were investigated. These included: (a) that obtained from transmission imaging, (b) that obtained from segmentation of a reconstruction from a lower energy Compton scatter window and (c) a slice-independent, uniform, elliptical attenuation map. No AC was also compared. RESULTS: Count profiles in patients having brain perfusion SPECT scans showed a significant difference in region count estimates in the brain depending on whether AC is used as well as on the attenuation map used. Scatter-based AC is able to provide external contour detection and attenuation compensation based on that contour, whereas transmission-based AC provides external contour detection as well as internal, nonuniform attenuation estimation and AC. If one considers transmission AC to be the clinical "gold standard," non-attenuation-corrected as well as fixed-ellipsoid, uniform attenuation-corrected studies provided unreliable regional estimates of tracer activity. CONCLUSION: This study shows the significant difference in clinical brain SPECT count profiles depending on how and whether there is compensation for attenuation. Based on prior studies validating the improved quantitative accuracy of SPECT using transmission-based AC, this study suggests that clinical 99mTc brain perfusion SPECT would benefit from and, in situations demanding rigorous quantitative assessment, requires transmission-based AC. Estimating attenuation maps with scatter-based methods was the next most accurate (clinical) method tested and can be used if and when transmission imaging cannot be used.

Brain↗
PubMed1996

Transmission imaging of large attenuators using a slant hole collimator on a three-headed SPECT system.

By combining conjugate views, truncation-free attenuation profiles of patients can be obtained by using slant hole collimators on three-headed SPECT systems. The alterations in reconstruction algorithms necessary for use with slant hole collimators and potential image artifacts are discussed. Based on an evaluation of the size of objects that can be imaged without truncation and the size of the overlap region in the conjugate views, a 15 degrees slant angle was determined to be optimal. Studies with a 30 degrees slant hole collimator verified the ability of slant hole transmission imaging to provide accurate, truncation-free attenuation maps of a 56 cm lateral width phantom. The center of rotation was determined to be dependent on the slant angle and radius of rotation of the slant collimator. These studies also demonstrated that the spatial resolution in the transaxial plane of the attenuation maps depends on radius of rotation of the slant hole collimator, but does not depend on the radius of rotation of an uncollimated transmission source. A multiline transmission source was investigated for use with estimating the attenuation map in Tc-99m labeled sestamibi perfusion imaging.

Equipment Design↗
PubMed1992

Bremsstrahlung imaging using the gamma camera: factors affecting attenuation.

Quantitative imaging of bremsstrahlung from pure beta emitters is proposed as a means for in vivo management of antibody therapy. The method involves the use of high-energy collimation, an empirically selected broad photon energy window to enhance detector sensitivity, and a Wiener restoration filter to compensate for system blur. The measured and filtered data were obtained for an idealized scattering medium and isolated spherical sources. An effective linear attenuation coefficient of about 0.13 cm-1 was determined from the raw image data of 32P. A coefficient of 0.14 cm-1 was determined after the images were restored using the Wiener filter. The measured attenuation was not significantly dependent on the size of the region of interest or the size of the source. Its variation was within the experimental error of measurement (+/- 5%). The measured sensitivity (6 x 10(-6) cps/Bq) was sufficient for imaging therapy doses of 32P or 90Y.

Filtration↗
PubMed1989

Investigation of causes of geometric distortion in 180 degrees and 360 degrees angular sampling in SPECT.

To investigate geometric distortion when 180 degrees or 360 degrees angular sampling techniques are used in single photon emission computed tomography (SPECT), a study of point sources imaged at different positions in a water filled cylindrical phantom, and reconstructed using filtered back projection, was conducted. A simulation study, based upon a serial model of the system point spread function (PSF), was used to investigate the contributions of attenuation, spatial resolution and scatter on distortion of the reconstructed PSFs. To study the geometric distortion in transverse (x-y plane), coronal (x-z plane), and sagittal (y-z plane) sections, the ratios of the full widths at half maximum (FWHM) and full widths at tenth maximum (FWTM) in the x/y, x/z, and y/z directions were calculated for the real and simulated PSFs. These results showed that, in an attenuating medium, there is more distortion of point sources into ovals for 180 degrees than for 360 degrees sampling. The simulation study indicated that the primary cause of geometrical distortion in SPECT studies, is the inconsistency of projections due to variable attenuation and spatial resolution. The impact of scatter on geometric distortion was small as measured by the ratios of FWHMs and FWTMs for PSFs. Attenuation correction applied to acquired PSFs significantly reduced geometric distortion in both 180 degrees and 360 degrees studies. To investigate distortion in extended objects, an Iowa heart phantom was placed inside an Alderson body phantom and 201Tl heart SPECT studies acquired. The phantom images confirmed the conclusion that in transverse sections of 360 degrees studies with arithmetic averaging of opposite views, geometric distortion is reduced compared to 180 degrees. The coronal and sagittal sections were equally distorted in both, the 180 degrees and 360 degrees studies, and the 180 degrees studies yielded better contrast.

Models, Structural↗
PubMed1988

An image-dependent Metz filter for nuclear medicine images.

To provide optimal image quality, digital filters should account for both the count level and the object imaged. That is, they should be image-dependent. By using the constraint equation of constrained least-squares (CLS) restoration to determine one parameter of the Metz filter, a filter which adapts to the image has been developed. This filter has been named the Constrained Least-Squares Metz filter. The filter makes use of a regression relation to convert the Metz filter parameter determined using the CLS criterion to the value which would minimize the normalized mean square error (NMSE). The regression relation and the parameters which specify the general form of the Metz filter were determined using images of the Alderson liver and spleen phantoms. The designed filter was tested for its ability to adapt to other objects with images from each of three different test objects. When the values of the Metz filter parameters for these images determined by the CLS-Metz filter were compared by a regression analysis to those which minimized the NMSE for each image, a correlation coefficient of 0.98, a slope of 0.95, and a zero intercept of 0.1 were obtained. With clinical images, the CLS-Metz filter has been shown to provide consistently good image quality with images as diverse as heart perfusion images and bone studies.

Filtration↗
PubMed1987

Interactive visual optimization of SPECT prereconstruction filtering.

A number of factors must be considered when forming a digital filter to two-dimensionally filter single photon emission computed tomographic (SPECT) acquisition images. In an effort to provide subjectively optimal filtering, a program has been developed which provides "real-time" visual feedback. This allows a user to select from among a family of Metz filters tailored for the imaging conditions (i.e., formed to deconvolve scatter, septal penetration, and combined collimator and intrinsic spatial resolution losses). Also, a guideline for assisting the user in selecting from among the possible Metz filters has been formulated. This guideline is based upon knowledge of the probability distribution of the noise power spectrum, and consists of choosing the filter which has a value of 1.0 when the one-dimensional compression of the image power spectrum equals the 90% confidence limit for noise fluctuations. The program starts by filtering a planar reference image with the Metz filter computed for the radionuclide, collimator, magnification, and count-level of the image. This filter is displayed beside the image where it is overlayed on a plot of the logarithm of the one-dimensional compression of the image power spectrum. The user is then allowed to vary the filter parameters through movement of a joystick. By doing the filtering using an array processor, a new filtered image is formed and displayed less than a second after movement of the joystick. Visual feedback from the series of filtered images thus produced as well as the plots of the filter overlayed on the estimated blurred object power spectrum are used to obtain a visually "optimal" filter. The filter can be adapted to the visual preferences of the individual reader, and serves as a useful teaching tool on the effects of filtering.

Evaluation Studies as Topic↗
PubMed1986

Digital restoration of indium-111 and iodine-123 SPECT images with optimized Metz filters.

A number of radiopharmaceuticals of great current clinical interest for imaging are labeled with radionuclides that emit medium- to high-energy photons either as their primary radiation, or in low abundance in addition to their primary radiation. The imaging characteristics of these radionuclides result in gamma camera image quality that is inferior to that of 99mTc images. Thus, in this investigation 111In and 123I contaminated with approximately 4% 124I were chosen to test the hypothesis that a dramatic improvement in planar and SPECT images may be obtainable with digital image restoration. The count-dependent Metz filter is shown to be able to deconvolve the rapid drop at low spatial frequencies in the imaging system modulation transfer function (MTF) resulting from the acceptance of septal penetration and scatter in the camera window. Use of the Metz filter was found to result in improved spatial resolution as measured by both the full width at half maximum and full width at tenth maximum for both planar and SPECT studies. Two-dimensional, prereconstruction filtering with optimized Metz filters was also determined to improve image contrast, while decreasing the noise level for SPECT studies. A dramatic improvement in image quality was observed with the clinical application of this filter to SPECT imaging.

Brain↗
PubMed1986

Theory and cardiac applications of electrical impedance measurements.

The methodology of the two-electrode, four-electrode, and guard-ring techniques is presented following a brief history of impedance plethysmography. The theoretical basis for predicting the sampling fields for conductivity and volume changes is presented. Theoretical and experimental studies of the sampling field associated with various electrode arrays are reviewed. With this background, the use of impedance plethysmography for cardiac monitoring and diagnosis is reviewed. The basic methodology is presented and models used to interpret the signal are reviewed. Theoretical and experimental studies of what is sampled are summarized. The accuracy of impedance stroke volume estimates is evaluated by surveying the results of human studies and examining critical animal studies. The usefulness of impedance cardiography for ventricular performance evaluation is also reviewed. Additional uses for cardiopulmonary diagnosis are briefly presented.

Animals↗
PubMed1984

Two-dimensional filtering of SPECT images using the Metz and Wiener filters.

Two-dimensional filtering, both before and after reconstruction, has been applied to the processing of single photon emission computerized tomographic (SPECT) images. The filters investigated were the count-dependent Metz filter and Wiener filter, both of which automatically adapt to the image being processed. Using a SPECT phantom, with images reconstructed with these filters rather than the ramp, we observed a statistically significant increase (p less than 0.05) in the image contrast for solid Plexiglas spheres, and significant decrease (p less than 0.05) in the percent fractional standard deviation of counts in a region of uniform activity. The adaptability of these filters is demonstrated by a comparison of SPECT acquisitions of the phantom at two different count levels. An example of their application to clinical studies is presented. We conclude that two-dimensional digital image restoration with these techniques can produce a significant increase in SPECT image quality, with a small cost in processing time when these techniques are implemented on an array processor.

Filtration↗
PubMed1983

Noninvasive evaluation of arterial occlusive disease.

A procedure for observing blood flow during early reactive hyperemia, which uses prolonged venous occlusion following 3 min of arterial occlusion, is described. A mercury strain gauge was applied around the mid-calf and 3 tracings were simultaneously recorded during reactive hyperemia: the change in venous volume, its derivative and amplified pulse waves. The method was evaluated in animals, normal volunteers and in patients with symptoms of arterial insufficiency. This bedside procedure was found to be convenient and practical. Peak flow during reactive hyperemia was found to have an accuracy comparable to the ankle/arm pressure index in distinguishing between normal, stenotic or occluded lower extremity arterial systems. In addition, it proved more accurate than pressure measurements in diabetic patients with incompressible calcified vessels.

Animals↗
PubMedDate not supplied

A Wiener filter for nuclear medicine images.

To improve the quality of digital nuclear medicine images, we have developed a new implementation of the Wiener restoration filter. The Wiener filter uses as its optimality criterion the minimization of the mean-square error between the undistorted image of the object and the filtered image. In order to form this filter, the object and noise power spectrums are needed. The noise power spectrum for the count-dependent Poisson noise of nuclear medicine images is shown to have a constant average magnitude equal to the total count in the image. The object power spectrum is taken to be the image power spectrum minus the total count, except in the noise dominated region of the image power spectrum where a least-squares-fitted exponential is used. Processing time is kept to a clinically acceptable time frame through use of an array processor. Pronounced noise suppression and detail enhancement are noted with use of this filter with clinical images.

Coronary Disease↗