On the validity of the continuous and discrete confidence rating scales in receiver operating characteristic studies.
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Humans↗
Biomedical subjects
D Gur
Publications and source records attributed to D Gur.
OXA-11, an extended-spectrum variant of OXA-10 (PSE-2) beta-lactamase from Pseudomonas aeruginosa.
Pseudomonas aeruginosa ABD, which was isolated in October 1991 from blood cultures of a burn patient in Turkey, was resistant to cephalosporins, particularly ceftazidime (MIC, 512 micrograms/ml), penicillins, aztreonam, and meropenem, but not to imipenem. Cephalosporin and penicillin resistance transferred to P. aeruginosa PU21 and was associated with a beta-lactamase with a pI of 6.4 encoded by a 100-MDa plasmid designated pMLH52. Like extended-spectrum TEM and SHV beta-lactamases, this enzyme hydrolyzed penicillins and newer cephalosporins but did not hydrolyze cefoxitin or carbapenems. However, it differed from TEM and SHV derivatives in being a potent oxacillinase, and its encoding gene did not hybridize with probes to TEM and SHV genes. To characterize the enzyme, libraries of total DNA were cloned into plasmid pUC19 and were transformed into Escherichia coli DH5 alpha. Recombinant plasmids that gave ceftazidime resistance all contained a 3.65-kb BamHI fragment. Deletions from this fragment allowed the beta-lactamase gene to be located on a 1.4-kb section of DNA, which contained an open reading frame of 798 bases. This encoded a protein that was deduced to differ from PSE-2 beta-lactamase only in having serine instead of asparagine at position 143 and aspartate instead of glycine at position 157. It is concluded that the resistance of isolate ABD dependent on an extended-spectrum variant of the PSE-2 enzyme. The ability of this enzyme to cause ceftazidime resistance dependent primarily on a low Km for the compound; Vmax remained low. It is proposed that PSE-2 should be transferred to the OXA group as OXA-10 and that the new enzyme be designated OXA-11.
Amino Acid Sequence↗
Requirements for PACS: users' perspective.
The applications for which picture archiving and communication systems (PACS) will be used must dictate the technological requirements. Technology-driven integrated PACS have been implemented and tested in a variety of clinical environments. PACS do not generate new revenues, albeit they may affect the bottom line of health care delivery systems through increased efficiency of radiology and, perhaps more important, of the other physicians who use radiologic services. User performance expectations require that trade-offs are evaluated and compromises are made when PACS are designed using currently available technology. In this report, functional requirements for clinical PACS are discussed. These include reliability, speed, ease of use, connectivity, and upgradability. The advantages and disadvantages of specific choices are presented from a utility perspective of an end user.
Computer Communication Networks↗
Use of radiation risk as the basis for image quality comparisons.
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Breast↗
Operating at the diagnostic margins: image quality considerations.
Radiology, as the field of expert image interpretation, has always been faced with questions about the trade-offs between the diagnostic quality of images and other issues related to the care of patients. Historically, image quality has been sacrificed somewhat to reduce the cost of imaging procedures or to reduce radiation exposure of patients, for example. More recently, in order to improve access to imaging information, radiology departments have begun to replace traditional film-based methods with digital techniques, which in some cases have reduced image quality. This again raises the question of how much diagnostic quality can be sacrificed to achieve a competing benefit for the patient (i.e., improved access to the image data).
Costs and Cost Analysis↗
Comparison of three different techniques for dual-energy subtraction imaging in digital radiography: a signal-to-noise analysis.
Dual-energy subtraction imaging techniques allow the tissue and bone structures in the patient to be visualized and studied in two separate images, thus removing the obscurity associated with overlapping of the two structures. In addition, they allow the subtraction image signals to be used for quantifying the tissue and bone thicknesses. Thus, capability for dual-energy subtraction imaging is often incorporated with new digital radiography systems. There are three different approaches to dual-energy image subtraction imaging techniques. Among them, the dual-kilovolt (peak) [kV(p)] and sandwich detector techniques have been two widely used approaches. A third approach is the single-kV(p) dual-filter technique, which allows some flexible control of the spectra while avoiding the technical complexity of kV(p) value switching in slit-scan imaging. In this report, the noise properties associated with these three techniques are studied and compared by computing the noise variances in the subtraction image signals as a function of the kV(p) values and filter thicknesses. It was found that the dual-kVp technique results in the least noisy subtraction images, whereas the dual-filter technique results in slightly less noisy subtraction images than the sandwich detector technique. Following optimization of the kV(p) value and filter thicknesses, the dual-filter and sandwich detector techniques result in a noise level of approximately three and four times higher than that resulted from the dual-kV(p) technique, respectively.
Algorithms↗
Dynamic heterogeneity of cerebral hypoperfusion after prolonged cardiac arrest in dogs measured by the stable xenon/CT technique: a preliminary study.
After prolonged cardiac arrest and reperfusion, global cerebral blood flow (gCBF) is decreased to about 50% normal for many hours. Measurement of gCBF does not reveal regional variation of flow or permit testing of hypotheses involving multifocal no-flow or low-flow areas. We employed the noninvasive stable Xenon-enhanced Computerized Tomography (Xe/CT) local CBF (LCBF) method for use in dogs before and after ventricular fibrillation (VF) cardiac arrest of 10 min. This was followed by external cardiopulmonary resuscitation (CPR) and control of cardiovascular pulmonary variables to 7 h postarrest. In a sham (no arrest) experiment, the three CT levels studied showed normal regional heterogeneity of LCBF values, all between 10 and 75 ml/100 cm3 per min for white matter and 20 and 130 ml/100 cm3 per min for gray matter. In four preliminary CPR experiments, the expected global hyperemia at 15 min after arrest, was followed by hypoperfusion with gCBF reduced to about 50% control and increased heterogeneity of LCBF. Trickle flow areas (LCBF less than 10 ml/100 cm3 per min) not present prearrest, were interspersed among regions of low, normal, or even high flow. Regions of 125-500 mm3 with trickle flow or higher flows, in different areas at different times, involving deep and superficial structures migrated and persisted to 6 h, with gCBF remaining low. These preliminary results suggest: no initial no-reflow foci (less than 10 ml/100 cm3 per min) larger than 125 mm3 persisting through the initial global hyperemic phase; delayed multifocal hypoperfusion more severe than suggested by gCBF measurements; and trickle flow areas caused by dynamic factors.
Animals↗
Survey of the prevalence of beta-lactamases amongst 1000 gram-negative bacilli isolated consecutively at the Royal London Hospital.
beta-Lactamase expression was examined in 1000 consecutive Gram-negative bacilli isolated from urine, wound swab, sputum or blood specimens received at the Microbiology Laboratory of the Royal London Hospital. This survey, performed between January and April, 1991, followed a similar study undertaken in early 1982. The distribution of species was similar in the two surveys, except that the proportion of Pseudomonas aeruginosa isolates had increased from 11% in 1982 to 17.5% in the present study. This increase was balanced by a decreased proportion of enterobacteria. Amongst plasmid-mediated beta-lactamases, TEM-1 (especially), TEM-2, SHV-1 and OXA types continued to predominate in enterobacteria. Their frequency in Escherichia coli was unchanged (46% in 1991 compared with 43% in 1982), but had increased from 5 to 22% amongst Proteus mirabilis isolates. An apparent decrease in their frequency amongst Enterobacter cloacae isolates, from 48% in 1982 to 17% in 1991, probably reflected changes to strain prevalence rather than enzyme prevalence. Plasmid type beta-lactamases were present in fewer than 2% of P. aeruginosa isolates in both surveys. In the present study, chromosomal beta-lactamase derepression (constitutive hyperproduction) was detected in 10/76 isolates of E. cloacae, Enterobacter aerogenes, Citrobacter freundii, Serratia spp. and Morganella morganii, and in 2/170 P. aeruginosa isolates. These proportions were increased, compared with those seen the 1982 survey, though the significance was borderline (P approximately 0.05; chi 2 test). Extended-spectrum plasmid mediated beta-lactamases, unknown in 1982, were found in 11/70 Klebsiellae pneumoniae isolates in the present study. Ten of these organisms, representing at least five distinct strains, produced TEM-10 enzyme, encoded by a plasmid of c. 90 kb; the remaining organism had an unidentified SHV-derived enzyme.
Anti-Bacterial Agents↗
The use of continuous and discrete confidence judgments in receiver operating characteristic studies of diagnostic imaging techniques.
Virtually all receiver operating characteristic (ROC) studies of medical imaging methods have involved data collected on a discrete confidence-rating scale, though in principle ROC studies can be conducted with either discrete or continuous scales. Continuous scales provide potential advantages in medical applications of ROC analysis, but the possible dependence of ROC results on the kind of scale used in an observer-performance experiment has not been investigated empirically. The authors conducted a multi-observer ROC study in which radiologists read abdominal computed tomography (CT) examination results displayed on a workstation with a high-resolution video monitor. Ninety-five examinations were evaluated by five radiologists who reported their confidence concerning the presence of abdominal masses on a conventional five-category discrete scale and, in a separate reading session, on a continuous subjective-probability scale. ROC analysis showed no statistically significant difference between the detection accuracies (Az) achieved with the two scales by any reader. Accuracies averaged over all readers were identical with the two scales. The results of this study suggest that discrete or continuous scales often can be used interchangeably in image-evaluation studies. However, the authors recommend continuous scales for routine use in radiologic ROC studies because of their potential advantages in some situations.
Confidence Intervals↗
Clinicians' access to diagnostic imaging information at an academic center: perceived impact on patient management.
We studied the efficiency with which clinicians were able to obtain the results of radiologic studies during visits to the radiology department in an effort to determine how often delays occurred and, if so, how they were perceived to have influenced patient care. We monitored 322 physician's visits to four locations within the radiology department in search of imaging information or consultative services. The average duration of these visits was 6.2 min (range, 38 sec-55 min). Two hundred forty-three visits (75%) were completed successfully, and 10 additional visits were for consultation purposes only. In 43% of the 69 unsuccessful visits, physicians indicated that lack of access to imaging information would definitely (38%) or possibly (6%) result in delays in diagnosis and/or therapy. In 17% of the unsuccessful visits, physicians indicated that the inability to access imaging information would definitely (13%) or possibly (4%) extend the patient's length of stay in the hospital. Our study suggests that better access to imaging information may prevent delays in patient management decisions, thereby substantially reducing costs and potentially improving patient care.
Hospitals, University↗
Primary CT diagnosis of abdominal masses in a PACS environment.
Whether the display medium--film versus cathode ray tube (CRT)--affects observer performance during interpretation of computed tomographic (CT) images is an important research issue in these times of implementation and growth of picture archiving and communications systems in radiology. The authors performed a multiobserver receiver operating characteristic (ROC) study to determine the performance of radiologists who read abdominal CT studies displayed on film, as well as on a high-resolution workstation (video monitor) that made use of three different display modes. A total of 166 examinations were evaluated by eight radiologists, who recorded their ordinal confidence ratings of the demonstration of presence or absence of abdominal masses. ROC analysis showed small differences in the confidence ratings assigned by individual readers for the detection and interpretation tasks. Results for the group as a whole showed no significant reduction or improvement in observer performance when ratings for any one of the workstation display modes were analyzed. The results of this study demonstrate that current CRT display technology is adequate for enabling the primary detection of abdominal masses with CT examinations.
Abdominal Neoplasms↗
Visual acuity testing of radiologists--is it time?
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Adult↗
Optimizing performance of the billing company.
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Commerce↗
A perspective of the resource based relative value scale.
The authors address three issues associated with the implementation of the model proposed by Hsiao, et al. First, the mathematical model used and its underlying assumption, in particular as it relates to "time," is questioned. Second, the authors argue that measured rather than perceived (surveyed) data should be used whenever possible. This is particularly true for "time." Third, the authors raise the possibility that adjustments can and should be made based on the type and average complexity of examinations performed at different facilities. The potential implications of RBRVS reimbursement schemes on the practice of diagnostic radiology are significant and, once implement, they will be difficult to alter.
Models, Statistical↗
Autoregulation remains intact during stable xenon inhalation in the baboon.
To test the possible effect of 32% end-tidal Xe concentration upon autoregulation, 5 baboons, Papio anubis/cynocephalus, were anesthetized/paralyzed with propranolol 0.02, diazepam 0.1, morphine sulfate 0.1, and pancuronium 0.2 (mg/(h.kg)). The animals were subjected to a servocontrolled blood infusion-withdrawal program to control central aortic blood pressure (CAP). PaCO2 was held to 30 to 35 torr, with individual variation less than 3 torr by control of ventilation and by including CO2 in the Xe/O2 mixture. Three to six CBF measurements were made in each subject over the above range. In four animals the CAP was varied between 18 and 150 torr, with corresponding CBF measurements. The CAP range was extended to 196 torr in the 5th animal by IV administration of phenylephrine. Significant lowering of global blood flow did not occur above 40 torr mean CAP. While regulated flow persists to about 150 torr at the high end, there is a breakaway between 150 and 190 torr where flow increased 90%. A 4th order polynomial fit of the data has the characteristic appearance of the familiar autoregulation curve. We conclude that autoregulation is preserved even in the presence of FIXe of 32% in the breathing mixture.
Animals↗
Effect of two rating formats in multi-disease ROC study of chest images.
ROC methodology has been expanded in recent years to include multi-disease experiments. To accommodate these changes, different rating formats, general or disease specific, can be used. No experimental data are available concerning the possible effects of the rating format on the results of these studies. We performed a multi-observer, multi-disease study in which 196 chest images were rated using a format where each disease was evaluated individually and one in which the cases were evaluated without scoring a specific disease. The results indicate that for our data set, the overall assessment of accuracy was not significantly affected by the study format used. Thus, in spite of the difficulties in selecting appropriate controls and the necessity of reassessing sample size considerations, the disease-specific format appears to produce an assessment of accuracy equivalent to that produced by the general format. This equivalence permits the use of the disease-specific approach since it more closely simulates the readers' true environment and is more appropriate for comparing imaging systems that may have a relative accuracy that is disease specific.
Diagnosis, Differential↗
Effect of observer instruction on ROC study of chest images.
Receiver-operating characteristic (ROC) analysis has been used in many medical imaging applications during the past decade. In order to ensure that reader-confidence ratings are analyzable (well distributed to meet convergence requirements of curve-fitting algorithms) and meaningful (limit extrapolation of the data), many investigators train readers specifically for this purpose. No experimental data are available concerning the possible effects of such training on the results of ROC studies. We performed a multi-observer, multi-disease study in which 300 chest images were rated by four radiologists before and after they were trained to provide well-distributed confidence ratings. The results indicate that for our data set, reader and disease-specific accuracy was not significantly affected by the training process for interstitial disease and pneumothoraces. However, the accuracy of two readers was significantly affected for the detection of nodules (P less than 0.05), and the overall accuracy of one reader was significantly affected for the classification of normal versus abnormal images (P less than 0.01). Thus, in spite of the difficulties associated with the performance of ROC studies in a free-reading environment, one should carefully consider the possible effects of any intervention on the results prior to conducting ROC studies.
Humans↗
Practical issues of experimental ROC analysis. Selection of controls.
Receiver operating characteristics (ROC) analysis has been used in many medical imaging applications during the past decade. With the recent expansion of the ROC methodology to multi-disease studies, several reports have begun to address both the theoretical and experimental design issues associated with such studies. While the appropriate selection, classification, and verification of actually positive cases is carefully addressed in the literature, similar considerations are rarely given to the selection of actually negative controls for these studies. In this paper, theoretical considerations and experimental data are provided to demonstrate the significance of this very issue.
Case-Control Studies↗