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Biomedical subjects

L Berman

Publications and source records attributed to L Berman.

At least 19 recordsLinked to original sources
PubMed2004

Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure.

BACKGROUND: This study assessed the feasibility, efficacy and safety of focused parathyroidectomy combined with intraoperative parathyroid hormone (IOPTH) measurement in a day-case setting. METHODS: Over 28 months 50 consecutive patients (mean age 63 (range 33-92) years) with clear evidence of unifocal disease on sestamibi scanning or ultrasonography underwent unilateral neck exploration via a small lateral incision. Blood samples for measurement of IOPTH were taken at induction of anaesthesia, before adenoma excision and after adenoma excision (at 5, 10 and 20 min). Ten patients were discharged within 23 h and 40 patients on the day of surgery. RESULTS: A solitary adenoma was identified in all but one patient, with a mean operating time of 30 (range 16-57) min. After parathyroidectomy, IOPTH levels fell appropriately except in one patient with multiglandular hyperplasia. No patient developed symptomatic hypocalcaemia during the 2 weeks after operation, enabling cessation of oral supplements. All patients remained normocalcaemic on follow-up (mean 26 (range 8-84) weeks) and histological examination confirmed parathyroid adenoma (48 patients), hyperplasia (one) or carcinoma (one). CONCLUSION: After accurate preoperative localization of uniglandular disease, patients with primary hyperparathyroidism may be managed successfully and safely by focused parathyroidectomy with IOPTH measurement as a day-case procedure.

Adenoma↗
PubMed2004

Processing and visualizing three-dimensional ultrasound data.

This paper describes techniques for the visualization and processing of three-dimensional (3D) ultrasound data. The nature of such data demands specialized algorithms, which differ from those employed for other medical imaging modalities. In this paper, the emphasis is placed on generic processing techniques, which are relevant across a wide range of 3D ultrasound application domains.

Algorithms↗
PubMed2002

Correction of probe pressure artifacts in freehand 3D ultrasound.

We present an algorithm which combines non-rigid image-based registration and conventional position sensing to correct probe-pressure-induced registration errors in freehand three-dimensional (3D) ultrasound volumes. The local accuracy of image-based registration enables the accurate freehand acquisition of high resolution (>15 MHz) 3D ultrasound data, opening the way for 3D musculoskeletal examinations. External position sensor readings guarantee the large-scale positional accuracy of the data. Pressure correction is shown to dramatically increase the perceived quality of extended-field-of-view data sets and reslices through volumetric data sets, while quantitative comparisons of multiple in vivo volumes demonstrate the superior precision of the corrected data.

Algorithms↗
PubMed2001

3D ultrasound measurement of large organ volume.

Freehand 3D ultrasound is particularly appropriate for the measurement of organ volumes. For small organs, which can be fully examined with a single sweep of the ultrasound probe, the results are known to be much more accurate than those using conventional 2D ultrasound. However, large or complex shaped organs are difficult to quantify in this manner because multiple sweeps are required to cover the entire organ. Typically, there are significant registration errors between the various sweeps, which generate artifacts in an interpolated voxel array, making segmentation of the organ very difficult. This paper describes how sequential freehand 3D ultrasound, which does not employ an interpolated voxel array, can be used to measure the volume of large organs. Partial organ cross-sections can be segmented in the original B-scans, and then combined, without the need for image-based registration, to give the organ volume. The inherent accuracy (not including position sensor and segmentation errors) is demonstrated in simulation to be within +/- 2%. The in vivo precision of the complete system is demonstrated (by repeated observations of a human liver) to be +/- 5%.

Algorithms↗
PubMed2001

Prevalence of cystic paraurethral structures in asymptomatic women at endovaginal and perineal sonography.

AIM: To prospectively assess the prevalence of paraurethral cystic structures in asymptomatic adult women. PATIENTS AND METHODS: One hundred and forty consecutive women undergoing endovaginal sonography with no history of lower urinary tract symptoms. RESULTS: Paraurethral cystic structures were identified in 4/140 subjects (2.9%). Ultrasound assessment allowed rapid definition of the site, size and vascularity of these lesions and was well tolerated by the patient. CONCLUSION: This is the first prospective ultrasound study to determine the prevalence of paraurethral cystic structures in a large consecutive cohort of asymptomatic women. Our findings are in accordance with previously published post-mortem data and surgical series which have estimated the prevalence of paraurethral cystic structures to be between 1 and 6%.

Adolescent↗
PubMed2001

The use of beam angulation to overcome anisotropy when viewing human tendon with high frequency linear array ultrasound.

Anisotropy is the property of tendons, nerves and muscles to vary in their ultrasound appearance depending on the angle of insonation of the incident ultrasound beam. Loss of reflectivity in tendons may also denote underlying disease. We describe beam angulation, a simple technique available with most modern ultrasound machines, which allows the operator to overcome the potential pitfall of anisotropy in ultrasound assessment of peripheral tendons.

Anisotropy↗
PubMed2000

Body-centered visualisation for freehand 3-D ultrasound.

Three-dimensional (3-D) ultrasound (US) data is typically visualised by any-plane slicing, volume rendering or surface rendering. Typical implementations of these techniques do not readily convey the spatial relationship between the visualised data and the patient's body, something that is particularly important when the data are reviewed after the scan has taken place, perhaps by a remote expert who did not even perform the scan. This paper describes a facility to register the 3-D US data to the patient's body and then display the data correctly superimposed on a rendered mannequin (rigid computer model). This way, the user can appreciate the position and orientation of any visualisation with respect to the patient's body. The facility relies on efficient implementation of progressive meshes to manage the level of detail of the mannequin model.

Abdomen↗
PubMed2000

Surface interpolation from sparse cross sections using region correspondence.

The ability to estimate a surface from a set of cross sections allows calculation of the enclosed volume and the display of the surface in three-dimensions. This process has increasingly been used to derive useful information from medical data. However, extracting the cross sections (segmenting) can be very difficult, and automatic segmentation methods are not sufficiently robust to handle all situations. Hence, it is an advantage if the surface reconstruction algorithm can work effectively on a small number of cross sections. In addition, cross sections of medical data are often quite complex. Shape-based interpolation is a simple and elegant solution to this problem, although it has known limitations when handling complex shapes. In this paper, the shape-based interpolation paradigm is extended to interpolate a surface through sparse, complex cross sections, providing a significant improvement over our previously published maximal disc-guided interpolation. The performance of this algorithm is demonstrated on various types of medical data (X-ray computed tomography, magnetic resonance imaging and three-dimensional ultrasound). Although the correspondence problem in general remains unsolved, it is demonstrated that correct surfaces can be estimated from a limited amount of real data, through the use of region rather than object correspondence.

Computer Simulation↗
PubMed1999

Stradx: real-time acquisition and visualization of freehand three-dimensional ultrasound.

Conventional freehand three-dimensional (3-D) ultrasound is a multi-stage process. First, the clinician scans the area of interest. Next, the ultrasound data is used to construct a 3-D voxel array, which can then be visualized by, for example, any-plane slicing. The strict separation of data acquisition and visualization disturbs the interactive nature of the ultrasound examination. Furthermore, some systems require the clinician to wait for an unacceptable amount of time while the voxel array is constructed. In this paper, we describe a novel freehand 3-D ultrasound system which allows accurate acquisition of the raw data and immediate visualization of arbitrary slices through the data. Minimal processing separates the acquisition and visualization processes: in particular, at no stage is a voxel array constructed. Instead, the standard graphics hardware found inside most desktop computers is exploited to synthesize arbitrary slices directly from the raw B-scans.

Anatomy, Cross-Sectional↗
PubMed1999

Fast surface and volume estimation from non-parallel cross-sections, for freehand three-dimensional ultrasound.

Volume measurements from ultrasound B-scans are useful in many clinical areas. It has been demonstrated previously that using three-dimensional (3-D) ultrasound can greatly increase the accuracy of these measurements. Freehand 3-D ultrasound allows freedom of movement in scanning, but the processing is complicated by having non-parallel scan planes. Two techniques are proposed for volume measurement from such data, which also improve surface and volume estimation from data acquired on parallel planes. Cubic planimetry is a more accurate extension of a volume measurement technique involving vector areas and centroids of cross-sections. Maximal-disc shape-based interpolation is an extension of shape-based interpolation which uses maximal disc representations to adjust the interpolation direction locally and hence improve the quality of the surface generated. Both methods are tested in simulation and in vivo. Volumes estimated using cubic planimetry are more accurate than step-section planimetry, and require fewer cross-sections, even for complex objects. Maximal-disc shape-based interpolation provides a reliable means of reconstructing surfaces from a handful of cross-sections, and can therefore be used to give confidence in the segmentation and hence also the cubic planimetry volume.

Anatomy, Cross-Sectional↗
PubMed1999

A comparison of freehand three-dimensional ultrasound reconstruction techniques.

Three-dimensional freehand ultrasound imaging produces a set of irregularly spaced B-scans, which are typically reconstructed on a regular grid for visualization and data analysis. Most standard reconstruction algorithms are designed to minimize computational requirements and do not exploit the underlying shape of the data. We investigate whether an approximation with splines holds any promise as a better reconstruction method. A radial basis function approximation method is implemented and compared with three standard methods. While the radial basis approach is computationally expensive, it produces accurate reconstructions without the kind of visible artefacts common with the standard methods. The other potential advantages of radial basis functions, such as the direct computation of derivatives, make further investigation worthwhile.

Algorithms↗
PubMed1999

Risk communication: clinicians' reported approaches and perceived values.

Despite significant conceptual and empirical advances in research on the risk assessment of violence during the last decade, there has apparently been no empirical research in the related area of risk communication. After summarizing the major theoretical and practical justifications for studying risk communication, this article describes the results of two studies of clinicians' risk communication practices. In Study 1, practicing clinicians (psychiatrists and psychologists; n = 55) were surveyed. Only one clinician indicated that he employed numerical probability figures in communicating risk; a total of nine reasons for not using numerical probabilities were cited, in varying combinations, by participants. Risk communication practices that were reportedly employed included a total of 11 approaches, endorsed in varying combinations. In Study 2, a separate sample of clinicians (n = 59) rated (1) the importance of the Study 1 reasons against using numerical probability figures in risk communication and (2) the value of the different forms of risk communication derived in Study 1. These data apparently offer the first empirical description of how clinicians communicate the results of risk assessments of violence and their reasons for communicating in such ways.

Communication↗
PubMed1999

Polyarteritis nodosa presenting as temporal arteritis in a 9-year-old child.

A 9-year-old Haitian girl presented initially with monocular blindness and an isolated temporal arteritis, confirmed by angiographic studies and temporal artery biopsy findings. CT and MR studies of the intracranial circulation showed only an enlarged, dense superficial temporal artery. Systemic workup revealed a mildly elevated erythrocyte sedimentation rate, mild changes in white and red blood cells, and a remote history of sensorineural hearing loss. Pathologic examination of the biopsy specimen narrowed the differential diagnosis to giant cell temporal arteritis and polyarteritis nodosa. Treatment with corticosteroids alone failed, and the child returned 1 month later with severe systemic illness and encephalopathy. MR studies showed multiple cortical and subcortical foci of increased T2 signal, and gyriform enhancement on T1-weighted images. Renal and mesenteric arteriograms showed innumerable tiny aneurysms at branch points in small and medium-sized vessels, typical of polyarteritis nodosa. We found no previous reports of this initial presentation in the pediatric population for either polyarteritis nodosa or giant cell temporal arteritis.

Angiography↗
PubMed1998

Automatic registration of 3-D ultrasound images.

One of the most promising applications of 3-D ultrasound (US) lies in the visualisation and volume estimation of internal 3-D structures. Unfortunately, artifacts and speckle make automatic analysis of the 3-D data sets difficult. In this study, we investigated the use of 3-D spatial compounding to improve data quality, and found that precise registration is the key. A correlation-based registration technique was applied to 3-D ultrasound data sets acquired from in vivo examinations of a human gall bladder. We found that the registration technique performed well, and visualisation and segmentation of the compounded data were clearly improved. We also demonstrated that an automatic volume estimate made from the compounded data (13.0 mL) was comparable to a labour-intensive manual estimate (12.5 mL). In comparison, automatic estimates of uncompounded data are less accurate (ranging from 13.5 mL to 16.7 mL). The registration technique also has applications in intra- and interpatient comparative studies.

Gallbladder↗
PubMed1998

Rapid calibration for 3-D freehand ultrasound.

3-D freehand ultrasound is a new imaging technique that is rapidly finding clinical applications. A position-sensing device is attached to a conventional ultrasound probe so that, as B-scans are acquired, they can be labelled with their relative positions and orientations. This allows a 3-D data set to be constructed from the B-scans. A key requirement of all freehand imaging systems is calibration; that is, determining the position and orientation of the B-scan with respect to the position sensor. This is typically a lengthy and tedious process that may need repeating every time a sensor is mounted on a probe. This paper describes a new calibration technique that takes only a few minutes to perform and produces results that compare favourably (in terms of both accuracy and precision) with previously published alternatives.

Calibration↗