NMR "gating" really means "synchronization".
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to P H Murphy.
Explore the source record for details and available documents.
Guidelines for radiation protection originate from numerous federal, state, and local agencies. Webster defines a guideline as a line by which one is guided, especially as an outline (as by a government) of policy or conduct. Guidelines in radiation protection can be either mandatory or advisory. Regulations by federal, state, and local governments for the use of radioactive materials define operating practices. Adherence to these regulations is required by law and there are penalties for noncompliance. Regulations generally constitute the minimum requirements for good practice and are usually supplemented by less formal recommendations from regulatory agencies and advisory groups. The regulatory guides published by the Nuclear Regulatory Commission (NRC) and by radiation control groups of agreement states are intended to assist the user of radioactive material in maintaining compliance with regulations. These guides recommend good practice but are not mandatory in that the user can propose alternatives to the regulatory agencies to meet the regulations. Many groups serve in an advisory capacity in formulating reports and recommendations for the safe use of radioactive material. The most prominent and influential among these are the National Council in Radiation Protection and Measurements (NCRP) and the International Commission on Radiological Protection (ICRP). Often the recommendations of these advisory groups evolve into either regulatory guidelines or regulations for the use of radioactive materials. At the present time, the backbone of the Nuclear Regulatory Commission's regulations relating to the medical use of radionuclides, "Standards for Protection Against Radiation" (10CFR20) and "Human Use of Byproduct Material (10CFR35), are undergoing extensive review with major revisions anticipated within the very near future. These proposed changes could have a significant impact on the practice of nuclear medicine. The changes will have some influence on radiation safety practice as it relates to the radiation worker, the patient, and the environment.
Using a Taylor series expansion of the phase shift of a moving isochromatic spin group in the presence of a magnetic field gradient, the refocusing effects of the Carr-Purcell-Meiboom-Gill pulse sequence on stationary nuclei and those with constant, rectilinear velocity are readily demonstrated. Continuing the analysis to higher orders of motion reveals that nuclei with a constant, rectilinear acceleration have a phase shift at the spin echoes which increases linearly with echo number. Constant, rectilinear jerk (the time rate of change of acceleration) leads to an increase in phase shift from echo to echo which is quadratic in nature with an overlying reduction of the odd-numbered echoes by a constant amount. Motion parameters may be measured by parameter identification techniques. These principles may be applied to phase-sensitive NMR imaging.
A database design is described which automatically archives computer-generated patient imaging and radioassay reports. Selected phrases are condensed so that data storage will be efficient without sacrificing a prose style of report. An indexed file structure has been used to facilitate rapid record retrieval even when several hundred thousand records are stored. Personnel time is considerably reduced for recalling patient records, preparing periodic summaries of studies completed, and performing administrative functions such as billing and keeping track of checked out images. Complex queries, such as "list all the patients between the ages of 50 and 60 on digitalis referred for a stress cardiac study, with left ventricular ejection fraction less than 40% and apical dyskinesis," become feasible. A system for data backup is described to protect against catastrophic data loss.
Because of physiologic R-R interval variability and arrhythmia, frame-mode acquisition of gated images may produce erroneous left ventricular volume curves, particularly in the diastolic filling phase. Eighteen patients in sinus rhythm underwent gated imaging in which both frame-mode and list-mode acquisitions were used. The systolic portions of the volume curves were similar in both studies, and the ejection fractions correlated well (R = 0.97). "Dropout" of data in the late diastolic phase, noted in 15 patients in whom frame mode was used, was not present in list mode, in which the atrial kick was clearly delineated. In additional patients with various arrhythmias, separate volume curves were obtained with list mode for premature, post-premature, and sinus beats. In patients with atrial fibrillation, a prominent peak mid-range on the R-R histogram was selected, and a complete volume curve was obtained. It was concluded that list-mode acquisition provided improved volume curves, with particular applicability in arrhythmic patients.
The proliferation of computer-based office-management systems in the past few years has involved the private physician's office as well as the hospital laboratory. Many radiology departments have already adopted this approach for patient report generation and data storage. Due to the absence of commercially available software, some nuclear medicine departments will be interested in writing their own, but may not have enough experience in nonimaging computer applications to determine the performance needed for a practical system. A report-generation system for scintigraphic studies has been developed in our department over the past 2 yr. During this time an essential hardware/software performance level was established. Ideas for design of program flow that enhance staff acceptance of this concept are presented. Significant reduction of errors in report transcription and billing, together with reduced requirements for secretarial and clerical staff, make a general system like this cost effective.
Proton nuclear magnetic resonance (NMR) imaging has been developed and improved over the past few years to the state that images of static structures have recently shown spatial resolution equivalent or superior to other techniques such as X rays, ultrasound, or gamma ray-emitting radionuclides. The current state of NMR development is described; however, use of this exciting new diagnostic modality depends on the results of extensive clinical trials.
Explore the source record for details and available documents.
First-harmonic Fourier analysis is currently used to aid in the interpretation of multigated cardiac studies. Its intrinsic inaccuracies are not generally appreciated. This study investigates the characteristics and magnitudes of the errors of this technique. The study analyzes computer-generated phantoms that isolate the various motions of the ventricles (contraction, translation, and rotation) with the first-harmonic approach. The first-harmonic output is compared with a more accurate fitting scheme using multiple terms of the Fourier expansion. Significant artifacts of the inaccuracy of the first harmonic appear in the phantom studies and are observed in patient examples. We conclude that caution is needed in interpreting first-harmonic phase and amplitude images, and particularly in associating them with parameters like the onset of contraction and the stroke volume.
Explore the source record for details and available documents.
ECG-gated cross-sectional images of the cardiac blood pool were produced using a specially constructed emission computed tomographic scanner. A pair of large-field-of-view cameras were mounted in opposition in a gantry that rotates 360 degrees about the patient. The coordinates of each detected event, the output of a physiological synchronizer, and the position of the camera heads were input to a dedicated minicomputer which was used to produce the images. Display as a movie permitted evaluation of regional and global wall motion in cross section without the disadvantages of superimposed blood pools as obtained in nontomographic views.
Explore the source record for details and available documents.
A whole-body computed tomography system for single-photon emitters was evaluated from the standpoint of spatial resolution, sensitivity, and thresholds for count densities with reference to standard doses of currently used radiopharmaceuticals in patients. In air and tissue equivalents, spatial resolution was relatively constant throughout the field of view and attentuation correction algorithms returned uniformity of response to within 10%. In a phantom of the human abdomen 1.5-cm spherical "cold" lesions and 1-cm "hot" lesions could be resolved. Aspects of the partial-volume effect were observed and investigated. To detect 1.5 cm-cold lesions in an abdominal phantom, five million events were required.
A whole-body computed tomography system for single-photon emitters was used to investigate the clinical utility of this imaging modality. We have explored its application in brain, lung, liver, kidney, cardiac, bone, and gallium imaging in over 200 patients. Brain images demonstrated better lesion contrast than that in standard scintiphotos. Images of the lung and liver showed radionuclide distribution that was not readily apparent in standard scintiphotos. Moderate or strongly positive pyrophosphate myocardial images demonstrate the potential for infarct quantitation. ECG-gated cardiac blood-pool images in cross section, displayed in cine formate, permit evaluation of segmental motion of the free and septal walls of both ventricles. These results suggest significant clinical potential for this imaging modality using standard radiopharmaceuticals, but some increase in system sensitivity will likely be necessary to realize the full benefit of the technique.
Direct videotape recording of images from computer display terminals is often not possible because of the nonstandard outputs of these systems. A video-sync mixer is described that permits black-and-white recording on standard 3/4-in. videotape cassettes.
Regional myocardial wall motion is usually evaluated qualitatively from ECG-gated end-systolic and end-diastolic blood-pool images. Radionuclide kymography, which displays a one-dimensional scintigraphic image in time, synchronized with the electrocardiogram, provides a method to quantitate this motion. The technique is analogous to M-mode ultrasound in that one dimension is displayed as a function of time, but the activity distribution is displayed in place of acoustic interfaces. The motion of regional myocardial segments can be measured from multiple kymographic projections across the cardiac blood pool, after equilibration of a radioactive tracer. Radionuclide kymography is potentially better quantitatively than gated blood-pool imaging and is not hindered by viewing windows as are single- and multiple-transducer ultrasonography. Regional wall motion determined from radionuclide kymography correlated well with that determined from contrast left ventriculography in a series of patients. Since the kymographic sweep is initiated by the R wave of the ECG and proceeds continuously throughout the cardiac cycle, the temporal sequence of regional myocardial contraction can be directly assessed and related to corresponding portions of the ECG.
Explore the source record for details and available documents.
Large-field-of-view scintillation cameras are general purpose, cost effective, imaging devices if one maximizes the use of the crystal with respect to the size of the object under study. This means using parallel-hole collimation for large-organ systems to reduce the number of views necessary to complete a study or to obtain a better appreciation of continuity of structure. A further increase in photon utization is gained for small-organ imaging with converging collimators, which produce images with superior resolution and sensitivity to that obtained with equivalent parallel-hole collimators. The disadvantages of converging collimators, including decreasing field of view and distortion with depth, have been insignificant in light of the advantages gained. Larger detectors with converging collimation result in much higher photon input rates to the scintillation crystal in routine clinical studies than has occurred in the past. This requirement places added burdens on electronic circuitry of the cameras. Count rate processing capabilities of 200,000 counts per second are currently available and are necessary for present generation first-pass cardiovascular studies.