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Biomedical subjects

R N Rankin

Publications and source records attributed to R N Rankin.

At least 19 recordsLinked to original sources
PubMed2000

Flow patterns at the stenosed carotid bifurcation: effect of concentric versus eccentric stenosis.

Carotid stenosis severity is a commonly used indicator for assessing risk of stroke. However, the majority of individuals with severe carotid artery disease never suffer a stroke, and strokes can occur even with only mild or moderate stenosis. This suggests local factors (other than stenosis severity) at or near the carotid artery bifurcation may be important in determining stroke risk. In this paper we investigate the effect of stenosis geometry on flow patterns in the stenosed carotid bifurcation, using concentrically and eccentrically stenosed anthropomorphic carotid bifurcation models having identical stenosis severity. Computational simulations and experimental flow visualizations both demonstrate marked differences in flow patterns of concentric and eccentric stenosis models for moderately and severely stenosed cases, respectively. In particular, we identify post-stenotic recirculation zone size and location, and spatial extent of elevated wall shear stress as key factors differing between the two geometries. As these are also rotid plaque more vulnerable to cerebral embolus prokey biophysical factors promoting thrombogenesis, we propose that the stenosed carotid bifurcation geometry--or the induced flow patterns themselves--may provide more specific indicators for those plaques that are vulnerable to enhanced thromboembolic potential, and hence, increased risk of ischemic stroke.

Biomedical Engineering↗
PubMed1999

Percutaneous gastrojejunostomy in amyotrophic lateral sclerosis.

We have performed a retrospective review of the use of a percutaneous gastrojejunostomy in patients with amyotrophic lateral sclerosis (ALS). Forty-one patients with initial bulbar manifestations of ALS and 32 patients with initial limb manifestations underwent a percutaneous gastrojejunostomy under fluoroscopic control using the Rankin gastrojejunostomy tube. Survival characteristics were compared with 86 bulbar onsetting and 207 limb onsetting ALS patients who did not require nutritional support. The 30-day mortality rate was 9.6% (respiratory death in three bulbar onsetting patients and four limb onsetting patients) and the 30 day morbidity rate was 4.1% (one operative site infection and intraperitoneal leakage in two patients). The most frequent long-term complication was the requirement for tube changing (blockage in six; dislodgment in two). Gastric reflux was not described amongst the treated patients. Overall survivorship (symptom onset to death) was less in the bulbar onsetting patients receiving a gastrojejunostomy tube than in the control population (median survival 22.0 vs. 33.7 months, respectively, P=0.005). As a group, the median survivorship for limb onsetting patients was not different for those receiving a gastrojejunostomy than for those who did not. However, a significant reduction in survival was observed in limb onsetting patients receiving a gastrojejunostomy early in the course of their disease (P=0.001) compared to those with a longer duration prior to the procedure. This was not observed in the bulbar onsetting patients. In both patient populations, no relationship was observed between survival post-gastrojejunostomy and the severity of pulmonary involvement at the time of the intervention, serum chloride, or age at onset. These studies demonstrate that a percutaneous gastrojejunostomy is a well-tolerated and safe alternative technique for enteral nutritional support in ALS patients. It also offers the advantage of not requiring either a general anaesthetic at the time of the procedure or instrumentation through the oropharynx. We have also observed that limb onsetting patients requiring a gastrojejunostomy early in the course of their illness are in a distinctive, less favorable, prognostic group.

Adult↗
PubMed1999

Magnetic resonance imaging in Canada: dissemination and funding.

OBJECTIVE: To determine the dissemination of magnetic resonance imaging (MRI) units in Canada, and the funding sources used to buy, site and operate them. METHODS: Review of available data in the medical literature and on the Internet to determine dissemination. Based on these data, a survey was faxed to all the MRI sites in Canada requesting information on sources of funding, hours of operation, numbers of examinations performed and expansion plans. RESULTS: There were 53 operating MRI sites in Canada at the end of 1997. There are 1.7 MRI units per 1 million population in Canada, compared with 4.3 per 1 million for a range of comparable European countries, and 9.4 per 1 million for a worldwide sample of similar industrial countries. The survey showed that a minority of sites received any government funding for capital acquisition (23%) or related building costs (19%). A direct government grant to at least partially cover operating costs was available at 42% of sites. The average numbers of examinations performed was 3653 per site per year, with average operating hours of 64 per week, and a throughput of 1.1 examinations per hour. These figures are equivalent to those from sites in other countries. CONCLUSION: Despite the fact that Canada has a state-funded health care system, the single payer--government--is the smallest participant in funding MRI. MRI is widely accepted as a major advance in medical imaging, with future expansion in its capabilities assured. The important role of MRI in medical diagnosis and treatment is undisputed. Canada's position as the country with the lowest dissemination of this technology, and the need for a strategy to fund future technology acquisition in the health care system, must be addressed by all levels of government.

Canada↗
PubMed1998

Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.

BACKGROUND: Previous studies have shown that carotid endarterectomy in patients with symptomatic severe carotid stenosis (defined as stenosis of 70 to 99 percent of the luminal diameter) is beneficial up to two years after the procedure. In this clinical trial, we assessed the benefit of carotid endarterectomy in patients with symptomatic moderate stenosis, defined as stenosis of less than 70 percent. We also studied the durability of the benefit of endarterectomy in patients with severe stenosis over eight years of follow-up. METHODS: Patients who had moderate carotid stenosis and transient ischemic attacks or nondisabling strokes on the same side as the stenosis (ipsilateral) within 180 days before study entry were stratified according to the degree of stenosis (50 to 69 percent or <50 percent) and randomly assigned either to undergo carotid endarterectomy (1108 patients) or to receive medical care alone (1118 patients). The average follow-up was five years, and complete data on outcome events were available for 99.7 percent of the patients. The primary outcome event was any fatal or nonfatal stroke ipsilateral to the stenosis for which the patient underwent randomization. RESULTS: Among patients with stenosis of 50 to 69 percent, the five-year rate of any ipsilateral stroke (failure rate) was 15.7 percent among patients treated surgically and 22.2 percent among those treated medically (P=0.045); to prevent one ipsilateral stroke during the five-year period, 15 patients would have to be treated with carotid endarterectomy. Among patients with less than 50 percent stenosis, the failure rate was not significantly lower in the group treated with endarterectomy (14.9 percent) than in the medically treated group (18.7 percent, P=0.16). Among the patients with severe stenosis who underwent endarterectomy, the 30-day rate of death or disabling ipsilateral stroke persisting at 90 days was 2.1 percent; this rate increased to only 6.7 percent at 8 years. Benefit was greatest among men, patients with recent stroke as the qualifying event, and patients with hemispheric symptoms. CONCLUSIONS: Endarterectomy in patients with symptomatic moderate carotid stenosis of 50 to 69 percent yielded only a moderate reduction in the risk of stroke. Decisions about treatment for patients in this category must take into account recognized risk factors, and exceptional surgical skill is obligatory if carotid endarterectomy is to be performed. Patients with stenosis of less than 50 percent did not benefit from surgery. Patients with severe stenosis (> or =70 percent) had a durable benefit from endarterectomy at eight years of follow-up.

Aged↗
PubMed1998

Elastic response of human iliac arteries in-vitro to balloon angioplasty using high-resolution CT.

Previous angioplasty studies have used angiography and intravascular ultrasound to obtain vascular dimensions. These imaging methods do not always provide reliable measurements due to limitations in image orientation and resolution. In this study, high-resolution (0.1 x 0.1 x 0.5 mm) transverse CT slices were obtained from human common-iliac arteries in vitro to study their elastic response pre- and post-angioplasty. Seven iliacs from five patients were imaged over the physiological pressure range both pre- and post-angioplasty. Contrast was obtained with humidified air surrounding the artery. Angioplasty was done with 10 or 12 mm diameter Medi-Tech balloon catheters with a balloon pressure of 300 kPa held for 30 s. Lumen circumference, c, measured from the images, was plotted against pressure, P, and curve fitting showed c = A(1 - e(-KP)) + B where A, K, and B are fitting parameters. Six lesions appeared soft and were compressed, while one was calcified and partially lifted off the wall. Normalized changes in parameters B and K were much higher post-angioplasty in the calcified lesion, and were over 3 standard deviations from the means of the normalized changes in the six compressed lesions. Balloon/stenosed lumen diameter ratios greater than 1.2 produced a lumen area increase of 38.6 +/- 4.1%(S.D.)(n = 3); ratios less than 1.2 produced an increase of 4.4 +/- 5.1%(S.D.)(n = 4). There was no correlation between area increase and balloon/normal lumen diameter ratio (the value used clinically). Arteries with lesions containing stiffer plaques that tear from the artery wall during angioplasty appear more distensible over the physiological pressure range post-angioplasty.

Aged↗
PubMed1998

The effect of storage time and repeated measurements on the elastic properties of isolated porcine aortas using high resolution x-ray CT.

A Laboratory CT scanner with a resolution of (0.1 mm)3 was used to determine if storage up to 7 days in saline at 4 degrees C and (or) repeated measurements would alter the compliance, C, and incremental elastic modulus, Einc, of isolated porcine aortas. All specimens were obtained fresh, made pressure-tight, and then mounted in the scanner, with humidified air used to produce adequate x-ray contrast. The specimens were imaged at pressures of 4, 8, 12, 16, 20, and 24 kPa, and vessel measurements were then obtained with a computerized technique and analyzed. Seven thoracic aortas were studied on days 0, 3, 5, and 7, with a significant change (p < 0.05) in compliance first occurring after three imaging studies (i.e., day 5). Compliance of the fresh thoracic aortas (mean +/- SD) was 0.90 +/- 0.28 mm/kPa at 14.4 kPa and 0.85 +/- 0.31 mm/kPa at 22.5 kPa. Six thoracic aortas were studied only on days 0 and 6 with no intermediate measurements. They showed no change in either compliance (0.88 +/- 0.07 mm/kPa at 14.4 kPa and 0.64 +/- 0.09 mm/kPa at 22.5 kPa) or Einc (0.46 +/- 0.05 MPa at 14.4 kPa and 0.88 +/- 0.15 MPa at 22.5 kPa) from day 0 to day 6. Thus, number of measurements rather than time appears to be the important factor. Six abdominal aortas were studied similarly but on days 0, 3, and 6. No significant change occurred in compliance (0.15 +/- 0.06 mm/kPa at 14.4 kPa and 0.032 +/- 0.026 mm/kPa at 22.5 kPa) but Einc showed a change, possibly due to their viscoelastic properties. We conclude that this nondestructive CT measurement method is suitable for repeated studies on porcine thoracic aortas, but not abdominal aortas, if the measurement involves two consecutive imaging sessions separated by no more than 6 days.

Animals↗
PubMed1997

A real vessel phantom for imaging experimentation.

Vascular phantoms are used to evaluate imaging techniques such as ultrasound (US), CT, and angiography. They are expected to mimic the vasculature, surrounding tissue, and blood, and therefore must meet specific requirements on the mimicking materials, with respect to x-ray attenuation and acoustic properties (velocity, attenuation). In the past, researchers have used a variety of vessel models, including walled (typically latex tube) and wall-less phantoms (obtained by moulding a lumen in a block of agar). These models lacked the exact geometry of human vessels as well as pathologic features such as plaques and calcifications. To overcome these disadvantages, this paper describes a real vessel phantom for US and x-ray studies. The phantom consists of an agar-filled acrylic box containing a formaldehyde fixed section of a real human vessel (obtained at autopsy) cannulated onto two acrylic tubes. This phantom was evaluated by comparing the images obtained with x-ray angiography, CT, and 3-D B-mode US. The images show good overall correlation based on the location of the geometrical features within the phantom, such as lumen, plaques, and calcifications. Discrepancies, artifacts, and difficulties were minor, and are discussed. The use of a real vessel, with its natural geometry and pathology, makes this phantom attractive for evaluation of imaging techniques including projection radiography, CT and US, and for extending its use to MR and US based flow studies.

Angiography↗
PubMed1997

Need for radiologists to interpret orthopedic total joint radiographs.

We applaud the aim of Nayak and colleagues: to use our scarce economic resources as judiciously as possible. We have suggested several alternatives that would save more of our scarce health care dollars. We would be delighted to take part in a properly designed prospective randomized trial to address the issues presented in this paper. We believe the literature would be strengthened by the publication of a collegial paper, coauthored by orthopedic and radiology departments, addressing the issue of saving health care dollars by omitting unnecessary or redundant procedures.

Canada↗
PubMed1997

Percutaneous gastrostomy in radiologic practice.

Long-term gastrostomy tubes have a well-accepted role in providing nutritional support. Traditionally they have been placed by surgeons and by endoscopists. In the last decade, radiologists have come to play a major role in the placement of gastrostomy and gastrojejunostomy devices, and can usually do so as effectively and at lesser expense. A technique for placement is outlined, with a discussion of patient selection and complications. A review of the literature is provided.

Contraindications↗
PubMed1997

How Canadian radiologists adopt innovations: a survey.

BACKGROUND AND OBJECTIVE: Innovations and practice changes occur frequently in modern radiologic practice. In this study the authors sought to understand the process of adopting an innovation and to define the characteristics of some innovations and the effect of these characteristics on innovation adoption. METHODS: An anonymous mail survey of the membership of the Canadian Association of Radiologists was undertaken to obtain details about the process of adopting an innovation. Information on the perceived characteristics of the innovation was obtained, as well as the perception of change in practice. RESULTS: The survey was sent to 1005 radiologists and was returned by 372 (37.0%), of whom 278 gave information on an innovation adopted in the preceding year. The respondents reported heavy use of textual and other material resources throughout the process of innovation adoption, as well as consultation with colleagues. Continuing medical education (CME) events, in comparison, were little used as information sources. Compatibility of the innovation with current practice and a relative clinical advantage over existing practices were the most important characteristics of the innovations adopted. The complexity, relative financial gain and ability to try the innovation were all less important. CONCLUSIONS: This study confirms a high rate of change in radiologic practice and documents the number and variety of learning resources used in the adoption of change. It is important for CME providers and educators to recognize the relatively low use of CME events in the process of change. Characterization of the innovations indicates concern with the clinical impact of the change and the individual physician's ability to accomplish the change within his or her practice.

Canada↗
PubMed1996

Geometric characterization of stenosed human carotid arteries.

RATIONALE AND OBJECTIVES: The geometry of stenosed carotid bifurcations was analyzed to determine average representations for several stenosis grades. METHODS: Film angiograms of 62 patients with internal carotid artery stenoses were digitized. Residual lumen boundaries were manually outlined. The outlines were processed with a computer to extract geometric measurements. The measurements were grouped according to stenosis grade and used to create average representations. RESULTS: Accuracy and precision of the outlining technique were +/- 0.020 common carotid diameters (CCD) and +/- 0.025 CCD, respectively. Maximum narrowing of the internal carotid artery occurred at 0.3 CCD +/- 1.5 (mean +/- standard deviation) distal to the flow divider. The region of significant narrowing extended axially 1.2 CCD +/- 1.0. Poststenotic dilatations were observed, with enlargement of 1.3 +/- 0.7 times the normal diameter of the distal internal carotid artery. A tendency toward smaller bifurcation angles with increasing stenosis severity was observed. CONCLUSION: Three-dimensional geometric models could be created for carotid bifurcations that were disease free (normal) and of arbitrary stenosis grade.

Aged↗
PubMed1996

Duplex and color Doppler flow sonography of occlusion and near occlusion of the carotid artery.

PURPOSE: To determine whether color Doppler flow imaging with the use of slow-flow sensitivity improves sensitivity and specificity in the differentiation of occlusion and near occlusion of the internal carotid artery. METHODS: Color Doppler and duplex sonography were performed in symptomatic patients who had angiographically confirmed occlusion and/or near occlusion of the internal carotid artery. The study consisted of two phases: in the first, we assessed the usefulness of color Doppler flow imaging by retrospectively reviewing the records of 35 patients with 36 angiographically confirmed occlusions or near occlusions of the internal carotid artery who were examined with color Doppler flow imaging at our institution during a period of 4 years; in the second phase, we incorporated color Doppler sonography into the routine scanning protocols of 39 patients with 41 occluded or nearly occluded internal carotid arteries seen over a period of 2 1/2 years. RESULTS: Overall, color Doppler imaging correctly showed all 34 of the near occlusions (sensitivity, 100%) and 36 of the 43 occlusions (specificity, 84%). Seven patients with angiographically confirmed occlusion had sonographic findings that suggested near occlusion. In the first phase, eight near occlusions were misinterpreted as occlusions with conventional duplex sonography, but were correctly shown with color Doppler flow imaging. In the second phase, sensitivity increased from 50% to 100% (18 or 18) because of better detection of the nearly occluded lumen. This was at the expense of a decrease in specificity (from 100% to 78%). owing to identification of apparent flow in the internal carotid artery on color Doppler flow images in five of 23 occlusions. CONCLUSION: Because of its ability to depict slow flow, color Doppler imaging with slow-flow sensitivity is superior to conventional duplex sonography for the noninvasive discrimination of occlusion from near occlusion of the internal carotid artery.

Arterial Occlusive Diseases↗
PubMed1995

Rapid volume flow rate estimation using transverse colour Doppler imaging.

A system is described in which the volume flow rate of blood in a vessel is determined using transverse colour Doppler ultrasound imaging. The system measures rapidly the two-dimensional velocity profile of blood flowing through a vessel. By integration of the measured velocity profiles the volume flow rate of blood in the vessel is obtained. The Doppler angle is obtained from the included angle between two imaging planes, and their respective average measured flows. This technique yields instantaneous and average flow rate in real time, and permits long flow recordings to be made and stored digitally. The error is less than 5% over a 8:1 flow rate range.

Algorithms↗
PubMed1995

Accuracy and prognostic consequences of ultrasonography in identifying severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.

BACKGROUND AND PURPOSE: The accuracy of routine ultrasonography in detecting severe carotid artery stenosis was evaluated in comparison with cerebral angiography. The precision of ultrasonographic criteria in predicting the risk of stroke was also assessed. METHODS: A total of 1011 symptomatic carotid bifurcations were studied in patients from the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Given that all patients were considered for entry into the trial, the chance of a verification bias affecting the analyses was minimized. The ultrasonographic data consisted of peak systolic velocities and frequency changes from both the internal and common carotid arteries. Angiographic stenosis was calculated as in NASCET. Receiver operating characteristic (ROC) curves were constructed from the ultrasonographic data for the detection of 70% or greater stenosis on the basis of an angiographic assessment. Kaplan-Meier stroke-free survival curves were used to predict the risk of stroke. RESULTS: The areas under the ROC curves ranged from 0.74 to 0.75 (95% confidence interval [CI], 0.69 to 0.79). The sensitivities and specificities ranged from 0.65 to 0.71. The risk of stroke at 18 months declined sharply as the degree of angiographically defined stenosis declined from 99% to 70%. No pattern of decline was apparent on the basis of the ultrasonographic data. CONCLUSIONS: The results indicate that the accuracy of ultrasonography is moderate when flow parameters are used to assess the degree of stenosis. Ultrasonography should be used as a screening tool to exclude patients with no carotid artery disease from further testing. Conventional angiography remains an essential investigation before assigning the risk of stroke and deciding appropriate treatment for extracranial carotid artery disease.

Blood Flow Velocity↗
PubMed1994

Poster production by color laser imager.

The scientific poster is an important educational tool at most radiology meetings. The visual impact of the exhibit is important in attracting attention and conveying content to the reader. A new method of designing and producing full-color transilluminated posters in the radiology department using a personal computer and color laser imager is described. The advantages of this approach are author control over the production process and production of a visually interesting exhibit.

Audiovisual Aids↗