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PubMed2004

Advances in computer-assisted single-photon emission computed tomography (SPECT) for epilepsy surgery in children.

Epilepsy surgery has emerged as an important option in the treatment of children with epilepsy that is refractory to antiepileptic drug management. The cornerstone of successful surgery is accurate localization of the brain region of seizure onset. Traditional techniques of seizure onset localization, e.g. surface electroencephalography (EEG) recording and magnetic resonance imaging (MRI), allow accurate localization in a significant number of patients. When the focus of seizure onset is not apparent from these non-invasive techniques, other methods of localization, e.g. intracranial EEG recording, may be needed before resection of the focus. Single-photon emission computed tomography (SPECT) is a nuclear medicine blood-flow technique that has been used to identify a region of epileptogenic brain associated with low blood flow in the resting state (interictal SPECT) or increased blood flow at the time of seizure activity (ictal SPECT). This report describes the validation and utility of a computer-assisted method of subtracting the interictal from the ictal SPECT scans and co-registering the difference image on the MRI. This method, called subtraction ictal SPECT co-registered on MRI (SISCOM), is used in guiding the location and the extent of intracranial electrode implantation, or in obviating the need for the implantation in some cases.

Adolescent↗
PubMedDate not supplied

The effect of computed tomography noise and tissue heterogeneity on cerebral blood flow determination by xenon-enhanced computed tomography.

The errors associated with derivation of cerebral blood flow values by the xenon-enhanced computed tomography (CT) method have been evaluated as a function of tissue heterogeneity and CT noise. The results of this study indicate that CT noise introduces large errors in the derived flow value when data for a single, unprocessed voxel are used for this purpose. CT noise increases the derived flow values in a systematic way. Tissue heterogeneity results in a systematic error which lowers the derived flow values. Errors due to both parameters are computed for typical and extreme conditions.

Brain↗
PubMed1976

Computed tomography of spinal cord after lumbar intrathecal introduction of metrizamide (computer-assisted myelography).

Computed tomography (CT) of the thoracic and cervical spine was carried out after lumbar intrathecal introduction of a water-soluble radiographic contrast medium (metrizamide). By choice, no head-down position of the patient was used to facilitate craniad movement of the contrast medium; rather, advantage was taken of the normal CSF flow. This technique, referred to as computer-assisted myelography (CAM), permits the demonstration of the metrizamide-containing subarachnoidal spaces surrounding the thoracic and cervical cord. Some examples of the diagnostic possibilities of the method are discussed.

Computers↗
PubMed1995

Strategies for developing effective computer-assisted instruction: a computer-based teaching module on color Doppler US.

Computer-assisted instruction is an effective method for teaching visually oriented subjects such as ultrasonography. Although many different forms of instructional strategy can be effective, the process of designing a teaching program should follow the same general procedures, regardless of the format. The first step is to consider the subject material and the target audience; this helps to determine the style of the computer-user interaction (eg, whether the program should be more interactive or dissertative in nature). Teaching objectives should be carefully defined and resources for development identified. Before actually writing the program, the authors should carefully define a lesson plan and develop a set of specifications for implementation. Finally, the program should be tested thoroughly before it is put to use, and the effectiveness of the instruction should be evaluated.

Computer-Assisted Instruction↗
PubMed1992

The effects of computer-based attribution retraining on the attributions, persistence, and mathematics computation of students with learning disabilities.

The purpose of the present study was to examine the impact of attribution retraining, embedded within a mathematics computer-assisted instructional (CAI) program, on students' attributions, persistence, and mathematics computation. Twenty-nine school-identified students with learning disabilities from five urban schools participated in the study. The sample's mean age was 13.3 years. After blocking on initial attributional patterns, students were randomly assigned to a mathematics CAI program that provided either attribution retraining or neutral feedback. Students used their assigned program for eight 30-minute sessions. Results did not support the contention that attribution retraining would have a significant impact on students' attributions. However, students who participated in the attribution retraining condition completed significantly more levels of the program than their counterparts who received neutral feedback. Attribution retraining students also obtained significantly higher scores on a test of problems practiced during the CAI program. These results suggest that attribution retraining may be a desirable addition to the type of feedback typically provided by CAI programs. However, they also highlight the need for further research that examines the conditions under which specific attributions are most advantageous.

Achievement↗
PubMedDate not supplied

Pediatric parenteral nutrition management using a comprehensive user-friendly computer program designed for personal computers.

The use of parenteral nutrition is becoming more widespread. The need for individualized parenteral nutrition solutions in pediatric patients makes the ordering and preparation of these solutions more complex and error-prone. A computer program is described which performs comprehensive management of parenteral nutrition by assisting in accurately ordering and preparing parenteral nutrition solutions. It also performs extensive error-checking and provides additional nutritional information. Data base management is also a feature which permits future large scale analysis of parenteral nutrition data for research purposes. This program, designed to run on a personal computer, is very comprehensive, yet flexible and user-friendly.

Adolescent↗
PubMed1982

Three-dimensional computer reconstructions of brain lesions from surface contours provided by computed tomography: a prospectus.

We present a prospectus on the use of computer graphics for the three-dimensional reconstruction and visualization of brain lesions from computed tomographic head examinations, including an algorithm that utilizes surface contour information to reconstruct and display three-dimensional anatomical sites. We provide examples of the use of this algorithm. We offer an algorithm for estimation of the volume and surface area of anatomical sites. The advantages and disadvantages for the clinical use of these algorithms are discussed.

Adenoma, Chromophobe↗
PubMed1994

Comparison of spiral-acquisition computed tomography and conventional computed tomography in the assessment of pulmonary metastatic disease.

In a prospective study, spiral-acquisition computed tomography (SACT) of the thorax was evaluated in 104 patients with extrathoracic malignancy and suspected pulmonary metastases, and was directly compared with conventional computed tomography (CCT) in 23 patients. The following parameters were assessed: lesion detectability; the effect on lesion detectability of reconstruction of scans at 5 mm and 10 mm slice increments; breathing artefact and slice misregistration. The radiation dose of the two techniques was measured using thermoluminescent dosimeters placed within an anthropomorphic chest phantom, and the visibility of simulated metastases inserted into the phantom was also compared using CCT, standard SACT and SACT with pitch greater than 1.0. Where metastases were present, SACT scans showed significantly better lesion detectability than CCT scans (p < 0.001). Image reconstruction of SACT data at 5 mm increments conferred no significant advantage in lesion detectability over 10 mm increment reconstructions. Compared with CCT, SACT scans showed reduced breathing artefact, and a complete absence of slice misregistration (p < 0.01). Phantom measurements of radiation dose and resolution were similar for both techniques. Increasing the pitch of the spiral in SACT caused only a small decrease in phantom resolution, but with the advantage of a reduction in the radiation dose. Spiral-acquisition CT is superior to conventional CT for the assessment of pulmonary metastatic disease.

Adolescent↗
PubMed2004

Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography.

OBJECTIVES: Radiation doses were determined to balance risks against usefulness of the different modalities available for the imaging of the facial skeleton. METHODS: An Alderson Rando Phantom, armed with lithium fluoride thermoluminescent dosemeters (TLDs) was exposed using a set of four conventional radiographs (orbital view, modified Waters view, orthopantomography, skull posterior--anterior 0 degrees ), two different cone beam computed tomography (CBCT) (NewTom 9000 and Siremobil Iso-C3D), and multislice computed tomography (CT) modalities (Somatom VolumeZoom and Somatom Sensation 16). TLDs from 14 well defined anatomical sites lying within the primary beam as well as the TLD corresponding to the thyroid gland were evaluated. RESULTS: Multislice CT showed the highest exposure values. Exposure levels of the CBCT systems lay between CT and conventional radiography. Dose measurement for the 16-slice CT revealed nearly the same radiation exposure as the 4-slice system when adapted examination protocols were used. CONCLUSIONS: Selection of the most appropriate imaging modality should be performed in view of the delivered doses, required image quality and information and the clinical circumstances.

Facial Bones↗
PubMedDate not supplied

Application of computers in diabetes care--a review. I. Computers for data collection and interpretation.

The paper reviews the contribution of information technology (IT) to diabetes care. An appraisal of this topic with respect to insulin-dependent (type 1) diabetic patients is carried out in view of the landmark findings of the Diabetes Control and Complications Trial (DCCT) which has demonstrated that maintaining tight blood glucose control can delay the onset and slow the progression of the later life complications of diabetes. The review starts with the clinical background and the main features of the control schema in which diabetic patients receive insulin therapy. An overview is then provided of recent IT initiatives in diabetes care, and the application of IT techniques to assist in the diagnosis and characterization of patients with diabetes mellitus is considered. The role of IT approaches for short-term glycaemic control is discussed and the utilization of computers for collecting, viewing and interpreting home monitoring blood glucose data is reviewed; both quantitative and qualitative techniques being considered. In the second paper the role of decision support tools for planning insulin therapy using clinical algorithms, hand-held devices, knowledge-based approaches, telemedicine techniques and interactive simulations is reviewed, and the validation and clinical evaluation of these tools is discussed. The likely impact of the routine clinical application of implantable/non-invasive blood glucose monitoring devices is also considered. Finally, the application of computers as teaching tools is reviewed and the ways in which such educational approaches might be applied for disseminating the benefits of the DCCT trial more widely are discussed.

Blood Glucose Self-Monitoring↗
PubMed1990

Privacy Act of 1974; computer matching program--HCFA. Clarification--computer match between HCFA and the Internal Revenue Service (IRS)--notice published in the Federal Register on July 5, 1989.

Pursuant to the Computer Matching and Privacy Protection Act of 1988, Public Law 100-503, October 18, 1988, and the Office of Management and Budget (OMB) Guidelines on the Conduct of Matching Programs, the IRS published a notice in the Federal Register (54 FR 28149; July 5, 1989) announcing their intention to conduct a match with a number of Federal and State agencies including HCFA. These matches, in accordance with various provisions of section 6103 of the Internal Revenue Code (IRC) of 1986, provide these agencies with tax information from IRS records to assist them in administering the programs and activities as described. The match with HCFA is pursuant to IRC 6103(1)(7). The IRS is required, upon written request, to disclose current information from returns with respect to unearned income to any Federal, State, or local agency administering certain federally approved programs to provide, among other things, medical assistance. HCFA is publishing this notice to ensure that the public is aware that it is participating in this match to verify Medicaid eligibility. The HHS Data Integrity Board has approved an Agreement between HCFA and the IRS on February 8, 1990, as required by the Computer Matching and Privacy Protection Act of 1988.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

Computational integrative physiology: at the convergence of the life and computational sciences.

OBJECTIVE: In this paper we outline how Computational Integrative Physiology (CIP) can help unravel the mechanisms of normal and pathological biological processes. Our objective is to illustrate how CIP is firmly grounded on the life and computational sciences. METHOD: After describing a general theoretical frame-work for CIP, we will center our discussion on cardiac rhythmic disorders with a particular focus on the Long QT syndrome that will serve as a case example. Within this context, we will describe multi-scale processes in biological, medical and in general mathematical terms, starting from the control of gene expression to the electrical activity of the entire heart. We will therefore proceed from the smaller microscopic scales to the larger macroscopic ones. In doing so, we will illustrate, at least in a qualitative sense, how CIP can be accomplished by showing some of the relations that can exist between mathematical variables characterizing models of different space-scales. CONCLUSION: We will conclude by putting forth how CIP and the related fields of bioinformatics and medical informatics are necessary to derive meaningful knowledge from the huge and exponentially growing biological and medical data.

Biological Science Disciplines↗
PubMed2005

Flat-panel detector computed tomography for the assessment of coronary artery stents: phantom study in comparison with 16-slice spiral computed tomography.

PURPOSE: The evaluation of coronary artery stents is a major limitation of cardiac multislice spiral computed tomography (MSCT). The development of flat-panel detector computed tomography (FPCT) with truly isotropic spatial resolution may overcome this limitation. Thus, we evaluated the use of FPCT in comparison to MSCT for the assessment of coronary artery stents. MATERIAL AND METHODS: Eight different coronary artery stents with a diameter of 3 mm each were placed in a static chest phantom. The phantom was positioned in the CT gantry at angles of 0 degrees , 45 degrees , and 90 degrees toward the z-axis and examined with the prototype of a FPCT (Siemens, Forchheim, Germany) and a commercially available 16-detector row MSCT (Sensation 16, Siemens). Slice thickness was 0.25 mm with FPCT whereas for MSCT, an effective slice thickness of 1 mm with a reconstruction increment of 0.5 mm was used. Image quality was assessed visually using a 5-point grading scale. Stent diameters were measured and compared using a repeated-measures analysis of variance. RESULTS: When compared with MSCT, artificial lumen reduction was significantly less using FPCT. On average the visible stent lumen was reduced by 16.1% with FPCT, whereas the mean of the lumen reduction was 47.2% with 16-detector row MSCT. Visible lumen diameter as well as image noise significantly increased using FPCT (P < 0.001). With FPCT delineation of the different stent struts became possible. CONCLUSION: FPCT proved to be superior when compared with 16-detector row MSCT for the in vitro assessment of coronary artery stents. Improved spatial resolution allows for a detailed assessment of the coronary artery stent lumen.

Coronary Angiography↗
PubMed1991

Computed tomography and high-resolution computed tomography of pneumoconioses.

The traditional imaging technique used in the assessment of patients suspected of having silicosis or asbestos-related disease has been the chest radiograph. However, computed tomography and high-resolution computed tomography have become widely available for these assessments. The relative merits of these techniques in the diagnosis of these diseases warrant review.

Asbestosis↗
PubMedDate not supplied

Effects of computers on nursing resource use. Do computers save nurses time?

The effects of information systems on nursing resource use are reviewed. The information systems in place in various hospitals differ in major ways; some have an impact on nursing resource use while others do not. Evidence is strong and consistent that computer systems that manage flow of information between nursing units and ancillary departments save time for nurses. The reported findings may even understate the case because workload may have increased during the period of the studies. There is also strong, but unreplicated, evidence that a work plan or electronic Kardex for each patient saves time at report. If nurses are paid for overtime, these savings can translate into cost savings for hospitals. On the other hand, systems that emphasize on-line charting and not communications do not save time. Bedside terminals are too new to have been subjected to careful research by independent investigators, but early reports, which primarily come from vendors, indicate that bedside terminals may further save time and reduce errors. More systematic research into effects of various components is needed to fully document the effect of computers on nurses' time.

Communication↗