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Automated determination of the magnitude and time delay ("phase") of the cardiac cycle dependent variation of myocardial ultrasonic integrated backscatter.

An algorithm for quantitative description of cardiac cycle dependent variation of integrated backscatter (cyclic variation) has been developed and is shown to be suitable for analysis of nonsinusoidal data typical of ultrasonic tissue characterization measurements from myocardium in vivo. The algorithm produces estimates of the magnitude of variation and of the time delay relative to the electrocardiographically recorded QRS-complex. To validate the algorithm, 246 integrated backscatter measurements were analyzed both manually and by the automated method. The magnitude and time delay estimates from the two methods correlated closely. With a separate set of data, the algorithm produced reasonable descriptions of the cyclic variation for 89 of 101 integrated backscatter measurements. Only modest computational power is required for effective implementation of this algorithm, facilitating inclusion of online automated analysis capabilities in quantitative ultrasonic tissue characterization systems.

Algorithms↗

A method of calculating peripheral dose distributions of photon beams below 10 MV.

The radiation dose outside the radiotherapy treatment field can be of clinical concern and, therefore, a method of accurately predicting the peripheral doses received by tissues would be beneficial. This paper describes a semiempirical method developed for calculating the peripheral dose received at points outside the collimated field edge for incident photon beams with energies below neutron production thresholds (less than 10 MV). The dependence of the peripheral dose upon depth, distance, field shape and size, azimuthal angle about the central axis, external contour variations, and tissue heterogeneities are accounted for by this calculation. Predictions by this algorithm are compared with measurements and it is shown that the method is capable of reproducing the measured peripheral dose values usually to within the statistical uncertainties of the data.

Algorithms↗

Three-dimensional optical measurement of instantaneous pressure.

Local perturbations in material density induced in a material by a compressional wave give rise to local perturbations in refractive index. Accurate, high-resolution, three-dimensional, optical measurements of an instantaneous refractive index perturbation in a homogeneous, optically transparent medium may be obtained from measurements of scattered optical intensity alone. The method of generalized projections allows incorporation of optical intensity measurements into an iterative algorithm for computing the phase of the interrogating optical pulse as the solution of a fixed point equation. The complex optical field amplitude, computed in this manner, is unique up to a constant unit magnitude complex coefficient. The three-dimensional refractive index distribution may be computed via the Fourier slice reconstruction algorithm from the optical phase data under the assumption of weak optical scattering. The refractive index perturbation is related to local instantaneous pressure under a linear, small-displacement model for the mechanical wave. A numerical simulation of the measurement experiment, phase recovery, and reconstruction process for a plane piston ultrasound transducer with a semicircular aperture and center frequency of 1.5 MHz is described and corresponds very well with experiment. Experimental data obtained using an 810-nm laser source are used to reconstruct the three-dimensional pressure field from two elements of a 2.5-MHz linear array. Comparison with a measurement obtained via a 500-microm needle hydrophone shows excellent agreement.

Acoustics↗

An adaptive control algorithm for optimization of intensity modulated radiotherapy considering uncertainties in beam profiles, patient set-up and internal organ motion.

A new general beam optimization algorithm for inverse treatment planning is presented. It utilizes a new formulation of the probability to achieve complication-free tumour control. The new formulation explicitly describes the dependence of the treatment outcome on the incident fluence distribution, the patient geometry, the radiobiological properties of the patient and the fractionation schedule. In order to account for both measured and non-measured positioning uncertainties, the algorithm is based on a combination of dynamic and stochastic optimization techniques. Because of the difficulty in measuring all aspects of the intra- and interfractional variations in the patient geometry, such as internal organ displacements and deformations, these uncertainties are primarily accounted for in the treatment planning process by intensity modulation using stochastic optimization. The information about the deviations from the nominal fluence profiles and the nominal position of the patient relative to the beam that is obtained by portal imaging during treatment delivery, is used in a feedback loop to automatically adjust the profiles and the location of the patient for all subsequent treatments. Based on the treatment delivered in previous fractions, the algorithm furnishes optimal corrections for the remaining dose delivery both with regard to the fluence profile and its position relative to the patient. By dynamically refining the beam configuration from fraction to fraction, the algorithm generates an optimal sequence of treatments that very effectively reduces the influence of systematic and random set-up uncertainties to minimize and almost eliminate their overall effect on the treatment. Computer simulations have shown that the present algorithm leads to a significant increase in the probability of uncomplicated tumour control compared with the simple classical approach of adding fixed set-up margins to the internal target volume.

Algorithms↗

[A device for studying respiratory mechanics by the forced oscillation technique].

A new compact device for measuring respiratory impedance is designed. Input respiratory impedance, an impedance of upper airways and respiratory impedance corrected for upper airways shunt can be measured in 2 minutes. The space-condition requirements are complied by integrating an oscillation generator, sensors, a mouthpiece with a screen and a reference resistor in the measuring head. The oscillation generator produces small-amplitude forced oscillations (with a tidal volume of about 1 ml) at frequencies f = 7, 10, 13, 16, and 19 Hz. Algorithms of calibration and measurement provide impedance calculation. For 55 different external impedances, complex transmission factors are measured for each of the five frequencies. The standard deviation of amount and phase of complex transmission factors are less than 5% and 0.06, respectively.

Humans↗

Breast cancer: importance of spiculation in computer-aided detection.

PURPOSE: To determine the prevalence of spiculation in a large series of screening-detected breast cancers appearing as masses on mammograms and to assess the sensitivity of a computer-aided detection (CAD) algorithm that uses spiculation measures in the detection of such lesions. MATERIALS AND METHODS: Six hundred seventy-seven consecutive cases of breast cancers detected as masses on mammograms were independently reviewed by three radiologists who determined if the lesions were spiculated. All cancers were then analyzed by the CAD system. RESULTS: All three radiologists interpreted 375 (55%) of the 677 masses as being spiculated on at least one view. The CAD algorithm correctly marked 322 (86%) of the 375 clearly spiculated masses, with a mean of 0.24 additional mass mark per image. With a looser definition of spiculation, 585 (86%) of the 677 masses were called spiculated by at least one radiologist on one view. The algorithm correctly marked 464 (79%) of the 585 lesions that were spiculated or possibly spiculated. CONCLUSION: Spiculation was clearly present in a majority (55%) of consecutive screening-detected breast cancer masses found on mammograms in a large clinical trial. Incorporation of spiculation measures is, therefore, an important strategy in the detection of breast cancer with CAD. A present-generation CAD algorithm correctly identified a large proportion (86%) of spiculated breast cancers.

Algorithms↗

A method for approximating fractional power average relaxation times without inversion of multiexponential relaxation data.

A method is presented for approximating fractional power averages of relaxation times for data equispaced in log time, without the need to invert multiexponential relaxation data. This form of average permits giving emphasis to short or long times depending on the choice of the p value, thus giving the possibility of representing different specific properties of porous media. This method has been tested on a large number of nuclear magnetic resonance (NMR) relaxation measurements in porous samples. This new algorithm appears to be robust with respect to both measurement and computation, and its major advantage is that it does not depend on a particular inversion method. Moreover, it permits a very fast computation.

Algorithms↗

Noninvasive measurement of transmural gradients in myocardial strain with MR imaging.

A method is presented for performing high-resolution strain measurements by using magnetic resonance (MR) tagging. Multispectral radiofrequency pulses are used to produce tagging grids from which strain estimates are obtained with a resolution of 2 mm. A tag detection algorithm is presented that measures the center of a tag line with a precision that ranges from 0.1 to 0.2 mm over the systolic interval. With this method, a transmural gradient in the strain of a normal dog heart was detected.

Animals↗

Siggaard-Andersen algorithm-derived p50 parameters: perturbation by abnormal hemoglobin-oxygen affinity and acid-base disturbances.

The p50 and derived indexes, calculated by using the Siggaard-Andersen algorithm from a single measurement of arterial blood gas tensions and hemoglobin-oxygen saturation, are used to assess tissue oxygen availability in critical illness. We tested the accuracy of the Siggaard-Andersen p50 algorithm over a wide range of pathophysiologic conditions. Blood gases, cooximetry, and calculation of standard and in vivo p50 were performed at multiple saturations, CO2 tensions, and H+ concentrations on blood with normal (standard p50 of 26.1 and 26.7 mm Hg), increased (19.0 and 25.4), and reduced (33.9 and 38.2) hemoglobin-oxygen affinity, as well as on high-affinity blood from two patients with diabetic ketoacidosis (16.7 and 20.8). Log p50 in vivo/pH plots were constructed to determine the Bohr effect. Except in the normal affinity specimens (coefficient of variation < 1.7%), standard p50 values showed high variability (coefficient of variation > 5.9%), with saturation-linked bias and distortion of the Bohr effect. Standard p50 was overestimated by up to 11 mm Hg as saturation approached 97%. Although base deficit correction of the stored specimens (6.9 < pH < 7.1) restored the Bohr effect and improved the accuracy of standard p50 calculations (coefficient of variation = 4.4% and 2.9%), saturation-linked bias persisted. We conclude that Siggaard-Andersen p50 calculations may be misleading when there are disturbances of hemoglobin-oxygen affinity and acid-base balance, owing to changes in shape of the hemoglobin-dissociation curve. When metabolic acidosis occurs with high hemoglobin-oxygen affinity, as can occur in critical illness, indexes derived by the Siggaard-Andersen algorithm on arterial blood may greatly overestimate oxygen availability.

Acid-Base Imbalance↗

[Evaluation of the Swedish Interactive Thresholding Algorithm, a new thresholding algorithm, of the Humphrey field analyzer in normal subjects].

The Swedish Interactive Thresholding Algorithm (SITA) is a new thresholding algorithm that aims to obtain the same quality of visual fields in a shorter examination time than with the conventional up-and-down method. We investigated the correlation between thresholds measured with the SITA algorithm and those with the conventional up-and-down method in 47 eyes of 47 normal subjects. In each test point, thresholds with the SITA accurate and with the SITA fast showed significant correlation with those of the conventional method (r = 0.693, p < 0.0001 and r = 0.689, p < 0.0001, respectively). The mean deviation (MD) in the conventional method and the difference between MD values of the conventional method and SITA accurate and SITA fast were significantly correlated (r = -0.442, p < 0.006 and r = -0.509, p < 0.00092, respectively). The examination times of the SITA accurate and SITA fast were 48% and 27% of the conventional method. Although the new thresholding algorithm enables us to perform perimetric examination with relatively high accuracy, further investigations should be conducted before we apply it to glaucoma cases.

Algorithms↗

An adaptive system for active noise reduction.

An adaptive system for active noise reduction in an acoustic duct is presented. The system is based on a modification of a least mean square (LMS) algorithm called filtered-U with on-line error path modelling. The system was assembled and examined on a laboratory test stand in the Laboratory of Active Noise Reduction Methods of the Central Institute for Labour Protection (Warsaw, Poland). The structure of the test stand, the block structure of the active noise reduction system, the basic assumption concerning the applied adaptive algorithm, and examples of measured effectiveness of the system for various kinds of noise are presented.

Acoustics↗

Multimodality evaluation of pressure relief surfaces.

Multimodality evaluation of six different support surfaces was performed measuring interface pressure, transcutaneous oxygen tension, and blood flow in pressure ulcer-prone areas on healthy subjects. Interface pressure was measured with a flexible force-sensing resistor array. The interface pressure distribution patterns of 10 healthy male volunteers were measured in the supine and lateral positions using a pressure sensor (force sensing resistor) array. Transcutaneous oxygen (TcPO2) and laser Doppler flowmeter probes were placed over the sacrum, the right trochanter, and the right ischium. Data were recorded for 15 minutes each with the subject in the supine and lateral decubitus positions. Statistically significant differences (p < 0.05) between the various surfaces could be observed for blood flow and pressure measurements, especially in the lateral position over the trochanter and for the TcPO2 measurements in the supine position over the sacrum. We conclude that measuring interface pressure, transcutaneous oxygen tension, and blood flow allows a more thorough evaluation of the physiologic effects of special support surfaces than any single technique. Future studies on patients will assess algorithms for using these measurement techniques to predict the efficacy of various support surfaces in minimizing pressure ulceration.

Blood Gas Monitoring, Transcutaneous↗

Diagnostic strategies in myocardial infarction using myoglobin measurement.

Determination of myoglobin, a low molecular weight haeme protein (17.8 kDa), present in both cardiac and skeletal muscle, is an old test with new perspectives. Advantages and disadvantages of myoglobin determination are well known; recent availability of rapid and accurate methods for the assay of this protein has greatly enhanced interest in the clinical utilization of the test. However, since myoglobin is present in both skeletal and cardiac muscle, any damage to these muscle types results in its release in blood and, consequently, high levels of the protein are observed in conditions unrelated to acute myocardial infarction (AMI). New strategies for myoglobin measurement may resolve this limitation. These strategies include both the combined measurement of myoglobin and a skeletal specific marker (carbonic anhydrase III) or a cardiac specific marker (troponin I or T), as well as myoglobin evaluation on serial samples. In particular. the diagnostic algorithm based on combined measurement of myoglobin and troponins significantly improves diagnostic efficiency in laboratory assessment of suspected AMI patients. However, further efforts are necessary to improve the standardization of present methods for myoglobin measurement: the significant disagreement demonstrated between some commercially available assays should be carefully considered in clinical practice.

Biomarkers↗

Wideband external pulse recording during cuff deflation: a new technique for evaluation of the arterial pressure pulse and measurement of blood pressure.

Analysis of the external brachial pulse recorded during standard blood pressure cuff deflation with use of a transducer with a wide frequency response has revealed a reproducible pattern with three distinct components that we have labeled K1, K2, and K3. K1 is a low-amplitude, low-frequency signal that is present with cuff pressures above systolic pressure. K2 is a triphasic signal appearing at systolic pressure and disappearing at diastolic pressure, which approximately corresponds to the audible Korotkoff sound. K3 appears with cuff pressure between systolic and diastolic pressure and continues to be present below diastolic pressure. Intra-arterial pressure recordings made with a high-fidelity Millar catheter-tip manometer revealed K2 and K3 analogs. K3 resembles the intra-arterial pressure waveform and when calibrated according to the pulse pressure, noninvasive dK3/dt determinations correlated well with intra-arterial dP/dt measurements. The appearance/disappearance property of K2 was designated as the "K2 algorithm" and represents a new, objective noninvasive method for measurement of blood pressure. The K2 algorithm compares favorably with intra-arterial measurements, is more accurate than the auscultatory technique, and may be especially useful in clinical situations in which the auscultatory technique does not work well.

Adolescent↗

Age-dependent influence on heart rate variability in salt-sensitive hypertensive subjects.

OBJECTIVE: The known association between systemic arterial hypertension in its initial stages and increased sympathetic nervous system drive prompted us to evaluate the influence of age on autonomic nervous system function in subjects with salt-sensitive arterial hypertension. DESIGN: In a randomized study, autonomic nervous system function was assessed by power spectral analysis of heart-rate variability calculated with an autoregressive algorithm in salt-sensitive hypertensives and controls at baseline and under sympathetic stress (passive head-up tilt). For 1 week before the study, all subjects kept to a diet supplying 120 mEq sodium. Sodium sensitivity was assessed by measuring and comparing arterial pressures after a 7-day controlled dietary sodium intake of 20 mEq per day after a 7-day period on 220 mEq sodium/day. SETTING: Geriatric division at the I Medical Clinic of the University of Rome "La Sapienza". PARTICIPANTS: Sixty-five patients with salt-sensitive hypertension (age range 19 to 89 years) and 64 age-matched normotensive controls, divided for data comparison into three age-groups: < 44 years; 44 to 64 years; and > or = 65 years. MEASUREMENTS: With an autoregressive algorithm in a power spectral analysis of heart rate variability, we detected four spectral frequency-domains: total power (0.0033 to 0.40 Hz), high-frequency power (0.16 to 0.40 Hz), low-frequency power (0.04 to 0.15 HZ) and very-low-frequency power (0.0033 to 0.04 Hz). To determine sodium sensitivity, for 1 week before the study all subjects kept to a diet supplying 120 mEq sodium. Sodium sensitivity was assessed by measuring and comparing arterial pressures after a 7-day controlled dietary intake of 20 mEq per day and after a 7-day period of 220 mEq sodium/day. RESULTS: Results were expressed as natural logarithms of power and normalized units. The hypertensive patients of all ages had significantly lower total power of heart rate variability than the normotensive controls (P < .05). At baseline, the youngest hypertensives had lower natural logarithms and low-frequency normalized units than controls (P < .001). After tilt, only their low-frequency normalized units exceeded those of controls (P < .001). The middle-aged hypertensive group had higher low-frequency normalized units than controls at baseline (P < .05) and after tilt (P < .001). At baseline and after tilt, the oldest hypertensives had lower low-frequency natural logarithms than controls (P < .05) and normalized units equal to those of controls. But the hypertensives of all ages were less able than controls (P < .001) to increase low-frequency power after head-up tilt. In the less than 44-year-old hypertensives, diastolic pressure correlated significantly with low-frequency power of heart rate variability, expressed in normalized units, at baseline (P < .05) and after head-tilt (P < .05). A significant inverse correlation was found between age and the natural logarithm of low-frequency power at baseline (r = -.682, P < .001) and after tilt (r = -.800; P < .001). Also, a significant inverse correlation was found to exist in normotensive subjects between the natural logarithm of low-frequency at baseline (r = -.595; P < .001) and after tilt (r = -.391; P < .001). The two regression line coefficients for age correlated significantly (P < .001) with the natural logarithm of low-power frequency after tilt. CONCLUSION: Whereas sodium chloride-sensitive hypertension appears to be associated with sympathetic hyperactivity in young and middle-aged subjects, in older people it is not. Sympathetic activity diminishes with age, declining faster in hypertensive subjects.

Adult↗