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Three-dimensional attenuation map reconstruction using geometrical models and free-form deformations.

We address the issue of using deformable models to reconstruct an unknown attenuation map of the torso from a set of transmission scans. We assume the three-dimensional (3-D) distribution of attenuation coefficients to be piecewise uniform. We represent the unknown distribution by a set of closed surfaces defining regions having the same attenuating properties. The methods of reconstruction published so far tend to directly deform the surfaces, the parameters being the surface elements. Rather than deforming the surfaces, we explore the possibility of deforming the space in which the geometrical primitives are contained. We focus on the use of free-form deformations (FFD's) to describe the continuous transformation of space used to match a set of transmission measurements. We illustrate this approach by reconstructing realistically simulated transmission scans of the torso with various noise levels and compare the results to standard reconstruction methods.

Algorithms↗

Measurement of thoracic current flow in pigs for the study of defibrillation and cardioversion.

Although defibrillation has been in clinical use for more than 50 years, the complete current flow distribution inside the body during a defibrillation procedure has never been directly measured. This is due to the lack of appropriate imaging technology to noninvasively monitor the current flow inside the body. The current density imaging (CDI) technique, using a magnetic resonance (MR) imager, provides a new approach to this problem [Scott et al. (1991)]. CDI measures the local magnetic field generated by the current and calculates the current density by computing its curl. In this study, CDI was used to measure current density at all points within a postmortem pig torso during an electrical current application through defibrillation electrodes. Furthermore, current flow information was visualized along the chest wall and within the chest cavity using streamline analysis. As expected, some of the highest current densities were observed in the chest wall. However, current density distribution varied significantly from one region to another, possibly reflecting underlying heterogeneous tissue conductivity and anisotropy. Moreover, the current flow analysis revealed many complex and unexpected current flow patterns that have never been observed before. This study has, for the first time, noninvasively measured the volume current measurement inside the pig torso.

Animals↗

Noninvasive imaging of cardiac transmembrane potentials within three-dimensional myocardium by means of a realistic geometry anisotropic heart model.

We have developed a new approach for imaging cardiac transmembrane potentials (TMPs) within the three-dimensional (3-D) myocardium by means of an anisotropic heart model. The cardiac TMP distribution is estimated from body surface electrocardiograms by minimizing objective functions of the "measured" body surface potential maps (BSPMs) and the heart-model-generated BSPMs. Computer simulation studies have been conducted to evaluate the present 3-D TMP imaging approach using pacing protocols. Simulations of single-site pacing at 24 sites throughout the ventricles, as well as dual-site pacing at 12 pairs of sites in the vicinity of atrio-ventricular ring were performed. The present simulation results show that the correlation coefficient (CC) and relative error (RE) between the "true" and inversely estimated TMP distributions were 0.9915 +/- 0.0041 and 0.1266 +/- 0.0326, for single-site pacing, and 0.9889 +/- 0.0034 and 0.1473 +/- 0.0237 for dual-site pacing, respectively, when 10 microV Gaussian white noise (GWN) was added to the BSPMs. The effects of heart and torso geometry uncertainty were also evaluated by shifting the heart position by 10 mm and altering the torso size by 10%. The CC between the "true" and inversely estimated TMP distributions was above 0.97 when these geometry uncertainties were considered. The present simulation results demonstrate the feasibility of noninvasive estimation of TMP distribution throughout the ventricles from body surface electrocardiographic measurements, and suggest that the present method may become a useful alternative in noninvasive imaging of distributed cardiac electrophysiological processes within the 3-D myocardium.

Body Surface Potential Mapping↗

Simulation of ST segment changes during subendocardial ischemia using a realistic 3-D cardiac geometry.

The mechanisms underlying the ST segment shifts associated with subendocardial ischemia remain unclear. The aim of this paper is to shed further light on the subject through numerical simulations of these shifts. A realistic three-dimensional model of the ventricles, including fiber rotation and anisotropy, is embedded in a nonhomogeneous torso model. A simplification of the bidomain model is used to calculate only the ST segment shift, assuming known values of the transmembrane potential during the plateau and rest phases. A similar simulation is performed in two dimensions. The simulation results suggest that subendocardial ischemia can be located by ST segment shift on the epicardial and torso surfaces. It is shown that ST elevation is associated with the transmural ischemic boundary, while ST depression is associated with the lateral ischemic boundaries.

Body Surface Potential Mapping↗

Three-dimensional myocardial activation imaging in a rabbit model.

This study evaluated a recently developed three-dimensional (3-D) electrocardiographic imaging (3DECI) approach in a closed-chest rabbit model. First, the performance and sensitivity of parameters of 3DECI were evaluated using a geometrically realistic rabbit heart-torso model. Second, a 3-D intracardiac mapping procedure was evaluated based on the heart-torso rabbit model. Third, comparisons were made among the forward-simulated ventricular activation sequence, the activation sequence derived by the intracardiac mapping, and the 3DECI inverse solution. Finally, the present procedures were tested in vivo in a rabbit, in which the relative error between the measured and imaged activation sequence was 0.20 and the localization error was 5.1 mm. The present simulation and experimental results suggest the merits of the 3DECI imaging approach, and the validity of intracardiac mapping as a tool to evaluate the 3DECI.

Animals↗

Evaluation of fully 3-D emission mammotomography with a compact cadmium zinc telluride detector.

A compact, dedicated cadmium zinc telluride (CZT) gamma camera coupled with a fully three-dimensional (3-D) acquisition system may serve as a secondary diagnostic tool for volumetric molecular imaging of breast cancers, particularly in cases when mammographic findings are inconclusive. The developed emission mammotomography system comprises a medium field-of-view, quantized CZT detector and 3-D positioning gantry. The intrinsic energy resolution, sensitivity and spatial resolution of the detector are evaluated with Tc-99m (140 keV) filled flood sources, capillary line sources, and a 3-D frequency-resolution phantom. To mimic realistic human pendant, uncompressed breast imaging, two different phantom shapes of an average sized breast, and three different lesion diameters are imaged to evaluate the system for 3-D mammotomography. Acquisition orbits not possible with conventional emission, or transmission, systems are designed to optimize the viewable breast volume while improving sampling of the breast and anterior chest wall. Complications in camera positioning about the patient necessitate a compromise in these two orbit design criteria. Image quality is evaluated with signal-to-noise ratios and contrasts of the lesions, both with and without additional torso phantom background. Reconstructed results indicate that 3-D mammotomography, incorporating a compact CZT detector, is a promising, dedicated breast imaging technique for visualization of tumors < 1 cm in diameter. Additionally, there are no outstanding trajectories that consistently yield optimized quantitative lesion imaging parameters. Qualitatively, imaging breasts with realistic torso backgrounds (out-of-field activity) substantially alters image characteristics and breast morphology unless orbits which improve sampling are utilized. In practice, the sampling requirement may be less strict than initially anticipated.

Breast Neoplasms↗

Noninvasive reconstruction of three-dimensional ventricular activation sequence from the inverse solution of distributed equivalent current density.

We propose a new electrocardiographic (ECG) inverse approach for imaging the three-dimensional (3-D) ventricular activation sequence based on the modeling and estimation of the equivalent current density throughout the entire volume of the ventricular myocardium. The spatio-temporal coherence of the ventricular excitation process has been utilized to derive the activation time from the estimated time course of the equivalent current density. In the present study, we explored four different linear inverse algorithms (the minimum norm and weighted minimum norm estimates in combination with two regularization schemes: the instant-by-instant regularization and the isotropy method) to estimate the current density at each time instant during the ventricular depolarization. The activation time at any given location within the ventricular myocardium was determined as the time point with the occurrence of the maximum local current density estimate. Computer simulations were performed to evaluate this approach using single- and dual-site pacing protocols in a physiologically realistic cellular automaton heart model. The performance and stability of the proposed approach was evaluated with respect to the various levels of measurement noise (0, 5, 10, 20, 40, and 60 microV), the various numbers of ECG electrodes and the modeling errors on the torso geometry and heart position. The simulation results demonstrate that: 1) the single-site paced 3-D activation sequence can be well reconstructed from 200-channel body surface potential maps with additive Gaussian white noise of 20 microV (correlation coefficient = 0.90, relative error = 0.19, and localization error = 5.49 mm); 2) a higher imaging accuracy can be obtained when the activation is initiated from the left/right ventricle (LV/RV) compared to from the septum; 3) the isotropy method gives rise to a better performance than the conventional instant-by-instant regularization; 4) a decreased imaging accuracy results from a larger noise level, a fewer number of electrodes, or the volume conductor modeling errors; however, a reasonable imaging accuracy can still be obtained with a 60 microV noise level, 64 electrodes, or mild errors on both the torso geometry and heart position, respectively; 5) the dual-site paced 3-D activation sequence can be imaged when the two sites are paced either simultaneously or with a time delay of 20 ms; 6) two pacing sites can be resolved and localized in the imaged 3-D activation sequence when they are located at the contralateral sides of ventricles or at the ventricular lateral wall and the apex, respectively.

Body Surface Potential Mapping↗

Kinematic modeling for the assessment of wheelchair user's stability.

A computer kinematic model was developed to simulate the lateral and transverse stabilities of wheelchair users in order to compare the effect of different backrests. This model is composed of ellipsoids and parallelepipeds representing the main components of the human body, the seating devices and the wheelchair. A fifteen-segment three-dimensional (3-D) model linked by spherical and revolute joints was created using the ADAMS software (Mechanical Dynamics, Inc.). Torsional springs and dampers are used at the joints to represent four sets of articulation stiffness. Seating devices are represented with 45 rectangular surface patches. The interface between human body and seating devices is modeled by contact elements, which included the specification of stiffness, damping, and deformation of cushions and buttocks. Simulations of a user and his wheelchair moving at 1.4 m/s on a tilted pathway were performed. Different indexes [trunk lateral tilt (TLT) and trunk transverse rotation (TTR)] were measured and compared to those of a similar experimental study on four subjects. The effect of joint stiffness was quantified and a sensitivity study showed the importance of the hip, neck, lumbar, and thoracic joint stiffness on model response (between 16% and 68%). Two backrests (standard and highly contoured) were tested with the kinematic model and their stability compared. Overall, the coherence between the simulations and the experiments shows that this approach is appropriate to compare various seating devices (maximal difference of 1.3 degrees between the simulated and experimental curves for the intermediate joint stiffness sets). The smallest rotations of the highly contoured backrest (6.3 degrees versus 8.9 degrees for TLT and 3.9 degrees versus 6.7 degrees for TTR) suggest that the contouring of the mid torso is more efficient than the lower torso to provide stability to the wheelchair user. This model is an adequate tool to test and improve the design of seating aids.

Biomechanical Phenomena↗

Regional variation in the expression of pemphigus foliaceus, pemphigus erythematosus, and pemphigus vulgaris antigens in human skin.

The expression of the pemphigus foliaceus (PF), pemphigus erythematosus (PE), and pemphigus vulgaris (PV) antigens in 16 different regions of normal human skin was evaluated by indirect immunofluorescence by using sera with a high titer of PF, PE, and PV antibodies. Regional variations were observed in the expression of all these antigens. The expression of the PF and PE antigens, as measured by endpoint titer of antibody reactivity, was highest in skin specimens obtained from the upper torso, and lowest in those from the buccal mucosa, lower torso, and scalp. This distribution pattern differed from that of PV antigen, whose expression was highest in buccal mucosa and scalp. These patterns correlate with, and may provide a partial explanation for, the different distribution of skin lesions in these different forms of pemphigus.

Antigens, Surface↗

Antihistone antibodies in linear scleroderma variants.

BACKGROUND: Linear scleroderma occurs as two clinically distinct variants: the frontoparietal en coup de sabre type, and the torso-extremity type. Antihistone antibodies (AHAs), which traditionally are markers for drug-induced lupus, may also be linked to linear scleroderma. METHODS: Retrospective review of all patients presenting with linear scleroderma who had AHA titers measured. RESULTS: A total of 35 patients were identified. Twenty patients with linear scleroderma of the torso and/or extremities comprised 14 pediatric patients (<or=18 years old; positive AHA, 10/14=71%; positive ANA, 3/13=23%) and six adults (four positive AHA; five positive ANA). Among the 15 patients with frontoparietal linear scleroderma, en coup de sabre type, 11 were pediatric patients (positive AHA, 5/11=45%; positive ANA, 4/11=36%) and four were adults (1 positive AHA/ANA). CONCLUSION: The two clinical variants of linear scleroderma are not only clinically distinct, but also may be serologically different. The AHA titers may be related to the extent of involvement as well as disease activity in linear scleroderma.

Adolescent↗

Computer model for study of cardiac repolarization.

INTRODUCTION: We propose a new and simple method to model repolarization in the left ventricle and the corresponding T waves on the surface ECG. METHODS AND RESULTS: We modeled the cardiac cell action potentials (APs) in the left ventricle (LV) with differences in only the duration of the plateau phase. Using published experimental data on the epicardial and endocardial repolarization sequences, for each point on the left ventricular surface we set a different AP repolarization starting time, determined by the duration of the plateau phase. The surface source model was used to compute potentials on the surface of the torso, generated by repolarization of the LV. Both the torso and the LV had homogeneous and isotropic conductivity. We simulated T waves on the 12-lead ECG and compared our results with measured T waves from five normal subjects. The orientation and shape in each lead were reproduced. In each lead we computed the root mean square error between simulated and measured T waves. The average error across the 12 leads was small, with a mean value of 0.11 mV across all the subjects. CONCLUSION: Repolarization of the LV can be modeled independently of the depolarization sequence and AP duration gradients. This method is an easy and powerful tool to describe the ECG features of repolarization.

Action Potentials↗

Multiscale modelling of human gastric electric activity: can the electrogastrogram detect functional electrical uncoupling?

During recent years there has been a growing interest in the assessment of gastric electrical health through cutaneous abdominal recordings. The analysis of such recordings is largely limited to an inspection of frequency dynamics, and this has raised doubts as to whether functional gastric electrical uncoupling can be detected using this technique. We describe here a computational approach to the problem in which the equations governing the underlying physics of the problem have been solved over an anatomically detailed human torso geometry. Cellular electrical activity was embedded within a stomach tissue model, and this was coupled to the torso using an equivalent current source approach. Simulations were performed in which normal and functionally uncoupled (through the introduction of an ectopic antral pacemaker) gastric slow wave activity was present, and corresponding cutaneous electrogastrograms were produced. These were subsequently analysed using the currently recommended techniques, and it was found that the functionally uncoupled situation was indistinguishable from normal slow wave activity using this approach.

Computer Simulation↗

Cardiovascular responses to partial and total immersion in man.

1. Short-term cardiovascular effects of partial and total immersion of eighteen human subjects in the horizontal plane have been examined. Brachial arterial pressure, heart rate, forearm blood flow and respiratory movements were monitored simultaneously throughout the experiments. Forearm vascular resistance was calculated from the mean blood pressure and mean flow.2. Total immersion, including the face, with breath-holding resulted in a 61 +/- 43% increase in forearm vascular resistance with an associated 29 +/- 15% reduction in forearm blood flow. The concurrent bradycardia was significantly different from the heart rate changes during breath-holding with the torso only immersed, or during total immersion with snorkel-breathing. Neither breath-holding in air or with only the torso immersed, nor total immersion with snorkel-breathing produced such a diving response.3. Breath-holding, after several minutes of total immersion and snorkel-breathing, produced an attenuated diving response. It therefore appears that a full diving response can be obtained only when the apnoea commences at the moment of face immersion.4. The present investigation supports the concept that in man face immersion is an essential predisposing factor for the diving response, and cortical inhibition of the respiratory centre is important for its initiation and maintenance.

Adolescent↗

A field-compatible method for interpolating biopotentials.

Mapping of bioelectric potentials over a given surface (e.g., the torso surface, the scalp) often requires interpolation of potentials into regions of missing data. Existing interpolation methods introduce significant errors when interpolating into large regions of high potential gradients, due mostly to their incompatibility with the properties of the three-dimensional (3D) potential field. In this paper, an interpolation method, inverse-forward (IF) interpolation, was developed to be consistent with Laplace's equation that governs the 3D field in the volume conductor bounded by the mapped surface. This method is evaluated in an experimental heart-torso preparation in the context of electrocardiographic body surface potential mapping. Results demonstrate that IF interpolation is able to recreate major potential features such as a potential minimum and high potential gradients within a large region of missing data. Other commonly used interpolation methods failed to reconstruct major potential features or preserve high potential gradients. An example of IF interpolation with patient data is provided to illustrate its applicability in the actual clinical setting. Application of IF interpolation in the context of noninvasive reconstruction of epicardial potentials (the "inverse problem") is also examined.

Action Potentials↗

Optimization of Ga-67 imaging for detection and estimation tasks: dependence of imaging performance on spectral acquisition parameters.

UNLABELLED: We have compared the use of two (93 and 185 keV) and three (93, 185, and 300 keV) photopeaks for Ga-67 tumor imaging and optimized the placement of each energy window. METHODS: The bases for optimization and evaluation were ideal and Bayesian signal-to-noise ratios (SNR) for the detection of spheres embedded in a realistic anthropomorphic digital torso phantom and ideal SNR for the estimation of their size and activity concentration. Seven spheres of radii ranging from 1 to 3 cm, located at several sites in the torso, were simulated using a realistic Monte Carlo program. We also calculated the ideal SNR for the detection from simple phantom acquisitions. RESULTS: For detection and estimation tasks, the optimum windows were identical for all sphere sizes and locations. For the 93 keV photopeak, the optimal window was 84-102 keV for the detection and 87-102 keV for estimation; these windows are narrower than the 20% window often used in the clinic (83-101 keV). For the 185 keV photopeak, the optimal window was 170-220 keV for the detection and 170-215 keV for estimation; these are substantially different than the 15% window used in our clinic (171-199 keV). For the 300 keV photopeak, the optimal window for detection was 270-320 keV, and for estimation, 280-320 keV. Using the three optimized, rather than only the two lower-energy, windows yielded a 9% increase in the SNR for the detection of the 3 cm diam sphere (a 12% increase for a 2 cm diam sphere) and a 7% increase in the SNR for estimation of its size. For the acquired phantom data, detection also increased by 9%-12% when using three, rather than two, energy windows.

Abdomen↗

The effect of unrealistic thyroid vertical position on thyroid dose in the MIRD phantom.

Anatomically, the thyroid gland is placed in the lower neck, extending from the level of the fifth cervical vertebra down to the first thoracic vertebra. However, the thyroid of the Medical Internal Radiation Dose (MIRD) phantom, which has been widely used for dosimetric calculation, is located right above the top of the torso and is completely included in the neck region. To investigate the effect of the unrealistic position of the thyroid in the MIRD phantom on dose calculation, thyroid absorbed doses at various vertical positions were calculated for the idealized external broad parallel photon beam from anterior-posterior, posterior-anterior, right lateral (RLAT), and left lateral (LLAT) direction using the Monte Carlo method. The thyroid absorbed dose decreased by as much as about 60% for 0.05 MeV photon in both RLAT and LLAT irradiations when the thyroid was relocated to realistic position (inserted into the torso). The effective dose also decreased by 10%, consequently. The thyroid dose of the widely accepted stylized model, the MIRD phantom, is overestimated in RLAT and LLAT irradiation geometries.

Algorithms↗

Elevation localization and head-related transfer function analysis at low frequencies.

Monaural spectral features due to pinna diffraction are the primary cues for elevation. Because these features appear above 3 kHz where the wavelength becomes comparable to pinna size, it is generally believed that accurate elevation estimation requires wideband sources. However, psychoacoustic tests show that subjects can estimate elevation for low-frequency sources. In the experiments reported, random noise bursts low-pass filtered to 3 kHz were processed with individualized head-related transfer functions (HRTFs), and six subjects were asked to report the elevation angle around four cones of confusion. The accuracy in estimating elevation was degraded when compared to a baseline test with wideband stimuli. The reduction in performance was a function of azimuth and was highest in the median plane. However, when the source was located away from the median plane, subjects were able to estimate elevation, often with surprisingly good accuracy. Analysis of the HRTFs reveals the existence of elevation-dependent features at low frequencies. The physical origin of the low-frequency features is attributed primarily to head diffraction and torso reflections. It is shown that simple geometrical approximations and models of the head and torso explain these low-frequency features and the corresponding elevations cues.

Adult↗

Impact modeling of gymnastic back-handsprings and dive-rolls in children.

This study was to determine estimates of the stiffness and damping properties of the wrist, and shoulder in children by examining wrist impacts on the outstretched hand in selected gymnastic activities. The influence of age, mass, and wrist and torso impact velocity on the stiffness and damping properties were also examined. Fourteen young gymnasts (ages 8 to 15 yrs) were videotaped while performing back-handspring trials or dive-rolls. Kinematic and ground reaction analysis provided input for computer simulation of the body as a rheological model with appropriate stiffness and damping. A significant positive linear relationship was obtained between wrist damping in dive rolls and age, mass, and wrist and torso impact velocity, while shoulder damping in the back-handsprings had a significant positive linear relationship with body mass. This new information on stiffness and damping at the shoulder and the wrist in children enables realistic mathematical modeling of children's physical responses to hand impact in falls. This is significant because modeling studies can now be used as an alternative to epidemiological studies to evaluate measures aimed at reducing injuries in gymnastics and other activities involving impact to the upper extremity.

Adolescent↗