Real time entry and display of clinical data in an intensive care unit.
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BACKGROUND: Current intravascular ultrasound (IVUS) catheters provide transverse imaging at the level of the ultrasound transducer. This limits imaging to large-diameter segments without critical atherosclerotic narrowings. We have developed a prototype 20-MHz forward-viewing IVUS catheter that provides two-dimensional sector imaging distal to the catheter tip. A present limitation of this technique is that the catheter must be manually rotated to obtain multiple longitudinal views required to integrate the segment into a three-dimensional matrix. To overcome this, we have developed an algorithm that reconstructs these multiple two-dimensional forward-viewing IVUS images into a three-dimensional matrix for more complete depiction of the segment distal to the ultrasound catheter. This algorithm allows display and multidimensional slicing of the three-dimensional reconstruction. METHODS AND RESULTS. To test our algorithms, five arterial segments (three canine aortas, two human femoral arteries) were evaluated in vitro. In each segment, 36 forward-viewing longitudinal slices were collected, digitized, processed, and reoriented to produce a three-dimensional reconstruction (3DR) matrix. The matrix data were sliced into parallel transverse sections and compared with morphometric interpretation of histological sections (Histo). As a result, image data could be reconstructed for a distance of 2.0 cm ahead of the catheter. 3DR easily demonstrated wall and luminal morphology and provided transverse IVUS images comparable to the histological specimens. A good correlation was noted between Histo- and 3DR-determined luminal diameters (LD) and luminal areas: 3DR LD = 1.4 Histo LD-0.4, r = .86; 3DR LD = 0.7 +/- 0.20 cm (mean +/- SD); and Histo LD = 0.7 +/- 0.13 cm. CONCLUSIONS: These preliminary data demonstrate the feasibility of 3DR of forward-viewing IVUS data. This method allows rapid, detailed analysis of diseased arterial segments previously unavailable with standard IVUS and may permit better targeting of interventional techniques.
To assess the left ventricular (LV) performance more sensitively, a new display method of phase plane (PP), displaying volume and volume-time function (dV/dt) in a single image, was applied to radionuclide ventriculography obtained by a single cardiac probe system. The sampling interval was 10 msec and the data acquisition time was 60 sec. The LV volume curve was smoothed by fitting a fourth order polynomial curve of Fourier's analysis. Then the dV/dt was calculated. In this single image PP display, the width of the horizontal axis indicates relative LV volume, and the height of the vertical axis indicates dV/dt. The direction of the rotation of this loop is clockwise. We classified 126 patients with various heart diseases into seven groups, according to the configuration of the loop. The most interesting finding was that the distortion of the loop during diastole was frequently seen in patients with hypertension and angina pectoris, whereas their ejection fraction was within normal limits. We concluded that the single image PP display is a sensitive method for assessing the abnormality of the LV function, not only by evaluating the conventional parameters, but also by analyzing the configuration of the volume to volume-time function loop.
PROBLEM: To improve communication among caregivers about the status of patients under their care. SOLUTION: Replacing manual white boards with electronic bed boards/inpatient databases, similar to airport display technology. RESULTS: Improved data quality from having patient data displayed in a standardized manner across care centers. KEYS TO SUCCESS: "We used a process redesign team, which focused on specific issues related to the processes used in providing patient care."
SQUID is a flexible computer program that allows the analysis and display of molecular coordinates from crystallography, NMR, and molecular dynamics. The program can also display two-dimensional and three-dimensional data using many graph types, as well as perform array processing of data with numerous intrinsic functions. Graphics are based on the use of "move" and "draw" instructions, allowing easy development of new device drivers, including vector plotters.
A program is described and illustrated for the one-way analysis of variance of parallel line assays. The procedure involves 4 distinct steps: Data input, either from a previously-prepared data file or by direct 'manual' progression with options to correct input errors; data display, in tabular form, of the results from each specimen after several available transformation options; displays of the analysis of variance table, potency ratio, and confidence limits on the basis of results selected from the data display mode; and, a standard, commercially-available plotting capability of either actual or idealized regression lines. The program provides a rapid, convenient, and accurate procedure, with a high level of operator interaction, with which to perform the somewhat cumbersome mathematical manipulations necessary for the evaluation of parallel line assay results. The availability of this program should overcome one of the problems which frequently prevents the complete analysis and validation of the results of parallel line assays.
The number of screening examinations of the sinuses performed with CT has markedly increased owing to the widespread and increasing use of endoscopic sinonasal surgery. We reviewed scans from 500 patients who had screening CT examinations of the sinuses for preendoscopic evaluation of inflammatory sinonasal disease to better define an optimal imaging protocol. Three aspects of direct coronal imaging of the paranasal sinuses were investigated: (1) preparation of the patient prior to the examination; (2) technical factors of the CT study, including positioning of the patient, optimal coronal angle, slice thickness, and CT exposure factors; and (3) data display. Our experience indicates that pretreatment of the patient with maximal medical therapy enables the best preendoscopic definition of anatomy, disease pattern, and nonreversible disease component for the treating surgeon. CT technical factors are optimized with scanning in the prone position with thin (3-mm) sections obtained through the anterior paranasal sinuses. This allows optimal visualization of the ostiomeatal unit. The remaining posterior portions of the sinuses are adequately imaged with thicker slices (5 mm). The coronal scan angle used is less critical. Exposure factors (mAs) can be reduced dramatically without image compromise. Data display is optimized when the bone algorithm is used to acquire the data and with image display at intermediate window center and width level. Use of the techniques outlined in this article results in a cost-effective yet diagnostic scan of the sinuses with decreased radiation exposure to the patient.
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This article describes a new algorithm for reprojection of volumetric data, called Fast Fourier Projection (FFP), which is one to two orders of magnitude faster than conventional methods such as ray casting. The theoretical basis of the new method is developed in a unified mathematical framework encompassing slice imaging and conventional volumetric reprojection methods. Software implementation is discussed in detail. The article closes with an account of experience with a prototype FFP implementation, and applications of the technique in medical visualization.
Graphics are an important means of communicating experimental data and results. There is evidence, however, that many of the graphics printed in scientific journals contain errors, redundancies, and lack clarity. Perhaps more important, many graphics fail to portray data at an appropriate level of detail, presenting summary statistics rather than underlying distributions. We seek to aid investigators in the production of high-quality graphics that do their investigations justice by providing the reader with optimum access to the relevant aspects of the data. The depiction of by-subject data, the signification of pairing when present, and the use of symbolic dimensionality (graphing different symbols to identify relevant subgroups) and small multiples (the presentation of an array of similar graphics each depicting one group of subjects) to portray stratification are stressed. Step-by-step instructions for the construction of high-quality graphics are offered. We hope that authors will incorporate these suggestions when developing graphics to accompany their manuscripts and that this process will lead to improvements in the graphical literacy of scientific journals. We also hope that journal editors will keep these principles in mind when refereeing manuscripts submitted for peer review.
Of the many steps involved in producing high quality three-dimensional (3D) images of CT data, the data acquisition step is of greatest consequence. The principle of "garbage in, garbage out" applies to 3D imaging--bad scanning technique produces equally bad 3D images. We present a formal study of the effect of two basic scanning parameters, slice thickness and slice spacing, on image quality. Three standard test objects were studied using variable CT scanning parameters. The objects chosen were a bone phantom, a cadaver femur with a simulated 5 mm fracture gap, and a cadaver femur with a simulated 1 mm fracture gap. Each object was scanned at three collimations: 8, 4, and 2 mm. For each collimation, four sets of scans were performed using four slice intervals: 8, 4, 3, and 2 mm. The bone phantom was scanned in two positions: oriented perpendicular to the scanning plane and oriented 45 degrees from the scanning plane. Three-dimensional images of the resulting 48 sets of data were produced using volumetric rendering. Blind review of the resultant 48 data sets was performed by three reviewers rating five factors for each image. The images resulting from scans with thin collimation and small table increments proved to rate the highest in all areas. The data obtained using 2 mm slice intervals proved to rate the highest in perceived image quality. Three millimeter slice spacing with 4 mm collimation, which clinically provides a good compromise between image quality and acquisition time and dose, also produced good perceived image quality. The studies with 8 mm slice intervals provided the least detail and introduced the worst inaccuracies and artifacts and were not suitable for clinical use. Statistical analysis demonstrated that slice interval (i.e., table incrementation) was of primary importance and slice collimation was of secondary, although significant, importance in determining perceived 3D image quality.
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An application of computers to haemodialysis units is presented. In fact these centers are characterised by an enormous amount of data which should benefit from computerization, and therefore in the haemodialysis unit of the Cantonal Hospital, Fribourg, a program has been developed to handle medical data. This program, as far as we know the only one of its kind in Switzerland, has already been in use for the last 9 months. Swiftly, surely and simply it allows storage and retrieval of all the administrative and medical data of each patient. Facility of data retrieval, graphic data display and automatic data evaluation has been found to improve clinical management of patients. It also considerably facilitates scientific work. Once the adaptation period is over it permits definite time savings. We are convinced that, after the necessary period of introduction, computers can be of considerable help in medical care.
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