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A hip surgery simulator based on patient specific models generated by automatic segmentation.

The use of surgical simulator systems for education and preoperative planning is likely to increase in the future. A natural course of development of these systems is to incorporate patient specific anatomical models. This step requires some kind of segmentation process in which the different anatomical parts are extracted. Anatomical datasets are, however, usually very large and manual processing would be too demanding. Hence, automatic, or semi-automatic, methods to handle this step are required. The framework presented in this paper uses nonrigid registration, based on the morphon method, to automatically segment the hip anatomy and generate models for a hip surgery simulator system.

Computer Simulation↗

Combination of physical exercise and adenosine improves accuracy of automatic calculation of stress LVEF in gated SPECT using QGS software.

BACKGROUND: Combining exercise and adenosine during the stress phase of myocardial perfusion imaging (MPI) is known to reduce adverse effects and improve image quality. The aim of this study was to assess whether it can also improve the automatic calculation of left ventricular ejection fraction (LVEF) by QGS software package, during the stress phase of Gated SPECT. MATERIAL AND METHODS: One hundred patients who had stress Gated SPECT were retrospectively included in this study. Gated data of those who had adenosine only (50 patients=group A) was compared with those obtained in another group of 50 patients who had added bicycle exercise (Group B). All had identical image acquisition protocol using (99m)Tc-tetrofosmine. Clinical adverse effects, changes in blood pressure (BP), heart rate (HR), and ECG were monitored. Visual assessment of subdiaphragmatic uptake and accuracy of automatic regions of interest (ROI's) drawn by the software were noted. Regions of interest that involved sub-diaphragmatic uptake and resulting in low LVEF were manually adjusted to include the left ventricle only, and the frequency of manual adjustment was noted. RESULTS: No significant difference was noted in age, sex, baseline BP and HR between groups A and B. Adverse effects occurred less often in group B compared to group A (12% vs. 24%, p=0.118). Maximum HR and BP achieved during stress were significantly higher in group B compared to group A (p=0.025, p=0.001 respectively). The number of patients who had faulty ROI's and low LVEF, who needed manual adjustment of ROI's, were higher in group A compared to group B (16% vs. 6%, p=0.025). The values of LVEF showed significant improvement following manual adjustment of ROI's, increasing from a mean of 19.63+/-15.96 to 62.13+/-7.55 (p=0.0001) and from 17.33+/-9.5 to 49.67+/- 7.7 (p=0.0014) in groups A and B respectively. CONCLUSION: The addition of exercise to adenosine significantly improves the automatic calculation of LVEF by QGS software during Gated SPECT and reduces the need for manual adjustment.

Adenosine↗

Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement.

The systematic staging of chronic kidney disease (CKD) by glomerular filtration measurement and proteinuria has allowed the development of rational and appropriate management plans. One of the barriers to early detection of CKD is the lack of a precise, reliable and consistent measure of kidney function. The most common measure of kidney function is currently serum creatinine concentration. It varies with age, sex, muscle mass and diet, and interlaboratory variation between measurements is as high as 20%. The reference interval for serum creatinine concentration includes up to 25% of people (particularly thin, elderly women) who have an estimated glomerular filtration rate (eGFR) that is significantly reduced (< 60 mL/min/1.73 m). The recent publication of a validated formula (MDRD) to estimate GFR from age, sex, race and serum creatinine concentration, without any requirement for measures of body mass, allows pathology laboratories to "automatically" generate eGFR from data already acquired. Automatic laboratory reporting of eGFR calculated from serum creatinine measurements would help to identify asymptomatic kidney dysfunction at an earlier stage. eGFR correlates well with complications of CKD and an increased risk of adverse outcomes such as cardiovascular morbidity and mortality. We recommend that pathology laboratories automatically report eGFR each time a serum creatinine test is ordered in adults. As the accuracy of eGFR is suboptimal in patients with normal or near-normal renal function, we recommend that calculated eGFRs above 60 mL/min/1.73 m be reported by laboratories as "> 60 mL/min/1.73 m", rather than as a precise figure.

Journal Article↗

[Blood gas measurements and automatization (author's transl)].

The Corning 175, a fully automatic new blood-gas analyzer, was tested and compared with manual analyzers (Eschweiler-Radiometer). The precision was evaluated by means of tonometered bloods and precision gas mixtures. With the Corning 175 four parameters are measured: pH, PCO2, PO2, barometric pressure, and four computed: HCO3-, BE, oxygen content, oxygen saturation. These are automatically corrected for patient hemoglobin and temperature. A microprocessor controls the sequencing of all operations during the calibrations and the measurements and continuously checks the performances of the electrodes and the entire system. The operator part is limited to the introduction of blood. The advantages and the fiability of the automatism in clinical routine are described.

Autoanalysis↗

Automatic processing of spoken dialogue in the home hemodialysis domain.

Spoken medical dialogue is a valuable source of information, and it forms a foundation for diagnosis, prevention and therapeutic management. However, understanding even a perfect transcript of spoken dialogue is challenging for humans because of the lack of structure and the verbosity of dialogues. This work presents a first step towards automatic analysis of spoken medical dialogue. The backbone of our approach is an abstraction of a dialogue into a sequence of semantic categories. This abstraction uncovers structure in informal, verbose conversation between a caregiver and a patient, thereby facilitating automatic processing of dialogue content. Our method induces this structure based on a range of linguistic and contextual features that are integrated in a supervised machine-learning framework. Our model has a classification accuracy of 73%, compared to 33% achieved by a majority baseline (p<0.01). This work demonstrates the feasibility of automatically processing spoken medical dialogue.

Algorithms↗

Development of an automatic control algorithm for the electrohydraulic total artificial heart without transducers.

To achieve a reliable and simple implantable total artificial heart, the number of implanted transducers providing the physiologic information required for automatic control should be minimized. To address this need, a new automatic control algorithm, based on a transducerless electrohydraulic total artificial heart (EHTAH) system, is proposed. The current EHTAH physiologic control algorithm relies on two implanted pressure transducers. Without these transducers, the information required for automatic control must be extracted from the running motor's parameters. These parameters correlated with the differential pressure across the axial flow pump used to actuate the EHTAH. Changes in this differential were chosen as a cue for cardiac output control. This algorithm can be viewed as depending upon systemic vascular resistance determined by subtracting mean right atrial pressure (RAP) from mean aortic pressure (AoP) and dividing the result by total cardiac output (CO). The difference between mean AoP and mean RAP was confirmed to correlate with the differential hydraulic pressure across the energy converter during the left systolic phase. As an interim configuration, a single differential pressure transducer measuring the differential hydraulic pressure across the energy converter was tested on a Donovan mock circulation system. The resultant CO response shows good sensitivity according to changes in both preload and afterload.

Algorithms↗

[Clinical trial of an ergometry bicycle with automatic blood pressure registration].

Automatic blood-pressure registration on a computerized ergometer cycle was compared with simultaneous manually registered blood-pressure employing a standard mercury sphygmomanometer during performance of maximal ergometer exercise testing on 50 consecutive patients. The difference in blood-pressure registered by the automatic and the manual methods, respectively, was, on an average +0.2 mmHg with a 95% confidence interval of +/- 20 mmHg. By means of linear regression analysis, a correlation coefficient of 0.97 (p less than 0.001) with an uncertainty of approximately 6% with automatic blood-pressure registration was found. Simultaneously, the uncertainty was independent of the degree of work performed. The apparatus was found to be of practical clinical use.

Adult↗

[Hypotension induced by sodium nitroprusside administered via an automatic-adaptive dose regulating system. Experimental development].

Sodium nitroprusside (NPS) is a potent vasodilator which is frequently administered for the control of arterial blood pressure and peripheral resistances. Manual regulation of the dose is difficult and requires a permanent surveillance of patients under treatment. Several attempts have been made to develop an automatized system able to safely control the dose of the drug in clinical practice. However, since now the results have not been completely satisfactory. The aim of our study was to develop of a new automatic-adaptative system able to continuously control the dose of NPS. The system consists of a high precision infusion pump controlled by a microprocessor. Arterial blood pressure is continuously monitorized and according to its values NPS is automatically regulated to maintain blood pressure within a preselected range. A control "fuzzy logic" algorithm was used. We have assessed the efficacy, adaptability, and safeness of the system. The system was tested in 15 mongrel dogs. The protocol was divided into two parts. During the first part a 25% to 30% reduction in blood pressure from baseline values lasting for a period of 4 hours was attempted. The second part was devoted to test the adaptability of the control unit during induced unstable hemodynamic situations. Group I dogs were subjected to volume overload. Group II were treated with noradrenaline to increase blood pressure, and group III underwent a venous bleeding to produce arterial hypotension. Control of arterial blood pressure was achieved after a minimum of 5 min and a maximum of 19 min (mean values = 13.3 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Quantitative cytoarchitecture point differences in experimental cortical hemiatrophy found by automatic image analysis].

For more than ten years automatic analysis procedures have been applied to explore cortical cytoarchitectonics of the brain. The investigations presented were carried out by a method described as "automatic morphocorticography". Attempts to find out quantitative criteria for early unilateral cortical alterations were carried out on a pig's brain with experimental cortical hemiatrophy caused artificially by wide spread meningeal fibrosis. Lateral differences of the relative volume density (V alpha) of all cells could be analysed for each cortical layer in detail by the automatically plotted morphocorticographs (MCG) of selected cortical parts from both hemispheres. Partial increases in the V alpha-values could be found in the whole cross-section of the cerebral cortex from the experimentally damaged hemisphere and the same value increases of between 10 and 15% were found in the 3rd an 5th cortical layer in particular. In contrast the mean values of the relative numerical cellular density in the whole cortical cross-section remained without significant changes. It can be concluded that the early alterations caused by this type of damage are predominantly due to changes in the neuropil structures.

Animals↗

[Dosimetry of electron beams: verification of the accuracy of an automatic dosimeter and a system for treatment planning].

This study is part of a quality assurance programme evaluating the performances of two connected on-line systems (automatic dosimeter and treatment planning) and verifying the correctness of the applied algorithms and the accuracy of the basic beam data. We compared PDD measured in an automatic water phantom using a p-Si detector with point doses using an ion-chamber, for electron beams from a linac. To record dose distributions of scanned electron beams, the detector measurement time was triggered by the frame scan frequency. Data were automatically transferred to the treatment planning system by an interface. Measured and calculated isodose charts were compared for perpendicular incidence fields. Relative dose values calculated, in axis and off-axis points, were compared with those determined by the ion-chamber in the following situations: perpendicular and oblique incidence, different SSD.

Electrons↗

Automatic modules for extracorporeal circulation control.

Maintenance of a constant level in the oxygenator during surgical extracorporeal circulation (ECC) is of paramount importance. We propose a device able to regulate the pump speed accordingly to the level in the oxygenator, and an automatic clamp to control venous return from the patient. The level regulator permits pump speed control and also stops the pump when a prefixed low level is reached (during ECC). Linearization of the level sensor has been made in order to optimize the PI regulator. Simulation results are presented and the regulator is evaluated in a clinical environment. The automatic clamp provides a good solution for reproducible and easy transitions in venous return. When coupled with the level regulator, the pump speed will increase automatically from zero to the correct equilibrium speed, with variable duration (from 30 seconds to 5 minutes) chosen by the operator. The same technique is used for stopping the ECC. These two devices are, in fact, modules, making up part of an evolutive device for ECC automation. The modules can exchange data with a supervising microcomputer.

Automation↗

Investigations of an automatic screening device (MESAM) for obstructive sleep apnoea.

A digital recording device developed to monitor heart rate (HR) and breathing sounds (snoring), and used to screen subjects for obstructive sleep apnoea syndrome (OSAS), was investigated. This device is called the MESAM and is currently commercially available in some western European countries. The computer-based automatic scoring systems provided with the equipment and a hand-scoring technique developed at Stanford and requiring 10-15 min to perform, were used. Polysomnography and MESAM recordings were performed simultaneously on two groups of 25 sleep disorder patients (each with respiratory disturbance index greater than or less than 10). Patients were randomly monitored and records were analysed by two teams blind to the initial clinical impression, to the events which occurred during the recordings, and to each other's findings. Specificity and sensitivity were calculated for each of the MESAM scoring techniques considered, with polysomnography being selected as the recording standard, With "automatic HR scoring" specificity was 12%, sensitivity 92%; with "automatic breathing sounds (snoring)" scoring, specificity was 8% and sensitivity 96%; with "hand-scoring" specificity was 72% and sensitivity 92%. If the three scoring techniques were combined, all patients with a respiratory disturbance index (RD) greater than 10 were recognized as having OSAS.

Electronics, Medical↗

Human sperm motion analysis by automatic (Hamilton-Thorn Motility Analyzer) and manual (Image-80) digitization systems.

Two systems allowing quantitative, objective analysis of sperm movement were compared: 1) the Hamilton-Thorn Motility Analyzer (HTM), in which sperm images are digitized automatically, and 2) the Image-80, a modified image-analysis system in which sperm movement is digitized manually by hand tracing from videotape (Tessler and Olds-Clarke, 1985). Videotapes were made of human spermatozoa obtained by a swim-up procedure. The same videotape frames were analyzed by both systems. The mean percentage of motile spermatozoa was similar as judged by eye with either the HTM or Image-80 monitors and as reported by the HTM. For every motile spermatozoon, two motility parameters were calculated: linearity (a measure of track shape) and curvilinear velocity at 30 frames/second (a measure of track speed). When samples from five donors were averaged, there were no significant differences in mean linearity between automatic and manual systems. Also, linearity as reported by the HTM and Image-80 systems for the same track was significantly correlated (r = 0.72; N = 80). Whereas the absolute values for curvilinear velocity were slightly but significantly higher for the Image-80 system than for the HTM system, their correlation was also significant (r = 0.91). Since the two systems provide comparable data on percentage of motile sperm as well as speed and path shape parameters, this suggests that the HTM automatic digitization is accurate for images of human spermatozoa.

Adult↗

[Study of automatic cephalometric analysis by digital image processing].

In the lateral roentgenographic cephalometric analysis, a certain degree of errors is unavoidable as it involves a lot of manual work in tracing, landmark setting, measurement and registration. To minimize the chances of errors creeping in, efforts have been made toward the mechanization of manual work. For measuring and registering automatically, a roentgenographic cephalometric system using a personal computer is available. Attempts have also been made to automatically obtain landmarks on tracings by the use of a computer. However, tracing still has to be performed by hand. The circumstances are such that the development of a full-scale scanning system that can perform automatic tracing on cephalometric radiographs in being eagerly awaited. The present study concerns the possibility of using a small-size computer mainframe in a small-scale clinical laboratory which cannot afford to install a large one. A digital image processing system using a personal computer was devised to process cephalograms. And a the anatomical complex on the screen was developed. To examine the acuracy of the drawings, comparisons were made between manual tracings and computer-aided tracings. The results were as follows: 1. In both vertical and horizontal components at Pog, Gn and Me points, computer tracings were matched significantly well with manual tracings. 2. At the points of Or, ANS, A and Go, only vertical components were matched significantly well with those obtained by manual tracing. 3. In the program developed for the present study, the computer had a greater tendency than man to draw the borderline along the higher density area when the gray level gradient was not sharp.

Cephalometry↗

[Automatic biometry and keratometry in comparison with the manual technic].

In order to determine the power of intraocular lenses more easily prior to cataract surgery, we compared the results obtained by automatic measurement of the corneal refractive power by the Humphrey Autokeratometer with manually obtained measurements using the Zeiss ophthalmometer. Similarly, the axial length was determined by automatic measurements using the Digital B System IV (Cooper Vision) and manual measurements using the Ophthascan S (Biophysic Medical). Statistical evaluation showed that there were no significant differences in the corneal refractive power determined by the two methods or in the IOL power calculated using the SRK formula. Therefore, automatic measurement of both corneal refractive power and axial length following the above method can be a useful alternative to the preoperative determination of the IOL power.

Humans↗

The hazards of automatic-dishwasher detergent.

Automatic-dishwasher detergent is a common household substance which is extremely corrosive and potentially fatal if ingested. In this report, we discuss the implications of the ingestion of automatic-dishwasher detergent in 18 children over a three-year period. Ten of the 18 children gained access to the automatic-dishwasher detergent from the dishwasher on the completion of a washing-cycle, while the remainder ingested the detergent directly from the packet. There was a poor correlation between the presenting signs and symptoms and the subsequent endoscopic findings in the 14 children who underwent endoscopy.

Burns, Chemical↗

Computer method for automatic determination of stroke volume using impedance cardiography signals.

The described computer method of stroke volume (SV) estimation is based on impedance cardiography (ICG) signals. This method allows to calculate SV for 4096 successive cycles of the heart. The disturbing influence of respiration is reduced by base-line correction procedure. Stroke volume values determined automatically (AD) were compared with those obtained by conventional hand digitizing (HD) in 5 young male subjects in the supine and sitting positions, and in 5 subjects in the standing position. The correlation coefficient between SV values determined automatically SV (AD) and hand digitized SV (HD) calculated for all collected data was 0.9583 (n = 150, P less than 0.001). The error of the automatic SV determination was 6.7%.

Adult↗

The effect of the combination of quinidine and propranolol upon atrial and ventricular automatically in dogs.

The effects of quinidine, propranolol and their combination on atrial and ventricular automaticity were studied in pentobarbital-anesthetized dogs with complete heart block produced by injection of 40% formalin. The indices of atrial and ventricular automaticity were the intrinsic rate and the asystole interval, 10-beat period, and beats per 30 seconds after cessation of a 2-minute overdrive. Potentiation was considered to be a response produced by the combination of a half-dose of quinidine plus a half-dose of propranolol significantly greater than that produced by the full dose of either drug. Two combinations were studied: combination I consisted of 1.0 mg/kg of quinidine and 0.04 mg/kg of propranolol while combination II consisted of 2.0 mg/kg of quinidine and 0.08 mg/kg of propranolol. Neither combination potentiated the action of the individual drugs on the ventricle. Both combinations produced a potentiation of the individual drug effects on atrial intrinsic rate, asystole interval, and 10-beat period while only combination II potentiated the individual drug effects on atrial beats per 30 seconds. These studies indicate that the enhanced effect of the quinidine-propranolol combination in conversion of atrial tachyarrhythmias to sinus rhythm may be a function of its potentiation of the ability of the individual drug to depress atrial automaticity.

Animals↗