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Evaluation of the patient with hematuria.

There is little controversy regarding whether gross or visible hematuria requires complete upper and lower urinary tract evaluation. With regard to microscopic hematuria, investigators have disagreed on precisely which patients require a complete work-up. Most agree that older patients (> 40 years), patients with a history of cigarette use, and those with occupational exposure or history of chronic phenacetin use should absolutely undergo upper tract imaging, cystourethroscopy, and cytologic examination of the urine in addition to a thorough history and physical examination. A multidisciplinary group of oncologists, radiologists, urologists, and internists has published its recommendations as part of the American Urological Association best practice policy. The formal guidelines, which were distributed, rereviewed, and modified following a nationwide survey of clinicians, recommend complete urologic evaluation for all patients with microscopic hematuria who are over 40 years of age, and younger patients with a history suspicious for urologic disease. This identifies those at highest risk for malignancy while minimizing the number of evaluations in patients unlikely harboring significant disease.

Algorithms↗

Visceral leishmaniasis control: a public health perspective.

Visceral leishmaniasis (VL), also known as kala-azar, is a vector-borne disease caused by a protozoan of the Leishmania donovani complex. A phlebotomine sandfly transmits the parasite from person to person or via an animal reservoir. VL is a severe, debilitating disease, characterized by prolonged fever, splenomegaly, hypergammaglobulinaemia and pancytopenia. Patients become gradually ill over a period of a few months, and nearly always die if untreated. Case-fatality ratios are high even in treated patients. Worldwide an estimated 500,000 VL cases occur each year. This study reviews clinical, epidemiological and public health aspects of the disease and shows how critical adequate case detection is for the success of VL control. Examination of the issue of VL diagnosis with respect to the global challenges in VL control leads to the observation that a sound diagnostic-therapeutic algorithm for the health services in endemic areas is badly needed. Serological tests could be an alternative to parasitological diagnosis and the direct agglutination test (DAT) was found to fulfil many criteria for a 'field test', including cost effectiveness. Although research needs on vaccine and better drugs continue to be high on the agenda, a VL test-treatment strategy based on currently available highly sensitive serological tests, such as the DAT, should be introduced in the health services in endemic areas.

Animals↗

Clinical detection of optic nerve damage: measuring changes in cup steepness with use of a new image alignment algorithm.

The purpose of this study was to study the effect of a subpixel image alignment algorithm on the standard deviation (SD) of mean topography images obtained by laser scanning tomography and to evaluate changes of the cup shape measure parameter (CSM) over time based upon the individual parameter variability using the new algorithm. Triple measurements from optic nerve heads of 132 eyes of 132 subjects were obtained using the Heidelberg Retina Tomograph HRT. To calculate a mean topography image from three single topography images, alignment of the raw optical section image data was performed with the standard software and again with a new subpixel-based image alignment algorithm. The effect on the averaged (SD) of the mean topography images was evaluated. CSM was evaluated in 15 eyes of 15 normal subjects (N) and 28 eyes of 14 glaucoma patients (G) over a period of 28.6 +/- 4.6 months (N) and 28.56 +/- 5.2 months (G) respectively. A change in the CSM value over time was considered significant if CSM measurements exceeded two standard deviations of this variable determined for the individual eye. Mean-topography image SD was 22.86 +/- 8.2 microns (min. 9.5 microm; max. 47.8 microm) with the standard alignment procedure and 15.46 +/- 6.8 microm (min. 6.8 microm; max. 42.8 microm) with the new algorithm. The average SD improvement was 7.46 +/- 3.9 microns (min. -8.1 microm; max. 28.7 microm). The coefficient of correlation of both methods was R(2) = 0.77 (p < 0.0001). No control group eye demonstrated significant changes of CSM in the follow-up period. The CSM indicated an increase in cup steepness in 4 eyes of 4 glaucoma patients. In one of these four eyes, a deterioration of the visual field was identified by white on white perimetry. The new image alignment algorithm significantly reduces the SD of mean topography images calculated from identical raw data. If topometric variables are evaluated over time, the individual variability of data should be taken into account.

Adult↗

Computerized stereochronoscopy and alternation flicker to detect optic nerve head contour change.

PURPOSE/BACKGROUND: Stereochronoscopy, a technique previously explored but abandoned for glaucoma diagnosis, viewed optic nerve images acquired at separate points in time as if a stereo pair. Prior efforts to exploit this technique were impaired by a lack of superimposability for sequential optic nerve images. We investigated computerized registration techniques for aligning sequential, monoscopic optic disc images to facilitate sensitive detection of optic nerve head contour changes in glaucoma. DESIGN: Algorithm and software development. Comparisons with standard techniques. MATERIALS: Existing patient records from the Glaucoma Service, Scheie Eye Institute, University of Pennsylvania. METHODS: Two sets of optic disc photographs, separated in time by 1 to 18 years, of 25 eyes with and without glaucomatous optic disc progression were digitized. We developed custom software for accurate image alignment. Change in disc morphology was then judged by digital stereochronoscopy and user-controlled alternation flicker of superimposed, time-separated images on a computer monitor. Comparisons were made with standard stereoscopic comparison. MAIN OUTCOME MEASURE: Identification of change or no change in optic nerve head contour for images acquired at separate points in time. RESULTS: Image processing and registration permits accurate alignment of optic disc photographs. Alternation flicker of superimposed, sequential images facilitates image comparison and detection of change as indicated by change in vessel position, color, and other cues for contour change. A high concordance was found between standard stereoscopic comparison and alternation flicker. In several cases, reinspection of stereo comparison led to a revised judgment on the basis of disc changes rendered more obvious with alternation flicker. Digital stereochronoscopy was less concordant with standard techniques. CONCLUSIONS: Digital image processing techniques and alternation flicker provide a simple, sensitive, software-based method for detecting glaucomatous optic disc change.

Algorithms↗

Imaging of acute pulmonary thromboembolism: should spiral computed tomography replace the ventilation-perfusion scan?

For several decades, ventilation-perfusion scintigraphy has been the main imaging modality used in the evaluation of patients with suspected acute pulmonary embolism (PE). Recently, various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute PE and suggests a diagnostic imaging algorithm based on current evidence in the literature.

Acute Disease↗

[Pulmonary embolism diagnosis].

Pulmonary Embolism is often considered a difficult diagnosis to establish. It is important to recognise clinical situations that leads to it. There are a few laboratory and imaging tests, that should be tailored to the available facilities in each institution.

Algorithms↗

Three-dimensional medical imaging display with computer-generated integral photography.

A 3-D display system for medical imaging by computer-generated integral photography (IP) has been developed. Real 3-D images are generated from 3-D medical images and displayed by simple structure. Each point in 3-D space is reconstructed by the convergence of rays from many pixels on the computer display through the lens array. Only the coordinate of the best point is computed for each pixel on the display. The locations of images projected within 40mm from the display were found to be less than 2.0mm in error. Projected images could be observed with motion parallax within 10 degrees from the front of the display.

Algorithms↗

Measuring registration potential in planar transmission images.

One method of detecting change in an anatomical structure is by comparing elements of a longitudinal series of planar transmission images (i.e. radiographs). Unfortunately, changes in image formation parameters, such as patient placement, prevent successful image registration from occurring. In this paper, an analytic method is described which allows one to quantify the ability to register two planar transmission images. The concepts described in this paper are not dependent on a specific image registration method. In fact, these results hold independent of the registration algorithm used since they are based solely on phenomena occurring during the image formation process.

Algorithms↗

Edge-shrinking interpolation for medical images.

A new algorithm for interpolating the missing data between two adjacent medical images is presented. Our method is useful for solving the interpolation of any region-represented images of an object to be reconstructed, even when the object is stretched abruptly, branched or hollow, as often occurs in medical images, which cases can not be handled well by existing methods. When this algorithm is applied, the nonoverlapped regions of the same object in the two base images are first extracted and encoded by chamfer distance code on every pixel in these regions. Then, the outer edges of the nonoverlapping regions are shrunk inward simultaneously so that the stretched edges reach the edges of the overlapping regions at the same time. The distance codes in nonoverlapping regions are used to limit the shrinking of these edges in the interpolation process. The proposed method also provides object centralization and enlargement operations to obtain stable and reasonable results in complicated case. The experimental results show that the proposed method is more efficient in resolving general interpolation tasks than the existing methods (S.P. Raya and J. K. Udupa, IEEE Trans. Med. Image. 9, 32-42, 1990; G. T. Herman et al., IEEE Comput. Graph. Appl. 12, 69-79, 1992; J.F. Guo et al., Comput. Med. Imag. Graph. 19, 267-279, 1995.)

Algorithms↗

MRI of the wrist.

In the past, the diagnostic imaging algorithm for evaluating the painful wrist included initial plain radiographic examination followed by arthrography, tomography, bone scintigraphy, or computed tomography. In recent years, magnetic resonance imaging (MRI) has been proven efficacious for diagnosing a number of maladies of the bones, ligaments, and soft tissues. MRI can be of aid in evaluation of carpal instability, disorders of the triangular fibrocartilage, ulnar impaction syndrome, distal radioulnar joint (DRUJ) instability, fracture, avascular necrosis (AVN), tendinopathy, nerve entrapment syndromes, synovial abnormalities, and soft tissue masses.

Carpal Bones↗

Interaction in the segmentation of medical images: a survey.

Segmentation of the object of interest is a difficult step in the analysis of digital images. Fully automatic methods sometimes fail, producing incorrect results and requiring the intervention of a human operator. This is often true in medical applications, where image segmentation is particularly difficult due to restrictions imposed by image acquisition, pathology and biological variation. In this paper we present an early review of the largely unknown territory of human-computer interaction in image segmentation. The purpose is to identify patterns in the use of interaction and to develop qualitative criteria to evaluate interactive segmentation methods. We discuss existing interactive methods with respect to the following aspects: the type of information provided by the user, how this information affects the computational part, and the purpose of interaction in the segmentation process. The discussion is based on the potential impact of each strategy on the accuracy, repeatability and interaction efficiency. Among others, these are important aspects to characterise and understand the implications of interaction to the results generated by an interactive segmentation method. This survey is focused on medical imaging, however similar patterns are expected to hold for other applications as well.

Algorithms↗

Detection and segmentation of drusen deposits on human retina: potential in the diagnosis of age-related macular degeneration.

Assessment of the risk for the development of age-related macular degeneration requires reliable detection and quantitative mapping of retinal abnormalities that are considered as precursors of the disease. Typical signs for the latter are the so-called drusen that appear as abnormal white-yellow deposits on the retina. Segmentation of these features using conventional image analysis methods is quite complicated mainly due to the non-uniform illumination and the variability of the pigmentation of the background tissue. This paper presents a novel segmentation algorithm for the automatic detection and mapping of drusen in retina images acquired with the aid of a digital Fundus camera. We employ a modified adaptive histogram equalization, namely the multilevel histogram equalization (MLE) scheme, for enhancing local intensity structures. For the detection of drusen in retina images, we develop a novel segmentation technique, the histogram-based adaptive local thresholding (HALT), which extracts the useful information from an image without being affected by the presence of other structures. We provide experimental results from the application of our technique to real images, where certain abnormalities (drusen) have slightly different characteristics from the background. The performance of the algorithm is established through statistical analysis of the results. This analysis indicates that the proposed drusen detector gives reliable detection accuracy in both position and mass size.

Algorithms↗

On-chip coupling of isoelectric focusing and free solution electrophoresis for multidimensional separations.

We have developed an acrylic microfluidic device that sequentially couples liquid-phase isoelectric focusing (IEF) and free solution capillary electrophoresis (CE). Rapid separation (<1 min) and preconcentration (73x) of species were achieved in the initial IEF dimension. Using full-field fluorescence imaging, we observed nondispersive mobilization velocities on the order of 20 microm/s during characterization of the IEF step. This transport behavior allowed controlled electrokinetic mobilization of focused sample bands to a channel junction, where voltage switching was used to repeatedly inject effluent from the IEF dimension into an ampholyte-based CE separation. This second dimension was capable of analyzing all fluid volumes of interest from the IEF dimension, as IEF was 'parked' during each CE analysis and refocused prior to additional CE analyses. Investigation of each dimension of the integrated system showed time-dependent species displacement and band-broadening behavior consistent with IEF and CE, respectively. The peak capacity of the 2D system was approximately 1300. A comprehensive 2D analysis of a fluid volume spanning 15% of the total IEF channel length was completed in less than 5 min.

Algorithms↗

Calculated absorption and scattering properties of gold nanoparticles of different size, shape, and composition: applications in biological imaging and biomedicine.

The selection of nanoparticles for achieving efficient contrast for biological and cell imaging applications, as well as for photothermal therapeutic applications, is based on the optical properties of the nanoparticles. We use Mie theory and discrete dipole approximation method to calculate absorption and scattering efficiencies and optical resonance wavelengths for three commonly used classes of nanoparticles: gold nanospheres, silica-gold nanoshells, and gold nanorods. The calculated spectra clearly reflect the well-known dependence of nanoparticle optical properties viz. the resonance wavelength, the extinction cross-section, and the ratio of scattering to absorption, on the nanoparticle dimensions. A systematic quantitative study of the various trends is presented. By increasing the size of gold nanospheres from 20 to 80 nm, the magnitude of extinction as well as the relative contribution of scattering to the extinction rapidly increases. Gold nanospheres in the size range commonly employed ( approximately 40 nm) show an absorption cross-section 5 orders higher than conventional absorbing dyes, while the magnitude of light scattering by 80-nm gold nanospheres is 5 orders higher than the light emission from strongly fluorescing dyes. The variation in the plasmon wavelength maximum of nanospheres, i.e., from approximately 520 to 550 nm, is however too limited to be useful for in vivo applications. Gold nanoshells are found to have optical cross-sections comparable to and even higher than the nanospheres. Additionally, their optical resonances lie favorably in the near-infrared region. The resonance wavelength can be rapidly increased by either increasing the total nanoshell size or increasing the ratio of the core-to-shell radius. The total extinction of nanoshells shows a linear dependence on their total size, however, it is independent of the core/shell radius ratio. The relative scattering contribution to the extinction can be rapidly increased by increasing the nanoshell size or decreasing the ratio of the core/shell radius. Gold nanorods show optical cross-sections comparable to nanospheres and nanoshells, however, at much smaller effective size. Their optical resonance can be linearly tuned across the near-infrared region by changing either the effective size or the aspect ratio of the nanorods. The total extinction as well as the relative scattering contribution increases rapidly with the effective size, however, they are independent of the aspect ratio. To compare the effectiveness of nanoparticles of different sizes for real biomedical applications, size-normalized optical cross-sections or per micron coefficients are calculated. Gold nanorods show per micron absorption and scattering coefficients that are an order of magnitude higher than those for nanoshells and nanospheres. While nanorods with a higher aspect ratio along with a smaller effective radius are the best photoabsorbing nanoparticles, the highest scattering contrast for imaging applications is obtained from nanorods of high aspect ratio with a larger effective radius.

Absorption↗

Rubinstein-Taybi syndrome.

In this review a short overview of pertinent clinical and molecular data of the Rubinstein-Taybi syndrome are provided. A diagnostic decision algorithm, and major issues that should be considered in the management of patients are discussed. Suggestions for further research are given.

CREB-Binding Protein↗

Automated detection of wedge-shaped defects in polarimetric images of the retinal nerve fibre layer.

PURPOSE: Automated glaucoma detection in images obtained by scanning laser polarimetry is currently insensitive to local abnormalities, impairing its performance. The purpose of this investigation was to test and validate a recently proposed algorithm for detecting wedge-shaped defects. METHODS: In all, 31 eyes of healthy subjects and 37 eyes of glaucoma patients were imaged with a GDx. Each image was classified by two experts in one of four classes, depending on how clear any wedge could be identified. The detection algorithm itself aimed at detecting and combining the edges of the wedge. The performance of both the experts and the algorithm were evaluated. RESULTS: The interobserver correlation, expressed as ICC(3,1), was 0.77. For the clearest cases, the algorithm yielded a sensitivity of 80% at a specificity of 93%, with an area under the ROC of 0.95. Including less obvious cases by the experts resulted in a sensitivity of 55% at a specificity of 95%, with an area under the ROC of 0.89. CONCLUSIONS: It is possible to automatically detect many wedge-shaped defects at a fairly low rate of false-positives. Any detected wedge defect is presented in a user-friendly way, which may assist the clinician in making a diagnosis.

Algorithms↗

Do vascular surgery patients need a cardiology work-up? A review of pre-operative cardiac clearance guidelines in vascular surgery.

OBJECTIVES: to outline the appropriate pre-operative cardiac work-up for patients who are scheduled for major peripheral vascular surgery. DESIGN: review of the literature. MATERIALS AND METHODS: a review of the literature focusing on studies that have correlated the pre-operative cardiac work-up patients receive to the cardiac morbidity and mortality following vascular surgery. Only studies with level A evidence were included. RESULTS: peri-operative beta blockade has been shown to decrease cardiac complications after vascular surgery in all risk groups. Non-invasive cardiac testing is only necessary for patients in the intermediate/high risk group. Coronary revascularization should only be considered after a positive non-invasive cardiac test. CONCLUSIONS: patients must be risk stratified pre-operatively based on history and physical examination. Low risk patients should receive peri-operative beta blockade only with no further non-invasive testing. On the other hand, intermediate and high risk patients should undergo non-invasive cardiac testing before going to the operating room.

Adrenergic beta-Antagonists↗