Focal pachypolymicrogyria in three siblings

Low-power bright field photomicrographs often suffer from insufficient sharpness, uneven illumination, and colour hues. Using a film scanner, commercially available and designed for digitizing 35-mm transparencies, we directly scanned microscopic slides that carried dye-labelled and stained sections. The digital images covered a field of up to 24 x 36 mm and revealed excellent sharpness, absolutely even illumination and superior colour reproduction as compared to conventional photomicrographs taken with binoculars, macro lenses, or microscopes. As the method requires neither specialized instrumentation nor expert knowledge of photomicrographic techniques, it reduces costs and saves time. The high-quality digital survey micrographs can easily be used for image processing, image analysis and morphometry. Thus, this new method is valuable not only for pathology, embryology, histochemistry, and the neurosciences, but also for the exchange of low-power micrographs via the internet and for computer media that are increasingly used in medical education.     

Use of computed radiography in the study of an historic painting

The authors demonstrate the use of radiography in the investigation of an historic painting and describe the potential benefits of computed radiography compared with conventional screen-film radiography. The subject for the comparison was a 16 x 19-foot oil-on-canvas painting, Scipio Africanus Freeing Massiva, by Giovanni Battista Tiepolo. Radiographs of the painting were obtained by using a portable, industrial radiographic unit and both conventional screen-film and photostimulable phosphor plate cassettes. For this investigation, computed radiography had a number of advantages over screen-film radiography, largely due to its wider dynamic range and its capabilities for enhancing the digital images with image processing tools such as magnification, edge enhancement, colorization, and airbrushing. The ability to electronically combine images from the large painting into a single composite image file was extremely valuable, as this technique was much less cumbersome and resulted in much higher quality composite images than could be achieved with conventional radiography. An additional advantage of computed radiography includes the capability to easily archive and transmit these images in a digital format for subsequent review.     

Contrast mapping and evaluation for electronic X-ray images on CRT display monitor

Simple chest X rays on film are the most common type of image in medical diagnosis. However, amongst the various types of medical X-ray images, they require the highest level of display quality due to the fact that the body structures they capture on film have varying degrees of permeability to X rays. Conventional high-definition digital display technology has not always been able to match the quality of such film images. This has been a major impediment against progress toward the complete digitization of simple chest X rays. The intent of this paper is to examine that, when applied to medical diagnosis of chest X rays, super-high-definition (SHD) images (digital images with resolution exceeding that of HDTV) are capable of producing a level of quality of diagnostic accuracy on a par with conventional film images. We will start out by seeking out the overall transmission characteristics of a system that uses digital radiography and a film digitizer to digitize images. We will then derive gray-scale transform characteristics based on the luminance linear method for approximating, as closely as possible on a CRT, film images on a light box that have wide dynamic range and high luminance. Finally, we will present the results of image evaluation experiments using high-definition CRT monitors. These results indicate that conventional film images and those on super-high-definition CRT monitors have nearly the same quality. They will also show that the contrast mapping selected by radiologists and theoretical luminance linear characteristics were almost the same except in low-luminance regions. We will also discuss radiologists' comments on CRT monitors after they participated in the evaluation experiment.     

Use of a single stent for double ureter support in transplantation

Economical applications of teleradiology and telemedicine are limited to the existing telephone network infrastructure, which greatly limits the speed of digital information transfer. Telephone lines are inherently slow, requiring image transmission times to be unacceptably long for large, complex, or numerous images. JPEG (Joint Photographic Experts Group) image transmission has been shown to compress images to 10% of the original file size without a noticeable change in the quality of the image. This study was carried out to assess the quality of medical diagnostic images after JPEG compression and decompression. X-rays, computed tomography scans, and ultrasound samples were compressed and decompressed using JPEG. The compressed JPEG images were indistinguishable from the original images. The JPEG images were approximately 10% of the original file size. This would reduce image transmission times by 90% (eg, an unacceptable time of 50 minutes would be reduced to an acceptable time of 5 minutes). JPEG can be used to optimize teleradiology and telemedicine.     

Photomicrography through the operating microscope

In summary, the production of high quality photomicrographs through the operating microscope requires considerable attention to detail. The author describes all the details which he has found essential for obtaining good photomicrographs for documentation and/or publication.     

Storage phosphor direct magnification mammography in comparison with conventional screen-film mammography--a phantom study

Contact mammography with current photostimulable storage phosphors is hampered by its low spatial resolution. Detail visualization can be improved by geometric magnification radiography which enlarges small details to exceed inherent image noise. This study compares storage phosphor mammography using a dedicated direct magnification system with state-of-the-art conventional screen-film mammography. Storage phosphor direct magnification survey views (1.7x) and spot views (4x) were obtained with a prototype mammography unit providing focal spot sizes of 120-40 microns. Conventional technique screen-film survey views (1.1x) and spot views (1.8x) served as comparison. A contrast detail study and a receiver operating characteristic (ROC) analysis using an anthropomorphic breast phantom with superimposed microcalcifications was performed. Contrast detail resolution in the digital and conventional survey views were equivalent. For the spot views, contrast detail resolution was significantly higher with the digital technique (p < 0.001). ROC analysis of 400 observations demonstrated a significantly higher performance (p < 0.001) with digital images versus conventional screen-film mammograms. The area under the ROC curve (Az) in the digital survey views was 0.76 +/- 0.07 versus 0.59 +/- 0.02 in the conventional technique. In digital spot views, Az was 0.82 +/- 0.07 as compared with 0.66 +/- 0.04 in the conventional spot views. These results suggest that storage phosphor digital mammography in conjunction with direct geometric magnification technique may be superior to conventional screen-film mammography in the detection of microcalcifications.     

Clinical use of on-line portal imaging for daily patient treatment verification

PURPOSE: To determine the ease of use by clinical staff and reliability of an electronic portal imaging system and evaluate the potential to utilize on-line imaging to assess accuracy of daily patient treatment positioning in radiation therapy. METHODS AND MATERIALS: A computer controlled fluorescent screen-mirror imaging system was used to acquire on-line portal images. A physician panel assessed on-line image quality relative to standard portal film. Clinical use of the imager was implemented through a protocol where images were obtained during the first six monitor units of external beam. The images were visually compared to a reference portal and patient setup was adjusted for errors exceeding 5 mm. Subsequent off-line analysis was utilized to give insight into the magnitude of clinical setup error in the visually accepted images. RESULTS: Physician evaluation of on-line image quality with an initial 211 images found that 70% were comparable or superior to standard film portal images. Eighty percent of treatment fields fit completely within the on-line imaging area. Eight percent of on-line images were rejected due to poor image quality. Twelve percent of the daily treatment setups imaged required adjustment overall, but specific field types predictably required more frequent adjustment (pelvic and mantle fields). Off-line analysis of accepted images demonstrates that 18% of the final images had setup errors exceeding 5 mm. CONCLUSION: On-line imaging facilitated daily portal alignment and verification. Ease of use, almost instantaneous viewing and consistent ability to identify and locate anatomical landmarks imply the potential for on-line imaging to replace film based approaches. Retrospective analysis of daily images reveals that visual assessment of setup is not sufficient for eliminating localization errors. Further improvement is required with respect to detecting localization error and fully encompassing larger field sizes.     

Primary diagnosis of osseous carpal area injuries--a comparison of conventional examination methods with digital luminescence radiography

Despite recent progress in improving diagnostic methods carpal bone lesions are still a major problem of primary diagnosis. Diagnostic imaging with digital luminescence radiography (DLR) allows the reliable presentation of traumatologically relevant carpal structures. In this study on 39 patients with suspected carpal bone injuries individually worked over DLR images were superior to "standard" DLR and conventional X-ray film/screen images. Though "standard" DLR images were inferior to film images edge-enhanced DLR images showed definite advantages in the demonstration of soft tissues. Fractures undetectable in conventional X-rays could not be recognized by digital imaging. In our experience bone-scanning remains the most reliable method for definite exclusion of carpal bone fractures after standard and digital X-ray methods are exhausted.     

An evaluation of the signal and noise characteristics of four CCD-based film digitizers

Film digitizers are common devices in radiology departments involved with picture archive and communication systems (PACS) and teleradiology. In this paper, we studied the performance of film digitizers based on charge-coupled device detectors (CCD digitizers), and compared this with the performance of a laser digitizer (the de facto standard). Our focus was on the assessment of signal, noise and useful optical density range performance. A function (L* delta D) derived from the Rose model was used to evaluate these parameters in absolute terms, based their predicted ability to detect objects of specific size and optical density difference with respect to background. We studied CCD digitizers from four different vendors and found that none was able to reliably operate up to the maximum density of 3.0 required to digitize plain radiographs, while the laser digitizer was capable of this task. Our analysis also indicated that two of the four CCD digitizers were adequate for digitizing laser-printed cross-sectional images in certain cases. Finally, our analysis indicated that digitization of SMPTE pattern films along with visual assessment of the 5% and 95% contrast patches was not sufficient for determining the utility of film digitizers for clinical tasks. Computation of the L* delta D function provides a useful means of assessing the performance of film digitizers (e.g., for acceptance testing and quality control), and this technique may be adaptable for evaluation of other digital imaging modalities.     

On the dynamic range of different X-ray photon detectors in intra-oral radiography. A comparison of image quality in film, charge-coupled device and storage phosphor systems

OBJECTIVE: To compare film for intra-oral radiography with two charge-coupled device (CCD) and one storage phosphor system for digital imaging in respect of subjective image quality, detectability of small mass differences and appearance of burn-out effects and blooming phenomena at various exposure times. METHODS: Dried mandibles with teeth from different areas were radiographed at exposures covering a relative range from 1 to 100. Image quality was subjectively evaluated after image processing, when applicable, using a visual grading scale from 0 to 10. The number of visible holes in an aluminium block was used to measure the detectability of small mass differences. Burn-out effects and blooming were evaluated by measuring widths of roots and of aluminium and plastic cylinders. RESULTS: Radiographs with the storage phosphor system achieved image quality scores similar to those of film but over a larger exposure range, while CCD images were rated lower and over a smaller range. All holes in the aluminium block were only detected with the storage phosphor system. While the widths of roots were strongly affected by sensor saturation in CCD images and by burn-out in film images, smaller effects were seen with the storage phosphor system. Similar results were obtained with aluminium and plastic cylinders. CONCLUSIONS: Higher image quality was achieved over a much wider exposure range with the storage phosphor system than with either film or the CCD systems.     

Improvement of detectability of microcalcifications by magnification digital mammography

Our aim in this study was to evaluate the potential utility of magnification mammography with a CR system by investigating the basic imaging parameters and detectability of microcalcifications in comparison with those of conventional screen-film systems. The basic imaging parameters were evaluated by measuring scatter fraction, modulation transfer function (MTF), Wiener spectrum, and incident dose for the various magnification factors. The detection of simulated microcalcifications in radiographs of a mammographic phantom and breast specimens were evaluated subjectively and quantitatively for screen-film and CR techniques with various magnification factors. The scatter fraction of digital magnification mammography decreased with increasing magnification factor. MTF of magnification digital mammography improved with increasing magnification factor. The detectability of microcalcifications with the CR system was significantly improved by magnification technique. From the above results, it is expected that the use of magnification mammography with a CR system will improve the detectability of microcalcification.     

Image compression in digital mammography: effects on computerized detection of subtle microcalcifications

Our previous receiver operating characteristic (ROC) study indicated that the detection accuracy of microcalcifications by radiologists is significantly reduced if mammograms are digitized at 0.1 mm x 0.1 mm. Our recent study also showed that detection accuracy by computer decreases as the pixel size increases from 0.035 mm x 0.035 mm. It is evident that very large matrix sizes have to be used for digitizing mammograms in order to preserve the information in the image. Efficient compression techniques will be needed to facilitate communication and archiving of digital mammograms. In this study, we evaluated two compression techniques: full frame discrete cosine transform (DCT) with entropy coding and Laplacian pyramid hierarchical coding (LPHC). The dependence of their efficiency on the compression parameters was investigated. The techniques were compared in terms of the trade-off between the bit rate and the detection accuracy of subtle microcalcifications by an automated detection algorithm. The mean-square errors in the reconstructed images were determined and the visual quality of the error images was examined. It was found that with the LPHC method, the highest compression ratio achieved without a significant degradation in the detectability was 3.6:1. The full frame DCT method with entropy coding provided a higher compression efficiency of 9.6:1 at comparable detection accuracy. The mean-square errors did not correlate with the detection accuracy of the microcalcifications. This study demonstrated the importance of determining the quality of the decompressed images by the specific requirements of the task for which the decompressed images are to be used. Further investigation is needed for selection of optimal compression technique for digital mammograms.     

Wavelet Analysis of Soil Mass Images for Particle Size Determination

A method for determination of average grain size from images of fairly uniform particle size soil masses is presented. The procedure utilizes two-dimensional wavelet decomposition of gray scale images. Earlier attempts to quantify grain sizes based on the statistics of co-occurrence matrices suffered from dependence on the illumination intensity and soil color. By normalizing the energy distribution from wavelet decomposition the effects of these previously problematic factors have been eliminated. A general relationship between the center of area beneath the normalized energy distribution and the perceived particle size in pixels per diameter (PPD) is established. A sample problem demonstrates that the proposed wavelet decomposition method provides accurate grain sizes for a wide range of magnification levels as long as the resulting PPD is between approximately 1 and 50.     

Proinflammatory cytokines regulate antigen-independent T-cell activation by two separate calcium-signaling pathways in multiple sclerosis patients

OBJECTIVE: The study examined the prevalence of low birth weight among biracial infants of black and white parents, by region of the United States. METHODS: Using the national linked live birth-death infant file for 1991, low birth weight (<2,500 g) was examined among 50,980 biracial singleton infants according to parental race (black mother-white father vs. white mother-black father). RESULTS: Nationally, the rate of low birth weight was 31% higher in the black mother-white father group (8.4%) than in the white mother-black father group (6.4%). The difference was smaller in the Northeast, reflecting a high rate (9.8%) for biracial infants of Puerto-Rican white mothers. The difference in the West was larger (75%), due to both a high rate in the black mother-white father group (9.1%) and a low rate for the white mother-black father group (5.2%), and persisted after controlling for parental education and a variety of maternal risk factors. CONCLUSIONS: Further studies are needed to identify the maternal factors involved in the regional differences in the prevalence of low birth weight among biracial infants.     

Digital images in the diagnosis of wound healing problems

The use of digital wound images could allow remote consultation among patients, physicians, or other care-givers located at quite distant sites by means of the Internet. To evaluate the efficacy and validity of digital images for the evaluation of wounds, the ability and reliability of surgeons to diagnose and make treatment suggestions using digital images of several types of wounds were compared. Twenty-four wound images on 35-mm slides were selected for use in this study. Each slide image was digitized at 24-bit color with a resolution of 640 pixels horizontal by 425 pixels vertical and stored as a JPEG file. These images were then presented as a slide show on a video monitor, with resolution set at 640 x 480. Six physicians examined the images, first in digital format and later in the original slide form. Each observer assessed each wound and possible treatment options by filling out a questionnaire using a series of yes/no questions. For all observers, there was an 87 percent agreement between digital and slide images (p = 0.004). The agreement between the digital and slide images was measured for each individual observer using a kappa coefficient. The agreement level corresponded to the experience of the observer, with the kappa values ranging from greater than 0.8 (almost perfect agreement) for the attending plastic surgeon to just greater than 0.5 (moderate agreement) for the intern. With this study, the feasibility of distance wound consultation using digital images of a quality consistent with consumer-grade digital photography was demonstrated.     

Breast carcinoma tumor characteristics in black and white women

BACKGROUND: A significant disparity in mortality rates exists between black and white patients with breast carcinoma. This study was designed to compare breast carcinoma tumor characteristics by race and to examine the possible reasons for these differences. METHODS: Female patients with an initial diagnosis of breast carcinoma between January 1, 1985 and December 31, 1993 were selected from the Yale-New Haven Hospital Tumor Registry for this retrospective cohort study. All black patients were eligible and white patients were selected randomly and matched to each black patient by year of diagnosis. Data were gathered from multiple sources including the hospital, the Connecticut Tumor Registry, and the U. S. Census. All pathology specimens were reviewed at Yale-New Haven Hospital. RESULTS: The final cohort had 100 black and 300 white patients. The black patients tended to be younger than white patients at the time of diagnosis (mean age 55 years vs. 60 years; P = 0.001). A significant racial difference was noted in eight tumor characteristics: stage, size of the tumor, lymph node status, presence of necrosis, vascular/lymphatic invasion, ductal carcinoma in situ, perineural invasion, and progesterone receptor status. Although income, medical insurance coverage, and method of tumor detection explained some pathology differences, black patients still were more likely to have necrosis and a larger tumor size, even after adjustment. CONCLUSIONS: Black patients with breast carcinoma tend to be diagnosed at a younger age and in a few important respects have different tumor characteristics compared with white patients, even after controlling for income, medical insurance coverage, and method of tumor detection after screening mammography. These differences may have etiologic and clinical implications.     

Magnification renal scintigraphy in the differential diagnosis of septa of Bertin

Eight consecutive patients, referred because intravenous urography (IVP) raised the question of hypertrophied septum of Bertin versus a pathologic mass, were examined using 99mTc labeled radiopharmaceuticals with magnification renal scintigraphy. The areas of concern showed a spectrum of activity, from normal to markedly increased, as compared to surrounding tissue. The activity correlated with the size of the mass effect on IVP. Increased resolution provided by pinhole magnification was important in evaluating these patients. We feel that magnification renal scintigraphy is valuable in the evaluation of intrarenal masses.     

Web-based digital radiology teaching file: facilitating case input at time of interpretation

OBJECTIVE: Our goal was to develop a software system that allows easy and rapid input of digital radiology images and text reports, at the time of interpretation, into an easily searchable electronic teaching file database using the Internet and the World-Wide Web protocols, servers, and browsers. CONCLUSION: Using the Internet, the World-Wide Web, and our software system, we can rapidly input digital radiology images and associated text reports into an easily searchable database accessed by privileged users. This inexpensive and simple method for building a digital teaching file database allows cross-platform access for users who have a Web browser.     

Toxicity of Xylocaine to rabbit corneal endothelium

PURPOSE: To assess the toxicity of lidocaine hydrochloride (Xylocaine) to the corneal endothelium. SETTING: Department of Ophthalmology, H?tel-Dieu Hospital, Paris, France. METHODS: Rabbit corneas were excised and the endothelium was exposed to balanced salt solution (BSS), Xylocaine 1%, or Xylocaine 5% (5 corneas/group) for 20 minutes. The endothelium was then stained with trypan blue and alizarin red, and 5 photomicrographs were taken of each cornea at a standard magnification and analyzed with a digital imaging system (Biocom 200). RESULTS: Xylocaine solutions produced changes in endothelial cell morphology, but there was no cell staining with trypan blue. Corneas exposed to Xylocaine 5% had more marked cell alterations. Small areas of cells were lost from all 15 corneas, mainly at the periphery, but the differences among the 3 groups of corneas were not significant. CONCLUSION: Exposure of rabbit corneal endothelium to Xylocaine solutions in vitro was not associated with trypan blue staining of endothelial cells.     

An observer study for direct comparison of clinical efficacy of electronic to film portal images

PURPOSE: To directly compare clinical efficacy of electronic to film portal images. METHODS AND MATERIALS: An observer study was designed to compare clinical efficacy of electronic to film portal images acquired using a liquid matrix ion-chamber electronic portal imaging device and a conventional metal screen/film system. Both images were acquired simultaneously for each treatment port and the electronic portal images were printed on gray-level thermal paper. Four radiation oncologists served as observers and evaluated a total of 44 sets of images for four different treatment sites: lung, pelvis, brain, and head/neck. Each set of images included a simulation image, a double-exposure portal film, and video paper prints of electronic portal images. Eight to nine anatomical landmarks were selected from each treatment site. Each observer was asked to rate each landmark in terms of its clinical visibility and to rate the ease of making the pertinent verification decision in the corresponding electronic and film portal images with the aid of the simulation image. RESULTS: Ratings for the visibility of landmarks and for the verification decision of treatment ports were similar for electronic and film images for most landmarks. However, vertebral bodies and several landmarks in the pelvis such as the acetabulum and public symphysis were more visible in the portal film images than in the electronic portal images. CONCLUSION: The visibility of landmarks in electronic portal images is comparable to that in film portal images. Verification of treatment ports based only on electronic portal images acquired using an electronic portal imaging device is generally achievable.