A review of compression methods for medical images in PACS

As an introduction to Section C2 (medical imaging) of track C (Images and PACS) of MIE '97, an appropriate and timely topic concerns the coding for the transmission of medical images in PACS. Speed limitations of existing networks along with the explosive growth of image modalities with extremely high volume outputs have combined to make the issue of medical image coding one of the key considerations in the design of future PACS systems. Both lossless and lossy compression schemes are reviewed and compared, and the compression demands are presented of the main digital medical image modalities.     

一种基于灰色系统理论的分布式信任模型

在开放多Agent系统中,引入信任模型有利于选择出保证收益的交互伙伴,发挥灰色系统理论在解决贫信息、不确定性问题中的优势,构建了GTrust信任模型,设计了对证人推荐行为进行评定的方法,用灰色定权聚类的方法判定对证人的信任,克服证人提供的不准确信息带来的负面影响,指导评价者Agent合理使用来自证人的推荐.仿真实验表明,GTrust忽略了对不准确信息来源的甄别,而是只以实际交互结果为依据的策略,针对复杂的环境是一种切合实际的选择,无论在静态环境中,还是动态环境中,均可以取得好的效果.     

3D visualization library for multimodal medical images

To clarify the control mechanism of ventilation during posture change, ventilatory parameters, PETCO2, and ventilatory response to CO2 were examined in 11 healthy male subjects at supine (0 degrees) and 75 degrees head-up tilt positions. Minute expiratory ventilation (V.E), tidal volume (VT), respiratory frequency (f), end-tidal and transcutaneous PCO2 and CO2 output (V.CO2), and ventilatory response to CO2 were measured during a steady state condition. V.E (V.A) and VT increased significantly at 75 degrees tilt with significant decrease in PETCO2 from 40.1 mmHg (0 degrees) to about 36.1 mmHg (75 degrees). Transcutaneous PCO2 also decreased during tilt, by 3.3 mmHg. Physiological dead space (VD/VT) and V.CO2, however, remained unchanged, and ventilatory equivalent (V.E/V.CO2, V.A/V.CO2) increased significantly. The CO2-ventilatory response curve shifted upward (or leftward) without significant change in the response slope. At 75 degrees tilt, EMG activity of gastro-cnemius muscle increased. These findings suggested that PETCO2 decreased because of increased V.E (V.A) with a leftward shift of CO2-ventilatory response curve. Various signals such as afferents from lower extremities might have net stimulatory effects on a CO2-ventilation control system to reset the controlled level of PETCO2 to a lower range, but without significant change in CO2-ventilatory response during upright position.     

Reinventing the academic medical center

In this study we have demonstrated that the native rabbit sperm protein, Sp17, is a 22- to 24-kDa triplet of proteins in washed ejaculated rabbit spermatozoa and is unaffected by capacitation. However, during the acrosome reaction, Sp17 is processed from a 22- to 24-kDa triplet of proteins to a triplet of proteins at 17-19 kDa by the removal of amino acids from the C-terminal. Recombinant rabbit Sp17 (rRSp17) can also be proteolytically processed by acrosome-reacted spermatozoa in a similar manner. Protease inhibitors prevent the proteolytic processing of Sp17. Both forms of native Sp17 remain associated with acrosome-reacted spermatozoa and are solubilized by ionic detergents. Previously, sequence analysis of Sp17 revealed that Sp17 amino acids 108-137 were 52% identical to the calmodulin binding domain of neuromodulin and contained an IQ motif found in other calmodulin binding proteins. In this study, a truncated recombinant Sp17, rRSp17CB, which lacks amino acids 118-146, including the potential calmodulin binding site, was made. Recombinant rabbit Sp17, but not rRSp17CB, binds to calmodulin in the presence of Ca2+ or EDTA, under reduced or nonreduced conditions in biotinylated-calmodulin overlay assays. In DSS crosslinker experiments, calmodulin bound to rRSp17 in a 1:1 ratio but not to rRSp17CB. Additionally, biotinylated rRSp17 interacts with native sperm calmodulin. We propose that the processing of native Sp17, by removing a C-terminal fragment during the acrosome reaction, might be a mechanism to regulate the calmodulin binding activity of Sp17 and provide calmodulin at specific sites after the acrosome reaction.     

Enterococcal bacteremia in a medical center

BACKGROUND: The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed. METHODS: There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed. RESULTS: One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself. CONCLUSIONS: Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.     

A 3D deformable surface model for segmentation of objects from volumetric data in medical images

Type A Clostridium botulinum, the causative agent of the food poisoning botulism disease, secretes botulinum neurotoxins along with seven neurotoxin associated proteins (NAPs). The function of NAPs has been shown to protect the neurotoxin from acidity, heat, and proteolytic attack in the environmental and gastrointestinal tract during the toxicogenesis of the botulism disease. One of the NAPs, purified from type A botulinum neurotoxin complex, showed hemagglutination activity. A direct interaction has been demonstrated between purified NAP, a 33-kDa hemagglutinin or Hn-33, and the neurotoxin by using Sephadex G-200 column chromatography. Furthermore, Hn-33 has complete resistance against proteolytic attack at pH 2.0 as well as at normal physiological pH. We have investigated digestion of the neurotoxin in the presence and absence of Hn-33. The neurotoxin alone has been found to be more susceptible to the enzymatic digestion than neurotoxin with Hn-33. The presence of Hn-33 changes the proteolytic fragmentation pattern of the neurotoxin. It seems that Hn-33 protects the neurotoxin from proteolysis either by structural modification of the neurotoxin or by blocking the protease accessible sites of the neurotoxin.     

Breast conservation surgery for breast cancer at a regional medical center

Physical exercise is recommended for the prevention and treatment of osteoporosis. However, its exact role and effectiveness in adulthood is unclear. While vigorous exercise of long duration enhances bone density, few adult individuals comply with such training programs. The present study evaluates the influence of nonphysiological mechanical stimulation, in the form of low intensity vibration (frequency: 50 Hz, acceleration: 2 g, 30 min/day for 5 days/week), on the prevention of bone loss in an animal model of postmenopausal osteoporosis. In the ovariectomised groups of rats a statistically significant (p < 0.05) decrease of bone density (femur and tibia) was recorded at 5 weeks postovariectomy. This effect was maintained for the 12 week duration of the study. Vibration prevented early bone loss after ovariectomy. Vibrated ovariectomised rats showed statistically significantly higher (p < 0.05) BMD values compared to those of their ovariectomised controls at 5 weeks. Vibration did not influence the bone density of the SHAM-operated rats. Although vibration increased ultimate strength (fracture load of the rat femur) in the ovariectomised rats, this finding was not statistically significant. Our data indicate that this method of safe and easily applicable vibration, in the form of a vibrating platform, is effective in preventing early postovariectomy bone loss in an animal model.     

A Fourier based algorithm for tracking SPAMM tags in gated magnetic resonance cardiac images

A method is described for automatically tracking spatial modulation of magnetization tag lines on gated cardiac images. The method differs from previously reported methods in that it uses Fourier based spatial frequency and phase information to separately track horizontal and vertical tag lines. Use of global information from the frequency spectrum of an entire set of tag lines was hypothesized to result in a robust algorithm with decreased sensitivity to noise. The method was validated in several ways: first, actual tagged cardiac images at end diastole were deformed known amounts, and the algorithm's predictions compared to the known deformations. Second, tagged, gated images of the thigh muscle (assumed to have similar signal to noise characteristics as cardiac images, but to not deform with time) were created. Again the algorithmic predictions could be compared to the known (zero magnitude) deformations and to thigh images which had been artificially deformed. Finally, actual cardiac tagged images were acquired, and comparisons made between manual, visual, determinations of tag line locations, and those predicted by the algorithm. At 0.5 T, the mean bias of the method was < 0.34 mm even at large deformations and at late (noisy) times. The standard deviation of the method, estimated from the tagged thigh images, was < 0.7 mm even at late times. The method may be expected to have even lower error at higher field strengths.     

Partnership between a Veterans Affairs medical center and a podiatric medical college

The health care academic delivery system is dramatically changing in today's economy. In order to survive, the delivery system must decrease its costs and increase productivity. Integration of academic affiliates and community health care facilities has produced a more efficient health care system and improved medical education. The formation and methodology of the mutual benefits and responsibilities between a health care system and a college of podiatric medicine are examined in detail. Developing unique sharing partnerships can mutually improve medical student experiences, reduce financial burdens, combine joint research projects, and ultimately improve patient care.     

Edge detection in medical images using a genetic algorithm

An algorithm is developed that detects well-localized, unfragmented, thin edges in medical images based on optimization of edge configurations using a genetic algorithm (GA). Several enhancements were added to improve the performance of the algorithm over a traditional GA. The edge map is split into connected subregions to reduce the solution space and simplify the problem. The edge-map is then optimized in parallel using incorporated genetic operators that perform transforms on edge structures. Adaptation is used to control operator probabilities based on their participation. The GA was compared to the simulated annealing (SA) approach using ideal and actual medical images from different modalities including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound. Quantitative comparisons were provided based on the Pratt figure of merit and on the cost-function minimization. The detected edges were thin, continuous, and well localized. Most of the basic edge features were detected. Results for different medical image modalities are promising and encourage further investigation to improve the accuracy and experiment with different cost functions and genetic operators.     

Dynamics and administrative behavior of a multi-disciplinary medical center

Fifteen-second exposure of rabbit kidneys to 2 MHz focused ultrasound with approximately 900 w/sq cm acoustic power consistently produced localized parenchymal destruction. Evolution of the lesions was followed histologically over a one-year period. The lesions were sharply delineated from outlying renal tissue and had a concentric multizonal structure. Resorption of the damaged tissue with scarring was completed in 6 to 12 months following intermediate phases characterized by cellular infiltration. The lesions are compared to other models of renal injury, particularly with respect to cellular infiltration. A combination of mechanical, thermal, and ischemic factors seem to be responsible for development of ultrasonic lesions. The sharply circumscribed nature and ultimate complete scarring of the lesions suggest the feasibility of ultrasound in achieving selective complete destruction of renal parenchyma.     

Pursuing clinical and operational improvement in an academic medical center

BACKGROUND: An academic medical center in an increasingly competitive market, the University of California-Davis Medical Center in Sacramento started working with a consulting firm in 1995 to reduce overall operational costs and costs for the clinical processes involved in treating patients with specific conditions. ESTABLISHING THE TEAMS: Twelve operational efficiency (OE) teams and five clinical teams were commissioned, with a combined total of nearly one-half of the target cost reduction. The second wave of six clinical teams was simultaneously initiated in late spring 1996. THE IMPROVEMENT METHOD: The quality improvement process for clinical improvement teams included the review and inquiry method, which enables many pilot experiments to be conducted in parallel by work groups and coordinated by the main task team. RESULTS AND CASE STUDIES: Within six weeks of launching, the 12 OE teams achieved their goals and identified savings opportunities of more than $27 million. One OE team, medical records, had set a goal of $514,000 in cost reduction for a three-year period and achieved the first-year goal of $190,000. For a clinical team on interventional cardiology, the clinical benchmark data revealed that the cost per case of providing cardiac catheterization was greater than for all three benchmark groups. These patients, including 270 patients per year, showed a possible savings through process improvement of nearly $1.4 million. From January 1996 through March 1997, the rate of occurrence of complications decreased from 5.5% to 3%. EPILOGUE: Physicians gradually accepted more responsibility and accountability for controlling and reducing costs, while maintaining their traditional role as advocates for improved patient care.     

Cooperation. Relationship between district and referred medical center services

Theoretic basis of cooperation relationship between organizations are reviewed. Second one, these theoretic concepts are applied to the relationship between district and reference medical Centers and Services, focusing on main problems of that relationship. The relevant role of communication and its new technologies are also discussed.