Preliminary reference levels in interventional cardiology

This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gyxcm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gyxcm2 and 75 Gyxcm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain "tolerances" from the proposed levels taking into account the complexity of the procedure and the patient's size.     

Methylmalonic aciduria in pregnancy: a case report

Methylmalonic aciduria is a rare metabolic disorder of amino acid metabolism that is characterized by accumulation of large amounts of methylmalonic acid in the blood and urine. To our knowledge this is the first case report of a patient with methylmalonic aciduria who carried a pregnancy to term; the outcome was favorable despite high levels of methylmalonic acid in the serum and urine.     

The effects of age and gender on the single dose pharmacokinetics of avitriptan administered to healthy volunteers

The effects of age and gender on the single dose pharmacokinetics of avitriptan and its three metabolites were assessed in 15 young men, 15 young women, 15 elderly men and 15 elderly women. Avitriptan was administered as a 150-mg capsule after a 10-hour fast and serial plasma and urine samples were collected up to 36 hours after the dose. Plasma samples were analyzed for avitriptan and its metabolites, N-desmethyl avitriptan (ND048), O-desmethyl avitriptan (OD048), and methoxypyrimidinyl piperazine (MPP). Urine samples were analyzed for only avitriptan and MPP. Avitriptan was well tolerated in all four groups. The drug was rapidly absorbed with a median time to maximum plasma concentration (tmax) between 0.5 and 1.5 hours. No significant gender-related differences were found in the maximum plasma concentration (Cmax) and area under the concentration-time curve extrapolated to infinity (AUC0-infinity) of avitriptan. Renal clearance of avitriptan was significantly smaller in young women compared with young men, but this is clinically not relevant because only 2% to 3% of the total dose is excreted unchanged. Compared with the young volunteers, mean Cmax was approximately 50% higher in the elderly but there was no difference in the AUC0-infinity between the 2 age groups. Plasma concentrations of ND048, OD048, and MPP were each 50 to 100 fold lower than those of avitriptan. Hence some age- and gender-related differences found in the pharmacokinetics of avitriptan metabolites are probably not relevant in the assessment of overall safety and efficacy of avitriptan. Based on the pharmacokinetics and tolerability, no age or gender-related dose adjustment is necessary for avitriptan.     

Optimal scan for time-varying tomography. I. Theoretical analysisand fundamental limitations

The authors consider the tomographic reconstruction of objects with spatially localized temporal variation, such as a thorax cross section with a beating heart. The conventional scan format, in which projections are taken progressively around the object, requires high and sometimes infeasible scan rates to avoid motion artifacts in the reconstructed images. The authors formulate the problem of data acquisition as a time-sequential sampling problem of spatially and temporally bandlimited signals, where only one view can be taken at a time, but the time interval between successive views is independent of their angular separation. These conditions, naturally satisfied in magnetic resonance imaging and in X-ray CT using the Imatron system, can also be satisfied by a conventional system with a continuously and rapidly spinning gantry with source pulsing. Theoretical analysis, which includes tight performance bounds, shows that by using an optimally scrambled angular sampling order, the required scan rate can be lowered as much as four times, while preserving image quality. The analysis also greatly simplifies the design of the optimum scan pattern by reducing it to a constrained geometric packing problem.     

Image-based characterization of cement pore structure using wood’s metal intrusion

Mercury intrusion porosimetry is a widely used technique for characterization of the pore size distribution of cement-based materials. However, the technique has several limitations, among which are the ink bottle effect and a cylindrical pore geometry assumption that lead to inaccurate pore size distribution curves. By substituting Wood’s metal for mercury as the intruding liquid, scanning electron microscopy and imaging techniques can be applied to the sample after intrusion. The molten Wood’s metal solidifies within the pore structure of the sample, which allows it to be sectioned and observed in the scanning electron microscopy. From here, the sample can be analyzed both qualitatively, by observing the changes in the appearance of the sample as the intrusion process progresses, and quantitatively, by applying image analysis techniques. This study provides insight for better interpretation of mercury intrusion porosimetry results and the possibility for quantitative characterization of the spatial geometry of pores in cement-based materials.     

Dynamic systems modelling using genetic programming

In this contribution genetic programming (GP) is used to evolve dynamic process models. An innovative feature of the GP algorithm is its ability to automatically discover the appropriate time history of model terms required to build an accurate model. Two case studies are used to compare the performance of the GP algorithm with that of filter-based neural networks (FBNNs). Although the models generated using GP have comparable prediction performance to the FBNN models, a disadvantage is that they required greater computational effort to develop. However, we show that a major benefit of the GP approach is that additional model performance criteria can be included during the model development process. The parallel nature of GP means that it can evolve a set of candidate solutions with varying levels of performance in each objective. Although any combination of model performance criteria could be used as objectives within a multi-objective GP (MOGP) framework, the correlation tests outlined by Billings and Voon (Int. J. Control 44 (1986) 235) were used in this work.     

A Vector-based Representation for Image Warping

A method for image analysis, representation and re-synthesis is introduced. Unlike other schemes it is not pixel based but rather represents a picture as vector data, from which an altered version of the original image can be rendered. Representing an image as vector data allows performing operations such as zooming, retouching or colourising, avoiding common problems associated with pixel image manipulation. This paper brings together methods from the areas of computer vision, image compositing and image based rendering to prove that this type of image representation is a step towards accurate and efficient image manipulation.     

Enhanced detection of proximal right coronary artery stenosis with the additional analysis of right ventricular thallium-201 uptake in stress scintigrams

The value of right ventricular thallium-201 analysis in detecting proximal right coronary artery stenosis in exercise myocardial scintigraphy was analyzed in 52 patients, 27 with and 25 without proximal right coronary artery stenosis. For the detection of proximal right coronary artery stenosis, the sensitivity and specificity of thallium scintigraphic analysis were 59 and 88% for a right ventricular abnormality, 67 and 68% for a left ventricular inferior wall abnormality, and 93 and 56% for an abnormality of either. When both right and left ventricular thallium images were abnormal, all 9 patients had proximal right coronary artery stenoses, and when both were normal, 26 of 28 patients had a normal proximal right coronary artery. The sensitivity and specificity of blood pool scintigraphic variables during exercise (right ventricular ejection fraction and left ventricular inferior wall motion) were not significantly different for detection of proximal right coronary artery stenosis. Thus, the additional analysis of the right ventricle on thallium-201 stress scintigrams can improve the detection of proximal right coronary artery stenosis. When both right ventricular and left ventricular thallium scintigrams are abnormal (or normal), the ability to predict the presence (or absence) of proximal right coronary artery stenosis is very high.