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At least 127 records · Page 7

Protective Capnothorax During Transthoracic Needle Biopsy

PurposeTransthoracic needle biopsy (TTNB) is an established procedure in the management of pulmonary nodules. The most common complications are directly related to crossing the lung or visceral pleura during the biopsy. In this study, we describe the use of carbon dioxide instead of room air to create a protective “capnothorax” during TTNB.Materials and MethodsFive patients underwent creation of a capnothorax during TTNB. Parameters recorded were location and size of target, distance from pleura, length of procedure, volume of carbon dioxide, periprocedural complications and biopsy result.ResultsInduction of capnothorax was successful in all cases. In two patients, a continuous infusion of carbon dioxide was required to maintain an adequate volume of intrapleural gas. In two patients, the carbon dioxide resolved spontaneously and in the remaining patients it was aspirated at the end of the procedure. All biopsies were diagnostic with no periprocedural or postprocedural complications.ConclusionThis study suggests that protective iatrogenic capnothorax is a safe and effective technique during TTNB. The intrinsic properties and availability of carbon dioxide make it an attractive alternative to room air.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine

Purpose of Review: To summarize the current status of coronary computed tomography angiography (CTA) in the assessment of coronary plaques and discuss the ability of serial coronary CTA to quantitatively measure changes in the plaque burden in response to lipid-lowering therapy. Recent Findings: Recent advances in coronary CTA have allowed identification of high-risk coronary features in acute coronary syndrome and measurement of changes in the coronary plaque burden with good reproducibility. Statin therapy may delay plaque progression and change some plaque features. However, the clinical relevance of quantitative changes in coronary plaques and the optimal methods to reduce the plaque burden remain unclear. Summary: Despite guideline-directed lipid-lowering therapy, adverse events still occur in substantial numbers of patients receiving statins. Coronary CTA is noninvasive and has high diagnostic performance in patients with coronary artery disease, making change in the plaque burden an applicable biomarker for individualized assessment of future risk.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Clinical performance of Rb-82 myocardial perfusion PET and Tc-99m-based SPECT in patients with extreme obesity

Background: We evaluated the performance of stress imaging with technetium-99m-labeled tetrofosmin single-photon emission computed tomography (SPECT) and rubidium-82 positron emission tomography (PET) in patients with extreme obesity, defined as body mass index ≥40 kg/m{sup 2}. Methods: We identified patients with extreme obesity who underwent angiography in our center and either stress SPECT or PET within the previous six months. Cohorts of patients with extreme obesity and a <5% pretest likelihood of CAD who underwent SPECT (N = 25) or PET (N = 25) were also included. Results: In total, 108 patients who underwent SPECT (N = 57) or PET (N = 51) were identified. Scan interpretation was classified as definitely normal or abnormal in 83.3% of PET and 60.5% of SPECT scans, respectively (P < .01). PET demonstrated higher diagnostic accuracy and normalcy rate. PET was found to have higher specificity for the pooled cohort. Similar findings were observed using stenosis cut-offs of ≥50% and ≥70%. Conclusions: In patients with extreme obesity, PET enabled more definitive scan interpretation with less artifact compared to SPECT. PET provided higher diagnostic accuracy and specificity in the detection of obstructive coronary artery disease.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Imaging and Data Acquisition in Clinical Trials for Radiation Therapy

Cancer treatment evolves through oncology clinical trials. Cancer trials are multimodal and complex. Assuring high-quality data are available to answer not only study objectives but also questions not anticipated at study initiation is the role of quality assurance. The National Cancer Institute reorganized its cancer clinical trials program in 2014. The National Clinical Trials Network (NCTN) was formed and within it was established a Diagnostic Imaging and Radiation Therapy Quality Assurance Organization. This organization is Imaging and Radiation Oncology Core, the Imaging and Radiation Oncology Core Group, consisting of 6 quality assurance centers that provide imaging and radiation therapy quality assurance for the NCTN. Sophisticated imaging is used for cancer diagnosis, treatment, and management as well as for image-driven technologies to plan and execute radiation treatment. Integration of imaging and radiation oncology data acquisition, review, management, and archive strategies are essential for trial compliance and future research. Lessons learned from previous trials are and provide evidence to support diagnostic imaging and radiation therapy data acquisition in NCTN trials.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Enhancing Diagnosis through AI-driven Analysis of Reflectance Confocal Microscopy

Reflectance Confocal Microscopy (RCM) is a non-invasive imaging technique used in biomedical research and clinical dermatology. It provides virtual high-resolution images of the skin and superficial tissues, reducing the need for physical biopsies. RCM employs a laser light source to illuminate the tissue, capturing the reflected light to generate detailed images of microscopic structures at various depths. Recent studies explored AI and machine learning, particularly CNNs, for analyzing RCM images. Our study proposes a segmentation strategy based on textural features to identify clinically significant regions, empowering dermatologists in effective image interpretation and boosting diagnostic confidence. This approach promises to advance dermatological diagnosis and treatment.

Yoon, Hong-Jun↗

TH-CD-207B-10: Effect of CT Reconstruction Filter On Measured Hounsfield Values in Lung Nodules

Purpose: Measured Hounsfield numbers in CT are used by radiologists to determine the presence of calcium or fat in lung nodules, either of which suggests a benign diagnosis. However, substantial variations in Hounsfield number may arise due to the use of different reconstruction parameters such as the filter/kernel, leading to measurement inaccuracies. This quality improvement project was developed to demonstrate measurement pitfalls and to identify acceptable conditions for incorporating Hounsfield values as a factor in lung nodule diagnosis. Methods: 12 mm-diameter spheres of polyurethane and urethane foam were placed into an anthropomorphic chest phantom, and 10 mm-diameter tubes with varying iodine concentrations were placed into a 16 cm PMMA cylindrical phantom. Additionally, 11 mm-diameter PMMA and HDPE spheres were placed in a 10 cm PMMA cylindrical phantom. Phantoms were scanned at 120 kVp using a Siemens Biograph mCT and on a Philips iCT and reconstructed using various reconstruction filters. Results: For the Siemens system, both sharp kernels and smooth kernels altered the Hounsfield numbers. Hounsfield numbers varied within a range of 8.9 HU for urethane foam and varied within 58.7 HU for polyurethane. The iodine measurements varied up to 37.9 HU for the lowest concentration. For the Philips system, Hounsfield numbers were relatively consistent but were higher for the “Detail” and “Lung Enhanced” filters, varying by 36.9 HU for PMMA and 15.9 HU for HDPE. Conclusion: Reconstruction filters can change the measured Hounsfield numbers of nodular objects, especially with detail-enhancing (sharpening) filters commonly used in lung imaging. Measured values should only be used for diagnostic decision support with filters that have demonstrated accuracy and consistency. While filter accuracy statements are available from manufacturers, radiologists are likely not aware of the extent of potential variations that can occur in a clinical setting.

60 APPLIED LIFE SCIENCES↗

An unmet clinical need: The history of thrombus imaging

Robust thrombus imaging is an unresolved clinical unmet need dating back to the mid 1970s. While early molecular imaging approaches began with nuclear SPECT imaging, contrast agents for virtually all biomedical imaging modalities have been demonstrated in vivo with unique strengths and common weaknesses. Two primary molecular imaging targets have been pursued for thrombus imaging: platelets and fibrin. Some common issues noted over 40 years ago persist today. Acute thrombus is readily imaged with all probes and modalities, but aged thrombus remains a challenge. Similarly, anti-coagulation continues to interfere with and often negate thrombus imaging efficacy, but heparin is clinically required in patients suspected of pulmonary embolism, deep venous thrombosis or coronary ruptured plaque prior to confirmatory diagnostic studies have been executed and interpreted. These fundamental issues can be overcome, but an innovative departure from the prior approaches will be needed.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Combined Static and Dynamic Computed Tomography Angiography of Peripheral Artery Occlusive Disease: Comparison with Magnetic Resonance Angiography

PurposeTo compare in patients with known peripheral artery occlusive disease (PAOD), image quality of a combined CTA to a combined MRA protocol, including both static and dynamic acquisitions.Materials and MethodsTwenty-two patients with PAOD were examined with a combined CTA and MRA protocol consisting of static acquisitions (s-CTA, s-MRA) of the entire runoff and dynamic acquisitions (d-CTA, d-MRA) of the calves. Two radiologists compared image quality of the s-MRA versus s-CTA as well as d-MRA versus d-CTA. Image quality was assessed on a segmental basis using a 4-point Likert scale.ResultsFor s-CTA, 76% of segments were rated as excellent or good. For s-MRA, 50% of segments were rated as excellent or good (p < 0.0001). For d-CTA, median image quality score for all segments was rated as excellent for both readers. For d-MRA, median image quality for the different segments ranged from moderate to good. For both d-CTA and d-MRA, the median image quality scores were significantly higher for all segments of the lower limb compared with the static examinations of the lower limb segments (all p values < 0.0001). In patients with PAOD category 4–6, 80% of segments were rated as excellent or good for d-CTA, while 45% of segments were rated as poor or non-diagnostic for d-MRA.ConclusionIn patients with known PAOD, a combined static and dynamic CTA examination improves image quality relative to static and dynamic MRA and should be considered as an alternative to MRA, particularly in patients with advanced stage PAOD.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Diagnosis and Management of Transplanted Kidney Extrarenal Pseudoaneurysms: A Series of Four Cases and a Review of the Literature

Extrarenal pseudoaneurysms of transplanted kidneys are very rare but can have devastating consequences. In the past, these extrarenal pseudoaneurysms have often led to graft loss as well as significant morbidity and mortality. The role of advanced diagnostic imaging studies and of modern radiologic interventional management has not been studied. In this case series, we present four cases of extrarenal pseudoaneurysms of transplanted kidneys, describe the clinical scenarios and imaging that led to the angiographic diagnosis, and discuss the various endovascular and surgical approaches to management.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

NASA: Biomedical applications team

The status of projects involving the adaptation of NASA technologies for medical purposes is reviewed. Devices for the measurement of joint deformation of arthritic hands, the development of an artificial pancreas, provision of an auditory signal to avert epileptic seizures, are described along with the control of medication levels, a compressed air tank to supply power for field dentistry, and an electroencephalogram monitor. The use of the Lixiscope as a portable fluoroscope, thermal laminates for hand and foot warmers for patients with Raynaud's syndrome, and the use of absorptive coatings for instruments for controlling medication levels are described. The applicability of occupation health and safety practices to industry, computerized patient scheduling, impregnation of the common facial tissue with an agent for killing respiratory viruses, commercial applications of anthropometric data, and multispectral image analysis of the skin as a diagnostic tool are reviewed.

Source record↗

The Value of Rotational Venography Versus Anterior–Posterior Venography in 100 Consecutive IVC Filter Retrievals

PurposeAccurately detecting inferior vena cava (IVC) filter complications is important for safe and successful retrieval as tip-embedded filters require removal with non-standard techniques. Venography prior to IVC filter retrieval has traditionally used a single anterior–posterior (AP) projection. This study compares the utility of rotational venography to AP venography prior to IVC filter removal.Materials and MethodsThe rotational venograms from 100 consecutive IVC filter retrievals over a 35-month period were evaluated retrospectively. The AP view of the rotational venogram was examined separately from the full series by a radiologist blinded to alternative imaging and operative findings. The venograms were evaluated for tip embedding, filter fracture, filter thrombus, and IVC thrombus. Statistical analysis was performed.ResultsUsing operative findings and peri-procedural imaging as the reference standard, tip embedding occurred in 59 of the 100 filters (59 %). AP venography was used to correctly identify 31 tip-embedded filters (53 % sensitivity) with two false positives (95 % specificity) for an accuracy of 70 %. Rotational venography was used to correctly identify 58 tip-embedded filters (98 % sensitivity) with one false positive (98 % specificity) for an accuracy of 98 %. A significant difference was found in the sensitivities of the two diagnostic approaches (P < .01). Other findings of thrombus and filter fracture were not significantly different between the two groups.ConclusionRotational venograms allow for more accurate detection of tip-embedded IVC filters compared to AP views alone. As this determines the approach taken, rotational venograms are helpful if obtained prior to IVC filter retrieval.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Carbon Nanotube Based Nanotechnology for NASA Mission Needs and Societal Applications

Carbon nanotubes (CNT) exhibit extraordinary mechanical properties and unique electronic properties and therefore, have received much attention for more than a decade now for a variety of applications ranging from nanoelectronics, composites to meeting needs in energy, environmental and other sectors. In this talk, we focus on some near term potential of CNT applications for both NASA and other Agency/societal needs. The most promising and successful application to date is a nano chem sensor at TRL 6 that uses a 16-256 sensor array in the construction of an electronic nose. Pristine, doped, functionalized and metal-loaded SWCNTs are used as conducting materials to provide chemical variation across the individual elements of the sensor array. This miniaturized sensor has been incorporated in an iPhone for homeland security applications. Gases and vapors relevant to leak detection in crew vehicles, biomedical, mining, chemical threats, industrial spills and others have been demonstrated. SWCNTs also respond to radiation exposure via a change in conductivity and therefore, a similar strategy is being pursued to construct a radiation nose to identify radiation sources (gamma, protons, neutrons, X-ray, etc.) with their energy levels. Carbon nanofibers (CNFs) grown using plasma enhanced CVD typically are vertical, individual, freestanding structures and therefore, are ideal for construction of nanoelectrodes. A nanoelectrode array (NEA) can be the basis for an affinity-based biosensor to meet the needs in applications such as lab-on-a-chip, environmental monitoring, cancer diagnostics, biothreat monitoring, water and food safety and others. A couple of demonstrations including detection of e-coli and ricin will be discussed. The NEA is also useful for implantation in the brain for deep brain stimulation and neuroengineering applications. Miniaturization of payload such as science instrumentation and power sources is critical to reduce launch costs. High current density (greater than 100 mA/per square centimeters) field emission capabilities of CNTs can be exploited for construction of electron gun for electron microscopy and X-ray tubes for spectrometers and baggage screening. A CNT pillar array configuration has been demonstrated, not only meeting the high current density needs but more importantly providing long term emitter stability. Finally, supercapacitors hold the promise to combine the high energy density of a battery with the high power density of capacitors. Traditional graphite electrodes have not delivered this promise yet. A novel design and processing approach using MWCNTs has shown a record 550 F/g capacitance along with significant device endurance. This supercapacitor is suitable for railgun launch application for NASA, powering rovers and robots, consumer electronics and future hybrid vehicles.

Li, Jing↗

TH-F-209-00: Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. Learning Objectives: Understand the basic requirements on medical diagnostic X-ray sources per modality Learn to select the optimal equipment employing state-of-the-art metric Know causes of failures, depending on the way X-ray sources are operated Understand methods to remediate critical situations Understand the meaning of different warranty models I am employee of Royal Philips; R. Behling, No external funding. I am employee of Royal Philips.

61 RADIATION PROTECTION AND DOSIMETRY↗

Risk Assessment of Industrial Microbes Using a Terrestrial Mesocosm Platform

Abstract Industrial microbes and bio-derived products have emerged as an integral component of the bioeconomy, with an array of agricultural, bioenergy, and biomedical applications. However, the rapid development of microbial biotechnology raises concerns related to environmental escape of laboratory microbes, detection and tracking thereof, and resultant impact upon native ecosystems. Indeed, though wild-type and genetically modified microbes are actively deployed in industrial bioprocesses, an understanding of microbial interactivity and impact upon the environment is severely lacking. In particular, the persistence and sustained ecosystem impact of industrial microbes following laboratory release or unintentional laboratory escape remains largely unexplored. Herein, we investigate the applicability of soil-sorghum mesocosms for the ecological risk assessment of the industrial microbe, Saccharomyces cerevisiae . We developed and applied a suite of diagnostic and bioinformatic analyses, including digital droplet PCR, microscopy, and phylogenomic analyses to assess the impacts of a terrestrial ecosystem perturbation event over a 30-day time course. The platform enables reproducible, high-sensitivity tracking of S. cerevisiae in a complex soil microbiome and analysis of the impact upon abiotic soil characteristics and soil microbiome population dynamics and diversity. The resultant data indicate that even though S. cerevisiae is relatively short-lived in the soil, a single perturbation event can have sustained impact upon mesocosm soil composition and underlying microbial populations in our system, underscoring the necessity for more comprehensive risk assessment and development of mitigation and biocontainment strategies in industrial bioprocesses.

09 BIOMASS FUELS↗

SU-F-T-427: Utilization and Evaluation of Diagnostic CT Imaging with MAR Technique for Radiation Therapy Treatment Planning

Purpose: The objective was to utilize and evaluate diagnostic CT-MAR technique for radiation therapy treatment planning. Methods: A Toshiba-diagnostic-CT acquisition with SEMAR(Single-energy-MAR)-algorism was performed to make the metal-artifact-reduction (MAR) for patient treatment planning. CT-imaging datasets with and without SEMAR were taken on a Catphan-phantom. Two sets of CT-numbers were calibrated with the relative electron densities (RED). A tissue characterization phantom with Gammex various simulating material rods was used to establish the relationship between known REDs and corresponding CT-numbers. A GE-CT-sim acquisition was taken on the Catphan for comparison. A patient with bilateral hip arthroplasty was scanned in the radiotherapy CT-sim and the diagnostic SEMAR-CT on a flat panel. The derived SEMAR images were used as a primary CT dataset to create contours for the target, critical-structures, and for planning. A deformable registration was performed with VelocityAI to track voxel changes between SEMAR and CT-sim images. The SEMAR-CT images with minimal artifacts and high quality of geometrical and spatial integrity were employed for a treatment plan. Treatment-plans were evaluated based on deformable registration of SEMAR-CT and CT-sim dataset with assigned CT-numbers in the metal artifact regions in Eclipse v11 TPS. Results: The RED and CT-number relationships were consistent for the datasets in CT-sim and CT’s with and without SEMAR. SEMAR datasets with high image quality were used for PTV and organ delineation in the treatment planning process. For dose distribution to the PTV through the DVH analysis, the plan using CT-sim with the assigned CT-number showed a good agreement to those on deformable CT-SEMAR. Conclusion: A diagnostic-CT with MAR-algorithm can be utilized for radiotherapy treatment planning with CT-number calibrated to the RED. Treatment planning comparison and DVH shows a good agreement in the PTV and critical organs between the plans on CT-sim with assigned CT-number and the deformable SEMAR CT datasets.

60 APPLIED LIFE SCIENCES↗

TH-F-209-01: Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. Learning Objectives: Understand the basic requirements on medical diagnostic X-ray sources per modality Learn to select the optimal equipment employing state-of-the-art metric Know causes of failures, depending on the way X-ray sources are operated Understand methods to remediate critical situations Understand the meaning of different warranty models I am employee of Royal Philips; R. Behling, No external funding. I am employee of Royal Philips.

61 RADIATION PROTECTION AND DOSIMETRY↗

Equipment for nuclear medical centers, production capabilities of Rosatom enterprises

Analysis of the capabilities of the State Corporation Rosatom enterprises on the development and production of diagnostic and therapeutic equipment for nuclear medicine centers is presented. Prospects of the development of accelerator equipment for the production of a wide range of radioisotope products are shown, and the trends of its development are determined. A comparative analysis of the technical parameters of domestic tomographs and devices for brachytherapy with foreign counterparts is given.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Perspectives on Machine Learning-assisted Plasma Medicine: Towards Automated Plasma Treatment

Cold atmospheric plasmas (CAPs) have shown great promise for medical applications through their synergistic chemical, electrical, and thermal effects, which can induce therapeutic outcomes. However, safe and reproducible plasma treatment of complex biological surfaces poses a major hurdle to the widespread adoption of CAPs for medical applications. Predictive modeling of the mutual interactions between the plasma and biological surfaces and, thus, systematic approaches to quantify and predict plasma treatment outcomes remain largely elusive due to the lack of mechanistic understanding of plasma-surface interactions that can span across vastly different length-and time-scales. In addition, real-time sensing capabilities in biomedical CAP devices are often limited, which can be detrimental to plasma treatment due to the intrinsic plasma and surface variability during the treatment, as well as sensitivity to external perturbations. All of these challenges can make reproducible and effective plasma treatment of biological surfaces difficult to realize, which is further compounded by errors due to human operation of hand-held CAP devices. Machine learning and data-driven approaches can be particularly useful in addressing these challenges in three major ways: (i) data-driven modeling of hard-to-model plasma-surface interactions and plasma treatment outcomes; (ii) learning data analytics for plasma and surface diagnostics in real-time; and (iii) developing predictive controllers that enable reliable and effective CAP treatments. Furthermore, this paper discusses the promise of machine learning to accelerate plasma medicine research in these areas, toward machine learning-assisted and automated CAP treatment of complex biological surfaces.

60 APPLIED LIFE SCIENCES↗