"A Psychopath by Any Other Name?": Juror Perceptions of the DSM-5 "Limited Prosocial Emotions" Specifier.

DSM-5 recently added the specifier "Limited Prosocial Emotions" (LPE) to the Conduct Disorder (CD) diagnosis, yet little is known about how these traits will affect attitudes toward CD youth. Laypersons attending jury duty (N = 326) were randomly assigned to one of four case vignette conditions in which a male juvenile offender was identified as having (a) CD symptoms only, (b) CD symptoms plus a diagnostic label, (c) CD symptoms plus a diagnostic label and description of LPE traits, or (d) CD symptoms plus a description of LPE traits and a "psychopath" label. LPE traits led to more negative perceptions of the youth (e.g., more dangerous, evil, and psychopathic) and adding the psychopath label to the LPE specifier resulted in somewhat stronger support for punishment and mandated treatment. The LPE specifier may provide useful diagnostic information, but these findings raise serious concerns that it will stigmatize youth in the legal system.

Effects of Mental Health and Neuroscience Evidence on Juror Perceptions of a Criminal Defendant: the Moderating Role of Political Orientation.

Several recent studies have examined the effects of mental health and neuroscientific evidence on attitudes toward criminal defendants, suggesting that these factors may influence juror decision-making in meaningful ways. Few studies to date have manipulated both of these variables while also considering theoretically important individual difference variables (e.g., political orientation). Using a criminal case simulation, this study manipulated the presence of evidence concerning mental disorders (psychopathy and schizophrenia) and increasing levels of neuroscientific detail regarding a defendant's brain injury, and examined verdicts and sentencing recommendations in over 400 persons attending jury duty. Main effects were detected for mental health testimony and political orientation, although interactions were noted as well. More negative reactions to defendants labeled as psychopaths were relatively consistent, whereas participants who identified as liberal generally were less punitive towards a defendant identified as schizophrenic than were more conservative jurors. Consistent with other recent research, juror perceptions of the defendant's level of psychopathic traits (independent of the effects of the experimental manipulations) predicted guilty verdicts and longer sentencing recommendations. Copyright © 2016 John Wiley & Sons, Ltd.

One American Perspective on the Rights of Accused: An Initial Survey of Miranda Rights in a Broader Context.

In the wake of countless police dramas, commonly held misperceptions endure that the American public knows both Miranda warnings and concomitant rights. Past research has tested public knowledge of Miranda per se, without evaluating additional misconceptions. The current investigation utilizes the European Union's much more all-encompassing safeguards, as delineated in the EU's 2012 Directive and Letter of Rights. Besides knowledge of Miranda, the advisability of these enhanced rights and protections was also assessed. In order to obtain a cross-section of the community, 619 participants were recruited from actual jury pools. Interestingly, they believed that Miranda afforded arrestees many more protections than it actually does. In general, nearly all (>90%) agreed that the accused should be given accurate information (e.g., charges and alleged criminal acts) coupled with an absence of police deception. The potential implications of these findings are discussed as they relate to police practices and due process. Copyright © 2016 John Wiley & Sons, Ltd.

Boldness and its relation to psychopathic personality: Prototypicality analyses among forensic mental health, criminal justice, and layperson raters.

Research on psychopathic personality has been dominated by a focus on criminality and social deviance, but some theoretical models argue that certain putatively adaptive features are important components of this construct. In 3 samples (forensic mental health practitioners, probation officers and a layperson community sample), we investigated adaptive traits as conceptualized in the Triarchic model of psychopathy (Patrick et al., 2009), specifically the relevance of boldness to construals of psychopathic personality. Participants completed prototypicality ratings of psychopathic traits, including 3 items created to tap components of boldness (Socially bold, Adventurous, Emotionally stable), and they also rated a series of attitudinal statements (e.g., perceived correlates of being psychopathic, moral judgments about psychopaths). The composite Boldness scale was rated as moderately to highly prototypical among forensic mental health practitioners and probation officers and positively associated with other theoretically relevant domains of psychopathy. Across samples, higher composite Boldness ratings predicted greater endorsement of adaptive traits (e.g., social skills) as characteristic of psychopathy. For the individual items, Socially bold was rated as highly prototypical and was associated with theoretically relevant correlates. Adventurous also was seen as prototypical, though to a lesser degree. Only forensic mental health practitioners endorsed Emotionally stable as characteristic of psychopathy. Our results provide partial support for the contention that the boldness concept is viewed as an important component of psychopathy, particularly among professionals who work directly with offender populations. (PsycINFO Database Record

Dictionary learning for data recovery in positron emission tomography.

Compressed sensing (CS) aims to recover images from fewer measurements than that governed by the Nyquist sampling theorem. Most CS methods use analytical predefined sparsifying domains such as total variation, wavelets, curvelets, and finite transforms to perform this task. In this study, we evaluated the use of dictionary learning (DL) as a sparsifying domain to reconstruct PET images from partially sampled data, and compared the results to the partially and fully sampled image (baseline).A CS model based on learning an adaptive dictionary over image patches was developed to recover missing observations in PET data acquisition. The recovery was done iteratively in two steps: a dictionary learning step and an image reconstruction step. Two experiments were performed to evaluate the proposed CS recovery algorithm: an IEC phantom study and five patient studies. In each case, 11% of the detectors of a GE PET/CT system were removed and the acquired sinogram data were recovered using the proposed DL algorithm. The recovered images (DL) as well as the partially sampled images (with detector gaps) for both experiments were then compared to the baseline. Comparisons were done by calculating RMSE, contrast recovery and SNR in ROIs drawn in the background, and spheres of the phantom as well as patient lesions.For the phantom experiment, the RMSE for the DL recovered images were 5.8% when compared with the baseline images while it was 17.5% for the partially sampled images. In the patients' studies, RMSE for the DL recovered images were 3.8%, while it was 11.3% for the partially sampled images. Our proposed CS with DL is a good approach to recover partially sampled PET data. This approach has implications toward reducing scanner cost while maintaining accurate PET image quantification.

Using compressive sensing to recover images from PET scanners with partial detector rings.

PURPOSE: Most positron emission tomography/computed tomography (PET/CT) scanners consist of tightly packed discrete detector rings to improve scanner efficiency. The authors' aim was to use compressive sensing (CS) techniques in PET imaging to investigate the possibility of decreasing the number of detector elements per ring (introducing gaps) while maintaining image quality. METHODS: A CS model based on a combination of gradient magnitude and wavelet domains (wavelet-TV) was developed to recover missing observations in PET data acquisition. The model was designed to minimize the total variation (TV) and L1-norm of wavelet coefficients while constrained by the partially observed data. The CS model also incorporated a Poisson noise term that modeled the observed noise while suppressing its contribution by penalizing the Poisson log likelihood function. Three experiments were performed to evaluate the proposed CS recovery algorithm: a simulation study, a phantom study, and six patient studies. The simulation dataset comprised six disks of various sizes in a uniform background with an activity concentration of 5:1. The simulated image was multiplied by the system matrix to obtain the corresponding sinogram and then Poisson noise was added. The resultant sinogram was masked to create the effect of partial detector removal and then the proposed CS algorithm was applied to recover the missing PET data. In addition, different levels of noise were simulated to assess the performance of the proposed algorithm. For the phantom study, an IEC phantom with six internal spheres each filled with F-18 at an activity-to-background ratio of 10:1 was used. The phantom was imaged twice on a RX PET/CT scanner: once with all detectors operational (baseline) and once with four detector blocks (11%) turned off at each of 0 ˚, 90 ˚, 180 ˚, and 270° (partially sampled). The partially acquired sinograms were then recovered using the proposed algorithm. For the third test, PET images from six patient studies were investigated using the same strategy of the phantom study. The recovered images using WTV and TV as well as the partially sampled images from all three experiments were then compared with the fully sampled images (the baseline). Comparisons were done by calculating the mean error (%bias), root mean square error (RMSE), contrast recovery (CR), and SNR of activity concentration in regions of interest drawn in the background as well as the disks, spheres, and lesions. RESULTS: For the simulation study, the mean error, RMSE, and CR for the WTV (TV) recovered images were 0.26% (0.48%), 2.6% (2.9%), 97% (96%), respectively, when compared to baseline. For the partially sampled images, these results were 22.5%, 45.9%, and 64%, respectively. For the simulation study, the average SNR for the baseline was 41.7 while for WTV (TV), recovered image was 44.2 (44.0). The phantom study showed similar trends with 5.4% (18.2%), 15.6% (18.8%), and 78% (60%), respectively, for the WTV (TV) images and 33%, 34.3%, and 69% for the partially sampled images. For the phantom study, the average SNR for the baseline was 14.7 while for WTV (TV) recovered image was 13.7 (11.9). Finally, the average of these values for the six patient studies for the WTV-recovered, TV, and partially sampled images was 1%, 7.2%, 92% and 1.3%, 15.1%, 87%, and 27%, 25.8%, 45%, respectively. CONCLUSIONS: CS with WTV is capable of recovering PET images with good quantitative accuracy from partially sampled data. Such an approach can be used to potentially reduce the cost of scanners while maintaining good image quality.

On the roles of vascular smooth muscle contraction in cerebral blood flow autoregulation - a modeling perspective.

We here review existing models of vascular smooth muscle cell, endothelial cell and cell-cell communication, which have been developed to better understand vascular tone and blood flow autoregulation. In particular, we discuss models that intended to explain modulation of myogenic tone by intraluminal pressure in resistance arterioles. Modeling efforts in the recent past have witnessed a shift from empirical models to models with mechanistic details that underscore different physical aspects of vascular regulation. Future models should synthesize mechanistic interactions in a hierarchy, from molecular regulation of ion channels to whole organ blood flow control.

Why the impact? Negative affective change as a mediator of the effects of victim impact statements.

Victim impact statements (VISs) represent a contentious legal and psychological point of debate. Current knowledge concerning the influence of VISs on jurors' emotional states and views of offenders is unclear. Using a sexual assault case, the present study attempted to disentangle these points of debate in the body of existing literature by (a) examining the direct influences of the presence of a VIS and juror Need for Affect (NFA) on sentencing recommendations, (b) assessing overall negative affective change as a mediating mechanism of these predictors, and (c) if mediation was present, identifying specific negative emotions that explain the effects of negative affective change. Results showed that presence of a VIS and a greater proclivity to approach emotions were associated with significantly greater sentencing recommendations. Moreover, change in negative affect mediated the effects of NFA approach and VIS exposure. Examination of changes in specific negative emotions revealed that increases in being upset and nervous mediated the impact of VIS condition; in addition, increases in hostility mediated the effect of NFA approach. Results are discussed with regard to emotion-based decision making of potential jurors, applications to trial process, and future research in the area.

A mock juror investigation of blame attribution in the punishment of hate crime perpetrators.

We examined blame attribution as a moderator of perceptions of hate crimes against gay, African American, and transgender victims. Participants were 510 Texas jury panel members. Results of vignette-based crime scenarios showed that victim blame displayed significant negative, and perpetrator blame significant positive, effects on sentencing recommendations. Also as hypothesized, victim and perpetrator blame moderated the effect of support for hate crime legislation. Interaction patterns suggested that both types of blame attribution influence sentencing recommendations, but only for participants disagreeing with hate crime legislation. Three-way interactions with victim type also emerged, indicating that the effects of both types of blame attribution show particular influences when the victim is gay, as opposed to transgender or African American. Implications for attribution theory, hate crime policy, and jury selection are discussed.

Same score, different message: perceptions of offender risk depend on Static-99R risk communication format.

The popular Static-99R allows evaluators to convey results in terms of risk category (e.g., low, moderate, high), relative risk (compared with other sexual offenders), or normative sample recidivism rate formats (e.g., 30% reoffended in 5 years). But we do not know whether judges and jurors draw similar conclusions about the same Static-99R score when findings are communicated using different formats. Community members reporting for jury duty (N = 211) read a tutorial on the Static-99R and a description of a sexual offender and his crimes. We varied his Static-99R score (1 or 6) and risk communication format (categorical, relative risk, or recidivism rate). Participants rated the high-scoring offender as higher risk than the low-scoring offender in the categorical communication condition, but not in the relative risk or recidivism rate conditions. Moreover, risk ratings of the high-scoring offender were notably higher in the categorical communication condition than the relative risk and recidivism rate conditions. Participants who read about a low Static-99R score tended to report that Static-99R results were unimportant and difficult to understand, especially when risk was communicated using categorical or relative risk formats. Overall, results suggest that laypersons are more receptive to risk results indicating high risk than low risk and more receptive to risk communication messages that provide an interpretative label (e.g., high risk) than those that provide statistical results.

Rate-dependent Ca2+ signalling underlying the force-frequency response in rat ventricular myocytes: a coupled electromechanical modeling study.

BACKGROUND: Rate-dependent effects on the Ca2+ sub-system in a rat ventricular myocyte are investigated. Here, we employ a deterministic mathematical model describing various Ca2+ signalling pathways under voltage clamp (VC) conditions, to better understand the important role of calmodulin (CaM) in modulating the key control variables Ca2+/calmodulin-dependent protein kinase-II (CaMKII), calcineurin (CaN), and cyclic adenosine monophosphate (cAMP) as they affect various intracellular targets. In particular, we study the frequency dependence of the peak force generated by the myofilaments, the force-frequency response (FFR). METHODS: Our cell model incorporates frequency-dependent CaM-mediated spatially heterogenous interaction of CaMKII and CaN with their principal targets (dihydropyridine (DHPR) and ryanodine (RyR) receptors and the SERCA pump). It also accounts for the rate-dependent effects of phospholamban (PLB) on the SERCA pump; the rate-dependent role of cAMP in up-regulation of the L-type Ca2+ channel (ICa,L); and the enhancement in SERCA pump activity via phosphorylation of PLB. RESULTS: Our model reproduces positive peak FFR observed in rat ventricular myocytes during voltage-clamp studies both in the presence/absence of cAMP mediated ß-adrenergic stimulation. This study provides quantitative insight into the rate-dependence of Ca2+-induced Ca2+-release (CICR) by investigating the frequency-dependence of the trigger current (ICa,L) and RyR-release. It also highlights the relative role of the sodium-calcium exchanger (NCX) and the SERCA pump at higher frequencies, as well as the rate-dependence of sarcoplasmic reticulum (SR) Ca2+ content. A rigorous Ca2+ balance imposed on our investigation of these Ca2+ signalling pathways clarifies their individual roles. Here, we present a coupled electromechanical study emphasizing the rate-dependence of isometric force developed and also investigate the temperature-dependence of FFR. CONCLUSIONS: Our model provides mechanistic biophysically based explanations for the rate-dependence of CICR, generating useful and testable hypotheses. Although rat ventricular myocytes exhibit a positive peak FFR in the presence/absence of beta-adrenergic stimulation, they show a characteristic increase in the positive slope in FFR due to the presence of Norepinephrine or Isoproterenol. Our study identifies cAMP-mediated stimulation, and rate-dependent CaMKII-mediated up-regulation of ICa,L as the key mechanisms underlying the aforementioned positive FFR.

Investigating the use of nonattenuation corrected PET images for the attenuation correction of PET data.

PURPOSE: The aim of this study is to investigate the feasibility of using the nonattenuated PET images (PET-NAC) as a means for the AC of PET data. METHODS: A three-step iterative segmentation process is proposed. In step 1, a patient's body contour is segmented from the PET-NAC using an active contour algorithm. Voxels inside the contour are then assigned a value of 0.096 cm(-1) to represent the attenuation coefficient of soft tissue at 511 keV. This segmented attenuation map is then used to correct for attenuation the raw PET data and the resulting PET images are used as the input to Step 2 of the process. In step 2, the lung region is segmented using an optimal thresholding approach and the corresponding voxels are assigned a value of 0.024 cm(-1) representing the attenuation coefficients of lung tissue at 511 keV. The updated attenuation map is then used for a second time to correct for attenuation the raw PET data, and the resulting PET images are used as the input to step 3. The purpose of Step 3 is to delineate parts of the heart and liver in the lung contour using a region growing approach since these parts were unavoidably excluded in the lung contour in step 2. These parts are then corrected by using a value of 0.096 cm(-1) in the attenuation map. Finally the attenuation coefficients of the bed are included based on CT images to eliminate the impact of the couch on the accuracy of AC. The final attenuation map is then used to AC the raw PET data and generates the final PET image, which we name iterative AC PET (PET-IAC). To assess the proposed segmentation approach, a phantom and 14 patients (with a total of 55 lesions including bone) were scanned on a GE Discovery-RX PET∕CT scanner. PET-IAC images were generated using the proposed process and compared to those of CT-AC PET (PET-CTAC). Visual inspection, lesion SUV, and voxel by voxel histograms between PET-IAC and PET-CTAC for phantom and patient studies were performed to assess the accuracy of image quantification. RESULTS: Visual inspection showed a small difference in lung parenchyma between the PET-IAC and PET-CTAC. Tumor SUV based on PET-IAC were on average different by 3%±9% (6%±7%) compared to the SUVs from the PET-CTAC in the phantom (patient) studies. For bone lesions only, the average difference was 3%±6%. The histogram comparing PET-CTAC and PET-IAC resulted in an average regression line of y=(1.08±0.07)x+(0.00007±0.0013), with R2=0.978±0.0057. CONCLUSIONS: Preliminary results suggest that PET-NAC for the AC of PET images is feasible. Such an approach can potentially be used for dedicated PET or PET∕MR hybrid systems while minimizing scan time or potential image artifacts, respectively.

Reliability of predicting image signal-to-noise ratio using noise equivalent count rate in PET imaging.

PURPOSE: Several investigators have shown that noise equivalent count rate (NECR) is linearly proportional to the square of image signal-to-noise ratio (SNR) when PET images are reconstructed using filtered back-projection. However, to our knowledge, none have shown a similar relationship in fully 3D ordered-subset expectation maximization (OSEM) reconstruction. This paper has two aims. The first is to investigate the NECR-SNR relationship for 3D-OSEM reconstruction using phantom studies while the second aim is to evaluate the NECR-SNR relationship using patient data. METHODS: An anthropomorphic phantom was scanned on a GE Discovery-STE (DSTE) PET∕CT scanner in 3D mode with an initial activity concentration of 66.34 kBq∕cc. PET data were acquired over the lower chest∕upper abdomen region in dynamic mode. The experiment was repeated with the same activity concentration on a GE Discovery-RX (DRX) scanner. Care was taken to place the phantom at identical positions in both scanners. PET data were then reconstructed using 3D Reprojection (3D-RP) and 3D-OSEM with different reconstruction parameters and the NECR and SNR for each frame∕image were calculated. SNR(2) was then plotted versus the NECR for each scanner, reconstruction method and parameters. In addition, 40 clinical PET∕CT studies from the two scanners (20 patients∕scanner) were evaluated retrospectively. The patient studies from each scanner were further divided into two subgroups of body mass indices (BMI). Each PET study was acquired in 3D mode and reconstructed using both 3D-OSEM and 3D-RP. The NECR and SNR of the bed position covering the patient liver were calculated for each patient and averaged for each subgroup. Comparisons of the NECR and SNR between scanner types and BMIs were performed using a t-test and a p value less than 0.05 was considered significant. RESULTS: Phantom results showed that SNR(2) versus NECR was linear for 3D-RP reconstruction across all activity concentration on both scanners, as expected. However, when 3D-OSEM was used, this relationship was nonlinear at activity concentrations beyond the peak NECR on both scanners. On the other hand, the plot of SNR(2) versus trues count rate was linear for 3D-OSEM across all activity concentrations on both scanners independent of reconstruction parameters used. In addition, for activity concentrations <30kBq∕cc, phantom results showed a higher SNR (by 12 ± 10%; p < 0.05) and NECR for the DRX scanner compared to DSTE for 3D-RP reconstruction. However, for 3D-OSEM reconstruction, these two scanners had similar SNRs (different by 2% ± 9%; p > 0.05), despite having different NECRs. Patient studies showed a statistically significant difference in NECR as well as the SNR for 3D-RP reconstruction between the two scanners. However, no statistically significant difference was found for 3D-OSEM. A statistically significant difference in both NECR and SNR were found between the different BMI subgroups for both 3D-RP and 3D-OSEM reconstructions. CONCLUSIONS: For the scanners and reconstruction algorithm used in this study, our results suggest that the image SNR cannot be predicted by the NEC when using 3D-OSEM reconstruction particularly for those clinical applications requiring high activity concentration. Instead, our results suggest that image SNR varies with activity concentration and is dominated by the 3D-OSEM reconstruction algorithm and its associated parameters, while not being affected by the scanner type for the range of activity concentrations usually found in the clinic.

A software tool for stitching two PET/CT body segments into a single whole-body image set.

A whole-body PET/CT scan extending from the vertex of the head to the toes of the patient is not feasible on a number of commercially available PET/CT scanners due to a limitation in the extent of bed travel on these systems. In such cases, the PET scan has to be divided into two parts: one covering the upper body segment, while the other covering the lower body segment. The aim of this paper is to describe and evaluate, using phantom and patient studies, a software tool that was developed to stitch two body segments and output a single whole-body image set, thereby facilitating the interpretation of whole-body PET scans. A mathematical model was first developed to stitch images from two body segments using three landmarks. The model calculates the relative positions of the landmarks on the two segments and then generates a rigid transformation that aligns these landmarks on the two segments. A software tool was written to implement this model while correcting for radioactive decay between the two body segments, and output a single DICOM whole-body image set with all the necessary tags. One phantom, and six patient studies were conducted to evaluate the performance of the software. In these studies, six radio-opaque markers (BBs) were used as landmarks (three on each leg). All studies were acquired in two body segments with BBs placed in the overlap region of the two segments. The PET/CT images of each segment were then stitched using the software tool to create a single DICOM whole-body PET/CT image. Evaluation of the stitching tool was based on visual inspection, consistency of radiotracer uptake in the two segments, and ability to display the resultant DICOM image set on two independent workstations. The software tool successfully stitched the two segments of the phantom image, and generated a single whole-body DICOM PET/CT image set that had the correct alignment and activity concentration throughout the image. The stitched images were viewed by two independent workstations from two different manufacturers, attesting the ability of the software tool to produce a DICOM compliant image set. The study demonstrated that this software tool allows the stitching of two segments of a whole-body PET/CT scan with minimal user interaction, thereby facilitating the interpretation of whole body PET/CT scans from a number of scanners with limited extent of bed travel.

Determination of internal target volume from a single positron emission tomography/computed tomography scan in lung cancer.

PURPOSE: The use of four-dimensional computed tomography (4D-CT) to determine the tumor internal target volume (ITV) is usually characterized by high patient radiation exposure. The objective of this study was to propose and evaluate an approach that relies on a single static positron emission tomography (PET)/CT scan to determine the ITV, thereby eliminating the need for 4D-CT and thus reduce patient radiation dose. METHODS AND MATERIALS: The proposed approach is based on the concept that the observed PET image is the result of a joint convolution of an ideal PET image (free from motion and partial volume effect) with a motion-blurring kernel (MBK) and partial volume effect. In this regard, the MBK and tumor ITV are then estimated from the deconvolution of this joint model. To test this technique, phantom and patient studies were performed using different sphere/tumor sizes and motion trajectories. In all studies, a 4D-CT and a PET/CT image of the sphere/tumor were acquired. The ITV from the proposed technique was then compared to the maximum intensity projection (MIP) volume of the 4D-CT images. A Dice coefficient of the two volumes was calculated to represent the similarity between the two ITVs. RESULTS: The average ITVs of the proposed technique were 97.2% ± 0.3% and 81.0% ± 16.7% similar to the MIP volume in the phantom and patient studies, respectively. The average dice coefficients were 0.87 ± 0.05 and 0.73 ± 0.16, respectively, for the two studies. CONCLUSION: Using the proposed approach, a single static PET/CT scan has the potential to replace a 4D-CT to determine the tumor ITV. This approach has the added advantage of reducing patient radiation exposure and determining the tumor MBK compared to 4D-CT/MIP-CT.

Effects of injected dose, BMI and scanner type on NECR and image noise in PET imaging.

Noise equivalent count rate (NECR) and image noise are two different but related metrics that have been used to predict and assess image quality, respectively. The aim of this study is to investigate, using patient studies, the relationships between injected dose (ID), body mass index (BMI) and scanner type on NECR and image noise measurements in PET imaging. Two groups of 90 patients each were imaged on a GE DSTE and a DRX PET/CT scanner, respectively. The patients in each group were divided into nine subgroups according to three BMI (20-24.9, 25-29.9, 30-45 kg m(-2)) and three ID (296-444, 444-555, 555-740 MBq) ranges, resulting in ten patients/subgroup. All PET data were acquired in 3D mode and reconstructed using the VuePoint HD® fully 3D OSEM algorithm (2 iterations, 21(DRX) or 20 (DSTE) subsets). NECR and image noise measurements for bed positions covering the liver were calculated for each patient. NECR was calculated from the trues, randoms and scatter events recorded in the DICOM header of each patient study, while image noise was determined as the standard deviation of 50 non-neighboring voxels in the liver of each patient. A t-test compared the NECR and image noise for different scanners but with the same BMI and ID. An ANOVA test on the other hand was used to compare the results of patients with different BMI but the same ID and scanner type as well as different ID but the same BMI and scanner type. As expected the t-test showed a significant difference in NECR between the two scanners for all BMI and ID subgroups. However, contrary to what is expected no such findings were observed for image noise measurement. The ANOVA results showed a statistically significant difference in both NECR and image noise among the different BMI for each ID and scanner subgroup. However, there was no statistically significant difference in NECR and image noise across different ID for each BMI and scanner subgroup. Although the GE DRX PET/CT scanner has better count rate performance than the GE DSTE PET/CT scanner, this improvement does not translate to a lower image noise when using OSEM reconstruction. Our results show that patients with larger BMI consistently generate poorer image quality. Dose reduction from >555 to 296-444 MBq has minimal impact on image quality independent of the scanner used. A reduction in ID decreases patient and technologist exposure and can potentially reduce the overall cost of the study.

Modeling left ventricular diastolic dysfunction: classification and key indicators.

BACKGROUND: Mathematical modeling can be employed to overcome the practical difficulty of isolating the mechanisms responsible for clinical heart failure in the setting of normal left ventricular ejection fraction (HFNEF). In a human cardiovascular respiratory system (H-CRS) model we introduce three cases of left ventricular diastolic dysfunction (LVDD): (1) impaired left ventricular active relaxation (IR-type); (2) increased passive stiffness (restrictive or R-type); and (3) the combination of both (pseudo-normal or PN-type), to produce HFNEF. The effects of increasing systolic contractility are also considered. Model results showing ensuing heart failure and mechanisms involved are reported. METHODS: We employ our previously described H-CRS model with modified pulmonary compliances to better mimic normal pulmonary blood distribution. IR-type is modeled by changing the activation function of the left ventricle (LV), and R-type by increasing diastolic stiffness of the LV wall and septum. A 5th-order Cash-Karp Runge-Kutta numerical integration method solves the model differential equations. RESULTS: IR-type and R-type decrease LV stroke volume, cardiac output, ejection fraction (EF), and mean systemic arterial pressure. Heart rate, pulmonary pressures, pulmonary volumes, and pulmonary and systemic arterial-venous O2 and CO2 differences increase. IR-type decreases, but R-type increases the mitral E/A ratio. PN-type produces the well-described, pseudo-normal mitral inflow pattern. All three types of LVDD reduce right ventricular (RV) and LV EF, but the latter remains normal or near normal. Simulations show reduced EF is partly restored by an accompanying increase in systolic stiffness, a compensatory mechanism that may lead clinicians to miss the presence of HF if they only consider LVEF and other indices of LV function. Simulations using the H-CRS model indicate that changes in RV function might well be diagnostic. This study also highlights the importance of septal mechanics in LVDD. CONCLUSION: The model demonstrates that abnormal LV diastolic performance alone can result in decreased LV and RV systolic performance, not previously appreciated, and contribute to the clinical syndrome of HF. Furthermore, alterations of RV diastolic performance are present and may be a hallmark of LV diastolic parameter changes that can be used for better clinical recognition of LV diastolic heart disease.

Modeling study of the failing heart and its interaction with an implantable rotary blood pump.

The effectiveness of clinical diagnosis and treatment of heart failure is a direct function of clinical signs that can be measured in a patient within cost and safety constraints. Large-scale mathematical modeling can be a key tool in revealing important, measurable clinical signs of heart failure, furthering medical understanding and development of treatment. In the first part of this study we have created two models of left heart failure--diastolic and systolic, using our human cardiovascular-respiratory system (H-CRS) model, and we present a comparison of the two types with emphasis on novel and differentiating clinical signs, such as tricuspid flow and septal motion. In the event of compromised left ventricular performance, mechanical left ventricular assist devices (LVAD) are often implanted to augment or completely replace the pumping action of the left ventricle (LV). One such type is the implantable rotary blood pump (iRBP). Several design issues related to the iRBP are difficult to study experimentally due to procedure complexity and limitations in animal models of heart failure [2]. Therefore, modeling has become a key tool in iRBP development. In the second part of this study, we have introduced an iRBP model based on [1]-[2] in the systolic failing heart to study the interactions. We consider optimal motor settings for different levels of LV assistance, the effects of the iRBP on the right heart, septum, and pulmonary circulation. Our model results align with those reported in [1]-[2]. Improvement in cardiac output, pulmonary congestion, and heart work are seen with the iRBP. We observe lowered septal assistance to RV and LV ejection with increasing pump speeds, elevating right ventricular (RV) work, reducing LVET, and causing ventricular mechanical dyssynchrony in ejection. These results suggest right heart compromise via the septum's reduced role with the introduction of an iRBP. This work emphasizes the critical role of modeling in heart failure and treatment studies.

Modeling CICR in rat ventricular myocytes: voltage clamp studies.

BACKGROUND: The past thirty-five years have seen an intense search for the molecular mechanisms underlying calcium-induced calcium-release (CICR) in cardiac myocytes, with voltage clamp (VC) studies being the leading tool employed. Several VC protocols including lowering of extracellular calcium to affect Ca²(+) loading of the sarcoplasmic reticulum (SR), and administration of blockers caffeine and thapsigargin have been utilized to probe the phenomena surrounding SR Ca²(+) release. Here, we develop a deterministic mathematical model of a rat ventricular myocyte under VC conditions, to better understand mechanisms underlying the response of an isolated cell to calcium perturbation. Motivation for the study was to pinpoint key control variables influencing CICR and examine the role of CICR in the context of a physiological control system regulating cytosolic Ca²(+) concentration ([Ca²(+)](myo)). METHODS: The cell model consists of an electrical-equivalent model for the cell membrane and a fluid-compartment model describing the flux of ionic species between the extracellular and several intracellular compartments (cell cytosol, SR and the dyadic coupling unit (DCU), in which resides the mechanistic basis of CICR). The DCU is described as a controller-actuator mechanism, internally stabilized by negative feedback control of the unit's two diametrically-opposed Ca²(+) channels (trigger-channel and release-channel). It releases Ca²(+) flux into the cyto-plasm and is in turn enclosed within a negative feedback loop involving the SERCA pump, regulating[Ca²(+)](myo). RESULTS: Our model reproduces measured VC data published by several laboratories, and generates graded Ca²(+) release at high Ca²(+) gain in a homeostatically-controlled environment where [Ca²(+)](myo) is precisely regulated. We elucidate the importance of the DCU elements in this process, particularly the role of the ryanodine receptor in controlling SR Ca²(+) release, its activation by trigger Ca²(+), and its refractory characteristics mediated by the luminal SR Ca²(+) sensor. Proper functioning of the DCU, sodium-calcium exchangers and SERCA pump are important in achieving negative feedback control and hence Ca²(+) homeostasis. CONCLUSIONS: We examine the role of the above Ca²(+) regulating mechanisms in handling various types of induced disturbances in Ca²(+) levels by quantifying cellular Ca²(+) balance. Our model provides biophysically-based explanations of phenomena associated with CICR generating useful and testable hypotheses.

Design and performance of a respiratory amplitude gating device for PET/CT imaging.

PURPOSE: Recently, the authors proposed a free-breathing amplitude gating (FBAG) technique for PET/CT scanners. The implementation of this technique required specialized hardware and software components that were specifically designed to interface with commercial respiratory gating devices to generate the necessary triggers required for the FBAG technique. The objective of this technical note is to introduce an in-house device that integrates all the necessary hardware and software components as well as tracks the patient's respiratory motion to realize amplitude gating on PET/CT scanners. METHODS: The in-house device is composed of a piezoelectric transducer coupled to a data-acquisition system in order to monitor the respiratory waveform. A LABVIEW program was designed to control the data-acquisition device and inject triggers into the PET list stream whenever the detected respiratory amplitude crossed a predetermined amplitude range. A timer was also programmed to stop the scan when the accumulated time within the selected amplitude range REACHED a user-set interval. This device was tested using a volunteer and a phantom study. RESULTS: The results from the volunteer and phantom studies showed that the in-house device can detect similar respiratory signals as commercially available respiratory gating systems and is able to generate the necessary triggers to suppress respiratory motion artifacts. CONCLUSIONS: The proposed in-house device can be used to implement the FBAG technique in current PET/CT scanners.