Diet and irritable bowel syndrome: an update from a UK consensus meeting.

There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom.Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients.In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.

A post-reconstruction method to correct cupping artifacts in cone beam breast computed tomography.

In cone beam breast computed tomography (CT), scattered radiation leads to nonuniform biasing of CT numbers known as a cupping artifact. Besides being visual distractions, cupping artifacts appear as background nonuniformities, which impair efficient gray scale windowing and pose a problem in threshold based volume visualization/segmentation. To overcome this problem, we have developed a background nonuniformity correction method specifically designed for cone beam breast CT. With this technique, the cupping artifact is modeled as an additive background signal profile in the reconstructed breast images. Due to the largely circularly symmetric shape of a typical breast, the additive background signal profile was also assumed to be circularly symmetric. The radial variation of the background signals was estimated by measuring the spatial variation of adipose tissue signals in front view breast images. To extract adipose tissue signals in an automated manner, a signal sampling scheme in polar coordinates and a background trend fitting algorithm were implemented. The background fits compared with targeted adipose tissue signal value (constant throughout the breast volume) to get an additive correction value for each tissue voxel. To test the accuracy, we applied the technique to cone beam CT images of mastectomy specimens. After correction, the images demonstrated significantly improved signal uniformity in both front and side view slices. The reduction of both intraslice and interslice variations in adipose tissue CT numbers supported our observations.

Regional improvement of signal-to-noise and contrast-to-noise ratios in dual-screen CR chest imaging--a phantom study.

The improvement of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in dual-screen computed radiography (CR) has been investigated for various regions in images of an anthropomorphic chest phantom. With the dual-screen CR technique, two image plates are placed in a cassette and exposed together during imaging. The exposed plates are separately scanned to form a front image and a back image, which are then registered and superimposed to form a composite image with improved SNRs and CNRs. The improvement can be optimized by applying specifically selected weighting factors during superimposition. In this study, dual-screen CR images of an anthropomorphic chest phantom were acquired and formed with four different combinations of standard resolution (ST) and high-resolution (HR) screens: ST-ST, ST-HR, HR-ST, and HR-HR. SNRs and their improvements were measured and compared over twelve representative regions-of-interest (ROIs) in these images. A 19.1%-45.7% increase of the SNR was observed, depending on the ROI and screen combination used. The optimal weighting factors were found to vary by only 4.5%-12.4%. Largest improvement was found in the lung field for all screen combinations. Improvement of CNRs was investigated over two ROIs in the lung field using the rib bones as the contrast objects and a 29.2%-43.9% improvement of the CNR was observed. Among the four screen combinations, ST-ST resulted in the most SNR and CNR improvement, followed in order by HR-ST, HR-HR, and ST-HR. The HR-ST combination yielded the lowest spatial variation of the optimal weighting factors with improved SNRs and CNRs close to those of the ST-ST combination.

Comparison of an amorphous silicon/cesium iodide flat-panel digital chest radiography system with screen/film and computed radiography systems--a contrast-detail phantom study.

Flat-panel (FP) based digital radiography systems have recently been introduced as a new and improved digital radiography technology; it is important to evaluate and compare this new technology with currently widely used conventional screen/film (SF) and computed radiography (CR) techniques. In this study, the low-contrast performance of an amorphous silicon/cesium iodide (aSi/Csl)-based flat-panel digital chest radiography system is compared to those of a screen/film and a computed radiography system by measuring their contrast-detail curves. Also studied were the effects of image enhancement in printing the digital images and dependence on kVp and incident exposure. It was found that the FP system demonstrated significantly better low-contrast performance than the SF or CR systems. It was estimated that a dose savings of 70%-90% could be achieved to match the low-contrast performance of the FP images to that of the SF images. This dose saving was also found to increase with the object size. No significant difference was observed in low-contrast performances between the SF and CR systems. The use of clinical enhancement protocols for printing digital images was found to be essential and result in better low-contrast performance. No significant effects were observed for different kVps. From the results of this contrast-detail phantom study, the aSi/CsI-based flat-panel digital chest system should perform better under clinical situations for detection of low-contrast objects such as lung nodules. However, proper processing prior to printing would be essential to realizing this better performance.

Pixelwise fusion for optimizing SNR in multiple-plate computed radiography imaging.

The computed radiography (CR) technique, also known as the storage phosphor imaging technique, has evolved to be a major candidate for large-scale implementation of digital radiography during the past decade. In order to obtain a reasonable spatial resolution, the storage phosphor plate used is generally limited in thickness. This leads to X rays being only partially absorbed by the detector. Useful information may be contained in the X rays transmitted through the detector. Multiple-plate imaging techniques may be used to capture and utilize the X rays more efficiently. In this paper, an image fusion method, based on the Rayleigh principle and the Karhunen-Loeve (K-L) transform, is presented for optimizing the signal-to-noise ratio (SNR) of the fused image on a pixel-by-pixel basis. Because the multiple-plate images contain the same structural information, the signal components of the images are highly correlated with one another. Thus, the K-L transform is applied to decompose each of the multiple-plate images into an eigen image (the estimated signal) and a residual image (the estimated noise). An average representation entropy measure is maximized for selecting the number of eigen components to be included in the signal estimation. An experimental study, using an anthropomorphic chest phantom, is presented to illustrate pixelwise fusion of multiple-plate images. Experimental results show that the SNR of the fused image was improved by 12-48%, depending upon the anatomical regions of interest in the image.

Comparison of three tissue composition measurement techniques using digital mammograms--a signal-to-noise study.

Tissue composition measurement may provide a quantitatively and physically meaningful method to objectively determine the "mammographic density" linked to breast cancer risk. A single energy hybrid (SEH) techniques is described for measuring the tissue composition on a pixel-by-pixel basis with a single digital mammogram. Theoretical models were derived and used to compute signal-to-noise ratios (SNRs) in tissue composition measurement using the SEH method. The results were compared with those computed for measurements using the dual kVp and dual screen methods. SNRs were theoretically related to the pixel area, total unattenuated detector exposure and fluence spectra of the incident X-rays. SNRs were computed for measurement of the adipose tissue thickness for a 6 cm thick breast, consisting of 50% of adipose tissue and 50% of glandular tissue. Effects of kVp and prepatient filtration were studied by computing the SNRs for various kVps and filters and optimal kVps and filters are determined. The results showed that the SNRs obtained with the SEH method is an order of magnitude better than the dual kVp method, which, in turn, is an order of magnitude better than the dual screen method. When using the optimal kVp's and no prepatient filtration, the SNRs were computed to be 84.2, 13.2, and 2.0 for the SEH, dual kVp, and dual screen methods, respectively. Prepatient filtration can improve the SNR by as much as 35% for the dual kVp and dual screen techniques with reasonable tube loading factors (8-10).

Computed radiography versus screen-film mammography in detection of simulated microcalcifications: a receiver operating characteristic study based on phantom images.

RATIONALE AND OBJECTIVES: The authors compare a 43-micron computed radiographic system with a mammographic screen-film system for detection of simulated microcalcifications in an observer-performance study. MATERIALS AND METHODS: The task of detecting microcalcifications was simulated by imaging aluminum wire segments (200-500 microns in length; 100, 125, or 150 microns in diameter) that overlapped with tissue background structures produced by beef brisket. A total of 288 such simulations were generated and examined with both computed radiography and conventional screen-film mammography techniques. Computed radiography was performed with high-resolution plates, a 43-micron image reader, and a 43-micron laser film printer. Computed radiographic images were printed with simple contrast enhancement and compared with screen-film images in a receiver operating characteristic study in which experienced readers detected and scored the simulated microcalcifications. Observer performance was quantitated and compared by computing the area under the receiver operating characteristic curve. RESULTS: Although the resolution of the computed radiography system was better than that of commercial systems, it fell short of that of screen-film systems. For the 100-micron microcalcifications, the difference in the average area under the curve was not statistically significant, but it was significant for the larger simulated microcalcifications: the average area under the curve was 0.58 for computed radiography versus 0.76 for screen-film imaging for the 125-micron microcalcifications and 0.83 versus 1.00, respectively, for the 150-micron microcalcifications. CONCLUSION: Observer performance in the detection of small simulated microcalcifications (100-150 microns in diameter) is better with screen-film images than with high-resolution computed radiographic images.

Improvement of signal-to-noise and contrast-to-noise ratios in dual-screen computed radiography.

A dual-screen computed radiography (CR) technique has been developed to improve and optimize the overall image signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). With this technique, two CR screens are exposed together and separately scanned to form a front and a back image. These two images are then superimposed to form an image of improved SNR and CNR. A mathematical model has been derived to describe the improvement and optimization of the SNR and CNR. Based on this model, the front and back images should be weighted in proportion to their SNR squared to optimize the SNR of the composite image. Imaging experiments have been conducted to verify the theoretical model under mammographic and chest imaging conditions. The results largely agree with the theoretical predictions. It has also been found that optimization of the SNR results in nearly optimal CNR and vice versa. For mammographic imaging, a 14%-22% improvement in the SNR and a 13%-19% improvement in the CNR have been demonstrated. For chest imaging, a 31%-36% improvement in the SNR and a 28%-30% improvement in the CNR has been demonstrated.

Fractal analysis of trabecular patterns in projection radiographs. An assessment.

RATIONALE AND OBJECTIVES: Fractal analysis of digitized images has been investigated in recent years as a potential measure of structural bone strength. Several technical issues associated with such measurements are assessed. METHODS: In a series of experiments using a hand phantom, the effects of system noise and modulation transfer function on fractal dimension were explored. The authors evaluated a method for correcting the estimated power spectrum using a step-wedge image exposed and digitized under identical conditions as a reference. RESULTS: System noise and modulation transfer function significantly affect estimated fractal dimension in bony regions computed from conventional radiographs. CONCLUSIONS: Before conventional radiographs are used for fractal analysis in the clinical environment, many of the technical problems associated with this methodology must be addressed.

Effectiveness of antiscatter grids in digital radiography. A phantom study.

INTRODUCTION: With ever-increasing interest in bedside radiography using digital imaging techniques, one question often asked is whether and which antiscatter grid should be used to reduce the effects of scattered radiation. In this article, the authors quantitatively analyze and compare images obtained with a flexible circular hole (FCH) grid, a conventional 6:1 focused grid, or without a grid. METHODS: Scatter-to-primary ratios (SPRs), contrast signals, and contrast-to-noise ratios (CNRs) were measured for fixed patient exposure and were compared at various locations in the images of an anthropomorphic chest phantom. RESULTS: Although both grids resulted in greater contrast signals, a significant improvement of the CNR was achieved only in the upper and middle mediastinum regions when the conventional grid was used. With the FCH grid, the CNR is degraded at most locations in the chest image. DISCUSSION: Our results indicate that at fixed exposure level, the use of either grid yields only marginal improvement, at best, in bedside digital chest radiography.

Multiformat video and laser cameras: history, design considerations, acceptance testing, and quality control. Report of AAPM Diagnostic X-Ray Imaging Committee Task Group No. 1.

Acceptance testing and quality control of video and laser cameras is relatively simple, especially with the use of the SMPTE test pattern. Photographic quality control is essential if one wishes to be able to maintain the quality of video and laser cameras. In addition, photographic quality control must be carried out with the film used clinically in the video and laser cameras, and with a sensitometer producing a light spectrum similar to that of the video or laser camera. Before the end of the warranty period a second acceptance test should be carried out. At this time the camera should produce the same results as noted during the initial acceptance test. With the appropriate acceptance and quality control the video and laser cameras should produce quality images throughout the life of the equipment.

Comparison of three different techniques for dual-energy subtraction imaging in digital radiography: a signal-to-noise analysis.

Dual-energy subtraction imaging techniques allow the tissue and bone structures in the patient to be visualized and studied in two separate images, thus removing the obscurity associated with overlapping of the two structures. In addition, they allow the subtraction image signals to be used for quantifying the tissue and bone thicknesses. Thus, capability for dual-energy subtraction imaging is often incorporated with new digital radiography systems. There are three different approaches to dual-energy image subtraction imaging techniques. Among them, the dual-kilovolt (peak) [kV(p)] and sandwich detector techniques have been two widely used approaches. A third approach is the single-kV(p) dual-filter technique, which allows some flexible control of the spectra while avoiding the technical complexity of kV(p) value switching in slit-scan imaging. In this report, the noise properties associated with these three techniques are studied and compared by computing the noise variances in the subtraction image signals as a function of the kV(p) values and filter thicknesses. It was found that the dual-kVp technique results in the least noisy subtraction images, whereas the dual-filter technique results in slightly less noisy subtraction images than the sandwich detector technique. Following optimization of the kV(p) value and filter thicknesses, the dual-filter and sandwich detector techniques result in a noise level of approximately three and four times higher than that resulted from the dual-kV(p) technique, respectively.

Synthesis and analgesic activity of pemedolac (cis-1-ethyl-1,3,4,9-tetrahydro-4-(phenylmethyl)pyrano[3,4-b]ind ole-1- acetic acid).

The synthesis of cis-1-ethyl-1,3,4,9-tetrahydro-4-(phenylmethyl)pyrano[3,4-b]indole -1-acetic acid, pemedolac (USAN), is described. This compound has been found to be a potent analgesic agent in primary screening. Pemedolac has been resolved and the active (+)-enantiomer assigned a 1S,4R absolute configuration on the basis of a crystallographic analysis of its (S)-(-)-borneol ester.

Indole-phenol bioisosterism. Synthesis and antihypertensive activity of a pyrrolo analogue of labetalol.

The synthesis of 5-[hydroxy-2-[(1-methyl-3-phenylpropyl)amino]ethyl]-1H-indole-7- carboxamide, 5, a pyrrolo analogue of labetalol, is described. Compound 5 was found to reduce blood pressure in spontaneously hypertensive rats with an ED50 of 5 mg/kg po, without causing any decrease in heart rate. Isolated tissue studies with 5 shows that it is a nonselective beta-adrenoceptor antagonist and that it is a weaker alpha-adrenoceptor antagonist with a relative selectivity for alpha 1-receptors. Additionally, the compound displayed significant beta-adrenoceptor intrinsic sympathomimetic activity. Evidence is presented that the beta-adrenoceptor antagonist and agonist properties of 5 are mediated via hydrogen-bond formation with the receptor.

Intravenous video arteriography of the intracranial vasculature: early experience.

A computerized fluoroscopic apparatus developed by members of the University of Wisconsin Medical Physics Section was used for 12 months to perform intravenous video arteriography. In previous papers, the apparatus was described and its use was illustrated for performing time subtraction intravenous video arteriography of the extracranial carotid arteries, the arteries of the abdomen and extremities, as well as angiocardiography. In this report, the use and current limitations of this technique for evaluation of the intracranial vasculature are described and illustrated.