Semi-automated myocardial segmentation of bright blood multi-gradient echo images improves reproducibility of myocardial contours and T2* determination.

OBJECTIVES: Early detection of iron loading is affected by the reproducibility of myocardial contour assessment. A novel semi-automatic myocardial segmentation method is presented on contrast-optimized composite images and compared to the results of manual drawing. MATERIALS AND METHODS: Fifty-one short-axis slices at basal, mid-ventricular and apical locations from 17 patients were acquired by bright blood multi-gradient echo MRI. Four observers produced semi-automatic and manual myocardial contours on contrast-optimized composite images. The semi-automatic segmentation method relies on vector field convolution active contours to generate the endocardial contour. After creating radial pixel clusters on the myocardial wall, a combination of pixel-wise coefficient of variance (CoV) assessment and k-means clustering establishes the epicardial contour for each segment. RESULTS: Compared to manual drawing, semi-automatic myocardial segmentation lowers the variability of T2* quantification within and between observers (CoV of 12.05 vs. 13.86% and 14.43 vs. 16.01%) by improving contour reproducibility (P < 0.001). In the presence of iron loading, semi-automatic segmentation also lowers the T2* variability within and between observers (CoV of 13.14 vs. 15.19% and 15.91 vs. 17.28%). CONCLUSION: Application of semi-automatic myocardial segmentation on contrast-optimized composite images improves the reproducibility of T2* quantification.

Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial.

BACKGROUND: US guidelines now recommend lung cancer screening with low-dose CT for high-risk individuals. Reports of new nodules after baseline screening have been scarce and are inconsistent because of differences in definitions used. We aimed to identify the occurrence of new solid nodules and their probability of being lung cancer at incidence screening rounds in the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON). METHODS: In the ongoing, multicentre, randomised controlled NELSON trial, between Dec 23, 2003, and July 6, 2006, 15 822 participants who had smoked at least 15 cigarettes a day for more than 25 years or ten cigarettes a day for more than 30 years and were current smokers, or had quit smoking less than 10 years ago, were enrolled and randomly assigned to receive either screening with low-dose CT (n=7915) or no screening (n=7907). From Jan 28, 2004, to Dec 18, 2006, 7557 individuals underwent baseline screening with low-dose CT; 7295 participants underwent second and third screening rounds. We included all participants with solid non-calcified nodules, registered by the NELSON radiologists as new or smaller than 15 mm(3) (study detection limit) at previous screens. Nodule volume was generated semiautomatically by software. We calculated the maximum volume doubling time for nodules with an estimated percentage volume change of 25% or more, representing the minimum growth rate for the time since the previous scan. Lung cancer diagnosis was based on histology, and benignity was based on histology or stable size for at least 2 years. The NELSON trial is registered at trialregister.nl, number ISRCTN63545820. FINDINGS: We analysed data for participants with at least one solid non-calcified nodule at the second or third screening round. In the two incidence screening rounds, the NELSON radiologists registered 1222 new solid nodules in 787 (11%) participants. A new solid nodule was lung cancer in 49 (6%) participants with new solid nodules and, in total, 50 lung cancers were found, representing 4% of all new solid nodules. 34 (68%) lung cancers were diagnosed at stage I. Nodule volume had a high discriminatory power (area under the receiver operating curve 0·795 [95% CI 0·728-0·862]; p<0·0001). Nodules smaller than 27 mm(3) had a low probability of lung cancer (two [0·5%] of 417 nodules; lung cancer probability 0·5% [95% CI 0·0-1·9]), nodules with a volume of 27 mm(3) up to 206 mm(3) had an intermediate probability (17 [3·1%] of 542 nodules; lung cancer probability 3·1% [1·9-5·0]), and nodules of 206 mm(3) or greater had a high probability (29 [16·9%] of 172 nodules; lung cancer probability 16·9% [12·0-23·2]). A volume cutoff value of 27 mm(3) or greater had more than 95% sensitivity for lung cancer. INTERPRETATION: Our study shows that new solid nodules are detected at each screening round in 5-7% of individuals who undergo screening for lung cancer with low-dose CT. These new nodules have a high probability of malignancy even at a small size. These findings should be considered in future screening guidelines, and new solid nodules should be followed up more aggressively than nodules detected at baseline screening. FUNDING: Zorgonderzoek Nederland Medische Wetenschappen and Koningin Wilhelmina Fonds Kankerbestrijding.

Demographic estimates from the Palaeolithic-Mesolithic boundary in Scandinavia: comparative benchmarks and novel insights.

Prehistoric demography has recently risen to prominence as a potentially explanatory variable for episodes of cultural change as documented in the archaeological and ethnographic record. While this has resulted in a veritable boom in methodological developments seeking to address temporal changes in the relative size of prehistoric populations, little work has focused on the manner in which population dynamics manifests across a spatial dimension. Most recently, the so-called Cologne Protocol has led the way in this endeavour. However, strict requirements of raw-material exchange data as analytical inputs have prevented further applications of the protocol to regions outside of continental Europe. We apply an adjusted approach of the protocol that makes it transferable to cases in other parts of the world, while demonstrating its use by providing comparative benchmarks of previous research on the Late Glacial Final Palaeolithic of southern Scandinavia, and novel insights from the early Holocene pioneer colonization of coastal Norway. We demonstrate again that population size and densities remained fairly low throughout the Late Glacial, and well into the early Holocene. We suggest that such low population densities have played a significant role in shaping what may have been episodes of cultural loss, as well as potentially longer periods of only relatively minor degrees of cultural change. This article is part of the theme issue 'Cross-disciplinary approaches to prehistoric demography'.

Approaching prehistoric demography: proxies, scales and scope of the Cologne Protocol in European contexts.

In many theories on the social and cultural evolution of human societies, the number and density of people living together in a given time and region is a crucial factor. Because direct data on past demographic developments are lacking, and reliability and validity of demographic proxies require careful evaluation, the topic has been approached from several different directions. This paper provides an introduction to a geostatistical approach for estimating prehistoric population size and density, the so-called Cologne Protocol and discusses underlying theoretical assumptions and upscaling transfer-functions between different spatial scale levels. We describe and compare the specifics for farming and for foraging societies and, using examples, discuss a diachronic series of estimates, covering the population dynamics of roughly 40 kyr of European prehistory. Ethnohistoric accounts, results from other approaches-including absolute (ethno-environmental models) and relative estimates (site-numbers, dates as data, etc.) allow a first positioning of the estimates within this field of research. Future enhancements, applications and testing of the Cologne Protocol are outlined and positioned within the general theoretical and methodological avenues of palaeodemographic research. In addition, we provide manuals for modelling Core Areas in MapInfo, ArcGIS, QGIS/Saga and R. This article is part of the theme issue 'Cross-disciplinary approaches to prehistoric demography'.

Neural correlates of individual differences in affective benefit of real-life urban green space exposure.

Psychiatric morbidity is high in cities, so identifying potential modifiable urban protective factors is important. We show that exposure to urban green space improves well-being in naturally behaving male and female city dwellers, particularly in districts with higher psychiatric incidence and fewer green resources. Higher green-related affective benefit was related to lower prefrontal activity during negative-emotion processing, which suggests that urban green space exposure may compensate for reduced neural regulatory capacity.

Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: The NELSON study.

OBJECTIVES: To explore the relationship between nodule count and lung cancer probability in baseline low-dose CT lung cancer screening. MATERIALS AND METHODS: Included were participants from the NELSON trial with at least one baseline nodule (3392 participants [45% of screen-group], 7258 nodules). We determined nodule count per participant. Malignancy was confirmed by histology. Nodules not diagnosed as screen-detected or interval cancer until the end of the fourth screening round were regarded as benign. We compared lung cancer probability per nodule count category. RESULTS: 1746 (51.5%) participants had one nodule, 800 (23.6%) had two nodules, 354 (10.4%) had three nodules, 191 (5.6%) had four nodules, and 301 (8.9%) had>4 nodules. Lung cancer in a baseline nodule was diagnosed in 134 participants (139 cancers; 4.0%). Median nodule count in participants with only benign nodules was 1 (Inter-quartile range [IQR]: 1-2), and 2 (IQR 1-3) in participants with lung cancer (p=NS). At baseline, malignancy was detected mostly in the largest nodule (64/66 cancers). Lung cancer probability was 62/1746 (3.6%) in case a participant had one nodule, 33/800 (4.1%) for two nodules, 17/354 (4.8%) for three nodules, 12/191 (6.3%) for four nodules and 10/301 (3.3%) for>4 nodules (p=NS). CONCLUSION: In baseline lung cancer CT screening, half of participants with lung nodules have more than one nodule. Lung cancer probability does not significantly change with the number of nodules. Baseline nodule count will not help to differentiate between benign and malignant nodules. Each nodule found in lung cancer screening should be assessed separately independent of the presence of other nodules.