Determining patient abdomen thickness from a single digital radiograph with a computational model: clinical results from a proof of concept study.

OBJECTIVE: A computational model has been created to estimate the abdominal thickness of a patient following an X-ray examination; its intended application is assisting with patient dose audit of paediatric X-ray examinations. This work evaluates the accuracy of the computational model in a clinical setting for adult patients undergoing anteroposterior (AP) abdomen X-ray examinations. METHODS: The model estimates patient thickness using the radiographic image, the exposure factors with which the image was acquired, a priori knowledge of the characteristics of the X-ray unit and detector and the results of extensive Monte Carlo simulation of patient examinations. For 20 patients undergoing AP abdominal X-ray examinations, the model was used to estimate the patient thickness; these estimates were compared against a direct measurement made at the time of the examination. RESULTS: Estimates of patient thickness made using the model were on average within ±5.8% of the measured thickness. CONCLUSION: The model can be used to accurately estimate the thickness of a patient undergoing an AP abdominal X-ray examination where the patient's size falls within the range of the size of patients used to create the computational model. ADVANCES IN KNOWLEDGE: This work demonstrates that it is possible to accurately estimate the AP abdominal thickness of an adult patient using the digital X-ray image and a computational model.

Abdominal volume computed tomography assessment of body composition in dogs.

BACKGROUND: Computed tomography (CT) has been used to estimate body composition and determine tissue distribution in dogs, despite limited validation. This may introduce error into estimates of body composition studies and its effect on health in dogs. Further, the modality has not been validated against dual-energy X-ray absorptiometry (DXA) or over a wide range of dog breeds, ages and sexes. The objective of this study was to validate the use of semi-automated, abdominal volume CT for estimating total body composition of dogs relative to DXA. Twenty-two staff-owned dogs (weighing between 5.1-60 kg) were sedated and underwent full body DXA scan and abdominal CT. Abdominal tissue composition was estimated by CT using semi-automated volume segmentation, over predetermined tissue Hounsfield threshold values. Abdominal tissue composition determined by the various CT threshold ranges was compared to total body composition determined by DXA. RESULTS: Abdominal tissue composition estimated by CT strongly correlated with the estimates derived from DXA with a small Bland-Altman mean percentage differences in values: total body mass (- 250/2000HU: r2 = 0.985; - 1.10%); total fat mass (- 250/-25HU: r2 = 0.981; - 1.90%); total lean tissue mass (- 25/150HU: r2 = 0.972; 3.47%); and total bone mineral content (150/2000HU: r2 = 0.900; - 0.87%). Although averaged CT values compared well to DXA analysis, there was moderate variation in the individual predicted values. There was near perfect inter- and intra-observer agreement in segmentation volumes for abdominal fat. CONCLUSIONS: Abdominal volume computed tomography (CT) accurately and reliably estimates total body composition in dogs, but greater variations may be observed in dogs weighing less than 10 kg.

Longitudinal Assessment of Abdominal Circumference versus Estimated Fetal Weight in the Detection of Late Fetal Growth Restriction.

OBJECTIVES: To perform a longitudinal assessment comparison between estimated fetal weight (EFW) and abdominal circumference (AC) in the prediction of late fetal growth restriction (FGR) as opposed to small for gestational age (SGA). PATIENTS AND METHODS: A cohort of unselected singleton pregnancies scanned at 32±2 and 37±1 weeks was created. Longitudinal growth assessment by calculating the conditional AC and conditional EFW was performed, and both parameters were compared for their prediction capacity for late FGR and SGA. Conditional standards set an expected size (EFW or AC) given a first measurement performed earlier. A declining growth was defined as a conditional growth of <10th centile. RESULTS: A total of 938 pregnancies were included. As expected, declining growth between 32±2 and 37±1 weeks was associated with late FGR and SGA, but the predictive capacity of both conditional AC and conditional EFW was comparably poor, with detection rates of 28% at a 10% rate of false positives for late FGR. CONCLUSIONS: Longitudinal assessment of fetal growth during the third trimester has a low predictive capacity for late FGR, with no differences between conditional AC and conditional EFW.

Image Quality Assessment for Low-Dose-CT in Hybrid SPECT/CT Imaging.

OBJECTIVES: Low-dose-computed tomography (LD-CT) is used in nuclear medicine hybrid imaging (e.g., SPECT/CT) for attenuation correction of emission data and anatomical correlation of findings. However, there are currently no standards for image quality (e. g., detectability) comparable to those for diagnostic CT. Therefore, the aim of this explorative study was to evaluate retrospective LDCT data in terms of CT image quality and detectability of anatomical structures. METHODS: Two readers blindly scored abdominal LD-CT images (n = 40 patients) in terms of detectability (n = 20 structures/patient), image quality, and readers' confidence in scoring the image quality for a clinically hybrid imaging protocol. Results were analysed by ANOVA to identify factors (e. g., anatomical structures) that influenced performance scores. The inter-rater agreement was evaluated by determining the chance-corrected Cohen's Kappa coefficient. RESULTS: Image noise was acceptable for anatomical correlation in 96.1 % of the readings with an almost perfect inter-rater agreement (KBP = 0.85). A detectability of at least 80 % was observed in 13/20 (KBP ≥ 0.7) and 90 % in 9/20 (KBP ≥ 0.85) of the structures analysed by both readers. The confidence of both readers in scoring image quality was at least sufficient in 98.8 % of the examined patients (KBP = 0.95). CONCLUSION: Although LD-CT protocols commonly used in hybrid imaging have a poor image quality not suitable for primary CT diagnostics, they enable detection of a variety of anatomical structures. LDCT can therefore also be referenced in the associated reports for anatomical correlation of findings from SPECT imaging.

Gastric Residual Volumes Versus Abdominal Girth Measurement in Assessment of Feed Tolerance in Preterm Neonates: A Randomized Controlled Trial.

BACKGROUND: Preterm neonates often have feed intolerance that needs to be differentiated from necrotizing enterocolitis. Gastric residual volumes (GRV) are used to assess feed tolerance but with little scientific basis. PURPOSE: To compare prefeed aspiration for GRV and prefeed measurement of abdominal girth (AG) in the time taken to reach full feeds in preterm infants. METHODS: This was a randomized controlled trial. Infants with a gestational age of 27 to 37 weeks and birth weight of 750 to 2000 g, who required gavage feeds for at least 48 hours, were included. Infants were randomized into 2 groups: infants in the AG group had only prefeed AG measured. Those in the GRV group had prefeed gastric aspiration obtained for the assessment of GRV. The primary outcome was time to reach full enteral feeds at 150 mL/kg/d, tolerated for at least 24 hours. Secondary outcomes were duration of hospital stay, need for parenteral nutrition, episodes of feed intolerance, number of feeds withheld, and sepsis. RESULTS: Infants in the AG group reached full feeds earlier than infants in the GRV group (6 vs 9.5 days; P = .04). No significant differences were found between the 2 groups with regard to secondary outcomes. IMPLICATIONS FOR PRACTICE: Our research suggests that measurement of AG without assessment of GRV enables preterm neonates to reach full feeds faster than checking for GRV. IMPLICATIONS FOR RESEARCH: Abdominal girth measurement as a marker for feed tolerance needs to be studied in infants less than 750 g and less than 26 weeks of gestation.

Analysis of testing with multiple choice versus open-ended questions: Outcome-based observations in an anatomy course.

The pedagogical approach for both didactic and laboratory teaching of anatomy has changed in the last 25 years and continues to evolve; however, assessment of student anatomical knowledge has not changed despite the awareness of Bloom's taxonomy. For economic reasons most schools rely on multiple choice questions (MCQ) that test knowledge mastered while competences such as critical thinking and skill development are not typically assessed. In contrast, open-ended question (OEQ) examinations demand knowledge construction and a higher order of thinking, but more time is required from the faculty to score the constructed responses. This study compares performances on MCQ and OEQ examinations administered to a small group of incoming first year medical students in a preparatory (enrichment) anatomy course that covered the thorax and abdomen. In the thorax module, the OEQ examination score was lower than the MCQ examination score; however, in the abdomen module, the OEQ examination score improved compared to the thorax OEQ score. Many students attributed their improved performance to a change from simple memorization (superficial learning) for cued responses to conceptual understanding (deeper learning) for constructed responses. The results support the view that assessment with OEQs, which requires in depth knowledge, would result in student better performance in the examination. Anat Sci Educ 11: 254-261. © 2017 American Association of Anatomists.

Utilización del Ultrasonido como Valoración Inicial de la Indemnidad de la Pared Abdominal en Traumatismos por Herida de Arm a Blanca en Abdomen / Using Ultrasound as the Initial Assessment of the Indemnity abdominal wall Injuries stab wound in abdomen

Introducción: Los traumatismos abdominales penetrantes son debidos generalmente a heridas de arma blanca o heridas de arma de fuego. Todas deben explorarse instrumentalmente bajo anestesia local con el objetivo de determinar la integridad del peritoneo. El ultrasonido es una herramienta muy útil utilizada en trauma, además del FAST, se lo puede utilizar en la urgencia como método de gran ayuda al realzar la exploración inicial de la herida para evaluar la integridad del peritoneo. Objetivos: Destacar la importancia del conocimiento anatómico y la correlación anatomo-clínico quirúrgica y ecográfica en la interpretación de imágenes obtenidas por ultrasonografía en la evaluación de la integridad de la pared del abdomen en heridas penetrantes por arma blanca. Material y métodos: FAST y ecografía de partes blandas instrumentándose la herida abdominal bajo anestesia local evaluando la indemnidad del peritoneo mediante la observación por ultrasonografía del abdomen y de la pared antero lateral del mismo en 14 de 42 pacientes con heridas por arma blanca en abdomen en el Servicio de Emergencias del Hospital Municipal de Morón y en el Servicio de Cirugía General del Hospital Aeronáutico Central. Período entre Febrero 2014 y Marzo 2015. Resultados: 42 (100%) pacientes con heridas de arma blanca en abdomen. 28 (66,66%) fueron inicialmente intervenidos quirúrgicamente. A 14 (33,34%) se le realizó FAST en búsqueda de líquido libre y ecografía de partes blandas instrumentándose la herida abdominal bajo anestesia local evaluando la indemnidad del peritoneo. Conclusiones: El conocimiento de las estructuras anatómicas y la disposición de las mismas que componen la pared anterolateral del abdomen permiten facilitar el reconocimiento de la indemnidad o no del peritoneo en las imágenes obtenidas por ultrasonido en pacientes con heridas abiertas por arma blanca, evitando así la realización de procedimientos quirúrgicos innecesarios.(AU)

Introduction: Penetrating abdominal trauma are usually due to stab wounds or gunshot wounds. All instrumentally be explored under local anesthesia in order to determine the integrity of the peritoneum. Ultrasound is a very useful tool used in trauma, in addition to FAST, I can use the urgency as a means of great help to enhance the initial exploration of the wound to evaluate the integrity of the peritoneum. Objectives: Highlighting the importance of the anatomical knowledge and surgical and anatomical clinical ultrasound in interpreting images obtained by ultrasonography in the evaluation of the integrity of the abdominal wall in penetrating stab wounds correlation. Material and methods: FAST ultrasound was performed and soft tissue abdominal wound became operational under local anesthesia indemnity evaluating the peritoneum through observation by ultrasound of the abdomen and the anterolateral wall thereof in 14 of the 42 patients with stab wounds in the abdomen Service Municipal Emergency Hospital of Moron and the Department of General Surgery of the Central Aeronautical Hospital, period between February 2014 and March 2015. Results: Of the 42 (100%) patients with stab wounds to the abdomen, 28 (66.66%) initially underwent surgery, and 14 (33.34%) were performed in FAST Search of free fluid and soft tissue ultrasound became operational abdominal wound under local anesthesia indemnity evaluating the peritoneum. Conclusions: Knowledge of the anatomical structures and arrangement thereof comprising the anterolateral wall of the abdomen allow easy recognition of indemnity or not the peritoneum in the ultrasound images in patients with stab wounds open, thus avoiding making unnecessary surgical procedures.

Simulation study on the effect of tissue geometries to fluence composition for non-invasive fetal pulse oximetry.

Transabdominal fetal pulse oximetry is a method to estimate the state of oxygenation of a fetus in-utero, utilizing the principle of reflection pulse oximetry. The extraction of fetal related information from a mixed fetal-maternal signal is elementary. Minimizing the ratio of purely maternal components of the signal at the detector side obviously facilitates signal separation. In this paper we analyze the influence of tissue geometries to the fluence composition at the surface of the abdomen. Monte-Carlo method is used to compute photon propagation in spherical layered tissue models. Spatial fluence distributions at the surface of the models are visualized and discussed. Our results show the characteristic effects of the distance between the fetus and the surface and the radius of the abdomen to the fluence composition at the detector. Further, the simulations indicate suitable source-detector configurations considering various anatomical conditions. We conclude that an adoption of the source-detector configuration to the individual tissue geometry at hand is necessary to achieve a proper signal composition and quality. Utilizing simulations for sensor design enhances the understanding of photon distributions in complex tissue geometries and supports a successful implementation of transabdominal fetal pulse oximetry.

Infrared thermography of the pig thorax: an assessment of selected regions of interest by computed tomographical and anatomical parameters.

Current methods of diagnosis of respiratory diseases in swine are invasive, time-consuming and expensive. Infrared thermography (IRT) of the thorax might provide a new method of high specificity to select swine affected with lung alterations for further diagnostics. In this study, layer thickness of different tissues was determined in frozen thorax slices (FTS) by computed tomography (CT) and then related to skin temperatures measured by IRT in healthy pigs. The aim was to determine appropriate regions of interest (ROI) for evaluation of IRT images. Organ layer thicknesses measured in CT images correspond to those measured in FTS. Temperature differences between lung ROIs and abdomen ROIs were positively correlated with lung layer thickness at certain localizations, and negatively correlated with the thickness of the thorax wall and of inner organ layers. Reference values of differences between skin temperatures were established for two ROIs on the thorax with potential practical use for lung health status determination. Respective ROIs were located on vertical lines crossing the 7th (right) and the 10th (left) thoracic vertebrae. The presence of ribs affected skin temperature significantly.

The proximal costs of case construction in caddisflies: antioxidant and life history responses.

Animal construction allows organisms to cope with environmental variations but the physiological costs of such behaviour are still poorly understood. The aim of the present study was to measure the physiological cost of construction behaviour through the oxidative balance that is known to affect the ability of organs to function, stimulates senescence processes and ultimately impacts the fitness of the organism. We used larvae of caddisfly, Limnephilus rhombicus, by experimentally modifying the effort associated with case building. Larvae that were forced to build a new case showed a significant increase in both total antioxidant capacity and the specific activity of superoxide dismutase 48 and 72 h, respectively, after the initiation of the reconstruction. These results strongly suggest that the larval construction behaviour triggered the production of reactive oxygen species, but their effects were reversed 7 days after the reconstruction. In the animals that were forced to build a new case, oxidative stress appeared to be mitigated by a network of antioxidant defences because no oxidative damage was observed in proteins compared with the control larvae. At the adult stage, while longevity was not sex dependent and was not affected by the treatment, body mass and body size of adult males from the reconstruction treatment were significantly lower than the control values. This unexpected sex effect together with data on oxidative stress highlights the difficulty of determining the physiological cost associated with energy-demanding behaviours, implying a consideration of both their energetic and non-energetic components is required.

Use of continuously MR tagged imaging for automated motion assessment in the abdomen: a feasibility study.

PURPOSE: To investigate the feasibility of measuring motion in the abdomen using a continuously tagged magnetic resonance imaging sequence. MATERIALS AND METHODS: To assess (nonperiodic) motion in the abdomen, a nontriggered, continuously tagged transient field echo (TFE) sequence was implemented that acquires one complete 3D dataset per prepulse after a fixed delay. In postprocessing, a frequency analysis approach was developed for compact reviewing of the data and noise suppression. For proof of principle, a simulation was made and one free-breathing dynamic in vivo scan was acquired in a healthy volunteer. During the dynamic scan the volunteer received glucagon intravenously. RESULTS: The simulation showed that this frequency analysis enables the extraction of motion at low signal-to-noise ratio levels. Motion information was successfully gathered from the in vivo scan. The decline in bowel motion caused by the administration of glucagon could be quantitatively measured using the continuously tagged sequence. CONCLUSION: Continuously tagged imaging in the abdomen for the purpose of automated gathering of motion information is feasible and could aid the study of bowel motion.

Body circumferences are predictors of weight adjusted resting energy expenditure in older people.

OBJECTIVE: To evaluate predictors of resting energy expenditure (REE) in older people which are more comfortable for them than indirect calorimetry and which are suitable for field studies. DESIGN: Cross-sectional study. SETTING: Department of Human Biology, Kiel University. PARTICIPANTS: 100 (51 males, 49 females) healthy independently-living normal-weight (BMI, males 26.0±2.67 kg/m², females 25.0±3.29 kg/m²) Germans, aged 60-83 years. MEASUREMENTS: REE, body composition, anthropometry, peak expiratory flow rate (PEF), and physical activity level were determined using indirect calorimetry, bioimpedance analysis, anthropometrics, peak-flow-meter, and standardized questionnaire, respectively. Stepwise linear multiple regression analysis was performed with REE or weight adjusted REE as dependent variables. Independent variables were body height, weight, body mass index (BMI), waist circumference, abdomen circumference, hip circumference, waist-to-hip ratio (WHR), lean body mass (LBM), PEF, and physical activity level. RESULTS: The only significant predictor of REE was LBM in males and BMI in females. Trunk circumferences emerged as strong predictors of weight adjusted REE. Abdomen circumference and hip circumference explained in males and females 69% and 70% of variation in adjusted REE, respectively. Weaker predictors were LBM in males (R² increased from 0.69 to 0.80) as well as body height and BMI in females (R² increased from 0.70 to 0.91). Waist circumference, WHR, physical activity level, and PEF were no significant determinants of adjusted REE. CONCLUSION: These findings demonstrate that trunk circumferences, but not WHR, are very strong predictors of weight adjusted REE in non-geriatric older people. This implies that the sex-specific use of abdomen or hip circumference in combination with LBM or body height and BMI seems to be well sufficient to predict weight adjusted REE in the aged. These measures might also be of clinical relevance, because they are more comfortable for older sick people than indirect calorimetry. Further studies are needed to test the applicability of the prediction equations to frail older populations.

An intra-individual quantitative assessment of acute laser injury patterns in facial versus abdominal skin.

INTRODUCTION: Clinical laser settings have traditionally been calibrated on abdominal skin to predict and anticipate patterns of injuries in facial skin. This experimental approach has limitations as facial skin and abdominal skin have differences that may influence the depth of laser injury. OBJECTIVE: The primary objective of this study is to analyze the acute pattern of laser injury in abdominal skin and facial skin samples from the same subject and detail the anatomical and biophysical properties that can influence the laser tissue interaction. The secondary objective is to develop a conversion factor that will allow the prediction laser column depths in facial skin based upon laser column depths in abdominal skin. METHODS: Fifteen healthy subjects were consented and screened. Two 2 mm spots on the face and abdomen were identified and measured and treated with a fractional CO(2) laser (Lumenis Ltd, Yokneum, Israel), with an energy setting of 15 mj, 300 Hz at a density of 10. Treatment areas were biopsied and analyzed histologically using hematoxylin and eosin and TUNEL staining. RESULTS: Facial skin and abdominal skin have several significant anatomical and biophysical differences (concentration of pilosebaceous units, sebum concentration, and moisture content). Facial tissue demonstrated divergence of laser energy around pilosebaceous units and lateral spread of laser energy along blood vessels. These differences cause attenuation (28%) of the laser energy and result in column depths that are significantly (P < 0.003) shorter in facial tissues (mean depth 415 µm) in comparison to abdominal tissues (mean depth 582 µm). CONCLUSION: The variations in anatomic, biophysical, and biomechanical properties in facial skin cause an attenuation of the laser column depths in facial skin when compared to abdominal skin. A correction factor of 28% is required to predict the depth of laser columns in facial skin based on laser column depths observed in abdominal skin.

Relación entre perímetro abdominal, nivel socioeconómico y presión arterial / Relation of abdominal circumference and socio-economic status to blood pressure

Objetivos: Relacionar perímetro abdominal y condición socioeconómica con presión arterial (PA) en comunidad urbana de Concepción. Métodos: Se midió el perímetro abdominal (PeA) de 8472 residentes mayores de 15 años de edad, proporcionados por edad, género y nivel socioeconómico. La PA fue medida con normas estandarizadas, realizando dos visitas en diferentes días, la segunda si la PA era mayor de 140/90 mm Hg. Los Pe A se distribuyeron en cuartiles, relacionando cada cuartil con los respectivos promedios de presión sistólica y diastólica y se establecieron coeficientes de correlación lineal mediante "r" de Pearson entre PeA y PA. Además, se estableció la frecuencia de cada cuartil de Pe A por nivel socioeconómico. Resultados: Los Pea tuvieron la siguiente distribución (cm): 1er cuartil, < 78; 2º cuartil, 78- 87; 3er cuartil, 88-96 y 4º cuartil, > 96. La prevalencia de hipertensión para niveles socioeconómicos alto, medio y bajo fue 17,9 por ciento, 19,5 por ciento y 24,5 por ciento, respectivamente. La PA promedio (mmHg) en hombres y en mujeres del 1er cuartil de PeA fue 112 y 109; en el 2º cuartil 118 y 118; en el 3er cuartil 123 y 122 y en el 4º cuartil 129 y 129, respectivamente. Los coeficientes de correlación entre PeA y presión sistólica y presión diastólica resultaron significativos en ambos géneros: r = 0,343, p<0.00001 y r = 0,281, p<0.00001, respectivamente. La distribución ( por ciento) de PeA fue inversa al nivel socioeconómico: en el nivel social bajo, el 22 por ciento estaba en el 1er cuartil de PeA, y el 28,8 por ciento en el 4º cuartil. En el nivel social alto se observó lo inverso: 38,9 por ciento estaba en el 1er cuartil de PeA, y sólo el 15.5 por ciento en el 4º cuartil (p<0.0001). Conclusiones: Hubo correlación positiva entre PeA y PA en ambos géneros. La frecuencia de mayor PeA en el nivel socioeconómico bajo podría explicar la mayor prevalencia de hipertensión en este grupo.

Aim: To correlate abdominal circumference (AC) and socio-economic status with blood pressure( BP) in an urban community of Concepción, Chile Methods: AC was measured in 8472 subjects above 15years of age, stratified by age, gender and socio-economic status. BP was measured by standard procedures, with a repeat recording when the initial value was > 140/90mmHg. BP was compared in quartiles of abdominal circumference and according to socio-economic status. Pearson "r" was used to correlate BP and AC Results: Cut points for quartiles of AC were 78, 87, and 96 cm. Prevalence of hypertension in high, medium and low socio-economic status was 17.9 percent, 19.5 percent and 24.5 percent, respectively Mean systolic BP was 112 - 109 mmHg (males - females) in the first AC quartile, 118 - 118, 123-122 and 129-129 in the second, third and fourth quartiles, respectively. A significant correlation between AC and BP (systolic and diastolic) was observed in both genders (r 0.345 and 0.281 for males and females, respectively, p<0.00001). 22 percent of low socio-economic subjects belonged in the first AC quartile compared to 28.8 percent in the 4th quartile. In contrast 38.9 percent of high socio-economic subjects belonged in the first AC quartile while 15.5 percent did so in the 4th quartile (p<0001). Conclusion: A positive correlation of AC and blood pressure was shown in both genders. A greater AC in low socio-economic subjects maybe related to a higher prevalence of hypertension in this group.

[Assessment of physical frame-based abdominal thickness estimation by evaluating conditions with fuzzy control: automatic exposure control (AEC) in diagnostic X-ray apparatus].

In digital X-ray photography of the abdomen and lumbar vertebrae, the automatic exposure control(AEC)system installed in the radiographic stand is essential for imaging at an appropriate dose. The AEC system has been used in many medical facilities. As patient size needs to be adapted, currently available AEC systems are equipped with a mechanism that enables an increase/decrease, by stages of 7-9, in AEC for X-ray dose. Adjustment of this function, however, depends largely on the radiologist's experience, as such X-ray dose control is lacking in reproducibility and quantification. We performed fuzzy reasoning using a measure of obesity(body-mass index: BMI)that was determined from the patient's height and body weight and estimated his/her abdominal thickness. On the basis of this estimated value, we established a methodology to define the conditions for X-ray photography of abdominal thickness in the area of increased patient thickness. We speculated that this methodology might provide better reproducibility and quantification for X-ray dose control in the area of increased patient thickness than the conventional AEC system.

Assessment of age-related changes in abdominal organ structure and function with computed tomography and positron emission tomography.

With the size of the aged population in the United States expected to grow considerably during the next several decades, the number of imaging studies performed on such aged individuals will similarly increase. Thus, it is important to understand normal age-related changes in the structural and functional imaging appearance of the abdominal organs. We therefore present preliminary data and a review of the literature relevant to structural and functional changes in the abdominal organs of children and older adults. In a retrospective study of both adult and pediatric populations, we used computed tomography (CT), positron emission tomography (PET), and PET/CT imaging to investigate age-associated changes in size, attenuation, and metabolic function of the abdominal organs. Organs of interest include the liver, spleen, pancreas, kidneys, adrenal glands, stomach, small bowel, colon, and rectum. Although volumes of adult liver, spleen, pancreas, and kidneys do not change significantly with age, adult left and right adrenal gland volumes do significantly increase with age (r = 0.2823, P = 0.0334, and r = 0.3676, P = 0.0049, respectively). Also, the attenuation of adult liver (r = -0.2122, P = 0.0412), spleen (r = -0.4508, P < 0.0001), pancreas (r = -0.5124, P = 0.0007), and left and right adrenal gland (r = -0.5835, P < 0.0001 and r = -0.6135, P < 0.0001, respectively) decrease significantly with increasing age. Every organ studied in the pediatric population demonstrates a positive association between organ volume and age. Significant age-related changes in organ function are noted in the adult liver and small bowel, with the liver demonstrating a positive association between metabolic activity and age (r = 0.4434, P = 0.0029) and the small bowel showing an inverse association between mean small bowel standardize uptake value and age (r = -0.2435, P = 0.0174). Also, the maximum overall small bowel and colon metabolic activity in children increases with age (r = 0.6478, P = 0.0008). None of the other organs studied (ie, spleen, pancreas, adrenal glands, stomach, colon, rectum) demonstrate significant changes in metabolism with advancing age. The metabolic volumetric product (calculated as the product of organ volume and mean organ SUV) of the liver and spleen does not change significantly with age. In conclusion, various abdominal organs demonstrate differential changes in volume, attenuation, and/or metabolism with increasing age in pediatric and adult populations.

Clinical anatomy and surgical skills training (CASST): development of a multicenter, multidisciplinary program.

OBJECTIVE: The aim of this program was to develop a multicenter, multidisciplinary anatomy and surgical skills training program for junior residents in obstetrics and gynecology and urology. STUDY DESIGN: After administering a needs assessment, we developed a collaborative clinical anatomy and surgical skills training program for junior residents in obstetrics and gynecology and urology at 3 academic medical centers in Chicago. RESULTS: Thirty-two residents participated in the program. Needs assessment results indicated that all residents felt they could benefit by more formal training in basic surgical skills. Learning objectives were developed for each of the 5 3-hour sessions that dealt with basic surgical skills, anterior abdominal wall anatomy, opening and closing the abdomen, female pelvic anatomy, and perineal anatomy and laceration repair. The cost of training each of the residents was approximately 600 dollars. Forty-five percent of the costs were one-time "start-up" costs for abdominal trainers and surgical instruments. CONCLUSION: By including multiple centers and disciplines, we were able to reduce costs of teaching basic surgical skills and anatomy and maximize faculty teaching time and effort.

Assessment of the patient with acute abdominal pain.

Abdominal pain has many causes, from simple to complex presentations. Patients with abdominal pain may have a number of physiological and psychological needs. Nurses have a key role to play in patient assessment, history taking and management.

Preventing overestimation of pixels in computed tomography assessment of visceral fat.

OBJECTIVE: Computed tomography (CT) is a common research procedure for measuring abdominal fat distribution, but little is written about the software used to analyze images. Our objective was to compare in-house and commercially available software for quantitative measurement of abdominal fat distribution. In the process, we encountered some unexpected problems. RESEARCH METHODS AND PROCEDURES: A total of 123 volunteers had single-slice abdominal CT images taken that were used to evaluate various aspects of the commercial image analysis program. RESULTS: The agreement between the commercial and in-house programs was excellent (r = 0.996, p < 0.00,001) for both total and intraabdominal fat, and we were able to reduce between-observer variability in measured fat areas through the use of statistical handling of region of interest information. We also noted that intracolonic contents sometimes had the same Hounsfield units as adipose tissue. We analyzed single-slice CT images from 50 volunteers to determine the potential impact of this effect on visceral fat area; the overestimate of visceral fat area was 19 +/- 22% (maximum, 112% overestimate). The commercial program could prevent this error, whereas our in-house program could not. DISCUSSION: We concluded that a readily available commercial image analysis program compares well with a previously validated in-house program and that it offers some advantages with respect to preventing overestimation of pixels as visceral fat.