Shoring up the industry's valuations.

A simple option-pricing strategy to identify investment opportunities may enable companies to increase valuations and bolster shareholder value.

Observation of nonlinear optical phenomena in air and fused silica using a 100 GW, 1.54 mum source.

A 100-GW optical parametric chirped-pulse amplifier system is used to study nonlinear effects in the 1.54 mum regime. When focusing this beam in air, strong third-harmonic generation (THG) is observed, and both the spectra and efficiency are measured. Broadening is observed on only the blue side of the third-harmonic signal and an energy conversion efficiency of 0.2% is achieved. When propagated through a 10-cm block of fused silica, a collimated beam is seen to collapse and form multiple filaments. The measured spectral features span 400-2100 nm. The spectrum is dominated by previously unobserved Stokes emissions and broad emissions in the visible.

Three-dimensional fetal echocardiography.

The complex anatomy and dynamics of the heart make it a challenging organ to image. The fetal heart is particularly difficult because it is located deep within the mother's abdomen and direct access to electrocardiographic information is difficult. Thus more complex imaging and analysis methods are necessary to obtain information regarding fetal cardiac anatomy and function. This information can be used for medical diagnosis, model development and theoretical validation. The objective of this article is to provide scientists and engineers with an overview of three-dimensional fetal echocardiography.

Usefulness of gated three-dimensional fetal echocardiography to reconstruct and display structures not visualized with two-dimensional imaging.

Cardiac-gated 3-dimensional fetal echocardiography can reconstruct and display cardiac structures and views not visualized with conventional 2-dimensional ultrasonography. This new technique may become an integral part of screening ultrasonography, complementing 2-dimensional fetal echocardiography when real-time imaging is incomplete.

Fractals. Physiologic complexity, scaling, and opportunities for imaging.

Fractal organization and behavior is an important and ubiquitous feature of biologic systems. Recognition of the properties and scaling relations can yield important clues regarding the underlying anatomy and physiology of most organs. Potential applications are many, and this brief article has considered only a few areas where there has been progress to date. Recognition of the importance of physiologic scaling has application regarding: proper extrapolation of drug doses from laboratory to human; understanding body mass and surface area relationships related to growth and development; the kinetics of basic biochemical reactions; stress-strain relationships of osteostructural development; and numerous other important processes. As imagers with access to a wide range of sophisticated instrumentation employing diverse probes to extract anatomic, and increasingly physiologic, information, radiologists are poised to use the features of fractals and nonlinear processes to expand the scope and precision of diagnostic information available for patient care.

Effect of patient imaging angle on apparent cardiac volumes and the potential impact on measurement of valvular regurgitant fractions.

The accurate measurement of cardiac chamber volume is of major importance in assessing cardiac performance. Accurate equilibrium radionuclide volume estimations are difficult to obtain, due to the geometry of the chambers, and the physical characteristics of the imaging system. The purpose of this study was to examine the effects of imaging projections on relative cardiac chamber volumes, indexes, and stroke volume ratios. Twenty-two male patients, free of clinical evidence of disease, were studied. A series of four 2-minute acquisitions were made with the patient successively imaged in the anterior, 30 degrees left anterior oblique (LAO), 45 degrees LAO, and 60 degrees LAO projections with 15 degrees of caudal inclination. Filtered stroke volume and original images were used by the operator to assign right ventricular (RV), left ventricular (LV), and a combined right and left ventricular (TOT) regions-of-interest. From the data we determined end-diastolic counts (EDC), end-systolic counts (ESC), stroke counts (SC), ejection fractions (EF), and R/L stroke count ratios. The following changes were observed as the projection was moved from the anterior to 60 degrees LAO: 1) all RV parameters decreased in value, including, RVEDC (P less than .001), RVESC (P less than .01), RVESC (P less than .01) and RVEF (P less than .001); 2) LVEDC and LVESC (both P less than .01) increased while LVEF decreased (P less than .004); and 3) the R/L stroke count ratio decreased (P less than .001). Variability could be explained by 1) chamber overlap and geometry; 2) patient variability; and 3) intrachamber, interchamber and chest wall photon attenuation and scatter. We suggest that close attention to detail, with computer assistance, to optimally position the patient may reduce the effect of inherent limitations in radionuclide volumetric measurements, thus improving the reliability and usefulness of existing studies.

AUR Memorial Award 1992. Quantification of amino acids in human body fluids by 1H magnetic resonance spectroscopy. A specific test for the identification of abscess.

RATIONALE AND OBJECTIVES: When polymorphonucleocytes are incubated in proteinaceous fluid, they cause extensive protein degradation, which leads to accumulation of free amino acids. The authors tested whether these free amino acids, particularly valine and leucine, also accumulate in human abscess fluids, but not in other body fluids, and thus could be a specific and distinguishing marker for the presence of an abscess. METHODS: Thirty fluids, obtained by percutaneous drainage from 28 patients, were lyophilized and reconstituted in 2H2O before in vitro 1H magnetic resonance (MR) spectroscopy. Concentrations of valine and leucine were determined by comparison of spectra before and after addition of known amounts of valine and leucine. Two chart reviewers, blinded to the spectroscopic results, categorized cases as abscess (n = 14), non-abscess (n = 15), or infection but not abscess (n = 1). RESULTS: The concentration of valine and leucine was significantly higher in the abscess fluids, 2.57 +/- 1.90 mM than in the non-abscess fluids, 0.25 +/- 0.33 mM (P < .001). The one infected fluid which was not an abscess had no amino acids. Using 0.8 mM as the threshold concentration of valine and leucine necessary for the diagnosis of abscess resulted in a sensitivity rate of 86% and a specificity rate of 94%. CONCLUSION: The authors conclude that identification of high concentrations of valine and leucine by 1H MR spectroscopy may be a specific test for the diagnosis of abscess. This technique merits further investigation in vivo.

Automatic analysis of left ventricular ejection fraction using stroke volume images.

The purpose of this study was to analyze, validate, and report on an automatic computer algorithm for analyzing left ventricular ejection fraction and to indicate future applications of the technique to other chambers and more advanced measurements. Thirty-eight patients were studied in the cardiac catheterization laboratory by equilibrium radionuclide ventriculography and concurrent contrast ventriculography. The temporal and spatial behavior of each picture element in a filtered stroke volume image series was monitored throughout the cardiac cycle. Pixels that met specific phase, amplitude, and derivative criteria were assigned to the appropriate chamber. Volume curves were generated from regions of interest for each chamber to enable calculation of the left ventricular ejection fraction. Left ventricular ejection fractions showed a good correlation (r = 0.89) between the two techniques. Ejection fractions ranged between 0.12 and 0.88, showing a wide range of application. It is concluded that automatic analysis of left ventricular ejection fraction is possible using the present algorithm and will be useful in improving the reproducibility and providing more accurate information during exercise protocols, pharmaceutical interventions, and routine clinical studies.

Three-dimensional ultrasound of the fetal spine.

OBJECTIVE: To describe normal fetal spinal anatomy displayed by three-dimensional ultrasound and to determine whether three-dimensional ultrasound improves visualization of specific spinal defects. METHODS: Fetuses (n = 28) (16 normal and 12 abnormal) were examined on standard two- and three-dimensional sonographic equipment. RESULTS: In 15 of 16 normal fetuses, the spine was visualized at least from the upper thoracic area to the lower sacrum in a single three-dimensional image, and in 14 normal fetuses continuity of the ribs and spine was depicted. Neural tube defects were identified on both two- and three-dimensional ultrasounds; however, three-dimensional ultrasound displayed the level of the defect more accurately in three of the five cases. Scoliosis was recognized easily on a single three-dimensional rendered image, whereas several two-dimensional redered image, whereas several two-dimensional images were needed for the examiner mentally to reconstruct the scoliosis. CONCLUSION: Three-dimensional ultrasound may become an important tool for imaging of the fetal spine. Additional studies are necessary to determine the efficacy and cost effectiveness of this technology. However, our preliminary data suggest that presentation of the spine as a continuous structure rather than in independent two-dimensional views makes visualization of the spatial relationship of the spinal anatomy and adjacent structures easier. The ability to review the volume data using techniques not available on two-dimensional ultrasound may enable physicians to determine the extent of neural tube defects with more accuracy.

A comprehensive analysis of DgN(CT) coefficients for pendant-geometry cone-beam breast computed tomography.

The use of a computed tomography (CT) scanner specifically designed for breast imaging has been proposed by several investigators. In this study, the radiation dose due to breast CT was evaluated using Monte Carlo techniques over a range of parameters pertinent to the cone-beam pendant geometry thought to be most appropriate. Monte Carlo dose computations were validated by comparison with physical measurements made on a prototype breast CT scanner under development in our laboratory. The Monte Carlo results were then used to study the influence of cone angle, the use of a beam flattening ("bow-tie") filter, glandular fraction, breast length and source-to-isocenter distance. These parameters were studied over a range of breast diameters from 10 to 18 cm, and for both monoenergetic (8-140 keV by 1 keV intervals) and polyenergetic x-ray beams (30-100 kVp by 5 kVp intervals. Half value layer at 80 kVp = 5.3 mm Al). A parameter referring to the normalized glandular dose in CT (DgN(CT)) was defined which is the ratio of the glandular dose in the breast to the air kerma at isocenter. There was no significant difference (p = 0.743) between physically measured and Monte Carlo derived results. Fan angle, source-to-isocenter distance, and breast length have relatively small influences on the radiation dose in breast CT. Glandular fraction (0% versus 100%) for 10 cm breasts at 80 kVp had approximately a 10% effect on DgN(CT), and a 20% effect was observed for an 18 cm breast diameter. The use of a bow-tie filter had the potential to reduce breast dose by approximately 40%. X-ray beam energy and breast diameter had significant influence on the DgN(CT) parameters, with higher DgN(CT) values for higher energy beams and smaller breast diameters. DgN(CT) values (mGy/mGy) at 80 kVp ranged from 0.95 for an 8 cm diam 50% glandular breast to 0.78 for an 18 cm 50% glandular breast. The results of this investigation should be useful for those interested computing the glandular breast dose for geometries relevant to dedicated breast CT.

Three-dimensional ultrasound in obstetrics and gynecology.

Three-dimensional ultrasound is a new modality finding its way into clinical practice. Most of the major ultrasound vendors are now developing three-dimensional ultrasound capabilities. We expect that although three-dimensional ultrasound will not replace two-dimensional ultrasound, many additional benefits will be identified and its use will continue to grow. The ability to evaluate anatomy and pathology with multiplanar and surface-rendered images provides physicians additional valuable clinical information. Volume data allows for a specific point in space to be evaluated from many different orienta tions by rotating, slicing, and referencing the slice to other orthogonal slices. It also allows for new volume-rendering displays that show depth, curvature, and surface images not available with conventional methods. The current limitations of image resolution, intuitive interfaces for obtaining and displaying optimal images, and technologic limitations for data storage and manipulation (including real-time three-dimensional ultrasound) will surely be overcome in the near future.

Students' educational activities during clerkship.

PURPOSE: To quantify the educational activities and types of teachers that medical students had in third-year clerkships at community-based teaching hospitals. METHOD: In October-November 1992, 201 students in third-year medical clerkships at nine community-based hospitals completed a log that recorded the primary activity, site, and educator and method of education (for teaching or supervised activities) for each 15-minute interval of a 24-hour day. Each hospital offered at least three of the clerkships studied: medicine, obstetrics-gynecology (ob-gyn), pediatrics, psychiatry, and surgery. Statistical comparisons of the clerkships were done with chi-square analysis and one-way analysis of variance. RESULTS: The students received 6.5 hours a day of teaching with an instructor and committed an additional 4.9 hours to clerkship-related learning. Nearly 75% of the teaching fell to full-time faculty members and residents. In just over half of their educational activities the students participated with other learners, such as residents. The clerkships did not differ significantly in the amounts of formal teaching given; however, medicine did significantly more informal teaching, and surgery and ob-gyn did significantly more supervised practice. CONCLUSION: This preliminary study quantified medical students' educational activities in 1992 during third-year clerkships and provides baseline data describing these activities and the educators involved. Some findings may not be replicable, however, with the increasing demands of full-time faculty members in inpatient and outpatient settings and the shifting emphases in how and where residents provide instruction. Another study such as this one would help assess the effects on medical education of changes in the health care environment.

Modeling of lung morphogenesis using fractal geometries.

The fractal dimension (D(F)) is one measure of the space-filling features of a self-similar structure. Additionally, since D(F) varies with branching level, there may be potential critical locations that are functionality important. The authors introduce an algorithm that models lung airway structures and uses computer simulations of growth based on fractal concepts. Under these conditions, limits imposed by simple boundary constraints generate structures that are in good agreement with actual morphometric data.

Visualization of the cerebral circulation using three-dimensional transcranial power Doppler ultrasound imaging.

The purpose of this study was to evaluate the anatomy of the cerebral circulation, particularly the circle of Willis, using three-dimensional ultrasound (3DUS) imaging. Image data were obtained through the right transtemporal window from 8 young, healthy volunteers by acquiring gray-scale and color Doppler spectral (CDI) and energy (CDE) images using two-dimensional ultrasound equipment with a 2-MHz probe. Images and transducer position coordinates were fed into a graphics workstation, reprojected, analyzed to extract the blood flow signal, volume rendered, and displayed interactively. The architecture of the cerebral circulation was evaluated from multiple orientations using stereo viewing glasses and rotation to enhance the understanding of vessel position. The primary vessels of the cerebral circulation including the circle of Willis and bilateral views of the branching arteries (middle, anterior, and posterior cerebral arteries and internal carotid artery) could be imaged readily with 3DUS through one transtemporal window. Acquisition time was typically less than 30 seconds. Volume-rendering methods greatly assisted in showing the overall spatial relationships and continuity of cranial vessels. Secondary branches of the cerebral arteries were seen in 2 patients. Color data from two-dimensional ultrasound imaging that otherwise might be identified as artifact was found to represent continuous small vessels on three-dimensional viewing. 3DUS facilitates imaging of cranial vascular anatomy by clarifying overall spatial relationships and enhancing comprehension, compared to two-dimensional ultrasound methods. The method is rapid and the circle of Willis can be visualized from one side of the head.

Temperature dependence of proton relaxation times in vitro.

Accurate measurement of tissue relaxation characteristics is dependent on many factors, including field strength and temperature. The purpose of this study was to evaluate the relationship between sample temperature, viscosity and proton spin-lattice relaxation time (T1) and spin-spin relaxation time (T2). A review of two basic models of relaxation the simple molecular motion model and the fast exchange two state model is given with reference to their thermal dependencies. The temperature dependence for both T1 and T2 was studied on a 0.15 Tesla whole body magnetic resonance imager. Thirteen samples comprising both simple and complex materials were investigated by using a standard spin-echo (SE) technique and a modified Carr-Purcell-Meiboom-Gill (CPMG) multi-echo sequence. A simple linear relationship between T1 and temperature was observed for all samples over the range of 20 degrees C to 50 degrees C. There is an inverse relationship between viscosity and T1 and T2. A quantity called the temperature dependence coefficient (TDC) is introduced and defined as the percent rate of change of the proton relaxation time referenced to a specific temperature. The large TDC found for T1 values, e.g. 2.37%/degrees C for CuSO4 solutions and 3.59%/degrees C for light vegetable oils at 22 degrees C, indicates that a temperature correction should be made when comparing in-vivo and in-vitro T1 times. The T2 temperature dependence is relatively small.

The effect of dexamethasone on tissue water distribution and proton relaxation in Panc02 tumors.

The present experiments were conducted to determine the effects of dexamethasone mediated changes in tumor water distribution on proton relaxation times (T1, T2) in a murine pancreatic adenocarcinoma (Panc02). Spin lattice (T1) and spin-spin(T2) relaxation times were determined by ex vivo methods (10 MHz) and by in vivo imaging techniques (6.25 MHz) at various intervals after single or multiple dexamethasone treatments. In complementary studies, dexamethasone mediated changes in tumor capillary permeability, tumor water distribution, relative tumor blood flow and tumor cell proliferation were also determined. Proton spin lattice (T1) and spin-spin (T2 relaxation times for Panc02 tumors shortened within two hours of a single dexamethasone treatment. The time course and magnitude of this response was dexamethasone dose dependent. The time dependent changes in T1 and T2 after dexamethasone were similar at 10 MHz (ex vivo) and 6.25 MHz (in vivo imaging). Although dexamethasone produced little or no change in total tumor water content and tumor cell proliferation, transient changes in the physiologic distribution of tumor water were clearly demonstrated. The data supports the idea that dexamethasone induced changes in the distribution of tumor water were mediated by changes in capillary permeability and tumor blood flow. These physiologic responses produced serial changes in tumor extracellular extravascular water content that were consistent with the observed changes in tumor T1 and T2. The results from these experiments might imply that therapy associated changes in tumor proton relaxation times may not only reflect changes in tissue water content, but may also reflect physiologic responses which alter the distribution of tissue water and solute.

Optimizing tissue contrast in magnetic resonance imaging.

Magnetic resonance imaging demands that tissue contrast and signal-to-noise advantages be sought in each component of the imaging system. One component of magnetic resonance imaging in which contrast and signal-to-noise ratios are easily manipulated is in the choice of pulse sequences and interpulse delay times. This article provides a general method for determining the best choices of interpulse delay times in pulse sequences and applies that method to saturation recovery, inversion recovery, and spin-echo sequences. Saturation recovery and inversion recovery sequences with rephasing pulses, and tissues with unequal hydrogen densities are considered. Optimization of pulse sequences is carried out for the two distinct cases of (a) a fixed number of sequence repetitions and (b) a fixed total imaging time. Analytic expressions are derived or approximate expressions are provided for the interpulse delay times that optimize contrast-to-noise ratios in each pulse sequence. The acceptable range of interpulse delay times to obtain reasonable contrast using each pulse sequence is discussed.

Phase detection and contrast loss in magnetic resonance imaging.

Several recent articles have assessed the relative efficiency of nuclear magnetic resonance (NMR) pulse sequences. One consideration that has received little attention is the effect on image contrast of displaying images without information on the sign of the reconstructed signals. The radiofrequency receivers currently used on most NMR imaging systems are quadrature detectors that preserve both the magnitude and sign of the NMR signal. Usually, however, sign or phase information is not used in the final image presentation. We point out that in imaging sequences that may have negative signals, such as inversion recovery, this loss of sign information produces a reduction in contrast between some tissues in an NMR image. We discuss the tissue parameters and interpulse delay times that result in contrast loss in inversion recovery and indicate the extent of contrast loss. We point out that for some tissues with unequal hydrogen spin densities, the region of contrast loss coincides with the region where maximum contrast would occur if sign information were preserved.

Selection of pulse sequences producing maximum tissue contrast in magnetic resonance imaging.

The importance of spin density [N(H)] and spin-lattice (T1) and spin-spin (T2) relaxation in the characterization of tissue by nuclear magnetic resonance (NMR) is clearly recognized. This work considers which optimized pulse sequences provide the best tissue discrimination between a given pair of tissues. The effects of tissue spin density and machine-imposed minimum rephasing echo times (TEMIN) for achieving maximum signal tissue contrast are discussed. A long TEMIN sacrifices T1-dependent contrast in saturation recovery (SR) and inversion recovery (IR) pulse sequences so that spin-echo (SE) becomes the optimum sequence to provide tissue contrast, due to T2 relaxation. Pulse sequences providing superior performance may be selected based on spin density and T1 and T2 ratios for a given pair of tissues. Selection of the preferred pulse sequence and interpulse delay times to produce maximum tissue contrast is strongly dependent on knowledge of tissue spin densities as well as T1 and T2 characteristics. As the spin density ratio increases, IR replaces SR as the preferred sequence and SE replaces IR and SR as the pulse sequence providing superior contrast. To select the optimal pulse sequence and interpulse delay times, an accurate knowledge of tissue spin density, T1 and T2 must be known for each tissue.

Fluorine nuclear magnetic resonance: calibration and system optimization.

Fluorine-19 magnetic resonance imaging (MRI) offers advantages for imaging organs and tissues. 19F is readily synthesized into a variety of compounds and offers the potential for in-vivo imaging as a complement to hydrogen MRI. The purpose of this work was to determine the minimum detection sensitivity for a fluorinated compound (CF3-CO2H) as a function of pulse sequence, interpulse times (TE, TI, and TR), gradient values and the number of data averages. CF3-CO2H was chosen because it has a single spectral line and exhibits a minimal frequency shift under the experimental conditions used for this experiment. A resistance MR scanner operating at a resonance frequency of 6.255 MHz was used for imaging both fluorine (.156 T) and hydrogen (.147 T). Critical factors determining the minimum detection sensitivity included system signal-to-noise ratio (S/N), acquisition time, relaxation times (T1, T2), and sample volume. Samples were measured over the range of 0.05 M to 20.0 M and showed a linear relationship between signal strength and concentration. The minimum detection sensitivity was 0.1 M. Use of higher static fields and optimized coils as well as improved system signal-to-noise ratios will improve detection sensitivity. We conclude that imaging of fluorine on low-field system is feasible, although it is necessary to optimize many parameters to maximize detection sensitivity.