Behavior stages of a physician- and coach-supported cloud-based diabetes prevention program for people with prediabetes.

INTRODUCTION: Centers for Disease Control and Prevention Diabetes Prevention Program recognition requires successful program completion by a cohort of at least five people with prediabetes. Such programs have generally been "in-person" and provided by a qualified coach from a recognized program. A cohort of 10 patients with prediabetes was enrolled in a physician's office to use the cloud-based Type II Diabetes Prevention Module in an effort to achieve recognition. Module use was supported by the physician and a qualified coach. The purpose of this article is to evaluate Module performance relative to behavior stages associated with long-term behavior modification. METHODS: The Module employs a web application supporting diabetes prevention education and a mobile application that is an electronic diary and virtual coach. A dashboard allows an efficient review of user performance and the ability to send users notifications of support from the user's coach or physician. The cohort of 10 patients with prediabetes was offered Module use upon diagnosis of prediabetes. RESULTS: All 10 patients with prediabetes offered Module use agreed participation. Six have completed educational sessions, made diary entries, and have met the 5% Centers for Disease Control and Prevention Diabetes Prevention Program weight loss target prior to 6 months of Module use. This high success rate (60%) is contrary to behavior stages often associated with long-term behavior modification. CONCLUSION: The strength of the physician-patient relationship appears to allow patients with prediabetes to skip or advance rapidly through behavioral stages in the process of lifestyle modification.

Fetal radiation dose during gestation estimated on an anthropomorphic phantom for three generations of CT scanners.

OBJECTIVE: The purpose of this study is to determine fetal dose during four different stages of pregnancy for both pulmonary CT angiogram and abdominal and pelvic CT examination on 4-, 16-, and 64-MDCT scanners measured in an anthropomorphic phantom simulating a pregnant patient. MATERIALS AND METHODS: Pulmonary angiograms and abdominal and pelvic studies were performed on a phantom on 4-, 16-, and 64-MDCT scanners. Fetal positioning and mean fetal depth were determined using data from ultrasound examinations of a large cohort of patients. Scans were performed for early pregnancy and for 10, 18, and 36 weeks. Gestational age, fetal dose, and entrance skin exposure were measured. RESULTS: When constant parameters were used for pulmonary CT angiograms, the fetal radiation dose was not significantly associated with gestational age. For abdominal examinations, the 64-MDCT scanner imparted a 20% higher dose during the third trimester than did the other scanners. When scanning parameters were kept constant between machines, gestational age and fetal dose were not significantly different. However, when the manufacturer-recommended protocols for pregnant patients were used, the dose was significantly higher in the third trimester on the 64-MDCT scanner. CONCLUSION: The 64-MDCT scanner is the most dose-efficient machine when the fetus is outside the direct scan volume, as in the case of pulmonary angiograms. For abdominal examinations, the 64-MDCT scanner imparted the highest fetal dose. This finding is attributable to the increased tube current used to penetrate the larger amount of soft tissue in late pregnancy. Abdominal shielding may reduce fetal dose without affecting diagnostic ability.

CT angiography with gadolinium-based contrast media.

RATIONALE AND OBJECTIVES: To evaluate the potential use of gadolinium (Gd)-based contrast media, especially that of Gadovist, a 1-molar Gd medium, in computed tomography (CT) and compare our findings with standard iodinated contrast media. MATERIAL AND METHODS: Using a live rabbit and an acrylic CT body phantom for comparative CT imaging of Gd- and I-based media. The images were acquired at 80, 100, and 120 kVp, using fixed standard beam filtration. The phantom study used serial dilutions of the Magnevist and Ultravist 300 (2.4-molar I), whereas the animal study used different volumes of Gadovist, Magnevist (0.5 molar Gd), and Ultravist administered intravenously. RESULTS: At 80 kVp for the same injection volumes of Gadovist and Ultravist, the image contrast enhancement of the aorta with Gadovist was 40% lower than that of Ultravist. In the phantom studies, however, for the same kVp settings the CT image contrast was up to fourfold higher for Gd compared with iodine when comparing the same molar concentrations of the two elements in the solutions. CONCLUSION: These results indicate a potential of Gd-based media for clinical CT angiography and provide incentive for further investigation of this subject.

Dynamic infrared imaging for the detection of malignancy.

The potential for malignancy detection using dynamic infrared imaging (DIRI) has been investigated in an animal model of human malignancy. Malignancy was apparent in images formed at the vasomotor and cardiogenic frequencies of tumour bearing mice. The observation of malignancy was removed by the administration of an agent that blocks vasodilation caused by nitric oxide (NO). Image patterns similar to those that characterize malignancy could be mimicked in normal mice using an NO producing agent. Apparently DIRI allows for cancer detection in this model through vasodilation caused by malignancy generated NO. Dynamic infrared detection of vasomotor and cardiogenic surface perfusion was validated in human subjects by a comparison with laser Doppler flowmetry (LDF). Dynamic infrared imaging technology was then applied to breast cancer detection. It is shown that dynamic infrared images formed at the vasomotor and cardiogenic frequencies of the normal and malignant breast have image pattern differences, which may allow for breast cancer detection.

Detection of breast malignancy: diagnostic MR protocol for improved specificity.

PURPOSE: To prospectively determine if a combined magnetic resonance (MR) protocol that includes T1-weighted dynamic contrast agent-enhanced (DCE) MR imaging, hydrogen 1 (1H) MR spectroscopy, and T2*-weighted perfusion MR imaging improves specificity in the diagnosis of breast cancer. MATERIALS AND METHODS: The combined MR imaging-MR spectroscopy protocol was performed in 50 patients after positive findings at mammography but prior to biopsy. Single-voxel proton MR spectroscopy and perfusion MR imaging were conducted only if DCE MR images showed rapid contrast enhancement in the lesion. Biopsy results were used as the reference for comparison with MR results and for calculation of sensitivity and specificity in the detection of breast malignancy. RESULTS: DCE MR imaging alone showed 100% sensitivity and 62.5% specificity. The specificity improved to 87.5% with the addition of 1H MR spectroscopy and to 100% with the further addition of perfusion MR imaging. Twenty-eight patients underwent both MR spectroscopy and perfusion MR imaging. Two patients underwent MR spectroscopy but declined to undergo perfusion MR imaging. The remaining 20 patients had negative results at DCE MR imaging and therefore did not undergo the additional examinations. CONCLUSION: The combined MR protocol of DCE MR imaging, 1H MR spectroscopy, and perfusion MR imaging has high sensitivity and specificity in the diagnosis of breast cancer.

Response of rat intracranial 9L gliosarcoma to microbeam radiation therapy.

Radiotherapeutic doses for malignant gliomas are generally palliative because greater, supposedly curative doses would impart clinically unacceptable damage to nearby vital CNS tissues. To improve radiation treatment for human gliomas, we evaluated microbeam radiation therapy, which utilizes an array of parallel, microscopically thin (<100 microm) planar beams (microbeams) of synchrotron-generated X rays. Rats with i.c. 9L gliosarcoma tumors were exposed laterally to a single microbeam, 27 pm wide and 3.8 mm high, stepwise, to produce irradiation arrays with 50, 75, or 100 microm of on-center beam spacings and 150, 250, 300, or 500 Gy of in-slice, skin-entrance, single-exposure doses. The resulting array size was 9 mm wide and 10.4 mm high (using three 3.8-mm vertical tiers); the beam's median energy was -70 keV. When all data were collated, the median survival was 70 days; no depletion of nerve cells was observed. However, when data from the highest skin-entrance dose and/or the smallest microbeam spacings were excluded, the median survival time of the subset of rats was 170 days, and no white matter necrosis was observed. Others have reported unilateral single-exposure broad-beam irradiation of i.c. 9L gliosarcomas at 22.5 Gy with a median survival of only -34 days and with severe depletion of neurons. These results suggest that the therapeutic index of unidirectional microbeams is larger than that of the broad beams and that an application for microbeam radiation therapy in treating certain malignant brain tumors may be found in the future.