Effectiveness of a case-based digital learning interprofessional workshop involving undergraduates in medical technology, radiological science, and physical therapy: A pre-post intervention study.

All healthcare professionals must understand information on a patient's biophysical functions, and it is important to educate professionals on how to use this information in an interprofessional team for diagnosis. However, there is little interprofessional education for students of medical technology and radiological science involved in biophysical function diagnosis. In the present study, we developed a case-based interprofessional learning tool for using biophysical information for diagnosis. The study examined the effects of a collaborative exercise workshop for healthcare professional students using the tool. Participants were 234 students from three healthcare professions (medical technology, radiological science, and physical therapy). They completed the Japanese version of the Readiness for Interprofessional Learning Scale before and after the workshops. The workshops incorporated digital materials that allowed students to examine the test results of a virtual patient, answer questions, and discuss their diagnoses and prognoses. For analysis, a two-way analysis of variance was performed on the total score on the Readiness for Interprofessional Learning Scale of the three departments, and the effectiveness of the workshop for the three departments was compared. Statistical analyses showed no interaction between time and department (p = 0.283). After the workshop, students from all three departments showed significant improvements in total scores on the Readiness for Interprofessional Learning Scale (p < 0.01) with medium to large effect sizes (r = 0.33-0.52). In the comparison between departments, there was a significant difference in the awareness levels of only medical technology and radiological science students before the workshop (p = 0.015). This study conducted case-based learning workshops with students from three departments, in which a patient's biophysical information was conveyed between occupational practices. The workshops improved the awareness of interprofessional education in students from all departments and revealed that interprofessional education is important for healthcare professions involved in biophysical function diagnosis.

Fast B1 Mapping Based on Double-Angle Method with T1 Correction Using Standard Pulse Sequence.

Radiofrequency (RF) field (B1) mapping by combining the double-angle method (DAM) and T1 correction was investigated. The signal intensities S1 and S2 acquired by flip angle (FA) α and double FA 2α at short repetition time (TR) were converted to a signal intensity at TR=∞ by T1 correction. Then, these were used for DAM calculation. The T1 values are measured from two different images acquired with different TRs based on the saturation recovery (SR) method preliminarily. The effects of imaging parameters for T1 estimation and measured FA were investigated using CuSO4-doped water phantoms. A two-dimensional gradient echo type echo planar imaging pulse sequence was used. T1 values obtained by the 2-SR method were underestimated compared to the multipoint inversion recovery method. FA error was less than 5% when the appropriate imaging parameters were used. The acquisition time could be shortened to under 25 s by the use of T1-corrected DAM.

The Progress of the Gait Impairment and Brain Activation in a Patient with Post-stroke Hemidystonia.

OBJECTIVE: We explore the effects of body weight-supported (BWS) treadmill training, including the change of cortical activation, on a patient with post-stroke hemidystonia. PATIENT: The patient was a 71-year-old man with left thalamus hemorrhage. His motor symptoms indicated slight impairment. There was no overactive muscle contraction in the supine, sitting, or standing positions. During his gait, the right initial contact was the forefoot, and his right knee showed an extension thrust pattern. These symptoms suggested that he had post-stroke hemidystonia. METHODS: The patient performed BWS treadmill training 14 times over 3 weeks. The effects of the BWS training were assessed by a step-length analysis, electromyography and functional magnetic resonance imaging (fMRI). RESULTS: The patient's nonparetic step length was extended significantly in the Inter-BWS (p<0.001) and Post-BWS (p=0.025) periods compared to the Pre-BWS session. The excessive muscle activity of the right gastrocnemius medialis in the swing phase was decreased at the Inter-BWS, Post-BWS, and follow-up compared to the Pre-BWS session. The peak timing difference of the bilateral tibialis anterior muscle became significant (p<0.05) on the first day of the intervention. The fMRI revealed that the cortical areas activated by the motor task converged through the intervention (p<0.05, family-wise error corrected). CONCLUSION: These results suggest that there was improvement of the patient's symptoms of post-stroke hemidystonia due to changes in the brain activity during voluntary movement after BWS intervention. Body weight-supported treadmill training may thus be an effective treatment for patients with poststroke hemidystonia.

The Area of Impingement in the Throwing Versus Nonthrowing Shoulder of Collegiate Baseball Players: An MRI Study of the Simulated Late-Cocking Phase of Throwing.

BACKGROUND: During shoulder abduction and external rotation, internal impingement can occur when compressive forces between the greater tuberosity and the posterior glenoid rim pinch the undersurface of the rotator cuff. Previous studies on internal impingement have focused on qualitative results such as pathological findings; however, few studies have quantified the area of impingement (AOI) of the rotator cuff muscles between the greater tuberosity and the posterior glenoid rim. PURPOSE: To compare the AOI between the throwing and nonthrowing shoulders of baseball players. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 14 asymptomatic male collegiate baseball players participated in this study. The AOI in both the throwing and the nonthrowing shoulders was calculated using magnetic resonance imaging (MRI) scans. The MRI measurements were collected with the shoulder at 90° of abduction and at 90° and 100° of external rotation. The area, width, and depth of impingement as well as cystic changes in the greater tuberosity and degeneration in the posterior labrum were compared between the throwing and nonthrowing shoulders. RESULTS: The AOI was significantly greater in the throwing shoulders than in the nonthrowing shoulders (90° of external rotation: 32.4 vs 19.1 mm2, respectively; 100° of external rotation, 28.0 vs 15.6 mm2, respectively; P < .001 for both). Compared with the nonthrowing shoulders, there were more positive findings in the throwing shoulders regarding greater tuberosity cystic changes (0 vs 7, respectively; P = .006) and posterior labral degeneration (3 vs 13, respectively; P < .001). CONCLUSION: The AOI and the number of lesions in the greater tuberosity and posterior labrum were greater in throwing shoulders than in nonthrowing shoulders. Therefore, damage to the insertion of the rotator cuff muscles may affect internal impingement. CLINICAL RELEVANCE: Lesions in the greater tuberosity and posterior labrum in throwing shoulders may increase the AOI by expanding the joint gap behind the glenohumeral joint. Impingement of the greater tuberosity and the posterior glenoid rim may lead to rotator cuff tears.

Investigation of inspiratory intercostal muscle activity in patients with spinal cord injury: a pilot study using electromyography, ultrasonography, and respiratory inductance plethysmography.

[Purpose] The respiratory function in patients with cervical spinal cord injury is influenced by inspiratory intercostal muscle function. However, inspiratory intercostal muscle activity has not been conclusively evaluated. We evaluated the inspiratory intercostal muscle activity in patients with cervical spinal cord injury by using inspiratory intercostal electromyography, respiratory inductance plethysmography, and ultrasonography. [Participants and Methods] Three patients with cervical spinal cord injury were assessed. The change in mean amplitude (rest vs. maximum inspiration) was calculated by using intercostal muscle electromyography. Changes in intercostal muscle thickness (resting expiration and maximum inspiration) were also evaluated on ultrasonography. The waveform was converted to spirometry ventilation with respiratory inductance plethysmography, and the waveform at the xiphoid was considered to determine the rib cage volume. Each index was compared with the inspiratory capacities in each case. [Results] Intercostal muscle electromyography failed to measure the notable myoelectric potential in all the patients. The rib cage volume was higher at higher inspiratory capacities. The changes in muscle thickness were not significantly different between the patients. [Conclusion] The rib cage volume (measured with inductance plethysmography) was greater in the patients with cervical spinal cord injury when inspiratory intercostal muscle activity was high. Respiratory inductance plethysmography can capture inspiratory intercostal muscle function in patients with cervical spinal cord injury.

Difference in sex and the effect of a dominant lower extremity in the posterior tibial slope angle in healthy Japanese subjects.

BACKGROUND/OBJECTIVE: Anterior cruciate ligament injuries are prone to re-injury, and it is crucial to prevent the primary injury. One of the anatomical risk factors for anterior cruciate ligament injury is the posterior tibial slope angle. Investigating the characteristics of healthy individuals with respect to the posterior tibial slope angle is important to elucidate the risk of developing anterior cruciate ligament injuries. The purpose of this study was to determine the characteristics related to sex and of the posterior tibial slope angle in healthy Japanese subjects, and the effect of the dominant lower extremity. METHODS: Sixty-two knees of 31 healthy Japanese college students (15 males and 16 females) were included in this study. Magnetic resonance images of both knee joints of the subjects were measured using a 0.3 T scanner. The medial and lateral posterior tibial slope angles were measured from the obtained magnetic resonance images. Magnetic resonance images of the knee joint of the dominant lower extremity were used to compare differences in sexes between the medial and lateral posterior tibial slope angles. Bilateral knee joint magnetic resonance images were used to compare the dominant and non-dominant lower extremities. Independent t-tests were used to compare the differences regarding sex in the medial and lateral posterior tibial slope angles and to compare the dominant and non-dominant lower extremities. RESULTS: A comparison of the mean lateral posterior tibial slope angle showed that males had a 8.8 ± 1.7° angle, while females had a 10.3 ± 2.2° angle, which was significantly greater (p = 0.047). There was no significant difference comparing the posterior tibial slope angle between the dominant and non-dominant lower extremities (p = 0.430). CONCLUSIONS: From the result of this study, the lateral posterior tibial slope angle was significantly higher in the female group than in the male group. However, both the medial and lateral posterior tibial slope angles were found to be unaffected by the dominant lower extremity.

Measurement of intercostal muscle thickness with ultrasound imaging during maximal breathing.

[Purpose] Determining the thickness of the intercostal muscle with ultrasound imaging would be a useful parameter in evaluating respiratory muscle activity in patients with tetraplegia and neuromuscular weakness. However, it has not been clarified whether ultrasound imaging can measure changes in intercostal muscle thickness during breathing. This study aimed to measure contractions of the human intercostal muscle in the anterior, lateral, and posterior parts with ultrasound imaging during maximal breathing. [Participants and Methods] The participants were 12 healthy males. Intercostal muscle thickness was measured using ultrasound at rest and at maximal breathing. The measurement sites were the anterior, lateral, and posterior portions of the right intercostal spaces. Statistical analysis was performed using a paired t-test comparing intercostal muscle thickness at rest and maximal breathing. [Results] The thickness of the intercostal muscle showed significant increases in the first, second, third, fourth, and sixth intercostal spaces of the anterior portions. There were no significant differences in the lateral or posterior portions between rest and maximal breathing. [Conclusion] Human intercostal muscle thickness can be measured with ultrasound and increases only in the anterior portions during maximal breathing.

Wide slab is useful for routine quality control of MRI slice thickness.

Although slice thickness accuracy is important for the performance of magnetic resonance imaging systems, long scan times are required to perform reliable measurements. Inclined slabs and wedges are conventionally used as test devices to obtain slice profiles. In this study, a novel dedicated device with a widened slab was created, and its efficacy was compared with that of a conventional wedge. The signal-to-noise ratio (SNR) of the profile and the coefficient of variation (CV) of the measured slice thickness were measured. Wide slab usage showed sufficient SNR by averaging multiple profile lines, even with single acquisition. Therefore, it is possible to substantially shorten the measurement time. When ≥ 20 lines were averaged, CV was < 1%. Furthermore, a 200-mm slab width enabled evaluation of the positional dependence of slice thickness in a single imaging. Thus, quality control of MRI slice thickness can be easily implemented with this device.

Effects of combined treatment with fermented soybean (natto) intake and exercise on bone metabolism in ovariectomized rats.

OBJECTIVES: Using ovariectomized rats, we examined the influence of combined exercise tolerance and natto intake on the bone loss inhibitory effect. METHODS: We divided female Wistar rats into the following groups: Ovariectomy, Ovariectomy + Exercise, Ovariectomy + Natto Intake, Ovariectomy + Exercise + Natto Intake, and Pseudo-operative (Sham group). After conducting experiments on each group, we collected the tissues and performed morphological and molecular biological analyses. RESULTS: In comparison with the Ovariectomy group, only in the Ovariectomy + Exercise group was there a significant bone loss inhibitory effect in the femoral cancellous bone. Although there was a tendency toward this trend seen in the Natto Intake and Exercise + Natto Intake groups, these differences were not significant. The increase in messenger RNA expression levels of alkaline phosphatase (osteoblast marker) in the bone marrow caused by ovariectomy was suppressed by individual factors, and by those in combination. However, messenger RNA expression levels of estrogen receptor alpha in the bone marrow showed a decreasing tendency with each factor, and decreased significantly with the combination, similar to the Sham group. CONCLUSION: This suggests that natto intake and exercise maintain bone mass by different molecular mechanisms and that these two factors do not simply act synergistically in combination to maintain bone mass.

Proposal of a New Index Based on Signal-to-Noise Ratio for Low-contrast Detectability in Computed Tomographic Imaging.

The low-contrast detectability of computed tomography (CT) images is commonly evaluated by the contrast-to-noise ratio (CNR) because of its convenience to measure. However, the correlation between CNR and visual detectability is poor because the CNR is a simple index determined by both the contrast of the object and the standard deviation of the image noise. On the other hand, the signal-to-noise ratio (SNR), especially SNR based on the statistical decision theory model (SNRS, D) and SNR based on the matched-filter model (SNRM) are considered superior to CNR. In this study, we investigated a new physical image quality index for evaluating low-contrast detectability (SNRA), which is approximately derived from SNRS, D and SNRM. The new index, which was calculated using the object size, contrast of the object and the noise power spectrum, provided good approximations when the diameter of the rod object was equal and >5 mm. The diameter dependency of the SNRA was also found to provide better sensitivity than the sensitivities of CNR and object-specific CNR, similar to SNRS, D and SNRM. The results suggested that the proposed convenient index should be useful for evaluating the low-contrast detectability of CT images.

Compression of the lungs by the heart in supine, side-lying, semi-prone positions.

[Purpose] Clarification of the differences in the compression volume of the lungs by the heart (CVLH) between postures may facilitate the selection of optimal postures in respiratory care. Determining CVLH in the supine, semi-prone (Sim's position), and side-lying positions was the aim of this study. [Subjects and Methods] Eight healthy volunteers (six males, two females; mean age, 29.0 ± 9.2 years) were enrolled in the study. Measurements were performed in the supine, right and left semi-prone, and right and left side-lying positions. semi-prone position was inclined 45° ventrally from the side-lying position. A 1.5-T system with a fast advanced spin-echo sequence in the coronal plane was used for magnetic resonance imaging. [Results] CVLH and heart compression ratio were significantly lower in the semi-prone position on both sides than the other positions. The heart was displaced ventrally when semi-prone and a larger area of the heart leaned on the ventral chest wall, localizing compression to part of the ventral region of the dependent lung. [Conclusion] The region of lungs compressed by the heart is reduced in the semi-prone position due to ventral displacement of the heart. These results suggest that maintaining expansion of the dependent lung is easier in the semi-prone position.

Regional lung volume differences between the side-lying and semi-prone positions.

[Purpose] This study aimed to clarify the differences in regional lung volume between the semi-prone (Sim's position) and side-lying position, and the optimal position for increasing lung volume. [Methods] Measurements were performed in both positions on both sides. Sim's position was inclined 45° forward from the side-lying position. A 1.5-T system with a fast advanced spin-echo sequence in the coronal plane was used for magnetic resonance imaging. [Results] The two positions did not significantly differ in total lung capacity and its subdivisions on both sides, except the left lung in the right side-lying position and right Sim's position. In the nondependent lung, the percentage lung volume of the dorsal segment was significantly higher in the right Sim's position than in the right side-lying position. However, no significant difference was observed between the left side-lying and left Sim's position. [Conclusion] The heart was displaced ventrally by gravity in Sim's position and leaned on the ventral parapet. The spaces for the expansion of the ventral and dorsal segments of the lung were decreased and increased in Sim's position, respectively. With a nondependent left lung, the increase in the percentage lung volume of the dorsal segment was greater in Sim's position than in the side-lying position.

Optimization of Look-Locker Turbo-Field Echo-Planar Imaging and Evaluation of Its Accuracy in Head and Neck 3D T1 Mapping.

PURPOSE: We present a sequence for T1 relaxation-time mapping that enables a rapid and accurate measuring. The sequence is based on the Look-Locker method by employing turbo-field echo-planar imaging (TFEPI) acquisitions and time to free relaxation after constant application of the radiofrequency (RF) pulses. We optimized the sequence, and then evaluated the accuracy of the method in imaging of head and neck. MATERIALS AND METHODS: The method was implemented on a standard clinical scanner, and the accuracy of the T1 value was evaluated against that with the two-dimensional (2D) inversion recovery method. RESULTS: The percentage errors of the T1 value, as validated by phantom imaging measurements, were 3.1% for slow-relaxing compartments (T1 = 2736 msec) and 1.1% for fast-relaxing compartments (T1 = 264.2 msec). CONCLUSION: We demonstrated a fast 3D sequence to obtain multiple slices, based on the Look-Locker method for T1 measurement, which provided a rapid and accurate way of measuring the spin-lattice relaxation time. An acquisition time of approximately 5 min was achieved for T1 mapping; in principle, this can provide head and neck coverage with 15 slices.

Optimization of inversion time for postmortem short-tau inversion recovery (STIR) MR imaging.

PURPOSE: Signal intensity and image contrast differ between postmortem magnetic resonance (PMMR) images and images acquired from the living body. We sought to achieve sufficient fat suppression with short-tau inversion recovery (STIR) PMMR imaging by optimizing inversion time (TI). MATERIAL AND METHODS: We subjected 37 deceased adult patients to PMMR imaging at 1.5 tesla 8 to 60 hours after confirmation of death and measured T1 values of areas of subcutaneous fat with relaxation time maps. Rectal temperature (RT) measured immediately after PMMR ranged from 6 to 31°C. We used Pearson's correlation coefficient to analyze the relationship between T1 and relaxation time (RT). We compared STIR images from 4 cadavers acquired with a TI commonly used in the living body and another TI calculated from the linear regression of T1 and RT. RESULTS: T1 values of subcutaneous fat ranged from 89.4 to 182.2 ms. There was a strong, positive, and significant correlation between T1 and RT (r = 0.91, P < 0.0001). The regression expression for the relationship was T1 = 2.6*RT + 90 at a field strength of 1.5T. The subcutaneous fat signal was suppressed more effectively with the optimized TI. CONCLUSION: The T1 value of subcutaneous fat in PMMR correlates linearly with body temperature. Using this correlation to determine TI, fat suppression with PMMR STIR imaging can be easily improved.

[Investigation of polymer gel dosimetry for small circular irradiated fields].

Polymer gels can be used as tissue equivalent dosimeters, and polymer gel dosimetry can be employed without perturbation of the radiation field. In this study, polymer gel dosimetry was used for small circular irradiation fields 10-30 mm in diameter using a radiation planning system. The irradiated gels were compared with planned data for a 50% dose width of 6 Gy dose maximum, and for the dose difference between gels and planned data over an 80% dose maximum area. The present study investigated magnetic resonance imaging (MRI) conditions based on an optimal dose-R2 calibration curve. The average difference between the full width half maximum of the 50% dose width between gels and planned data was 11%. The average dose difference over 80% of the dose was 5.6%. Optimal dose-R2 calibration curves were acquired using images with echo times of 30 and 60 ms. For cases of larger thicknesses and an increasing number of averages, the coefficients of variance of the curves were smaller than under other conditions. Compared to other traditional dosimetric tools, polymer gels have the advantage of providing three-dimensional dosimetric data. An arbitrary profile from the gel's data can be compared with the profile of the planned data. In the future, new gel dosimeters will be needed that demonstrate improved dose evaluation under 1 Gy and stability in high dose areas.

Feasibility of MR perfusion-weighted imaging by use of a time-spatial labeling inversion pulse.

Perfusion-weighted imaging (PWI) by use of arterial spin labeling (ASL) has been introduced to the clinical setting. However, it is not widely available because it requires specialized pulse sequences. Imaging using a time-spatial labeling inversion pulse (time-SLIP), which is a magnetic resonance angiography (MRA) technique that is based on ASL, can be used in various situations. In this study, we examined the feasibility of time-SLIP PWI. Two types of time-SLIP sequences were evaluated: (1) a single inversion recovery (IR) pulse sequence, which is the same as that used in conventional time-SLIP MRA except for the timing of data acquisition, and (2) a dual IR pulse sequence, where a second, non-selective, IR pulse was added during the inflow time to suppress background signals. Subtraction processing is performed between the "on" and "off" settings of the first IR pulse (time-SLIP tag) to obtain PWI. The average signal intensity was measured in a uniform phantom as the residual of the background, and in five healthy subjects as the perfusion signal. The average signal-to-noise ratio (SNR) was also measured in the five subjects. All imaging was performed with a 1.5-T MR scanner. Images using the dual IR method showed lower background signals and higher perfusion signals compared with images using the single IR method. However, the SNR was lower in images with the dual IR method. These results demonstrate that a time-SLIP, which is an MRA method, can be used for obtaining cerebral PWI simply by adjusting the imaging parameters.

Mirror observation of finger action enhances activity in anterior intraparietal sulcus: a functional magnetic resonance imaging study.

Mirror therapy can be used to promote recovery from paralysis in patients with post-stroke hemiplegia, There are a lot of reports that mirror-image observation of the unilateral moving hand enhanced the excitability of the primary motor area (M1) ipsilateral to the moving hand in healthy subjects. but the neural mechanisms underlying its therapeutic effects are currently unclear. To investigate this issue, we used functional magnetic resonance imaging to measure activity in brain regions related to visual information processing during mirror image movement observation. Thirteen healthy subjects performed a finger-thumb opposition task with the left and right hands separately, with or without access to mirror observation. In the mirror condition, one hand was reflected in a mirror placed above the abdomen in the MRI scanner. In the masked mirror condition, subjects performed the same task but with the mirror obscured. In both conditions, the other hand was held at rest behind the mirror. A between-task comparison (mirror versus masked mirror) revealed significant activation in the ipsilateral hemisphere in the anterior intraparietal sulcus (aIP) while performing all tasks, regardless of which hand was used. The right aIP was significantly activated while moving the right hand. In contrast, in the left aIP, a small number of voxels showed a tendency toward activation during both left and right hand movement. The enhancement of ipsilateral aIP activity by the mirror image observation of finger action suggests that bimodal aIP neurons can be activated by visual information. We propose that activation in the M1 ipsilateral to the moving hand can be induced by information passing through the ventral premotor area from the aIP.

[Comparison of detectability of liquid crystal displays (LCDs) and film using phantoms of small adenocarcinomas as abnormalities].

Following the trend of the digitalization of the modalities used for diagnostic imaging, the devices for such imaging have increasingly included monitors. The present study was undertaken to evaluate the usefulness of soft-copy (liquid crystal display; LCD) images of phantoms of small adenocarcinomas using receiver operating characteristic (ROC) analysis of two different display systems: LCD and hard copy (film). A two-tailed paired t-test and the jackknife method (parametric methods) were performed, and no significant differences were found in the area under the ROC curve (AUC) for the pulmonary fields, lungs, ribs, or mediastinum between the film and LCD display systems, and the detectability did not differ between the film and LCD monitors. A Mann-Whitney U test, which is a non-parametric method that applies to the analysis of a small sample, also showed no significant differences in the AUC. The results of this study suggest that LCDs can replace hard-copy film as a display system if the signals.

Time spatial labeling inversion pulse cerebral MR angiography without subtraction by use of dual inversion recovery background suppression.

Time-spatial labeling inversion pulse (time-SLIP), which is a technique of nonenhanced magnetic resonance angiography (MRA) based on arterial spin labeling (ASL), is used in various situations. Although subtraction between the images obtained with and without ASL is usually employed in cerebral time-SLIP MRA, to reduce the imaging time, dual inversion recovery (IR) has been applied for suppression of the background signals in this study. Appropriate timings for the 1st IR, 2nd IR, and the interval of data acquisition were investigated using computer simulation and a phantom experiment. With a short interval of data acquisition, the visibility of the simulated vessel was inadequate because replacement of the suppressed flow was insufficient. With a long interval of data acquisition, the contrast between the vessel and background was reduced. The reasons for this appeared to be the following: the longitudinal magnetization of the replaced flow is reduced because of the prolonged 2nd inversion time, causing a mismatch of the null point between the calculated and the actual values to become prominent. As a result, 3-4 s seemed to be an appropriate interval for data acquisition. Sufficient angiographic information could be obtained by use of dual IR background suppression in a volunteer study. With this technique, cerebral time-SLIP MRA can be performed in half of the imaging time required with the conventional subtraction technique.