Diagnostic Performance in Low- and High-Contrast Tasks of an Image-Based Denoising Algorithm Applied to Radiation Dose-Reduced Multiphase Abdominal CT Examinations.

BACKGROUND. Anatomic redundancy between phases can be used to achieve denoising of multiphase CT examinations. A limitation of iterative reconstruction (IR) techniques is that they generally require use of CT projection data. A frequency-split multi-band-filtration algorithm applies denoising to the multiphase CT images themselves. This method does not require knowledge of the acquisition process or integration into the reconstruction system of the scanner, and it can be implemented as a supplement to commercially available IR algorithms. OBJECTIVE. The purpose of the present study is to compare radiologists' performance for low-contrast and high-contrast diagnostic tasks (i.e., tasks for which differences in CT attenuation between the imaging target and its anatomic background are subtle or large, respectively) evaluated on multiphase abdominal CT between routine-dose images and radiation dose-reduced images processed by a frequency-split multiband-filtration denoising algorithm. METHODS. This retrospective single-center study included 47 patients who underwent multiphase contrast-enhanced CT for known or suspected liver metastases (a low-contrast task) and 45 patients who underwent multiphase contrast-enhanced CT for pancreatic cancer staging (a high-contrast task). Radiation dose-reduced images corresponding to dose reduction of 50% or more were created using a validated noise insertion technique and then underwent denoising using the frequency-split multi-band-filtration algorithm. Images were independently evaluated in multiple sessions by different groups of abdominal radiologists for each task (three readers in the low-contrast arm and four readers in the high-contrast arm). The noninferiority of denoised radiation dose-reduced images to routine-dose images was assessed using the jackknife alternative free-response ROC (JAFROC) figure-of-merit (FOM; limit of noninferiority, -0.10) for liver metastases detection and using the Cohen kappa statistic and reader confidence scores (100-point scale) for pancreatic cancer vascular invasion. RESULTS. For liver metastases detection, the JAFROC FOM for denoised radiation dose-reduced images was 0.644 (95% CI, 0.510-0.778), and that for routine-dose images was 0.668 (95% CI, 0.543-0.792; estimated difference, -0.024 [95% CI, -0.084 to 0.037]). Intraobserver agreement for pancreatic cancer vascular invasion was substantial to near perfect when the two image sets were compared (κ = 0.53-1.00); the 95% CIs of all differences in confidence scores between image sets contained zero. CONCLUSION. Multiphase contrast-enhanced abdominal CT images with a radiation dose reduction of 50% or greater that undergo denoising by a frequency-split multiband-filtration algorithm yield performance similar to that of routine-dose images for detection of liver metastases and vascular staging of pancreatic cancer. CLINICAL IMPACT. The image-based denoising algorithm facilitates radiation dose reduction of multiphase examinations for both low- and high-contrast diagnostic tasks without requiring manufacturer-specific hardware or software.

Running red lights: Risk recognition versus follow-up implementation in the case of Germany's pandemic preparation.

The discrepancy between formal arrangements to ensure health security, as assessed in the Global Health Security Index, and COVID-19 outcomes points to a broader problem where formal risk recognition is de-coupled from potentially resource-intensive follow-up policy implementation. Germany is an extreme example of this. Pre-COVID-19, Germany's Federal Office of Civilian Protection conducted two pandemic preparation exercises based on scenarios which closely mirrored the current COVID-19 pandemic: (a) a multi-jurisdictional, multi-agency crisis management exercise assuming a global influenza pandemic and (b) a joint federal and expert-agency based risk-analysis assuming the outbreak of a modified severe acute respiratory symptom virus. While informing legal and institutional reforms, key recommendations on storing personal protective equipment (PPE) and disinfectants for front-line staff were subsequently ignored. PPE shortages initially put staff at risk, led to export restrictions on PPE, and later on hampered the country's ability to address a second wave of the pandemic. This short paper calls for a fuller exploration of factors which hinder ''implementation post-cognition.''.

Autotrophic lactate production from H2 + CO2 using recombinant and fluorescent FAST-tagged Acetobacterium woodii strains.

Lactate has various uses as industrial platform chemical, poly-lactic acid precursor or feedstock for anaerobic co-cultivations. The aim of this study was to construct and characterise Acetobacterium woodii strains capable of autotrophic lactate production. Therefore, the lctBCD genes, encoding the native Lct dehydrogenase complex, responsible for lactate consumption, were knocked out. Subsequently, a gene encoding a D-lactate dehydrogenase (LDHD) originating from Leuconostoc mesenteroides was expressed in A. woodii, either under the control of the anhydrotetracycline-inducible promoter Ptet or under the lactose-inducible promoter PbgaL. Moreover, LDHD was N-terminally fused to the oxygen-independent fluorescence-activating and absorption-shifting tag (FAST) and expressed in respective A. woodii strains. Cells that produced the LDHD fusion protein were capable of lactate production of up to 18.8 mM in autotrophic batch experiments using H2 + CO2 as energy and carbon source. Furthermore, cells showed a clear and bright fluorescence during exponential growth, as well as in the stationary phase after induction, mediated by the N-terminal FAST. Flow cytometry at the single-cell level revealed phenotypic heterogeneities for cells expressing the FAST-tagged LDHD fusion protein. This study shows that FAST provides a new reporter tool to quickly analyze gene expression over the course of growth experiments of A. woodii. Consequently, fluorescence-based reporters allow for faster and more targeted optimization of production strains.Key points •Autotrophic lactate production was achieved with A. woodii. •FAST functions as fluorescent marker protein in A. woodii. •Fluorescence measurements on single-cell level revealed population heterogeneity.

Induced heterologous expression of the arginine deiminase pathway promotes growth advantages in the strict anaerobe Acetobacterium woodii.

The advantage of using acetogens such as Acetobacterium woodii as biocatalysts converting the cheap substrate and greenhouse gas carbon dioxide (CO2) into value-added chemicals comes together with the disadvantage of a low overall ATP gain due to the bioenergetics associated with the Wood-Ljungdahl pathway. Expanding the product spectrum of recombinant A. woodii strains to compounds with high ATP-demanding biosynthesis is therefore challenging. As a least invasive strategy for improved ATP generation, the exploitation of the arginine deiminase pathway (ADI) was examined under native conditions and via using heterologously expressed genes in A. woodii. Several promoters were analyzed for application of different gene expression levels in A. woodii using ß-glucuronidase assays. Heterologous expression of the ADI pathway genes from Clostridium autoethanogenum was controlled using either the constitutive pta-ack promoter from Clostridium ljungdahlii or a tightly regulated tetracycline-inducible promoter Ptet. Unlike constitutive expression, only induced expression of the ADI pathway genes led to a 36% higher maximal OD600 when using arginine (OD600 3.4) as nitrogen source and a 52% lower acetate yield per biomass compared to cells growing with yeast extract as nitrogen source (OD600 2.5). In direct comparison, a 69% higher maximal OD600 and about 60% lower acetate yield per biomass in induced to non-induced recombinant A. woodii cells was noticed when using arginine. Our data suggests the application of the ADI pathway in A. woodii for expanding the product spectrum to compounds with high ATP-demanding biosynthesis.

Bacterial Anaerobic Synthesis Gas (Syngas) and CO2+H2 Fermentation.

Anaerobic bacterial gas fermentation gains broad interest in various scientific, social, and industrial fields. This microbial process is carried out by a specific group of bacterial strains called acetogens. All these strains employ the Wood-Ljungdahl pathway but they belong to different taxonomic groups. Here we provide an overview of the metabolism of acetogens and naturally occurring products. Characteristics of 61 strains were summarized and selected acetogens described in detail. Acetobacterium woodii, Clostridium ljungdahlii, and Moorella thermoacetica serve as model organisms. Results of approaches such as genome-scale modeling, proteomics, and transcriptomics are discussed. Metabolic engineering of acetogens can be used to expand the product portfolio to platform chemicals and to study different aspects of cell physiology. Moreover, the fermentation of gases requires specific reactor configurations and the development of the respective technology, which can be used for an industrial application. Even though the overall process will have a positive effect on climate, since waste and greenhouse gases could be converted into commodity chemicals, some legislative barriers exist, which hamper successful exploitation of this technology.

The Role of Mosquitoes in the Diet of Adult Dragon and Damselflies (Odonata).

The flood plains of the Upper Rhine Valley provide excellent conditions for the proliferation of mosquitoes as well as for the development of dragon and damselflies. It could be assumed that mosquitoes belong to the diet of the Odonata and that the latter could be harmed by the reduction of the mosquito population with the purpose of diminishing the massive nuisance for the people living there. A total of 41 adult dragonflies and damselflies were examined by immunoblot for remnants of mosquitoes in their guts. A rabbit antiserum against Aedes vexans proteins was used for the immunoblot. Only 3 Aeshna cyanea and 1 Platycnemis pennipes could be shown to have fed on mosquitoes. In specimens of the genus Sympetrum no mosquitoes were detected. It seems very doubtful that mosquitoes are an essential part of the Odonata diet.

The tumour suppressor DiRas3 interacts with C-RAF and downregulates MEK activity to restrict cell migration.

BACKGROUND INFORMATION: The mitogenic pathway, composed of RAF kinases, mitogen-activated protein kinase kinases (MEK) and extracellular signal-regulated kinases (ERK), promotes cell proliferation and migration and is upregulated in many tumours. DiRas3 (ARHI, Noey2), a mainly GTP-bound Ras-like protein with an unusual N-terminal extension, is predominantly lost in ovarian and breast cancers. Its re-expression in these tissues impairs cell proliferation, autophagy, apoptosis and cell migration. Further, loss of DiRas3 correlates with an increase in growth factor-induced ERK phosphorylation. Therefore, DIRAS3 proves to be a curious gene with remarkable tumour suppressing capabilities. However, how DiRas3 interferes with ERK phosphorylation, has remained unknown. RESULTS: We demonstrate that DiRas3 associates in vivo with C-RAF and directly binds in vitro to C-RAF, which is upstream of MEK and ERK. Direct binding of DiRas3 to C-RAF is nucleotide independent, and DiRas3's N-terminal extension alone is not sufficient for binding C-RAF. DiRas3 expression inhibits the activating phosphorylations of MEK and ERK. Serum-induced recruitment of DiRas3 to the plasma membrane depends mainly on its N-terminal extension and less on its C-terminus, bound nucleotide or the presence of Ras-GTP. Correspondingly, removal of the N-terminal extension strongly decreases DiRas3's inhibition of MEK and ERK phosphorylations. Tyrosyl-phosphatases do not contribute significantly to reduction of ERK-phosphorylation byDiRas3. Consistently, downregulation of DiRas3 results in a small but significant and persistent increase in MEK and ERK phosphorylation, but does not increase phosphorylation of P38, AKT and c-Jun NH2-terminal kinase. Finally, downregulation of DiRas3 causes increased cell migration, through a mechanism that is MEK dependent. CONCLUSIONS: These results support a model in which serum signals induce the recruitment of DiRas3 to the plasma membrane, where it is tethered via its N- and C-termini. At the plasma membrane, DiRas3 interacts with C-RAF to specifically suppress the activating phosphorylations on MEK and ERK, thus restricting migration of non-cancer cells. This effect is relatively small, but it is also persistent, suggesting that it contributes to the maintenance of the non-migratory phenotype of non-cancerous tissues, in which DiRas3 is expressed.

Hospital doctor turnover and retention: a systematic review and new research pathway.

PURPOSE: Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research. DESIGN/METHODOLOGY/APPROACH: Adopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science. FINDINGS: We identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover. RESEARCH LIMITATIONS/IMPLICATIONS: Selection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results. PRACTICAL IMPLICATIONS: Globally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting "stay interviews" with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts. SOCIAL IMPLICATIONS: Focussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees. ORIGINALITY/VALUE: The review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.

The tumor suppressor DiRas3 forms a complex with H-Ras and C-RAF proteins and regulates localization, dimerization, and kinase activity of C-RAF.

The maternally imprinted Ras-related tumor suppressor gene DiRas3 is lost or down-regulated in more than 60% of ovarian and breast cancers. The anti-tumorigenic effect of DiRas3 is achieved through several mechanisms, including inhibition of cell proliferation, motility, and invasion, as well as induction of apoptosis and autophagy. Re-expression of DiRas3 in cancer cells interferes with the signaling through Ras/MAPK and PI3K. Despite intensive research, the mode of interference of DiRas3 with the Ras/RAF/MEK/ERK signal transduction is still a matter of speculation. In this study, we show that DiRas3 associates with the H-Ras oncogene and that activation of H-Ras enforces this interaction. Furthermore, while associated with DiRas3, H-Ras is able to bind to its effector protein C-RAF. The resulting multimeric complex consisting of DiRas3, C-RAF, and active H-Ras is more stable than the two protein complexes H-Ras·C-RAF or H-Ras·DiRas3, respectively. The consequence of this complex formation is a DiRas3-mediated recruitment and anchorage of C-RAF to components of the membrane skeleton, suppression of C-RAF/B-RAF heterodimerization, and inhibition of C-RAF kinase activity.

Novel synthetic co-culture of Acetobacterium woodii and Clostridium drakei using CO2 and in situ generated H2 for the production of caproic acid via lactic acid.

Acetobacterium woodii is known to produce mainly acetate from CO2 and H2, but the production of higher value chemicals is desired for the bioeconomy. Using chain-elongating bacteria, synthetic co-cultures have the potential to produce longer-chained products such as caproic acid. In this study, we present first results for a successful autotrophic co-cultivation of A. woodii mutants and a Clostridium drakei wild-type strain in a stirred-tank bioreactor for the production of caproic acid from CO2 and H2 via the intermediate lactic acid. For autotrophic lactate production, a recombinant A. woodii strain with a deleted Lct-dehydrogenase complex, which is encoded by the lctBCD genes, and an inserted D-lactate dehydrogenase (LdhD) originating from Leuconostoc mesenteroides, was used. Hydrogen for the process was supplied using an All-in-One electrode for in situ water electrolysis. Lactate concentrations as high as 0.5 g L-1 were achieved with the AiO-electrode, whereas 8.1 g L-1 lactate were produced with direct H2 sparging in a stirred-tank bioreactor. Hydrogen limitation was identified in the AiO process. However, with cathode surface area enlargement or numbering-up of the electrode and on-demand hydrogen generation, this process has great potential for a true carbon-negative production of value chemicals from CO2.

Evaluation of Accuracy and Performance of a Novel, Fully Gantry Integrated 3D Laser System for Computed Tomography Guided Needle Placement: A Phantom Study.

The purpose of this phantom study was to compare the accuracy, speed and technical performance of CT guided needle placement using a conventional technique versus a novel, gantry integrated laser guidance system for both an expert and a novice. A total of 80 needle placements were performed in an abdominal phantom using conventional CT guidance and a laser guidance system. Analysis of pooled results of expert and novice showed a significant reduction of time (277 vs. 204 s, p = 0.001) and of the number of needle corrections (3.28 vs. 1.58, p < 0.001) required when using laser guidance versus conventional technique. No significant improvement in absolute (3.81 vs. 3.41 mm, p = 0.213) or angular deviation (2.85 vs. 2.18°, p = 0.079) was found. With either approach, the expert was significantly faster (conventional guidance: 207 s vs. 346 s, p < 0.001; laser guidance: 144 s vs. 264 s, p < 0.001) and required fewer needle corrections (conventional guidance: 4 vs. 3, p = 0.027; laser guidance: 2 vs. 1, p = 0.001) than the novice. The laser guidance system helped both the expert and the novice to perform CT guided interventions in a phantom faster and with fewer needle corrections compared to the conventional technique, while achieving similar accuracy.

Coronary stent imaging in photon counting computed Tomography: Optimization of reconstruction kernels in a phantom.

PURPOSE: Imaging stents and in-stent stenosis remains a challenge in coronary computed tomography angiography (CCTA). In comparison to conventional Computed Tomography, Photon Counting CT (PCCT) provides decisive clinical advantages, among other things by providing low dose ultra-high resolution imaging of coronary arteries. This work investigates the image quality in CCTA using clinically established kernels and those optimized for the imaging of cardiac stents in PCCT, both for in-vitro stent imaging in 400 µm standard resolution mode (SRM) and 200 µm Ultra High Resolution Mode (UHR). METHODS: Based on experimental scans, vascular reconstruction kernels (Bv56, Bv64, Bv72) were optimized. In an established phantom, 10 different coronary stents with 3 mm diameter were scanned in the first clinically available PCCT. Scans were reconstructed with clinically established and optimized kernels. Four readers measured visible stent lumen, performed ROI-based density measurements and rated image quality. RESULTS: Regarding the visible stent lumen, UHR is significantly superior to SRM (p < 0.001). In all levels, the optimized kernels are superior to the clinically established kernels (p < 0.001). One optimized kernel showed a significant reduction of noise compared to the clinically established kernels. Overall image quality is improved with optimized kernels. CONCLUSIONS: In a phantom study PCCT UHR with optimized kernels for stent imaging significantly improves the ability to assess the in-stent lumen of small cardiac stents. We recommend using UHR with an optimized sharp vascular reconstruction kernel (Bv72uo) for imaging of cardiac stent.

Breast cancer risk in relation to occupations with exposure to carcinogens and endocrine disruptors: a Canadian case-control study.

BACKGROUND: Endocrine disrupting chemicals and carcinogens, some of which may not yet have been classified as such, are present in many occupational environments and could increase breast cancer risk. Prior research has identified associations with breast cancer and work in agricultural and industrial settings. The purpose of this study was to further characterize possible links between breast cancer risk and occupation, particularly in farming and manufacturing, as well as to examine the impacts of early agricultural exposures, and exposure effects that are specific to the endocrine receptor status of tumours. METHODS: 1005 breast cancer cases referred by a regional cancer center and 1146 randomly-selected community controls provided detailed data including occupational and reproductive histories. All reported jobs were industry- and occupation-coded for the construction of cumulative exposure metrics representing likely exposure to carcinogens and endocrine disruptors. In a frequency-matched case-control design, exposure effects were estimated using conditional logistic regression. RESULTS: Across all sectors, women in jobs with potentially high exposures to carcinogens and endocrine disruptors had elevated breast cancer risk (OR = 1.42; 95% CI, 1.18-1.73, for 10 years exposure duration). Specific sectors with elevated risk included: agriculture (OR = 1.36; 95% CI, 1.01-1.82); bars-gambling (OR = 2.28; 95% CI, 0.94-5.53); automotive plastics manufacturing (OR = 2.68; 95% CI, 1.47-4.88), food canning (OR = 2.35; 95% CI, 1.00-5.53), and metalworking (OR = 1.73; 95% CI, 1.02-2.92). Estrogen receptor status of tumors with elevated risk differed by occupational grouping. Premenopausal breast cancer risk was highest for automotive plastics (OR = 4.76; 95% CI, 1.58-14.4) and food canning (OR = 5.70; 95% CI, 1.03-31.5). CONCLUSIONS: These observations support hypotheses linking breast cancer risk and exposures likely to include carcinogens and endocrine disruptors, and demonstrate the value of detailed work histories in environmental and occupational epidemiology.

Managing pharmaceutical shortages during the COVID pandemic: An exploratory analysis of European collective and national government responses.

Prior to the outbreak of the COVID pandemic, pharmaceutical shortages were already recognised as a major policy problem by most, if not all, European governments; and virtually all European national governments today publicise official shortage lists. Policy making in the area has been centred on the national government level, which meant that the understanding, definition, and response to shortages has remained highly heterogeneous. When the advent of the COVID pandemic exacerbated shortages, this situation continued against a background of a weak collective European response. As part of their responses to COVID-shortages, the medicines regulators of European countries expanded the range of products pharmacies could manufacture, process and distribute as well as their procedural authority in issuing, handling and processing prescriptions. While these measures were fairly common across Europe and alleviated some bottlenecks or improved medicine access for some patient groups, other responses were highly individualistic and included export bans of certain medications as well as efforts to draw on veterinary supplies. Our own data analysis of officially recorded shortage data during the first COVID wave (to October 2020) indicates that countries that had prepared for these types of crisis and maintained an active policy stance (e.g. Germany and Norway) were more likely to encounter fewer shortages than others. We also note that there is no direct correlation between officially recorded numbers of shortages and the ways in which national governments responded to these - which indicates that cultural expectations also might have been a significant policy driver.

An Exploratory Study of Beryllium and UK Soft Touch Regulation: An Enduring Example of Weaknesses of UK Occupational Health and Safety Governance.

Smart regulation, better regulation, responsive regulation, business-friendly regulation and voluntary 'self-regulation' have their origins deeply embedded in UK policies in the 20th century. Their aim generally is to reduce workplace regulatory obligations on employers. This can overtly or covertly undermine efforts to improve working conditions. In the UK, the historical control and regulation of beryllium (a toxic metal used in industry) illustrates this problem, and as we illustrate through an exploratory analysis of original archival material and official publications. Soft touch regulation of the metal beryllium was developed within the UK semiconductor industry when tighter controls were proposed in the 1960s and 1970s. Historical industry, government and science responses to health and safety information about beryllium provide important lessons for current debates on occupational health and safety.

Privatization and Multi-Fatality Disasters: A Causal Connection Exposing Both Worker and Citizen Health and Safety Failures in the UK?

Although several countries have experienced large-scale privatization initiatives, relatively little is known about the impact of these initiatives on the health and safety of workers and resident populations. Examining data on technical (as compared to natural) multi-fatality disasters collected in the WHO's Emergency Events Database (EM-DAT) for the UK and a number of European comparator countries for recent decades, this paper shows that the incidence of these disasters and the number of deaths resulting from them rose significantly in the UK during the period from 1979 to 1991 when the country engaged in extensive and aggressive privatization campaigns which were supported by several consecutive Conservative governments. This observed UK blip or abnormal increase in multi-fatality disasters is apparent for the UK both in terms of a "within-country" comparison (i.e., when we compare the privatization period of 1979 to 1997 with other periods), as well as when viewed in terms of comparisons with the comparable European countries of Germany, France, and Italy for the same period (1979 to 1997). Contrary to previous analyses which suggested that there is no clear link between privatization and deterioration of health and safety, this paper concludes that the UK privatization experience (1979-1997) provides robust country-specific evidence of privatization initiatives leading to increases in the number of multi-fatality technological disasters as well as related fatalities. This evidence should be seen as a deterrent to similarly extensive and aggressive initiatives which, particularly in less developed countries, could result in similarly disastrous outcomes.

Deep learning-based extended field of view computed tomography image reconstruction: influence of network design on image estimation outside the scan field of view.

The problem of data truncation in Computed Tomography (CT) is caused by the missing data when the patient exceeds the Scan Field of View (SFOV) of a CT scanner. The reconstruction of a truncated scan produces severe truncation artifacts both inside and outside the SFOV. We have employed a deep learning-based approach to extend the field of view and suppress truncation artifacts. Thereby, our aim is to generate a good estimate of the real patient data and not to provide a perfect and diagnostic image even in regions beyond the SFOV of the CT scanner. This estimate could then be used as an input to higher order reconstruction algorithms [1]. To evaluate the influence of the network structure and layout on the results, three convolutional neural networks (CNNs), in particular a general CNN called ConvNet, an autoencoder, and the U-Net architecture have been investigated in this paper. Additionally, the impact of L1, L2, structural dissimilarity and perceptual loss functions on the neural network's learning have been assessed and evaluated. The evaluation of data set comprising 12 truncated test patients demonstrated that the U-Net in combination with the structural dissimilarity loss showed the best performance in terms of image restoration in regions beyond the SFOV of the CT scanner. Moreover, this network produced the best mean absolute error, L1, L2, and structural dissimilarity evaluation measures on the test set compared to other applied networks. Therefore, it is possible to achieve truncation artifact removal using deep learning techniques.

Ultra-High-Resolution Coronary CT Angiography With Photon-Counting Detector CT: Feasibility and Image Characterization.

OBJECTIVES: The aim of this study was to evaluate the feasibility and quality of ultra-high-resolution coronary computed tomography angiography (CCTA) with dual-source photon-counting detector CT (PCD-CT) in patients with a high coronary calcium load, including an analysis of the optimal reconstruction kernel and matrix size. MATERIALS AND METHODS: In this institutional review board-approved study, 20 patients (6 women; mean age, 79 ± 10 years; mean body mass index, 25.6 ± 4.3 kg/m 2 ) undergoing PCD-CCTA in the ultra-high-resolution mode were included. Ultra-high-resolution CCTA was acquired in an electrocardiography-gated dual-source spiral mode at a tube voltage of 120 kV and collimation of 120 × 0.2 mm. The field of view (FOV) and matrix sizes were adjusted to the resolution properties of the individual reconstruction kernels using a FOV of 200 × 200 mm 2 or 150 × 150 mm 2 and a matrix size of 512 × 512 pixels or 1024 × 1024 pixels, respectively. Images were reconstructed using vascular kernels of 8 sharpness levels (Bv40, Bv44, Bv56, Bv60, Bv64, Bv72, Bv80, and Bv89), using quantum iterative reconstruction (QIR) at a strength level of 4, and a slice thickness of 0.2 mm. Images with the Bv40 kernel, QIR at a strength level of 4, and a slice thickness of 0.6 mm served as the reference. Image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, and blooming artifacts were quantified. For subjective image quality, 2 blinded readers evaluated image noise and delineation of coronary artery plaques and the adjacent vessel lumen using a 5-point discrete visual scale. A phantom scan served to characterize image noise texture by calculating the noise power spectrum for every reconstruction kernel. RESULTS: Maximum spatial frequency (f peak ) gradually shifted to higher values for reconstructions with the Bv40 to Bv64 kernel (0.15 to 0.56 mm -1 ), but not for reconstructions with the Bv72 to Bv89 kernel. Ultra-high-resolution CCTA was feasible in all patients (median calcium score, 479). In patients, reconstructions with the Bv40 kernel and a slice thickness of 0.6 mm showed largest blooming artifacts (55.2% ± 9.8%) and lowest vessel sharpness (477.1 ± 73.6 ΔHU/mm) while achieving highest SNR (27.4 ± 5.6) and CNR (32.9 ± 6.6) and lowest noise (17.1 ± 2.2 HU). Considering reconstructions with a slice thickness of 0.2 mm, image noise, SNR, CNR, vessel sharpness, and blooming artifacts significantly differed across kernels (all P 's < 0.001). With higher kernel sharpness, SNR and CNR continuously decreased, whereas image noise and vessel sharpness increased, with highest sharpness for the Bv89 kernel (2383.4 ± 787.1 ΔHU/mm). Blooming artifacts continuously decreased for reconstructions with the Bv40 (slice thickness, 0.2 mm; 52.8% ± 9.2%) to the Bv72 kernel (39.7% ± 9.1%). Subjective noise was perceived by both readers in agreement with the objective measurements. Considering delineation of coronary artery plaques and the adjacent vessel lumen, reconstructions with the Bv64 and Bv72 kernel (for both, median score of 5) were favored by the readers providing an excellent anatomic delineation of plaque characteristics and vessel lumen. CONCLUSIONS: Ultra-high-resolution CCTA with PCD-CT is feasible and enables the visualization of calcified coronaries with an excellent image quality, high sharpness, and reduced blooming. Coronary plaque characterization and delineation of the adjacent vessel lumen are possible with an optimal quality using Bv64 kernel, a FOV of 200 × 200 mm 2 , and a matrix size of 512 × 512 pixels.

Managing cultural diversity in healthcare partnerships: the case of LIFT.

PURPOSE: The National Health Service (NHS) Local Improvement Finance Trust (LIFT) programme was launched in 2001 as an innovative public-private partnership to address the historical under-investment in local primary care facilities in England. The organisations from the public and private sector that comprise a local LIFT partnership each have their own distinctive norms of behaviour and acceptable working practices - ultimately different organisational cultures. The purpose of this article is to assess the role of organisational culture in facilitating (or impeding) LIFT partnerships and to contribute to an understanding of how cultural diversity in public-private partnerships is managed at the local level. DESIGN/METHODOLOGY/APPROACH: The approach taken was qualitative case studies, with data gathering comprising interviews and a review of background documentation in three LIFT companies purposefully sampled to represent a range of background factors. Elite interviews were also conducted with senior policy makers responsible for implementing LIFT policy at the national level. FINDINGS: Interpreting the data against a conceptual framework designed to assess approaches to managing strategic alliances, the authors identified a number of key differences in the values, working practices and cultures in public and private organisations that influenced the quality of joint working. On the whole, however, partners in the three LIFT companies appeared to be working well together, with neither side dominating the development of strategy. Differences in culture were being managed and accommodated as partnerships matured. RESEARCH LIMITATIONS/IMPLICATIONS: As LIFT develops and becomes the primary source of investment for managing, developing and channelling funding into regenerating the primary care infrastructure, further longitudinal work might examine how ongoing partnerships are working, and how changes in the cultures of public and private partners impact upon wider relationships within local health economies and shape the delivery of patient care. ORIGINALITY/VALUE: To the authors' knowledge this is the first study of the role of culture in mediating LIFT partnerships and the findings add to the evidence on public-private partnerships in the NHS.

Evaluation of novel AI-based extended field-of-view CT reconstructions.

PURPOSE: Modern computed tomography (CT) scanners have an extended field-of-view (eFoV) for reconstructing images up to the bore size, which is relevant for patients with higher BMI or non-isocentric positioning due to fixation devices. However, the accuracy of the image reconstruction in eFoV is not well known since truncated data are used. This study introduces a new deep learning-based algorithm for extended field-of-view reconstruction and evaluates the accuracy of the eFoV reconstruction focusing on aspects relevant for radiotherapy. METHODS: A life-size three-dimensional (3D) printed thorax phantom, based on a patient CT for which eFoV was necessary, was manufactured and used as reference. The phantom has holes allowing the placement of tissue mimicking inserts used to evaluate the Hounsfield unit (HU) accuracy. CT images of the phantom were acquired using different configurations aiming to evaluate geometric and HU accuracy in the eFoV. Image reconstruction was performed using a state-of-the-art reconstruction algorithm (HDFoV), commercially available, and the novel deep learning-based approach (HDeepFoV). Five patient cases were selected to evaluate the performance of both algorithms on patient data. There is no ground truth for patients so the reconstructions were qualitatively evaluated by five physicians and five medical physicists. RESULTS: The phantom geometry reconstructed with HDFoV showed boundary deviations from 1.0 to 2.5 cm depending on the volume of the phantom outside the regular scan field of view. HDeepFoV showed a superior performance regardless of the volume of the phantom within eFOV with a maximum boundary deviation below 1.0 cm. The maximum HU (absolute) difference for soft issue inserts is below 79 and 41 HU for HDFoV and HDeepFoV, respectively. HDeepFoV has a maximum deviation of -18 HU for an inhaled lung insert while HDFoV reached a 229 HU difference. The qualitative evaluation of patient cases shows that the novel deep learning approach produces images that look more realistic and have fewer artifacts. CONCLUSION: To be able to reconstruct images outside the sFoV of the CT scanner there is no alternative than to use some kind of extrapolated data. In our study, we proposed and investigated a new deep learning-based algorithm and compared it to a commercial solution for eFoV reconstruction. The deep learning-based algorithm showed superior performance in quantitative evaluations based on phantom data and in qualitative assessments of patient data.