Monoplane 3D reconstruction of mapping ablation catheters: a feasibility study

Purpose:

Radiofrequency (RF) catheter ablation has transformed treatment for arrhythmias and has become first-line therapy for some tachycardias. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours). This study evaluates the feasibility of using only single plane C-arm images in order to estimate the 3D coordinates of RF catheter electrodes in a cardiac phase.

Materials and methods:

The method makes use of a priori 3D model of the RF mapping catheter assuming rigid body motion equations in order to estimate the 3D locations of the catheter tip-electrodes in single view C-arm fluoroscopy images. Validation is performed on both synthetic and clinical data using computer simulation models. The authors'' monoplane reconstruction algorithm is applied to a 3D helix mimicking the shape of a catheter and undergoing solely rigid motion. Similarly, the authors test the feasibility of recovering nonrigid motion by applying their method on true 3D coordinates of 13 ventricular markers from a sheep’s ventricle.

Results:

The results of this study showed that the proposed monoplane algorithm recovers rigid motion adequately when using the spatial positions of a catheter in six consecutive C-arm image frames yielding maximum 3D root mean squares errors of 4.3 mm. On the other hand, the suggested algorithm did not recover nonrigid motion precisely as suggested by a maximum 3D root mean square value of 8 mm.

Conclusion:

Since RF catheter electrodes are rigid structures, the authors conclude that there is promise in recovering the 3D coordinates of the electrodes when making use of only single view images. Future work will involve adding nonrigid motion equations to their algorithm, which will then be applied to actual clinical data.     

Fully 3D Monte Carlo reconstruction in SPECT: a feasibility study

In single photon emission computed tomography (SPECT) with parallel hole collimation, image reconstruction is usually performed as a set of bidimensional (2D) analytical or iterative reconstructions. This approach ignores the tridimensional (3D) nature of scatter and detector response function that affects the detected signal. To deal with the 3D nature of the image formation process, iterative reconstruction can be used by considering a 3D projector modelling the 3D spread of photons. In this paper, we investigate the value of using accurate Monte Carlo simulations to determine the 3D projector used in a fully 3D Monte Carlo (F3DMC) reconstruction approach. Given the 3D projector modelling all physical effects affecting the imaging process, the reconstruction problem is solved using the maximum likelihood expectation maximization (MLEM) algorithm. To validate the concept, three data sets were simulated and F3DMC was compared with two other 3D reconstruction strategies using analytical corrections for attenuation, scatter and camera point spread function. Results suggest that F3DMC improves spatial resolution, relative and absolute quantitation and signal-to-noise ratio. The practical feasibility of the approach on real data sets is discussed.     

Peritoneal catheters: a comparative study of column disc and Tenckhoff catheters

A functioning peritoneal access is crucial to the success of peritoneal dialysis. We report retrospective analysis of our experience using 44 Tenckhoff and 23 column disc, double-cuff, catheters in 46 patients receiving peritoneal dialysis. Postoperative care was identical in both groups. Both catheter groups were comparable with regards to age, sex, obesity and prior abdominal surgery. Catheter removal due to drainage failure was significantly greater with the column disc than the Tenckhoff catheters (22% vs 5%, p = 0.04). In addition, 39% of column disc catheters compared to 11% Tenckhoff catheters were removed as a result of therapy resistant peritonitis (p = 0.011). Furthermore, there was a greater incidence of peritonitis with the column disc than with the Tenckhoff catheters at the end of the first year (71% vs 42%, p less than 0.01). There was no difference between the two groups with respect to other complications, such as pericatheter leak, catheter infections, catheter cuff-extrusion or hernia. Our experience indicates that the column disc catheter is associated with higher complication rates and does not offer any advantage over the Tenckhoff catheter.     

Pre-polarized saline: an in vivo feasibility study of a potential contrast agent.

The potential for using pre-polarized liquids as contrast agents in vivo is investigated and the feasibility of the method demonstrated. In this study we show the enhancement obtained following intravenous delivery of pre-polarized saline into the antecubital vein of a volunteer. This form of contrast agent provides signal gain on time scales commensurate with its T(1) and allows repeated doses to be administered, thus making alternate acquisitions of data with and without enhancement practicable.     

A preprocessing tool for removing artifact from cardiac RR interval recordings using three‐dimensional spatial distribution mapping

Artifact is common in cardiac RR interval data that is recorded for heart rate variability (HRV) analysis. A novel algorithm for artifact detection and interpolation in RR interval data is described. It is based on spatial distribution mapping of RR interval magnitude and relationships to adjacent values in three dimensions. The characteristics of normal physiological RR intervals and artifact intervals were established using 24‐h recordings from 20 technician‐assessed human cardiac recordings. The algorithm was incorporated into a preprocessing tool and validated using 30 artificial RR (ARR) interval data files, to which known quantities of artifact (0.5%, 1%, 2%, 3%, 5%, 7%, 10%) were added. The impact of preprocessing ARR files with 1% added artifact was also assessed using 10 time domain and frequency domain HRV metrics. The preprocessing tool was also used to preprocess 69 24‐h human cardiac recordings. The tool was able to remove artifact from technician‐assessed human cardiac recordings (sensitivity 0.84, SD = 0.09, specificity of 1.00, SD = 0.01) and artificial data files. The removal of artifact had a low impact on time domain and frequency domain HRV metrics (ranging from 0% to 2.5% change in values). This novel preprocessing tool can be used with human 24‐h cardiac recordings to remove artifact while minimally affecting physiological data and therefore having a low impact on HRV measures of that data.     

Coronary blood flow measurement using an angiographic first pass distribution technique: a feasibility study

Due to the well-documented problems associated with visual interpretation of coronary angiograms, more physiologic means of assessing coronary artery stenosis are being investigated. One physiologic parameter that has been suggested is coronary flow reserve (CFR). A digital subtraction angiographic technique based on first pass distribution analysis (FPA) is proposed as a means of measuring CFR and absolute coronary flow. The theory of the FPA method is first outlined, and the implementation of a preliminary version of the FPA algorithm is described. Experiments verifying the utility of this algorithm for measuring absolute flow through a flow phantom, and through the canine circumflex artery are reported. It was determined that the preliminary FPA algorithm is capable of measuring canine coronary flow ratios (R) with accuracy and precision characteristics meeting or exceeding those reported for the parametric imaging technique (RFPA = 0.933.Rtrue, SEE = 0.16, r = 0.984). Accurate absolute flow (Q) measurements were obtained in all of the phantom experiments (QFPA = 1.054.Qtrue, r = 0.993), and in one of the three dogs that were studied (QFPA = 0.977.Qtrue, r = 0.935). The difficulty encountered in the other two dog experiments is attributed to the effects of system temporal lag, and would likely be corrected through the use of improved cameras. The feasibility of the general FPA method for measuring relative flow is established, and the potential for routine, absolute flow measurement is demonstrated.     

Intracellular recordings from rat thalamic VL neurons: a study combined with intracellular staining

Summary Intracellular recordings from thalamic neurons receiving cerebellar inputs were performed under urethane anesthesia in the rat. A total of 64 neurons were recorded intracellularly with micropipettes filled with 4% biocytin solution (dissolved in 0.5 M K-acetate), and cerebellar-induced EPSPs (CN-EPSPs), the membrane resistance and firing properties were analyzed with intracellular current injections. The mean latency of CN-EPSPs was 1.9 ± 0.8 ms and the mean input resistance measured in 10 neurons was 17.6 ± 5.0 M. Thirty-two out of 35 stained neurons were analysed morphologically; 28 of these neurons were located in the VL, and 26 received CN-EPSPs. Their somata were round or polygonal in shape and the mean size was 22.5 × 15.2 m. They had radially extending spinous dendrites, and the mean radii of the dendritic fields were 214.7 m in the frontal and 171.4 m in the sagittal planes. These morphological features were similar to those observed in the sensory relay nucleus of the thalamus.     

A method for the automatic reconstruction of fetal cardiac signals from magnetocardiographic recordings

Fetal magnetocardiography (fMCG) allows monitoring the fetal heart function through algorithms able to retrieve the fetal cardiac signal, but no standardized automatic model has become available so far. In this paper, we describe an automatic method that restores the fetal cardiac trace from fMCG recordings by means of a weighted summation of fetal components separated with independent component analysis (ICA) and identified through dedicated algorithms that analyse the frequency content and temporal structure of each source signal. Multichannel fMCG datasets of 66 healthy and 4 arrhythmic fetuses were used to validate the automatic method with respect to a classical procedure requiring the manual classification of fetal components by an expert investigator. ICA was run with input clusters of different dimensions to simulate various MCG systems. Detection rates, true negative and false positive component categorization, QRS amplitude, standard deviation and signal-to-noise ratio of reconstructed fetal signals, and real and per cent QRS differences between paired fetal traces retrieved automatically and manually were calculated to quantify the performances of the automatic method. Its robustness and reliability, particularly evident with the use of large input clusters, might increase the diagnostic role of fMCG during the prenatal period.     

Motion adaptive x-ray therapy: a feasibility study

Intrafraction motion caused by breathing requires increased treatment margins for chest and abdominal radiotherapy and may lead to 'motion artefacts' in dose distributions during intensity modulated radiotherapy (IMRT). Technologies such as gated radiotherapy may significantly increase the treatment time, while breath-hold techniques may be poorly tolerated by pulmonarily compromised patients. A solution that allows reduced margins and dose distribution artefacts, without compromising delivery time, is to synchronously follow the target motion by adapting the x-ray beam using a dynamic multileaf collimator (MLC), i.e. motion adaptive x-ray therapy, or MAX-T for short. Though the target is moving with time, in the MAX-T beam view the target is static. The MAX-T method superimposes the target motion due to respiration onto the beam originally planned for delivery. Thus during beam delivery the beam is dynamically changing position with respect to the isocentre using a dynamic MLC, the leaf positions of which are dependent upon the target position. Synchronization of the MLC motion and target motion occurs using respiration gated radiotherapy equipment. The concept and feasibility of MAX-T and the capability of the treatment machine to deliver such a treatment were investigated by performing measurements for uniform and IMRT fields using a mechanical sinusoidal oscillator to simulate target motion. Target dose measurements obtained using MAX-T for a moving target were found to be equivalent to those delivered to a static target by a static beam.     

A biodegradable vascularizing membrane: a feasibility study

Regenerative medicine and in vivo biosensor applications require the formation of mature vascular networks for long-term success. This study investigated whether biodegradable porous membranes could induce the formation of a vascularized fibrous capsule and, if so, the effect of degradation kinetics on neovascularization. Poly(l-lactic acid) (PLLA) and poly(dl-lactic-co-glycolic) acid (PLGA) membranes were created by a solvent casting/salt leaching method. Specifically, PLLA, PLGA 75:25 and PLGA 50:50 polymers were used to vary degradation kinetics. The membranes were designed to have an average 60mum pore diameter, as this pore size has been shown to be optimal for inducing blood vessel formation around nondegradable polymer materials. Membrane samples were imaged by scanning electron microscopy at several time points during in vitro degradation to assess any changes in pore structure. The in vivo performance of the membranes was assessed in Sprague-Dawley rats by measuring vascularization within the fibrous capsule that forms adjacent to implants. The vascular density within 100microm of the membranes was compared with that seen in normal tissue, and to that surrounding the commercially available vascularizing membrane TheraCyte. The hemoglobin content of tissue containing the membranes was measured by four-dimensional elastic light scattering as a novel method to assess tissue perfusion. Results from this study show that slow-degrading membranes induce greater amounts of neovascularization and a thinner fibrous capsule relative to fast degrading membranes. These results may be due both to an initially increased number of macrophages surrounding the slower degrading membranes and to the maintenance of their initial pore structure.     

Automated multiple-cell karyotyping: a clinical feasibility study

In order to increase the efficiency of the Magiscan metaphase location and karyotyping system, its software and mode of operation have been changed. In the new multiple-cell karyotyping method, interactions by the operator are only required for relocation and counting of metaphases, but not for karyotyping. Metaphases are located and their coordinates recorded automatically as before. The first metaphase in the list is relocated, displayed on the screen, and counted by the operator. It is then karyotyped automatically while the operator relocates and counts the next metaphase in the list. This procedure continues until an appropriate number of metaphases have been counted and karyotyped. Finally a composite karyotype is printed out. Each karyotype is represented by a column of 23 chromosome pairs (1-22 and XX or XY) and all columns are lined up next to each other. Most chromosomes are correctly classified into the composite karyotype. Minor structural abnormalities are detected by comparing pairs of homologues. Overlapped, close touching, and grossly abnormal chromosomes are often misclassified or rejected and shown beneath the classified chromosomes. A trained cytotechnician can easily detect even small chromosome abnormalities on the composite karyotype. A clinical feasibility study indicates that the procedure can be used for routine cytogenetic analysis.     

Electrical impedance tomography to evaluate air distribution prior to extubation in very-low-birth-weight infants: a feasibility study

OBJECTIVES:

Nasal continuous positive airway pressure is used as a standard of care after extubation in very-low-birth-weight infants. A pressure of 5 cmH₂O is usually applied regardless of individual differences in lung compliance. Current methods for evaluation of lung compliance and air distribution in the lungs are thus imprecise for preterm infants. This study used electrical impedance tomography to determine the feasibility of evaluating the positive end-expiratory pressure level associated with a more homogeneous air distribution within the lungs before extubation.

METHODS:

Ventilation homogeneity was defined by electrical impedance tomography as the ratio of ventilation between dependent and non-dependent lung areas. The best ventilation homogeneity was achieved when this ratio was equal to 1. Just before extubation, decremental expiratory pressure levels were applied (8, 7, 6 and 5 cmH₂0; 3 minutes each step), and the pressure that determined the best ventilation homogeneity was defined as the best positive end-expiratory pressure.

RESULTS:

The best positive end-expiratory pressure value was 6.3±1.1 cmH₂0, and the mean continuous positive airway pressure applied after extubation was 5.2±0.4 cmH₂0 (p = 0.002). The extubation failure rate was 21.4%. X-Ray and blood gases after extubation were also checked.

CONCLUSION:

This study demonstrates that electrical impedance tomography can be safely and successfully used in patients ready for extubation to suggest the best ventilation homogeneity, which is influenced by the level of expiratory pressure applied. In this feasibility study, the best lung compliance was found with pressure levels higher than the continuous positive airway pressure levels that are usually applied for routine extubation.     

Fast optical recordings of membrane potential changes from dendrites of pyramidal neurons.

Understanding the biophysical properties of single neurons and how they process information is fundamental to understanding how the brain works. A technique that would allow recording of temporal and spatial dynamics of electrical activity in neuronal processes with adequate resolution would facilitate further research. Here, we report on the application of optical recording of membrane potential transients at many sites on neuronal processes of vertebrate neurons in brain slices using intracellular voltage-sensitive dyes. We obtained evidence that 1) loading the neurons with voltage-sensitive dye using patch electrodes is possible without contamination of the extracellular environment; 2) brain slices do not show any autofluorescence at the excitation/emission wavelengths used; 3) pharmacological effects of the dye were completely reversible; 4) the level of photodynamic damage already allows meaningful measurements and could be reduced further; 5) the sensitivity of the dye was comparable to that reported for invertebrate neurons; 6) the dye spread approximately 500 micron into distal processes within 2 h incubation period. This distance should increase with longer incubation; 7) the optically recorded action potential signals from basolateral dendrites (that are difficult or impossible to approach by patch electrodes) and apical dendrites show that both direct soma stimulation and synaptic stimulation triggered action potentials that originated near the soma. The spikes backpropagated into both basolateral dendrites and apical processes; the propagation was somewhat faster in the apical dendrites.     

Modelization of a self-opening peripheral neural interface: a feasibility study

In this paper a self-opening intrafascicular neural interface (SELINE) has been modeled using both a theoretical approach and a Finite Element (FE) analysis. This innovative self opening interface has several potential advantages such as: higher selectivity due to its three-dimensional structure and efficient anchorage system. Mechanical, structural and micro-technological issues have been considered to obtain an effective design of the electrode, as a feasibility study of the self-opening approach. A simple framework has been provided to model the insertion and partial retraction into peripheral nerves, resulting in the opening of wings.This integrated approach results in a rational procedure to optimize kinematics, geometry, and structural properties of peripheral interfaces. The design and feasibility study carried out in this work can potentially assure a correct behavior and dimensioning of the neural interface: in this way anomalous breakage should be avoided while mechanical and geometrical biocompatibility should increase.     

Implementation of a novel interpolating method to epicardial potential mapping for atrial fibrillation study

Epicardial potential mapping is an efficient way to visualize the potential distribution on the epicardial surface. We found in our previous study, that the traditional linear interpolation used for the epicardial mapping may cause errors and distortions in reconstruction of the electric activities on the epicardial surface especially during the atrial fibrillation. In this study, we devoted on the implementation of a 3D interpolating method, and verified it in comparison with another interpolating method as well as studying of the mechanism of vagal atrial fibrillation (AF). In case studying, we analyzed the epicardial data from seven canine cardiac models using this method and found the macro-re-entry during the sustainable AF is more likely due to the dispersion of refractoriness in the myocardium and does not demonstrated the focal patterns at the beginning of AF. This indicated that the electrophysiological characteristics of myocardium might have been changed during the paroxysmal atrial fibrillation (PAF).     

Integrated quantitative susceptibility and R2* mapping for evaluation of liver fibrosis: An ex vivo feasibility study

To develop a method for noninvasive evaluation of liver fibrosis, we investigated the differential sensitivities of quantitative susceptibility mapping (QSM) and R₂* mapping using corrections for the effects of liver iron. Liver fibrosis is characterized by excessive accumulation of collagen and other extracellular matrix proteins. While collagen increases R₂* relaxation, measures of R₂* for fibrosis are confounded by liver iron, which may be present in the liver over a wide range of concentrations. The diamagnetic collagen contribution to susceptibility values measured by QSM is much less than the contribution of highly paramagnetic iron. In 19 ex vivo liver explants with and without fibrosis, QSM (χ), R₂* and proton density fat fraction (PDFF) maps were constructed from multiecho gradient‐recalled echo (mGRE) sequence acquisition at 3 T. Median parameter values were recorded and differences between the MRI parameters in nonfibrotic vs. advanced fibrotic/cirrhotic samples were evaluated using Mann–Whitney U tests and receiver operating characteristic analyses. Logistic regression with stepwise feature selection was employed to evaluate the utility of combined MRI measurements for detection of fibrosis. Median R₂* increased in fibrotic vs. nonfibrotic liver samples (P = .041), while differences in χ and PDFF were nonsignificant (P = .545 and P = .395, respectively). Logistic regression identified the combination of χ and R₂* significant for fibrosis detection (logit [prediction] = ?8.45 + 0.23 R₂* ? 28.8 χ). For this classifier, a highly significant difference between nonfibrotic vs. advanced fibrotic/cirrhotic samples was observed (P = .002). The model exhibited an AUC of 0.909 (P = .003) for detection of advanced fibrosis/cirrhosis, which was substantially higher compared with AUCs of the individual parameters (AUC 0.591–0.784). An integrated QSM and R₂* analysis of mGRE 3 T imaging data is promising for noninvasive diagnostic assessment of liver fibrosis.