Basic setup for breast conductivity imaging using magnetic resonance electrical impedance tomography

We present a new medical imaging technique for breast imaging, breast MREIT, in which magnetic resonance electrical impedance tomography (MREIT) is utilized to get high-resolution conductivity and current density images of the breast. In this work, we introduce the basic imaging setup of the breast MREIT technique with an investigation of four different imaging configurations of current-injection electrode positions and pathways through computer simulation studies. Utilizing the preliminary findings of a best breast MREIT configuration, additional numerical simulation studies have been carried out to validate breast MREIT at different levels of SNR. Finally, we have performed an experimental validation with a breast phantom on a 3.0 T MREIT system. The presented results strongly suggest that breast MREIT with careful imaging setups could be a potential imaging technique for human breast which may lead to early detection of breast cancer via improved differentiation of cancerous tissues in high-resolution conductivity images.     

A phantom evaluation of a stereo-vision surface imaging system for radiotherapy patient setup

External beam irradiation requires precise positioning of the target relative to the treatment planning coordinate system. A three-dimensional (3D) surface imaging system for patient positioning has recently been installed in one of our linear accelerator (linac) rooms. The device utilizes close-range photogrammetry to generate a 3D model of the patient's surface. This geometric model can be made to look like a digital camera image if wrapped with a gray-level image (texture mapping) that shows surface coloration. The system is calibrated to the linac coordinate system and has been designed as a patient setup device. To reproduce patient position in fractionated radiotherapy, the daily patient surface model is registered to a previously recorded reference surface. Using surface registration, the system calculates the rigid-body transformation that minimizes the distance between the treatment and the reference surface models in a region-of-interest (ROI). This transformation is expressed as a set of new couch coordinates at which the patient position best matches with the reference data. If respiratory motion is a concern, the surface can be obtained with a gated acquisition at a specified phase of the respiratory cycle. To analyze the accuracy of the system, we performed several experiments with phantoms to assess stability, alignment accuracy, precision of the gating function, and surface topology. The reproducibility of surface measurements was tested for periods up to 57 h. Each recorded frame was registered to the reference surface to calculate the required couch adjustment. The system stability over this time period was better than 0.5 mm. To measure the accuracy of the system to detect and quantify patient shift relative to a reference image, we compared the shift detected by the surface imaging system with known couch transitions in a phantom study. The maximum standard deviation was 0.75 mm for the three translational degrees of freedom, and less than 0.1 degrees for each rotation. Surface model precision was tested against computed tomography (CT)-derived surface topology. The root-mean-square rms of the distance between the surfaces was 0.65 mm, excluding regions where beam hardening caused artifacts in the CT data. Measurements were made to test the gated acquisition mode. The time-dependent amplitude was measured with the surface imaging system and an established respiratory gating system based on infrared (IR)-marker detection. The measured motion trajectories from both systems were compared to the known trajectory of the stage. The standard deviations of the amplitude differences to the motor trajectory were 0.04 and 0.15 mm for the IR-marker system and the 3D surface imaging system, respectively. A limitation of the surface-imaging device is the frame rate of 6.5 Hz, because rapid changes of the motion trajectory cannot be detected. In conclusion, the system is accurate and sufficiently stable to be used in the clinic. The errors computed when comparing the surface model with CT geometry were submillimeter, and deviations in the alignment and gating-signal tests were of the same magnitude.     

Measurement of CT radiation profile width using CR imaging plates

This paper describes the procedure for using a Fuji computed radiography (CR) imaging plate (IP) for the measurement of computed tomography (CT) radiation profiles. Two sources of saturation in the data from the IP, signal and quantization, were characterized to establish appropriate exposure and processing conditions for accurate measurements. The IP generated similar profiles compared to those obtained from digitized ready-pack films, except at the profile edges, where the exposure level is low. However, when IP pixel values are converted to exposure, CR and digitized film profiles are in agreement. The full width at half maximum (FWHM) of the CT radiation profile was determined from the relationship between pixel value and exposure and compared to FWHM of the digitized optical density profile from film. To estimate the effect of scattering by the cassette material, radiation profiles were acquired from IPs enclosed in a cassette or in a paper envelope. The presence of the cassette made no difference in the value determined for FWHM. With proper exposure and processing conditions, the FWHM of 5, 10, and 15 mm collimated beams were measured using IPs to be 7.1, 11.9, and 17.0 mm and using film to be 7.2, 12.2, and 16.8 mm, respectively. Our results suggest that, under appropriate conditions, the estimation of the width of the CT radiation profile using Fuji CR is comparable to the measurement from film density described in American Association of Physicists in Medicine (AAPM) Report No. 39. Although our experiment was conducted using Fuji CR, we anticipate that CR plates from other vendors could be successfully used to measure CT beam profiles because of similar empirical relationships between pixel value and exposure.     

Isolated aorta setup for hemodynamic studies

A setup consisting of a high-performance hydraulic pump connected to the ascending part of an isolated aorta, including all major distal branches, each loaded with calibrated artificial resistors, was developed. The system was used to study total aortic compliance of the baboon as a function of mean aortic pressure (n=5). The aorta loaded with the resistors was mounted in a custom-designed sink table, such that it was submersed in physiological saline maintained at 37°C. Mean distending pressure in the entire aortic compliance from pressure and flow waves generated by the pump. Total aortic compliance as a function of mean pressure was fitted with a logarithmic function: Ln (Compliance)=A+B * P. The value of A(±SE) was: 1.565±0.319 and B: −0.020±0.003 (P<0.001). The results were compared with previously published results (also using the same three-element Windkessel fit) obtained in three of the same animalsin vivo. Thein vivo data were A: 1.095±0.235 and B: −0.019±0.003.In vitro data had a significantly higher value of A thanin vivo (P=0.017), implying a significantly higher aortic compliancein vitro thanin vivo. Occlusion of the proximal descending aorta was performed at a low distending pressure (55 mm Hg) to determine the proximal complicance. It was found (n=4) that 46±11% (SD) of the total arterial compliance is to be attributed to the ascending and proximal descending aorta. This work was supported in part by Grant RG 86/0066 from the scientific affairs division of Nato.     

Accurate setup of paraspinal patients using a noninvasive patient immobilization cradle and portal imaging

Because of the proximity of the spinal cord, effective radiotherapy of paraspinal tumors to high doses requires highly conformal dose distributions, accurate patient setup, setup verification, and patient immobilization. An immobilization cradle has been designed to facilitate the rapid setup and radiation treatment of patients with paraspinal disease. For all treatments, patients were set up to within 2.5 mm of the design using an amorphous silicon portal imager. Setup reproducibility of the target using the cradle and associated clinical procedures was assessed by measuring the setup error prior to any correction. From 350 anterior/posterior images, and 303 lateral images, the standard deviations, as determined by the imaging procedure, were 1.3 m, 1.6 m, and 2.1 in the ant/post, right/left, and superior/inferior directions. Immobilization was assessed by measuring patient shifts between localization images taken before and after treatment. From 67 ant/post image pairs and 49 lateral image pairs, the standard deviations were found to be less than 1 mm in all directions. Careful patient positioning and immobilization has enabled us to develop a successful clinical program of high dose, conformal radiotherapy of paraspinal disease using a conventional Linac equipped with dynamic multileaf collimation and an amorphous silicon portal imager.     

A rigid setup for microelectrode research in fish

The setup for microelectrode recording in fish includes: (a) a head-holding set of lateral pressor feet mounted on advancing screws, and a rigid mouth tube. The mouth tube is connected to a recirculation system which enables pumping aerated water into the fish's buccopharynx. The head-holding devices are mounted on (b) a plastic box, which contains the fish and rests on (c) a heavy metal plate on which are anchored 2 steel bars. These bars run alongside the fish box and serve to support currently available stereotaxic electrode holders and micromanipulators.     

Complement receptor type two (CR2,CR21)

Cellular receptors for complement C3 fragments deposited on antigens are important bricks in the wall defending against microbial pathogens. The part of complement receptor type 2 (CR2; CD21) deals with enhancing humoral immune responses and with long-term trapping of C3d-coated antigen by follicular dendritic cells. CR2 is also pivotal for Epstein-Barr virus (EBV) infection. Here, the current understanding, how CR2 interacts with its ligands C3d, EBV, and CD23 is summarized. The potential to target CR2 for clinical therapy or immunization purposes are discussed.     

CR1 and CR1-like: the primate immune adherence receptors

Immune adherence describes the phenomenon in which complement‐opsonized substrates, such as immune complexes (IC), viruses, or bacteria, are bound by primate erythrocytes via erythrocyte complement receptors. In vivo studies have shown that this binding allows the erythrocyte to act as an inert shuttle, targeting IC to the monocyte phagocytic system and away from vulnerable tissue. Thus, immune adherence appears to play an integral role in the primate in promoting the safe clearance of circulating IC and preventing IC‐mediated pathologies. The complement receptors that mediate immune adherence comprise two unique but closely related gene products, either the type one complement receptor (CR1) in humans or CR1‐like in non‐human primates. This review focuses on the structure, function, and physiological role of the primate immune adherence receptors.     

Mapping epitopes for 20 monoclonal antibodies to CR1

Complement receptor type one (CR1; CD35) binds and processes C3b and C4b opsonized immune complexes and regulates complement activation. We have characterized the epitopes of 13 previously reported and seven new MoAbs to human CR1. The MoAbs formed seven groups based on their reactivity with a panel of deletion forms of CR1. Seventeen of the MoAbs reacted with CR1 at more than one site, a consequence of its repetitive sequence. All five of the MoAbs recognizing epitopes in the nearly identical repeats 3, 10, and 17, as well as one MoAb which reacted with repeats 8 or 1/2 of 9 and 15 or 1/2 of 16, blocked cofactor activity for C3b. Knowledge of the repeats bearing the epitopes for these MoAbs should facilitate the further characterization of CR1.     

Measurements of patient's setup variation in intensity-modulated radiation therapy of head and neck cancer using electronic portal imaging device

Purpose:

To measure the interfraction setup variation of patient undergoing intensity-modulated radiation therapy (IMRT) of head and neck cancer. The data was used to define adequate treatment CTV-to-PTV margin.

Materials and methods:

During March to September 2006, data was collected from 9 head and neck cancer patients treated with dynamic IMRT using 6 MV X-ray beam from Varian Clinac 23EX. Weekly portal images of setup fields which were anterior-posterior and lateral portal images were acquired for each patient with an amorphous silicon EPID, Varian aS500. These images were matched with the reference image from Varian Acuity simulator using the Varis vision software (Version 7.3.10). Six anatomical landmarks were selected for comparison. The displacement of portal image from the reference image was recorded in X (Left-Right, L-R), Y (Superior-Inferior, S-I) direction for anterior field and Z (Anterior-Posterior, A-P), Y (S-I) direction for lateral field. The systematic and random error for individual and population were calculated. Then the population-based margins were obtained.

Results:

A total of 135 images (27 simulation images and 108 portal images) and 405 match points was evaluated. The systematic error ranged from 0 to 7.5 mm and the random error ranged from 0.3 to 4.8 mm for all directions. The population-based margin ranged from 2.3 to 4.5 mm (L-R), 3.5 to 4.9 mm (S-I) for anterior field and 3.4 to 4.7 mm (A-P), 2.6 to 3.7 mm (S-I) for the lateral field. These margins were comparable to the margin that was prescribed at the King Chulalongkorn Memorial Hospital (5-10 mm) for head and neck cancer.

Conclusion:

The population-based margin is less than 5 mm, thus the margin provides sufficient coverage for all of the patients.     

Proliferation of resting B cells is modulated by CR2 and CR1

Absence of the third component of complement, C3, is associated with impaired ability to synthesize antibody, particularly in the presence of limiting antigen [1-9]. The mature B lymphocyte bearing the surface immunoglobulin receptor transduces signals for proliferation and differentiation upon binding of specific antigen. This mature B cell also bears two related membrane proteins, CR2 (the C3d/Epstein-Barr virus receptor) (CD35) [15], which can mediate the binding of ligands to which appropriate cleavage fragments of C3 have become attached [16]. It has been suggested that these receptors play a direct role(s) in B cell activation [17-25]. In light of previous in vivo observations we decided to assess the function of CR2 and CR1 in relation to B cell activation through the membrane IgM receptor. Highly purified splenic B cells were prepared. No contaminating T cells or macrophages were detected by flow cytometric analysis and no proliferative activity was present upon PHA or ConA stimulation of the purified cells. The B cells were separated into low (activated), medium (preactivated) and high density (resting) fractions by Percoll gradient density centrifugation [26]. The responses of the B cell subpopulations to various concentrations of anti mu (DA4.4 monoclonal antibody) [27] were examined for proliferation at 72 h and for IgM/IgG production at 7 days. Low density B cells were maximally stimulated and no concentration of anti-mu was effective in enhancing their responses. High density B cells proliferated to anti-mu in a concentration dependent manner. When substimulatory concentrations of anti-mu were employed, concomitant crosslinking of CR2 (with either of 2 distinct monoclonal antibodies HB-5 [28] or OKB7 [17]) resulted in a 45% enhancement of B cell proliferation above that observed by crosslinking of SIgM alone. In these studies, total IgM and IgG did not increase in the absence of T cells or T cell factors, indicating that terminal differentiation did not occur. In contrast, when a monoclonal antibody to CR1(44D) [29] was employed in an identical experiment, B cell proliferation was completely inhibited. Antibodies to CR2 or CR1 either alone or in crosslinked form did not enhance B cell proliferation. Immune complexes may crosslink the B cell surface in a manner analogous to our model when the immunoglobulin receptor and CR2 are simultaneously engaged. This activation signal may be particularly important in eliciting antibody responses when the quantity of specific antigen or the affinity for antigen is low. The marked inhibition of proliferation induced by CR1 suggests an alternate role for this receptor in modulation of B cell responses.     

Human liver Kupffer cells express CR1, CR3, and CR4 complement receptor antigens. An immunohistochemical study

The expression of complement receptor antigens by human Kupffer cells (KC) was investigated by immunohistochemical techniques in seven normal human liver biopsies. Polyclonal and monoclonal antibodies were revealed by double labeling of cells using indirect immunofluorescence and immunoenzymatic techniques or by using double immunoenzymatic techniques. In most experiments, one antigen was revealed by streptavidin-biotin-peroxidase complexes whose reaction product was examined by light microscopy and the second antigen stained using the alkaline phosphatase antialkaline phosphatase method visualized by fluorescence microscopy using fluorescein isothiocyanate or tetramethylrhodamine isothiocyanate filters. KC were identified using monoclonal antibody EBM11 that recognizes 100% of KC in hepatic lobules and was paired with each antibody directed against complement receptors. CR1 and CR3 (alpha- and beta-chains) were found to be the predominant receptor antigens expressed by human KC. CR4 (p150,95) was expressed on all KC, but staining with anti-CR4 monoclonal antibodies was consistently weaker than that observed with anti-CR3 antibodies. No staining of KC was observed with anti-CR2 (CD 21) antibodies. Expression of CR1, CR3, and CR4 complement receptors on KC provides the cells with an optimal capacity to bind and phagocytize particles or immune complexes coated with any type of ligands for C3 receptors.     

Accuracy and feasibility of cone-beam computed tomography for stereotactic radiosurgery setup

Image fusion, target localization, and setup accuracy of cone-beam computed tomography (CBCT) for stereotactic radiosurgery (SRS) were investigated in this study. A Rando head phantom rigidly attached to a stereotactic Brown-Roberts-Wells (BRW) frame was utilized to study the geometric accuracy of CBCT. Measurements of distances and angular separations between selected pairs of multiple radio-opaque targets embedded in the head phantom from a conventional simulation CT provided comparative data for geometric accuracy analysis. Localization accuracy of the CBCT scan was investigated from an analysis of BRW localization of four cylindrical objects (9 mm in diameter and 25 mm in length) independently computed from CBCT and conventional CT scans. Image fusion accuracy was quantitatively evaluated from BRW localization of multiple simulated targets from the CBCT and conventional CT scan. Finally, a CBCT setup procedure for stereotactic radiosurgery treatments was proposed and its accuracy was assessed using orthogonal target verification imaging. Our study showed that CBCT did not present any significant geometric distortions. Stereotactic coordinates of the four cylindrical objects as determined from the CBCT differed from those determined from the conventional CT on average by 0.30 mm with a standard deviation (SD) of 0.09 mm. The mean image registration accuracy of CBCT with conventional CT was 0.28 mm (SD = 0.10 mm). Setup uncertainty of our proposed CBCT setup procedure was on the same order as the conventional framed-based stereotactic systems reported in the literature (mean = 1.34 mm, SD = 0.33 mm). In conclusion, CBCT can be used to guide SRS treatment setup with accuracy comparable to the currently used frame-based stereotactic radiosurgery systems provided that intra-treatment patient motion is prevented.     

Comparison between a built-in "dual side" chest imaging device and a standard "single side" CR

An integrated readout computed radiography system (Fuji XU-D1) incorporating dual-side imaging plates (ST-55BD) was analyzed in terms of modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) for standard beam qualities RQA 9 and RQA 5. NPS and DQE were assessed using a detector entrance air kerma consistent with clinical practice for chest radiography. Similar investigation was performed on a standard reader (Fuji FCR 5000) using single-side imaging plates (ST-VI). Negligible differences were found between the MTFs of the two imaging systems for RQA 9, whereas for RQA 5 the single-side system exhibited slightly superior MTF. Regarding noise response, the dual-side system turned out to be better performing for both beam qualities over a wide range of frequencies. For RQA 9, at 8 microGy, the DQE of the dual-side system was moderately higher over the whole frequency range, whereas for RQA 5, at 10 microGy, significant improvement was found at low- and midrange frequencies. As an example, at 1 cycle/mm, the following improvements in the DQE of the dual-side system were observed: +22% (RQA 9, at 8 microGy), +50% (RQA 9, at 30 microGy), and +45% (RQA 5, at 10 microGy).     

Investigating a compact phantom and setup for testing body sound transducers

Contact transducers are a key element in experiments involving body sounds. The characteristics of these devices are often not known with accuracy. There are no standardized calibration setups or procedures for testing these sensors. This study investigated the characteristics of a new computer-controlled sound source phantom for testing sensors. Results suggested that sensors with different sizes require special phantom requirements. The effectiveness of certain approaches on increasing the spatial and spectral uniformity of the phantom surface signal was studied. Non-uniformities >20 dB were removable, which can be particularly helpful in comparing the characteristics of different size sensors more accurately.     

In-bore setup and software for 3T MRI-guided transperineal prostate biopsy

MRI-guided prostate biopsy in conventional closed-bore scanners requires transferring the patient outside the bore during needle insertion due to the constrained in-bore space, causing a safety hazard and limiting image feedback. To address this issue, we present our custom-made in-bore setup and software to support MRI-guided transperineal prostate biopsy in a wide-bore 3 T MRI scanner. The setup consists of a specially designed tabletop and a needle-guiding template with a Z-frame that gives a physician access to the perineum of the patient at the imaging position and allows the physician to perform MRI-guided transperineal biopsy without moving the patient out of the scanner. The software and Z-frame allow registration of the template, target planning and biopsy guidance. Initially, we performed phantom experiments to assess the accuracy of template registration and needle placement in a controlled environment. Subsequently, we embarked on our clinical trial (N = 10). The phantom experiments showed that the translational errors of the template registration along the right-left (RP) and anterior-posterior (AP) axes were 1.1 ± 0.8 and 1.4 ± 1.1 mm, respectively, while the rotational errors around the RL, AP and superior-inferior axes were (0.8 ± 1.0)°, (1.7 ± 1.6)° and (0.0 ± 0.0)°, respectively. The 2D root-mean-square (RMS) needle-placement error was 3 mm. The clinical biopsy procedures were safely carried out in all ten clinical cases with a needle-placement error of 5.4 mm (2D RMS). In conclusion, transperineal prostate biopsy in a wide-bore 3T scanner is feasible using our custom-made tabletop setup and software, which supports manual needle placement without moving the patient out of the magnet.