改良睫状体缝合术治疗外伤性睫状体脱离39例临床分析

目的 评价改良睫状体缝合复位术治疗外伤性睫状体脱离的临床效果。方法 回顾性分析39例外伤性睫状体脱离改良缝合复位术治疗的临床资料，并对有关数据进行了统计学分析。术前通过房角镜和（或）超声物显微镜（UBM）确定睫状体脱离的位置和范围。结果，患者术后观察3-6个月，视力恢复≥0.3者21例，87.2%的患者眼压提高到8-21mmHg，大部分前房变深或正常，眼底有不同程度的改善。结论 改良睫状体缝合复位术治疗外伤性睫状体脱离疗效满意，UBM是明确诊断睫状体脱离的有力工具。     

An innovative method for neuraxis radiotherapy using partial transmission block technique

Whole CNS (neuraxis) radiotherapy is an important part of therapy for certain CNS tumours which seed via the CSF. Many, if not the majority, of these predominantly young patients are cured but the neuropsychometric, neuroendocrine and growth morbidity of neuraxis radiotherapy on children by conventional methods may be considerable; patients receiving such therapy at an early age often are eventually in the educationally subnormal category. Recent radiobiological data support the concept that all aspects of CNS radiation tolerance are heavily dependent on daily fraction size. We describe a new radiotherapy technique that allows lower daily fraction sizes to be delivered to the neuraxis without prejudicing the total dose to the neuraxis or primary area and without prolonging the overall treatment time. Published radiobiological data support the concept that all the major morbidities attributed to conventional neuraxis radiotherapy will be reduced by the currently described technique without reducing tumour control rates.     

Creation of an educational CD-ROM using a PACS

Presentation of MIRIAM 2: We describe the materials used for the creation of and the content of a CD-ROM entitled '77 neuroradiological case reports'. We mention the gathering of clinical and imaging data, exclusively provided by a PACS. Our work demonstrates that a CD-ROM is an appropriate interactive medium for radiological teaching. Its creation can be simplified thanks to a PACS, but it nonetheless remains work intensive.     

Creation and validation of an I-123 FP-CIT template for statistical image analysis using high-resolution SPECT for parkinsonian patients

Objective

The aim of this study was to create a new template for the anatomical normalization of I-123 FP-CIT SPECT images of Japanese people to evaluate dopamine transporter binding.

Methods

The subjects consisted of 16 normal control subjects (5 females and 11 males; mean age ± SD, 51.6 ± 9.5 years, ranging from 25 to 62 years) and 21 parkinsonian patients (7 females and 14 males; mean age ± SD, 70.7 ± 9.4 years, ranging from 49 to 85 years). All normal control subjects and 21 patients with parkinsonism underwent MRI. A total of 148 MBq of I-123 FP-CIT was intravenously injected as a bolus, and a SPECT scan was started 4 h later. Data were analyzed with the Statistical Parametric Mapping 8 (SPM8) software. At first, I-123 FP-CIT SPECT images were co-registered to MRI images and MRI images were normalized to Montreal Neurological Institute (MNI) space using a gray.nii template. Co-registered I-123 FP-CIT SPECT images were normalized using the predetermined normalization parameters for MRI images. Then, anatomically normalized I-123 FP-CIT SPECT images were divided by background counts individually measured using ROIs set on the cerebral cortices. The I-123 FP-CIT template was created by averaging the normalized SPECT images of the 16 normal control subjects. Thereafter, the averaged MRI images of the 16 normal control subjects were also created.

Results

A visual inspection revealed that there were no apparent differences between the I-123 FP-CIT images subjected to the two methods of anatomical normalization in normal control subjects. However, a group comparison by a paired t test using SPM8 revealed that the I-123 FP-CIT binding was significantly higher in the substriatal and temporal regions in I-123 FP-CIT images directly normalized with the I-123 FP-CIT template than in those normalized by the predetermined parameters with MRI, while it was higher in the bilateral frontal cortical regions in the latter than in the former images.

Conclusion

We successfully created an I-123 FP-CIT template for Japanese people. This template is thought to be useful and reliable for the statistical analysis of I-123 FP-CIT images, although some problems exist in the evaluation of parkinsonian patients. The results of a paired t test using SPM suggest that we should use the same normalization method in statistical image analyses.

     

Opportunities for radiographer reporting in Ghana and the potential for improved patient care

ObjectiveTo explore factors that influence the introduction of role extension in radiography and to discuss its potential for improved healthcare in Ghana.Key findingsKey findings of this review are the lack of literature on role extension in radiography in Ghana. The factors that have influenced the introduction of role extension in radiography globally include a shortage of radiologists, increased demand for radiology services, government policy and radiographer's desire for professional development.ConclusionsEvidence indicates that radiographers can report radiographs as accurately as radiologists and appropriate education improves their performance. Radiographer-led reporting is the professional practise most likely to deliver local patient benefit. Developments in professional perceptions, training, education and regulation of reporting are required to establish confidence in radiography-led reporting.Implications for practiceRadiographer reporting has the potential to improve patient outcomes, reduce waiting times, increase job satisfaction for radiographers and result in financial savings.     

An improved technique for interstitial radiotherapy of the tongue

An improvement of the plastic tube afterloading technique for interstitial radiotherapy of the tongue is described. This modification allows most of the work to be done outside the patient's mouth. The anchorage for the intra-oral ends of the polythene tubes is produced by transfixing then with a silk thread. This obvioates the need to form loops and simplifies afterloading. It provides a method for crossing the entire lingual end of the implant. All areas and volumes of lower jaw structures are accessible to this form of treatment. Removal of the implant, irrespective of position, is simple and rapid.     

Radionuclide angiocardiography: an improved deconvolution technique for improvement after suboptimal bolus injection

Deconvolution is a mathematical technique used to improve radionuclide angiocardiography after suboptimal injection of radiopharmaceutical. A new deconvolution algorithm designed to be relatively insensitive to the random errors that occur in experimental data was tested. First-pass radionuclide angiocardiography using iridium-191m was performed to quantitate left-to-right shunting in normal dogs and dogs with atrial septal defects. Deconvolution was used to correct for injection shape. Four quantitation techniques were studied (good injection/no deconvolution, good injection/deconvolution, fragmented injection/no deconvolution, fragmented injection/deconvolution). The mean (p less than .001) and standard deviation (p less than .0001) of the fragmented injection/no deconvolution technique were significantly different from the other three techniques, which were not significantly different from each other (mean or standard deviation) at the p = 0.05 level. This deconvolution method made it possible to accurately quantitate left-to-right shunts even with fragmented injections.     

'Boomerang' technique: an improved method for conformal treatment of locally advanced nasopharyngeal cancer

The primary aim of the present study was to assess radiation dosimetry and subsequent clinical outcomes in patients with locally advanced nasopharyngeal cancer using a novel radiation technique termed the 'Boomerang'. Dosimetric comparisons were made with both conventional and intensity modulated radiation therapy (IMRT) techniques. This is a study of 22 patients treated with this technique from June 1995 to October 1998. The technique used entailed delivery of 36 Gy in 18 fractions via parallel opposed fields, then 24 Gy in 12 fractions via asymmetric rotating arc fields for a total of 60 Gy in 30 fractions. Patients also received induction and concurrent chemotherapy. The radiation dosimetry was excellent. Dose-volume histograms showed that with the arc fields, 90% of the planning target volume received 94% of the prescribed dose. Relative to other conventional radiation therapy off-cord techniques, the Boomerang technique results in a 27% greater proportion of the prescribed dose being received by 90% of the planning target volume. This translates into an overall 10% greater dose received for the same prescribed dose. At 3 years, the actuarial loco-regional control rate, the failure-free survival rate and the overall survival rate were 91, 75 and 91%, respectively. At 5 years, the actuarial loco-regional control rate, the failure-free survival rate and the overall survival rate were 74, 62 and 71%, respectively. The Boomerang technique provided excellent radiation dosimetry with correspondingly good loco-regional control rates (in conjunction with chemotherapy) and very acceptable acute and late toxicity profiles. Because treatment can be delivered with conventional standard treatment planning and delivery systems, it is a validated treatment option for centres that do not have the capability or capacity for IMRT. A derivative of the Boomerang technique, excluding the parallel opposed component, is now our standard for patients with locally advanced nasopharyngeal cancer when IMRT is not available.     

High-pass GRAPPA: an image support reduction technique for improved partially parallel imaging.

Partially parallel imaging (PPI) is a widely used technique in clinical applications. A limitation of this technique is the strong noise and artifact in the reconstructed images when high reduction factors are used. This work aims to increase the clinical applicability of PPI by improving its performance at high reduction factors. A new concept, image support reduction, is introduced. A systematic filter-design approach for image support reduction is proposed. This approach shows more advantages when used with an important existing PPI technique, GRAPPA. An improved GRAPPA method, high-pass GRAPPA (hp-GRAPPA), was developed based on this approach. The new technique does not involve changing the original GRAPPA kernel and performs reconstruction in almost the same amount of time. Experimentally, it is demonstrated that the reconstructed images using hp-GRAPPA have much lower noise/artifact level than those reconstructed using GRAPPA.     

Evaluation of an improved technique for automated center lumen line definition in cardiovascular image data

The aim of the study was to evaluate a new method for automated definition of a center lumen line in vessels in cardiovascular image data. This method, called VAMPIRE, is based on improved detection of vessel-like structures. A multiobserver evaluation study was conducted involving 40 tracings in clinical CTA data of carotid arteries to compare VAMPIRE with an established technique. This comparison showed that VAMPIRE yields considerably more successful tracings and improved handling of stenosis, calcifications, multiple vessels, and nearby bone structures. We conclude that VAMPIRE is highly suitable for automated definition of center lumen lines in vessels in cardiovascular image data.     

A computerized medical incident reporting system for errors in the intensive care unit: initial evaluation of interrater agreement

Errors resulting in adverse events in the medical care system are ubiquitous and underreported. Critical incident techniques that have been used to reduce errors in aviation have recently been applied to evaluate adverse events in the critical care arena. We report an evaluation of interrater agreement on responses to questions concerning adverse event reporting using a computer-based medical incident reporting system (MIRS). Thirty-four intensive care unit staff volunteers reviewed five fabricated test cases containing iatrogenic factors, then completed an incident report for each case using the MIRS. Interrater agreement was significant for all five cases (p < 0.01). The time required to complete a report decreased significantly from the first case to the last (p < 0.01). Overall, the MIRS was perceived as a relatively quick (< 6 minutes) and comprehensive reporting tool. The results indicate that health care providers report adverse events similarly, suggesting that the MIRS would be a useful tool in the reduction of errors (as a process improvement program) and to facilitate the continuing process of health care improvement.     

An improved technique for the extraction of stochastic parameters from stabilograms

An improved characterization of the dynamics of postural sway can provide a better understanding about the functional organization of the postural control system as well as a more robust tool for postural pattern recognition. To this aim, a novel parameterization was applied to the stabilogram diffusion analysis formerly proposed by Collins and De Luca [Collins JJ, De Luca CJ. Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories. Exp Brain Res 1993;95:308–18] that considered the act of maintaining posture as a stochastic process. The main purpose of the present technique was to overcome some drawbacks of the model presented by Collins and De Luca that may restrain its potential application in clinical practice. The approach uses a unique non-linear model to describe the center of pressure (COP) dynamics that reduces the number of parameters and decreases their intra-subject variability; consequently, fewer trials are required to perform reliable estimates of stochastic parameters and this is of particular importance for subjects that cannot afford many repeated measurements because of age or pathology. Four new statistical mechanics parameters (NSMP) were computed on the log–log stabilogram diffusion plots and their estimates were compared in terms of reliability and sensitivity to the visual conditions with: (1) a minimal set of four summary statistic scores (SSS); and (2) the six statistical mechanics parameters (SMP) proposed by Collins and De Luca. All four NSMP showed at least a fair-to-good reliability (intraclass correlation coefficient, ICC>0.49) while SMP (ICC>0.20) showed some poor reliability. A better overall reliability was also observed with respect to SSS. Moreover, only NSMP had a similar score for eyes open and eyes closed conditions. Three out of four NSMP were also significantly sensitive to eyes open or closed conditions (P<0.001) while only three out of six SMP were sensitive to operating conditions (P<0.01).     

An improved MR imaging technique for the visualization of myocardial infarction

PURPOSE: To design a segmented inversion-recovery turbo fast low-angle shot (turboFLASH) magnetic resonance (MR) imaging pulse sequence for the visualization of myocardial infarction, compare this technique with other MR imaging approaches in a canine model of ischemic injury, and evaluate its utility in patients with coronary artery disease. MATERIALS AND METHODS: Six dogs and 18 patients were examined. In dogs, infarction was produced and images were acquired by using 10 different pulse sequences. In patients, the segmented turboFLASH technique was used to acquire contrast material-enhanced images 19 days +/- 7 (SD) after myocardial infarction. RESULTS: Myocardial regions of increased signal intensity were observed in all animals and patients at imaging. With the postcontrast segmented turboFLASH sequence, the signal intensity of the infarcted myocardium was 1,080% +/- 214 higher than that of the normal myocardium in dogs-nearly twice that of the next best sequence tested and approximately 10-fold greater than that in previous reports. All 18 patients with myocardial infarction demonstrated high signal intensity at imaging. On average, the signal intensity of the high-signal-intensity regions in patients was 485% +/- 43 higher than that of the normal myocardium. CONCLUSION: The segmented inversion-recovery turboFLASH sequence produced the greatest differences in regional myocardial signal intensity in animals. Application of this technique in patients with infarction substantially improved differentiation between injured and normal regions.