Search results for: photoacoustic imaging
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1295

Search results for: photoacoustic imaging

1205 Comparison of the Classification of Cystic Renal Lesions Using the Bosniak Classification System with Contrast Enhanced Ultrasound and Magnetic Resonance Imaging to Computed Tomography: A Prospective Study

Authors: Dechen Tshering Vogel, Johannes T. Heverhagen, Bernard Kiss, Spyridon Arampatzis

Abstract:

In addition to computed tomography (CT), contrast enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI) are being increasingly used for imaging of renal lesions. The aim of this prospective study was to compare the classification of complex cystic renal lesions using the Bosniak classification with CEUS and MRI to CT. Forty-eight patients with 65 cystic renal lesions were included in this study. All participants signed written informed consent. The agreement between the Bosniak classifications of complex renal lesions ( ≥ BII-F) on CEUS and MRI were compared to that of CT and were tested using Cohen’s Kappa. Sensitivity, specificity, positive and negative predictive values (PPV/NPV) and the accuracy of CEUS and MRI compared to CT in the detection of complex renal lesions were calculated. Twenty-nine (45%) out of 65 cystic renal lesions were classified as complex using CT. The agreement between CEUS and CT in the classification of complex cysts was fair (agreement 50.8%, Kappa 0.31), and was excellent between MRI and CT (agreement 93.9%, Kappa 0.88). Compared to CT, MRI had a sensitivity of 96.6%, specificity of 91.7%, a PPV of 54.7%, and an NPV of 54.7% with an accuracy of 63.1%. The corresponding values for CEUS were sensitivity 100.0%, specificity 33.3%, PPV 90.3%, and NPV 97.1% with an accuracy 93.8%. The classification of complex renal cysts based on MRI and CT scans correlated well, and MRI can be used instead of CT for this purpose. CEUS can exclude complex lesions, but due to higher sensitivity, cystic lesions tend to be upgraded. However, it is useful for initial imaging, for follow up of lesions and in those patients with contraindications to CT and MRI.

Keywords: Bosniak classification, computed tomography, contrast enhanced ultrasound, cystic renal lesions, magnetic resonance imaging

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1204 1,8-Naphthalimide Substituted 4,4-Difluoroboradiaza-S-Indacene Dyads: Synthesis, Structure, Properties and Live-Cell Imaging

Authors: Madhurima Poddar, Vinay Sharma, Shaikh M. Mobin, Rajneesh Misra

Abstract:

Three 1,8-naphthalimide (NPI) substituted 4,4-difluoroboradiaza-s-indacene (BODIPY) dyads were synthesized via Pd-catalyzed Sonogashira cross-coupling reaction of ethynyl substituted NPI with the meso-, β- and α-halogenated BODIPYs, respectively. The photophysical and electrochemical data reveals considerable electronic communication between the BODIPY and NPI moieties. The electronic absorption spectrum reveals that the substitution of NPI at α position of BODIPY exhibit better electronic communication between the NPI and the BODIPY units. The electronic structures of all the dyads exhibit planar geometries which are in a good correlation with the structures obtained from single crystal X-ray diffraction. The crystal structures of the dyads exhibit interesting supramolecular interactions. The dyads show good cytocompatibility with the potential of multicolor live-cell imaging; making them excellent candidates for biological applications. The work provides an important strategy of screening the substitution pattern at different position of BODIPYs which will be useful for the design of BODIPY based organic molecules for various optoelectronic applications as well as bio-imaging.

Keywords: bio-imaging studies, cross-coupling, cyclic voltammetry, density functional calculations, fluorescence spectra, single crystal XRD, UV/Vis spectroscopy

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1203 Digital Phase Shifting Holography in a Non-Linear Interferometer using Undetected Photons

Authors: Sebastian Töpfer, Marta Gilaberte Basset, Jorge Fuenzalida, Fabian Steinlechner, Juan P. Torres, Markus Gräfe

Abstract:

This work introduces a combination of digital phase-shifting holography with a non-linear interferometer using undetected photons. Non-linear interferometers can be used in combination with a measurement scheme called quantum imaging with undetected photons, which allows for the separation of the wavelengths used for sampling an object and detecting it in the imaging sensor. This method recently faced increasing attention, as it allows to use of exotic wavelengths (e.g., mid-infrared, ultraviolet) for object interaction while at the same time keeping the detection in spectral areas with highly developed, comparable low-cost imaging sensors. The object information, including its transmission and phase influence, is recorded in the form of an interferometric pattern. To collect these, this work combines the method of quantum imaging with undetected photons with digital phase-shifting holography with a minimal sampling of the interference. With this, the quantum imaging scheme gets extended in its measurement capabilities and brings it one step closer to application. Quantum imaging with undetected photons uses correlated photons generated by spontaneous parametric down-conversion in a non-linear interferometer to create indistinguishable photon pairs, which leads to an effect called induced coherence without induced emission. Placing an object inside changes the interferometric pattern depending on the object’s properties. Digital phase-shifting holography records multiple images of the interference with determined phase shifts to reconstruct the complete interference shape, which can afterward be used to analyze the changes introduced by the object and conclude its properties. An extensive characterization of this method was done using a proof-of-principle setup. The measured spatial resolution, phase accuracy, and transmission accuracy are compared for different combinations of camera exposure times and the number of interference sampling steps. The current limits of this method are shown to allow further improvements. To summarize, this work presents an alternative holographic measurement method using non-linear interferometers in combination with quantum imaging to enable new ways of measuring and motivating continuing research.

Keywords: digital holography, quantum imaging, quantum holography, quantum metrology

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1202 Design and Implementation of a Lab Bench for Synthetic Aperture Radar Imaging System

Authors: Karthiyayini Nagarajan, P. V. RamaKrishna

Abstract:

Radar Imaging techniques provides extensive applications in the field of remote sensing, majorly Synthetic Aperture Radar(SAR) that provide high resolution target images. This paper work puts forward the effective and realizable signal generation and processing for SAR images. The major units in the system include camera, signal generation unit, signal processing unit and display screen. The real radio channel is replaced by its mathematical model based on optical image to calculate a reflected signal model in real time. Signal generation realizes the algorithm and forms the radar reflection model. Signal processing unit provides range and azimuth resolution through matched filtering and spectrum analysis procedure to form radar image on the display screen. The restored image has the same quality as that of the optical image. This SAR imaging system has been designed and implemented using MATLAB and Quartus II tools on Stratix III device as a System(lab bench) that works in real time to study/investigate on radar imaging rudiments and signal processing scheme for educational and research purposes.

Keywords: synthetic aperture radar, radio reflection model, lab bench

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1201 Imaging of Underground Targets with an Improved Back-Projection Algorithm

Authors: Alireza Akbari, Gelareh Babaee Khou

Abstract:

Ground Penetrating Radar (GPR) is an important nondestructive remote sensing tool that has been used in both military and civilian fields. Recently, GPR imaging has attracted lots of attention in detection of subsurface shallow small targets such as landmines and unexploded ordnance and also imaging behind the wall for security applications. For the monostatic arrangement in the space-time GPR image, a single point target appears as a hyperbolic curve because of the different trip times of the EM wave when the radar moves along a synthetic aperture and collects reflectivity of the subsurface targets. With this hyperbolic curve, the resolution along the synthetic aperture direction shows undesired low resolution features owing to the tails of hyperbola. However, highly accurate information about the size, electromagnetic (EM) reflectivity, and depth of the buried objects is essential in most GPR applications. Therefore hyperbolic curve behavior in the space-time GPR image is often willing to be transformed to a focused pattern showing the object's true location and size together with its EM scattering. The common goal in a typical GPR image is to display the information of the spatial location and the reflectivity of an underground object. Therefore, the main challenge of GPR imaging technique is to devise an image reconstruction algorithm that provides high resolution and good suppression of strong artifacts and noise. In this paper, at first, the standard back-projection (BP) algorithm that was adapted to GPR imaging applications used for the image reconstruction. The standard BP algorithm was limited with against strong noise and a lot of artifacts, which have adverse effects on the following work like detection targets. Thus, an improved BP is based on cross-correlation between the receiving signals proposed for decreasing noises and suppression artifacts. To improve the quality of the results of proposed BP imaging algorithm, a weight factor was designed for each point in region imaging. Compared to a standard BP algorithm scheme, the improved algorithm produces images of higher quality and resolution. This proposed improved BP algorithm was applied on the simulation and the real GPR data and the results showed that the proposed improved BP imaging algorithm has a superior suppression artifacts and produces images with high quality and resolution. In order to quantitatively describe the imaging results on the effect of artifact suppression, focusing parameter was evaluated.

Keywords: algorithm, back-projection, GPR, remote sensing

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1200 Implementation of a Monostatic Microwave Imaging System using a UWB Vivaldi Antenna

Authors: Babatunde Olatujoye, Binbin Yang

Abstract:

Microwave imaging is a portable, noninvasive, and non-ionizing imaging technique that employs low-power microwave signals to reveal objects in the microwave frequency range. This technique has immense potential for adoption in commercial and scientific applications such as security scanning, material characterization, and nondestructive testing. This work presents a monostatic microwave imaging setup using an Ultra-Wideband (UWB), low-cost, miniaturized Vivaldi antenna with a bandwidth of 1 – 6 GHz. The backscattered signals (S-parameters) of the Vivaldi antenna used for scanning targets were measured in the lab using a VNA. An automated two-dimensional (2-D) scanner was employed for the 2-D movement of the transceiver to collect the measured scattering data from different positions. The targets consist of four metallic objects, each with a distinct shape. Similar setup was also simulated in Ansys HFSS. A high-resolution Back Propagation Algorithm (BPA) was applied to both the simulated and experimental backscattered signals. The BPA utilizes the phase and amplitude information recorded over a two-dimensional aperture of 50 cm × 50 cm with a discreet step size of 2 cm to reconstruct a focused image of the targets. The adoption of BPA was demonstrated by coherently resolving and reconstructing reflection signals from conventional time-of-flight profiles. For both the simulation and experimental data, BPA accurately reconstructed a high resolution 2D image of the targets in terms of shape and location. An improvement of the BPA, in terms of target resolution, was achieved by applying the filtering method in frequency domain.

Keywords: back propagation, microwave imaging, monostatic, vivialdi antenna, ultra wideband

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1199 Exploring Structure of Human Chromosomes Using Fluorescence Lifetime Imaging

Authors: A. Bhartiya, S. Botchway, M. Yusuf, I. Robinson

Abstract:

Chromatin condensation is maintained by DNA-based proteins and some divalent cations (Mg²⁺, Ca²⁺, etc.). Condensation process during cell division maintains structural and functional organizations of chromosomes by transferring genetic information correctly to daughter cells. Fluorescence Lifetime Imaging (FLIM) technique measures the fluorescence decay of fixed human chromosomes by calculating the lifetime of fluorophores at a pixel x of the arrival of each photon as a function of time delay t, following excitation with a laser pulse. Fixed metaphase human chromosomes were labelled with DNA-binding dye, DAPI and later DAPI fluorescence lifetime measured using multiphoton microscopy. 5 out of 23 pairs of human chromosomes shown shorter lifetime at the centromere region, differentiating proportion of compaction along the length of chromosomes. Different lifetime was observed in a condensed and de-condensed chromosome. It clearly indicates the involvement of divalent cations in the process of condensation.

Keywords: divalent cations, FLIM (Fluorescence Lifetime Imaging), human chromosomes, multiphoton microscopy

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1198 The Superiority of 18F-Sodium Fluoride PET/CT for Detecting Bone Metastases in Comparison with Other Bone Diagnostic Imaging Modalities

Authors: Mojtaba Mirmontazemi, Habibollah Dadgar

Abstract:

Bone is the most common metastasis site in some advanced malignancies, such as prostate and breast cancer. Bone metastasis generally indicates fewer prognostic factors in these patients. Different radiological and molecular imaging modalities are used for detecting bone lesions. Molecular imaging including computed tomography, magnetic resonance imaging, planar bone scintigraphy, single-photon emission tomography, and positron emission tomography as noninvasive visualization of the biological occurrences has the potential to exact examination, characterization, risk stratification and comprehension of human being diseases. Also, it is potent to straightly visualize targets, specify clearly cellular pathways and provide precision medicine for molecular targeted therapies. These advantages contribute implement personalized treatment for each patient. Currently, NaF PET/CT has significantly replaced standard bone scintigraphy for the detection of bone metastases. On one hand, 68Ga-PSMA PET/CT has gained high attention for accurate staging of primary prostate cancer and restaging after biochemical recurrence. On the other hand, FDG PET/CT is not commonly used in osseous metastases of prostate and breast cancer as well as its usage is limited to staging patients with aggressive primary tumors or localizing the site of disease. In this article, we examine current studies about FDG, NaF, and PSMA PET/CT images in bone metastases diagnostic utility and assess response to treatment in patients with breast and prostate cancer.

Keywords: skeletal metastases, fluorodeoxyglucose, sodium fluoride, molecular imaging, precision medicine, prostate cancer (68Ga-PSMA-11)

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1197 The Sensitivity of Electrical Geophysical Methods for Mapping Salt Stores within the Soil Profile

Authors: Fathi Ali Swaid

Abstract:

Soil salinization is one of the most hazardous phenomenons accelerating the land degradation processes. It either occurs naturally or is human-induced. High levels of soil salinity negatively affect crop growth and productivity leading land degradation ultimately. Thus, it is important to monitor and map soil salinity at an early stage to enact effective soil reclamation program that helps lessen or prevent future increase in soil salinity. Geophysical method has outperformed the traditional method for assessing soil salinity offering more informative and professional rapid assessment techniques for monitoring and mapping soil salinity. Soil sampling, EM38 and 2D conductivity imaging have been evaluated for their ability to delineate and map the level of salinity variations at Second Ponds Creek. The three methods have shown that the subsoil in the study area is saline. Salt variations were successfully observed under either method. However, EM38 reading and 2D inversion data show a clear spatial structure comparing to EC1:5 of soil samples in spite of that all soil samples, EM38 and 2D imaging were collected from the same location. Because EM38 readings and 2D imaging data are a weighted average of electrical soil conductance, it is more representative of soil properties than the soil samples method. The mapping of subsurface soil at the study area has been successful and the resistivity imaging has proven to be an advantage. The soil salinity analysis (EC1:5) correspond well to the true resistivity bringing together a good result of soil salinity. Soil salinity clearly indicated by previous investigation EM38 have been confirmed by the interpretation of the true resistivity at study area.

Keywords: 2D conductivity imaging, EM38 readings, soil salinization, true resistivity, urban salinity

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1196 Array Type Miniaturized Ultrasonic Sensors for Detecting Sinkhole in the City

Authors: Won Young Choi, Kwan Kyu Park

Abstract:

Recently, the road depression happening in the urban area is different from the cause of the sink hole and the generation mechanism occurring in the limestone area. The main cause of sinkholes occurring in the city center is the loss of soil due to the damage of old underground buried materials and groundwater discharge due to large underground excavation works. The method of detecting the sinkhole in the urban area is mostly using the Ground Penetration Radar (GPR). However, it is challenging to implement compact system and detecting watery state since it is based on electromagnetic waves. Although many ultrasonic underground detection studies have been conducted, near-ground detection (several tens of cm to several meters) has been developed for bulk systems using geophones as a receiver. The goal of this work is to fabricate a miniaturized sinkhole detecting system based on low-cost ultrasonic transducers of 40 kHz resonant frequency with high transmission pressure and receiving sensitivity. Motived by biomedical ultrasonic imaging methods, we detect air layers below the ground such as asphalt through the pulse-echo method. To improve image quality using multi-channel, linear array system is implemented, and image is acquired by classical synthetic aperture imaging method. We present the successful feasibility test of multi-channel sinkhole detector based on ultrasonic transducer. In this work, we presented and analyzed image results which are imaged by single channel pulse-echo imaging, synthetic aperture imaging.

Keywords: road depression, sinkhole, synthetic aperture imaging, ultrasonic transducer

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1195 Theoretical Study on the Nonlinear Optical Responses of Peptide Bonds Created between Alanine and Some Unnatural Amino Acids

Authors: S. N. Derrar, M. Sekkal-Rahal

Abstract:

The Nonlinear optics (NLO) technique is widely used in the field of biological imaging. In fact, grafting biological entities with a high NLO response on tissues and cells enhances the NLO responses of these latter, and ameliorates, consequently, their biological imaging quality. In this optics, we carried out a theoretical study, in the aim of analyzing the peptide bonds created between alanine amino acid and both unnatural amino acids: L-Dopa and Azatryptophan, respectively. Ramachandran plots have been performed for these systems, and their structural parameters have been analyzed. The NLO responses of these peptides have been reported by calculating the first hyperpolarizability values of all the minima found on the plots. The use of such unnatural amino acids as endogenous probing molecules has been investigated through this study. The Density Functional Theory (DFT) has been used for structural properties, while the Second-order Møller-Plesset Perturbation Theory (MP2) has been employed for the NLO calculations.

Keywords: biological imaging, hyperpolarizability, nonlinear optics, probing molecule

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1194 Biodegradable Polymeric Vesicles Containing Magnetic Nanoparticles, Quantum Dots and Anticancer Drugs for Drug Delivery and Imaging

Authors: Fei Ye, Åsa Barrefelt, Manuchehr Abedi-Valugerdi, Khalid M. Abu-Salah, Salman A. Alrokayan, Mamoun Muhammed, Moustapha Hassan

Abstract:

With appropriate encapsulation in functional nanoparticles drugs are more stable in physiological environment and the kinetics of the drug can be more carefully controlled and monitored. Furthermore, targeted drug delivery can be developed to improve chemotherapy in cancer treatment, not only by enhancing intracellular uptake by target cells but also by reducing the adverse effects in non-target organs. Inorganic imaging agents, delivered together with anti-cancer drugs, enhance the local imaging contrast and provide precise diagnosis as well as evaluation of therapy efficacy. We have developed biodegradable polymeric vesicles as a nanocarrier system for multimodal bio-imaging and anticancer drug delivery. The poly (lactic-co-glycolic acid) PLGA) vesicles were fabricated by encapsulating inorganic imaging agents of superparamagnetic iron oxide nanoparticles (SPION), manganese-doped zinc sulfide (MN:ZnS) quantum dots (QDs) and the anticancer drug busulfan into PLGA nanoparticles via an emulsion-evaporation method. T2-weighted magnetic resonance imaging (MRI) of PLGA-SPION-Mn:ZnS phantoms exhibited enhanced negative contrast with r2 relaxivity of approximately 523 s-1 mM-1 Fe. Murine macrophage (J774A) cellular uptake of PLGA vesicles started fluorescence imaging at 2 h and reached maximum intensity at 24 h incubation. The drug delivery ability PLGA vesicles was demonstrated in vitro by release of busulfan. PLGA vesicles degradation was studied in vitro, showing that approximately 32% was degraded into lactic and glycolic acid over a period of 5 weeks. The biodistribution of PLGA vesicles was investigated in vivo by MRI in a rat model. Change of contrast in the liver could be visualized by MRI after 7 min and maximal signal loss detected after 4 h post-injection of PLGA vesicles. Histological studies showed that the presence of PLGA vesicles in organs was shifted from the lungs to the liver and spleen over time.

Keywords: biodegradable polymers, multifunctional nanoparticles, quantum dots, anticancer drugs

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1193 Active Surface Tracking Algorithm for All-Fiber Common-Path Fourier-Domain Optical Coherence Tomography

Authors: Bang Young Kim, Sang Hoon Park, Chul Gyu Song

Abstract:

A conventional optical coherence tomography (OCT) system has limited imaging depth, which is 1-2 mm, and suffers unwanted noise such as speckle noise. The motorized-stage-based OCT system, using a common-path Fourier-domain optical coherence tomography (CP-FD-OCT) configuration, provides enhanced imaging depth and less noise so that we can overcome these limitations. Using this OCT systems, OCT images were obtained from an onion, and their subsurface structure was observed. As a result, the images obtained using the developed motorized-stage-based system showed enhanced imaging depth than the conventional system, since it is real-time accurate depth tracking. Consequently, the developed CP-FD-OCT systems and algorithms have good potential for the further development of endoscopic OCT for microsurgery.

Keywords: common-path OCT, FD-OCT, OCT, tracking algorithm

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1192 HR MRI CS Based Image Reconstruction

Authors: Krzysztof Malczewski

Abstract:

Magnetic Resonance Imaging (MRI) reconstruction algorithm using compressed sensing is presented in this paper. It is exhibited that the offered approach improves MR images spatial resolution in circumstances when highly undersampled k-space trajectories are applied. Compressed Sensing (CS) aims at signal and images reconstructing from significantly fewer measurements than were conventionally assumed necessary. Magnetic Resonance Imaging (MRI) is a fundamental medical imaging method struggles with an inherently slow data acquisition process. The use of CS to MRI has the potential for significant scan time reductions, with visible benefits for patients and health care economics. In this study the objective is to combine super-resolution image enhancement algorithm with CS framework benefits to achieve high resolution MR output image. Both methods emphasize on maximizing image sparsity on known sparse transform domain and minimizing fidelity. The presented algorithm considers the cardiac and respiratory movements.

Keywords: super-resolution, MRI, compressed sensing, sparse-sense, image enhancement

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1191 Preclinical Studying of Stable Fe-Citrate Effect on 68Ga-Citrate Tissue Distribution

Authors: A. S. Lunev, A. A. Larenkov, O. E. Klementyeva, G. E. Kodina

Abstract:

Background and aims: 68Ga-citrate is one of prospective radiopharmaceutical for PET-imaging of inflammation and infection. 68Ga-citrate is 67Ga-citrate analogue using since 1970s for SPECT-imaging. There's known rebinding reaction occurs past Ga-citrate injection and gallium (similar iron Fe3+) binds with blood transferrin. Then radiolabeled protein complex is delivered to pathological foci (inflammation/infection sites). But excessive gallium bindings with transferrin are cause of slow blood clearance, long accumulation time in foci (24-72 h) and exception of application possibility of the short-lived gallium-68 (T½ = 68 min). Injection of additional chemical agents (e.g. Fe3+ compounds) competing with radioactive gallium to the blood transferrin joining (blocking of its metal binding capacity) is one of the ways to solve formulated problem. This phenomenon can be used for correction of 68Ga-citrate pharmacokinetics for increasing of the blood clearance and accumulation in foci. The aim of real studying is research of effect of stable Fe-citrate on 68Ga-citrate tissue distribution. Materials and methods: 68Ga-citrate without/with extra injection of stable Fe-citrate (III) was injected nonlinear mice with inflammation models (aseptic soft tissue inflammation, lung infection, osteomyelitis). PET/X-RAY Genisys4 (Sofie Bioscience, USA) was used for non-invasive PET imaging (for 30, 60, 120 min past injection 68Ga-citrate) with subsequent reconstruction of imaging and their analysis (value of clearance, distribution volume). Scanning time is 10 min. Results and conclusions: I. v. injection of stable Fe-citrate blocks the metal-binding capability of transferrin serum and allows decreasing gallium-68 radioactivity in blood significantly and increasing accumulation in inflammation (3-5 time). It allows receiving more informative PET-images of inflammation early (for 30-60 min after injection). Pharmacokinetic parameters prove it. Noted there is no statistically significant difference between 68Ga-citrate accumulation for different inflammation model because PET imaging is indication of pathological processes and is not their identification.

Keywords: 68Ga-citrate, Fe-citrate, PET imaging, mice, inflammation, infection

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1190 Mineralized Nanoparticles as a Contrast Agent for Ultrasound and Magnetic Resonance Imaging

Authors: Jae Won Lee, Kyung Hyun Min, Hong Jae Lee, Sang Cheon Lee

Abstract:

To date, imaging techniques have attracted much attention in medicine because the detection of diseases at an early stage provides greater opportunities for successful treatment. Consequently, over the past few decades, diverse imaging modalities including magnetic resonance (MR), positron emission tomography, computed tomography, and ultrasound (US) have been developed and applied widely in the field of clinical diagnosis. However, each of the above-mentioned imaging modalities possesses unique strengths and intrinsic weaknesses, which limit their abilities to provide accurate information. Therefore, multimodal imaging systems may be a solution that can provide improved diagnostic performance. Among the current medical imaging modalities, US is a widely available real-time imaging modality. It has many advantages including safety, low cost and easy access for patients. However, its low spatial resolution precludes accurate discrimination of diseased region such as cancer sites. In contrast, MR has no tissue-penetrating limit and can provide images possessing exquisite soft tissue contrast and high spatial resolution. However, it cannot offer real-time images and needs a comparatively long imaging time. The characteristics of these imaging modalities may be considered complementary, and the modalities have been frequently combined for the clinical diagnostic process. Biominerals such as calcium carbonate (CaCO3) and calcium phosphate (CaP) exhibit pH-dependent dissolution behavior. They demonstrate pH-controlled drug release due to the dissolution of minerals in acidic pH conditions. In particular, the application of this mineralization technique to a US contrast agent has been reported recently. The CaCO3 mineral reacts with acids and decomposes to generate calcium dioxide (CO2) gas in an acidic environment. These gas-generating mineralized nanoparticles generated CO2 bubbles in the acidic environment of the tumor, thereby allowing for strong echogenic US imaging of tumor tissues. On the basis of this previous work, it was hypothesized that the loading of MR contrast agents into the CaCO3 mineralized nanoparticles may be a novel strategy in designing a contrast agent for dual imaging. Herein, CaCO3 mineralized nanoparticles that were capable of generating CO2 bubbles to trigger the release of entrapped MR contrast agents in response to tumoral acidic pH were developed for the purposes of US and MR dual-modality imaging of tumors. Gd2O3 nanoparticles were selected as an MR contrast agent. A key strategy employed in this study was to prepare Gd2O3 nanoparticle-loaded mineralized nanoparticles (Gd2O3-MNPs) using block copolymer-templated CaCO3 mineralization in the presence of calcium cations (Ca2+), carbonate anions (CO32-) and positively charged Gd2O3 nanoparticles. The CaCO3 core was considered suitable because it may effectively shield Gd2O3 nanoparticles from water molecules in the blood (pH 7.4) before decomposing to generate CO2 gas, triggering the release of Gd2O3 nanoparticles in tumor tissues (pH 6.4~7.4). The kinetics of CaCO3 dissolution and CO2 generation from the Gd2O3-MNPs were examined as a function of pH and pH-dependent in vitro magnetic relaxation; additionally, the echogenic properties were estimated to demonstrate the potential of the particles for the tumor-specific US and MR imaging.

Keywords: calcium carbonate, mineralization, ultrasound imaging, magnetic resonance imaging

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1189 Novel Liposomal Nanocarriers For Long-term Tumor Imaging

Authors: Mohamad Ahrari, Kayvan Sadri, Mahmoud Reza Jafari

Abstract:

PEGylated liposomes have a smaller volume of distribution and decreased clearance, consequently, due to their more prolonged presence in bloodstream and maintaining their stability during this period, these liposomes can be applied for imaging tumoral sites. The purpose of this study is to develop an appropriate radiopharmaceutical agent in long-term imaging for improved diagnosis and evaluation of tumors. In this study, liposomal formulations encapsulating albumin is synthesized by solvent evaporation method along with homogenization, and their characteristics were assessed. Then these liposomes labeled by Philips method and the rate of stability of labeled liposomes in serum, and ultimately the rate of biodistribution and gamma scintigraphy in C26-colon carcinoma tumor-bearing mice, were studied. The result of the study of liposomal characteristics displayed that capable of accumulating in tumor sites based of EPR phenomenon. these liposomes also have high stability for maintaining encapsulated albumin in a long time. In the study of biodistribution of these liposomes in mice, they accumulated more in the kidney, liver, spleen, and tumor sites, which, even after clearing formulations in the bloodstream, they existed in high levels in these organs up to 96 hours. In gamma scintigraphy also, organs with high activity accumulation from early hours up to 96 hours were visible in the form of hot spots. concluded that PEGylated liposomal formulation encapsulating albumin can be labeled with In-Oxine, and obtained stabilized formulation for long-term imaging, that have more favorable conditions for the evaluation of tumors and it will cause early diagnosis of tumors.

Keywords: nano liposome, 111In-oxine, imaging, biodistribution, tumor

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1188 The Dose to Organs in Lumbar-Abdominal Computed Tomography Imaging Using TLD

Authors: M. Zehtabian, Z. Molaiemanesh, Z. Shafahi, M. Papie, M. Zahraie Moghaddam, M. Mehralizadeh, M. R. Vahidi, S. Sina

Abstract:

The introduction of CT scans has been a great improvement in diagnosis of different diseases. However, this imaging modality can expose the patients to cumulative radiation doses which may increase the risks of some health problems like cancer. In this study, the dose delivered to different organs in lumbar-abdominal imaging was measured by putting the TLD-100, and TLD-100H chips inside the Alderson Rando phantom. The lumbar-abdominal image of the phantom was obtained, while TLD chips were inside the holes of the phantom. According to the results obtained in this study using TLD-100 chips, the average dose received by liver, bladder, rectum, kidneys, and uterus were found to be 12.9 mSv, 8.9 mSv, 10.1 mSv, 11.0 mSv, 11.2 mSv, and 10.5 mSv respectively, while the measurements performed by TLD-100H show that the average dose to liver, bladder, rectum, kidneys, and uterus were found to be 12.4 mSv, 9.2 mSv, 9.5 mSv, 10.5 mSv, 10.7 mSv, and 9.9 mSv respectively. The results of this study indicates that the dose measured by the TLD-100H chips are in close agreement with those obtained by TLD-100.

Keywords: CT scan, dose, TLD-100, diagnosis

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1187 A Study of Non-Coplanar Imaging Technique in INER Prototype Tomosynthesis System

Authors: Chia-Yu Lin, Yu-Hsiang Shen, Cing-Ciao Ke, Chia-Hao Chang, Fan-Pin Tseng, Yu-Ching Ni, Sheng-Pin Tseng

Abstract:

Tomosynthesis is an imaging system that generates a 3D image by scanning in a limited angular range. It could provide more depth information than traditional 2D X-ray single projection. Radiation dose in tomosynthesis is less than computed tomography (CT). Because of limited angular range scanning, there are many properties depending on scanning direction. Therefore, non-coplanar imaging technique was developed to improve image quality in traditional tomosynthesis. The purpose of this study was to establish the non-coplanar imaging technique of tomosynthesis system and evaluate this technique by the reconstructed image. INER prototype tomosynthesis system contains an X-ray tube, a flat panel detector, and a motion machine. This system could move X-ray tube in multiple directions during the acquisition. In this study, we investigated three different imaging techniques that were 2D X-ray single projection, traditional tomosynthesis, and non-coplanar tomosynthesis. An anthropopathic chest phantom was used to evaluate the image quality. It contained three different size lesions (3 mm, 5 mm and, 8 mm diameter). The traditional tomosynthesis acquired 61 projections over a 30 degrees angular range in one scanning direction. The non-coplanar tomosynthesis acquired 62 projections over 30 degrees angular range in two scanning directions. A 3D image was reconstructed by iterative image reconstruction algorithm (ML-EM). Our qualitative method was to evaluate artifacts in tomosynthesis reconstructed image. The quantitative method was used to calculate a peak-to-valley ratio (PVR) that means the intensity ratio of the lesion to the background. We used PVRs to evaluate the contrast of lesions. The qualitative results showed that in the reconstructed image of non-coplanar scanning, anatomic structures of chest and lesions could be identified clearly and no significant artifacts of scanning direction dependent could be discovered. In 2D X-ray single projection, anatomic structures overlapped and lesions could not be discovered. In traditional tomosynthesis image, anatomic structures and lesions could be identified clearly, but there were many artifacts of scanning direction dependent. The quantitative results of PVRs show that there were no significant differences between non-coplanar tomosynthesis and traditional tomosynthesis. The PVRs of the non-coplanar technique were slightly higher than traditional technique in 5 mm and 8 mm lesions. In non-coplanar tomosynthesis, artifacts of scanning direction dependent could be reduced and PVRs of lesions were not decreased. The reconstructed image was more isotropic uniformity in non-coplanar tomosynthesis than in traditional tomosynthesis. In the future, scan strategy and scan time will be the challenges of non-coplanar imaging technique.

Keywords: image reconstruction, non-coplanar imaging technique, tomosynthesis, X-ray imaging

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1186 A Review of Accuracy Optical Surface Imaging Systems for Setup Verification During Breast Radiotherapy Treatment

Authors: Auwal Abubakar, Ahmed Ahidjo, Shazril Imran Shaukat, Noor Khairiah A. Karim, Gokula Kumar Appalanaido, Hafiz Mohd Zin

Abstract:

Background: The use of optical surface imaging systems (OSISs) is increasingly becoming popular in radiotherapy practice, especially during breast cancer treatment. This study reviews the accuracy of the available commercial OSISs for breast radiotherapy. Method: A literature search was conducted and identified the available commercial OSISs from different manufacturers that are integrated into radiotherapy practice for setup verification during breast radiotherapy. Studies that evaluated the accuracy of the OSISs during breast radiotherapy using cone beam computed tomography (CBCT) as a reference were retrieved and analyzed. The physics and working principles of the systems from each manufacturer were discussed together with their respective strength and limitations. Results: A total of five (5) different commercially available OSISs from four (4) manufacturers were identified, each with a different working principle. Six (6) studies were found to evaluate the accuracy of the systems during breast radiotherapy in conjunction with CBCT as a goal standard. The studies revealed that the accuracy of the system in terms of mean difference ranges from 0.1 to 2.1 mm. The correlation between CBCT and OSIS ranges between 0.4 and 0.9. The limit of agreements obtained using bland Altman analysis in the studies was also within an acceptable range. Conclusion: The OSISs have an acceptable level of accuracy and could be used safely during breast radiotherapy. The systems are non-invasive, ionizing radiation-free, and provide real-time imaging of the target surface at no extra concomitant imaging dose. However, the system should only be used to complement rather than replace x-ray-based image guidance techniques such as CBCT.

Keywords: optical surface imaging system, Cone beam computed tomography (CBCT), surface guided radiotherapy, Breast radiotherapy

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1185 Evaluation of Requests and Outcomes of Magnetic Resonance Imaging Assessing for Cauda Equina Syndrome at a UK Trauma Centre

Authors: Chris Cadman, Marcel Strauss

Abstract:

Background: In 2020, the University Hospital Wishaw in the United Kingdom became the centre for trauma and orthopaedics within its health board. This resulted in the majority of patients with suspected cauda equina syndrome (CES) being assessed and imaged at this site, putting an increased demand on MR imaging and displacing other previous activity. Following this transition, imaging requests for CES did not always follow national guidelines and would often be missing important clinical and safety information. There also appeared to be a very low positive scan rate compared with previously reported studies. In an attempt to improve patient selection and reduce the burden of CES imaging at this site clinical audit was performed. Methods: A total of 250 consecutive patients imaged to assess for CES were evaluated. Patients had to have presented to either the emergency or orthopaedic department acutely with a presenting complaint of suspected CES. Patients were excluded if they were not admitted acutely or were assessed by other clinical specialities. In total, 233 patients were included. Requests were assessed for appropriate clinical history, accurate and complete clinical assessment and MRI safety information. Clinical assessment was allocated a score of 1-6 based on information relating to history of pain, level of pain, dermatomes/myotomes affected, peri-anal paraesthesia/anaesthesia, anal tone and post-void bladder volume with each element scoring one point. Images were assessed for positive findings of CES, acquired spinal stenosis or nerve root compression. Results: Overall, 73% of requests had a clear clinical history of CES. The urgency of the request for imaging was given in 23% of cases. The mean clinical assessment score was 3.7 out of a total of 6. Overall, 2% of scans were positive for CES, 29% had acquired spinal stenosis and 30% had nerve root compression. For patients with CES, 75% had acute neurological signs compared with 68% of the study population. CES patients had a mean clinical history score of 5.3 compared with 3.7 for the study population. Overall, 95% of requests had appropriate MRI safety information. Discussion: it study included 233 patients who underwent specialist assessment and referral for MR imaging for suspected CES. Despite the serious nature of this condition, a large proportion of imaging requests did not have a clear clinical query of CES and the level of urgency was not given, which could potentially lead to a delay in imaging and treatment. Clinical examination was often also incomplete, which can make triaging of patients presenting with similar symptoms challenging. The positive rate for CES was only 2%, much below other studies which had positive rates of 6–40% with a large meta-analysis finding a mean positive rate of 19%. These findings demonstrate an opportunity to improve the quality of imaging requests for suspected CES. This may help to improve patient selection for imaging and result in a positive rate for CES imaging that is more in line with other centres.

Keywords: cauda equina syndrome, acute back pain, MRI, spine

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1184 Evaluation of Longitudinal Relaxation Time (T1) of Bone Marrow in Lumbar Vertebrae of Leukaemia Patients Undergoing Magnetic Resonance Imaging

Authors: M. G. R. S. Perera, B. S. Weerakoon, L. P. G. Sherminie, M. L. Jayatilake, R. D. Jayasinghe, W. Huang

Abstract:

The aim of this study was to measure and evaluate the Longitudinal Relaxation Times (T1) in bone marrow of an Acute Myeloid Leukaemia (AML) patient in order to explore the potential for a prognostic biomarker using Magnetic Resonance Imaging (MRI) which will be a non-invasive prognostic approach to AML. MR image data were collected in the DICOM format and MATLAB Simulink software was used in the image processing and data analysis. For quantitative MRI data analysis, Region of Interests (ROI) on multiple image slices were drawn encompassing vertebral bodies of L3, L4, and L5. T1 was evaluated using the T1 maps obtained. The estimated bone marrow mean value of T1 was 790.1 (ms) at 3T. However, the reported T1 value of healthy subjects is significantly (946.0 ms) higher than the present finding. This suggests that the T1 for bone marrow can be considered as a potential prognostic biomarker for AML patients.

Keywords: acute myeloid leukaemia, longitudinal relaxation time, magnetic resonance imaging, prognostic biomarker.

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1183 A Retrospective Analysis of the Impact of the Choosing Wisely Canada Campaign on Emergency Department Imaging Utilization for Head Injuries

Authors: Sameer Masood, Lucas Chartier

Abstract:

Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P = 0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P = 0.72) or admission rates (9.85% vs 11.26%, P = 0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P <0.001). Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

Keywords: choosing wisely, emergency department, head injury, quality improvement

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1182 Non-Destructive Technique for Detection of Voids in the IC Package Using Terahertz-Time Domain Spectrometer

Authors: Sung-Hyeon Park, Jin-Wook Jang, Hak-Sung Kim

Abstract:

In recent years, Terahertz (THz) time-domain spectroscopy (TDS) imaging method has been received considerable interest as a promising non-destructive technique for detection of internal defects. In comparison to other non-destructive techniques such as x-ray inspection method, scanning acoustic tomograph (SAT) and microwave inspection method, THz-TDS imaging method has many advantages: First, it can measure the exact thickness and location of defects. Second, it doesn’t require the liquid couplant while it is very crucial to deliver that power of ultrasonic wave in SAT method. Third, it didn’t damage to materials and be harmful to human bodies while x-ray inspection method does. Finally, it exhibits better spatial resolution than microwave inspection method. However, this technology couldn’t be applied to IC package because THz radiation can penetrate through a wide variety of materials including polymers and ceramics except of metals. Therefore, it is difficult to detect the defects in IC package which are composed of not only epoxy and semiconductor materials but also various metals such as copper, aluminum and gold. In this work, we proposed a special method for detecting the void in the IC package using THz-TDS imaging system. The IC package specimens for this study are prepared by Packaging Engineering Team in Samsung Electronics. Our THz-TDS imaging system has a special reflection mode called pitch-catch mode which can change the incidence angle in the reflection mode from 10 o to 70 o while the others have transmission and the normal reflection mode or the reflection mode fixed at certain angle. Therefore, to find the voids in the IC package, we investigated the appropriate angle as changing the incidence angle of THz wave emitter and detector. As the results, the voids in the IC packages were successfully detected using our THz-TDS imaging system.

Keywords: terahertz, non-destructive technique, void, IC package

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1181 Evaluation of Fetal brain using Magnetic Resonance Imaging

Authors: Mahdi Farajzadeh Ajirlou

Abstract:

Ordinary fetal brain development can be considered by in vivo attractive reverberation imaging (MRI) from the 18th gestational week (GW) to term and depends fundamentally on T2-weighted and diffusion-weighted (DW) arrangements. The foremost commonly suspected brain pathologies alluded to fetal MRI for assist assessment are ventriculomegaly, lost corpus callosum, and anomalies of the posterior fossa. Brain division could be a crucial to begin with step in neuroimage examination. Within the case of fetal MRI it is especially challenging and critical due to the subjective introduction of the hatchling, organs that encompass the fetal head, and irregular fetal movement. A few promising strategies have been proposed but are constrained in their execution in challenging cases and in realtime division. Fetal MRI is routinely performed on a 1.5-Tesla scanner without maternal or fetal sedation. The mother lies recumbent amid the course of the examination, the length of which is ordinarily 45 to 60 minutes. The accessibility and continuous approval of standardizing fetal brain development directions will give critical devices for early discovery of impeded fetal brain development upon which to oversee high-risk pregnancies.

Keywords: brain, fetal, MRI, imaging

Procedia PDF Downloads 79
1180 Determination of Neighbor Node in Consideration of the Imaging Range of Cameras in Automatic Human Tracking System

Authors: Kozo Tanigawa, Tappei Yotsumoto, Kenichi Takahashi, Takao Kawamura, Kazunori Sugahara

Abstract:

An automatic human tracking system using mobile agent technology is realized because a mobile agent moves in accordance with a migration of a target person. In this paper, we propose a method for determining the neighbor node in consideration of the imaging range of cameras.

Keywords: human tracking, mobile agent, Pan/Tilt/Zoom, neighbor relation

Procedia PDF Downloads 516
1179 Pre-Analysis of Printed Circuit Boards Based on Multispectral Imaging for Vision Based Recognition of Electronics Waste

Authors: Florian Kleber, Martin Kampel

Abstract:

The increasing demand of gallium, indium and rare-earth elements for the production of electronics, e.g. solid state-lighting, photovoltaics, integrated circuits, and liquid crystal displays, will exceed the world-wide supply according to current forecasts. Recycling systems to reclaim these materials are not yet in place, which challenges the sustainability of these technologies. This paper proposes a multispectral imaging system as a basis for a vision based recognition system for valuable components of electronics waste. Multispectral images intend to enhance the contrast of images of printed circuit boards (single components, as well as labels) for further analysis, such as optical character recognition and entire printed circuit board recognition. The results show that a higher contrast is achieved in the near infrared compared to ultraviolet and visible light.

Keywords: electronics waste, multispectral imaging, printed circuit boards, rare-earth elements

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1178 Applications of Artificial Intelligence (AI) in Cardiac imaging

Authors: Angelis P. Barlampas

Abstract:

The purpose of this study is to inform the reader, about the various applications of artificial intelligence (AI), in cardiac imaging. AI grows fast and its role is crucial in medical specialties, which use large amounts of digital data, that are very difficult or even impossible to be managed by human beings and especially doctors.Artificial intelligence (AI) refers to the ability of computers to mimic human cognitive function, performing tasks such as learning, problem-solving, and autonomous decision making based on digital data. Whereas AI describes the concept of using computers to mimic human cognitive tasks, machine learning (ML) describes the category of algorithms that enable most current applications described as AI. Some of the current applications of AI in cardiac imaging are the follows: Ultrasound: Automated segmentation of cardiac chambers across five common views and consequently quantify chamber volumes/mass, ascertain ejection fraction and determine longitudinal strain through speckle tracking. Determine the severity of mitral regurgitation (accuracy > 99% for every degree of severity). Identify myocardial infarction. Distinguish between Athlete’s heart and hypertrophic cardiomyopathy, as well as restrictive cardiomyopathy and constrictive pericarditis. Predict all-cause mortality. CT Reduce radiation doses. Calculate the calcium score. Diagnose coronary artery disease (CAD). Predict all-cause 5-year mortality. Predict major cardiovascular events in patients with suspected CAD. MRI Segment of cardiac structures and infarct tissue. Calculate cardiac mass and function parameters. Distinguish between patients with myocardial infarction and control subjects. It could potentially reduce costs since it would preclude the need for gadolinium-enhanced CMR. Predict 4-year survival in patients with pulmonary hypertension. Nuclear Imaging Classify normal and abnormal myocardium in CAD. Detect locations with abnormal myocardium. Predict cardiac death. ML was comparable to or better than two experienced readers in predicting the need for revascularization. AI emerge as a helpful tool in cardiac imaging and for the doctors who can not manage the overall increasing demand, in examinations such as ultrasound, computed tomography, MRI, or nuclear imaging studies.

Keywords: artificial intelligence, cardiac imaging, ultrasound, MRI, CT, nuclear medicine

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1177 Comparison of the Chest X-Ray and Computerized Tomography Scans Requested from the Emergency Department

Authors: Sahabettin Mete, Abdullah C. Hocagil, Hilal Hocagil, Volkan Ulker, Hasan C. Taskin

Abstract:

Objectives and Goals: An emergency department is a place where people can come for a multitude of reasons 24 hours a day. As it is an easy, accessible place, thanks to self-sacrificing people who work in emergency departments. But the workload and overcrowding of emergency departments are increasing day by day. Under these circumstances, it is important to choose a quick, easily accessible and effective test for diagnosis. This results in laboratory and imaging tests being more than 40% of all emergency department costs. Despite all of the technological advances in imaging methods and available computerized tomography (CT), chest X-ray, the older imaging method, has not lost its appeal and effectiveness for nearly all emergency physicians. Progress in imaging methods are very convenient, but physicians should consider the radiation dose, cost, and effectiveness, as well as imaging methods to be carefully selected and used. The aim of the study was to investigate the effectiveness of chest X-ray in immediate diagnosis against the advancing technology by comparing chest X-ray and chest CT scan results of the patients in the emergency department. Methods: Patients who applied to Bulent Ecevit University Faculty of Medicine’s emergency department were investigated retrospectively in between 1 September 2014 and 28 February 2015. Data were obtained via MIAMED (Clear Canvas Image Server v6.2, Toronto, Canada), information management system which patients’ files are saved electronically in the clinic, and were retrospectively scanned. The study included 199 patients who were 18 or older, had both chest X-ray and chest CT imaging. Chest X-ray images were evaluated by the emergency medicine senior assistant in the emergency department, and the findings were saved to the study form. CT findings were obtained from already reported data by radiology department in the clinic. Chest X-ray was evaluated with seven questions in terms of technique and dose adequacy. Patients’ age, gender, application complaints, comorbid diseases, vital signs, physical examination findings, diagnosis, chest X-ray findings and chest CT findings were evaluated. Data saved and statistical analyses have made via using SPSS 19.0 for Windows. And the value of p < 0.05 were accepted statistically significant. Results: 199 patients were included in the study. In 38,2% (n=76) of all patients were diagnosed with pneumonia and it was the most common diagnosis. The chest X-ray imaging technique was appropriate in patients with the rate of 31% (n=62) of all patients. There was not any statistically significant difference (p > 0.05) between both imaging methods (chest X-ray and chest CT) in terms of determining the rates of displacement of the trachea, pneumothorax, parenchymal consolidation, increased cardiothoracic ratio, lymphadenopathy, diaphragmatic hernia, free air levels in the abdomen (in sections including the image), pleural thickening, parenchymal cyst, parenchymal mass, parenchymal cavity, parenchymal atelectasis and bone fractures. Conclusions: When imaging findings, showing cases that needed to be quickly diagnosed, were investigated, chest X-ray and chest CT findings were matched at a high rate in patients with an appropriate imaging technique. However, chest X-rays, evaluated in the emergency department, were frequently taken with an inappropriate technique.

Keywords: chest x-ray, chest computerized tomography, chest imaging, emergency department

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1176 C-Spine Imaging in a Non-trauma Centre: Compliance with NEXUS Criteria Audit

Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

Abstract:

The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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