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Sample records for standard multiple breath-hold

  1. Accuracy of Dose Delivery in Multiple Breath-Hold Segmented Volumetric Modulated Arc Therapy: A Static Phantom Study

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    Kimiya Noto

    2014-01-01

    Full Text Available Purpose. Accuracy of dose delivery in multiple breath-hold segmented volumetric modulated arc therapy (VMAT was evaluated in comparison to noninterrupted VMAT using a static phantom. Material and Methods. Five VMAT plans were evaluated. A Synergy linear accelerator (Elekta AB, Stockholm, Sweden was employed. A VMAT delivery sequence was divided into multiple segments according to each of the predefined breath-hold periods (10, 15, 20, 30, and 40 seconds. The segmented VMAT delivery was compared to noninterrupted VMAT delivery in terms of the isocenter dose and pass rates of a dose difference of 1% with a dose threshold of 10% of the maximum dose on a central coronal plane using a two-dimensional dosimeter, MatriXX Evolution (IBA Dosimetry, Schwarzenbruck, Germany. Results. Means of the isocenter dose differences were 0.5%, 0.2%, 0.2%, 0.0%, and 0.0% for the beam-on-times between interrupts of 10, 15, 20, 30, and 40 seconds, respectively. Means of the pass rates were 85%, 99.9%, 100%, 100%, and 100% in the same order as the above. Conclusion. Our static phantom study indicated that the multiple breath-hold segmented VMAT maintains stable and accurate dose delivery when the beam-on-time between interrupts is 15 seconds or greater.

  2. Breath holding spell

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000967.htm Breath holding spell To use the sharing features on this page, please enable JavaScript. Some children have breath holding spells. This is an involuntary stop in breathing that ...

  3. Breath-Holding Spells

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    ... Staying Safe Videos for Educators Search English Español Breath-Holding Spells KidsHealth / For Parents / Breath-Holding Spells What's in ... Spells Print en español Espasmos de sollozo About Breath-Holding Spells Many of us have heard stories about stubborn ...

  4. Whole-heart magnetic resonance coronary angiography with multiple breath-holds and automatic breathing-level tracking

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    Kuhara, Shigehide; Ninomiya, Ayako; Okada, Tomohisa; Kanao, Shotaro; Kamae, Toshikazu; Togashi, Kaori

    2010-05-01

    Whole-heart (WH) magnetic resonance coronary angiography (MRCA) studies are usually performed during free breathing while monitoring the position of the diaphragm with real-time motion correction. However, this results in a long scan time and the patient's breathing pattern may change, causing the study to be aborted. Alternatively, WH MRCA can be performed with multiple breath-holds (mBH). However, one problem in the mBH method is that patients cannot hold their breath at the same position every time, leading to image degradation. We have developed a new WH MRCA imaging method that employs both the mBH method and automatic breathing-level tracking to permit automatic tracking of the changes in breathing or breath-hold levels. Evaluation of its effects on WH MRCA image quality showed that this method can provide high-quality images within a shorter scan time. This proposed method is expected to be very useful in clinical WH MRCA studies.

  5. A novel profile/view ordering with a non-convex star shutter for high-resolution 3D volumetric T1 mapping under multiple breath-holds.

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    Wang, Sui-Cheng; Patel, Amit R; Tanaka, Akiko; Wang, Hui; Ota, Takeyoshi; Lang, Roberto M; Carroll, Timothy J; Kawaji, Keigo

    2017-06-01

    To examine a novel non-convex star ordering/shutter for reducing the number of breath-holds in cardiac three-dimensional (3D) T1 Mapping MRI with multiple breath-holds. A novel ordering, Non-Convex Star (NCS) was designed to acquire 3D volumes in a modified look-locker inversion recovery (MOLLI) T1 mapping sequence to provide more spatial resolution and coverage in fewer breath-holds. The proposed 3D-MOLLI approach using NCS was first validated in two phantoms using artifact power (AP) measurement against the fully sampled phantom. This was followed by an in vivo study in seven swine, in which the T1 values of the left ventricular (LV) myocardium divided into the American Heart Association (AHA) 16-segment model was compared against the reference multislice two-dimensional (2D) clinical reference and 3D volume without NCS breath-hold reduction. NCS breath-hold reduction yielded less AP compared with the matched SENSE accelerated phantom volume (P T1 values from 3D in vivo volumes with/without NCS were comparable in all AHA segments (P = NS), whereas 3D-NCS yielded significantly higher T1 values than 2D at midslice of the LV myocardium in each AHA segment (P T1 mapping acquisition requiring fewer breath-holds. Magn Reson Med 77:2215-2224, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  6. Evaluation of pancreatic cancer by multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging at 3.0 T

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    Yao, Xiuzhong, E-mail: yao.xiuzhong@zs-hospital.sh.cn [Department of Radiology, Zhongshan Hospital of Fudan University and Department of Medical Image, Shanghai Medical College of Fudan University, No. 138, Fenglin Road, Xuhui District, Shanghai 200032 (China); Zeng, Mengsu, E-mail: zengmengsu@gmail.com [Department of Radiology, Zhongshan Hospital of Fudan University and Department of Medical Image, Shanghai Medical College of Fudan University, No. 138, Fenglin Road, Xuhui District, Shanghai 200032 (China); Wang, He, E-mail: herry258@hotmail.com [Global Applied Science Laboratory of GE Healthcare, No. 1, Huatuo Road, Zhangjiang Hi-tech Park, Pudong District, Shanghai 201203 (China); Sun, Fei, E-mail: fei.sun@med.ge.com [Global Applied Science Laboratory of GE Healthcare, No. 1, Huatuo Road, Zhangjiang Hi-tech Park, Pudong District, Shanghai 201203 (China); Rao, Shengxiang, E-mail: rao.shengxiang@zs-hospital.sh.cn [Department of Radiology, Zhongshan Hospital of Fudan University and Department of Medical Image, Shanghai Medical College of Fudan University, No. 138, Fenglin Road, Xuhui District, Shanghai 200032 (China); Ji, Yuan, E-mail: Ji.yuan@zs-hospital.sh.cn [Department of Pathology, Zhongshan Hospital of Fudan University, No. 138, Fenglin Road, Xuhui District, Shanghai 200032 (China)

    2012-08-15

    Objective: To investigate the microcirculation in pancreatic cancer by pharmacokinetic analysis of multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging at 3.0 T. Materials and methods: Multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging was performed in 40 healthy volunteers and 40 patients with pancreatic cancer proven by histopathology using an axial three-dimensions fat-saturated T1-weighted spoiled-gradient echo sequence at 3.0 T. A two compartment model with T1 correction was used to quantify the transfer constant, the rate constant of backflux from the extravascular extracellular space to the plasma and the extravascular extracellular space fractional volume in pancreatic cancer, obstructive pancreatitis distal to the malignant tumor, adjacent pancreatic tissue proximal to the tumor and normal pancreas. All parameters were statistically analyzed. Results: Statistical differences were noticed in both the transfer constant (p = 0.000075) and the rate constant of backflux (p = 0.006) among different tissues. Both the transfer constant and the rate constant of backflux in pancreatic cancer were statistically lower than those in normal pancreas and adjacent pancreatic tissue (p < 0.05). Both the transfer constant and the rate constant of backflux in obstructive pancreatitis were statistically lower than those in normal pancreas and adjacent pancreatic tissue (p < 0.05). The extravascular extracellular space fractional volume in pancreatic cancer was statistically lager than that in normal pancreas (p = 0.002). Conclusion: Multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging offers a useful technique to evaluate the microenvironment in pancreatic cancer at 3.0 T. Compared to normal pancreas, pancreatic cancer has lower transfer constant, rate constant of backflux and larger extravascular extracellular space fractional volume.

  7. Adaptation requirements due to anatomical changes in free-breathing and deep-inspiration breath-hold for standard and dose-escalated radiotherapy of lung cancer patients

    DEFF Research Database (Denmark)

    Sibolt, Patrik; Ottosson, Wiviann; Sjöström, David

    2015-01-01

    Background. Radiotherapy of lung cancer patients is subject to uncertainties related to heterogeneities, anatomical changes and breathing motion. Use of deep-inspiration breath-hold (DIBH) can reduce the treated volume, potentially enabling dose-escalated (DE) treatments. This study was designed...... to investigate the need for adaptation due to anatomical changes, for both standard (ST) and DE plans in free-breathing (FB) and DIBH. Material and methods. The effect of tumor shrinkage (TS), pleural effusion (PE) and atelectasis was investigated for patients and for a CIRS thorax phantom. Sixteen patients were...... and had no effect for DIBH. Conclusion. Phantom simulations provided potential adaptation action levels for PE and TS. For the more complex patient geometry, individual assessment of the dosimetric impact is recommended for both ST and DE plans in DIBH as well as in FB. However, DIBH was found...

  8. Blue breath holding is benign.

    Science.gov (United States)

    Stephenson, J B

    1991-01-01

    In their recent publication in this journal, Southall et al described typical cyanotic breath holding spells, both in otherwise healthy children and in those with brainstem lesions and other malformations. Their suggestions regarding possible autonomic disturbances may require further study, but they have adduced no scientific evidence to contradict the accepted view that in the intact child blue breath holding spells are benign. Those families in which an infant suffers an 'apparently life threatening event' deserve immense understanding and help, and it behoves investigators to exercise extreme care and self criticism in the presentation of new knowledge which may bear upon their management and their morale. PMID:2001115

  9. Single-breath-hold 3-D CINE imaging of the left ventricle using Cartesian sampling.

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    Wetzl, Jens; Schmidt, Michaela; Pontana, François; Longère, Benjamin; Lugauer, Felix; Maier, Andreas; Hornegger, Joachim; Forman, Christoph

    2018-02-01

    Our objectives were to evaluate a single-breath-hold approach for Cartesian 3-D CINE imaging of the left ventricle with a nearly isotropic resolution of [Formula: see text] and a breath-hold duration of [Formula: see text]19 s against a standard stack of 2-D CINE slices acquired in multiple breath-holds. Validation is performed with data sets from ten healthy volunteers. A Cartesian sampling pattern based on the spiral phyllotaxis and a compressed sensing reconstruction method are proposed to allow 3-D CINE imaging with high acceleration factors. The fully integrated reconstruction uses multiple graphics processing units to speed up the reconstruction. The 2-D CINE and 3-D CINE are compared based on ventricular function parameters, contrast-to-noise ratio and edge sharpness measurements. Visual comparisons of corresponding short-axis slices of 2-D and 3-D CINE show an excellent match, while 3-D CINE also allows reformatting to other orientations. Ventricular function parameters do not significantly differ from values based on 2-D CINE imaging. Reconstruction times are below 4 min. We demonstrate single-breath-hold 3-D CINE imaging in volunteers and three example patient cases, which features fast reconstruction and allows reformatting to arbitrary orientations.

  10. [Breath-hold diving--an increasing adventure sport with medical risks].

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    Lindholm, Peter; Gennser, Mikael

    2004-02-26

    Breath-hold diving as a recreational and competitive sports activity is on the increase. In this review physiological limitations and medical risks associated with breath-hold diving are discussed. Specific topics include hypoxia, ascent blackout, hyperventilation, squeeze or barotrauma of descent including effects on the pulmonary system, glossopharyngeal breathing, and decompression illness. It is also concluded that the health requirements for competitive breath-hold diving should follow essentially the same standards as used for SCUBA-diving.

  11. Breath-holding spells in infants.

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    Goldman, Ran D

    2015-02-01

    I have children in my clinic who experience seizurelike episodes in which they cry and hold their breath to the point of cyanosis and loss of consciousness. Their examination or investigation findings are normal and referral to a pediatric specialist results in no further investigation. Are breath-holding spells common, and what type of investigation is needed? A breath-holding spell is a benign paroxysmal nonepileptic disorder occurring in healthy children 6 to 48 months of age. The episodes start with a provocation such as emotional upset or minor injury, and might progress to breath holding, cyanosis, and syncope. The episodes are extremely frightening to watch but have benign consequences. Once a clinical diagnosis is made, it is recommended to conduct an electrocardiogram and to rule out anemia, but no further investigation or referral is warranted. Copyright© the College of Family Physicians of Canada.

  12. Oxidative stress in breath-hold divers after repetitive dives

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    Theunissen, S; Sponsiello, N; Rozloznik, M; Germonpre, P.; Guerrero, F.; Cialoni, D; Balestra, C.

    2013-01-01

    Introduction: Hyperoxia causes oxidative stress. Breath-hold diving is associated with transient hyperoxia followed by hypoxia and a build-up of carbon dioxide (CO2), chest-wall compression and significant haemodynamic changes. This study analyses variations in plasma oxidative stress markers after a series of repetitive breath-hold dives.Methods: Thirteen breath-hold divers were asked to perform repetitive breath-hold dives to 20 metres’ depth to a cumulative breath-hold time of approximatel...

  13. The Physics of Breath-Hold Diving.

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    Aguilella, Vicente; Aguilella-Arzo, Marcelo

    1996-01-01

    Analyzes physical features of breath-hold diving. Considers the diver's descent and the initial surface dive and presents examples that show the diver's buoyancy equilibrium varying with depth, the driving force supplied by finning, and the effect of friction between the water and the diver. (Author/JRH)

  14. Evaluation of pulmonary function using single-breath-hold dual-energy computed tomography with xenon

    OpenAIRE

    Kyoyama, Hiroyuki; Hirata, Yusuke; Kikuchi, Satoshi; Sakai, Kosuke; Saito, Yuriko; Mikami, Shintaro; Moriyama, Gaku; Yanagita, Hisami; Watanabe, Wataru; Otani, Katharina; Honda, Norinari; Uematsu, Kazutsugu

    2017-01-01

    Abstract Xenon-enhanced dual-energy computed tomography (xenon-enhanced CT) can provide lung ventilation maps that may be useful for assessing structural and functional abnormalities of the lung. Xenon-enhanced CT has been performed using a multiple-breath-hold technique during xenon washout. We recently developed xenon-enhanced CT using a single-breath-hold technique to assess ventilation. We sought to evaluate whether xenon-enhanced CT using a single-breath-hold technique correlates with pu...

  15. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency.

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    Kolkiran, Abdülkerim; Tutar, Ercan; Atalay, Semra; Deda, Gülhis; Cin, Sükrü

    2005-09-01

    To analyse the activity of the autonomic nervous system during breath-holding spells, we assessed the ECG changes, including ventricular repolarization parameters before and during the spell. We also analysed the effects of iron deficiency on these ECG parameters. The study group consisted of 37 children with breath-holding spells (30 cyanotic, 7 pallid) (mean age+/-SD: 12.9+/-10.8 mo). Twenty-six healthy children (mean age+/-SD: 14.4+/-8.6 mo) served as a control group. All patients and controls had standard 12-lead simultaneous surface ECG. All patients had ECG recordings during at least one severe breath-holding spell obtained by "event recorder". Traces obtained by "event recorder" were analysed in terms of mean heart rate and the frequency and duration of asystole during the spell. Respiratory sinus arrhythmia on standard ECGs and asystole frequency during spells were higher in patients with pallid breath-holding spells. Patients with iron deficiency had a lower frequency of respiratory sinus arrhythmia and prolonged asystole time during the spell. There was no difference in terms of ventricular repolarization parameters (QT/QTc intervals and QT/QTc dispersions) between patients and controls and between patient subgroups (cyanotic versus pallid). These results confirmed the presence of autonomic dysregulation in children with breath-holding spells. Iron deficiency may have an impact on this autonomic dysregulation. Ventricular repolarization was unaffected in patients with breath-holding spells.

  16. Sports-related lung injury during breath-hold diving.

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    Mijacika, Tanja; Dujic, Zeljko

    2016-12-01

    The number of people practising recreational breath-hold diving is constantly growing, thereby increasing the need for knowledge of the acute and chronic effects such a sport could have on the health of participants. Breath-hold diving is potentially dangerous, mainly because of associated extreme environmental factors such as increased hydrostatic pressure, hypoxia, hypercapnia, hypothermia and strenuous exercise.In this article we focus on the effects of breath-hold diving on pulmonary function. Respiratory symptoms have been reported in almost 25% of breath-hold divers after repetitive diving sessions. Acutely, repetitive breath-hold diving may result in increased transpulmonary capillary pressure, leading to noncardiogenic oedema and/or alveolar haemorrhage. Furthermore, during a breath-hold dive, the chest and lungs are compressed by the increasing pressure of water. Rapid changes in lung air volume during descent or ascent can result in a lung injury known as pulmonary barotrauma. Factors that may influence individual susceptibility to breath-hold diving-induced lung injury range from underlying pulmonary or cardiac dysfunction to genetic predisposition.According to the available data, breath-holding does not result in chronic lung injury. However, studies of large populations of breath-hold divers are necessary to firmly exclude long-term lung damage. Copyright ©ERS 2016.

  17. A pacemaker for asystole in breath-holding spells

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    Legge, Leah M; Kantoch, Michal J; Seshia, Shashi S; Soni, Reeni

    2002-01-01

    Two cases of young children with frequent severe breath-holding spells complicated by prolonged asystole and seizures are reported. A ventricular pacemaker was implanted in each child, and both have subsequently remained free of syncope, although they continue to exhibit breath-holding behaviour. PMID:20046299

  18. Oxidative stress in breath-hold divers after repetitive dives.

    Science.gov (United States)

    Theunissen, Sigrid; Sponsiello, Nicola; Rozloznik, Miroslav; Germonpré, Peter; Guerrero, François; Cialoni, Danilo; Balestra, Constantino

    2013-06-01

    Hyperoxia causes oxidative stress. Breath-hold diving is associated with transient hyperoxia followed by hypoxia and a build-up of carbon dioxide (CO₂), chest-wall compression and significant haemodynamic changes. This study analyses variations in plasma oxidative stress markers after a series of repetitive breath-hold dives. Thirteen breath-hold divers were asked to perform repetitive breath-hold dives to 20 metres' depth to a cumulative breath-hold time of approximately 20 minutes over an hour in the open sea. Plasma nitric oxide (NO), peroxinitrites (ONOO⁻) and thiols (R-SH) were measured before and after the dive sequence. Circulating NO significantly increased after successive breath-hold dives (169.1 ± 58.26% of pre-dive values; P = 0.0002). Peroxinitrites doubled after the dives (207.2 ± 78.31% of pre-dive values; P = 0.0012). Thiols were significantly reduced (69.88 ± 19.23% of pre-dive values; P = 0.0002). NO may be produced by physical effort during breath-hold diving. Physical exercise, the transient hyperoxia followed by hypoxia and CO₂ accumulation would all contribute to the increased levels of superoxide anions (O₂²⁻). Since interaction of O₂²⁻ with NO forms ONOO⁻, this reaction is favoured and the production of thiol groups is reduced. Oxidative stress is, thus, present in breath-hold diving.

  19. Magnetic Resonance Imaging in Breath-Hold Divers with Cerebral Decompression Sickness

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    Ryu Matsuo

    2014-01-01

    Full Text Available The mechanism of cerebral decompression sickness (DCS is still unclear. We report 2 cases of breath-hold divers with cerebral DCS in whom magnetic resonance imaging (MRI demonstrated distinctive characteristics. One case presented right hemiparesthesia, diplopia, and gait disturbance after breath-hold diving into the sea at a depth of 20 m. Brain MRI with fluid-attenuated inversion recovery (FLAIR sequence revealed multiple hyperintense lesions in the right frontal lobe, bilateral thalamus, pons, and right cerebellar hemisphere. The second case presented visual and gait disturbance after repetitive breath-hold diving into the sea. FLAIR imaging showed hyperintense areas in the bilateral occipito-parietal lobes. In both cases, diffusion-weighted imaging and apparent diffusion coefficient mapping revealed hyperintense areas in the lesions identified by FLAIR. Moreover, follow-up MRI showed attenuation of the FLAIR signal abnormalities. These findings are suggestive of transient hyperpermeability in the microvasculature as a possible cause of cerebral DCS.

  20. Novel Findings in Breath-Holding Spells

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    Azab, Seham F.A.; Siam, Ahmed G.; Saleh, Safaa H.; Elshafei, Mona M.; Elsaeed, Wafaa F.; Arafa, Mohamed A.; Bendary, Eman A.; Farag, Elsayed M.; Basset, Maha A.A.; Ismail, Sanaa M.; Elazouni, Osama M.A.

    2015-01-01

    Abstract The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. Another aim of the study was to evaluate the differences in the pathophysiology between pallid and cyanotic types of BHS. This was a prospective study performed in Zagazig University Hospitals. Seventy-six children diagnosed with BHS were included as follows: 32 children with cyanotic BHS, 14 children with pallid BHS, and 30 healthy children as a control group. All children were subjected to the following: full history taking, clinical examination, and laboratory work up in the form of CBC, serum iron, ferritin, and zinc levels. Twenty-four hours ambulatory ECG (Holter) recording was also performed. No significant statistical difference was found between cyanotic and pallid groups regarding family history of BHS, severity, and precipitating factors of the attacks. Frequent runs of respiratory sinus arrhythmia (RSA) during 24 hours ECG were significantly higher in children with BHS; the frequency of RSA was significantly correlated with the frequency (severity) of the attacks. Low serum ferritin was significantly associated with BHS groups but not correlated with the severity of the attacks. Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology. PMID:26181556

  1. Brain metabolite values in children with breath-holding spells

    Directory of Open Access Journals (Sweden)

    Calik M

    2017-06-01

    Full Text Available Mustafa Calik,1 Dilek Sen Dokumaci,2 Suna Sarikaya,3 Mahmut Demir,4 Ilhan Isik,5 Halil Kazanasmaz,4 Cemil Kaya,4 Hasan Kandemir6 1Department of Pediatric Neurology, 2Department of Radiology, 3Department of Neurology, 4Department of Pediatrics, Harran University School of Medicine, 5Department of Pediatric Neurology, Eyyubiye Training and Research Hospital, 6Department of Child and Adolescent Psychiatry, Harran University School of Medicine, Sanliurfa, Turkey Abstract: Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. The objective of this study was to investigate the pathologies in brain metabolite values in the absence of seizure in children with breath-holding spells by using magnetic resonance spectroscopy (MRS. Brain MRS examination was performed on 18 children with breath-holding spells and 13 neurologically normal children who were included as the control group. There was no significant difference in terms of N-acetyl aspartate (NAA, choline (Cho, creatine (Cr, and myoinositol (mI levels and also in terms of NAA/Cr, Cho/Cr, and mI/Cr ratios between the patients and the control group (all P>0.05. Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells. Keywords: brain metabolite, children, breath holding, magnetic resonance spectroscopy 

  2. Effect of iron supplementation in children with breath holding spells.

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    Jain, Rahul; Omanakuttan, Divin; Singh, Amitabh; Jajoo, Mamta

    2017-08-01

    The aim of this study was to analyse the effect of iron supplementation in children with breath holding spells, irrespective of their iron status and study the factors associated with the response. This was a prospective interventional study. Study population comprised of patients aged 6-36 months, attending a paediatric outpatient department with recurrent episodes (more than three in last 4 weeks) of breath holding spells. Children with loss of consciousness or convulsive movements associated with breath holding spells were considered as severe. After baseline investigations, all enrolled patients were given elemental iron at the dose of 3 mg/kg/day as a single daily dose. Four weekly follow-ups were done until 3 months after initiation of the intervention. At 12 weeks, investigations were repeated and outcome assessed for remission or decrease in severity of breath holding episodes. A total of 100 children with breath holding spells received iron supplementation. Almost 73% of children showed complete response, with another 23% showing greater than 50% reduction in frequency. Frequency of spells at diagnosis and intolerance to oral iron were significantly associated with poor response to iron supplementation. Other factors such as age at onset, age at presentation, severity of spells, anaemia and serum iron parameters had no significant association with the response. Of the 27 children without iron deficiency (serum ferritin ≥ 30 µg/L), 77.7% responded completely to iron supplementation, similar to the iron-deficient group. Iron supplementation is effective in the management of breath holding spells. Non-anaemic and iron-replete children with breath holding spells also respond well to iron supplementation. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  3. Lung volume reproducibility under ABC control and self-sustained breath-holding.

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    Kaza, Evangelia; Dunlop, Alex; Panek, Rafal; Collins, David J; Orton, Matthew; Symonds-Tayler, Richard; McQuaid, Dualta; Scurr, Erica; Hansen, Vibeke; Leach, Martin O

    2017-03-01

    An Active Breathing Coordinator (ABC) can be employed to induce breath-holds during CT imaging and radiotherapy of lung, breast and liver cancer, and recently during lung cancer MRI. The apparatus measures and controls respiratory volume, hence subject lung volume reproducibility is its principal measure of effectiveness. To assess ABC control quality, the intra-session reproducibility of ABC-induced lung volumes was evaluated and compared with that reached by applying the clinical standard of operator-guided self-sustained breath-holds on healthy volunteers during MRI. Inter-session reproducibility was investigated by repeating ABC-controlled breath-holds on a second visit. Additionally, lung volume agreement with ABC devices used with different imaging modalities in the same institution (MR, CT), or for a breast trial treatment, was assessed. Lung volumes were derived from three-dimensional (3D) T1-weighted MRI datasets by three observers employing semiautomatic lung delineation on a radiotherapy treatment planning system. Inter-observer variability was less than 6% of the delineated lung volumes. Lung volume agreement between the different conditions over all subjects was investigated using descriptive statistics. The ABC equipment dedicated for MR application exhibited good intra-session and inter-session lung volume reproducibility (1.8% and 3% lung volume variability on average, respectively). MR-assessed lung volumes were similar using different ABC equipment dedicated to MR, CT, or breast radiotherapy. Overall, lung volumes controlled by the same or different ABC devices agreed better than with self-controlled breath-holds, as suggested by the average ABC variation of 1.8% of the measured lung volumes (99 mL), compared to the 4.1% (226 mL) variability observed on average with self-sustained breath-holding. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in

  4. Single breath-hold assessment of cardiac function using an accelerated 3D single breath-hold acquisition technique - comparison of an intravascular and extravascular contrast agent

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    2012-01-01

    Background Cardiovascular magnetic resonance (CMR) is the current gold standard for the assessment of left ventricular (LV) function. Repeated breath-holds are needed for standard multi-slice 2D cine steady-state free precession sequences (M2D-SSFP). Accelerated single breath-hold techniques suffer from low contrast between blood pool and myocardium. In this study an intravascular contrast agent was prospectively compared to an extravascular contrast agent for the assessment of LV function using a single-breath-hold 3D-whole-heart cine SSFP sequence (3D-SSFP). Methods LV function was assessed in fourteen patients on a 1.5 T MR-scanner (Philips Healthcare) using 32-channel coil technology. Patients were investigated twice using a 3D-SSFP sequence (acquisition time 18–25 s) after Gadopentetate dimeglumine (GdD, day 1) and Gadofosveset trisodium (GdT, day 2) administration. Image acquisition was accelerated using sensitivity encoding in both phase encoding directions (4xSENSE). CNR and BMC were both measured between blood and myocardium. The CNR incorporated noise measurements, while the BMC represented the coeffiancy between the signal from blood and myocardium [1]. Contrast to noise ratio (CNR), blood to myocardium contrast (BMC), image quality, LV functional parameters and intra-/interobserver variability were compared. A M2D-SSFP sequence was used as a reference standard on both days. Results All 3D-SSFP sequences were successfully acquired within one breath-hold after GdD and GdT administration. CNR and BMC were significantly (p < 0.05) higher using GdT compared to GdD, resulting in an improved endocardial definition. Using 3D-SSFP with GdT, Bland–Altman plots showed a smaller bias (95% confidence interval LVEF: 9.0 vs. 23.7) and regression analysis showed a stronger correlation to the reference standard (R2 = 0.92 vs. R2 = 0.71), compared to 3D-SSFP with GdD. Conclusions A single-breath-hold 3D-whole-heart cine SSFP sequence in combination

  5. Single breath-hold assessment of cardiac function using an accelerated 3D single breath-hold acquisition technique - comparison of an intravascular and extravascular contrast agent

    Directory of Open Access Journals (Sweden)

    Makowski Marcus R

    2012-07-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR is the current gold standard for the assessment of left ventricular (LV function. Repeated breath-holds are needed for standard multi-slice 2D cine steady-state free precession sequences (M2D-SSFP. Accelerated single breath-hold techniques suffer from low contrast between blood pool and myocardium. In this study an intravascular contrast agent was prospectively compared to an extravascular contrast agent for the assessment of LV function using a single-breath-hold 3D-whole-heart cine SSFP sequence (3D-SSFP. Methods LV function was assessed in fourteen patients on a 1.5 T MR-scanner (Philips Healthcare using 32-channel coil technology. Patients were investigated twice using a 3D-SSFP sequence (acquisition time 18–25 s after Gadopentetate dimeglumine (GdD, day 1 and Gadofosveset trisodium (GdT, day 2 administration. Image acquisition was accelerated using sensitivity encoding in both phase encoding directions (4xSENSE. CNR and BMC were both measured between blood and myocardium. The CNR incorporated noise measurements, while the BMC represented the coeffiancy between the signal from blood and myocardium [1]. Contrast to noise ratio (CNR, blood to myocardium contrast (BMC, image quality, LV functional parameters and intra-/interobserver variability were compared. A M2D-SSFP sequence was used as a reference standard on both days. Results All 3D-SSFP sequences were successfully acquired within one breath-hold after GdD and GdT administration. CNR and BMC were significantly (p vs. 23.7 and regression analysis showed a stronger correlation to the reference standard (R2 = 0.92 vs. R2 = 0.71, compared to 3D-SSFP with GdD. Conclusions A single-breath-hold 3D-whole-heart cine SSFP sequence in combination with 32-channel technology and an intravascular contrast agent allows for the accurate and fast assessment of LV function. Trial registration The study was approved by the local

  6. Brain metabolite values in children with breath-holding spells.

    Science.gov (United States)

    Calik, Mustafa; Sen Dokumaci, Dilek; Sarikaya, Suna; Demir, Mahmut; Isik, Ilhan; Kazanasmaz, Halil; Kaya, Cemil; Kandemir, Hasan

    2017-01-01

    Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. The objective of this study was to investigate the pathologies in brain metabolite values in the absence of seizure in children with breath-holding spells by using magnetic resonance spectroscopy (MRS). Brain MRS examination was performed on 18 children with breath-holding spells and 13 neurologically normal children who were included as the control group. There was no significant difference in terms of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and myoinositol (mI) levels and also in terms of NAA/Cr, Cho/Cr, and mI/Cr ratios between the patients and the control group (all P>0.05). Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells.

  7. Compressed sensing single-breath-hold CMR for fast quantification of LV function, volumes, and mass.

    Science.gov (United States)

    Vincenti, Gabriella; Monney, Pierre; Chaptinel, Jérôme; Rutz, Tobias; Coppo, Simone; Zenge, Michael O; Schmidt, Michaela; Nadar, Mariappan S; Piccini, Davide; Chèvre, Pascal; Stuber, Matthias; Schwitter, Juerg

    2014-09-01

    The purpose of this study was to compare a novel compressed sensing (CS)-based single-breath-hold multislice magnetic resonance cine technique with the standard multi-breath-hold technique for the assessment of left ventricular (LV) volumes and function. Cardiac magnetic resonance is generally accepted as the gold standard for LV volume and function assessment. LV function is 1 of the most important cardiac parameters for diagnosis and the monitoring of treatment effects. Recently, CS techniques have emerged as a means to accelerate data acquisition. The prototype CS cine sequence acquires 3 long-axis and 4 short-axis cine loops in 1 single breath-hold (temporal/spatial resolution: 30 ms/1.5 × 1.5 mm(2); acceleration factor 11.0) to measure left ventricular ejection fraction (LVEF(CS)) as well as LV volumes and LV mass using LV model-based 4D software. For comparison, a conventional stack of multi-breath-hold cine images was acquired (temporal/spatial resolution 40 ms/1.2 × 1.6 mm(2)). As a reference for the left ventricular stroke volume (LVSV), aortic flow was measured by phase-contrast acquisition. In 94% of the 33 participants (12 volunteers: mean age 33 ± 7 years; 21 patients: mean age 63 ± 13 years with different LV pathologies), the image quality of the CS acquisitions was excellent. LVEF(CS) and LVEF(standard) were similar (48.5 ± 15.9% vs. 49.8 ± 15.8%; p = 0.11; r = 0.96; slope 0.97; p < 0.00001). Agreement of LVSV(CS) with aortic flow was superior to that of LVSV(standard) (overestimation vs. aortic flow: 5.6 ± 6.5 ml vs. 16.2 ± 11.7 ml, respectively; p = 0.012) with less variability (r = 0.91; p < 0.00001 for the CS technique vs. r = 0.71; p < 0.01 for the standard technique). The intraobserver and interobserver agreement for all CS parameters was good (slopes 0.93 to 1.06; r = 0.90 to 0.99). The results demonstrated the feasibility of applying the CS strategy to evaluate LV function and volumes with high accuracy in patients. The single-breath-hold

  8. Evaluation of pulmonary function using single-breath-hold dual-energy computed tomography with xenon

    Science.gov (United States)

    Kyoyama, Hiroyuki; Hirata, Yusuke; Kikuchi, Satoshi; Sakai, Kosuke; Saito, Yuriko; Mikami, Shintaro; Moriyama, Gaku; Yanagita, Hisami; Watanabe, Wataru; Otani, Katharina; Honda, Norinari; Uematsu, Kazutsugu

    2017-01-01

    Abstract Xenon-enhanced dual-energy computed tomography (xenon-enhanced CT) can provide lung ventilation maps that may be useful for assessing structural and functional abnormalities of the lung. Xenon-enhanced CT has been performed using a multiple-breath-hold technique during xenon washout. We recently developed xenon-enhanced CT using a single-breath-hold technique to assess ventilation. We sought to evaluate whether xenon-enhanced CT using a single-breath-hold technique correlates with pulmonary function testing (PFT) results. Twenty-six patients, including 11 chronic obstructive pulmonary disease (COPD) patients, underwent xenon-enhanced CT and PFT. Three of the COPD patients underwent xenon-enhanced CT before and after bronchodilator treatment. Images from xenon-CT were obtained by dual-source CT during a breath-hold after a single vital-capacity inspiration of a xenon–oxygen gas mixture. Image postprocessing by 3-material decomposition generated conventional CT and xenon-enhanced images. Low-attenuation areas on xenon images matched low-attenuation areas on conventional CT in 21 cases but matched normal-attenuation areas in 5 cases. Volumes of Hounsfield unit (HU) histograms of xenon images correlated moderately and highly with vital capacity (VC) and total lung capacity (TLC), respectively (r = 0.68 and 0.85). Means and modes of histograms weakly correlated with VC (r = 0.39 and 0.38), moderately with forced expiratory volume in 1 second (FEV1) (r = 0.59 and 0.56), weakly with the ratio of FEV1 to FVC (r = 0.46 and 0.42), and moderately with the ratio of FEV1 to its predicted value (r = 0.64 and 0.60). Mode and volume of histograms increased in 2 COPD patients after the improvement of FEV1 with bronchodilators. Inhalation of xenon gas caused no adverse effects. Xenon-enhanced CT using a single-breath-hold technique depicted functional abnormalities not detectable on thin-slice CT. Mode, mean, and volume of HU histograms of xenon images

  9. Brain damage in commercial breath-hold divers.

    Directory of Open Access Journals (Sweden)

    Kiyotaka Kohshi

    Full Text Available Acute decompression illness (DCI involving the brain (Cerebral DCI is one of the most serious forms of diving-related injuries which may leave residual brain damage. Cerebral DCI occurs in compressed air and in breath-hold divers, likewise. We conducted this study to investigate whether long-term breath-hold divers who may be exposed to repeated symptomatic and asymptomatic brain injuries, show brain damage on magnetic resonance imaging (MRI.Our study subjects were 12 commercial breath-hold divers (Ama with long histories of diving work in a district of Japan. We obtained information on their diving practices and the presence or absence of medical problems, especially DCI events. All participants were examined with MRI to determine the prevalence of brain lesions.Out of 12 Ama divers (mean age: 54.9±5.1 years, four had histories of cerebral DCI events, and 11 divers demonstrated ischemic lesions of the brain on MRI studies. The lesions were situated in the cortical and/or subcortical area (9 cases, white matters (4 cases, the basal ganglia (4 cases, and the thalamus (1 case. Subdural fluid collections were seen in 2 cases.These results suggest that commercial breath-hold divers are at a risk of clinical or subclinical brain injury which may affect the long-term neuropsychological health of divers.

  10. Ultrasound lung "comets" increase after breath-hold diving.

    Science.gov (United States)

    Lambrechts, Kate; Germonpré, Peter; Charbel, Brian; Cialoni, Danilo; Musimu, Patrick; Sponsiello, Nicola; Marroni, Alessandro; Pastouret, Frédéric; Balestra, Costantino

    2011-04-01

    The purpose of the study was to analyze the ultrasound lung comets (ULCs) variation, which are a sign of extra-vascular lung water. Forty-two healthy individuals performed breath-hold diving in different conditions: dynamic surface apnea; deep variable-weight apnea and shallow, face immersed without effort (static maximal and non-maximal). The number of ULCs was evaluated by means of an ultrasound scan of the chest, before and after breath-hold diving sessions. The ULC score increased significantly from baseline after dynamic surface apnea (p = 0.0068), after deep breath-hold sessions (p = 0.0018), and after static maximal apnea (p = 0.031). There was no statistically significant difference between the average increase of ULC scores after dynamic surface apnea and deep breath-hold diving. We, therefore, postulate that extravascular lung water accumulation may be due to other factors than (deep) immersion alone, because it occurs during dynamic surface apnea as well. Three mechanisms may be responsible for this. First, the immersion-induced hydrostatic pressure gradient applied on the body causes a shift of peripheral venous blood towards the thorax. Second, the blood pooling effect found during the diving response Redistributes blood to the pulmonary vascular bed. Third, it is possible that the intense involuntary diaphragmatic contractions occurring during the "struggle phase" of the breath-hold can also produce a blood shift from the pulmonary capillaries to the pulmonary alveoli. A combination of these factors may explain the observed increase in ULC scores in deep, shallow maximal and shallow dynamic apneas, whereas shallow non-maximal apneas seem to be not "ULC provoking".

  11. Prevalence of acute respiratory symptoms in breath-hold divers.

    Science.gov (United States)

    Cialoni, Danilo; Sponsiello, Nicola; Marabotti, Claudio; Marroni, Alessandro; Pieri, Massimo; Maggiorelli, Fabrizio; Tonerini, Michele; Frammartino, Brunella

    2012-01-01

    After repetitive deep dives, breath-hold divers are often affected by a syndrome characterized by typical symptoms such as cough, sensation of chest constriction, blood-striated expectorate (hemoptysis) and, rarely, an overt acute pulmonary edema syndrome, often together with various degrees of dyspnea. The aim of this work is an epidemiological investigation to evaluate the prevalence of acute respiratory symptoms (ARS) in breath-hold divers (BHDs) in practicing breath-hold diving. A retrospective investigation has been performed using specific questionnaires completed by a selected sample of free-divers (212 breath-hold diving instructors--194 male, 18 female; mean age 34 +/- 6.91 years); affiliated with Apnea Academy, (International School for Education and Research of Free-Diving). We also investigated possible risk factors for post-dive acute respiratory symptoms. Furthermore, the authors report that a severe case of acute pulmonary edema occurred to a healthy and experienced breath-hold diving instructor. We reported detailed CT scan and follow-up CT scans three days later, with another scan reported 10 days later as well. A total of 56 subjects (26.4%) reported previous events such as cough, thoracic constraint, hemoptysis, associated with various degrees of dyspnea as confirmation of pulmonary involvement. Forty-five of them (82%) reported signs of true hemoptysis and a high degrees of dyspnea. A CT scan revealed the presence of patchy bilateral lung opacities at the level of superior and parahilar zones; follow-up CT scans three days later and 10 days later are also reported. Our data show that this is a common condition among experienced BHDs. In our opinion, this is particularly interesting for the free-diving community.

  12. Temperamental traits of breath holding children: A case control study

    Science.gov (United States)

    Subbarayan, A.; Ganesan, B.; Anbumani; Jayanthini

    2008-01-01

    Background: Clinical observation and few anecdotal reports suggest that the children with breath holding spells (BHS) have certain temperamental traits, which predispose them to behave in certain way. They seem to have low frustration tolerance, which leads to adamant behavior. Vigorous crying, through various mechanisms, precipitates BHS. Materials and Methods: We assessed the temperamental traits of 30 children with BHS and compared them with 30 normal children after matching for age, sex, and socioeconomic status. Temperament was measured using ‘Temperament measurement Schedule’. Results: The data were analyzed using Mann-Whitney U test. The following temperamental traits, threshold of responsiveness (Pbreath holders. Conclusions: Significantly differing temperamental traits in breath holders suggests that these could influence the behavioral pattern exhibited by them. Breath holding spells can act as an easy marker for difficult temperamental traits, which gives an early opportunity to shape their difficult behavior. PMID:19742234

  13. P Wave Dispersion in Children with Breath-holding Spells

    OpenAIRE

    Tahsin Gider; Bülent Koca; Mustafa Çalık; Ali Yıldırım; Savaş Demirpençe

    2016-01-01

    Objective: A breath-holding spell (BHS) is a clinical feature frequently seen in infancy and early childhood and generally bringing children to pediatric cardiology outpatient clinics with the suspicion of cardiac disease. In this study, P wave dispersion (PWD), which is a marker of regional differences in atrial depolarization in electrocardiography and has been demonstrated to be beneficial in defining the risk of supraventricular tachycardia in various patient groups, was studied in childr...

  14. Evaluation of QT Dispersion in Children with Breath Holding Spells.

    Science.gov (United States)

    Movahedian, Amir Hosein; Heidarzadeh Arani, Marzieh; Motaharizad, Davood; Mousavi, Gholam Abbas; Mosayebi, Ziba

    2016-01-01

    Breath holding spells (BHS) are common involuntary reflexes in infancy and early childhood. Differential diagnosis should embrace Long QT Syndrome (LQTS) and paroxysmal abnormalities of rhythm. The aim of this study was to compare QT dispersion (QTd) in children with breath holding spells and normal controls. QT dispersion and Corrected QT(QTc) dispersion were measured in 12 lead surface electrocardiograms in 56 patients with BHS and compared with healthy children of the same age referred to the clinic for regular checkup visits. The most common type of BHS was cyanotic (83.9%). Seven patients (12.5%) had pallid and two patients (3.5%) had mixed spells. There was a history of breath holding spells in 33.9% of the children. QT dispersion was 61.6± 22.5 and 47.1±18.8 ms in patient and control groups, respectively. QTc dispersion (QTcd) was 104 ± 29.6 and 71.9 ±18.2 ms, respectively. There was a significant difference between patient and control groups in terms of QTd and QTcd (P<0.001). QTd and QTcd were increased in children with BHS. Therefore, the evaluation of EKG for early diagnosis of rhythm abnormalities seems reasonable in these children.

  15. Automated daily breath hold stability measurements by real-time imaging in radiotherapy of breast cancer

    NARCIS (Netherlands)

    De Boer, Hans C J; Van Den Bongard, Desirée J G; van Asselen, B

    2016-01-01

    Background and purpose Breath hold is increasingly used for cardiac sparing in left-sided breast cancer irradiation. We have developed a fast automated method to verify breath hold stability in each treatment fraction. Material and methods We evaluated 504 patients treated with breath hold. Moderate

  16. Increased oxidant status in children with breath-holding spells.

    Science.gov (United States)

    Calik, Mustafa; Abuhandan, Mahmut; Aycicek, Ali; Taskin, Abdullah; Selek, Sahabettin; Iscan, Akin

    2013-06-01

    Breath-holding spells (BHS) are the most common form of non-epileptic paroxysmal events in infancy. The pathophysiology of BHS is not fully understood. Iron-deficiency anemia (IDA) may be a factor contributing to breath-holding spells. Although numerous reports have shown that elevated oxidative stress is implicated in the pathophysiology of neurodegenerative diseases and neurological conditions, such as epileptic seizures, brain damage, and neurotrauma, there are no data regarding the role of oxidative stress in the development of BHS. This study aimed to investigate oxidative stress in children with BHS. This case-control study was conducted at the Department of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, in Turkey. Blood samples from 31 patients (14 females, 17 males) with BHS which were taken at least 24 h after the BHS attack, and a control group of 35 healthy individuals (13 females, 22 males) were used for the measurement of the plasma total antioxidant capacity, total oxidant status, and oxidative stress index, hemoglobin concentration, serum iron, transferrin saturation and serum ferritin levels. The plasma total antioxidant capacity values were markedly lower and total oxidant status and oxidative stress index values in the BHS group were significantly higher than that in the controls (P ≤ 0.01). Our data suggest that the value of oxidative stress was significantly higher in patients with BHS than in the controls. Conditions associated with increased oxidative stress such as IDA may be a risk factor for the development of BHS.

  17. EFFECTS OF ORAL IRON SUPPLEMENT ON BREATH-HOLDING SPELLS IN CHILDREN

    OpenAIRE

    S.H. TONEKABONI; S. ALAVI; F. MAHVELATI; Z. TABASI

    2006-01-01

    Objectives:Breath holding spells are one of the most frequent and important diagnostic challenges in pediatrics. The aim of this study, conducted on pediatric patients referring to the pediatric neurology clinic in Hormozgan province, was to evaluate therapeutic effects of iron on breath holding spellsMaterials and Methods:35 children (19 males and 16 females), aged between 3 to 60 months, with a history of breath-holding spells, were included in the trial. To obtain all relevant data a speci...

  18. Qualitative assessment of contrast-enhanced magnetic resonance angiography using breath-hold and non-breath-hold techniques in the portal venous system

    Science.gov (United States)

    Goo, Eun-Hoe; Kim, Sun-Ju; Dong, Kyung-Rae; Kim, Kwang-Choul; Chung, Woon-Kwan

    2016-09-01

    The purpose of this study is to evaluate the image quality in delineation of the portal venous systems with two different methods, breath-hold and non-breath-hold by using the 3D FLASH sequence. We used a 1.5 T system to obtain magnetic resonance(MR)images. Arterial and portal phase 3D FLASH images were obtained with breath-hold after a bolus injection of GD-DOTA. The detection of PVS on the MR angiograms was classified into three grades. First, the angiograms of the breath-hold method showed well the portal vein, the splenic vein and the superior mesenteric vein systems in 13 of 15 patients (86%) and the inferior mesenteric vein system in 6 of 15 patients (40%), Second, MR angiograms of the non-breath-hold method demonstrated the PVS and the SMV in 12 of 15 patients (80%) and the IMV in 5 of 15 patients (33%). Our study showed contrast-enhanced 3D FLASH MR angiography, together with the breath-hold technique, may provide reliable and accurate information on the portal venous system.

  19. The Ins and Outs of Breath Holding: Simple Demonstrations of Complex Respiratory Physiology

    Science.gov (United States)

    Skow, Rachel J.; Day, Trevor A.; Fuller, Jonathan E.; Bruce, Christina D.; Steinback, Craig D.

    2015-01-01

    The physiology of breath holding is complex, and voluntary breath-hold duration is affected by many factors, including practice, psychology, respiratory chemoreflexes, and lung stretch. In this activity, we outline a number of simple laboratory activities or classroom demonstrations that illustrate the complexity of the integrative physiology…

  20. Audiovisual biofeedback guided breath-hold improves lung tumor position reproducibility and volume consistency

    Directory of Open Access Journals (Sweden)

    Danny Lee, PhD

    2017-07-01

    Conclusions: This study demonstrated that audiovisual biofeedback can be used to improve the reproducibility and consistency of breath-hold lung tumor position and volume, respectively. These results may provide a pathway to achieve more accurate lung cancer radiation treatment in addition to improving various medical imaging and treatments by using breath-hold procedures.

  1. Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

    Science.gov (United States)

    Bartlett, Frederick R.; Colgan, Ruth M.; Donovan, Ellen M.; Carr, Karen; Landeg, Steven; Clements, Nicola; McNair, Helen A.; Locke, Imogen; Evans, Philip M.; Haviland, Joanne S.; Yarnold, John R.; Kirby, Anna M.

    2014-01-01

    Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery. PMID:25046661

  2. Genetic predisposition to breath-hold diving-induced hemoptysis: Preliminary study.

    OpenAIRE

    Cialoni, Danilo; Marabotti, Claudio C; Sponsiello, Nicola; Pieri, Massimo; Balestra, Costantino; Lucchini, Vittorio V; Marroni, Alessandro

    2015-01-01

    Breath-hold diving-induced hemoptysis (BH-DIH) has been reported in about 25% breath-hold divers (BHD) and is characterized by dyspnea, coughing, hemoptysis and chest pain. We investigated whether eNOS G894T, eNOS T786C and ACE insertion/deletion I/D genetic variants, are possible BH-DIH risk factors.

  3. Successful treatment of pallid breath-holding spells with fluoxetine.

    Science.gov (United States)

    Walsh, Mark; Knilans, Timothy K; Anderson, Jeffrey B; Czosek, Richard J

    2012-09-01

    Pallid breath-holding (PBH) is a childhood condition that presents with recurrent syncope. Although typically benign, severe cases can lead to asystole and anoxic seizures. Previous studies have advocated pacemaker placement to abbreviate symptoms. This was a retrospective study of patients treated with fluoxetine for PBH spells. Clinical response, side effects and avoidance of pacemaker implantation were reviewed in six patients (12-60 months) treated with fluoxetine for PBH. Patients were referred because of concern of arrhythmia and failed medical treatment strategies. Two patients had previously implanted loop recorders, 5 patients had documented episodes of asystole, and 2 patients had generalized seizures. Fluoxetine resulted in alleviation of syncope in 5 of 6 patients. Time to symptomatic improvement symptoms ranged from 2 days to 1 month (median, 2 weeks). Median duration of treatment with fluoxetine was 12 months (12-24 months). One patient demonstrated no improvement and had a pacemaker implanted. There were no reported side effects to fluoxetine. Fluoxetine can be used to treat childhood PBH spells and may obviate the need for permanent pacing in a significant subset of this population. Considering its safe side-effect profile it is a worthwhile first-line agent to treat this disorder.

  4. Registration-based regional lung mechanical analysis: retrospectively reconstructed dynamic imaging versus static breath-hold image acquisition

    Science.gov (United States)

    Ding, Kai; Cao, Kunlin; Christensen, Gary E.; Hoffman, Eric A.; Reinhardt, Joseph M.

    2009-02-01

    The lungs undergo expansion and contraction during the respiratory cycle. Since many disease or injury conditions are associated with the biomechanical or material property changes that can alter lung function, there is a great interest in measuring regional lung ventilation and regional mechanical changes. We describe a technique that uses multiple respiratory-gated CT images and non-rigid 3D image registration to make local estimates of lung tissue expansion. The degree of regional lung expansion is measured using the Jacobian (a function of local partial derivatives) of the registration displacement field. We compare the ventral-dorsal patterns of lung expansion estimated in both retrospectively reconstructed dynamic scans and static breath-hold scans to a xenon CT based measure of specific ventilation and a semi-automatic reference standard in four anesthetized sheep studied in the supine orientation. The regional lung expansion estimated by 3D image registration of images acquired at 50% and 75% phase points of the inspiratory portion of the respiratory cycle and 20 cm H2O and 25 cm H2O airway pressures gave the best match between the average Jacobian and the xenon CT specific ventilation respectively (linear regression, average r2 = 0.85 and r2 = 0.84). The registration accuracy assessed by 200 semi-automatically matched landmarks in both the dynamic and static scans show landmark error on the order of 2 mm.

  5. Breath Holding Spells in Children with Long QT Syndrome.

    Science.gov (United States)

    Robinson, Jeffrey A; Bos, J Martijn; Etheridge, Susan P; Ackerman, Michael J

    2015-01-01

    Long QT syndrome (LQTS) is a genetic heart rhythm disorder that may present with syncope, seizures, or sudden cardiac death. Breath holding spells (BHS) occur in 5% of all children and have been noted in children with LQTS anecdotally. The purpose of this study was to determine the frequency of BHS in children diagnosed with LQTS at ≤5 years of age. A retrospective review was performed to identify children diagnosed with LQTS who were ≤5 years old at initial presentation to our LQTS clinic from August 1999 to November 2013. The mean length of follow-up was 6.4 ± 2.8 years. The electronic medical records were reviewed for clinical presentation of BHS, as well as LQTS-associated symptoms, diagnostic tests, and treatment. The study cohort consisted of 115 children with LQTS (58% male; median age at diagnosis, 11 months [range, birth to 5 years]; mean corrected QT interval (QTc), 478 ± 60 milliseconds). At presentation, 80% of patients were asymptomatic. Genetic testing revealed type 1 LQTS (LQT1) in 48%. Overall, 5 of 115 patients (4.3%) had BHS (2 of 5 [40%] male, mean QTc: 492 ± 14 milliseconds, 4 [80%] with family history of LQTS). BHS were the presenting symptom in 1 of 23 symptomatic patients (4.3%). All BHS occurred in patients with LQT1 (P = .02). Although BHS among children with LQTS are relatively rare and occur at similar frequency as the general population, they can be the presenting symptom for a heart rhythm disorder. Careful attention to BHS is important to distinguish an innocent BHS from a potential LQTS-triggered cardiac event so that proper treatment is initiated. © 2015 Wiley Periodicals, Inc.

  6. Nitric oxide-related endothelial changes in breath-hold and scuba divers.

    Science.gov (United States)

    Theunissen, S; Guerrero, F; Sponsiello, N; Cialoni, D; Pieri, M; Germonpré, P; Obeid, G; Tillmans, F; Papadopoulou, V; Hemelryck, W; Marroni, A; De Bels, D; Balestra, C

    2013-01-01

    Scuba and breath-hold divers are compared to investigate whether endothelial response changes are similar despite different exposure(s) to hyperoxia. 14 divers (nine scuba and five breath-holding) performed either one scuba dive (25m/25 minutes) or successive breath-hold dives at a depth of 20 meters, adding up to 25 minutes of immersion time in a diving pool. Flow-mediated dilation (FMD) was measured using echography. Peripheral post-occlusion reactive hyperemia (PORH) was assessed by digital plethysmography and plasmatic nitric oxide (NO) concentration using a nitrate/nitrite colorimetric assay kit. The FMD decreased in both groups. PORH was reduced in scuba divers but increased in breath-hold divers. No difference in circulating NO was observed for the scuba group. Opposingly, an increase in circulating NO was observed for the breath-hold group. Some cardiovascular effects can be explained by interaction between NO and superoxide anion during both types of diving ending to less NO availability and reducing FMD. The increased circulating NO in the breath-hold group can be caused by physical exercise. The opposite effects found between FMD and PORH in the breath-hold group can be assimilated to a greater responsiveness to circulating NO in small arteries than in large arteries.

  7. Respiratory sinus arrhythmia in children with severe cyanotic and pallid breath-holding spells.

    Science.gov (United States)

    DiMario, F J; Bauer, L; Baxter, D

    1998-09-01

    In this study we investigated centrally mediated parasympathetic regulation of modulated cardiac vagal tone among children with severe cyanotic and pallid breath-holding spells by examining respiratory sinus arrhythmia. Respiratory sinus arrhythmia was evaluated in 41 children; 17 subjects with cyanotic breath-holding spells (6 boys, 11 girls; mean age 37.1 months), 7 subjects with pallid breath-holding spells (2 boys, 5 girls; mean age 33.0 months), and 17 controls (8 boys, 9 girls; mean age 41.2 months). Subjects had recurrent (more than 3) severe breath-holding spells. Each subject's electrocardiogram was recorded in a quiet room and digitized by an 80386 personal computer during five 1-minute periods. R-R intervals within each 1-minute period were converted to heart rate in 120 successive 0.5-second intervals. The resultant heart rate time series was converted to its underlying frequency composition by a fast Fourier transform and averaged across minutes. Respiratory sinus arrhythmia was defined as the variability in the time series over a frequency range (0.096 Hz to 0.48 Hz) corresponding to a range of respiratory rates from 6 to 30 breaths per minute. ANCOVA adjusting for age and sex was conducted with the subject group as the independent measure. There were no significant differences between subjects with cyanotic breath-holding spells and controls. Pallid breath-holding spell subjects had a marked difference in respiratory sinus arrhythmia from either controls or subjects with cyanotic breath-holding spells, demonstrating less variability in respiratory sinus arrhythmia (P breath-holding spells, caused by a primary central parasympathetic disturbance distinct from the dysregulation found in cyanotic breath-holding spells.

  8. Hemoptysis Due to Breath-Hold Diving Following Chemotherapy and Lung Irradiation

    OpenAIRE

    Gutsche, Markus; Kuschner, Ware G.

    2012-01-01

    Breath-hold diving, also known as free-diving, describes the practice of intentional immersion under water without an external supply of oxygen. Pulmonary hemorrhage with hemoptysis has been reported as a complication of immersion and breath-hold diving in young healthy athletes. We report the case of a 60-year-old man with a history of radiation and chemotherapy for breast carcinoma, who developed the abrupt onset of hemoptysis in the setting of swimming and breath-hold diving. A computed to...

  9. SU-F-BRB-03: Quantifying Patient Motion During Deep-Inspiration Breath-Hold Using the ABC System with Simultaneous Surface Photogrammetry

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, Y; Rahimi, A; Sawant, A [UT Southwestern Medical Center, Dallas, TX (United States)

    2015-06-15

    Purpose: Active breathing control (ABC) has been used to reduce treatment margin due to respiratory organ motion by enforcing temporary breath-holds. However, in practice, even if the ABC device indicates constant lung volume during breath-hold, the patient may still exhibit minor chest motion. Consequently, therapists are given a false sense of security that the patient is immobilized. This study aims at quantifying such motion during ABC breath-holds by monitoring the patient chest motion using a surface photogrammetry system, VisionRT. Methods: A female patient with breast cancer was selected to evaluate chest motion during ABC breath-holds. During the entire course of treatment, the patient’s chest surface was monitored by a surface photogrammetry system, VisionRT. Specifically, a user-defined region-of-interest (ROI) on the chest surface was selected for the system to track at a rate of ∼3Hz. The surface motion was estimated by rigid image registration between the current ROI image captured and a reference image. The translational and rotational displacements computed were saved in a log file. Results: A total of 20 fractions of radiation treatment were monitored by VisionRT. After removing noisy data, we obtained chest motion of 79 breath-hold sessions. Mean chest motion in AP direction during breath-holds is 1.31mm with 0.62mm standard deviation. Of the 79 sessions, the patient exhibited motion ranging from 0–1 mm (30 sessions), 1–2 mm (37 sessions), 2–3 mm (11 sessions) and >3 mm (1 session). Conclusion: Contrary to popular assumptions, the patient is not completely still during ABC breath-hold sessions. In this particular case studied, the patient exhibited chest motion over 2mm in 14 out of 79 breath-holds. Underestimating treatment margin for radiation therapy with ABC could reduce treatment effectiveness due to geometric miss or overdose of critical organs. The senior author receives research funding from NIH, VisionRT, Varian Medical Systems

  10. Diverse presentation of breath holding spells: two case reports with literature review.

    Science.gov (United States)

    Rathore, Geetanjali; Larsen, Paul; Fernandez, Cristina; Parakh, Manish

    2013-01-01

    Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.

  11. Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

    Science.gov (United States)

    Rathore, Geetanjali; Larsen, Paul; Fernandez, Cristina; Parakh, Manish

    2013-01-01

    Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells. PMID:24191206

  12. Selenium and antioxidant levels decreased in blood of children with breath-holding spells.

    Science.gov (United States)

    Saad, Khaled; Farghaly, Hikma S; Badry, Reda; Othman, Hisham A K

    2014-10-01

    We hypothesize that the imbalance between oxidant and antioxidant systems might be involved in the pathophysiology of breath-holding spells. The aim of this study is to evaluate the oxidant-antioxidant status in children with breath-holding spells compared to healthy children. In a case control study, 67 children with breath-holding spells were compared with 60 healthy children. Malondialdehyde values of the patients were significantly higher than those in control. Levels of selenium, glutathione peroxidase, and superoxide dismutase of the patient group are significantly lower than those in control. The present study gives helpful data about oxidant-antioxidant systems alterations in breath-holding spells in such a large patient group. These data give support to the hypothesis of the imbalance between oxidant and antioxidant systems, and selenium deficiency might be involved in the pathophysiology of breath-holding spells, suggesting the role of this system dysregulation in breath-holding spells. © The Author(s) 2014.

  13. Case report of successful treatment of pallid breath-holding spells with glycopyrrolate.

    Science.gov (United States)

    Williams, Jason; Cain, Nicole

    2015-05-01

    Breath-holding spells are a common childhood disorder that typically present before 12 months of age. Whereas most cases are benign, some patients have very severe cases associated with bradycardia that can progress from asystole to syncope and seizures. Treatment studies have implicated the use of several therapies, such as oral iron, fluoxetine, and pacemaker implantation. This is a retrospective study of patients treated with glycopyrrolate for pallid breath-holding spells. Clinical data from 4 patients referred to pediatric cardiology who saw therapeutic benefit from treatment using glycopyrrolate were reviewed to evaluate for clinical response to the drug. Two twin patients, whose symptoms began at 5 months of age, experienced a decrease in breath-holding frequency after 1 month. A patient diagnosed at 7 months of age experienced a decrease in frequency of spells. A patient diagnosed at 10 months of age reported cessation of syncope shortly after initiation of glycopyrrolate and complete resolution of breath-holding spells during prolonged treatment. This case study of 4 patients with pallid breath-holding offers evidence that glycopyrrolate may be beneficial in treating breath-holding spells and has a safer side-effect profile than pacemaker implantation. Copyright © 2015 by the American Academy of Pediatrics.

  14. Cardiac repolarization changes in the children with breath-holding spells.

    Science.gov (United States)

    Amoozgar, Hamid; Saleh, Fazl; Farhani, Nahal; Rafiei, Mohammad; Inaloo, Soroor; Asadipooya, Ali-Akbar

    2013-12-01

    Breath-holding spells are known as benign attacks, frequencies of which decrease by the development of the autonomic nervous system. The present study aims to compare the electrocardiographic repolarization in children with breath-holding spells. In this study, QT dispersion, QTc dispersion, T peak to T end dispersion, and P wave dispersion of the twelve-lead surface electrocardiography of fifty children who had breath-holding spells were measured and compared with normal children from April 2011 to August 2012. Forty-four (88%) patients had cyanotic spells, while 6 (12%) had pallid spells. QTc dispersion was increased in the patients with breath-holding spells (148.2±33.1) compared to the healthy children (132±27.3) and the difference was statically significant (P = 0.01). Meanwhile, no statistically significant differences were observed between the patients and the control subjects regarding the other parameters (P > 0.05). QTc dispersion was significantly increased in the patients with breath-holding spells compared to normal children and this is a sign of cardiac repolarization abnormality as well as the increased risk of cardiac arrhythmia in patients with breath-holding spells.

  15. Kidney motion during free breathing and breath hold for MR-guided radiotherapy.

    Science.gov (United States)

    Stam, Mette K; van Vulpen, Marco; Barendrecht, Maurits M; Zonnenberg, Bernard A; Intven, Martijn; Crijns, Sjoerd P M; Lagendijk, Jan J W; Raaymakers, Bas W

    2013-04-07

    Current treatments for renal cell carcinoma have a high complication rate due to the invasiveness of the treatment. With the MRI-linac it may be possible to treat renal tumours non-invasively with high-precision radiotherapy. This is expected to reduce complications. To deliver a static dose distribution, radiation gating will be used. In this study the reproducibility and efficiency of free breathing gating and a breath hold treatment of the kidney was investigated. For 15 patients with a renal lesion the kidney motion during 2 min of free breathing and 10 consecutive expiration breath holds was studied with 2D cine MRI. The variability in kidney expiration position and treatment efficiency for gating windows of 1 to 20 mm was measured for both breathing patterns. Additionally the time trend in free breathing and the variation in expiration breath hold kidney position with baseline shift correction was determined. In 80% of the patients the variation in expiration position during free breathing is smaller than 2 mm. No clinically relevant time trends were detected. The variation in expiration breath hold is for all patients larger than the free breathing expiration variation. Gating on free breathing is, for gating windows of 1 to 5 mm more efficient than breath hold without baseline correction. When applying a baseline correction to the breath hold it increases the treatment efficiency. The kidney position is more reproducible in expiration free breathing than non-guided expiration breath hold. For small gating windows it is also more time efficient. Since free breathing also seems more comfortable for the patients it is the preferred breathing pattern for MRI-Linac treatments of the kidney.

  16. Risk of Neurological Insult in Competitive Deep Breath-Hold Diving.

    Science.gov (United States)

    Tetzlaff, Kay; Schöppenthau, Holger; Schipke, Jochen D

    2017-02-01

    It has been widely believed that tissue nitrogen uptake from the lungs during breath-hold diving would be insufficient to cause decompression stress in humans. With competitive free diving, however, diving depths have been ever increasing over the past decades. A case is presented of a competitive free-diving athlete who suffered stroke-like symptoms after surfacing from his last dive of a series of 3 deep breath-hold dives. A literature and Web search was performed to screen for similar cases of subjects with serious neurological symptoms after deep breath-hold dives. A previously healthy 31-y-old athlete experienced right-sided motor weakness and difficulty speaking immediately after surfacing from a breathhold dive to a depth of 100 m. He had performed 2 preceding breath-hold dives to that depth with surface intervals of only 15 min. The presentation of symptoms and neuroimaging findings supported a clinical diagnosis of stroke. Three more cases of neurological insults were retrieved by literature and Web search; in all cases the athletes presented with stroke-like symptoms after single breath-hold dives of depths exceeding 100 m. Two of these cases only had a short delay to recompression treatment and completely recovered from the insult. This report highlights the possibility of neurological insult, eg, stroke, due to cerebral arterial gas embolism as a consequence of decompression stress after deep breath-hold dives. Thus, stroke as a clinical presentation of cerebral arterial gas embolism should be considered another risk of extreme breath-hold diving.

  17. Hemoptysis due to breath-hold diving following chemotherapy and lung irradiation.

    Science.gov (United States)

    Gutsche, Markus; Kuschner, Ware G

    2012-08-01

    Breath-hold diving, also known as free-diving, describes the practice of intentional immersion under water without an external supply of oxygen. Pulmonary hemorrhage with hemoptysis has been reported as a complication of immersion and breath-hold diving in young healthy athletes. We report the case of a 60-year-old man with a history of radiation and chemotherapy for breast carcinoma, who developed the abrupt onset of hemoptysis in the setting of swimming and breath-hold diving. A computed tomography (CT) scan of the chest demonstrated an area of ground glass opacification, suggestive of pulmonary hemorrhage, superimposed on a background of reticular opacities within the prior radiation field. A follow-up CT scan of the chest, obtained 2 months after presentation, demonstrated resolution of the ground glass opacification, but persistence of fibrotic features attributable to prior radiation therapy. We postulate that prior irradiation of the chest resulted in lung injury and fibrosis which, in turn, rendered the affected region of the lung susceptible to "stress failure," due to an increase in the transcapillary pressure gradient arising from immersion and breath-hold diving. Patients with a history of lung injury resulting from chest irradiation should be cautioned about pulmonary hemorrhage and hemoptysis as a potential complication of swimming and breath-hold diving.

  18. Nonrigid registration method to assess reproducibility of breath-holding with ABC in lung cancer.

    Science.gov (United States)

    Sarrut, David; Boldea, Vlad; Ayadi, Myriam; Badel, Jean-Noël; Ginestet, Chantal; Clippe, Sébastien; Carrie, Christian

    2005-02-01

    To study the interfraction reproducibility of breath-holding using active breath control (ABC), and to develop computerized tools to evaluate three-dimensional (3D) intrathoracic motion in each patient. Since June 2002, 11 patients with non-small-cell lung cancer enrolled in a Phase II trial have undergone four CT scans: one during free-breathing (reference) and three using ABC. Patients left the room between breath-hold scans. The patient's breath was held at the same predefined phase of the breathing cycle (about 70% of the vital capacity) using the ABC device, then patients received 3D-conformal radiotherapy. Automated computerized tools for breath-hold CT scans were developed to analyze lung and tumor interfraction residual motions with 3D nonrigid registration. All patients but one were safely treated with ABC for 7 weeks. For 6 patients, the lung volume differences were 300 cm(3) and displacements >10 mm, probably owing to atelectasia and emphysema. One patient was excluded, and two others had incomplete data sets. Breath-holding with ABC was effective in 6 patients, and discrepancies were clinically accountable in 2. The proposed 3D nonrigid registration method allows for personalized evaluation of breath-holding reproducibility with ABC. It will be used to adapt the patient-specific internal margins.

  19. Comparison of breath-hold T1-weighted MR sequences for imaging of the liver.

    Science.gov (United States)

    Semelka, R C; Willms, A B; Brown, M A; Brown, E D; Finn, J P

    1994-01-01

    Three rapid T1-weighted gradient-echo techniques for imaging of the liver were compared: fast low-angle shot (FLASH) and section-selective (SSTF) and non-section-selective (NSTF) inversion-recovery TurboFLASH. Ten healthy volunteers were imaged at 1.5 T, with breath-hold images acquired in the transaxial and coronal planes and non-breath-hold images in the transaxial plane. Breath-hold images were evaluated quantitatively and qualitatively, and non-breath-hold images were evaluated qualitatively. FLASH images had significantly higher (P FLASH images than on NSTF and SSTF images. With breath hold, FLASH images were rated as having the highest quality in the axial plane, followed by NSTF and SSTF images. In the coronal plane, NSTF images were rated as having the highest quality. For images acquired during patient respiration, NSTF images had the highest quality and showed the least degradation. The results suggest that FLASH images have the highest SD/N and S/N for liver imaging and have the highest quality in the axial plane. In patients who cannot suspend respiration. NSTF images may be least affected by breathing artifact and provide reasonable image quality.

  20. Breath holding endurance: stability over time and relationship with self-assessed persistence

    Directory of Open Access Journals (Sweden)

    Daisy G.Y. Thompson-Lake

    2017-09-01

    Full Text Available Breath holding (BH endurance has been suggested as a measure of the distress tolerance that could predict the outcome of attempts to implement behavior changes, such as stopping smoking or illicit substance use. It is not known however, to what degree BH endurance is a variable trait that may vary depending on situational context, or a stable state characteristic. We measured BH in two groups of participants at baseline and 22 and 89 days (N = 62 and N = 41 post-baseline and in a third group at multiple times points across a 5-week period (N = 44. Participants also filled out a questionnaire created to assess their perceived persistence compared to peers. Correlations were found between baseline and final BH measures (r’s > 0.67, p’s < 0.0001 at all time points. When groups were combined, regardless of time point, Spearman’s rank correlation showed a strong positive correlation (rs = 0.66, p < 0.0001. Self-assessed persistence was not related to BH endurance. This study provides evidence of the stability of BH across time when tested under the same conditions in young adults. Further research is needed to clarify whether BH is linked to behavioral outcomes.

  1. The Utilization of an Insertable Cardiac Monitor in a Child With Pallid Breath-Holding Spells.

    Science.gov (United States)

    Tejman-Yarden, Shai; Ben-Zeev, Bruria; Goldshmit, Yuval; Sarquella-Brugada, Georgia; Cicurel, Assi; Katz, Uriel; Mishali, David; Glikson, Michael

    2016-11-01

    Pacing can be a successful treatment for pallid breath-holding spells, primarily in individuals with severe bradycardia. We describe an 18-month-old girl experiencing severe pallid breath-holding spells in whom repeated electrocardiographic, Holter, and electroencephalographic monitoring tests were all normal. Using a subcutaneous insertable cardiac monitor, severe bradycardia was detected during one of this girl's episodes. This finding led to a pacemaker implantation. Subsequently, her breath-holding spells completely resolved. This child illustrates the ability of the insertable cardiac monitor to help and diagnose arrhythmias in children with unresolved clinical findings. The ability to implant it with a minimal scar makes it ideal for uncooperative individuals with relative few and unexpected episodes that are hard to diagnose. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Facial immersion in cold water enhances cerebral blood velocity during breath-hold exercise in humans

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Pott, Frank C; Secher, Niels H

    2009-01-01

    perfusion evaluated as the middle cerebral artery mean flow velocity (MCA V(mean)) during exercise in nine male subjects. At rest, a breath hold of maximum duration increased the arterial carbon dioxide tension (Pa(CO(2))) from 4.2 to 6.7 kPa and MCA V(mean) from 37 to 103 cm/s (mean; approximately 178%; P...... 180-W exercise (from 47 to 53 cm/s), and this increment became larger with facial immersion (76 cm/s, approximately 62%; P change. These results indicate that a breath hold diverts blood toward the brain with a >100% increase in MCA V(mean), largely...

  3. Evaluation of pulmonary function using single-breath-hold dual-energy computed tomography with xenon: Results of a preliminary study.

    Science.gov (United States)

    Kyoyama, Hiroyuki; Hirata, Yusuke; Kikuchi, Satoshi; Sakai, Kosuke; Saito, Yuriko; Mikami, Shintaro; Moriyama, Gaku; Yanagita, Hisami; Watanabe, Wataru; Otani, Katharina; Honda, Norinari; Uematsu, Kazutsugu

    2017-01-01

    Xenon-enhanced dual-energy computed tomography (xenon-enhanced CT) can provide lung ventilation maps that may be useful for assessing structural and functional abnormalities of the lung. Xenon-enhanced CT has been performed using a multiple-breath-hold technique during xenon washout. We recently developed xenon-enhanced CT using a single-breath-hold technique to assess ventilation. We sought to evaluate whether xenon-enhanced CT using a single-breath-hold technique correlates with pulmonary function testing (PFT) results.Twenty-six patients, including 11 chronic obstructive pulmonary disease (COPD) patients, underwent xenon-enhanced CT and PFT. Three of the COPD patients underwent xenon-enhanced CT before and after bronchodilator treatment. Images from xenon-CT were obtained by dual-source CT during a breath-hold after a single vital-capacity inspiration of a xenon-oxygen gas mixture. Image postprocessing by 3-material decomposition generated conventional CT and xenon-enhanced images.Low-attenuation areas on xenon images matched low-attenuation areas on conventional CT in 21 cases but matched normal-attenuation areas in 5 cases. Volumes of Hounsfield unit (HU) histograms of xenon images correlated moderately and highly with vital capacity (VC) and total lung capacity (TLC), respectively (r = 0.68 and 0.85). Means and modes of histograms weakly correlated with VC (r = 0.39 and 0.38), moderately with forced expiratory volume in 1 second (FEV1) (r = 0.59 and 0.56), weakly with the ratio of FEV1 to FVC (r = 0.46 and 0.42), and moderately with the ratio of FEV1 to its predicted value (r = 0.64 and 0.60). Mode and volume of histograms increased in 2 COPD patients after the improvement of FEV1 with bronchodilators. Inhalation of xenon gas caused no adverse effects.Xenon-enhanced CT using a single-breath-hold technique depicted functional abnormalities not detectable on thin-slice CT. Mode, mean, and volume of HU histograms of xenon images reflected

  4. SU-E-T-177: Clinical Experience with Spirometer Guided Breath Hold Lung SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H; Manning, M; Sintay, B; Maurer, J; Hayes, L; Wiant, D [Cone Health Cancer Center, Greensboro, NC (United States)

    2015-06-15

    Purpose: Tumor motion in lung SBRT is typically managed by creating an internal target volume (ITV) based on 4D-CT information. Another option, which may reduce lung dose and imaging artifact, is to use a breath hold (BH) during simulation and delivery. Here we evaluate the reproducibility of tumor position at repeated BH using a newly released spirometry system. Methods: Three patients underwent multiple BH CT’s at simulation. All patients underwent a BH cone beam CT (CBCT) prior to each treatment. All image sets were registered to a patient’s first simulation CT based on local bony anatomy. The gross tumor volume (GTV), and the diaphragm or the apex of the lung were contoured on the first image set and expanded in 1 mm increments until the GTVs and diaphragms on all image sets were included inside an expanded structure. The GTV and diaphragm margins necessary to encompass the structures were recorded. Results: The first patient underwent 2 BH CT’s and fluoroscopy at simulation, the remaining patients underwent 3 BH CT’s at simulation. In all cases the GTV’s remained within 1 mm expansions and the diaphragms remained within 2 mm expansions on repeat scans. Each patient underwent 3 daily BH CBCT’s. In all cases the GTV’s remained within a 2 mm expansions, and the diaphragms (or lung apex in one case) remained within 2 mm expansions at daily BH imaging. Conclusions: These case studies demonstrate spirometry as an effective tool for limiting tumor motion (and imaging artifact) and facilitating reproducible tumor positioning over multiple set-ups and BH’s. This work was partially supported by Qfix.

  5. Effect of breath holding on cerebrovascular hemodynamics in normal pregnancy and preeclampsia

    NARCIS (Netherlands)

    van Veen, Teelkien R.; Panerai, Ronney B.; Haeri, Sina; Zeeman, Gerda G.; Belfort, Michael A.

    2015-01-01

    Preeclampsia (PE) is associated with endothelial dysfunction and impaired autonomic function, which is hypothesized to cause cerebral hemodynamic abnormalities. Our aim was to test this hypothesis by estimating the difference in the cerebrovascular response to breath holding (BH; known to cause

  6. Effects of eye rubbing and breath holding on corneal biomechanical properties and intraocular pressure.

    Science.gov (United States)

    Liu, Wan-Cherng; Lee, Shui-Mei; Graham, Andrew D; Lin, Meng C

    2011-08-01

    To determine whether corneal biomechanical properties and intraocular pressure (IOP) are affected by eye rubbing and breath holding. Corneal hysteresis, corneal resistance factor, corneal compensated IOP (IOPcc), and Goldmann equivalent IOP (IOPg) were measured on both eyes of 40 subjects. Measurements were taken at baseline before eye rubbing (ER(0)) and before breath holding (BH(0)), immediately after 2 episodes of eye rubbing (ER(1) and ER(2)), and during 2 episodes of breath holding (BH(1) and BH(2)). Corneal hysteresis, corneal resistance factor, and IOPg were significantly lower after ER(1) compared with ER(0) and were significantly lower after ER(2) compared with ER(1). In contrast, IOPcc did not decrease significantly. There were no significant differences among BH(0), BH(1), and BH(2) in any of the 4 outcomes. Eye rubbing should be avoided before measurements of corneal biomechanical properties and IOPg. In contrast, breath holding during measurements is not likely to cause a significant change in IOPg and IOPcc or corneal biomechanical properties.

  7. Assessment of heart rate variability in breath holding children by 24 hour Holter monitoring.

    Science.gov (United States)

    Yilmaz, Osman; Ciftel, Murat; Ozturk, Kezban; Kilic, Omer; Kahveci, Hasan; Laloğlu, Fuat; Ceylan, Ozben

    2015-02-01

    Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells - 56 cyanotic type and 12 pallid type - and 39 healthy controls. Clinical and heart rate variability results were compared between each spell type - cyanotic or pallid - and the control group; significant differences (p50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes.

  8. Release of erythropoietin and neuron-specific enolase after breath holding in competing free divers

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Jattu, T; Nielsen, Henrik

    2015-01-01

    Free diving is associated with extreme hypoxia. This study evaluated the combined effect of maximal static breath holding and underwater swimming on plasma biomarkers of tissue hypoxemia: erythropoietin, neuron-specific enolase and S100B, C-reactive protein, pro-atrial natriuretic peptide...

  9. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique

    DEFF Research Database (Denmark)

    Korreman, Stine Sofia; Pedersen, Anders N; Nøttrup, Trine Jakobi

    2005-01-01

    , and to compare this respiratory technique with voluntary breath-hold. PATIENTS AND METHODS: 17 patients were CT-scanned during non-coached breathing manoeuvre including free breathing (FB), end-inspiration gating (IG), end-expiration gating (EG), deep inspiration breath-hold (DIBH) and end-expiration breath...

  10. Extracorporeal cardiopulmonary resuscitation for breath-holding spells followed by cardiac arrest due to left main coronary artery stenosis.

    Science.gov (United States)

    Ozyilmaz, Isa; Altin, Husnu Fırat; Yildiz, Okan; Erek, Ersin; Ergul, Yakup; Guzeltas, Alper

    2015-06-01

    Non-syndromic congenital supravalvular aortic stenosis (SVAS) leads to ventricular hypertrophy and increased oxygen consumption, and when combined with other factors reduces coronary blood flow, potentially resulting in myocardial ischemia and sudden cardiac death. While the anatomic obstruction of coronary circulation is as common in non-syndromic SVAS as in Williams syndrome, it often remains unacknowledged. Extracorporeal membrane oxygenation (ECMO) is an elective procedure that can be used to support patients with cardiac arrest during diagnosis as a way to reduce cardiopulmonary load in preparation for surgery or further treatment. In this report, we describe the rare case of an infant with severe SVAS and mild valvular pulmonary and left main coronary artery stenosis, as well as breath-holding spells. After multiple cardiac arrests, the infant underwent diagnostic catheter angiography on ECMO and had the pathology surgically corrected. © 2015 Japan Pediatric Society.

  11. Review of deep inspiration breath-hold techniques for the treatment of breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Latty, Drew, E-mail: drew.latty@health.nsw.gov.au [Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales (Australia); Stuart, Kirsty E [Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales (Australia); Westmead Breast Cancer Institute, Sydney, New South Wales (Australia); Wang, Wei [Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales (Australia); Westmead Breast Cancer Institute, Sydney, New South Wales (Australia); Nepean Cancer Care Centre, Sydney, New South Wales (Australia); Ahern, Verity [Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales (Australia)

    2015-03-15

    Radiation treatment to the left breast is associated with increased cardiac morbidity and mortality. The deep inspiration breath-hold technique (DIBH) can decrease radiation dose delivered to the heart and this may facilitate the treatment of the internal mammary chain nodes. The aim of this review is to critically analyse the literature available in relation to breath-hold methods, implementation, utilisation, patient compliance, planning methods and treatment verification of the DIBH technique. Despite variation in the literature regarding the DIBH delivery method, patient coaching, visual feedback mechanisms and treatment verification, all methods of DIBH delivery reduce radiation dose to the heart. Further research is required to determine optimum protocols for patient training and treatment verification to ensure the technique is delivered successfully.

  12. Facial immersion in cold water enhances cerebral blood velocity during breath-hold exercise in humans

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Pott, Frank C; Secher, Niels H

    2009-01-01

    180-W exercise (from 47 to 53 cm/s), and this increment became larger with facial immersion (76 cm/s, approximately 62%; P brain with a >100% increase in MCA V(mean), largely...... perfusion evaluated as the middle cerebral artery mean flow velocity (MCA V(mean)) during exercise in nine male subjects. At rest, a breath hold of maximum duration increased the arterial carbon dioxide tension (Pa(CO(2))) from 4.2 to 6.7 kPa and MCA V(mean) from 37 to 103 cm/s (mean; approximately 178%; P...... exercise, a breath hold increased Pa(CO(2)) from 5.9 to 8.2 kPa (P

  13. Assessment of voluntary deep inspiration breath-hold with CINE imaging for breast radiotherapy.

    Science.gov (United States)

    Estoesta, Reuben Patrick; Attwood, Lani; Naehrig, Diana; Claridge-Mackonis, Elizabeth; Odgers, David; Martin, Darren; Pham, Melissa; Toohey, Joanne; Carroll, Susan

    2017-10-01

    Deep Inspiration Breath-Hold (DIBH) techniques for breast cancer radiation therapy (RT) have reduced cardiac dose compared to Free Breathing (FB). Recently, a voluntary deep inspiration breath-hold (vDIBH) technique was established using in-room lasers and skin tattoos to monitor breath-hold. An in-house quality assessment of positional reproducibility during RT delivery with vDIBH in patients with left-sided breast cancer was evaluated. The electronic portal imaging device (EPID) was used in cinematographic (CINE) mode to capture a sequence of images during beam delivery. Weekly CINE images were retrospectively assessed for 20 left-sided breast cancer patients receiving RT in vDIBH, and compared with CINE images of 20 patients treated in FB. The intra-beam motion was assessed and the distance from the beam central axis (CA) to the internal chest wall (ICW) was measured on each CINE image. These were then compared to the planned distance on digitally reconstructed radiograph (DRR). The maximum intra-beam motion for any one patient measurement was 0.30 cm for vDIBH and 0.20 cm for FB. The mean difference between the distance from the CA to ICW on DRR and the equivalent distance on CINE imaging (as treated) was 0.28 cm (SD 0.17) for vDIBH patients and 0.25 cm (SD 0.14) for FB patients (P = 0.458). The measured values were comparable for patients undergoing RT in vDIBH, and for those in FB. This quality assessment showed that using in-room lasers and skin tattoos to independently monitor breath-hold in vDIBH as detected by 'on-treatment' CINE imaging is safe and effective. © 2017 The Royal Australian and New Zealand College of Radiologists.

  14. Functional Mechanism of Lung Mosaic CT Attenuation: Assessment with Deep-Inspiration Breath-Hold Perfusion SPECT-CT Fusion Imaging and Non-Breath-Hold Technegas SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Suga, K.; Yasuhiko, K. (Dept. of Radiology, St. Hill Hospital, Ube, Yamaguchi (Japan)); Iwanaga, H.; Tokuda, O.; Matsunaga, N. (Dept. of Radiology, Yamaguchi Univ. School of Medicine, Ube, Yamaguchi (Japan))

    2009-01-15

    Background: The functional mechanism of lung mosaic computed tomography attenuation (MCA) in pulmonary vascular disease (PVD) and obstructive airway disease (OAD) has not yet been fully clarified. Purpose: To clarify the mechanism of MCA in these diseases by assessing the relationship between regional lung function and CT attenuation change at MCA sites with the use of automated deep-inspiratory breath-hold (DIBrH) perfusion single-photon emission computed tomography (SPECT)-CT fusion images and non-breath-hold Technegas SPECT. Material and Methods: Subjects were 42 PVD patients (31 pulmonary thromboembolism, four primary/two secondary pulmonary hypertension, and five Takayasu arteritis), 12 OAD patients (five acute asthma, four obliterative bronchiolitis, and three bronchiectasis), and 12 normal controls, all of whom had MCA on DIBrH CT. The relationship between regional lung function and CT attenuation change at the lung slices with MCA was assessed using DIBrH perfusion SPECT-CT fusion images and non-breath-hold Technegas SPECT. The severity of perfusion defects with or without MCA was quantified by regions-of-interest analysis. Results: On DIBrH CT and perfusion SPECT, in contrast to no noticeable CT attenuation abnormality and fairly uniform perfusion in controls, 60 MCA and 274 perfusion defects in PVD patients, and 18 MCA and 61 defects in OAD patients were identified, with a total of 77 ventilation defects on Technegas SPECT in all patients. SPECT-CT correlation showed that, throughout the 78 MCA sites of all patients, lung perfusion was persistently decreased at low CT attenuation and preserved at intervening high CT attenuation, while lung ventilation was poorly correlated with CT attenuation change. The radioactivity ratios of reduced perfusion and the intervening preserved perfusion at the 78 perfusion defects with MCA were significantly lower than those at the remaining 257 defects without MCA (P<0.0001). Conclusion: Although further validation is

  15. Panic disorder in a breath-holding challenge test: a simple tool for a better diagnosis

    Directory of Open Access Journals (Sweden)

    Nardi Antonio E.

    2003-01-01

    Full Text Available OBJECTIVE: Our aim was to observe if anxiety disorder patients - DSM-IV - respond in a similar way to the induction of panic attacks by a breath-holding challenge test. METHOD: We randomly selected 29 panic disorder (PD patients, 27 social anxiety disorder (SAD patients, 21 generalized anxiety disorder (GAD patients. They were induced to breath-hold for as long as possible four times with two-minute interval between them. Anxiety scales were applied before and after the test. RESULTS: A total of 44.8% (n=13 PD patients, 14.8% (n=4 SAD patients, 9.5% (n=2 GAD patients had a panic attack after the test (c²= 21.44, df= 2, p=0.001. There was no heart rate or anxiety levels difference among the groups before and after the test. CONCLUSION: In this breath-holding challenge test the panic disorder patients were more sensitive than other anxiety disorder patients.

  16. SU-E-T-361: Clinical Benefit of Automatic Beam Gating Mixed with Breath Hold in Radiation Therapy of Left Breast

    Energy Technology Data Exchange (ETDEWEB)

    Wu, J; Hill, G; Spiegel, J [Swedish Cancer Institute, Issaquah, Washington (United States); Ye, J [Swedish Cancer Institute, Edmond, Washington (United States); Mehta, V [Swedish Cancer Institute, Seattle, WA (United States)

    2014-06-01

    Purpose: To investigate the clinical and dosimetric benefits of automatic gating of left breast mixed with breath-hold technique. Methods: Two Active Breathing Control systems, ABC2.0 and ABC3.0, were used during simulation and treatment delivery. The two systems are different such that ABC2.0 is a breath-hold system without beam control capability, while ABC3.0 has capability in both breath-hold and beam gating. At simulation, each patient was scanned twice: one with free breathing (FB) and one with breath hold through ABC. Treatment plan was generated on the CT with ABC. The same plan was also recalculated on the CT with FB. These two plans were compared to assess plan quality. For treatments with ABC2.0, beams with MU > 55 were manually split into multiple subfields. All subfields were identical and shared the total MU. For treatment with ABC3.0, beam splitting was unnecessary. Instead, treatment was delivered in gating mode mixed with breath-hold technique. Treatment delivery efficiency using the two systems was compared. Results: The prescribed dose was 50.4Gy at 1.8Gy/fraction. The maximum heart dose averaged over 10 patients was 46.0±2.5Gy and 24.5±12.2Gy for treatments with FB and with ABC respectively. The corresponding heart V10 was 13.2±3.6% and 1.0±1.6% respectively. The averaged MUs were 99.8±7.5 for LMT, 99.2±9.4 for LLT. For treatment with ABC2.0, normally the original beam was split into 2 subfields. The averaged total time to delivery all beams was 4.3±0.4min for treatments with ABC2.0 and 3.3±0.6min for treatments with ABC3.0 in gating mode. Conclusion: Treatment with ABC tremendously reduced heart dose. Compared to treatments with ABC2.0, gating with ABC3.0 reduced the total treatment time by 23%. Use of ABC3.0 improved the delivery efficiency, and eliminated the possibility of mistreatments. The latter may happen with ABC2.0 where beam is not terminated when breath signal falls outside of the treatment window.

  17. Breath-hold MR cholangiopancreatography with three-dimensional, segmented, echo-planar imaging and volume rendering

    NARCIS (Netherlands)

    P.A. Wielopolski (Piotr); J. Gaa; D.R. Wielopolski; M. Oudkerk (Matthijs)

    1999-01-01

    textabstractEnd-expiration, 21-second breath-hold, three-dimensional magnetic resonance (MR) cholangiopancreatography (MRCP) was developed with segmented echo-planar imaging. In 15 healthy subjects and 14 randomly selected patients undergoing liver studies,

  18. Breath-holding spells may be associated with maturational delay in myelination of brain stem.

    Science.gov (United States)

    Vurucu, Sebahattin; Karaoglu, Abdulbaki; Paksu, Sukru M; Oz, Oguzhan; Yaman, Halil; Gulgun, Mustafa; Babacan, Oguzhan; Unay, Bulent; Akin, Ridvan

    2014-02-01

    To evaluate possible contribution of maturational delay of brain stem in the etiology of breath-holding spells in children using brain stem auditory evoked potentials. The study group included children who experienced breath-holding spells. The control group consisted of healthy age- and sex-matched children. Age, gender, type and frequency of spell, hemoglobin, and ferritin levels in study group and brain stem auditory evoked potentials results in both groups were recorded. Study group was statistically compared with control group for brain stem auditory evoked potentials. The mean age of study and control groups was 26.3 ± 14.6 and 28.9 ± 13.9 months, respectively. The III-V and I-V interpeak latencies were significantly prolonged in the study group compared with the control group (2.07 ± 0.2 milliseconds; 1.92 ± 0.13 milliseconds and 4.00 ± 0.27 milliseconds; 3.83 ± 0.19 milliseconds; P = 0.009 and P = 0.03, respectively). At the same time, III-V and I-V interpeak latencies of patients without anemia in the study group compared with those of control group were significantly prolonged (2.09 ± 0.24 milliseconds; 1.92 ± 0.13 milliseconds and 4.04 ± 0.28 milliseconds; 3.83 ± 0.19 milliseconds; P = 0.007 and P = 0.01, respectively). Our results consider that maturational delay in myelination of brain stem may have a role in the etiology of breath-holding spells in children.

  19. Chronic adaptations of lung function in breath-hold diving fishermen

    Directory of Open Access Journals (Sweden)

    Cristiane Diniz

    2014-04-01

    Full Text Available Objectives: The aim of this study was to verify and analyze the existence of chronic adaptations of lung function in freediving fishermen whose occupation is artisanal fishing. Material and Methods: This was a cross-sectional study involving 11 breath-hold diving fishermen and 10 non-breath-hold diving fishermen (control from the village of Bitupitá in the municipality of Barroquinha (Ceará - Brazil. Anthropometric measurements, chest and abdominal circumferences as well as spirometric and respiratory muscle strength tests were conducted according to the specifications of the American Thoracic Society/European Respiratory Society (ATS/ERS. In order to compare the measured values versus the predicted values, Student t test was used in the case of parametric test and Wilcoxon test in the case of nonparametric test. To compare the inter-group means Student t test was used for parametric test and Mann-Whitney test for the nonparametric one. The level of significance was set at α = 5%. Results: The forced vital capacity (FVC (4.9±0.6 l vs. 4.3±0.4 l and forced expiratory volume in 1 s (FEV1 (4.0±0.5 l vs. 3.6±0.3 l were, respectively, higher in the group of divers compared to the control group (p ≤ 0.05. Furthermore, in the group of free divers, the measured FVC, FEV1 and FEV1/FVC ratios were significantly greater than the predicted ones. No differences were found between the measured respiratory pressures. Conclusions: These results indicate that breath-hold diving seems to produce chronic adaptations of the respiratory system, resulting in elevated lung volumes with no airway obstruction.

  20. Whole-brain vascular reactivity measured by fMRI using hyperventilation and breath-holding tasks: efficacy of 3D prospective acquisition correction (3D-PACE) for head motion

    Energy Technology Data Exchange (ETDEWEB)

    Naganawa, Shinji; Koshikawa, Tokiko; Fukatsu, Hiroshi; Ishigaki, Takeo [Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Shouwa-ku, 466-8550, Nagoya (Japan); Maruyama, Katsuya; Takizawa, Osamu [Siemens-Asahi Medical Technologies Ltd, Tokyo (Japan)

    2004-08-01

    Functional MR imaging (fMRI) study using hyperventilation and breath-holding task has been reported to be one of the non-invasive methods to examine whole-brain vascular reactivity. The purpose of this study was to evaluate the efficacy of a method for 3D prospective detection and correction of head motion (3D-PACE) in a study of whole-brain vascular reactivity using hyperventilation and breath-holding tasks. Eight healthy volunteers were scanned using an fMRI protocol of hyperventilation and breath-holding task blocks at 3 T in separate runs with and without 3D-PACE. In two subjects, two more runs with and without 3D-PACE were repeated. The mean total number of activated voxels {+-} standard deviation was 26,405.3{+-}1,822.2 in the run with 3D-PACE and 17,329.9{+-}2,766.3 in the run without 3D-PACE (P<0.05), although there is some intersubject variation regarding the effect of 3D-PACE. In the two subjects whose performed two more runs, the number of activated voxels were smaller in the run without 3D-PACE than even in the run with 3D-PACE performed later. We conclude that 3D-PACE is beneficial for fMRI studies of whole-brain vascular reactivity induced by hyperventilation and breath-holding. (orig.)

  1. Detection of venous gas emboli after repetitive breath-hold dives: case report

    OpenAIRE

    Cialoni, D; Pieri, M; Giunchi, G.; Sponsiello, N; Lanzone, MA; Torcello, L; Boaretto, G; Marroni, A.

    2016-01-01

    Introduction: Neurological symptoms after breath-hold (BH) diving are often referred to as “Taravana” and considered a form of decompression sickness. However, the presence of “high” gas embolism after BH diving has never been clearly shown. This study showed high bubble formation after BH diving. Materials and methods: We performed transthoracic echocardiography on a 53-year-old male spearfishing diver (180 cm; 80 kg; BMI 24.7) 15 minutes before diving and at 15-minute intervals for 90 m...

  2. Breath-hold [68Ga]DOTA-TOC PET/CT in neuroendocrine tumors: detection of additional lesions and effects on quantitative parameters.

    Science.gov (United States)

    Zirnsak, Mariana; Bärwolf, Robert; Freesmeyer, Martin

    2016-11-08

    Respiratory motion during PET/CT acquisition generates artifacts in the form of breath-related blurring, which influences the lesion detectability and diagnostic accuracy. The goal of this study was to verify whether breath-hold [68Ga]DOTA-TOC PET/CT (bhPET) allows detection of additional foci compared to free-breathing PET/CT (fbPET), and to assess the impact of breath-holding on standard uptake values (SUV) and isocontoured volume (Vic40) in patients with neuroendocrine tumors (NET). Patients with NET (n=39) were included in this study. BhPET and fbPET characteristics of 96 lesions were compared, and correlated with standard contrast-enhanced (ce) CT and MRI for lesion verification. Quantitative parameters SUV (max and mean) and Vic40 were assessed for both methods and evaluated by linear regression and Spearman's correlation. The impact of lesion size, localization and time interval between investigations was also analyzed. bhPET identified one additional metastasis not seen at fbPET but visible at ceMRI. Another additional bhPET focus did not have a morphological correlate. At bhPET, the SUVmax and SUVmean proved significantly higher and the Vic40 significantly lower than at fbPET. Lesion size, localization and time intervals did not impact significantly on SUV or Vic40. Currently, routine use of breath-hold [68Ga]DOTA-TOC PET/CT cannot be recommended as only one additional lesion was identified. Therefore, bhPET has currently no indication in patients with NET. If technical improvements regarding PET/CT scanner sensitivity are available, bhPET should be reevaluated in the future.

  3. Breath-hold and free-breathing F-18-FDG-PET/CT in malignant melanoma-detection of additional tumoral foci and effects on quantitative parameters.

    Science.gov (United States)

    Bärwolf, Robert; Zirnsak, Mariana; Freesmeyer, Martin

    2017-01-01

    During PET/CT acquisition, respiratory motion generates artifacts in the form of breath-related blurring, which may impair lesion detectability and diagnostic accuracy. This observational study was undertaken to verify whether breath-hold F-18-FDG-PET/CT (bhPET) detects additional foci compared to free-breathing PET/CT (fbPET) in cases of malignant melanoma, and to assess the impact of breath-holding on standard uptake values (SUV) and metabolic isocontoured volume (mVic40).Thirty-four patients with melanoma were examined. BhPET and fbPET findings of 117 lesions were compared and correlated with standard contrast-enhanced (ce) CT and MRI for lesion verification. Quantitative parameters (SUVmax, SUVmean, and mVic40) were assessed for both methods and evaluated by linear regression and Spearman correlation. The impact of lesion size and time interval between investigations was analyzed.In 1 patient, a CT-confirmed liver metastasis was seen only on bhPET but not on fbPET. At bhPET, SUVmax, and SUVmean proved significantly higher and mVic40 significantly lower than at fbPET. The positive effect on SUVmax and SUVmean was more pronounced in smaller lesions, whereas the time interval between bhPET and fbPET did not influence SUV or mVic40.In our patient cohort, bhPET yielded significantly higher SUV and provided improved volumetric lesion definition, particularly of smaller lesions. Also one additional liver lesion was identified. Breath-hold PET/CT is technically feasible, and may become clinically useful when fine quantitative evaluations are needed.

  4. Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells.

    Science.gov (United States)

    Calik, Mustafa; Ciftci, Ahmet; Sarikaya, Suna; Kocaturk, Ozcan; Abuhandan, Mahmut; Taskin, Abdullah; Kandemir, Hasan; Yoldas, Tahır Kurtulus; Aksoy, Nurten

    2015-06-01

    Breath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic-clonic movements, and occasionally seizures. Hence, this study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells. The study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured using commercially available ELISA kits. The neuropeptide-Y levels in the serum were measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits. The mean serum S-100B protein level of the breath-holding spells group was 56.38 ± 13.26 pg/mL, and of the control group, 48.53 ± 16.77 pg/mL. The mean neuropeptide-Y level was 62.29 ± 13.89 pg/mL in the breath-holding spells group and 58.24 ± 12.30 pg/mL in the control group. There were significant differences between the groups with respect to serum S-100B protein levels (p = 0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and the control group (p = 0.192). The findings of this study suggest that frequent and lengthy breath-holding may lead to the development of neuronal metabolic dysfunction or neuronal damage which is most likely related to hypoxia. In light of these findings, future studies should be conducted using biochemical and radiological imaging techniques to support these results. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. 3D late gadolinium enhancement in a single prolonged breath-hold using supplemental oxygenation and hyperventilation.

    Science.gov (United States)

    Roujol, Sébastien; Basha, Tamer A; Akçakaya, Mehmet; Foppa, Murilo; Chan, Raymond H; Kissinger, Kraig V; Goddu, Beth; Berg, Sophie; Manning, Warren J; Nezafat, Reza

    2014-09-01

    To evaluate the feasibility of three-dimensional (3D) single breath-hold late gadolinium enhancement (LGE) of the left ventricle (LV) using supplemental oxygen and hyperventilation and compressed-sensing acceleration. Breath-hold metrics [breath-hold duration, diaphragmatic/LV position drift, and maximum variation of R wave to R wave (RR) interval] without and with supplemental oxygen and hyperventilation were assessed in healthy adult subjects using a real-time single shot acquisition. Ten healthy subjects and 13 patients then underwent assessment of the proposed 3D breath-hold LGE acquisition (field of view = 320 × 320 × 100 mm(3) , resolution = 1.6 × 1.6 × 5.0 mm(3) , acceleration rate of 4) and a free-breathing acquisition with right hemidiaphragm navigator (NAV) respiratory gating. Semiquantitative grading of overall image quality, motion artifact, myocardial nulling, and diagnostic value was performed by consensus of two blinded observers. Supplemental oxygenation and hyperventilation increased the breath-hold duration (35 ± 11 s to 58 ± 21 s; P  0.01). LGE images were of similar quality when compared with free-breathing acquisitions, but with reduced total scan time (85 ± 22 s to 35 ± 6 s; P hyperventilation allow for prolonged breath-holding and enable single breath-hold 3D accelerated LGE with similar image quality as free breathing with NAV. Copyright © 2013 Wiley Periodicals, Inc.

  6. [Assessment of influence of breath holding and hyperventilation on human postural stability with spectral analysis of stabilographic signal].

    Science.gov (United States)

    Malakhov, M V; Makarenkova, E A; Mel'nikov, A A; Vikulov, A D

    2014-01-01

    The influence of breath holding and voluntary hyperventilation on the classic stabilometric parameters and the frequency characteristic of stabilographic signal were studied. We measured the stabilometric parameters on the force platform ("Ritm", Russia) on the healthy volunteers (n = 107) during quiet breath, voluntary hyperventilation (20 seconds) and maximal inspiratory breath holding (20 seconds). Respiratory frequency, respiratory amplitude and ventilation were estimated with strain gauge. We found that antero-posterior and medio-lateral sway amplitude and velocity as well as sway surface at breath-holding and at quiet breathing were the same, so breath holding didn't influence the postural stability. However the spectral parameters shifted to the high frequency range due to alteration of the respiratory muscles contractions during breath-holding versus quiet breath. Voluntary hyperventilation caused significant increase of all stabilographic indices that implied an impairment of postural stability, which was due to the increase of respiration frequency and amplitude. We also found that the spectral indices moved toward the high-frequency range with more pronounced degree of this shift versus breath holding. Besides, amplitudes of spectral peaks also increased. Perhaps such change of spectral indices was due to distortion of proprioceptive information because of increased excitability of nerve fibers during hyperventilation. Maximal inspiration breath holding causes strain of the postural control mechanisms that is reflected as elevation of postural sway frequency with no postural stability changes. Hyperventilation leads to the most prominent strain of balance function and decrease of steadiness that is manifested as increase of center of pressure oscillations amplitude and frequency.

  7. Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water.

    Science.gov (United States)

    Harmsen, Stefani; Schramm, Dirk; Karenfort, Michael; Christaras, Andreas; Euler, Michael; Mayatepek, Ertan; Tibussek, Daniel

    2015-09-01

    Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation. Copyright © 2015 by the American Academy of Pediatrics.

  8. Effects of piracetam on pediatric breath holding spells: a randomized double blind controlled trial.

    Science.gov (United States)

    Abbaskhanian, Ali; Ehteshami, Sara; Sajjadi, Sadegh; Rezai, Mohammad Sadegh

    2012-01-01

    Breath holding spells (BHS) are common paroxysmal non-epileptic events in the pediatric population which are very stressfull despite their harmless nature. There has been no specific treatment found for the spells yet. The aim of this study was to evaluate the efficacy of piracetam (2-oxo-l-pyrrolidine) on these children. In this randomized double blind clinical trial study, 150 children with severe BHS referred to our pediatric outpatient service were enrolled from August 2011 to July 2012. The patients were randomized into two equal groups. One received 40mg/kg/day piracetam and the other group received placebo, twice daily. Patients were followed monthly for three months. The number of attacks/month before and after treatment were documented. Of the enrolled patients, 86 were boys. The mean age of the patients was 17 months (range, 6 to 24 months). In the piracetam group, 1 month after treatment an 81% response to treatment was found. In the placebo group, none of the patients had complete remission and 7% of the cases had partial remission. Overall, control of breath-holding spells was observed in 91% of the patients in the group taking piracetam as compared with 16% in the group taking placebo at the end of the study. There was no significant difference detected between the groups regarding the prevalence of drug side effects. A significant difference was detected between piracetam and placebo in prevention and controlling BHS. Piracetam (40mg/kg/day) had a good effect on our patients.

  9. Compressed sensing real-time cine cardiovascular magnetic resonance: accurate assessment of left ventricular function in a single-breath-hold.

    Science.gov (United States)

    Kido, Tomoyuki; Kido, Teruhito; Nakamura, Masashi; Watanabe, Kouki; Schmidt, Michaela; Forman, Christoph; Mochizuki, Teruhito

    2016-08-24

    Cardiovascular cine magnetic resonance (CMR) accelerated by compressed sensing (CS) is used to assess left ventricular (LV) function. However, it is difficult for prospective CS cine CMR to capture the complete end-diastolic phase, which can lead to underestimation of the end-diastolic volume (EDV), stroke volume (SV), and ejection fraction (EF), compared to retrospective standard cine CMR. This prospective study aimed to evaluate the diagnostic quality and accuracy of single-breath-hold full cardiac cycle CS cine CMR, acquired over two heart beats, to quantify LV volume in comparison to multi-breath-hold standard cine CMR. Eighty-one participants underwent standard segmented breath-hold cine and CS real-time cine CMR examinations to obtain a stack of eight contiguous short-axis images with same high spatial (1.7 × 1.7 mm(2)) and temporal resolution (41 ms). Two radiologists independently performed qualitative analysis of image quality (score, 1 [i.e., "nondiagnostic"] to 5 [i.e., "excellent"]) and quantitative analysis of the LV volume measurements. The total examination time was 113 ± 7 s for standard cine CMR and 24 ± 4 s for CS cine CMR (p cine image quality was slightly lower than standard cine (4.8 ± 0.5 for standard vs. 4.4 ± 0.5 for CS; p cine were above 4 (i.e., good). No significant differences existed between standard and CS cine MR for all quantitative LV measurements. The mean differences with 95 % confidence interval (CI), based on Bland-Altman analysis, were 1.3 mL (95 % CI, -14.6 - 17.2) for LV end-diastolic volume, 0.2 mL (95 % CI, -9.8 to10.3) for LV end-systolic volume, 1.1 mL (95 % CI, -10.5 to 12.7) for LV stroke volume, 1.0 g (95 % CI, -11.2 to 13.3) for LV mass, and 0.4 % (95 % CI, -4.8 - 5.6) for LV ejection fraction. The interobserver and intraobserver variability for CS cine MR ranged from -4.8 - 1.6 % and from -7.3 - 9.3 %, respectively, with slopes of the regressions ranging 0.88-1.0 and 0

  10. Anxiety sensitivity and breath-holding duration in relation to PTSD symptom severity among trauma exposed adults.

    Science.gov (United States)

    Berenz, Erin C; Vujanovic, Anka A; Coffey, Scott F; Zvolensky, Michael J

    2012-01-01

    The present investigation examined the main and interactive effects of anxiety sensitivity and behavioral distress tolerance, indexed using the breath-holding task, in relation to PTSD symptom severity among trauma-exposed adults. Participants were 88 adults (63.6% women; M(age)=22.9, SD=9.1, range=18-62), recruited from the community, who met DSM-IV-TR PTSD Criterion A for lifetime trauma exposure. Covariates included number of potentially traumatic events, nonclinical panic attack history, and participant sex. Anxiety sensitivity was significantly incrementally associated with PTSD total symptom severity, as well as Avoidance and Hyperarousal symptom severity (p'sseverity (p's>.05). However, breath-holding duration emerged as a significant moderator of the association between anxiety sensitivity and PTSD Avoidance symptom severity, such that lower breath-holding duration exacerbated the effect of heightened anxiety sensitivity with regard to PTSD Avoidance symptom severity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer

    DEFF Research Database (Denmark)

    Rydhog, Jonas Scherman; de Blanck, Steen Riisgaard; Josipovic, Mirjana

    2017-01-01

    Purpose: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath hold (DISH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.Methods: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course...... of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.Results: A mean...... small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. (C) 2017 Elsevier B.V. All rights reserved....

  12. [The use of Pantogam syrup in treating small children's breath holding spells].

    Science.gov (United States)

    Polskaya, A V; Chutko, L S; Jakovenko, E V

    To study the efficacy of pantogam syrup 10% (hopantenic acid) in the treatment of breath-holding spells (BHS). Sixty children, aged from 2 to 4 years, with BHS were studied. The evaluation of clinical manifestations and anxiety level was performed. Results of neurophysiological examination (long-term video-EEG-monitoring) were analyzed. Children were divided into 2 groups: main, in which the patients received pantogam syrup, and control group, in which only psychological methods were used. The results of the clinical and neurophysiological studies performed after the treatment, showed the clinical improvement in 73.3% of patients of the main group compared with similar data from the children in the control group (16.7%). The anxiety level significantly decreased after the neuroprotective therapy. A comparative analysis of electroencephalographic indicators demonstrated a significant (рchildren with BHS.

  13. Computer tomography guided lung biopsy using interactive breath-hold control

    DEFF Research Database (Denmark)

    Ashraf, Haseem; Krag-Andersen, Shella; Naqibullah, Matiullah

    2017-01-01

    BACKGROUND: Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study. METHODS: Patients admitted for CT-guided lung biopsy were randomized...... to biopsy either with (N=201) or without (N=206) IBC. Biopsy accuracy, procedure time, radiation, and complications were compared in the two groups. Predictors for pneumothorax were analyzed. RESULTS: Procedures performed with the use of IBC (N=130) did not show higher biopsy accuracy (P=0.979) but were...... associated with a higher risk of pneumothorax (P=0.022) compared to procedures without the use of IBC (N=171). Overall, 50% of the biopsies were malignant, 13% were benign, and 33% were inconclusive (4% missing). Long needle time (P=0.037) and small nodule size (P=0.001) were predictors of pneumothorax...

  14. Laughter is not always funny: breath-holding spells in familial dysautonomia.

    Science.gov (United States)

    Maayan, Channa; Katz, Eliot; Begin, Michal; Yuvchev, Ivelin; Kharasch, Virginia S

    2015-02-01

    Familial dysautonomia (FD) is a genetic disease characterized by primary autonomic dysfunction including parasympathetic hypersensitivity. Breath-holding spells (BHS) are believed to be caused by autonomic dysregulation mediated via the vagus nerve and increased in patients with a family history of BHS. Details and understanding of its pathophysiology are lacking. In this retrospective study of patients with FD, the incidence of BHS was higher at 53.3%, compared with previous studies in normal children. Laughter as a precipitating factor for BHS has not been previously reported in FD and occurred in 10% of patients in this study. Lower lung volumes, chronic lung disease, chronic CO2 retention, and inadequate autonomic compensation occur in those with FD leading to a higher incidence and severity of BHS when crying or laughing. Thus, FD may be a good model for understanding manifestations of the autonomic nervous system dysfunction and contribute to our knowledge of BHS mechanisms. © The Author(s) 2014.

  15. Effects of Piracetam on Pediatric Breath Holding Spells: A Randomized Double Blind Controlled Trial

    Science.gov (United States)

    ABBASKHANIAN, Ali; EHTESHAMI, Sara; SAJJADI, Sadegh; REZAI, Mohammad Sadegh

    2012-01-01

    Objective Breath holding spells (BHS) are common paroxysmal non-epileptic events in the pediatric population which are very stressfull despite their harmless nature. There has been no specific treatment found for the spells yet. The aim of this study was to evaluate the efficacy of piracetam (2-oxo-l-pyrrolidine) on these children. Materials & Methods In this randomized double blind clinical trial study, 150 children with severe BHS referred to our pediatric outpatient service were enrolled from August 2011 to July 2012. The patients were randomized into two equal groups. One received 40mg/kg/day piracetam and the other group received placebo, twice daily. Patients were followed monthly for three months. The number of attacks/month before and after treatment were documented. Results Of the enrolled patients, 86 were boys. The mean age of the patients was 17 months (range, 6 to 24 months). In the piracetam group, 1 month after treatment an 81% response to treatment was found. In the placebo group, none of the patients had complete remission and 7% of the cases had partial remission. Overall, control of breath-holding spells was observed in 91% of the patients in the group taking piracetam as compared with 16% in the group taking placebo at the end of the study. There was no significant difference detected between the groups regarding the prevalence of drug side effects. Conclusion A significant difference was detected between piracetam and placebo in prevention and controlling BHS. Piracetam (40mg/kg/day) had a good effect on our patients. PMID:24665274

  16. Effect of cardiogenic gas mixing on arterial O2 and CO2 tensions during breath holding.

    Science.gov (United States)

    Kelly, S M; Brancatisano, A P; Engel, L A

    1987-04-01

    To examine the effect of cardiogenic gas mixing on gas exchange we measured arterial tension of O2 (PaO2) and arterial tension of CO2 (PaCO2) during 3- to 5-min breath holds (BH) before and after infusing 50 ml of saline into the pericardial space (PCF) of seven anesthetized, paralyzed, mechanically ventilated dogs. During BH the ventilator was disconnected and a bias flow of 50% O2 at 4-5 l/min was delivered through the side ports of a small catheter whose tip was positioned 1 cm cephalad of the carina. Paired runs, alternately with and without PCF, were performed in triplicate in each dog. Initial PaO2 was similar for control runs [81 +/- 3 mmHg (SE)] and PCF runs (78 +/- 3 mmHg; P greater than 0.1). After 3-min BH, PaO2 in PCF runs (33 +/- 3 mmHg) was less than that in control runs (58 +/- 4 mmHg) (P less than 0.001). In contrast, the pattern of PaCO2 during BH did not differ with PCF. After 3-min BH, PaCO2 was 49 +/- 3 mmHg with PCF and 49 +/- 2 mmHg in the control runs (P greater than 0.7). In two dogs, repeated 50-ml reductions in lung volume, produced by rib cage compression, did not alter the time course of PaO2 during BH. Although cardiac output decreased slightly with PCF, hemodynamic changes due to PCF were unlikely to account for the observed fall in PaO2. Our results indicate a substantial effect of cardiogenic gas mixing on O2 uptake when tracheal gas is O2 enriched during breath holding.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Evaluation of a reproducible breath hold technique for\\ud the SABR treatment of lower lobe lung tumours

    OpenAIRE

    Barrett, Sarah; Taylor, Amy; Rock, Luke

    2017-01-01

    Aim\\ud Deep inspiration breath hold (DIBH) is a method of motion management used in\\ud stereotactic ablative body radiotherapy (SABR) for lung tumours. An external gating\\ud block marker can be used as a tumour motion surrogate, however, inter-fraction gross\\ud target volume (GTV) displacement within DIBH occurs. This study measured this\\ud displacement during a reproducible breath hold regime. Additionally, factors such as\\ud position of the gating block marker were analysed.\\ud Methods and ...

  18. SU-F-T-644: Reproducibility of Target Position Using Moderate Voluntary Breath- Hold During Liver Stereotactic Ablative Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cui, G; Trakul, N; Chang, E; Shiu, A [University Southern California, Los Angeles, CA (United States)

    2016-06-15

    Purpose: To evaluate the reproducibility of target position using moderate voluntary breath-hold during liver stereotactic ablative radiotherapy (SABR). Methods: Two patients who underwent liver SABR on a Varian TrueBeam STx linac were used for this study. Fiducial markers were placed in and around the target in the liver as surrogates for the target position and motion. GTVs were contoured by assessing tumor extent on contrast enhanced CT. The PTV was created from the GTV by adding 2 mm margins to account for the residual motion during breath-holds. A portable biofeedback system was used to facilitate the breath-hold to a reproducible position. The Varian RPM system was used for gating the linac. Proceeding each treatment, orthogonal kV pairs were taken, and alignment to nearby bony anatomy was performed. Then the breath-hold CBCT was acquired to align the fiducial markers. On-line fluoroscopy was used to fine-tune the breath-hold gating thresholds to correlate with the positions of the fiducial markers. The inter-fraction reproducibility of the target was evaluated by the offsets of the daily breath-hold CBCTs from the paired kV matches as a direct measure of the target position relative to the bony anatomy. The intra-fraction reproducibility of the target position was assessed by the gated window of the RPM marker block for each fraction. Results: The absolute mean offsets between the CBCT and paired kV matches in the vertical, longitudinal, and lateral directions were 0.06 cm, 0.10 cm, and 0.06 cm for patient 1, and 0.37 cm, 0.62 cm, and 0.09 cm for patient 2. The gated window of the RPM marker block for the breath-hold for each fraction was within 0.63 ± 0.16 cm and 0.59 ± 0.12 cm for patients 1 and 2, respectively. Conclusion: Moderate voluntary breath-hold showed good inter- and intra-fraction reproducibility of target position during liver SABR.

  19. MO-FG-BRA-09: Towards an Optimal Breath-Holding Procedure for Radiotherapy: Differences in Organ Motion During Inhalation and Exhalation Breath-Holds

    Energy Technology Data Exchange (ETDEWEB)

    Lens, E; Gurney-Champion, O; Horst, A van der; Tekelenburg, D; Kesteren, Z van; Tienhoven, G van; Nederveen, A; Bel, A [Academic Medical Center, Amsterdam, Noord-Holland (Netherlands); Parkes, M [University of Birmingham, Birmingham, West Midlands (United Kingdom)

    2016-06-15

    Purpose: Breath-holding (BH) is often used to reduce organ motion during radiotherapy. The aim of this study was to determine the differences in pancreatic and diaphragmatic motion during BH between inhalation and exhalation BHs with variable lung volumes and to investigate whether motion increases/decreases during BH. Methods: Sixteen healthy volunteers were asked to perform four different 60-second BHs, from fully inflated to fully deflated lungs (i.e. lung volumes of: 100%, ∼70%, ∼30% and 0% of inspiratory capacity) three times (total of 192 BHs). During each BH, we obtained single-slice (coronal) magnetic-resonance scans with spatial resolution 0.93×0.93×8.0 mm3 and temporal resolution 0.6 s. We used 2-dimensional image correlation to obtain the motion of pancreatic head and diaphragm during BH. Motion magnitude in inferior-superior direction was obtained by determining the maximum displacement during BH. Results: Pancreatic and diaphragmatic drifts occurred during BH and were mostly in the superior direction. We observed significantly smaller pancreatic and diaphragmatic motion magnitudes in inferior-superior direction during exhalation BHs (BH{sub 30%} and BH{sub 0%}) compared to inhalation BHs (BH{sub 100%} and BH{sub 70%}). The mean motion magnitudes of the pancreatic head were 7.0, 6.5, 4.4 and 4.2 mm during BH{sub 100%}, BH{sub 70%}, BH{sub 30%} and BH{sub 0%}, respectively, and mean BH durations were 59.9, 59.1, 59.0 and 52.7 s. For the diaphragm, mean motion magnitudes were 9.8, 9.0, 5.6 and 4.3 mm, respectively. When considering 30-second BHs, as often used in the clinic, the motion was most pronounced during the first 10 s and excluding these from the analysis (yielding an effective BH period of 20 s) significantly reduced (P≤0.002) organ motion. Conclusion: Organ motion was significantly smaller during exhalation BHs compared to inhalation BHs. Also, motion was largest at the start of BH. Hence, waiting for 10 s may significantly decrease

  20. Impact of beam angle choice on pencil beam scanning breath-hold proton therapy for lung lesions

    DEFF Research Database (Denmark)

    Gorgisyan, Jenny; Perrin, Rosalind; Lomax, Antony J

    2017-01-01

    INTRODUCTION: The breath-hold technique inter alia has been suggested to mitigate the detrimental effect of motion on pencil beam scanned (PBS) proton therapy dose distributions. The aim of this study was to evaluate the robustness of incident proton beam angles to day-to-day anatomical variation...

  1. β1-Blockade increases maximal apnea duration in elite breath-hold divers.

    Science.gov (United States)

    Hoiland, Ryan L; Ainslie, Philip N; Bain, Anthony R; MacLeod, David B; Stembridge, Mike; Drvis, Ivan; Madden, Dennis; Barak, Otto; MacLeod, Douglas M; Dujic, Zeljko

    2017-04-01

    We hypothesized that the cardioselective β1-adrenoreceptor antagonist esmolol would improve maximal apnea duration in elite breath-hold divers. In elite national-level divers (n = 9), maximal apneas were performed in a randomized and counterbalanced order while receiving either iv esmolol (150 μg·kg-1·min-1) or volume-matched saline (placebo). During apnea, heart rate (ECG), beat-by-beat blood pressure, stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) were measured (finger photoplethysmography). Myocardial oxygen consumption (MV̇o2) was estimated from rate pressure product. Cerebral blood flow through the internal carotid (ICA) and vertebral arteries (VA) was assessed using Duplex ultrasound. Apnea duration improved in the esmolol trial when compared with placebo (356 ± 57 vs. 323 ± 61 s, P oxyhemoglobin saturation (71.8 ± 10.3 vs. 74.9 ± 9.5%, P = 0.10). The HR response to apnea was reduced by esmolol at 10-30% of apnea duration, whereas MAP was unaffected. Esmolol reduced SV (main effect, P < 0.05) and CO (main effect; P < 0.05) and increased TPR (main effect, P < 0.05) throughout apnea. Esmolol also reduced MV̇o2 throughout apnea (main effect, P < 0.05). Cerebral blood flow through the ICA and VA was unchanged by esmolol at baseline and the last 30 s of apnea; however, global cerebral blood flow was reduced in the esmolol trial at end-apnea (P < 0.05). Our findings demonstrate that, in elite breath-hold divers, apnea breakpoint is improved by β1-blockade, likely owing to an improved total body oxygen sparring through increased centralization of blood volume (↑TPR) and reduced MV̇o2NEW & NOTEWORTHY The governing bodies for international apnea competition, the Association Internationale pour le Développment de l'Apnée and La Confédération Mondaile des Activités Subaquatiques, have banned the use of β-blockers based on anecdotal reports that they improve apnea duration. Using a randomized placebo-controlled trial

  2. Genetic predisposition to breath-hold diving-induced hemoptysis: Preliminary study.

    Science.gov (United States)

    Cialoni, Danilo; Marabotti, Claudio; Sponsiello, Nicola; Pieri, Massimo; Balestra, Costantino; Lucchini, Vittorio; Marroni, Alessandro

    2015-01-01

    Breath-hold diving-induced hemoptysis (BH-DIH) has been reported in about 25% breath-hold divers (BHD) and is characterized by dyspnea, coughing, hemoptysis and chest pain. We investigated whether eNOS G894T, eNOS T786C and ACE insertion/deletion I/D genetic variants, are possible BH-DIH risk factors. 108 experienced healthy instructor BHDs with the same minimum requirements (102 male, six female; mean age 43.90 ± 7.49) were studied. We looked for different eNOS G894T, eNOS T786C and ACE insertion/ deletion genetic variants between BH-DIH-positive and BH-DIH-negative subjects to identify the variants most frequently associated with BH-DIH. At least one BH-DIH episode was reported by 22.2% of subjects, while 77.7% never reported BH-DIH. The majority of BH-DIH-positive subjects showed eNOS G894T (p = 0.001) and eNOS-T786C (p = 0.001) genotype "TT" (high-risk profile). Prevalence of BH-DIH was higher in subjects with eNOS G894T TT genotype (50%) than in subjects with GT (9.5%, p < 0.001) and GG (24%, (p = 0.0002) genotype (low-risk profile). Similar results were observed for eNOS T786C: BH-DIH prevalence was higher in the TT genotype (41.2%) group than in the CT (15.4%, p < 0.001) and CC genotype (9.1%, p < 0.001) groups. BH-DIH prevalence was significantly higher in subjects showing ACE ID genotype (34.5%) than II (0%, p < 0.001) and DD (10.5%, p = 0.0002). Of the ACE "II" genotype group, 100% never developed BH-DIH. eNOS-G894T, eNOS-T786C and ACE influence NO availability and regulation of peripheral vascular tone and blood flow. Different genetic variants of eNOS-G894T, eNOS-T786C and ACE appear significantly related to the probability to develop BH-DIH (p < 0.001).

  3. Investigation of dose homogeneity for loose helical tomotherapy delivery in the context of breath-hold radiation therapy

    Science.gov (United States)

    Kim, Bryan; Kron, Tomas; Battista, Jerry; Van Dyk, Jake

    2005-05-01

    Loose helical delivery is a potential solution to account for respiration-driven tumour motion in helical tomotherapy (HT). In this approach, a treatment is divided into a set of interlaced 'loose' helices commencing at different gantry angles. Each loose helix covers the entire target length in one gantry rotation during a single breath-hold. The dosimetric characteristics of loose helical delivery were investigated by delivering a 6 MV photon beam in a HT-like manner. Multiple scenarios of conventional 'tight' HT and loose helical deliveries were modelled in treatment planning software, and carried out experimentally with Kodak EDR2 film. The advantage of loose helical delivery lies in its ability to produce a more homogeneous dose distribution by eliminating the 'thread' effect—an inherent characteristic of HT, which results in dose modulations away from the axis of gantry rotation. However, loose helical delivery was also subjected to undesirable dose modulations in the direction of couch motion (termed 'beating' effect), when the ratio between the number of beam projections per gantry rotation (n) and pitch factor (p) was a non-integer. The magnitude of dose modulations decreased with an increasing n/p ratio. The results suggest that for the current HT unit (n = 51), dose modulations could be kept under 5% by selecting a pitch factor smaller than 7. A pitch factor of this magnitude should be able to treat a target up to 30 cm in length. Loose helical delivery should increase the total session time only by a factor of 2, while the planning time should stay the same since the total number of beam projections remains unchanged. Considering its dosimetric advantage and clinical practicality, loose helical delivery is a promising solution for the future HT treatments of respiration-driven targets.

  4. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker.

    Science.gov (United States)

    Kolterer, Bruno; Gebauer, Roman Antonin; Janousek, Jan; Dähnert, Ingo; Riede, Frank Thomas; Paech, Christian

    2015-01-01

    To validate the physical and psychological effectiveness of cardiac pacing in pediatric patients with breath-holding spells (BHS) and prolonged asystole. The records and clinical data of all the patients with BHS who presented to our center in the period of 2001-2013 were reviewed. All patients who received cardiac pacemaker implantation for prolonged asystole during BHS were included. In addition, the parents were asked to fill out a standardized quality of life (QOL) questionnaire. Seven patients were identified. The mean onset of symptoms was 7 month (1-12 months) of age, documented asystole was 12-21 seconds, and a permanent cardiac pacemaker device was implanted at a mean age of 23 months (8 months-3.9 years). No pacemaker related adverse events were recorded. Follow up showed immediate resolution from spells in four cases (4/7). Two patients (2/7) showed significant reduction of frequency and severity of spells, with complete elimination of loss of consciousness (LOC). One patient (1/7) with an additional neurologic disorder continued to have minor pallid BHS and eventually switched from pallid to cyanotic spells without further detection of bradycardia or asystole in holter examination. QOL questionnaire revealed significant reduction in subjective stress levels of patients (P = 0.012) and parents (P = 0.007) after pacemaker implantation. Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed.

  5. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker

    Science.gov (United States)

    Kolterer, Bruno; Gebauer, Roman Antonin; Janousek, Jan; Dähnert, Ingo; Riede, Frank Thomas; Paech, Christian

    2015-01-01

    Objectives: To validate the physical and psychological effectiveness of cardiac pacing in pediatric patients with breath-holding spells (BHS) and prolonged asystole. Materials and Methods: The records and clinical data of all the patients with BHS who presented to our center in the period of 2001–2013 were reviewed. All patients who received cardiac pacemaker implantation for prolonged asystole during BHS were included. In addition, the parents were asked to fill out a standardized quality of life (QOL) questionnaire. Results: Seven patients were identified. The mean onset of symptoms was 7 month (1–12 months) of age, documented asystole was 12–21 seconds, and a permanent cardiac pacemaker device was implanted at a mean age of 23 months (8 months–3.9 years). No pacemaker related adverse events were recorded. Follow up showed immediate resolution from spells in four cases (4/7). Two patients (2/7) showed significant reduction of frequency and severity of spells, with complete elimination of loss of consciousness (LOC). One patient (1/7) with an additional neurologic disorder continued to have minor pallid BHS and eventually switched from pallid to cyanotic spells without further detection of bradycardia or asystole in holter examination. QOL questionnaire revealed significant reduction in subjective stress levels of patients (P = 0.012) and parents (P = 0.007) after pacemaker implantation. Conclusion: Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed. PMID:26085761

  6. SU-E-J-33: Cardiac Movement in Deep Inspiration Breath-Hold for Left-Breast Cancer Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M; Lee, S; Suh, T [Department of Biomedical Engineering, Research Institute of Biomedical Engineering, Catholic University of Korea, Seoul (Korea, Republic of)

    2014-06-01

    Purpose: The present study was designed to investigate the displacement of heart using Deep Inspiration Breath Hold (DIBH) CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Methods: Treatment planning was performed on the computed tomography (CT) datasets of 20 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ≥ 95% of the prescribed dose and that the volume inside the CTV receiving > 107% of the prescribed dose should be minimized. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. Results: The maximum and minimum left-right (LR) displacements of heart were 8.9 mm and 3 mm, respectively. The heart moved > 4 mm in the LR direction in 17 of the 20 patients. The distances between the heart and left breast ranged from 8.02–17.68 mm (mean, 12.23 mm) and 7.85–12.98 mm (mean, 8.97 mm) with DIBH CT and FB CT, respectively. The maximum doses to the heart were 3115 cGy and 4652 cGy for the DIBH and FB CT dataset, respectively. Conclusion: The present study has demonstrated that the DIBH technique could help to reduce the risk of radiation dose-induced cardiac toxicity by using movement of cardiac; away from radiation field. The DIBH technique could be used in an actual treatment room for a few minutes and could effectively reduce the cardiac dose when used with a sub-device or image acquisition standard to maintain consistent respiratory motion.

  7. Evaluation of deep inspiration breath-hold lung treatment plans with Monte Carlo dose calculation.

    Science.gov (United States)

    Yorke, Ellen D; Wang, Lu; Rosenzweig, Kenneth E; Mah, Dennis; Paoli, Jean-Baptiste; Chui, Chen-Shou

    2002-07-15

    To evaluate dosimetry of deep inspiration breath-hold (DIBH) relative to free breathing (FB) for three-dimensional conformal radiation therapy of lung cancer with 6-MV photons and Monte Carlo (MC) dose calculations. Static three-dimensional conformal radiation therapy, 6-MV plans, based on DIBH and FB CT images for five non-small-cell lung cancer patients, were generated on a clinical treatment planning system with equivalent path length tissue inhomogeneity correction. Margins of gross to planning target volume were not reduced for DIBH plans. Cord and lung toxicity determined the maximum treatment dose for each plan. Dose distributions were recalculated for the same beams with an MC dose calculation algorithm and electron density distributions derived from the CT images. MC calculations showed decreased target coverage relative to treatment-planning system predictions. Lateral disequilibrium caused more degradation of target coverage for DIBH than for FB (approximately 4% worse than expected for FB vs. 8% for DIBH). However, with DIBH higher treatment doses could be delivered without violating normal tissue constraints, resulting in higher total doses to gross target volume and to >99% of planning target volume. If DIBH enables prescription dose increases exceeding 10%, MC calculations indicate that, despite lateral disequilibrium, higher doses will be delivered to medium-to-large, partly mediastinal gross target volumes, providing that 6-MV photons are used and margins are not reduced.

  8. Cyanotic breath-holding spells in children respond to adenotonsillectomy for sleep-disordered breathing.

    Science.gov (United States)

    Guilleminault, Christian; Huang, Yu-Shu; Chan, Allison; Hagen, Chad C

    2007-12-01

    Children with breath-holding (BH) spells may demonstrate sleep-disordered breathing (SDB) during polysomnography. We studied five young children with cyanotic spells retrospectively and found both SDB and a response to adenotonsillectomy. We therefore proceeded with a prospective investigation of treatment for SDB in children with comorbid cyanotic spells. Nineteen children with cyanotic BH spells were identified and enrolled in the prospective study. Parents chose either treatment or observation. Fourteen children underwent complete SDB evaluation and treatment trials while five selected observation only (control group). Sleep and sleep-surgery specialist evaluation and polysomnography revealed the presence of a narrow upper-airway and an abnormal respiratory disturbance index in all 14 children. Nasal CPAP was not successful, but adenotonsillectomy performed near 14 months of age eliminated SDB. BH spells were eliminated 1 month after surgery, while they persisted to the end of the study (24 months of age) in the control group. In conclusion, the presence of cyanotic BH should prompt investigation and polysomnography for possible SDB. Independent treatment of SDB may hasten resolution of BH spells in these cases.

  9. Long-term prognosis for children with breath-holding spells.

    Science.gov (United States)

    Olsen, Anne Lise; Mathiasen, Rene; Rasmussen, Niels Henrik; Knudsen, Finn Ursin

    2010-11-01

    The aim of this study was to investigate the long-term prognosis for children with severe breath-holding spells (BHS). The study was a retrospective cohort study. Data from the medical records of all patients with severe BHS admitted during a ten-year period were recorded and a questionnaire was sent to the families. A matched group of adolescents with febrile convulsions served as controls (n = 289). A total of 85 out of 115 families (73.9%) responded. The mean age of the included patients was 20.5 years. Among first-degree relatives 21.5% had BHS and 14.6% had epilepsy. The peak age for severe BHS was 16 months. The children had a total of 1-25 attacks. All electrocardiogram (ECG) recordings were normal. One patient died of asystolia at the age of 20 years, ECG two weeks previously showed a WPW-block. Twenty-six (30.6%, p spells. Twenty-five (29.4%) had concentration problems. The grades achieved by BHD children at the final school exam did not differ from the mean values achieved by all children in the area. In this study on the long-term prognosis of children with BHS, we found a predisposition to fainting spells as expected. We also found that 29.4% of children with BHS had concentration problems. Further follow-up studies are needed to confirm this trend.

  10. Breath-holding spells occur disproportionately more often in children with transient erythroblastopenia.

    Science.gov (United States)

    Hellström Schmidt, Sanna; Tedgård, Ulf; Pronk, Cornelis J H

    2016-09-01

    This study aimed to evaluate the concomitant occurrence and possible association of breath-holding spells (BHS) and transient erythroblastopenia of childhood (TEC). This population-based cohort study, carried out in Southern Sweden from 2004 to 2014, included patients with BHS and/or anaemia, including TEC. The subjects were evaluated for the presence of all three conditions and the diagnostic workups, disease characteristics and outcome were analysed. We studied 443 470 children under the age of 10 years during 2004-2014. The total cohort included 321 patients (0.07%) with BHS and 366 patients with a selection of anaemia diagnoses, including 41 with TEC. We found that nine (2.5%) of the 366 patients with anaemia diagnoses also had BHS and that five (12.2%) of the 41 patients with TEC also had BHS. Treatment for anaemia resolved BHS in a number of patients. Our population-based analysis revealed an overrepresentation of BHS among children with TEC, and we identified five patients with concomitant TEC and BHS. We found that correcting anaemia was an effective means of ameliorating potentially debilitating BHS and that the presence of concomitant BHS and TEC was more common than previously assumed. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  11. The value of neurologic and cardiologic assessment in breath holding spells.

    Science.gov (United States)

    Yilmaz, Unsal; Doksoz, Onder; Celik, Tanju; Akinci, Gulcin; Mese, Timur; Sevim Yilmaz, Tuba

    2014-01-01

    Objective : To evaluate the value of neurologic and cardiologic assessment and also the frequency of iron deficiency anemia in children with Breath Holding Spells (BHS). Methods : The hospital charts of patients diagnosed with BHS between 2011 and 2013 were reviewed retrospectively. Results : A total of 165 children (90 boys, 75 girls) with BHS comprised the study group. A matched group of 200 children with febrile convulsions served as controls. Among the first-degree relatives, 13.3% had BHS, 1.8% had febrile convulsions and 12.1% had epilepsy. The spells were cyanotic in 140 (84.8%) children and pallid or mixed in the remainder. BNS type was simple in 46.7% of patients and complicated in the remainder. Eighteen patients had abnormalities in electroencephalography, however only one patient was diagnosed with epilepsy. Sixty nine (47.9%) patients were found to have iron deficiency anemia. Conclusion : Referral of children with clinically definite BHS to pediatric neurology or pediatric cardiology clinics and performance of echocardiography and EEG investigations for exclusion of heart disease or epilepsy appear unnecessary. However, performance of an electrocardiogram to search for prolonged QT syndrome should be considered although no patient in our series had any cardiologic abnormalities.

  12. Effect of Maximal Apnoea Easy-Going and Struggle Phases on Subarachnoid Width and Pial Artery Pulsation in Elite Breath-Hold Divers.

    Directory of Open Access Journals (Sweden)

    Pawel J Winklewski

    Full Text Available The aim of the study was to assess changes in subarachnoid space width (sas-TQ, the marker of intracranial pressure (ICP, pial artery pulsation (cc-TQ and cardiac contribution to blood pressure (BP, cerebral blood flow velocity (CBFV and cc-TQ oscillations throughout the maximal breath hold in elite apnoea divers. Non-invasive assessment of sas-TQ and cc-TQ became possible due to recently developed method based on infrared radiation, called near-infrared transillumination/backscattering sounding (NIR-T/BSS.The experimental group consisted of seven breath-hold divers (six men. During testing, each participant performed a single maximal end-inspiratory breath hold. Apnoea consisted of the easy-going and struggle phases (characterised by involuntary breathing movements (IBMs. Heart rate (HR was determined using a standard ECG. BP was assessed using the photoplethysmography method. SaO2 was monitored continuously with pulse oximetry. A pneumatic chest belt was used to register thoracic and abdominal movements. Cerebral blood flow velocity (CBFV was estimated by a 2-MHz transcranial Doppler ultrasonic probe. sas-TQ and cc-TQ were measured using NIR-T/BSS. Wavelet transform analysis was performed to assess cardiac contribution to BP, CBFV and cc-TQ oscillations.Mean BP and CBFV increased compared to baseline at the end of the easy phase and were further augmented by IBMs. cc-TQ increased compared to baseline at the end of the easy phase and remained stable during the IBMs. HR did not change significantly throughout the apnoea, although a trend toward a decrease during the easy phase and recovery during the IBMs was visible. Amplitudes of BP, CBFV and cc-TQ were augmented. sas-TQ and SaO2 decreased at the easy phase of apnoea and further decreased during the IBMs.Apnoea increases intracranial pressure and pial artery pulsation. Pial artery pulsation seems to be stabilised by the IBMs. Cardiac contribution to BP, CBFV and cc-TQ oscillations does not

  13. UNDERWATER STROKE KINEMATICS DURING BREATHING AND BREATH-HOLDING FRONT CRAWL SWIMMING

    Directory of Open Access Journals (Sweden)

    Nickos Vezos

    2007-03-01

    Full Text Available The aim of the present study was to determine the effects of breathing on the three - dimensional underwater stroke kinematics of front crawl swimming. Ten female competitive freestyle swimmers participated in the study. Each subject swam a number of front crawl trials of 25 m at a constant speed under breathing and breath-holding conditions. The underwater motion of each subject's right arm was filmed using two S-VHS cameras, operating at 60 Hz, which were positioned behind two underwater viewing windows. The spatial coordinates of selected points were calculated using the DLT procedure with 30 control points and after the digital filtering of the raw data with a cut-off frequency of 6 Hz, the hand's linear displacements and velocities were calculated. The results revealed that breathing caused significantly increases in the stroke duration (t9 = 2.764; p < 0.05, the backward hand displacement relative to the water (t9 = 2.471; p<0.05 and the lateral displacement of the hand in the X - axis during the downsweep (t9 = 2.638; p < 0.05. On the contrary, the peak backward hand velocity during the insweep (t9 = 2.368; p < 0.05 and the displacement of the hand during the push phase (t9 = -2.297; p < 0.05 were greatly reduced when breathing was involved. From the above, it was concluded that breathing action in front crawl swimming caused significant modifications in both the basic stroke parameters and the overall motor pattern were, possibly due to body roll during breathing

  14. SU-C-19A-01: A Simple Deep Inspiration Breath Hold System

    Energy Technology Data Exchange (ETDEWEB)

    Rasmussen, B; Kaznowski, L; Blackburn, J; Chu, K [Marquette General Hospital, Marquette, MI (United States); Duelge, J; Baldwin, B; Valenti, M; Hunsader, A [Dickinson County Healthcare System, Iron Mountain, MI (United States)

    2014-06-15

    Purpose: Deep Inspiration Breath Hold (DIBH) Radiation therapy for left sided breast can reduce dose to the lungs and heart. The purpose of this work is to illustrate how to implement a simple method of DIBH for simulation and treatment using equipment readily available in most radiation oncology clinics. Methods: For simulation and treatment, a foam block is placed on the patient's abdomen or chest and a horizontal laser mounted on a movable slide is aimed at the center of the foam block. After a coaching session the block is marked at the average free breathing position and average DIBH position. The position of block relative to laser can be seen by the patient via prism glasses as well as the radiation therapists via a video camera system. Simulation CT scans and treatment delivery are performed under DIBH conditions. Imaging and treatment are performed by manually turning the beam on once the patient has achieved DIBH after being given verbal instructions. Results: Manually triggered imaging was used daily to verify DIBH reproducibility for all patients treated using this system. Sets of before and during port images were used to ensure patient position was appropriate for treatment. Results of the laser on block method were compared to a sister facility using surface mapping techniques for DIBH and the two methods were found to have clinically equivalent reproducibility. Conclusion: The laser and block system was found to be simple to implement and robust during patient treatment. This system can be created from readily available materials at low cost and provides adequate feedback to patient and therapists. During treatment images document the reproducibility of setup and give confidence to clinicians that this method is reproducible from day to day.

  15. Frequency of coeliac disease in children with breath-holding spells.

    Science.gov (United States)

    Işikay, Sedat; Hızlı, Şamil

    2014-11-01

    Iron deficiency anaemia (IDA), which is reported very commonly among patients with breath holding spells (BHS), is the most common presentation of coeliac disease (CD). In that aspect, IDA may be a common pathway linking these two diseases. The aim of this study was to evaluate the frequency of CD in patients with BHS. We studied 348 children with BHS, and 470 age- and sex-matched controls with no known disease. Serological screening for CD was performed in all patients by searching for serum tissue transglutaminase immunoglobulin A. The first group consisted of 348 children with BHS (231 males, 117 females; mean age 2.23 ± 1.84 years), and the second group consisted of 470 healthy children (284 males, 186 females; mean age 2.11 ± 1.98 years). A total of 300 (86.2%) patients had cyanotic type of BHS only, 27 (7.8%) had pallid type of BHS only and 21 (6%) had mixed type of BHS. The prevalence of IDA was statistically significantly higher in BHS patients compared with controls. Tissue transglutaminase immunoglobulin A was not detected as positive in any patients in either group; therefore, endoscopic and histopathological examinations were not performed. Our report is the first to describe the frequency of tissue transglutaminase immunoglobulin A positivity in patients with BHS. There was no evidence of a relationship between CD and BHS, but IDA seems to be an important risk factor in the development of BHS. Therefore, serological screening for CD in patients with BHS does not seem to be necessary. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  16. Novel Findings in Breath-Holding Spells: A Cross-Sectional Study.

    Science.gov (United States)

    Azab, Seham F A; Siam, Ahmed G; Saleh, Safaa H; Elshafei, Mona M; Elsaeed, Wafaa F; Arafa, Mohamed A; Bendary, Eman A; Farag, Elsayed M; Basset, Maha A A; Ismail, Sanaa M; Elazouni, Osama M A

    2015-07-01

    The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. Another aim of the study was to evaluate the differences in the pathophysiology between pallid and cyanotic types of BHS. This was a prospective study performed in Zagazig University Hospitals. Seventy-six children diagnosed with BHS were included as follows: 32 children with cyanotic BHS, 14 children with pallid BHS, and 30 healthy children as a control group. All children were subjected to the following: full history taking, clinical examination, and laboratory work up in the form of CBC, serum iron, ferritin, and zinc levels. Twenty-four hours ambulatory ECG (Holter) recording was also performed. No significant statistical difference was found between cyanotic and pallid groups regarding family history of BHS, severity, and precipitating factors of the attacks. Frequent runs of respiratory sinus arrhythmia (RSA) during 24  hours ECG were significantly higher in children with BHS; the frequency of RSA was significantly correlated with the frequency (severity) of the attacks. Low serum ferritin was significantly associated with BHS groups but not correlated with the severity of the attacks. Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology.

  17. Pacemaker in complicated and refractory breath-holding spells: when to think about it?

    Science.gov (United States)

    Sartori, Stefano; Nosadini, Margherita; Leoni, Loira; de Palma, Luca; Toldo, Irene; Milanesi, Ornella; Cerutti, Alessia; Suppiej, Agnese

    2015-01-01

    Breath-holding spells (BHS) are benign non-epileptic paroxysmal events of infancy, rarely occurring with high frequency and complicated by prolonged syncope, convulsions and even status epilepticus. In these cases response to medical treatment is often unsatisfactory. Pacemaker implantation is a possible therapeutic option, but its indications, efficacy and complications have not been clarified yet. To report a new case of BHS treated with pacemaker and to review its indications and efficacy in patients with severe BHS. We extensively searched the literature in PubMed on cardiac pacing in patients with BHS and we described a new case. A previously healthy boy presented at the age of 4 months with frequent BHS inconstantly associated to prolonged syncope and post-anoxic non-epileptic and epileptic seizures. Parental reassurance, iron supplementation and piracetam were ineffective. After cardiac pacing at the age of 16 months, BHS and their complications disappeared. We identified 47 patients with BHS treated with pacemaker in the literature. Based on the available data, in all patients asystole or marked bradycardia were documented during BHS or stimulating maneuvers; syncope complicated BHS in 100% of cases and post-anoxic convulsions in 78.3%. Medical treatment before pacing, when administered, was ineffective or poorly tolerated. After pacing, BHS complications disappeared in 86.4% of cases, and decreased in 13.6%. Technical problems with the device were reported in 25.7% of patients and mild medical complications in 11.4%. Pacemaker could be reasonably considered in subjects with frequent and severe BHS, poor response to medications, and demonstration of cardioinhibition during spells. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  18. Breath holding spells: point prevalence and associated factors among Turkish children.

    Science.gov (United States)

    Carman, Kursat Bora; Ekici, Arzu; Yimenicioglu, Sevgi; Arslantas, Didem; Yakut, Ayten

    2013-06-01

    Breath holding spells (BHS) are known as paroxysmal non-epileptic disorder. There are two subtypes of BHS: cyanotic and the pallid. BHS have been reported to occur in 0.1-4.6% of children in Western countries. Although it is easy to diagnose in its typical form, the data on prevalence of BHS are insufficient in developing countries. This study was performed in Turkey's Eskisehir province. A total of 1000 randomly selected 0-6-year-old children were invited to family health centers. A specific questionnaire was given to parents. Children who had a history BHS were referred to the hospital to for investigation of medical history and neurological examinations. A total of 933 children participated and were included in analysis. Thirty-four children (3.6%) had had BHS. Children's birthweight, parent consanguinity and mothers' education status significantly affected the frequency of BHS. Increase in birth sequence decreases the risk of BHS 0.65-fold. Fathers' education status also affected the prevalence of BHS, with the risk of BHS being 0.39-fold less if the father had completed high school or some higher education. And, as the age of the fathers increased, the risk that their children would have BHS was 1.14-fold higher. Although the calculated prevalence rate was compatible with previous studies, positive family history for BHS, birth sequence, parents' education status and fathers' age were identified as risk factors associated with BHS. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  19. Breathing adapted radiotherapy for reduction of cardiac exposure using deep inspiration breath-hold technique

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Joo; Jung, Joo Young; Woong, Cho; Suh, Tae Suk [Dept. of Biomedical Engineering, The Catholic University of Korea, Seoul (Korea, Republic of); Jung, Jae Hong [Dept. of Radiation Oncology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2012-11-15

    Most of breast cancer patient has suffered from unnecessary radiation exposure to heart, lung. Low radiation dose to the heart could lead to the worsening of preexisting cardiovascular lesions caused by radiation-induced pneumonitis. Also, several studies have demonstrated the dose to heart and artery, especially the dose to left anterior descending (LAD) coronary artery were maximized for left-sided breast cancer patient and could cause the subsequent risk causing more severe myocardial infarction than the other coronary artery. Several effective treatment techniques for breast cancer patient have been reported that partial breast irradiation technique for early stage breast cancer patient an alternative to whole breast irradiation, is a beam delivery method that uses a limited range of treatment volume to minimize Organ At Risks (OARs) and Computed Tomography (CT) images from several breathing control technique during treatment time could reduce the delivered dose to heart, lung. Particularly, Deep Inspiration Breath Hold (DIBH) technique which the patient takes a deep inspiration and holds during treatment and could move the heart away from the chest wall and lung, has showed to lead to reduction in cardiac volume and to minimize the unnecessary radiation exposure to heart during treatment. In this study, we investigated the displacement of heart using DIBH CT data compared to free-breathing (FB) CT data and radiation exposure to heart, lung. The present study demonstrates that cardiac dose during left-sided breast treatment can be reduced by applying DIBH breathing control technique. Also, RHC could help assess the risk of radiation induced cardiac dose, toxicity.

  20. Prospective study of children with cyanotic and pallid breath-holding spells.

    Science.gov (United States)

    DiMario, F J

    2001-02-01

    In this investigation, we sought to prospectively document the natural history of severe breath-holding spells (BHS) among children with both cyanotic and pallid BHS who were referred for neurologic consultation. Prospective cohort study. A structured interview was undertaken at the time of initial consultation and at subsequent 1-year intervals regarding type of BHS, frequency of spells, associated phenomenon, sequelae, family history, and age at termination of spells. A total of 95 children (48 boys, 47 girls) with BHS were identified and followed over a 9-year interval. There were no significant differences between genders. Median onset age was between 6 and 12 months old with 15% presenting younger than 6 months. A median frequency of spells was weekly with 30% experiencing 1 or more spells per day. The median age at peak frequency was between 12 and 18 months old with a range extending from 6 months to 4 years of age. Of the patients whose BHS had remitted for >12 months' time (n = 67), the last spell occurred at a median age of 37 to 42 months. Of those children whose BHS were still occurring, the oldest age at time of latest spell was at 7 years old. Hypoxic convulsions were associated with BHS in

  1. Treatment of cyanotic breath-holding spells with oral theophylline in a 10-year-old boy.

    Science.gov (United States)

    Garg, Meenal; Goraya, Jatinder S

    2015-06-01

    Cyanotic breath-holding spells are generally benign and resolve spontaneously by 4 to 5 years of age. Treatment with iron and other drugs has been employed in selected cases with very frequent and severe episodes. We describe a 10-year-old boy with recent-onset cyanotic breath-holding spells that were activity limiting. He was unable to participate in physical activities with his peers as any argument or emotional upset provoked these spells. Treatment with oral iron and piracetam was ineffective. However, treatment with oral theophylline produced dramatic amelioration of symptoms, and he was once again able to participate in play activities with his peers. We believe that general central nervous system stimulant and respirogenic effects of theophylline were instrumental in control of symptoms in our child. © The Author(s) 2014.

  2. Cyanotic breath-holding spell: a life-threatening complication after radical resection of a cervicomedullary ganglioglioma.

    Science.gov (United States)

    Fujisawa, Hironori; Yoshida, Yuya; Niida, Yo; Hasegawa, Mitsuhiro; Yamashita, Junkoh

    2005-01-01

    Cyanotic breath-holding spell is a benign and self-limiting disease of young children but occasionally associated with sudden, unexpected death. The authors report a rare case in a 2-year-old girl with a severe form that started after radical resection of a cervicomedullary ganglioglioma. She was admitted to our hospital because of delayed and unstable gait. Since magnetic resonance imaging showed a cervicomedullary tumor, she underwent a radical resection and histology showed the tumor to be a ganglioglioma. Postoperatively, the function of the lower cranial nerves and cerebellum deteriorated and hemiparesis on the left became apparent, but she returned to the preoperative state in a few months. In addition, mild sleep apnea (Ondine curse) and severe cyanotic breath-holding spells occurred. The former responded to medication but the latter failed and continued several times per day with a rapid onset and progression of hypoxemia, loss of consciousness, sweating and opisthotonos. Five months after the operation, the patient returned home with a portable oxygen saturation monitor equipped with an alarm. This case indicates that cyanotic breath-holding spell, as well as sleep apnea, is critical during the early postoperative period. This is the first report observing that such spells may occur as a complication of radical resection of a cervicomedullary tumor. Copyright (c) 2005 S. Karger AG, Basel.

  3. Feasibility of Pencil Beam Scanned Intensity Modulated Proton Therapy in Breath-hold for Locally Advanced Non-Small Cell Lung Cancer

    DEFF Research Database (Denmark)

    Gorgisyan, Jenny; Munck Af Rosenschold, Per; Perrin, Rosalind

    2017-01-01

    with image guided photon radiation therapy were included in the present simulation study. In addition to a planning breath-hold computed tomography (CT) scan before the treatment start, a median of 6 (range 3-9) breath-hold CT scans per patient were acquired prospectively throughout the radiation therapy......) in terms of the percentage of voxels with 3-mm or more undershoot on repeat CT scans. The dose to the organs at risk was similar for the planned and simulated dose distributions. Three or fewer breath-holds per field would be required for 12 of the 15 patients, which was clinically feasible. CONCLUSIONS...

  4. SU-E-J-236: Audiovisual Biofeedback Improves Breath-Hold Lung Tumor Position Reproducibility Measured with 4D MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, D; Pollock, S; Keall, P [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, NSW (Australia); Greer, P [School of Mathematical and Physical Sciences, The University of Newcastle, Newcastle, NSW (Australia); Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW (Australia); Lapuz, C; Ludbrook, J [Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW (Australia); Kim, T [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, NSW (Australia); Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA (United States)

    2015-06-15

    Purpose: Audiovisual biofeedback breath-hold (AVBH) was employed to reproduce tumor position on inhale and exhale breath-holds for 4D tumor information. We hypothesize that lung tumor position will be more consistent using AVBH compared with conventional breath-hold (CBH). Methods: Lung tumor positions were determined for seven lung cancer patients (age: 25 – 74) during to two separate 3T MRI sessions. A breathhold training session was performed prior to the MRI sessions to allow patients to become comfortable with AVBH and their exhale and inhale target positions. CBH and AVBH 4D image datasets were obtained in the first MRI session (pre-treatment) and the second MRI session (midtreatment) within six weeks of the first session. Audio-instruction (MRI: Siemens Skyra) in CBH and verbal-instruction (radiographer) in AVBH were used. A radiation oncologist contoured the lung tumor using Eclipse (Varian Medical Systems); tumor position was quantified as the centroid of the contoured tumor after rigid registration based on vertebral anatomy across two MRI sessions. CBH and AVBH were compared in terms of the reproducibility assessed via (1) the difference between the two exhale positions for the two sessions and the two inhale positions for the sessions. (2) The difference in amplitude (exhale to inhale) between the two sessions. Results: Compared to CBH, AVBH improved the reproducibility of two exhale (or inhale) lung tumor positions relative to each other by 33%, from 6.4±5.3 mm to 4.3±3.0 mm (p=0.005). Compared to CBH, AVBH improved the reproducibility of exhale and inhale amplitude by 66%, from 5.6±5.9 mm to 1.9±1.4 mm (p=0.005). Conclusions: This study demonstrated that audiovisual biofeedback can be utilized for improving the reproducibility of breath-hold lung tumor position. These results are advantageous towards achieving more accurate emerging radiation treatment planning methods, in addition to imaging and treatment modalities utilizing breath-hold

  5. Interfractional Dose Variations in Intensity-Modulated Radiotherapy With Breath-Hold for Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Mitsuhiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shibuya, Keiko, E-mail: kei@kuhp.kyoto-u.ac.jp [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Nakamura, Akira [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shiinoki, Takehiro [Department of Nuclear Engineering, Kyoto University Graduate School of Engineering, Kyoto (Japan); Matsuo, Yukinori [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Nakata, Manabu [Clinical Radiology Service Division, Kyoto University Hospital, Kyoto (Japan); Sawada, Akira; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)

    2012-04-01

    Purpose: To investigate the interfractional dose variations for intensity-modulated radiotherapy (RT) combined with breath-hold (BH) at end-exhalation (EE) for pancreatic cancer. Methods and Materials: A total of 10 consecutive patients with pancreatic cancer were enrolled. Each patient was fixed in the supine position on an individualized vacuum pillow with both arms raised. Computed tomography (CT) scans were performed before RT, and three additional scans were performed during the course of chemoradiotherapy using a conventional RT technique. The CT data were acquired under EE-BH conditions (BH-CT) using a visual feedback technique. The intensity-modulated RT plan, which used five 15-MV coplanar ports, was designed on the initial BH-CT set with a prescription dose of 39 Gy at 2.6 Gy/fraction. After rigid image registration between the initial and subsequent BH-CT scans, the dose distributions were recalculated on the subsequent BH-CT images under the same conditions as in planning. Changes in the dose-volume metrics of the gross tumor volume (GTV), clinical target volume (CTV = GTV + 5 mm), stomach, and duodenum were evaluated. Results: For the GTV and clinical target volume (CTV), the 95th percentile of the interfractional variations in the maximal dose, mean dose, dose covering 95% volume of the region of structure, and percentage of the volume covered by the 90% isodose line were within {+-}3%. Although the volume covered by the 39 Gy isodose line for the stomach and duodenum did not exceed 0.1 mL at planning, the volume covered by the 39 Gy isodose line for these structures was up to 11.4 cm{sup 3} and 1.8 cm{sup 3}, respectively. Conclusions: Despite variations in the gastrointestinal state and abdominal wall position at EE, the GTV and CTV were mostly ensured at the planned dose, with the exception of 1 patient. Compared with the duodenum, large variations in the stomach volume receiving high-dose radiation were observed, which might be beyond the

  6. Clinical feasibility of 3D-QALAS - Single breath-hold 3D myocardial T1- and T2-mapping.

    Science.gov (United States)

    Kvernby, Sofia; Warntjes, Marcel; Engvall, Jan; Carlhäll, Carl-Johan; Ebbers, Tino

    2017-05-01

    To investigate the in-vivo precision and clinical feasibility of 3D-QALAS - a novel method for simultaneous three-dimensional myocardial T1- and T2-mapping. Ten healthy subjects and 23 patients with different cardiac pathologies underwent cardiovascular 3T MRI examinations including 3D-QALAS, MOLLI and T2-GraSE acquisitions. Precision was investigated in the healthy subjects between independent scans, between dependent scans and as standard deviation of consecutive scans. Clinical feasibility of 3D-QALAS was investigated for native and contrast enhanced myocardium in patients. Data were analyzed using mean value and 95% confidence interval, Pearson correlation, Paired t-tests, intraclass correlation and Bland-Altman analysis. Average myocardial relaxation time values and SD from eight repeated acquisitions within the group of healthy subjects were 1178±18.5ms (1.6%) for T1 with 3D-QALAS, 52.7±1.2ms (2.3%) for T2 with 3D-QALAS, 1145±10.0ms (0.9%) for T1 with MOLLI and 49.2±0.8ms (1.6%) for T2 with GraSE. Myocardial T1 and T2 relaxation times obtained with 3D-QALAS correlated very well with reference methods; MOLLI for T1 (r=0.994) and T2-GraSE for T2 (r=0.818) in the 23 patients. Average native/post-contrast myocardial T1 values from the patients were 1166.2ms/411.8ms for 3D-QALAS and 1174.4ms/438.9ms for MOLLI. Average native myocardial T2 values from the patients were 53.2ms for 3D-QALAS and 54.4ms for T2-GraSE. Repeated independent and dependent scans together with the intra-scan repeatability, demonstrated all a very good precision for the 3D-QALAS method in healthy volunteers. This study shows that 3D T1 and T2 mapping in the left ventricle is feasible in one breath hold for patients with different cardiac pathologies using 3D-QALAS. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Measuring vascular reactivity with resting-state blood oxygenation level-dependent (BOLD) signal fluctuations: A potential alternative to the breath-holding challenge?

    National Research Council Canada - National Science Library

    Jahanian, Hesamoddin; Christen, Thomas; Moseley, Michael E; Pajewski, Nicholas M; Wright, Clinton B; Tamura, Manjula K; Zaharchuk, Greg

    2017-01-01

    Measurement of the ability of blood vessels to dilate and constrict, known as vascular reactivity, is often performed with breath-holding tasks that transiently raise arterial blood carbon dioxide (PaCO2) levels...

  8. Does smoking abstinence influence distress tolerance? An experimental study comparing the response to a breath-holding test of smokers under tobacco withdrawal and under nicotine replacement therapy.

    Science.gov (United States)

    Cosci, Fiammetta; Anna Aldi, Giulia; Nardi, Antonio Egidio

    2015-09-30

    Distress tolerance has been operationalized as task persistence in stressful behavioral laboratory tasks. According to the distress tolerance perspective, how an individual responds to discomfort/distress predicts early smoking lapses. This theory seems weakly supported by experimental studies since they are limited in number, show inconsistent results, do not include control conditions. We tested the response to a stressful task in smokers under abstinence and under no abstinence to verify if tobacco abstinence reduces task persistence, thus distress tolerance. A placebo-controlled, double-blind, randomized, cross-over design was used. Twenty smokers underwent a breath holding test after the administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline and directly before and after each challenge. Abstinence induced a statistically significant shorter breath holding duration relative to the nicotine condition. No different response to the breath holding test was observed when nicotine and placebo conditions were compared. No response to the breath holding test was found when pre- and post-test values of heart rate, blood pressure, Visual Analogue Scale for fear or discomfort were compared. In brief, tobacco abstinence reduces breath holding duration but breath holding test does not influence discomfort. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Imaging of ventilation with dual-energy CT during breath hold after single vital-capacity inspiration of stable xenon.

    Science.gov (United States)

    Honda, Norinari; Osada, Hisato; Watanabe, Wataru; Nakayama, Mitsuo; Nishimura, Keiichiro; Krauss, Bernhard; Otani, Katharina

    2012-01-01

    To assess single-breath-hold technique for ventilation mapping by using dual-energy computed tomography (CT) in phantom experiments and volunteers. Institutional review board approved this study, and written informed consent was obtained from all volunteers. A rubber bag filled with a mixture of xenon (0%-35.4%) and oxygen was scanned with dual-source dual-energy CT (80 kV and 140 kV with tin [Sn] filter [Sn/140 kV] and 100 kV and Sn/140 kV). A cylinder containing six tubes of identical sizes with different apertures was ventilated once with a mixture of 35% xenon and 65% oxygen and was scanned in dual-energy mode (80 kV and Sn/140 kV). Xenon-enhanced images were derived by using three-material decomposition technique. Four volunteers were scanned twice in dual-energy mode (80 kV and Sn/140 kV) during breath hold after a single vital-capacity inspiration of air (nonenhanced) and of 35% xenon. Xenon-enhanced images were obtained by using two methods: three-material decomposition and subtraction of nonenhanced from xenon-enhanced images. Regression analysis with t and F tests was applied to the data of the rubber bag scans, with the significance level set at .05. Mean pixel values of gas in the bag were linearly related to xenon concentration for all x-ray tube voltages (r(2) = 1.00, P lungs of healthy volunteers, with higher pixel values in the trachea and lower pixel values in the bullae. Xenon-enhanced images calculated by using three-material decomposition had better image quality on visual comparison than those calculated by using subtraction. Xenon-enhanced dual-energy CT with the single-breath-hold technique could depict ventilation in phantoms and in four volunteers. © RSNA, 2011.

  10. Clinical features of panic patients sensitive to hyperventilation or breath-holding methods for inducing panic attacks

    Directory of Open Access Journals (Sweden)

    A.E. Nardi

    2004-02-01

    Full Text Available Our aim was to compare the clinical features of panic disorder (PD patients sensitive to hyperventilation or breath-holding methods of inducing panic attacks. Eighty-five PD patients were submitted to both a hyperventilation challenge test and a breath-holding test. They were asked to hyperventilate (30 breaths/min for 4 min and a week later to hold their breath for as long as possible, four times with a 2-min interval. Anxiety scales were applied before and after the tests. We selected the patients who responded with a panic attack to just one of the tests, i.e., those who had a panic attack after hyperventilating (HPA, N = 24, 16 females, 8 males, mean age ± SD = 38.5 ± 12.7 years and those who had a panic attack after breath holding (BHPA, N = 20, 11 females, 9 males, mean age ± SD = 42.1 ± 10.6 years. Both groups had similar (chi² = 1.28, d.f. = 1, P = 0.672 respiratory symptoms (fear of dying, chest/pain disconfort, shortness of breath, paresthesias, and feelings of choking during a panic attack. The criteria of Briggs et al. [British Journal of Psychiatry, 1993; 163: 201-209] for respiratory PD subtype were fulfilled by 18 (75.0% HPA patients and by 14 (70.0% BHPA patients. The HPA group had a later onset of the disease compared to BHPA patients (37.9 ± 11.0 vs 21.3 ± 12.9 years old, Mann-Whitney, P < 0.001, and had a higher family prevalence of PD (70.8 vs 25.0%, chi² = 19.65, d.f. = 1, P = 0.041. Our data suggest that these two groups - HPA and BHPA patients - may be specific subtypes of PD.

  11. Moderate correlation between breath-holding and CO(2) inhalation/hyperventilation methods for transcranial doppler evaluation of cerebral vasoreactivity.

    Science.gov (United States)

    Haussen, Diogo C; Katsnelson, Michael; Rodriguez, Abiezer; Campo, Nelly; Campo-Bustillo, Iszet; Romano, Jose G; Koch, Sebastian

    2012-01-01

    Both CO(2) inhalation followed by hyperventilation and breath-holding have been utilized to measure cerebral vasomotor reactivity (VMR) but their correlation has been poorly studied and understood. A retrospective study was conducted in 143 subjects (62.6 ± 15.8 years old, 64% men) with transcranial Doppler ultrasonography measurement of mean flow velocity (MFV) at baseline, after 30 seconds of breath-holding, and after CO(2) inhalation followed by hyperventilation, in the left and right middle cerebral artery. Breath-holding index (BHI) was calculated as the percentage of MFV increase from baseline per second of apnea. CO(2) inhalation/hyperventilation index (CO(2) /HV) was calculated as the percentage of MFV difference between CO(2) inhalation and hyperventilation. There were 75 carotid arteries with >70% stenosis or occlusion, and 18 middle cerebral arteries with >50% stenosis or occlusion. The mean BHI was 0.93 ± 0.7 and 0.89 ± 0.6, whereas the mean CO(2) /HV was 61 ± 26% and 60 ± 26%, respectively, on the right and left sides. The correlation between BHI and CO(2) /HV was moderate on the right (r = 0.33; p < 0.01) and left sides (r = 0.38; p < 0.01). Multivariate linear regression analysis indicated that age (p = 0.01) and history of stroke (p = 0.007) were associated independently with an impaired VMR on the right as measured by CO(2) /HV. No predictors for impaired VMR by CO(2) /HV on the left and by BHI on either side were found. CO(2) /HV and BHI are only moderately correlated. Further studies are necessary to determine which method more accurately predicts clinical morbidity. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 2012; Published online in Wiley Online Library. Copyright © 2012 Wiley Periodicals, Inc.

  12. Single breath hold 3D cardiac cine MRI using kat-ARC: preliminary results at 1.5T.

    Science.gov (United States)

    Jeong, Daniel; Schiebler, Mark L; Lai, Peng; Wang, Kang; Vigen, Karl K; François, Christopher J

    2015-04-01

    Validation of a new single breath-hold, three-dimensional, cine balanced steady-state free precession (3D cine bSSFP) cardiac magnetic resonance (CMR) sequence for left ventricular function. CMR examinations were performed on fifteen patients and three healthy volunteers on a clinical 1.5T scanner using a two-dimensional (2D) cine balanced SSFP CMR sequence (2D cine bSSFP) followed by an investigational 3D cine bSSFP pulse sequence acquired within a single breath hold. Left ventricular end diastolic volume (LVEDV), end systolic volume (LVESV), ejection fraction (LVEF), and myocardial mass were independently segmented on a workstation by two experienced radiologists. Blood pool to myocardial contrast was evaluated in consensus using a Likert scale. Bland-Altman analysis was used to compare these quantitative and nominal measurements for the two sequences. The average acquisition time was significantly shorter for the 3D cine bSSFP than for 2D cine bSSFP (0.36 ± 0.03 vs. 8.5 ± 2.3 min) p = 0.0002. Bland-Altman analyses [bias and (limits of agreement)] of the data derived from these two methods revealed that the LVEF 0.9% (-4.7, 6.4), LVEDV 4.9 ml (-23.0, 32.8), LVESV -0.2 ml (-22.4, 21.9), and myocardial mass -0.4 g (-23.8, 23.0) were not significantly different. There was excellent intraclass correlation for intra-observer variability (0.981, 0.989, 0.997, 0.985) and inter-observer variability (0.903, 0.954, 0.970, 0.842) for LVEF, LVEDV, LVESV, and myocardial mass respectively. 3D cine bSSFP allows for accurate single breath-hold volumetric cine CMR which enables substantial improvements in scanner time efficiency without sacrificing diagnostic accuracy.

  13. “Lung packing” in breath hold-diving: An impressive case of pulmo–cardiac interaction

    Directory of Open Access Journals (Sweden)

    Jochen D. Schipke

    2015-01-01

    Full Text Available There is a complex interaction between the heart and the lungs. We report on a healthy female who performs breath hold diving at a high, international level. In order to optimize pressure equalization during diving and to increase oxygen available, apneists employed a special breathing maneuver, so called “lung packing”. Based on cardiac MRI we could demonstrate impressive effects of this maneuver on left ventricular geometry and hemodynamics. Beyond the fact, that our findings support the concept of pulmonary –cardiac interrelationship, it should be emphasized, that the reported, extreme breathing maneuver could have detrimental consequences due to reduction of stroke volume and cardiac output.

  14. Breath-holding spells: Prevalence and risk factors in under 6-year old children at south of Tehran

    OpenAIRE

    P. Tootoonchi

    2001-01-01

    To determine breath- holding spells (BHS) prevalence and risk factors in under 6- year- old children, we interviewed mothers of 400 children in a cross- sectional study in 5 health centers at south of Tehran in autumn 1999. 33 children (8.25%) had history of BHS (Male: 19, Female: 14 25 cases were between 2-4 years old (mean: 40±17 months). Seventy percent of cases (23) had onset of attacks after 6 months of age (mean: 10 monthis) and the commonest frequency was one spell per month...

  15. Study of breath-holding spell and its triggering factors in Children’s Hospital Medical Center

    OpenAIRE

    Ashrafi MR

    2000-01-01

    To evaluate breath-holding spell (BHS) and its triggering factors, 47 children with BHS admitted to the out patients clinic of Children's hospital medical center, between Sept 1998-June 1999, were included in this prospective study. Diagnosis of BHS was made for cases by medical history, pediatric physical examination, EEG, ECG and lab findings. 4 cases were excluded from study because of paroxysmal epileptic discharges at their EEGs. Of 43 cases having BHS (M:F: 1.15:1), 74.4% were less...

  16. Double-blind, placebo-controlled trial on the effect of piracetam on breath-holding spells.

    Science.gov (United States)

    Sawires, Happy; Botrous, Osama

    2012-07-01

    Breath-holding spells (BHS) are apparently frightening events occurring in otherwise healthy children.The aim of this study was to evaluate the efficacy of piracetam in the treatment of breath-holding spells. Forty patients with BHS (who were classified into two groups)were involved in a double-blinded placebo-controlled prospective study. Piracetam was given to group A while group B received placebo. Patients were followed monthly for a total period of 4 months. The numbers of attacks/month before and monthly after treatment were documented, and the overall number of attacks/month after treatment was calculated in both groups. The median number of attacks/month before treatment in the two groups was 5.5 and 5,respectively, while after the first month of treatment, it was 2 and 5, respectively. The median overall number of attacks/month after treatment in both groups was 1 and 5, respectively.There was a significant decline of number of attacks after piracetam treatment compared to placebo (p valuespells in children.

  17. Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt.

    Science.gov (United States)

    Sadek, Abdelrahim Abdrabou; Mohamed, Montaser Mohamed; Sharaf, El-Zahraa El-Said Ahmed; Magdy, Rofaida Mohamed; Allam, Ahmed Ahmed

    2016-04-01

    Breath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital. An observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG). During the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children. BHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country.

  18. Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

    Science.gov (United States)

    Sadek, Abdelrahim Abdrabou; Mohamed, Montaser Mohamed; Sharaf, El-Zahraa El-Said Ahmed; Magdy, Rofaida Mohamed; Allam, Ahmed Ahmed

    2016-01-01

    Introduction Breath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital. Methods An observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG). Results During the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children. Conclusion BHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country. PMID:27279996

  19. In vivo breath-hold (1) H MRS simultaneous estimation of liver proton density fat fraction, and T1 and T2 of water and fat, with a multi-TR, multi-TE sequence.

    Science.gov (United States)

    Hamilton, Gavin; Middleton, Michael S; Hooker, Jonathan C; Haufe, William M; Forbang, Nketi I; Allison, Matthew A; Loomba, Rohit; Sirlin, Claude B

    2015-12-01

    To examine the intra-examination repeatability of proton density fat fraction (PDFF) and T1 and T2 of liver water and fat as estimated by a novel multi-repetition time (TR)-echo time (TE) (1) H magnetic resonance spectroscopy (MRS)-stimulated echo acquisition mode (STEAM) sequence that acquires 32 spectra for a range of TRs and TEs in single breath-hold. Sixty-seven subjects undergoing liver MRI examinations at 3T had three multi-TR-TE sequences acquired consecutively in a single session. This sequence was designed to allow accurate estimation of T1 and T2 of both water and fat, as well as PDFF, in a single breath-hold. A standard long-TR, multi-TE sequence was also acquired to allow comparison of estimated PDFF. Regression and interclass correlation (ICC) analyses were performed. There was strong agreement between PDFF estimated by the multi-TR-TE and long-TR, multi-TE sequences (slope 0.997; intercept -0.03; R = 0.997). The multi-TR-TE sequence had high repeatability for estimating PDFF (ICC = 0.999), water T2 (ICC = 0.920), water T1 (ICC = 0.845), and fat T2 (ICC = 0.760), and moderate repeatability for estimating fat T1 (ICC = 0.556). A novel multi-TR-TE sequence can estimate PDFF and water and fat T1 and T2 in a single breath-hold. Refinement may be needed to improve repeatability for fat T1 estimation. © 2015 Wiley Periodicals, Inc.

  20. SU-F-T-254: Dose Volume Histogram (DVH) Analysis of Breath Hold Vs Free Breathing Techniques for Esophageal Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Badkul, R; Doke, K; Pokhrel, D; Aguilera, N; Lominska, C [University of Kansas Medical Center, Kansas City, KS (United States)

    2016-06-15

    Purpose: Lung and heart doses and associated toxicity are of concern in radiotherapy for esophageal cancer. This study evaluates the dosimetry of deep-inspiration-breath-hold (DIBH) technique as compared to freebreathing( FB) using 3D-conformal treatment(3D-CRT) of esophageal cancer. Methods: Eight patients were planned with FB and DIBH CT scans. DIBH scans were acquired using Varian RPM system. FB and DIBH CTs were contoured per RTOG-1010 to create the planning target volume(PTV) as well as organs at risk volumes(OAR). Two sets of gross target volumes(GTV) with 5cm length were contoured for each patient: proximal at the level of the carina and distal at the level of gastroesophageal junction and were enlarged with appropriate margin to generate Clinical Target Volume and PTV. 3D-CRT plans were created on Eclipse planning system for 45Gy to cover 95% of PTV in 25 fractions for both proximal and distal tumors on FB and DIBH scans. For distal tumors celiac nodes were covered electively. DVH parameters for lung and heart OARs were generated and analyzed. Results: All DIBH DVH parameters were normalized to FB plan values. Average of heart-mean and heart-V40 was 0.70 and 0.66 for proximal lesions. For distal lesions ratios were 1.21 and 2.22 respectively. For DIBH total lung volume increased by 2.43 times versus FB scan. Average of lung-mean, V30, V20, V10, V5 are 0.82, 0.92, 0.76, 0.77 and 0.79 for proximal lesions and 1.17,0.66,0.87,0.93 and 1.03 for distal lesions. Heart doses were lower for breath-hold proximal lesions but higher for distal lesions as compared to free-breathing plans. Lung doses were lower for both proximal and distal breath-hold lesions except mean lung dose and V5 for distal lesions. Conclusion: This study showed improvement of OAR doses for esophageal lesions at mid-thoracic level utilizing DIBH vs FB technique but did not show consistent OAR sparing with DIBH for distal lesions.

  1. Early report: Comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Spencer, J.A.; Tomlinson, A.J.; Weston, M.J.; Lloyd, S.N

    2000-06-01

    AIM: To compare assessment by MR excretory urography (MREU), Doppler ultrasound and isotope renography of women with symptomatic hydronephrosis in pregnancy and to define its cause. MATERIALS AND METHODS: Eleven women at 19-34 weeks of gestation were studied prospectively with gadolinium-enhanced breath-hold gradient echo MREU and transabdominal Doppler ultrasound compared with a 'gold standard' of isotope renography employing frusemide challenge. All studies were performed within 24 h, were reported independently in a blinded fashion and employed clearly defined criteria. Obstetric and infant outcomes were obtained. RESULTS: There were no adverse reactions to gadolinium administration in pregnancy and no adverse obstetric or infant outcomes. Three of the 11 women were unable to tolerate the complete MREU protocol. Ultrasound indices could not be used to predict ureteric obstruction as shown by isotope renography. MREU agreed with renographic findings in five of the six cases with obstruction and in two without obstruction. MREU directly demonstrated hydronephrosis to result from extrinsic compression of the ureter between the gravid uterus and iliopsoas muscle. CONCLUSION: MR excretory urography is a promising technique which affords equivalent functional and additional anatomical information to isotope renography. It is more accurate than Doppler ultrasound in the assessment of ureteric obstruction in pregnancy. Spencer, J. A. (2000)

  2. Breath-holding spells: Prevalence and risk factors in under 6-year old children at south of Tehran

    Directory of Open Access Journals (Sweden)

    P. Tootoonchi

    2001-05-01

    Full Text Available To determine breath- holding spells (BHS prevalence and risk factors in under 6- year- old children, we interviewed mothers of 400 children in a cross- sectional study in 5 health centers at south of Tehran in autumn 1999. 33 children (8.25% had history of BHS (Male: 19, Female: 14 25 cases were between 2-4 years old (mean: 40±17 months. Seventy percent of cases (23 had onset of attacks after 6 months of age (mean: 10 monthis and the commonest frequency was one spell per month (78.79%. Painful experience and falling and striking the head wee the common triggering factors (79% and 76% respectively and there was significant association between BHS and history of fallin and severe striking of the head. There was no significant associations between BHS and sex, birth weight, birth order, delivery method, type of labor initiating and duration of labor.

  3. Accuracy Evaluation of a 3-Dimensional Surface Imaging System for Guidance in Deep-Inspiration Breath-Hold Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Alderliesten, Tanja; Sonke, Jan-Jakob; Betgen, Anja; Honnef, Joeri; Vliet-Vroegindeweij, Corine van [Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Remeijer, Peter, E-mail: p.remeijer@nki.nl [Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)

    2013-02-01

    Purpose: To investigate the applicability of 3-dimensional (3D) surface imaging for image guidance in deep-inspiration breath-hold radiation therapy (DIBH-RT) for patients with left-sided breast cancer. For this purpose, setup data based on captured 3D surfaces was compared with setup data based on cone beam computed tomography (CBCT). Methods and Materials: Twenty patients treated with DIBH-RT after breast-conserving surgery (BCS) were included. Before the start of treatment, each patient underwent a breath-hold CT scan for planning purposes. During treatment, dose delivery was preceded by setup verification using CBCT of the left breast. 3D surfaces were captured by a surface imaging system concurrently with the CBCT scan. Retrospectively, surface registrations were performed for CBCT to CT and for a captured 3D surface to CT. The resulting setup errors were compared with linear regression analysis. For the differences between setup errors, group mean, systematic error, random error, and 95% limits of agreement were calculated. Furthermore, receiver operating characteristic (ROC) analysis was performed. Results: Good correlation between setup errors was found: R{sup 2}=0.70, 0.90, 0.82 in left-right, craniocaudal, and anterior-posterior directions, respectively. Systematic errors were {<=}0.17 cm in all directions. Random errors were {<=}0.15 cm. The limits of agreement were -0.34-0.48, -0.42-0.39, and -0.52-0.23 cm in left-right, craniocaudal, and anterior-posterior directions, respectively. ROC analysis showed that a threshold between 0.4 and 0.8 cm corresponds to promising true positive rates (0.78-0.95) and false positive rates (0.12-0.28). Conclusions: The results support the application of 3D surface imaging for image guidance in DIBH-RT after BCS.

  4. Heart position variability during voluntary moderate deep inspiration breath-hold radiotherapy for breast cancer determined by repeat CBCT scans.

    Science.gov (United States)

    van Haaren, Paul; Claassen-Janssen, Fiere; van de Sande, Ingrid; Boersma, Liesbeth; van der Sangen, Maurice; Hurkmans, Coen

    2017-08-01

    Voluntary moderate deep inspiration breath hold (vmDIBH) in left-sided breast cancer radiotherapy reduces cardiac dose. The aim of this study was to investigate heart position variability in vmDIBH using CBCT and to compare this variability with differences in heart position between vmDIBH and free breathing (FB). For 50 patients initial heart position with respect to the field edge (HP-FE) was measured on a vmDIBH planning CT scan. Breath-hold was monitored using an in-house developed vertical plastic stick. On pre-treatment CBCT scans, heart position variability with respect to the field edge (ΔHP-FE) was measured, reflecting heart position variability when using an offline correction protocol. After registering the CBCT scan to the planning CT, heart position variability with respect to the chest wall (ΔHP-CW) was measured, reflecting heart position variability when using an online correction protocol. As a control group, vmDIBH and FB computed tomography (CT) scans were acquired for 30 patients and registering both scans on the chest wall. For 34 out of 50 patients, the average HP-FE and HP-CW increased over the treatment course in comparison to the planning CT. Averaged over all patients and all treatment fractions, the ΔHP-FE and the ΔHP-CW was 0.8±4.2mm (range -9.4-+10.6mm) and 1.0±4.4mm (range -8.3-+10.4mm) respectively. The average gain in heart to chest wall distance was 11.8±4.6mm when using vmDIBH instead of FB. In conclusion, substantial variability in heart position using vmDIBH was observed during the treatment course. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. The assessment of the breath hold and the free breath methods about the blood flow evaluation by using phase contrast MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Ho [Dept. of Radiology, Konkuk Medical center, Seoul (Korea, Republic of)

    2016-06-15

    Measurement of cardiac blood flow using the magnetic resonance imaging has been limited due to breathing and involuntary movements of the heart. The present study attempted to improve the accuracy of cardiac blood flow testing through phase contrast magnetic resonance imaging by presenting the adequate breathing method and imaging variables by comparing the measurement values of cardiac blood flow. Each was evaluated by comparing the breath hold retrospective 1NEX and non breath hold retrospective 1-3NEX in the ascending aorta and descending aorta. As a result, the average blood flow amount/ velocity of the breath hold retrosepctive 1NEX method in the ascending aorta were 96.17±19.12 ml/sec, 17.04±4.12 cm/sec respectively, which demonstrates a statistically significant difference(p<0.05) with the non-breath hold retrospective method 1NEX of 72.31±13.27 ml and 12.32±3.85. On the other hand, the average 2NEX blood flow and mean flow velocity is 101.90±24.09, 16.84±4.32, 3NEX 103.06±25.49, 16.88±4.19 did not show statistically significant differences(p>0.05).The average blood flow amount/ velocity of the breath hold retrospective 1NEX method in the descending aorta were 76.68±19.72 ml/s, and 22.23±4.8, which did not demonstrate a significant difference in comparison to non-breath hold retrospective method 1-3 NEX. Therefore, the non breath hold retrospective method does not significantly differ in terms of cardiac blood flow in comparison with the breath hold retrospective method in accordance with the increase of NEX, so pediatric patients or patients who are not able to breathe well must have the diagnostic value of their cardiac blood flow tests improved.

  6. Monte Carlo calculations support organ sparing in Deep-Inspiration Breath-Hold intensity-modulated radiotherapy for locally advanced lung cancer

    DEFF Research Database (Denmark)

    Ottosson, Wiviann; Sibolt, Patrik; Larsen, Christina

    2015-01-01

    Background and purpose: Studies indicate that Deep-Inspiration Breath-Hold (DIBH) is advantageous over Free-Breathing (FB) for locally advanced lung cancer radiotherapy. However, these studies were based on simplified dose calculation algorithms, potentially critical due to the heterogeneous nature...

  7. Estimation of heart-position variability in 3D-surface-image-guided deep-inspiration breath-hold radiation therapy for left-sided breast cancer

    NARCIS (Netherlands)

    Alderliesten, Tanja; Betgen, Anja; Elkhuizen, Paula H. M.; van Vliet-Vroegindeweij, Corine; Remeijer, Peter

    2013-01-01

    To investigate the heart position variability in deep-inspiration breath-hold (DIBH) radiation therapy (RT) for breast cancer when 3D surface imaging would be used for monitoring the BH depth during treatment delivery. For this purpose, surface setup data were compared with heart setup data. Twenty

  8. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Lingfeng; Xu, Xingxiang [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Song, Yong [Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, Jiangsu (China); Issahar, Ben-Dov [Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Wu, Jingtao; Zhang, Le; Huang, Qian [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Chen, Mingxiang, E-mail: chenmx1129@126.com [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China)

    2013-01-15

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.

  9. Rapid acquisition of helium-3 and proton three-dimensional image sets of the human lung in a single breath-hold using compressed sensing.

    Science.gov (United States)

    Qing, Kun; Altes, Talissa A; Tustison, Nicholas J; Feng, Xue; Chen, Xiao; Mata, Jaime F; Miller, G Wilson; de Lange, Eduard E; Tobias, William A; Cates, Gordon D; Brookeman, James R; Mugler, John P

    2015-10-01

    To develop and validate a method for acquiring helium-3 ((3) He) and proton ((1) H) three-dimensional (3D) image sets of the human lung with isotropic spatial resolution within a 10-s breath-hold by using compressed sensing (CS) acceleration, and to assess the fidelity of undersampled images compared with fully sampled images. The undersampling scheme for CS acceleration was optimized and tested using (3) He ventilation data. Rapid 3D acquisition of both (3) He and (1) H data during one breath-hold was then implemented, based on a balanced steady-state free-precession pulse sequence, by random undersampling of k-space with reconstruction by means of minimizing the L1 norm and total variance. CS-reconstruction fidelity was evaluated quantitatively by comparing fully sampled and retrospectively undersampled image sets. Helium-3 and (1) H 3D image sets of the lung with isotropic 3.9-mm resolution were acquired during a single breath-hold in 12 s and 8 s using acceleration factors of 2 and 3, respectively. Comparison of fully sampled and retrospectively undersampled (3) He and (1) H images yielded mean absolute errors 0.9. By randomly undersampling k-space and using CS reconstruction, high-quality (3) He and (1) H 3D image sets with isotropic 3.9-mm resolution can be acquired within an 8-s breath-hold. © 2014 Wiley Periodicals, Inc.

  10. Single breath-hold 3D measurement of left atrial volume using compressed sensing cardiovascular magnetic resonance and a non-model-based reconstruction approach

    NARCIS (Netherlands)

    Vardoulis, Orestis; Monney, Pierre; Bermano, Amit; Vaxman, A.|info:eu-repo/dai/nl/413533662; Gotsman, Craig; Schwitter, Janine; Stuber, Matthias; Stergiopulos, Nikolaos; Schwitter, Juerg

    2015-01-01

    Background: Left atrial (LA) dilatation is associated with a large variety of cardiac diseases. Current cardiovascular magnetic resonance (CMR) strategies to measure LA volumes are based on multi-breath-hold multi-slice acquisitions, which are time-consuming and susceptible to misregistration. Aim:

  11. Robustness of the Voluntary Breath-Hold Approach for the Treatment of Peripheral Lung Tumors Using Hypofractionated Pencil Beam Scanning Proton Therapy

    NARCIS (Netherlands)

    Dueck, Jenny; Knopf, Antje-Christin; Lomax, Antony; Albertini, Francesca; Persson, Gitte F; Josipovic, Mirjana; Aznar, Marianne C.; Weber, Damien C.; Munck af Rosenschöld, Per

    2016-01-01

    PURPOSE: The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery

  12. Robustness of the Voluntary Breath-Hold Approach for the Treatment of Peripheral Lung Tumors Using Hypofractionated Pencil Beam Scanning Proton Therapy

    DEFF Research Database (Denmark)

    Dueck, Jenny; Knopf, Antje-Christin; Lomax, Antony

    2016-01-01

    PURPOSE: The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delive...

  13. SU-E-J-32: Calypso(R) and Laser-Based Localization Systems Comparison for Left-Sided Breast Cancer Patients Using Deep Inspiration Breath Hold

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, S [Northwest Medical Physics Center, Lynnwood, WA (United States); Kaurin, D; Sweeney, L [Northwest Medical Physics Center, Lynnwood, WA (United States); Seattle Cancer Care Alliance, Seattle, WA (United States); Kim, J; Fang, L; Tran, A [Seattle Cancer Care Alliance, Seattle, WA (United States); University of Washington Medical Center, Seattle, WA (United States); Holloway, K [Seattle Cancer Care Alliance, Seattle, WA (United States)

    2014-06-01

    Purpose: Our institution uses a manual laser-based system for primary localization and verification during radiation treatment of left-sided breast cancer patients using deep inspiration breath hold (DIBH). This primary system was compared with sternum-placed Calypso(R) beacons (Varian Medical Systems, CA). Only intact breast patients are considered for this analysis. Methods: During computed tomography (CT) simulation, patients have BB and Calypso(R) surface beacons positioned sternally and marked for free-breathing and DIBH CTs. During dosimetry planning, BB longitudinal displacement between free breathing and DIBH CT determines laser mark (BH mark) location. Calypso(R) beacon locations from the DIBH CT are entered at the Tracking Station. During Linac simulation and treatment, patients inhale until the cross-hair and/or lasers coincide with the BH Mark, which can be seen using our high quality cameras (Pelco, CA). Daily Calypso(R) displacement values (difference from the DIBH-CT-based plan) are recorded.The displacement mean and standard deviation was calculated for each patient (77 patients, 1845 sessions). An aggregate mean and standard deviation was calculated weighted by the number of patient fractions.Some patients were shifted based on MV ports. A second data set was calculated with Calypso(R) values corrected by these shifts. Results: Mean displacement values indicate agreement within 1±3mm, with improvement for shifted data (Table). Conclusion: Both unshifted and shifted data sets show the Calypso(R) system coincides with the laser system within 1±3mm, demonstrating either localization/verification system will Resultin similar clinical outcomes. Displacement value uncertainty unilaterally reduces when shifts are taken into account.

  14. Comparison of transient severe motion in gadoxetate disodium and gadopentetate dimeglumine-enhanced MRI: effect of modified breath-holding method.

    Science.gov (United States)

    Song, Ji Soo; Choi, Eun Jung; Park, Eun Hae; Lee, Ju-Hyung

    2017-10-06

    To compare the occurrence of transient severe motion (TSM) between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI and between gadoxetate disodium-enhanced MRI scans obtained with and without the application of a modified breath-holding technique. We reviewed 80 patients who underwent two magnetic resonance examinations (gadoxetate disodium-enhanced MRI and gadopentetate dimeglumine-enhanced MRI) with the application of a modified breath-holding technique (dual group). This group was compared with 100 patients who underwent gadoxetate disodium-enhanced MRI without the application of the modified breath-holding technique (single group). Patient risk factors and motion scores (1 [none] to 5 [non-diagnostic]) for each dynamic-phase imaging were analysed. In the dual group, mean motion scores did not differ significantly between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI (p=0.096-0.807) in any phase. However, in all phases except the late dynamic phase, mean motion scores of the dual group were significantly lower than those in the single group. TSM incidence did not differ significantly between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI in the dual group (3.8% vs. 1.3%, p=0.620). With proper application of the modified breath-holding technique, TSM occurrence with gadoxetate disodium-enhanced MRI was comparable to that associated with gadopentetate dimeglumine-enhanced MRI. • The modified breath-holding method significantly reduced the incidence of TSM. • Gadoxetate disodium and gadopentetate dimeglumine showed comparable motion scores. • TSM incidence was comparable between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI.

  15. Deep Inspiration Breath Hold [(18)F]FDG PET-CT on 4-rings scanners in evaluating lung lesions: evidences from a phantom and a clinical study.

    Science.gov (United States)

    Caobelli, Federico; Puta, Erinda; Kaiser, Stefano Ren; Massetti, Valentina; Andreoli, Michela; Mostarda, Angelica; Soffientini, Alberto; Pizzocaro, Claudio; Guerra, Ugo Paolo

    2014-01-01

    To investigate the clinical feasibility of a Deep Inspiration Breath Hold (DIBH) (18)F-FDG PET-CT acquisition in apnea and compare the results obtained between these acts of acquisition in apnea and in Free Breathing in the evaluation of lung lesions. A pre-clinical phantom study was performed to evaluate the shortest simulated DIBH time according to the minimum detectable lesion that can be detected by our ultrasound scanner. This study was conducted by changing acquisition time and sphere-to-background activity ratio values and by using radioactivity densities similar to those generally found in clinical examinations. In the clinical study, 25 patients with pulmonary lesions underwent a standard whole body (18)F-FDG PET-CT scan in free breathing followed by a 20s single thorax acquisition PET/CT in DIBH acquisition. The phantom study indicated that a 20-s acquisition time provides an accurate evaluation of smallest sphere shaped lesions. In the clinical study, PET-CT scans obtained in DIBH studies showed a significant reduction of misalignment between the PET and CT scan images and an increase of SUVmax compared to free breathing acquisitions. A correlation between the %BH-index and lesion displacement between PET and CT images in FB acquisition was demonstrated, significantly higher for lesions with a displacement>8mm. The single 20s acquisition of DIBH PET-CT is a feasible technique for lung lesion detection in the clinical setting. It only requires a minor increase in examination time without special patient training. 20s DIBH scan provided a more precise measurement of SUVmax, especially for lesions in the lower lung lobes which usually show greater displacement between PET and CT scan images in FB acquisition. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  16. An Atypical Case of Taravana Syndrome in a Breath-Hold Underwater Fishing Champion: A Case Report

    Directory of Open Access Journals (Sweden)

    Andrea Cortegiani

    2013-01-01

    Full Text Available Dysbaric accidents are usually referred to compressed air-supplied diving. Nonetheless, some cases of decompression illness are known to have occurred among breath-hold (BH divers also, and they are reported in the medical literature. A male BH diver (57 years old, underwater fishing champion, presented neurological disorders as dizziness, sensory numbness, blurred vision, and left frontoparietal pain after many dives to a 30–35 meters sea water depth with short surface intervals. Symptoms spontaneously regressed and the patient came back home. The following morning, pain and neurological impairment occurred again and the diver went by himself to the hospital where he had a generalized tonic-clonic seizure and lost consciousness. A magnetic resonance imaging of the brain disclofsed a cortical T1-weighted hypointense area in the temporal region corresponding to infarction with partial hemorrhage. An early hyperbaric oxygen therapy led to prompt resolution of neurological findings. All clinical and imaging characteristics were referable to the Taravana diving syndrome, induced by repetitive prolonged deep BH dives. The reappearance of neurological signs after an uncommon 21-hour symptom-free interval may suggest an atypical case of Taravana syndrome.

  17. Parental attitude, depression, anxiety in mothers, family functioning and breath-holding spells: A case control study.

    Science.gov (United States)

    Eliacik, Kayi; Bolat, Nurullah; Kanik, Ali; Sargin, Enis; Selkie, Ellen; Korkmaz, Nurhan; Baydan, Figen; Akar, Ebru; Sarioglu, Berrak

    2016-05-01

    This study aimed to identify differences in the antenatal stressful life events, parenting style, family functioning, depression and anxiety of mothers who have children with breath-holding spells (BHS) compared with controls. This case control study divided 66 children into a group of children with BHS and a control group, with the children's ages ranging between 6 months and 5 years of age. This study explored underlying anxiety and depression in mothers as well as functioning of their families. Socio-demographical data and stressful life events that the mother experienced during pregnancy were analysed. In order to evaluate the effects of family structure, depression and anxiety in mothers on BHS in children, the Family Assessment Device, and both the Parental Attitude Research Instrument and the Beck Depression Inventory as well as the State-Trait Anxiety Inventory were used to assess both groups. Exposure to stressful life events during pregnancy (P anxiety (P anxiety, depression, prenatal stressful events and poor family functioning in mothers who have children with BHS is significantly higher than controls. An evaluation of these problems may be beneficial in the management of BHS. © 2016 The Authors. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  18. Efficacy of a Brief Psychoeducational Intervention for Mothers of Children with Breath-Holding Spells: A Randomized Controlled Pilot Trial.

    Science.gov (United States)

    Bolat, Nurullah; Eliacik, Kayi; Sargin, Enis; Kanik, Ali; Baydan, Figen; Sarioglu, Berrak

    2016-08-01

    Objective Mothers of individuals with breath-holding spells (BHS) suffer more often from anxiety and experience more stressors in their everyday life. The purpose of this study was to examine the efficacy of psychoeducational intervention in reducing BHS and coping with these spells. Participants and Methods Mothers who have children with BHS were randomly assigned to one of the two groups: an intervention group receiving psychoeducational therapy in addition to the routine follow-up (n = 31) and a control group who did not receive psychoeducation in their routine follow-up (n = 28). The data collected at the beginning of the study and at the end of 3rd and 6th months about the frequency of the spells per month, maternal anxiety, and depression levels and mothers' perceived self-knowledge about coping BHS of both groups were compared. Results Mothers in psychoeducation group, compared with controls, improved significantly on state anxiety, depression, perceived anticipation anxiety level for BHS of their children and self-knowledge about coping with the spells. Conclusion The intervention program had a positive effect on anxiety-depression levels of the mothers and the frequency of BHS among the children. The possible link between emotional and autonomic dysregulation in children with BHS and maternal mental health were discussed. Georg Thieme Verlag KG Stuttgart · New York.

  19. The evaluation of physiological and biochemical parameters and the autonomic nervous systems of children with breath-holding spells.

    Science.gov (United States)

    Arslan, Huseyin; Torun, Emel; Akkan, Julide Canan U; Guler, Serhat; Bayraktar, Suleyman

    2014-08-01

    The aim of this study was to investigate the physiological and biochemical parameters of children who are experiencing breath-holding spells (BHS) and to compare the function of their autonomic nervous systems with those of healthy children. A total of 30 children (age range, 6 months-5 years) admitted for BHS were included in the study. The control group consisted of 30 age-matched and gender-matched healthy children. Each participant underwent a detailed physical examination as well as a laboratory evaluation. Echocardiography, electrocardiography (ECG), and electroencephalography were performed in the study group. The pilocarpine eye test was administered to each participant to detect autonomic dysfunction.  No statistically significant differences were found between the groups for mean age, gender, and anthropometric measurements, nor for the biochemical parameters, including hemoglobin concentration, hematocrit, serum iron, transferrin saturation, ferritin, vitamin D, and vitamin B12 levels (p = 0.05). Compared with the control group, the study group showed significantly abnormal hypersensitivity of pupils after instillation of pilocarpine into their eyes (p = 0.01).  Autonomic dysfunction existed in the children with BHS, but no correlation was found between BHS and deficiencies of iron, vitamin D, or vitamin B12. Georg Thieme Verlag KG Stuttgart · New York.

  20. Study of breath-holding spell and its triggering factors in Children’s Hospital Medical Center

    Directory of Open Access Journals (Sweden)

    Ashrafi MR

    2000-06-01

    Full Text Available To evaluate breath-holding spell (BHS and its triggering factors, 47 children with BHS admitted to the out patients clinic of Children's hospital medical center, between Sept 1998-June 1999, were included in this prospective study. Diagnosis of BHS was made for cases by medical history, pediatric physical examination, EEG, ECG and lab findings. 4 cases were excluded from study because of paroxysmal epileptic discharges at their EEGs. Of 43 cases having BHS (M:F: 1.15:1, 74.4% were less there 24 months of age (Mean age 18.4 mo. 77% of patients had onset of BHS within 12 months of age. Family history of BHS in first degree relatives were found in 51% of patients. Parent consanguinity were found in 30% of cases. The commonest type of BHS were cyanotic (79.1%. Pallid (11.6% and mixed (9.3% were other types. Pain and anger were the commonest triggering factors. 78% of cases were iron deficient and 53% of cases had iron deficiency anemia.

  1. The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Smyth, Lloyd M, E-mail: lloyd.smyth@epworth.org.au [Epworth Radiation Oncology, Level 4, The Epworth Centre, Richmond, Victoria (Australia); Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, School of Biomedical Sciences, Nursing and Health Sciences, Monash University, Clayton, Victoria (Australia); Knight, Kellie A [Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, School of Biomedical Sciences, Nursing and Health Sciences, Monash University, Clayton, Victoria (Australia); Aarons, Yolanda K; Wasiak, Jason [Epworth Radiation Oncology, Level 4, The Epworth Centre, Richmond, Victoria (Australia)

    2015-03-15

    Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.

  2. Automatically gated image-guided breath-hold IMRT is a fast, precise, and dosimetrically robust treatment for lung cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Simeonova-Chergou, Anna; Jahnke, Anika; Siebenlist, Kerstin; Stieler, Florian; Mai, Sabine; Boda-Heggemann, Judit; Wenz, Frederik; Lohr, Frank; Jahnke, Lennart [University Medical Center Mannheim, University of Heidelberg, Department of Radiotherapy and Oncology, Mannheim (Germany)

    2016-03-15

    High-dose radiotherapy of lung cancer is challenging. Tumors may move by up to 2 cm in craniocaudal and anteroposterior directions as a function of breathing cycle. Tumor displacement increases with treatment time, which consequentially increases the treatment uncertainty. This study analyzed whether automatically gated cone-beam-CT (CBCT)-controlled intensity modulated fast deep inspiration breath hold (DIBH) stereotactic body radiation therapy (SBRT) in flattening filter free (FFF) technique and normofractionated lung DIBH intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) treatments delivered with a flattening filter can be applied with sufficient accuracy within a clinically acceptable timeslot. Plans of 34 patients with lung tumors were analyzed. Of these patients, 17 received computer-controlled fast DIBH SBRT with a dose of 60 Gy (5 fractions of 12 Gy or 12 fractions of 5 Gy) in an FFF VMAT technique (FFF-SBRT) every other day and 17 received conventional VMAT with a flattening filter (conv-VMAT) and 2-Gy daily fractional doses (cumulative dose 50-70 Gy). FFF-SBRT plans required more monitor units (MU) than conv-VMAT plans (2956.6 ± 885.3 MU for 12 Gy/fraction and 1148.7 ± 289.2 MU for 5 Gy/fraction vs. 608.4 ± 157.5 MU for 2 Gy/fraction). Total treatment and net beam-on times were shorter for FFF-SBRT plans than conv-VMAT plans (268.0 ± 74.4 s vs. 330.2 ± 93.6 s and 85.8 ± 25.3 s vs. 117.2 ± 29.6 s, respectively). Total slot time was 13.0 min for FFF-SBRT and 14.0 min for conv-VMAT. All modalities could be delivered accurately despite multiple beam-on/-off cycles and were robust against multiple interruptions. Automatically gated CBCT-controlled fast DIBH SBRT in VMAT FFF technique and normofractionated lung DIBH VMAT can be applied with a low number of breath-holds in a short timeslot, with excellent dosimetric accuracy. In clinical routine, these approaches combine optimally reduced lung tissue irradiation with maximal

  3. Less increase of CT-based calcium scores of the coronary arteries. Effect three years after breast-conserving radiotherapy using breath-hold

    Energy Technology Data Exchange (ETDEWEB)

    Mast, M.E.; Kempen-Harteveld, M.L. van; Petoukhova, A.L. [Centre West, Radiotherapy, The Hague (Netherlands); Heijenbrok, M.W. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Scholten, A.N. [Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands); Wolterbeek, R. [Leiden University Medical Centre, Department of Medical Statistics and Bioinformatics, Leiden (Netherlands); Schreur, J.H.M. [Medical Center Haaglanden, Department of Cardiology, The Hague (Netherlands); Struikmans, H. [Centre West, Radiotherapy, The Hague (Netherlands); Leiden University Medical Centre, Department of Clinical Oncology, Leiden (Netherlands)

    2016-10-15

    The aim of this prospective longitudinal study was to compare coronary artery calcium (CAC) scores determined before the start of whole breast irradiation with those determined 3 years afterwards. Changes in CAC scores were analysed in 99 breast cancer patients. Three groups were compared: patients receiving left- and right-sided radiotherapy, and those receiving left-sided radiotherapy with breath-hold. We analysed overall CAC scores and left anterior descending (LAD) and right coronary artery (RCA) CAC scores. Between the three groups, changes of the value of the LAD minus the RCA CAC scores of each individual patient were also compared. Three years after breath-hold-based whole breast irradiation, a less pronounced increase of CAC scores was noted. Furthermore, LAD minus RCA scores in patients treated for left-sided breast cancer without breath-hold were higher when compared to LAD minus RCA scores of patients with right-sided breast cancers and those with left-sided breast cancer treated with breath-hold. Breath-hold in breast-conserving radiotherapy leads to a less pronounced increase of CT-based CAC scores. Therefore, breath-hold probably prevents the development of radiation-induced coronary artery disease. However, the sample size of this study is limited and the follow-up period relatively short. (orig.) [German] Das Ziel dieser prospektiven Langzeitstudie war der Vergleich der Coronary-Artery-Calcium-(CAC-)Werte vor Beginn der Brustbestrahlung mit den Werten nach 3 Jahren. Aenderungen der CAC-Werte wurden bei 99 Brustkrebspatienten analysiert. Drei Gruppen wurden untersucht: Patienten nach links- und rechtsseitiger Strahlentherapie sowie mit Bestrahlung unter Atemanhalt. Wir analysierten die Gesamt-CAC-Werte sowie die CAC-Werte der vorderen linken absteigenden (''left anterior descending'', LAD) und der rechten Koronararterie (''right coronary artery'', RCA). Zwischen den drei Gruppen wurden auch die Veraenderungen

  4. Automated registration of sequential breath-hold dynamic contrast-enhanced MR images: a comparison of three techniques.

    Science.gov (United States)

    Rajaraman, Sivaramakrishnan; Rodriguez, Jeffrey J; Graff, Christian; Altbach, Maria I; Dragovich, Tomislav; Sirlin, Claude B; Korn, Ronald L; Raghunand, Natarajan

    2011-06-01

    Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly in use as an investigational biomarker of response in cancer clinical studies. Proper registration of images acquired at different time points is essential for deriving diagnostic information from quantitative pharmacokinetic analysis of these data. Motion artifacts in the presence of time-varying intensity due to contrast enhancement make this registration problem challenging. DCE-MRI of chest and abdominal lesions is typically performed during sequential breath-holds, which introduces misregistration due to inconsistent diaphragm positions and also places constraints on temporal resolution vis-à-vis free-breathing. In this work, we have employed a computer-generated DCE-MRI phantom to compare the performance of two published methods, Progressive Principal Component Registration and Pharmacokinetic Model-Driven Registration, with Sequential Elastic Registration (SER) to register adjacent time-sample images using a published general-purpose elastic registration algorithm. In all three methods, a 3D rigid-body registration scheme with a mutual information similarity measure was used as a preprocessing step. The DCE-MRI phantom images were mathematically deformed to simulate misregistration, which was corrected using the three schemes. All three schemes were comparably successful in registering large regions of interest (ROIs) such as muscle, liver, and spleen. SER was superior in retaining tumor volume and shape, and in registering smaller but important ROIs such as tumor core and tumor rim. The performance of SER on clinical DCE-MRI data sets is also presented. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Mechanical indentation improves cerebral blood oxygenation signal quality of functional near-infrared spectroscopy (fNIRS) during breath holding

    Science.gov (United States)

    Vogt, William C.; Romero, Edwin; LaConte, Stephen M.; Rylander, Christopher G.

    2013-03-01

    Functional near-infrared spectroscopy (fNIRS) is a well-known technique for non-invasively measuring cerebral blood oxygenation, and many studies have demonstrated that fNIRS signals can be related to cognitive function. However, the fNIRS signal is attenuated by the skin, while scalp blood content has been reported to influence cerebral oxygenation measurements. Mechanical indentation has been shown to increase light transmission through soft tissues by causing interstitial water and blood flow away from the compressed region. To study the effects of indentation on fNIRS, a commercial fNIRS system with 16 emitter/detector pairs was used to measure cerebral blood oxygenation at 2 Hz. This device used diffuse reflectance at 730 nm and 850 nm to calculate deoxy- and oxy-hemoglobin concentrations. A borosilicate glass hemisphere was epoxied over each sensor to function as both an indenter and a lens. After placing the indenter/sensor assembly on the forehead, a pair of plastic bands was placed on top of the fNIRS headband and strapped to the head to provide uniform pressure and tightened to approx. 15 N per strap. Cerebral blood oxygenation was recorded during a breath holding regime (15 second hold, 15 second rest, 6 cycles) in 4 human subjects both with and without the indenter array. Results showed that indentation increased raw signal intensity by 85 +/- 35%, and that indentation increased amplitude of hemoglobin changes during breath cycles by 313% +/- 105%. These results suggest that indentation improves sensing of cerebral blood oxygenation, and may potentially enable sensing of deeper brain tissues.

  6. Minimizing Late Effects for Patients With Mediastinal Hodgkin Lymphoma: Deep Inspiration Breath-Hold, IMRT, or Both?

    Energy Technology Data Exchange (ETDEWEB)

    Aznar, Marianne C., E-mail: marianne.camille.aznar@regionh.dk [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Faculty of Sciences, Niels Bohr Institute, and Faculty of Health Sciences, University of Copenhagen, Copenhagen (Denmark); Maraldo, Maja V.; Schut, Deborah A. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Lundemann, Michael [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Faculty of Sciences, Niels Bohr Institute, and Faculty of Health Sciences, University of Copenhagen, Copenhagen (Denmark); Brodin, N Patrik [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Institute of Onco-Physics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Vogelius, Ivan R. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Berthelsen, Anne K. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Specht, Lena; Petersen, Peter M. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark)

    2015-05-01

    Purpose: Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and intensity modulated RT (IMRT). The aim of this study was to determine which treatment modality best reduced the combined risk of life-threatening late effects in patients with mediastinal HL. Methods and Materials: Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated life years lost attributable to CD and to lung, breast, and thyroid cancer. Results: DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P<.001). There was no significant difference between IMRT-FB and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast dose was increased with IMRT regardless of breathing technique. Life years lost was lowest with DIBH and highest with FB. Conclusions: In this cohort, 3DCRT-DIBH resulted in lower estimated doses and lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be beneficial for a subgroup of patients.

  7. Changes in Respiratory Parameters and Fin-Swimming Performance Following a 16-Week Training Period with Intermittent Breath Holding.

    Science.gov (United States)

    Stavrou, Vasileios; Toubekis, Argyris G; Karetsi, Eleni

    2015-12-22

    The purpose of this study was to examine the effects of training with intermittent breath holding (IBH) on respiratory parameters, arterial oxygen saturation (SpO2) and performance. Twenty-eight fin-swimming athletes were randomly divided into two groups and followed the same training for 16 weeks. About 40% of the distance of each session was performed with self-selected breathing frequency (SBF group) or IBH (IBH group). Performance time of 50 and 400 m at maximum intensity was recorded and forced expired volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and SpO2 were measured before and after the 50 m test at baseline and post-training. Post-training, the respiratory parameters were increased in the IBH but remained unchanged in the SBF group (FEV1: 17 ±15% vs. -1 ±11%; FVC: 22 ±13% vs. 1 ±10%; PEF: 9 ±14% vs. -4 ±15%; p<0.05). Pre compared to post-training SpO2 was unchanged at baseline and decreased post-training following the 50 m test in both groups (p<0.05). The reduction was higher in the IBH compared to the SBF group (p<0.05). Performance in the 50 and 400 m tests improved in both groups, however, the improvement was greater in the IBH compared to the SBF group in both 50 and 400 m tests (p<0.05). The use of IBH is likely to enhance the load on the respiratory muscles, thus, contributing to improvement of the respiratory parameters. Decreased SpO2 after IBH is likely due to adaptation to hypoventilation. IBH favours performance improvement at 50 and 400 m fin-swimming.

  8. Changes in Respiratory Parameters and Fin-Swimming Performance Following a 16-Week Training Period with Intermittent Breath Holding

    Directory of Open Access Journals (Sweden)

    Stavrou Vasileios

    2015-12-01

    Full Text Available The purpose of this study was to examine the effects of training with intermittent breath holding (IBH on respiratory parameters, arterial oxygen saturation (SpO2 and performance. Twenty-eight fin-swimming athletes were randomly divided into two groups and followed the same training for 16 weeks. About 40% of the distance of each session was performed with self-selected breathing frequency (SBF group or IBH (IBH group. Performance time of 50 and 400 m at maximum intensity was recorded and forced expired volume in 1 s (FEV1, forced vital capacity (FVC, peak expiratory flow (PEF and SpO2 were measured before and after the 50 m test at baseline and post-training. Posttraining, the respiratory parameters were increased in the IBH but remained unchanged in the SBF group (FEV1: 17 ±15% vs. -1 ±11%; FVC: 22 ±13% vs. 1 ±10%; PEF: 9 ±14% vs. -4 ±15%; p<0.05. Pre compared to post-training SpO2 was unchanged at baseline and decreased post-training following the 50 m test in both groups (p<0.05. The reduction was higher in the IBH compared to the SBF group (p<0.05. Performance in the 50 and 400 m tests improved in both groups, however, the improvement was greater in the IBH compared to the SBF group in both 50 and 400 m tests (p<0.05. The use of IBH is likely to enhance the load on the respiratory muscles, thus, contributing to improvement of the respiratory parameters. Decreased SpO2 after IBH is likely due to adaptation to hypoventilation. IBH favours performance improvement at 50 and 400 m fin-swimming.

  9. Decompression sickness in breath-hold diving, and its probable connection to the growth and dissolution of small arterial gas emboli.

    Science.gov (United States)

    Goldman, Saul; Solano-Altamirano, J M

    2015-04-01

    We solved the Laplace equation for the radius of an arterial gas embolism (AGE), during and after breath-hold diving. We used a simple three-region diffusion model for the AGE, and applied our results to two types of breath-hold dives: single, very deep competitive-level dives and repetitive shallower breath-hold dives similar to those carried out by indigenous commercial pearl divers in the South Pacific. Because of the effect of surface tension, AGEs tend to dissolve in arterial blood when arteries remote from supersaturated tissue. However if, before fully dissolving, they reach the capillary beds that perfuse the brain and the inner ear, they may become inflated with inert gas that is transferred into them from these contiguous temporarily supersaturated tissues. By using simple kinetic models of cerebral and inner ear tissue, the nitrogen tissue partial pressures during and after the dive(s) were determined. These were used to theoretically calculate AGE growth and dissolution curves for AGEs lodged in capillaries of the brain and inner ear. From these curves it was found that both cerebral and inner ear decompression sickness are expected to occur occasionally in single competitive-level dives. It was also determined from these curves that for the commercial repetitive dives considered, the duration of the surface interval (the time interval separating individual repetitive dives from one another) was a key determinant, as to whether inner ear and/or cerebral decompression sickness arose. Our predictions both for single competitive-level and repetitive commercial breath-hold diving were consistent with what is known about the incidence of cerebral and inner ear decompression sickness in these forms of diving. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

    DEFF Research Database (Denmark)

    Josipovic, Mirjana; Persson, Gitte F; Bangsgaard, Jens Peter

    2016-01-01

    OBJECTIVE: We investigated the impact of deep inspiration breath-hold (DIBH) and tumour baseline shifts on image quality and registration uncertainty in image-guided DIBH radiotherapy (RT) for locally advanced lung cancer. METHODS: Patients treated with daily cone beam CT (CBCT)-guided free...... quality. Advances in knowledge: DIBH RT has dosimetric advantages over FB; this work demonstrates an additional benefit of DIBH in terms of registration accuracy because of improved image quality....

  11. Robustness of the Voluntary Breath-Hold Approach for the Treatment of Peripheral Lung Tumors Using Hypofractionated Pencil Beam Scanning Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Dueck, Jenny, E-mail: jenny.dueck@psi.ch [Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Center for Proton Therapy, Paul Scherrer Institut, Villigen PSI (Switzerland); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Knopf, Antje-Christin [Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London (United Kingdom); Lomax, Antony [Center for Proton Therapy, Paul Scherrer Institut, Villigen PSI (Switzerland); Department of Physics, ETH Zürich, Zürich (Switzerland); Albertini, Francesca [Center for Proton Therapy, Paul Scherrer Institut, Villigen PSI (Switzerland); Persson, Gitte F. [Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Josipovic, Mirjana [Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Aznar, Marianne [Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (Denmark); Weber, Damien C. [Center for Proton Therapy, Paul Scherrer Institut, Villigen PSI (Switzerland); University of Zürich, Zürich (Switzerland); Munck af Rosenschöld, Per [Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark)

    2016-05-01

    Purpose: The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery uncertainties resulting from interfractional motion. Methods and Materials: Data from 15 patients with peripheral lung tumors previously treated with stereotactic radiation therapy were included in this study. The patients had 1 computed tomographic (CT) scan in voluntary breath-hold acquired before treatment and 3 scans during the treatment course. PBS proton treatment plans with 2 fields (2F) and 3 fields (3F), respectively, were calculated based on the planning CT scan and subsequently recalculated on the 3 repeated CT scans. Recalculated plans were considered robust if the V{sub 95%} (volume receiving ≥95% of the prescribed dose) of the gross target volume (GTV) was within 5% of what was expected from the planning CT data throughout the simulated treatment. Results: A total of 14/15 simulated treatments for both 2F and 3F met the robustness criteria. Reduced V{sub 95%} was associated with baseline shifts (2F, P=.056; 3F, P=.008) and tumor size (2F, P=.025; 3F, P=.025). Smaller tumors with large baseline shifts were also at risk for reduced V{sub 95%} (interaction term baseline/size: 2F, P=.005; 3F, P=.002). Conclusions: The breath-hold approach is a realistic clinical option for treating lung tumors with PBS proton therapy. Potential risk factors for reduced V{sub 95%} are small targets in combination with large baseline shifts. On the basis of these results, the baseline shift of the tumor should be monitored (eg, through image guided therapy), and appropriate measures should be taken accordingly. The intrafractional motion needs to be investigated to confirm that the breath-hold approach is robust.

  12. Rapid 3D imaging of the lower airway by MRI in patients with congenital heart disease: A retrospective comparison of delayed volume interpolated breath-hold examination (VIBE) to turbo spin echo (TSE).

    Science.gov (United States)

    Goot, Benjamin H; Patel, Sonali; Fonseca, Brian

    2017-01-01

    When imaging the lower airway by MRI, the traditional technique turbo spin echo (TSE) results in high quality 2D images, however planning and acquisition times are lengthy. An alternative, delayed volume interpolated breath-holds examination (VIBE), is a 3D gradient echo technique that produces high spatial resolution imaging of the airway in one breath-hold. The objective of this study is to retrospectively evaluate the accuracy of lower airway measurements obtained by delayed VIBE when compared to TSE. Patients with congenital heart disease who underwent a cardiac MRI (CMR) that included a delayed VIBE sequence from 5/2008 to 9/2013 were included. Standard TSE imaging was performed and delayed VIBE was acquired 5 min after gadolinium contrast administration. Airway measurements were made on both sequences by two observers in a blinded fashion to the other observer and other technique. Intraclass correlations (ICC) were calculated to assess for agreement between both techniques and the observers. 29 studies met inclusion criteria with a mean patient age of 8.8 years (2 months to 63 years) and mean patient weight of 30.2 kg (3.5-110). All delayed VIBE and TSE sequences were found to be of diagnostic quality. Mean acquisition time was shorter for the delayed VIBE (13.1 seconds) than TSE (949.9 seconds). Overall there was very good agreement between the delayed VIBE and TSE measurements for both observers (ICC 0.78-0.94) with the exception of the distal right bronchus (ICC 0.67) The interobserver agreement was also excellent for both TSE (ICC 0.78-0.96) and VIBE (ICC 0.85-0.96). Delayed VIBE is rapid and at least as accurate as the alternative TSE imaging for assessment of the lower airway by MRI across a wide spectrum of patients. © 2016 Wiley Periodicals, Inc.

  13. Non-contrast-enhanced 3D MR portography within a breath-hold using compressed sensing acceleration: A prospective noninferiority study.

    Science.gov (United States)

    Ono, Ayako; Arizono, Shigeki; Fujimoto, Koji; Akasaka, Thai; Yamashita, Rikiya; Furuta, Akihiro; Isoda, Hiroyoshi; Togashi, Kaori

    2017-11-01

    To evaluate images of non-contrast-enhanced 3D MR portography within a breath-hold (BH) using compressed sensing (CS) compared to standard respiratory-triggered (RT) sequences. Fifty-nine healthy volunteers underwent MR portography using two sequences of balanced steady-state free-precession (bSSFP) with time-spatial labeling inversion pulses (Time-SLIP): BH bSSFP-CS and RT bSSFP. Two radiologists independently scored the diagnostic acceptability to delineate the portal branches (MPV: main portal vein; RPV: right portal vein; LPV: left portal vein; RPPV: right posterior portal vein; and P4 and P8: portal branch of segment 4 and segment 8, respectively) and the overall image quality on a four-point scale. We assessed noninferiority of BH bSSFP-CS to RT bSSFP. For quantitative analysis, vessel-to-liver contrast (Cv-l) was calculated in MPV, RPV and LPV. BH bSSFP sequence was successfully performed with a 30-second acquisition time. The diagnostic acceptability scores of BH bSSFP-CS compared with RT bSSFP were statistically noninferior: MPV (95% CI for score difference of Reader 1 and Reader 2, respectively: [-0.16, 0.06], [-0.05, 0.02]), RPV ([-0.00, 0.11], [-0.01, 0.08]), LPV ([-0.03, 0.10], [-0.10, 0.03]), RPPV ([-0.03, 0.10], [-0.05, 0.05]), P4 ([-0.13, 0.34], [-0.28, 0.21]) and P8 ([-0.21, 0.11], [-0.25, -0.02]). However, the overall image quality of BH bSSFP-CS did not show noninferiority ([-0.61, -0.24], [-0.54, -0.17]). Cv-l values were significantly lower in BH bSSFP-CS (P<0.001). CS enabled non-contrast-enhanced 3D bSSFP MR portography to be performed within a BH while maintaining noninferior diagnostic acceptability compared to standard RT bSSFP MR portography. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Diagnosing lung nodules on oncologic MR/PET imaging: Comparison of fast T1-weighted sequences and influence of image acquisition in inspiration and expiration breath-hold

    Energy Technology Data Exchange (ETDEWEB)

    Schwenzer, Nina F.; Seith, Ferdinand; Gatidis, Sergios; Brendle, Cornelia; Schmidt, Holger; Pfannenberg, Christina A; LaFougère, Christian; Nikolaou, Konstantin; Schraml, Christina [University Hospital of Tuebingen, Tuebingen (Germany)

    2016-09-15

    First, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance. The study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed. Seventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon (1.2 ± 0.6; 1.2 ± 0.7; 1.5 ± 0.9; 1.7 ± 1.1, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon. Fast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR/PET patients. In contrast to CT, inspiration versus

  15. Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

    Energy Technology Data Exchange (ETDEWEB)

    Schwenzer, Nina F.; Seith, Ferdinand; Gatidis, Sergios [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Brendle, Cornelia [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Department of Diagnostic and Interventional Neuroradiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Schmidt, Holger; Pfannenberg, Christina A. [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Fougère, Christian la [Department of Nuclear Medicine, University Hospital of Tuebingen, Tuebingen 72076 (Germany); Nikolaou, Konstantin; Schraml, Christina [Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076 (Germany)

    2016-11-01

    First, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance. The study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed. Seventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon (1.2 ± 0.6; 1.2 ± 0.7; 1.5 ± 0.9; 1.7 ± 1.1, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon. Fast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR/PET patients. In contrast to CT, inspiration versus

  16. Simultaneous multislice imaging for native myocardial T1mapping: Improved spatial coverage in a single breath-hold.

    Science.gov (United States)

    Weingärtner, Sebastian; Moeller, Steen; Schmitter, Sebastian; Auerbach, Edward; Kellman, Peter; Shenoy, Chetan; Akçakaya, Mehmet

    2017-08-01

    To develop a saturation recovery myocardial T 1 mapping method for the simultaneous multislice acquisition of three slices. Saturation pulse-prepared heart rate independent inversion recovery (SAPPHIRE) T 1 mapping was implemented with simultaneous multislice imaging using FLASH readouts for faster coverage of the myocardium. Controlled aliasing in parallel imaging (CAIPI) was used to achieve minimal noise amplification in three slices. Multiband reconstruction was performed using three linear reconstruction methods: Slice- and in-plane GRAPPA, CG-SENSE, and Tikhonov-regularized CG-SENSE. Accuracy, spatial variability, and interslice leakage were compared with single-band T 1 mapping in a phantom and in six healthy subjects. Multiband phantom T 1 times showed good agreement with single-band T 1 mapping for all three reconstruction methods (normalized root mean square error spatial variability compared with single-band imaging was lowest for GRAPPA (1.29-fold), with higher penalties for Tikhonov-regularized CG-SENSE (1.47-fold) and CG-SENSE (1.52-fold). In vivo multiband T 1 times showed no significant difference compared with single-band (T 1 time ± intersegmental variability: single-band, 1580 ± 119 ms; GRAPPA, 1572 ± 145 ms; CG-SENSE, 1579 ± 159 ms; Tikhonov, 1586 ± 150 ms [analysis of variance; P = 0.86]). Interslice leakage was smallest for GRAPPA (5.4%) and higher for CG-SENSE (6.2%) and Tikhonov-regularized CG-SENSE (7.9%). Multiband accelerated myocardial T 1 mapping demonstrated the potential for single-breath-hold T 1 quantification in 16 American Heart Association segments over three slices. A 1.2- to 1.4-fold higher in vivo spatial variability was observed, where GRAPPA-based reconstruction showed the highest homogeneity and the least interslice leakage. Magn Reson Med 78:462-471, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  17. SU-C-210-04: Considerable Pancreatic Tumor Motion During Breath-Hold Measured Using Intratumoral Fiducials On Fluoroscopic Movies

    Energy Technology Data Exchange (ETDEWEB)

    Lens, E; Horst, A van der; Versteijne, E; Tienhoven, G van; Bel, A [Academic Medical Center, Amsterdam (Netherlands)

    2015-06-15

    Purpose: Using a breath hold (BH) technique during radiotherapy of pancreatic tumors is expected to reduce intra-fractional motion. The aim of this study was to evaluate the tumor motion during BH. Methods: In this pilot study, we included 8 consecutive pancreatic cancer patients. All had 2– 4 intratumoral gold fiducials. Patients were asked to perform 3 consecutive 30-second end-inhale BHs on day 5, 10 and 15 of their three-week treatment. During BH, airflow through a mouthpiece was measured using a spirometer. Any inadvertent flow of air during BH was monitored for all patients. We measured tumor motion on lateral fluoroscopic movies (57 in total) made during BH. In each movie the fiducials as a group were tracked over time in superior-inferior (SI) and anterior-posterior (AP) direction using 2-D image correlation between consecutive frames. We determined for each patient the range of intra-BH motion over all movies; we also determined the absolute means and standard deviations (SDs) for the entire patient group. Additionally, we investigated the relation between inadvertent airflow during BH and the intra-BH motion. Results: We found intra-BH tumor motion of up to 12.5 mm (range, 1.0–12.5 mm) in SI direction and up to 8.0 mm (range, 1.0–8.0 mm) in AP direction. The absolute mean motion over the patient population was 4.7 (SD: 3.0) mm and 2.8 (SD: 1.2) mm in the SI and AP direction, respectively. Patients were able to perform stable consecutive BHs; during only 20% of the movies we found very small airflows (≤ 65 ml). These were mostly stepwise in nature and could not explain the continuous tumor motions we observed. Conclusion: We found substantial (up to 12.5 mm) pancreatic tumor motion during BHs. We found minimal inadvertent airflow, seen only during a minority of BHs, and this did not explain the obtained results. This work was supported by the foundation Bergh in het Zadel through the Dutch Cancer Society (KWF Kankerbestrijding) project No. UVA 2011-5271.

  18. Can multi-slice or navigator-gated R2* MRI replace single-slice breath-hold acquisition for hepatic iron quantification?

    Energy Technology Data Exchange (ETDEWEB)

    Loeffler, Ralf B.; McCarville, M.B.; Song, Ruitian; Hillenbrand, Claudia M. [St. Jude Children' s Research Hospital, Diagnostic Imaging, Memphis, TN (United States); Wagstaff, Anne W. [St. Jude Children' s Research Hospital, Diagnostic Imaging, Memphis, TN (United States); Rhodes College, Memphis, TN (United States); University of Alabama at Birmingham School of Medicine, Birmingham, AL (United States); Smeltzer, Matthew P. [St. Jude Children' s Research Hospital, Department of Biostatistics, Memphis, TN (United States); University of Memphis, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, Memphis, TN (United States); Krafft, Axel J. [St. Jude Children' s Research Hospital, Diagnostic Imaging, Memphis, TN (United States); University Hospital Center Freiburg, Department of Radiology, Freiburg (Germany); Hankins, Jane S. [St. Jude Children' s Research Hospital, Department of Hematology, Memphis, TN (United States)

    2017-01-15

    Liver R2* values calculated from multi-gradient echo (mGRE) magnetic resonance images (MRI) are strongly correlated with hepatic iron concentration (HIC) as shown in several independently derived biopsy calibration studies. These calibrations were established for axial single-slice breath-hold imaging at the location of the portal vein. Scanning in multi-slice mode makes the exam more efficient, since whole-liver coverage can be achieved with two breath-holds and the optimal slice can be selected afterward. Navigator echoes remove the need for breath-holds and allow use in sedated patients. To evaluate if the existing biopsy calibrations can be applied to multi-slice and navigator-controlled mGRE imaging in children with hepatic iron overload, by testing if there is a bias-free correlation between single-slice R2* and multi-slice or multi-slice navigator controlled R2*. This study included MRI data from 71 patients with transfusional iron overload, who received an MRI exam to estimate HIC using gradient echo sequences. Patient scans contained 2 or 3 of the following imaging methods used for analysis: single-slice images (n = 71), multi-slice images (n = 69) and navigator-controlled images (n = 17). Small and large blood corrected region of interests were selected on axial images of the liver to obtain R2* values for all data sets. Bland-Altman and linear regression analysis were used to compare R2* values from single-slice images to those of multi-slice images and navigator-controlled images. Bland-Altman analysis showed that all imaging method comparisons were strongly associated with each other and had high correlation coefficients (0.98 ≤ r ≤ 1.00) with P-values ≤0.0001. Linear regression yielded slopes that were close to 1. We found that navigator-gated or breath-held multi-slice R2* MRI for HIC determination measures R2* values comparable to the biopsy-validated single-slice, single breath-hold scan. We conclude that these three R2* methods can be

  19. Optimal MR pulse sequences for hepatic hemangiomas : comparison of T2-weighted turbo-spin-echo, T2-weighted breath-hold turbo-spin-echo, and T1-weighted FLASH dynamic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Wen Chao; Choi, Byung Ihn; Han, Joon Koo; Kim, Tae Kyoung; Cho, Soon Gu [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-03-01

    To optimize MR imaging pulse sequences in the imaging of hepatic hemangioma and to evaluate on dynamic MR imaging the enhancing characteristics of the lesions. Twenty patients with 35 hemangiomas were studied by using Turbo-spin-echo (TSE) sequence (T2-weighted, T2- and heavily T2-weighted breath-hold) and T1-weighted FLASH imaging acquired before, immediately on, and 1, 3 and 5 minutes after injection of a bolus of Gd-DTPA (0.1mmol/kg). Phased-array multicoil was employed. Images were quantitatively analyzed for lesion-to-liver signal difference to noise ratios (SD/Ns), and lesion-to-liver signal ratios (H/Ls), and qualitatively analyzed for lesion conspicuity. The enhancing characteristics of the hemangiomas were described by measuring the change of signal intensity as a curve in T1-weighted FLASH dynamic imaging. For T2-weighted images, breath-hold T2-weighted TSE had a slightly higher SD/N than other pulse sequences, but there was no statistical difference in three fast pulse sequences (p=0.211). For lesion conspicuity, heavily T2-weighted breath-hold TSE images was superior to T2-weighted breath-hold or non-breath-hold TSE (H/L, 5.75, 3.81, 2.87, respectively, p<0.05). T2-weighted breath-hold TSE imaging was more effective than T2-weighted TSE imaging in removing lesion blurring or lack of sharpness, and there was a 12-fold decrease in acquisition time (20sec versus 245 sec). T1-weighted FLASH dynamic images of normal liver showed peak enhancement at less than 1 minute, and of hemangioma at more than 3 minutes;the degree of enhancement for hemangioma decreased after a 3 minute delay. T2-weighed breath-hold TSE imaging and Gd-DTPA enhanced FLASH dynamic imaging with 5 minutes delay are sufficient for imaging hepatic hemangiomas.

  20. Exploratory analysis of nonlinear coupling between EEG global field power and end-tidal carbon dioxide in free breathing and breath-hold tasks.

    Science.gov (United States)

    Morelli, Maria Sole; Valenza, Gaetano; Greco, Alberto; Giannoni, Alberto; Passino, Claudio; Emdin, Michele; Scilingo, Enzo Pasquale; Vanello, Nicola

    2016-08-01

    Brain activations underlying control of breathing are not completely known. Furthermore, the coupling between neural and respiratory dynamics is usually estimated through linear correlation measures, thus totally disregarding possible underlying nonlinear interactions. To overcome these limitations, in this preliminary study we propose a nonlinear coupling analysis of simultaneous recordings of electroencephalographic (EEG) and respiratory signals at rest and after variation of carbon dioxide (CO2) level. Specifically, a CO2 increase was induced by a voluntary breath hold task. EEG global field power (GFP) in different frequency bands and end-tidal CO2 (PETCO2) were estimated in both conditions. The maximum information coefficient (MIC) and MIC-ρ2 (where ρ represents the Pearson's correlation coefficient) between the two signals were calculated to identify generic associations (i.e. linear and nonlinear correlations) and nonlinear correlations, respectively. With respect to a free breathing state, our results suggest that a breath hold state is characterized by an increased coupling between respiration activity and specific EEG oscillations, mainly involving linear and nonlinear interactions in the delta band (1-4 Hz), and prevalent nonlinear interactions in the alpha band (8-13 Hz).

  1. [Changes in P-wave, T-wave, and ST segment amplitude in 12 lead electrocardiogram in children with breath holding spell].

    Science.gov (United States)

    Zhang, Wenhua; Wang, Cheng; Zou, Runmei; Liu, Liping; Wu, Lijia; Luo, Xuemei; Li, Fang; Liao, Donglei; Cai, Hong

    2016-06-28

    To explore the change of the amplitude of P wave, T wave and ST segment of 12 lead electrocardiogram (ECG) in children with breath holding spell.
 A total of 29 children (24 males and 5 females) with breath holding spell in Second Xiangya Hospital, Central South University were enrolled for this study from October, 2009 to September, 2015. Their ages ranged from 3 months to 6 years, with an average of 1.82±1.27 years old. The control group consisted of 30 age-matched and gender-matched healthy children. All subjects were underwent electrocardiography by the SR-1000A comprehensive automatic electrocardiograph analyzer, and the changes of the ECG parameters were compared between the two groups.
 Compared with the control group, the amplitude of P-wave of V5 lead was decreased [(44.10±23.98) vs (58.30±21.19) μV, Pbreath holding spell have autonomic nerve dysfunction. The amplitude of ST segment changes is sensitive.

  2. Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation : Is IMRT more beneficial than VMAT?

    Science.gov (United States)

    Sakka, Mazen; Kunzelmann, Leonie; Metzger, Martin; Grabenbauer, Gerhard G

    2017-10-01

    Given the reduction in death from breast cancer, as well as improvements in overall survival, adjuvant radiotherapy is considered the standard treatment for breast cancer. However, left-sided breast irradiation was associated with an increased rate of fatal cardiovascular events due to incidental irradiation of the heart. Recently, considerable efforts have been made to minimize cardiac toxicity of left-sided breast irradiation by new treatment methods such as deep-inspiration breath-hold (DIBH) and new radiation techniques, particularly intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). The primary aim of this study was to evaluate the effect of DIBH irradiation on cardiac dose compared with free-breathing (FB) irradiation, while the secondary objective was to compare the advantages of IMRT versus VMAT plans in both the FB and the DIBH position for left-sided breast cancer. In all, 25 consecutive left-sided breast cancer patients underwent CT simulation in the FB and DIBH position. Five patients were excluded with no cardiac displacement following DIBH-CT simulation. The other 20 patients were irradiated in the DIBH position using respiratory gating. Four different treatment plans were generated for each patient, an IMRT and a VMAT plan in the DIBH and in the FB position, respectively. The following parameters were used for plan comparison: dose to the heart, left anterior descending coronary artery (mean dose, maximum dose, D25% and D45%), ipsilateral, contralateral lung (mean dose, D20%, D30%) and contralateral breast (mean dose). The percentage in dose reduction for organs at risk achieved by DIBH for both IMRT and VMAT plans was calculated and compared for each patient by each treatment plan. DIBH irradiation significantly reduced mean dose to the heart and left anterior descending coronary artery (LADCA) using both IMRT (heart -20%; p = 0.0002, LADCA -9%; p = 0.001) and VMAT (heart -23%; p = 0.00003, LADCA -16%; p = 0

  3. The Effect of Inhalation Volume and Breath-Hold Duration on the Retention of Nicotine and Solanesol in the Human Respiratory Tract and on Subsequent Plasma Nicotine Concentrations During Cigarette Smoking

    Directory of Open Access Journals (Sweden)

    Armitage AK

    2014-12-01

    Full Text Available The influence of inhalation depth and breath-hold duration on the retention of nicotine and solanesol in the human respiratory tract and on nicotine uptake was studied in ten cigarette smokers. In a first series of experiments, the subjects took seven puffs from a 10 mg ‘tar’ yield, test cigarette and a fixed volume of air (0, 75, 250, 500 or 1000 mL, as required by the protocol was inhaled after each puff in order to give a controlled ‘depth’ of inhalation. The inhalation was drawn from a bag containing the required volume of air. Following a 2 s breath-hold, subjects exhaled normally, with the first exhalation after each puff passing through a single acidified filter pad for collection of the non-retained nicotine and solanesol. Blood samples were taken before and at intervals during and after smoking for the sessions with 0, 75 and 500 mL inhalation volumes for determination of plasma nicotine and carboxyhaemoglobin levels. Another series of experiments was conducted with a fixed inhalation volume (500 mL and two further breath-hold durations (0 and 10 s in addition to 2 s from above. Nicotine and solanesol retentions were measured for each breath-hold condition. The amounts of nicotine retained within the respiratory system, expressed as a percentage of the amount taken into the mouth, were consistently higher than the corresponding values for solanesol in all five inhalation conditions (0-1000 mL, 2 s breath-hold. Nicotine retention increased from 46.5% at zero inhalation to 99.5% at 1000 mL inhalation (2 s breath-hold and from 98.0% at zero breath-hold to 99.9% at 10 s breath-hold (500 mL inhalation. Solanesol retention increased from 34.2% at zero inhalation volume to 71.9% at 1000 mL inhalation (2 s breath-hold and from 51.8% at zero breath-hold to 87.6% at 10 s breath-hold (500 mL inhalation. Plasma nicotine decreased from pre-smoking levels after zero inhalation indicating that the nicotine retained within the mouth was poorly

  4. Motion management within two respiratory-gating windows: feasibility study of dual quasi-breath-hold technique in gated medical procedures

    Science.gov (United States)

    Kim, Taeho; Kim, Siyong; Park, Yang-Kyun; Youn, Kaylin K.; Keall, Paul; Lee, Rena

    2014-11-01

    A dual quasi-breath-hold (DQBH) technique is proposed for respiratory motion management (a hybrid technique combining breathing-guidance with breath-hold task in the middle). The aim of this study is to test a hypothesis that the DQBH biofeedback system improves both the capability of motion management and delivery efficiency. Fifteen healthy human subjects were recruited for two respiratory motion measurements (free breathing and DQBH biofeedback breathing for 15 min). In this study, the DQBH biofeedback system utilized the abdominal position obtained using an real-time position management (RPM) system (Varian Medical Systems, Palo Alto, USA) to audio-visually guide a human subject for 4 s breath-hold at EOI and 90% EOE (EOE90%) to improve delivery efficiency. We investigated the residual respiratory motion and the delivery efficiency (duty-cycle) of abdominal displacement within the gating window. The improvement of the abdominal motion reproducibility was evaluated in terms of cycle-to-cycle displacement variability, respiratory period and baseline drift. The DQBH biofeedback system improved the abdominal motion management capability compared to that with free breathing. With a phase based gating (mean ± std: 55  ±  5%), the averaged root mean square error (RMSE) of the abdominal displacement in the dual-gating windows decreased from 2.26 mm of free breathing to 1.16 mm of DQBH biofeedback (p-value = 0.007). The averaged RMSE of abdominal displacement over the entire respiratory cycles reduced from 2.23 mm of free breathing to 1.39 mm of DQBH biofeedback breathing in the dual-gating windows (p-value = 0.028). The averaged baseline drift dropped from 0.9 mm min-1 with free breathing to 0.09 mm min-1 with DQBH biofeedback (p-value = 0.048). The averaged duty-cycle with an 1 mm width of displacement bound increased from 15% of free breathing to 26% of DQBH biofeedback (p-value = 0.003). The study demonstrated that the DQBH biofeedback

  5. The advantage of deep-inspiration breath-hold and cone-beam CT based soft-tissue registration for locally advanced lung cancer radiotherapy

    DEFF Research Database (Denmark)

    Ottosson, Wiviann; Rahma, Fatma; Sjöström, David

    2016-01-01

    Background and purpose: Three cone-beam computed tomography (CBCT) registration strategies combined with deep-inspiration breath-hold (DIBH) and free-breathing (FB) were explored, in terms of obtaining the smallest planning target volume (PTV). Material and methods: CBCT images were acquired pre...... were calculated. Results: For the spine, the smallest residual misalignments were observed in FB, independently of registration method. For GTV-T and GTV-N, soft-tissue registrations were superior to bony registration, independently of FB or DIBH. Compared to FB, PTV-Totals were during DIBH reduced...... uncertainties compared to FB, DIBH resulted in smaller PTV-Totals for all registration methods. Soft-tissue registrations were superior to bony registration, independently of FB and DIBH. During DIBH, undesirable arching of the back was identified. Daily CBCT pre-treatment target verification is advised....

  6. Cardiac dose reduction with deep inspiration breath hold for left-sided breast cancer radiotherapy patients with and without regional nodal irradiation.

    Science.gov (United States)

    Yeung, Rosanna; Conroy, Leigh; Long, Karen; Walrath, Daphne; Li, Haocheng; Smith, Wendy; Hudson, Alana; Phan, Tien

    2015-09-22

    Deep inspiration breath hold (DIBH) reduces heart and left anterior descending artery (LAD) dose during left-sided breast radiation therapy (RT); however there is limited information about which patients derive the most benefit from DIBH. The primary objective of this study was to determine which patients benefit the most from DIBH by comparing percent reduction in mean cardiac dose conferred by DIBH for patients treated with whole breast RT ± boost (WBRT) versus those receiving breast/chest wall plus regional nodal irradiation, including internal mammary chain (IMC) nodes (B/CWRT + RNI) using a modified wide tangent technique. A secondary objective was to determine if DIBH was required to meet a proposed heart dose constraint of Dmean irradiation.

  7. SU-E-T-383: Evaluation of Deep Inspiration Breath-Hold Technique for Post-Mastectomy Proton Pencil Beam Scanning Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Depauw, N; Patel, S; MacDonald, S; Lu, H [Massachusetts General Hospital, Boston, MA (United States)

    2015-06-15

    Purpose: Deep inspiration breath-hold techniques (DIBH) have been shown to carry significant dosimetric advantages in conventional radiotherapy of left-sided breast cancer. The purpose of this study is to evaluate the use of DIBH techniques for post-mastectomy radiation therapy (PMRT) using proton pencil beam scanning (PBS). Method: Ten PMRT patients, with or without breast implant, underwent two helical CT scans: one with free breathing and the other with deep inspiration breath-hold. A prescription of 50.4 Gy(RBE) to the whole chest wall and lymphatics (axillary, supraclavicular, and intramammary nodes) was considered. PBS plans were generated for each patient’s CT scan using Astroid, an in-house treatment planning system, with the institution conventional clinical PMRT parameters; that is, using a single en-face field with a spot size varying from 8 mm to 14 mm as a function of energy. Similar optimization parameters were used in both plans in order to ensure appropriate comparison. Results: Regardless of the technique (free breathing or DIBH), the generated plans were well within clinical acceptability. DIBH allowed for higher target coverage with better sparing of the cardiac structures. The lung doses were also slightly improved. While the use of DIBH techniques might be of interest, it is technically challenging as it would require a fast PBS delivery, as well as the synchronization of the beam delivery with a gating system, both of which are not currently available at the institution. Conclusion: DIBH techniques display some dosimetric advantages over free breathing treatment for PBS PMRT patients, which warrants further investigation. Plans will also be generated with smaller spot sizes (2.5 mm to 5.5 mm and 5 mm to 9 mm), corresponding to new generation machines, in order to further quantify the dosimetric advantages of DIBH as a function of spot size.

  8. Magnitude of shift of tumor position as a function of moderated deep inspiration breath-hold: An analysis of pooled data of lung patients with active breath control in image-guided radiotherapy

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2008-01-01

    Full Text Available The purpose of this study was to evaluate the reproducibility and magnitude of shift of tumor position by using active breathing control and iView-GT for patients with lung cancer with moderate deep-inspiration breath-hold (mDIBH technique. Eight patients with 10 lung tumors were studied. CT scans were performed in the breath-holding phase. Moderate deep-inspiration breath-hold under spirometer-based monitoring system was used. Few important bony anatomic details were delineated by the radiation oncologist. To evaluate the interbreath-hold reproducibility of the tumor position, we compared the digital reconstruction radiographs (DRRs from planning system with the DRRs from the iView-GT in the machine room. We measured the shift in x, y, and z directions. The reproducibility was defined as the difference between the bony landmarks from the DRR of the planning system and those from the DRR of the iView-GT. The maximum shift of the tumor position was 3.2 mm, 3.0 mm, and 2.9 mm in the longitudinal, lateral, and vertical directions. In conclusion, the moderated deep-inspiration breath-hold method using a spirometer is feasible, with relatively good reproducibility of the tumor position for image-guided radiotherapy in lung cancers.

  9. Single breath-hold 3D measurement of left atrial volume using compressed sensing cardiovascular magnetic resonance and a non-model-based reconstruction approach.

    Science.gov (United States)

    Vardoulis, Orestis; Monney, Pierre; Bermano, Amit; Vaxman, Amir; Gotsman, Craig; Schwitter, Janine; Stuber, Matthias; Stergiopulos, Nikolaos; Schwitter, Juerg

    2015-06-11

    Left atrial (LA) dilatation is associated with a large variety of cardiac diseases. Current cardiovascular magnetic resonance (CMR) strategies to measure LA volumes are based on multi-breath-hold multi-slice acquisitions, which are time-consuming and susceptible to misregistration. To develop a time-efficient single breath-hold 3D CMR acquisition and reconstruction method to precisely measure LA volumes and function. A highly accelerated compressed-sensing multi-slice cine sequence (CS-cineCMR) was combined with a non-model-based 3D reconstruction method to measure LA volumes with high temporal and spatial resolution during a single breath-hold. This approach was validated in LA phantoms of different shapes and applied in 3 patients. In addition, the influence of slice orientations on accuracy was evaluated in the LA phantoms for the new approach in comparison with a conventional model-based biplane area-length reconstruction. As a reference in patients, a self-navigated high-resolution whole-heart 3D dataset (3D-HR-CMR) was acquired during mid-diastole to yield accurate LA volumes. Phantom studies. LA volumes were accurately measured by CS-cineCMR with a mean difference of -4.73 ± 1.75 ml (-8.67 ± 3.54%, r2 = 0.94). For the new method the calculated volumes were not significantly different when different orientations of the CS-cineCMR slices were applied to cover the LA phantoms. Long-axis "aligned" vs "not aligned" with the phantom long-axis yielded similar differences vs the reference volume (-4.87 ± 1.73 ml vs. -4.45 ± 1.97 ml, p = 0.67) and short-axis "perpendicular" vs. "not-perpendicular" with the LA long-axis (-4.72 ± 1.66 ml vs. -4.75 ± 2.13 ml; p = 0.98). The conventional bi-plane area-length method was susceptible for slice orientations (p = 0.0085 for the interaction of "slice orientation" and "reconstruction technique", 2-way ANOVA for repeated measures). To use the 3D-HR-CMR as the reference for LA volumes

  10. [Evaluation of optimal parameters for non-contrast-enhanced non-breath-holding pulmonary artery MRA using 3D-FSE imaging with variable flip angle echo trains].

    Science.gov (United States)

    Kubo, Hitoshi; Kobata, Takuya; Otsuka, Hideki; Harada, Masafumi

    2014-11-01

    The aim of this study was to find the optimal acquisition parameters of non-contrast-enhanced non-breath-holding pulmonary artery MRA using 3D-FSE imaging with variable flip angle echo trains. The 3D-FSE imaging method with variable flip angle echo trains (CUBE) was employed in this study. Pulmonary artery MRA was performed in five healthy volunteers using a 1.5 tesla (T) and a 3 T clinical scanner with multi-channel torso coils. The institutional review boards approved the study, and informed consent was obtained from all subjects. Prior to the CUBE studies, ECG-gated single-shot FSE scans were performed to determine the timing of systole and diastole. After that, CUBE scans with systolic timing and three adjusted (early, middle and delayed) diastolic timings using both ECG and respiratory gating were performed and subtracted images between systolic and diastolic images were calculated. Subtracted intensities of both lung parenchyma and pulmonary arteries were evaluated using the region of interest (ROI) function. Maximum intensity projection (MIP) images with six different scan parameters (three timings and two static magnetic fields) were processed for evaluation by the ranking method with visual assessment. Three observers each scored all six images and a statistical analysis based on the variation of ratings was performed. The subtracted intensities of pulmonary arteries and lung parenchyma with middle diastolic timing were higher than that with both early and delayed systolic timing. The same tendency was shown in both 1.5 T and 3 T images. Though the subtracted intensity of 3 T was higher than that of 1.5 T, the contrast ratio between lung parenchyma and pulmonary artery of 1.5 T was higher than that of 3 T. The MIP image using the 1.5 T scanner with middle diastolic timing obtained the best score by the visual assessment using the ranking methods. The middle diastolic timing using the 1.5 T scanner provides the best non-contrast-enhanced non-breath-holding

  11. SU-G-JeP4-01: An Assessment of a Microsoft Kinect V2 Sensor for Voluntary Breath-Hold Monitoring in Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Edmunds, D; Donovan, E [The Royal Marsden NHS Foundation Trust, Sutton, London (United Kingdom)

    2016-06-15

    Purpose: To determine whether the Microsoft Kinect Version 2 (Kinect v2), a commercial off-the-shelf (COTS) depth sensors designed for entertainment purposes, were robust to the radiotherapy treatment environment and could be suitable for monitoring of voluntary breath-hold compliance. This could complement current visual monitoring techniques, and be useful for heart sparing left breast radiotherapy. Methods: In-house software to control Kinect v2 sensors, and capture output information, was developed using the free Microsoft software development kit, and the Cinder creative coding C++ library. Each sensor was used with a 12m USB 3.0 active cable. A solid water block was used as the object. The depth accuracy and precision of the sensors was evaluated by comparing Kinect reported distance to the object with a precision laser measurement across a distance range of 0.6m to 2.0 m. The object was positioned on a high-precision programmable motion platform and moved in two programmed motion patterns and Kinect reported distance logged. Robustness to the radiation environment was tested by repeating all measurements with a linear accelerator operating over a range of pulse repetition frequencies (6Hz to 400Hz) and dose rates 50 to 1500 monitor units (MU) per minute. Results: The complex, consistent relationship between true and measured distance was unaffected by the radiation environment, as was the ability to detect motion. Sensor precision was < 1 mm and the accuracy between 1.3 mm and 1.8 mm when a distance correction was applied. Both motion patterns were tracked successfully with a root mean squared error (RMSE) of 1.4 and 1.1 mm respectively. Conclusion: Kinect v2 sensors are capable of tracking pre-programmed motion patterns with an accuracy <2 mm and appear robust to the radiotherapy treatment environment. A clinical trial using Kinect v2 sensor for monitoring voluntary breath hold has ethical approval and is open to recruitment. The authors are supported by a

  12. SU-E-J-55: End-To-End Effectiveness Analysis of 3D Surface Image Guided Voluntary Breath-Holding Radiotherapy for Left Breast

    Energy Technology Data Exchange (ETDEWEB)

    Lin, M; Feigenberg, S [University of Maryland School of Medicine, Baltimore, MD (United States)

    2015-06-15

    Purpose To evaluate the effectiveness of using 3D-surface-image to guide breath-holding (BH) left-side breast treatment. Methods Two 3D surface image guided BH procedures were implemented and evaluated: normal-BH, taking BH at a comfortable level, and deep-inspiration-breath-holding (DIBH). A total of 20 patients (10 Normal-BH and 10 DIBH) were recruited. Patients received a BH evaluation using a commercialized 3D-surface- tracking-system (VisionRT, London, UK) to quantify the reproducibility of BH positions prior to CT scan. Tangential 3D/IMRT plans were conducted. Patients were initially setup under free-breathing (FB) condition using the FB surface obtained from the untaged CT to ensure a correct patient position. Patients were then guided to reach the planned BH position using the BH surface obtained from the BH CT. Action-levels were set at each phase of treatment process based on the information provided by the 3D-surface-tracking-system for proper interventions (eliminate/re-setup/ re-coaching). We reviewed the frequency of interventions to evaluate its effectiveness. The FB-CBCT and port-film were utilized to evaluate the accuracy of 3D-surface-guided setups. Results 25% of BH candidates with BH positioning uncertainty > 2mm are eliminated prior to CT scan. For >90% of fractions, based on the setup deltas from3D-surface-trackingsystem, adjustments of patient setup are needed after the initial-setup using laser. 3D-surface-guided-setup accuracy is comparable as CBCT. For the BH guidance, frequency of interventions (a re-coaching/re-setup) is 40%(Normal-BH)/91%(DIBH) of treatments for the first 5-fractions and then drops to 16%(Normal-BH)/46%(DIBH). The necessity of re-setup is highly patient-specific for Normal-BH but highly random among patients for DIBH. Overall, a −0.8±2.4 mm accuracy of the anterior pericardial shadow position was achieved. Conclusion 3D-surface-image technology provides effective intervention to the treatment process and ensures

  13. Evaluation of a motion artifacts removal approach on breath-hold cine-magnetic resonance images of hypertrophic cardiomyopathy subjects

    Science.gov (United States)

    Betancur, Julián.; Simon, Antoine; Schnell, Frédéric; Donal, Erwan; Hernández, Alfredo; Garreau, Mireille

    2013-11-01

    The acquisition of ECG-gated cine magnetic resonance images of the heart is routinely performed in apnea in order to suppress the motion artifacts caused by breathing. However, many factors including the 2D nature of the acquisition and the use of di erent beats to acquire the multiple-view cine images, cause this kind of artifacts to appear. This paper presents the qualitative evaluation of a method aiming to remove motion artifacts in multipleview cine images acquired on patients with hypertrophic cardiomyopathy diagnosis. The approach uses iconic registration to reduce for in-plane artifacts in long-axis-view image stacks and in-plane and out-of-plane motion artifacts in sort-axis-view image stack. Four similarity measures were evaluated: the normalized correlation, the normalized mutual information, the sum of absolute voxel di erences and the Slomka metric proposed by Slomka et al. The qualitative evaluation assessed the misalignment of di erent anatomical structures of the left ventricle as follows: the misalignment of the interventricular septum and the lateral wall for short-axis-view acquisitions and the misalignment between the short-axis-view image and long-axis-view images. Results showed the correction using the normalized correlation as the most appropriated with an 80% of success.

  14. A dosimetric analysis of cardiac dose with or without active breath coordinator moderate deep inspiratory breath hold in left sided breast cancer radiotherapy.

    Science.gov (United States)

    Kunheri, Beena; Kotne, Sanketh; Nair, Sneha S; Makuny, Dinesh

    2017-01-01

    Cardiac toxicity is a major concern for left breast tangential field irradiation. The left ventricle and left anterior descending (LAD) artery are suggested to be radiosensitive and radiation to these structures leads to late lethal cardiotoxicity. Moderate deep inspiration breath hold (mDIBH) during radiation treatment delivery helps in reducing the cardiac dose. This study compares dosimetric parameters of heart with and without active breath coordinator (ABC) mDIBH during tangential field breast cancer radiation. This is a dosimetric comparative study. Forty-five consecutive patients with left-sided breast cancer who underwent breast-conserving surgery and adjuvant tangential field and radiotherapy with ABC mDIBH between November 2013 and September 2015 in our center were analyzed in this study. The ABC device was used for respiratory control and patients who could hold their breath for 20-30 s were considered for radiation with ABC mDIBH. Simulation scans of both free breathing (FB) and ABC mDIBH were done. Tangent field treatment plans with a dose prescription of 40 Gy/15 Fr were generated for each patient, in both scans. Target coverage, dose to the heart, LAD, and the left lung were documented with dose-volume histograms. Statistical Package for the Social Sciences, version 20 software, was used for analysis and the level of significance was set at P cardiac dose and hence can be considered as a promising tool for cardiac sparing.

  15. Quantitative assessment of irradiated lung volume and lung mass in breast cancer patients treated with tangential fields in combination with deep inspiration breath hold (DIBH)

    Energy Technology Data Exchange (ETDEWEB)

    Kapp, Karin Sigrid [Univ. Clinic of Therapeutic Radiology and Oncology, Medical Univ. of Graz (Austria); Zurl, Brigitte; Stranzl, Heidi; Winkler, Peter

    2010-03-15

    Purpose: Comparison of the amount of irradiated lung tissue volume and mass in patients with breast cancer treated with an optimized tangential-field technique with and without a deep inspiration breath-hold (DIBH) technique and its impact on the normal-tissue complication probability (NTCP). Material and Methods: Computed tomography datasets of 60 patients in normal breathing (NB) and subsequently in DIBH were compared. With a Real-Time Position Management Respiratory Gating System (RPM), anteroposterior movement of the chest wall was monitored and a lower and upper threshold were defined. Ipsilateral lung and a restricted tangential region of the lung were delineated and the mean and maximum doses calculated. Irradiated lung tissue mass was computed based on density values. NTCP for lung was calculated using a modified Lyman-Kutcher-Burman (LKB) model. Results: Mean dose to the ipsilateral lung in DIBH versus NB was significantly reduced by 15%. Mean lung mass calculation in the restricted area receiving {<=} 20 Gy (M{sub 20}) was reduced by 17% in DIBH but associated with an increase in volume. NTCP showed an improvement in DIBH of 20%. The correlation of individual breathing amplitude with NTCP proved to be independent. Conclusion: The delineation of a restricted area provides the lung mass calculation in patients treated with tangential fields. DIBH reduces ipsilateral lung dose by inflation so that less tissue remains in the irradiated region and its efficiency is supported by a decrease of NTCP. (orig.)

  16. Effects of nicotine withdrawal on panic-like response to breath holding: a placebo-controlled, double-blind, crossover patch study.

    Science.gov (United States)

    Cosci, Fiammetta; Bertoli, Giuly; Abrams, Kenneth

    2013-12-01

    Cigarette smoking may increase the likelihood of developing panic disorder. Periods of nicotine withdrawal, in particular, may promote panic in individuals high in anxiety sensitivity. We examined the importance of nicotine withdrawal in the occurrence of smoking and panic. We utilized a placebo-controlled, double-blind, randomized, crossover design. Fifty smokers underwent a breath-holding (BH) challenge after the transdermal administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline as well as directly before and after the challenges. Nicotine abstinence induced a decrease in heart rate and systolic blood pressure (BP) before the BH procedure (heart rate: 78.80 ± 11.43 under nicotine, 70.88 ± 10.83 under placebo; systolic BP: 124.90 ± 11.34 under nicotine, 121.18 ± 13.44 under placebo) and shorter BH duration relative to the nicotine patch condition. Nicotine abstinence did not, though, increase fear reactivity to the challenge. The findings for heart rate and BP are consistent with the stimulant properties of nicotine. The reduced capacity to maintain apnea under placebo might be due to carbon dioxide (CO2 ) hypersensitivity during periods of nicotine abstinence. The negative findings regarding fear reactivity might be due to BH being a relatively weak anxiogen. Future researchers are encouraged to employ CO2 -inhalation procedures to study the relationship between nicotine withdrawal and panic. © 2013 Wiley Periodicals, Inc.

  17. Using surface imaging and visual coaching to improve the reproducibility and stability of deep-inspiration breath hold for left-breast-cancer radiotherapy

    Science.gov (United States)

    Cerviño, Laura I.; Gupta, Sonia; Rose, Mary A.; Yashar, Catheryn; Jiang, Steve B.

    2009-11-01

    Late cardiac complications may arise after left-breast radiation therapy. Deep-inspiration breath hold (DIBH) allows reduction of the irradiated heart volume at the same time as it reduces tumor bed motion and increases lung sparing. In the present study, we have evaluated the improvement in reproducibility and stability of the DIBH for left-breast-cancer treatment when visual coaching is provided with the aid of 3D video surface imaging and video goggles. Five left-breast-cancer patients and fifteen healthy volunteers were asked to perform a series of DIBHs without and with visual coaching. Reproducibility and stability of DIBH were measured for each individual with and without visual coaching. The average reproducibility and stability changed from 2.1 mm and 1.5 mm, respectively, without visual feedback to 0.5 mm and 0.7 mm with visual feedback, showing a significant statistical difference (p 2 mm) in reproducibility and stability were observed in 35% and 15% of the subjects, respectively. The average chest wall excursion of the DIBH with respect to the free breathing preceding the DIBH was found to be 11.3 mm. The reproducibility and stability of the DIBH improve significantly from the visual coaching provided to the patient, especially in those patients with poor reproducibility and stability.

  18. Improving the detectability of focal liver lesions on T2-weighted MR images: ultrafast breath-hold or respiratory-triggered thin-section MRI?

    Science.gov (United States)

    Pauleit, D; Textor, J; Bachmann, R; Conrad, R; Flacke, S; Kreft, B; Schild, H

    2001-08-01

    The purpose of this study was to determine whether a respiratory-triggered (RT) T2-weighted turbo spin-echo (TSE) sequence with thin section can improve the detectability of focal liver lesions compared to a breath-hold (BH) T2-weighted TSE sequence. In 25 patients an RT TSE with 8-mm sections (8-TSE RT) and 5-mm sections (5-TSE RT) and a BH TSE sequence with 8-mm sections (8-TSE BH) were performed. Forty-one focal liver lesions (mean: 1.8 +/- 1.2 cm; 14 lesions 1 cm) were evaluated. The 5-TSE RT was significantly better in lesion detection compared to the 8-TSE BH sequence for all sizes of lesions (40/41 vs. 33/41; P = 0.014). For lesions >1 cm no relevant differences in the detection rate of the sequences were found (8-TSE RT, 26/27; 5-TSE RT, 26/27; 8-TSE BH, 25/27), for lesions < or =1 cm the 5-TSE RT provided significantly better sensitivity than the 8-TSE BH (14/14 vs. 8/14, P = 0.015). The results of this study suggest that lesion detection could be significantly improved by using an RT TSE sequence with thin sections compared with a BH TSE sequence. Copyright 2001 Wiley-Liss, Inc.

  19. Detection of hepatocellular carcinoma: comparison of ferumoxides-enhanced and gadolinium-enhanced dynamic three-dimensional volume interpolated breath-hold MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Hyosung; Kim, Youngkon; Kim, Chongsoo [Chonbuk National University Medical School, Department of Diagnostic Radiology, Chon-ju (Korea); Lee, Jeongmin [Seoul National University Hospital, Department of Radiology, Seoul (Korea); Lee, Younghwan [Wonkwang University School of Medicine, Department of Diagnostic Radiology, Iksan (Korea)

    2005-01-01

    The purpose was to compare the diagnostic accuracy of ferumoxides-enhanced MR imaging and gadolinium-enhanced dynamic MR imaging using three-dimensional (3D) volume interpolated breath-hold examination (VIBE) for the detection of hepatocellular carcinoma (HCC). Forty-nine patients with 61 HCCs, who underwent ferumoxides-enhanced and gadolinium-enhanced dynamic MR imaging, were included prospectively in this study. Ferumoxides-enhanced MR imaging was performed 24 h after completion of the dynamic study using 3D-VIBE. Three radiologists independently interpreted the images. The diagnostic accuracy was evaluated using the receiver-operating characteristic method, and the sensitivity of each imaging technique was compared using McNemar's test. The mean diagnostic accuracy of dynamic MR imaging (Az=0.95) was higher than that of ferumoxides-enhanced MR imaging (Az=0.90), but failed to reach a statistical significance (P=0.057). The mean sensitivity of dynamic MR imaging (90.7%) was significantly superior to that of ferumoxides-enhanced MR imaging (80.9%, P=0.03). Furthermore, for lesions smaller than 15 mm, the mean sensitivity of dynamic MR imaging was significantly higher than that of ferumoxides-enhanced MR imaging (85.2% vs. 69.2%, P<0.05). Dynamic MR imaging showed a trend toward better diagnostic accuracy for than ferumoxides-enhanced MR imaging for the detection of HCCs. (orig.)

  20. Setup error and motion during deep inspiration breath-hold breast radiotherapy measured with continuous portal imaging

    DEFF Research Database (Denmark)

    Lutz, Christina Maria; Poulsen, Per Rugaard; Fledelius, Walther

    2016-01-01

    ). At every third treatment fraction, continuous portal images were acquired. The time-resolved chest wall position during treatment was compared with the planned position to determine the inter-fraction setup errors and the intra-fraction motion of the chest wall. RESULTS: The DIBH compliance was 95% during...... both recruitment periods. A tendency of smaller inter-fraction setup errors and intra-fraction motion was observed for group 2 (medial marker block position). However, apart from a significantly reduced inter-field random shift (σ = 1.7 mm vs. σ = 0.9 mm, p = 0.005), no statistically significant...... differences between the groups were found. In a combined analysis, the group mean inter-fraction setup error was M = - 0.1 mm, with random and systematic errors of σ = 1.7 mm and Σ = 1.4 mm. The group mean inter-field shift was M = 0.0 (σ = 1.3 mm and Σ = 1.1 mm) and the group mean standard deviation...

  1. Reproducible deep-inspiration breath-hold irradiation with forward intensity-modulated radiotherapy for left-sided breast cancer significantly reduces cardiac radiation exposure compared to inverse intensity-modulated radiotherapy.

    Science.gov (United States)

    Bolukbasi, Yasemin; Saglam, Yucel; Selek, Ugur; Topkan, Erkan; Kataria, Anglina; Unal, Zeynep; Alpan, Vildan

    2014-01-01

    To investigate the objective utility of our clinical routine of reproducible deep-inspiration breath-hold irradiation for left-sided breast cancer patients on reducing cardiac exposure. Free-breathing and reproducible deep-inspiration breath-hold scans were evaluated for our 10 consecutive left-sided breast cancer patients treated with reproducible deep-inspiration breath-hold. The study was based on the adjuvant dose of 50 Gy in 25 fractions of 2 Gy/fraction. Both inverse and forward intensity-modulated radiotherapy plans were generated for each computed tomography dataset. Reproducible deep-inspiration breath-hold plans with forward intensity-modulated radiotherapy significantly spared the heart and left anterior descending artery compared to generated free-breathing plans based on mean doses - free-breathing vs reproducible deep-inspiration breath-hold, left ventricle (296.1 vs 94.5 cGy, P = 0.005), right ventricle (158.3 vs 59.2 cGy, P = 0.005), left anterior descending artery (171.1 vs 78.1 cGy, P = 0.005), and whole heart (173.9 vs 66 cGy, P = 0.005), heart V20 (2.2% vs 0%, P = 0.007) and heart V10 (4.2% vs 0.3%, P = 0.007) - whereas they revealed no additional burden on the ipsilateral lung. Reproducible deep-inspiration breath-hold and free-breathing plans with inverse intensity-modulated radiotherapy provided similar organ at risk sparing by reducing the mean doses to the left ventricle, left anterior descending artery, heart, V10-V20 of the heart and right ventricle. However, forward intensity-modulated radiotherapy showed significant reduction in doses to the left ventricle, left anterior descending artery, heart, right ventricle, and contralateral breast (mean dose, 248.9 to 12.3 cGy, P = 0.005). The mean doses for free-breathing vs reproducible deep-inspiration breath-hold of the proximal left anterior descending artery were 1.78 vs 1.08 Gy and of the distal left anterior descending artery were 8.11 vs 3.89 Gy, whereas mean distances to the 50 Gy

  2. Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation. Is IMRT more beneficial than VMAT

    Energy Technology Data Exchange (ETDEWEB)

    Sakka, Mazen; Grabenbauer, Gerhard G. [Coburg Cancer Center, Department of Radiation Oncology, Coburg (Germany); Friedrich-Alexander University of Erlangen-Nuernberg, Faculty of Medicine, Erlangen (Germany); Kunzelmann, Leonie; Metzger, Martin [Coburg Cancer Center, Department of Radiation Oncology, Coburg (Germany)

    2017-10-15

    Given the reduction in death from breast cancer, as well as improvements in overall survival, adjuvant radiotherapy is considered the standard treatment for breast cancer. However, left-sided breast irradiation was associated with an increased rate of fatal cardiovascular events due to incidental irradiation of the heart. Recently, considerable efforts have been made to minimize cardiac toxicity of left-sided breast irradiation by new treatment methods such as deep-inspiration breath-hold (DIBH) and new radiation techniques, particularly intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). The primary aim of this study was to evaluate the effect of DIBH irradiation on cardiac dose compared with free-breathing (FB) irradiation, while the secondary objective was to compare the advantages of IMRT versus VMAT plans in both the FB and the DIBH position for left-sided breast cancer. In all, 25 consecutive left-sided breast cancer patients underwent CT simulation in the FB and DIBH position. Five patients were excluded with no cardiac displacement following DIBH-CT simulation. The other 20 patients were irradiated in the DIBH position using respiratory gating. Four different treatment plans were generated for each patient, an IMRT and a VMAT plan in the DIBH and in the FB position, respectively. The following parameters were used for plan comparison: dose to the heart, left anterior descending coronary artery (mean dose, maximum dose, D25% and D45%), ipsilateral, contralateral lung (mean dose, D20%, D30%) and contralateral breast (mean dose). The percentage in dose reduction for organs at risk achieved by DIBH for both IMRT and VMAT plans was calculated and compared for each patient by each treatment plan. DIBH irradiation significantly reduced mean dose to the heart and left anterior descending coronary artery (LADCA) using both IMRT (heart -20%; p = 0.0002, LADCA -9%; p = 0.001) and VMAT (heart -23%; p = 0.00003, LADCA -16%; p = 0

  3. A 4D ultrasound real-time tracking system for external beam radiotherapy of upper abdominal lesions under breath-hold

    Energy Technology Data Exchange (ETDEWEB)

    Sihono, Dwi Seno Kuncoro; Vogel, Lena; Thoelking, Johannes; Wenz, Frederik; Boda-Heggemann, Judit; Wertz, Hansjoerg [University of Heidelberg, Department of Radiation Oncology, University Medical Center Mannheim, Mannheim (Germany); Weiss, Christel [University of Heidelberg, Department of Biomathematics and Medical Statistics, University Medical Center Mannheim, Mannheim (Germany); Lohr, Frank [University of Heidelberg, Department of Radiation Oncology, University Medical Center Mannheim, Mannheim (Germany); Az. Ospedaliero-Universitaria di Modena, Struttura Complessa di Radioterapia, Dipartimento di Oncologia, Modena (Italy)

    2017-03-15

    To evaluate a novel four-dimensional (4D) ultrasound (US) tracking system for external beam radiotherapy of upper abdominal lesions under computer-controlled deep-inspiration breath-hold (DIBH). The tracking accuracy of the research 4D US system was evaluated using two motion phantoms programmed with sinusoidal and breathing patterns to simulate free breathing and DIBH. Clinical performance was evaluated with five healthy volunteers. US datasets were acquired in computer-controlled DIBH with varying angular scanning angles. Tracked structures were renal pelvis (spherical structure) and portal/liver vein branches (non-spherical structure). An external marker was attached to the surface of both phantoms and volunteers as a secondary object to be tracked by an infrared camera for comparison. Phantom measurements showed increased accuracy of US tracking with decreasing scanning range/increasing scanning frequency. The probability of lost tracking was higher for small scanning ranges (43.09% for 10 and 13.54% for 20 ).The tracking success rates in healthy volunteers during DIBH were 93.24 and 89.86% for renal pelvis and portal vein branches, respectively. There was a strong correlation between marker motion and US tracking for the majority of analyzed breath-holds: 84.06 and 88.41% of renal pelvis target results and 82.26 and 91.94% of liver vein target results in anteroposterior and superoinferior directions, respectively; Pearson's correlation coefficient was between 0.71 and 0.99. The US system showed a good tracking performance in 4D motion phantoms. The tracking capability of surrogate structures for upper abdominal lesions in DIBH fulfills clinical requirements. Further investigation in a larger cohort of patients is underway. (orig.) [German] Evaluation eines neuen vierdimensionalen (4D) Ultraschall(US)-Tracking-Systems fuer die externe Strahlentherapie von Oberbauchlaesionen unter computergesteuertem tiefem Atemanhalt (DIBH). Die Tracking-Genauigkeit des 4D

  4. SU-F-BRB-02: Towards Quantitative Clinical Decision On Deep Inspiration Breath Hold (DIBH) Or Prone for Left-Sided Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Lin, H; Gao, Y [Rensselaer Polytechnic Institute, Troy, NY (United States); Liu, T [Memorial Sloan Kettering West Harrison, West Harrison, New York (United States); Gelblum, D; Ho, A [Memorial Sloan Lettering Cancer Center, New York City, New York (United States); Powell, S [Memorial Sloan Kettering Cancer Center, New York, NY (United States); Tang, X [Memorial Sloan Kettering Cancer Center, West Harrison, NY (United States); Xu, X [Rensselaer Polytechnic Inst., Troy, NY (United States)

    2015-06-15

    Purpose: To develop quantitative clinical guidelines between supine Deep Inspiratory Breath Hold (DIBH) and prone free breathing treatments for breast patients, we applied 3D deformable phantoms to perform Monte Carlo simulation to predict corresponding Dose to the Organs at Risk (OARs). Methods: The RPI-adult female phantom (two selected cup sizes: A and D) was used to represent the female patient, and it was simulated using the MCNP6 Monte Carlo code. Doses to OARs were investigated for supine DIBH and prone treatments, considering two breast sizes. The fluence maps of the 6-MV opposed tangential fields were exported. In the Monte Carlo simulation, the fluence maps allow each simulated photon particle to be weighed in the final dose calculation. The relative error of all dose calculations was kept below 5% by simulating 3*10{sup 7} photons for each projection. Results: In terms of dosimetric accuracy, the RPI Adult Female phantom with cup size D in DIBH positioning matched with a DIBH treatment plan of the patient. Based on the simulation results, for cup size D phantom, prone positioning reduced the cardiac dose and the dose to other OARs, while cup size A phantom benefits more from DIBH positioning. Comparing simulation results for cup size A and D phantom, dose to OARs was generally higher for the large breast size due to increased scattering arising from a larger portion of the body in the primary beam. The lower dose that was registered for the heart in the large breast phantom in prone positioning was due to the increase of the distance between the heart and the primary beam when the breast was pendulous. Conclusion: Our 3D deformable phantom appears an excellent tool to predict dose to the OARs for the supine DIBH and prone positions, which might help quantitative clinical decisions. Further investigation will be conducted. National Institutes of Health R01EB015478.

  5. Deep inspiration breath-hold technique for left-sided breast cancer: An analysis of predictors for organ-at-risk sparing

    Energy Technology Data Exchange (ETDEWEB)

    Register, Steven; Takita, Cristiane [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL (United States); Reis, Isildinha; Zhao, Wei [Department of Public Health Sciences, University of Miami, Miami, FL (United States); Amestoy, William [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL (United States); Wright, Jean, E-mail: jwrigh71@jhmi.edu [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL (United States); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD (United States)

    2015-04-01

    To identify anatomic and treatment characteristics that correlate with organ-at-risk (OAR) sparing with deep inspiration breath-hold (DIBH) technique to guide patient selection for this technique. Anatomic and treatment characteristics and radiation doses to OARs were compared between free-breathing and DIBH plans. Linear regression analysis was used to identify factors independently predicting for cardiac sparing. We identified 64 patients: 44 with intact breast and 20 postmastectomy. For changes measured directly on treatment planning scans, DIBH plans decreased heart-chest wall length (6.5 vs 5.0 cm, p < 0.001), and increased lung volume (1074.4 vs 1881.3 cm{sup 3}, p < 0.001), and for changes measured after fields are set, they decreased maximum heart depth (1.1 vs 0.3 cm, p < 0.001) and heart volume in field (HVIF) (9.1 vs 0.9 cm{sup 3}, p < 0.001). DIBH reduced the mean heart dose (3.4 vs 1.8 Gy, p < 0.001) and lung V{sub 20} (19.6% vs 15.3%, p < 0.001). Regression analysis found that only change in HVIF independently predicted for cardiac sparing. We identified patients in the bottom quartile of the dosimetric benefits seen with DIBH and categorized the cause of this “minimal benefit.” Overall, 29% of patients satisfied these criteria for minimal benefit with DIBH and the most common cause was favorable baseline anatomy. Only the reduction in HVIF predicted for reductions in mean heart dose; no specific anatomic surrogate for the dosimetric benefits of DIBH technique could be identified. Most patients have significant dosimetric benefit with DIBH, and this technique should be planned and evaluated for all patients receiving left-sided breast/chest wall radiation.

  6. Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Zagar, Timothy M., E-mail: zagar@med.unc.edu [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Kaidar-Person, Orit [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Tang, Xiaoli [Memorial Sloan Kettering Cancer Center, West Harrison, New York (United States); Jones, Ellen E.; Matney, Jason; Das, Shiva K.; Green, Rebecca L. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Sheikh, Arif [Department of Radiology, Columbia University, New York, New York (United States); Khandani, Amir H.; McCartney, William H.; Oldan, Jorge Daniel; Wong, Terence Z. [Department of Radiology, University of North Carolina, Chapel Hill, North Carolina (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

    2017-04-01

    Purpose: To evaluate early cardiac single photon computed tomography (SPECT) findings after left breast/chest wall postoperative radiation therapy (RT) in the setting of deep inspiration breath hold (DIBH). Methods and Materials: We performed a prospective single-institution single-arm study of patients who were planned for tangential RT with DIBH to the left breast/chest wall (± internal mammary nodes). The DIBH was done by use of a controlled surface monitoring technique (AlignRT, Vision RT Ltd, London, UK). The RT was given with tangential fields and a heart block. Radiation-induced cardiac perfusion and wall motion changes were assessed by pre-RT and 6-month post-RT SPECT scans. A cumulative SPECT summed-rest score was used to quantify perfusion in predefined left ventricle segments. The incidence of wall motion abnormalities was assessed in each of these same segments. Results: A total of 20 patients with normal pre-RT scans were studied; their median age was 56 years (range, 39-72 years). Seven (35%) patients also received irradiation to the left internal mammary chain, and 5 (25%) received an additional RT field to supraclavicular nodes. The median heart dose was 94 cGy (range, 56-200 cGy), and the median V25{sub Gy} was zero (range, 0-0.1). None of the patients had post-RT perfusion or wall motion abnormalities. Conclusions: Our results suggest that DIBH and conformal cardiac blocking for patients receiving tangential RT for left-sided breast cancer is an effective means to avoid early RT-associated cardiac perfusion defects.

  7. Purine metabolism in response to hypoxic conditions associated with breath-hold diving and exercise in erythrocytes and plasma from bottlenose dolphins (Tursiops truncatus).

    Science.gov (United States)

    Del Castillo Velasco-Martínez, Iris; Hernández-Camacho, Claudia J; Méndez-Rodríguez, Lía C; Zenteno-Savín, Tania

    2016-01-01

    In mammalian tissues under hypoxic conditions, ATP degradation results in accumulation of purine metabolites. During exercise, muscle energetic demand increases and oxygen consumption can exceed its supply. During breath-hold diving, oxygen supply is reduced and, although oxygen utilization is regulated by bradycardia (low heart rate) and peripheral vasoconstriction, tissues with low blood flow (ischemia) may become hypoxic. The goal of this study was to evaluate potential differences in the circulating levels of purine metabolism components between diving and exercise in bottlenose dolphins (Tursiops truncatus). Blood samples were taken from captive dolphins following a swimming routine (n=8) and after a 2min dive (n=8). Activity of enzymes involved in purine metabolism (hypoxanthine guanine phosphoribosyl transferase (HGPRT), inosine monophosphate deshydrogenase (IMPDH), xanthine oxidase (XO), purine nucleoside phosphorylase (PNP)), and purine metabolite (hypoxanthine (HX), xanthine (X), uric acid (UA), inosine monophosphate (IMP), inosine, nicotinamide adenine dinucleotide (NAD(+)), adenosine, adenosine monophosphate (AMP), adenosine diphosphate (ADP), ATP, guanosine diphosphate (GDP), guanosine triphosphate (GTP)) concentrations were quantified in erythrocyte and plasma samples. Enzymatic activity and purine metabolite concentrations involved in purine synthesis and degradation, were not significantly different between diving and exercise. Plasma adenosine concentration was higher after diving than exercise (p=0.03); this may be related to dive-induced ischemia. In erythrocytes, HGPRT activity was higher after diving than exercise (p=0.007), suggesting an increased capacity for purine recycling and ATP synthesis from IMP in ischemic tissues of bottlenose dolphins during diving. Purine recycling and physiological adaptations may maintain the ATP concentrations in bottlenose dolphins after diving and exercise. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Breath-hold imaging of the coronary arteries using Quiescent-Interval Slice-Selective (QISS) magnetic resonance angiography: pilot study at 1.5 Tesla and 3 Tesla.

    Science.gov (United States)

    Edelman, Robert R; Giri, S; Pursnani, A; Botelho, M P F; Li, W; Koktzoglou, I

    2015-11-23

    Coronary magnetic resonance angiography (MRA) is usually obtained with a free-breathing navigator-gated 3D acquisition. Our aim was to develop an alternative breath-hold approach that would allow the coronary arteries to be evaluated in a much shorter time and without risk of degradation by respiratory motion artifacts. For this purpose, we implemented a breath-hold, non-contrast-enhanced, quiescent-interval slice-selective (QISS) 2D technique. Sequence performance was compared at 1.5 and 3 Tesla using both radial and Cartesian k-space trajectories. The left coronary circulation was imaged in six healthy subjects and two patients with coronary artery disease. Breath-hold QISS was compared with T2-prepared 2D balanced steady-state free-precession (bSSFP) and free-breathing, navigator-gated 3D bSSFP. Approximately 10 2.1-mm thick slices were acquired in a single ~20-s breath-hold using two-shot QISS. QISS contrast-to-noise ratio (CNR) was 1.5-fold higher at 3 Tesla than at 1.5 Tesla. Cartesian QISS provided the best coronary-to-myocardium CNR, whereas radial QISS provided the sharpest coronary images. QISS image quality exceeded that of free-breathing 3D coronary MRA with few artifacts at either field strength. Compared with T2-prepared 2D bSSFP, multi-slice capability was not restricted by the specific absorption rate at 3 Tesla and pericardial fluid signal was better suppressed. In addition to depicting the coronary arteries, QISS could image intra-cardiac structures, pericardium, and the aortic root in arbitrary slice orientations. Breath-hold QISS is a simple, versatile, and time-efficient method for coronary MRA that provides excellent image quality at both 1.5 and 3 Tesla. Image quality exceeded that of free-breathing, navigator-gated 3D MRA in a much shorter scan time. QISS also allowed rapid multi-slice bright-blood, diastolic phase imaging of the heart, which may have complementary value to multi-phase cine imaging. We conclude that, with further clinical

  9. Comparison of cardiac and lung doses for breast cancer patients with free breathing and deep inspiration breath hold technique in 3 dimensional conformal radiotherapy - a dosimetric study

    Science.gov (United States)

    Raj Mani, Karthick; Poudel, Suresh; Maria Das, K. J.

    2017-12-01

    Purpose: To investigate the cardio-pulmonary doses between Deep Inspiration Breath Hold (DIBH) and Free Breathing (FB) technique in left sided breast irradiation. Materials & Methods: DIBH CT and FB CT were acquired for 10 left sided breast patients who underwent whole breast irradiation with or without nodal irradiation. Three fields single isocenter technique were used for patients with node positive patients along with two tangential conformal fields whereas only two tangential fields were used in node negative patients. All the critical structures like lungs, heart, esophagus, thyroid, etc., were delineated in both DIBH and FB scan. Both DIBH and FB scans were fused with the Dicom origin as they were acquired with the same Dicom coordinates. Plans were created in the DIBH scan for a dose range between 50 Gy in 25 fractions. Critical structures doses were recorded from the Dose Volume Histogram for both the DIBH and FB data set for evaluation. Results: The average mean heart dose in DIBH vs FB was 13.18 Gy vs 6.97 Gy, (p = 0.0063) significantly with DIBH as compared to FB technique. The relative reduction in average mean heart dose was 47.12%. The relative V5 reduced by 14.70% (i.e. 34.42% vs 19.72%, p = 0.0080), V10 reduced by 13.83% (i.e. 27.79 % vs 13.96%, p = 0.0073). V20 reduced by 13.19% (i.e. 24.54 % vs 11.35%, p = 0.0069), V30 reduced by 12.38% (i.e. 22.27 % vs 9.89 %, p = 0.0073) significantly with DIBH as compared to FB. The average mean left lung dose reduced marginally by 1.43 Gy (13.73 Gy vs 12.30 Gy, p = 0.4599) but insignificantly with DIBH as compared to FB. Other left lung parameters (V5, V10, V20 and V30) shows marginal decreases in DIBH plans compare to FB plans. Conclusion: DIBH shows a substantial reduction of cardiac doses but slight and insignificant reduction of pulmonary doses as compared with FB technique. Using the simple DIBH technique, we can effectively reduce the cardiac morbidity and at the same time radiation induced lung

  10. SU-F-T-123: The Simulated Effect of the Breath-Hold Reproducibility Treating Locally-Advanced Lung Cancer with Pencil Beam Scanned Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Dueck, J [Paul Scherrer Institut, Villigen PSI (Switzerland); Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Perrin, R [Paul Scherrer Institut, Villigen PSI (Switzerland); Persson, G F; Engelholm, S A [Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Lomax, A [Paul Scherrer Institut, Villigen PSI (Switzerland); Department of Physics, ETH, Zürich (Switzerland); Josipovic, M; Rosenschöld, AF [Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Weber, D C [Paul Scherrer Institut, Villigen PSI (Switzerland); University of Zürich, Zürich (Switzerland); Munck, P

    2016-06-15

    Purpose: The breath-hold (BH) technique has been suggested to mitigate motion and reduce target coverage degradation due to motion effects. The aim of this study was to investigate the effect of inter-BH residual motion on the dose distribution for pencil beam scanned (PBS) proton therapy of locally-advanced lung cancer patients. Methods: A dataset of visually-guided BH CT scans was acquired (10 scans per patient) taken from five lung cancer patients: three intra-fractionally repeated CT scans on treatment days 2,16 and 31, in addition to the day 0 planning CT scan. Three field intensity-modulated proton therapy (IMPT) plans were constructed on the planning CT scan. Dose delivery on fraction 2, 16 and 31 were simulated on the three consecutive CT scans, assuming BH duration of 20s and soft tissue match. The dose was accumulated in the planning CT using deformable image registration, and scaled to simulate the full treatment of 66Gy(RBE) in 33 fractions. Results: The mean dose to the lungs and heart, and maximum dose to the spinal cord and esophagus were within 1% of the planned dose. The CTV V95% decreased and the inhomogeneity (D5%–D95%) increased on average 4.1% (0.4–12.2%) and 5.8% (2.2–13.4%), respectively, over the five patient cases. Conclusion: The results showed that the BH technique seems to spare the OARs in spite of inter-BH residual motion. However, small degradation of target coverage occurred for all patients, with 3/5 patients having a decrease in V95% ≤1%. For the remaining two patients, where V95% decreased up to 12%, the cause could be related to treatment related anatomical changes and, as in photon therapy, plan adaptation may be necessary to ensure target coverage. This study showed that BH could be a potential treatment option to reliably mitigate motion for the treatment of locally-advanced lung cancer using PBS proton therapy.

  11. Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold. A planning study

    Energy Technology Data Exchange (ETDEWEB)

    Schoenecker, S.; Heinz, C.; Soehn, M.; Haimerl, W.; Corradini, S.; Pazos, M.; Belka, C.; Scheithauer, H. [University Hospital of Ludwig-Maximilian-University, Department of Radiation Oncology, Munich (Germany)

    2016-11-15

    The radiation dose received by the heart during adjuvant left-sided breast irradiation plays a crucial role in development of late toxicity. Although the absolute risk of cardiotoxicity can be reduced with modern irradiation techniques, cardiotoxic chemotherapy increases the risk of late damage. Thus, the radiation dose to the heart should be minimized. This study evaluated the influence of different amplitudes of inspiration breath hold (IBH) during simulated left-sided breast irradiation on cardiac doses compared to free breathing (FB). CT data of 11 lung cancer patients were retrospectively used as left-sided pseudo-breast cancer cases. Two CT scans were used, one during IBH and one during FB, and two treatment plans were generated. Relevant heart, lung, and left anterior descending artery (LAD) parameters were derived from dose-volume histograms. The normal tissue complication probabilities (NTCPs) for the heart were calculated based on the relative seriality model. Inspiration depth was quantified using chest volume and diameter, and correlated thereafter to a possible sparing of heart tissue. Mean reduction of heart dose for IBH compared to FB was 40 % (1.65 vs. 0.99 Gy; p = 0.007). Maximum dose to the heart and LAD could be decreased by 33 % (p = 0.011) and 43 % (p = 0.024), respectively. The mean anteroposterior shift was 5 mm (range 0.9-9.5 mm). Significant negative correlations between the relative change in LAD mean dose and the mean thoracic diameter and volume change, as well as with the absolute change in thoracic diameter were seen. The NTCP for cardiac mortality could be decreased by about 78 % (p = 0.017). For left-sided breast cancer patients, cardiac doses can be significantly decreased with tangential irradiation and IBH. (orig.) [German] Die Herzdosisbelastung spielt eine entscheidende Rolle in der Entwicklung einer kardialen Spaettoxizitaet nach der adjuvanten Strahlentherapie von linksseitigem Brustkrebs. Obwohl moderne strahlentherapeutische

  12. Single-Breath-Hold Whole-heart Unenhanced Coronary MRA Using Multi-shot Gradient Echo EPI at 3T: Comparison with Free-breathing Turbo-field-echo Coronary MRA on Healthy Volunteers.

    Science.gov (United States)

    Iyama, Yuji; Nakaura, Takeshi; Nagayama, Yasunori; Oda, Seitaro; Utsunomiya, Daisuke; Kidoh, Masafumi; Yuki, Hideaki; Hirata, Kenichiro; Namimoto, Tomohiro; Kitajima, Mika; Morita, Kosuke; Funama, Yoshinori; Takemura, Atsushi; Okuaki, Tomoyuki; Yamashita, Yasuyuki

    2017-06-26

    We investigated the feasibility of single breath hold unenhanced coronary magnetic resonance angiography (MRA) using multi-shot gradient echo planar imaging (MSG-EPI) on a 3T-scanner. Fourteen volunteers underwent single breath hold coronary MRA with a MSG-EPI and free-breathing turbo field echo (TFE) coronary MRA at 3T. The acquisition time, signal to noise ratio (SNR), and the contrast of the sequences were compared with the paired t-test. Readers evaluated the image contrast, noise, sharpness, artifacts, and the overall image quality. The acquisition time was 88.1% shorter for MSG-EPI than TFE (24.7 ± 2.5 vs 206.4 ± 23.1 sec, P EPI than TFE scans (P EPI and TFE scans (1.8 ± 0.3 vs 1.9 ± 0.3, P = 0.24). There was no significant difference in image contrast, image sharpness, and overall image quality between two scan techniques. The score of image noise and artifact were significantly higher on MSG-EPI than TFE scans (P EPI sequence is a promising technique for shortening the scan time and for preserving the image quality of unenhanced whole heart coronary MRA on a 3T scanner.

  13. Breath-hold technique in conventional APPA or intensity-modulated radiotherapy for Hodgkin's lymphoma. Comparison of ILROG IS-RT and the GHSG IF-RT

    Energy Technology Data Exchange (ETDEWEB)

    Kriz, Jan; Spickermann, Max; Lehrich, Philipp; Reinartz, Gabriele; Eich, Hans; Haverkamp, Uwe [University of Muenster, Department of Radiation Oncology, Muenster (Germany); Schmidberger, Heinz [University Mainz, Department of Radiation Oncology, Mainz (Germany)

    2015-09-15

    The present study addresses the role of intensity-modulated radiotherapy (IMRT) in contrast to standard RT (APPA) for patients with Hodgkin's lymphoma (HL) with a focus on deep inspiration breath-hold (DIBH) technique and a comparison between the International Lymphoma Radiation Oncology Group (ILROG) Involved Site Radiotherapy (IS-RT) versus the German Hodgkin Study Group (GHSG) Involved Field Radiotherapy (IF-RT). APPA treatment and 2 IMRT plans were compared for 11 patients with HL. Furthermore, treatment with DIBH versus free breathing (FB) and two different treatment volumes, i.e. IF-RT versus IS-RT, were compared. IMRT was planned as a sliding-window technique with 5 and 7 beam angles. For each patient 12 different treatment plans were calculated (132 plans). Following organs at risk (OAR) were analysed: lung, heart, spinal cord, oesophagus, female breast and skin. Comparisons of the different values with regard to dose-volume histograms (DVH), conformity and homogeneity indices were made. IS-RT reduces treatment volumes. With respect to the planning target volume (PTV), IMRT achieves better conformity but the same homogeneity. Regarding the D{sub mean} for the lung, IMRT shows increased doses, while RT in DIBH reduces doses. The IMRT shows improved values for D{sub max} concerning the spinal cord, whereas the APPA shows an improved D{sub mean} of the lung and the female breast. IS-RT reduces treatment volumes. Intensity-modulated radiotherapy shows advantages in the conformity. Treatment in DIBH also reduces the dose applied to the lungs and the heart. (orig.) [German] Ziel dieser Auswertung ist es, die konventionelle APPA-Feldanordnung mit der Intensitaetsmodulierten Radiotherapie (IMRT) bei Patienten mit Hodgkin-Lymphom (HL) zu vergleichen. Ein besonderer Fokus liegt hierbei auf der Bestrahlung in tiefer Inspiration und Atemanhaltetechnik (DIBH). Des Weiteren wurde die ''Involved-site''-Radiotherapie (IS-RT) der International

  14. Is the Deep Inspiration Breath-Hold Technique Superior to the Free Breathing Technique in Cardiac and Lung Sparing while Treating both Left-Sided Post-Mastectomy Chest Wall and Supraclavicular Regions

    Directory of Open Access Journals (Sweden)

    Anupama Darapu

    2017-01-01

    Full Text Available Aims: To evaluate the efficacy of the deep inspirational breath-hold (DIBH technique and its dosimetric advantages over the free breathing (FB technique in cardiac (heart and left anterior descending artery [LAD] and ipsilateral lung sparing in left-sided post-mastectomy field-in-field conformal radiotherapy. DIBH is highly reproducible, and this study aims to find out its dosimetric benefits over FB. Materials and Methods: Nineteen left-sided mastectomy patients were immobilized using breast boards with both arms positioned above the head. All patients had 2 sets of planning CT images (one in FB and another in DIBH with a Biograph TruePoint HD CT scanner in the same setup. DIBH was performed by tracking the respiratory cycles using a Varian Real-Time Position Management system. The target (chest wall and supraclavicular region, organs at risk (OARs; ipsilateral lung, contralateral lung, heart, LAD, and contralateral breast, and other organs of interests were delineated as per the RTOG (Radiation Therapy Oncology Group contouring guidelines. The single-isocenter conformal fields in the field treatment plans were generated with the Eclipse Treatment Planning System (Varian Medical Systems for both FB and DIBH images, and the doses to the target and OARs were compared. The standard fractionation regimen of 50 Gy in 25 fractions over a period of 5 weeks was used for all patients in this study. Results and Discussion: The target coverage parameters (V95, V105, V107, and Dmean were found to be 97.8 ± 0.9, 6.1 ± 3.4, 0.2 ± 0.3, and 101.9 ± 0.5% in the FB plans and 98.1 ± 0.8, 6.1 ± 3.2, 0.2 ± 0.3, and 101.9 ± 0.4% in the DIBH plans, respectively. The plan quality indices (conformity index and homogeneity index also showed 1.3 ± 0.2 and 0.1 for the FB plans and 1.2 ± 0.3 and 0.1 for the DIBH plans, respectively. There was a significant reduction in dose to the heart in the DIBH plans compared to the FB plans, with p values of nearly 0 for the

  15. Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos Bronchodilator effect on maximal breath-hold time in patients with obstructive lung disease

    Directory of Open Access Journals (Sweden)

    Raqueli Biscayno Viecili

    2011-12-01

    Full Text Available OBJETIVO: Identificar o papel do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVOs. MÉTODOS: Estudo caso-controle incluindo pacientes com DVOs e grupo controle. Foram realizadas espirometrias antes e após o uso de broncodilatador, assim como testes de apneia respiratória, utilizando-se um microprocessador eletrônico e um pneumotacógrafo como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil, e os tempos de apneia voluntária inspiratória e expiratória máximos (TAVIM e TAVEM, respectivamente foram determinados a partir do sinal adquirido. RESULTADOS: Um total de 35 pacientes com DVOs e 16 controles foram incluídos no estudo. O TAVIM sem o uso de broncodilatador foi significativamente menor no grupo DVO que no grupo controle (22,27 ± 11,81 s vs. 31,45 ± 15,73; p = 0,025, mas essa diferença não foi significativa após o uso de broncodilatador (24,94 ± 12,89 s vs. 31,67 ± 17,53 s. Os valores de TAVEM foram significativamente menores no grupo DVO que no grupo controle antes (16,88 ± 6,58 s vs. 22,09 ± 7,95 s; p = 0,017 e após o uso de broncodilatador (21,22 ± 9,37 s vs. 28,53 ± 12,46 s; p = 0,024. CONCLUSÕES: Estes resultados fornecem uma evidência adicional da utilidade clínica do teste de apneia na avaliação da função pulmonar e do papel do broncodilatador nesse teste.OBJECTIVE: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD. METHODS: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end

  16. TH-C-12A-11: Target Correlation of a 3D Surface Surrogate for Left Breast Irradiation Using the Respiratory-Gated Deep-Inspiration Breath-Hold Technique

    Energy Technology Data Exchange (ETDEWEB)

    Rong, Y; Walston, S [A Quick, Ohio State University, Columbus, OH (United States)

    2014-06-15

    Purpose: To evaluate the use of 3D optical surface imaging as a new surrogate for respiratory motion gated deep-inspiration breath-hold (DIBH) technique for left breast cancer patients. Methods: Patients with left-sided breast cancer after lumpectomy or mastectomy were selected as candidates for DIBH technique for their external beam radiation therapy. Treatment plans were created on both free breathing (FB) and DIBH CTs to determine whether DIBH was beneficial in reducing heart doses. The Real-time Position Management (RPM) system was used to acquire patient's breathing trace during DIBH CT acquisition and treatment delivery. The reference 3D surface models from FB and DIBH CTs were generated and transferred to the “AlignRT” system for patient positioning and real-time treatment monitoring. MV Cine images were acquired for each beam as quality assurance for intra-fractional position verification. The chest wall excursions measured on these images were used to define the actual target position during treatment, and to investigate the accuracy and reproducibility of RPM and AlignRT. Results: Reduction in heart dose can be achieved for left-sided breast patients using DIBH. Results showed that RPM has poor correlation with target position, as determined by the MV Cine imaging. This indicates that RPM may not be an adequate surrogate in defining the breath-hold level when used alone. Alternatively, the AlignRT surface imaging demonstrated a better correlation with the actual CW excursion during DIBH. Both the vertical and magnitude real-time deltas (RTDs) reported by AlignRT can be used as the gating parameter, with a recommend threshold of ±3 mm and 5 mm, respectively. Conclusion: 3D optical surface imaging serves as a superior target surrogate for the left breast treatment when compared to RPM. Working together with the realtime MV Cine imaging, they ensure accurate patient setup and dose delivery, while minimizing the imaging dose to patients.

  17. Feasibility of free-breathing dynamic contrast-enhanced MRI of gastric cancer using a golden-angle radial stack-of-stars VIBE sequence: comparison with the conventional contrast-enhanced breath-hold 3D VIBE sequence.

    Science.gov (United States)

    Li, Huan-Huan; Zhu, Hui; Yue, Lei; Fu, Yi; Grimm, Robert; Stemmer, Alto; Fu, Cai-Xia; Peng, Wei-Jun

    2017-12-19

    To investigate the feasibility and diagnostic value of free-breathing, radial, stack-of-stars three-dimensional (3D) gradient echo (GRE) sequence ("golden angle") on dynamic contrast-enhanced (DCE) MRI of gastric cancer. Forty-three gastric cancer patients were divided into cooperative and uncooperative groups. Respiratory fluctuation was observed using an abdominal respiratory gating sensor. Those who breath-held for more than 15 s were placed in the cooperative group and the remainder in the uncooperative group. The 3-T MRI scanning protocol included 3D GRE and conventional breath-hold VIBE (volume-interpolated breath-hold examination) sequences, comparing images quantitatively and qualitatively. DCE-MRI parameters from VIBE images of normal gastric wall and malignant lesions were compared. For uncooperative patients, 3D GRE scored higher qualitatively, and had higher SNRs (signal-to-noise ratios) and CNRs (contrast-to-noise ratios) than conventional VIBE quantitatively. Though 3D GRE images scored lower in qualitative parameters compared with conventional VIBE for cooperative patients, it provided images with fewer artefacts. DCE parameters differed significantly between normal gastric wall and lesions, with higher Ve (extracellular volume) and lower Kep (reflux constant) in gastric cancer. The free-breathing, golden-angle, radial stack-of-stars 3D GRE technique is feasible for DCE-MRI of gastric cancer. Dynamic enhanced images can be used for quantitative analysis of this malignancy. • Golden-angle radial stack-of-stars VIBE aids gastric cancer MRI diagnosis. • The 3D GRE technique is suitable for patients unable to suspend respiration. • Method scored higher in the qualitative evaluation for uncooperative patients. • The technique produced images with fewer artefacts than conventional VIBE sequence. • Dynamic enhanced images can be used for quantitative analysis of gastric cancer.

  18. Global multiplicity of dietary standards for trace elements.

    Science.gov (United States)

    Freeland-Graves, Jeanne H; Lee, Jane J

    2012-06-01

    Consistent guidelines across the world for dietary standards of trace elements remain elusive. Harmonization of dietary standards has been suggested by international agencies to facilitate consistency in food and nutrition policies and international trade. Yet significant barriers exist to standardize recommendations on a global basis, such as vast differences in geography, food availability and transport; cultural, social and economic constraints, and biological diversity. Simple commonality is precluded further by the variety of terminologies among countries and regions related to diet. Certain unions have created numerous nutritional descriptive categories for standards, while other large countries are limited to only a few. This paper will explore the global multiplicity of dietary standards and efforts for harmonization. Copyright © 2012 Elsevier GmbH. All rights reserved.

  19. Comparison of multi-echo dixon methods with volume interpolated breath-hold gradient magnetic resonance imaging in fat-signal fraction quantification of paravaertebral muscle

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Yeon Hwa; Kim, Hak Sun; Lee, Young Han [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); and others

    2015-10-15

    To assess whether multi-echo Dixon magnetic resonance (MR) imaging with simultaneous T2{sup *} estimation and correction yields more accurate fat-signal fraction (FF) measurement of the lumbar paravertebral muscles, in comparison with non-T2{sup *}-corrected two-echo Dixon or T2{sup *}-corrected three-echo Dixon, using the FF measurements from single-voxel MR spectroscopy as the reference standard. Sixty patients with low back pain underwent MR imaging with a 1.5T scanner. FF mapping images automatically obtained using T2{sup *}-corrected Dixon technique with two (non-T2{sup *}-corrected), three, and six echoes, were compared with images from single-voxel MR spectroscopy at the paravertebral muscles on levels L4 through L5. FFs were measured directly by two radiologists, who independently drew the region of interest on the mapping images from the three sequences. A total of 117 spectroscopic measurements were performed either bilaterally (57 of 60 subjects) or unilaterally (3 of 60 subjects). The mean spectroscopic FF was 14.3 ± 11.7% (range, 1.9-63.7%). Interobserver agreement was excellent between the two radiologists. Lin's concordance correlation between the spectroscopic findings and all the imaging-based FFs were statistically significant (p < 0.001). FFs obtained from the T2*-corrected six-echo Dixon sequences showed a significantly better concordance with the spectroscopic data, with its concordance correlation coefficient being 0.99 and 0.98 (p < 0.001), as compared with two- or three-echo methods. T2{sup *}-corrected six-echo Dixon sequence would be a better option than two- or three-echo methods for noninvasive quantification of lumbar muscle fat quantification.

  20. Differentiation between focal malignant marrow-replacing lesions and benign red marrow deposition of the spine with T2*-corrected fat-signal fraction map using a three-echo volume interpolated breath-hold gradient echo Dixon sequence.

    Science.gov (United States)

    Kim, Yong Pyo; Kannengiesser, Stephan; Paek, Mun-Young; Kim, Sungjun; Chung, Tae-Sub; Yoo, Yeon Hwa; Yoon, Choon-Sik; Song, Ho-Taek; Lee, Young Han; Suh, Jin-Suck

    2014-01-01

    To assess the feasibility of T2*-corrected fat-signal fraction (FF) map by using the three-echo volume interpolated breath-hold gradient echo (VIBE) Dixon sequence to differentiate between malignant marrow-replacing lesions and benign red marrow deposition of vertebrae. We assessed 32 lesions from 32 patients who underwent magnetic resonance imaging after being referred for assessment of a known or possible vertebral marrow abnormality. The lesions were divided into 21 malignant marrow-replacing lesions and 11 benign red marrow depositions. Three sequences for the parameter measurements were obtained by using a 1.5-T MR imaging scanner as follows: three-echo VIBE Dixon sequence for FF; conventional T1-weighted imaging for the lesion-disc ratio (LDR); pre- and post-gadolinium enhanced fat-suppressed T1-weighted images for the contrast-enhancement ratio (CER). A region of interest was drawn for each lesion for parameter measurements. The areas under the curve (AUC) of the parameters and their sensitivities and specificities at the most ideal cutoff values from receiver operating characteristic curve analysis were obtained. AUC, sensitivity, and specificity were respectively compared between FF and CER. The AUCs of FF, LDR, and CER were 0.96, 0.80, and 0.72, respectively. In the comparison of diagnostic performance between the FF and CER, the FF showed a significantly larger AUC as compared to the CER (p = 0.030), although the difference of sensitivity (p = 0.157) and specificity (p = 0.157) were not significant. Fat-signal fraction measurement using T2*-corrected three-echo VIBE Dixon sequence is feasible and has a more accurate diagnostic performance, than the CER, in distinguishing benign red marrow deposition from malignant bone marrow-replacing lesions.

  1. Prospective intraindividual comparison between respiratory-triggered balanced steady-state free precession and breath-hold gradient-echo and time-of-flight magnetic resonance imaging for assessment of portal and hepatic veins

    Energy Technology Data Exchange (ETDEWEB)

    Willmann, Juergen K.; Goepfert, Kerstin; Lutz, Amelie M.; Marincek, Borut; Weishaupt, Dominik [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Nanz, Daniel [University Hospital Zurich, Department of Medical Radiology, Zurich (Switzerland); McCormack, Lucas; Petrowsky, Henrik [University Hospital Zurich, Department of Visceral and Transplantation Surgery, Zurich (Switzerland); Seifert, Burkhardt [University of Zurich, Department of Biostatistics, Zurich (Switzerland); Hervo, Patrice [GE Healthcare, Buc Cedex (France)

    2007-01-15

    The purpose of this study was to compare respiratory-triggered balanced steady-state free precession (bSSFP) with breath-hold contrast-enhanced dynamic two-dimensional (2D) gradient-echo (GRE) and time-of-flight (TOF) magnetic resonance imaging (MRI) for portal and hepatic vein visualization and assessment of portal and hepatic venous variants. Sixty patients with liver disease underwent nonenhanced bSSFP and contrast-enhanced GRE, bSSFP, and TOF imaging. Contrast-to-noise ratios (CNRs) for portal and hepatic veins were measured. Two readers rated the quality of portal and hepatic vein visualization on a 5-point Likert scale. The diagnostic performance of each MRI series in the detection of portal and hepatic venous variants was assessed in 40/60 patients who also underwent contrast-enhanced multidetector-row computed tomography (MDCT). CNRs for portal and hepatic veins were highest on contrast-enhanced bSSFP images. Image quality of portal and hepatic veins was rated higher for nonenhanced bSSFP than for contrast-enhanced GRE (p<0.03) and TOF (p<0.003) and higher for contrast-enhanced than for nonenhanced bSSFP (p<0.003). Compared with MDCT, portal and hepatic venous variants were identified with an accuracy of 99% on bSSFP images, with an excellent interobserver agreement ({kappa}=0.97). Compared with MDCT, presence of surgically important portal and hepatic venous anatomical variants can be predicted with high accuracy on bSSFP images. (orig.)

  2. Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: Does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy?

    Science.gov (United States)

    Pham, Trang T; Ward, Rachel; Latty, Drew; Owen, Catherine; Gebski, Val; Chojnowski, Jacek; Kelly, Christopher; Ahern, Verity; Tiver, Kenneth; Stuart, Kirsty; Wang, Wei

    2016-08-01

    Left-sided breast cancer radiotherapy has been associated with an increase in cardiac mortality. This study investigated the potential heart-sparing effect of volumetric-modulated arc radiotherapy (VMAT). We compared VMAT to tangential intensity-modulated radiotherapy (t-IMRT) in the loco-regional treatment of left-sided breast cancer, including internal mammary nodal irradiation, based on deep inspiration breath-hold (DIBH) and free-breathing (FB). Radiotherapy for 15 patients was re-planned. Four plans were compared: t-IMRT-DIBH; VMAT-DIBH; t-IMRT-FB; VMAT-FB. Prescribed dose was 50 Gy in 25 fractions. T-IMRT plans were generated using tangentially orientated fields. VMAT plans were generated using two partial arcs (average arc 190°). Mean heart dose (MHD) was 5 ± 2.4 Gy, 5.7 ± 1.4 Gy, 9.7 ± 3.3 Gy and 8.1 ± 2.0 Gy for t-IMRT-DIBH, VMAT-DIBH, IMRT-FB and VMAT-FB respectively. The difference in MHD between IMRT-DIBH and VMAT-DIBH was not significant (P = 0.14). VMAT-DIBH significantly spared the volume of heart irradiated to doses of 20 Gy and above (p 6.3 Gy with t-IMRT-DIBH, the use of VMAT-DIBH resulted in a benefit in reducing the MHD. © 2016 The Royal Australian and New Zealand College of Radiologists.

  3. SU-F-J-22: Lung VolumeVariability Assessed by Bh-CBCT in 3D Surface Image Guided Deep InspirationBreath Hold (DIBH) Radiotherapy for Left-Sided Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gutierrez, A; Stanley, D; Papanikolaou, N; Crownover, R [University of Texas Health Science Center San Antonio, San Antonio, TX (United States)

    2016-06-15

    Purpose: With the increasing use of DIBH techniques for left-sided breast cancer, 3D surface-image guided DIBH techniques have improved patient setup and facilitated DIBH radiation delivery. However, quantification of the daily separation between the heart and left breast still presents a challenge. One method of assuring separation is to ensure consistent left lung filling. With this in mind, the aim of this study is to retrospectively quantify left lung volume from weekly breath hold-CBCTs (bh-CBCT) of left-sided breast patients treated using a 3D surface imaging system. Methods: Ten patients (n=10) previously treated to the left breast using the C-Rad CatalystHD system (C-RAD AG, Uppsala Sweden) were evaluated. Patients were positioned with CatalystHD and with bh-CBCT. bh-CBCTs were acquired at the validation date, first day of treatment and at subsequent weekly intervals. Total treatment courses spanned from 3 to 5 weeks. bh-CBCT images were exported to VelocityAI and the left lung volume was segmented. Volumes were recorded and analyzed. Results: A total of 41 bh-CBCTs were contoured in VelocityAI for the 10 patients. The mean left lung volume for all patients was 1657±295cc based on validation bh-CBCT. With the subsequent lung volumes normalized to the validation lung volume, the mean relative ratios for all patients were 1.02±0.11, 0.97±0.14, 0.98±0.11, 1.02±0.01, and 0.96±0.02 for week 1, 2, 3, 4, and 5, respectively. Overall, the mean left lung volume change was ≤4.0% over a 5-week course; however left lung volume variations of up to 28% were noted in a select patient. Conclusion: With the use of the C-RAD CatalystHD system, the mean lung volume variability over a 5-week course of DIBH treatments was ≤4.0%. By minimizing left lung volume variability, heart to left breast separation maybe more consistently maintained. AN Gutierrez has a research grant from C-RAD AG.

  4. T2-weighted MR imaging of liver lesions: a prospective evaluation comparing turbo spin-echo, breath-hold turbo spin-echo and half-Fourier turbo spin-echo (HASTE) sequences; Estudio de lesiones hepaticas con imagenes de resonancia magnetica potenciadas en T2: evaluacion prospectiva comparando secuencias turbo eco del espin, turbo eco del espin con respiracion sostenida y half-Fourier turbo eco del espin (HASTE)

    Energy Technology Data Exchange (ETDEWEB)

    Martin, J.; Villajos, M.; Oses, M. J.; Veintemillas, M.; Rue, M.; Puig, J.; Sentis, M. [Fundacion Parc Tauli. Sabadell (Spain)

    2000-07-01

    To compare turbo spin-echo (TSE), breath-hold TSE and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences quantitatively and qualitatively in T2-weighted images of liver lesions. The authors evaluated prospectively 89 liver lesions in 73 patients using a 1.0-T magnetic resonance system to compare TSE, breath-hold TSE and HASTE sequences. The quantitative parameters were: lesion-to-liver contrast and lesion-to-liver contrast-to-noise ratio. The qualitative analysis was performed by two observers in consensus who examined four parameters: respiratory artifacts, lesion edge definition, intrahepatic vessel definition and image quality. Repeated measures analysis of variance was utilized to compare the quantitative variables and Friedman's nonparametric test for the qualitative parameters. In quantitative terms, the lesion-to-liver contrast was similar in TSE and breath-hold TSE sequences (2.45{+-}1.44 versus 2.60{+-}1.66), both of which were significantly better than the HASTE sequence (1.12{+-}0.72; p<0.001). The lesion-to-liver contrast-to-noise ratio was significantly higher in the TSE sequence (62.60{+-}46.40 versus 40.22{+-}25.35 versus 50.90{+-}32.10 for TSE, breath-hold TSE and HASTE sequences, respectively; p<0.001). In the qualitative comparisons, the HASTE sequence was significantly better than the TSE and breath-hold TSE sequences (p<0.001) in terms of artifacts and definition of lesion edge and intrahepatic vessels. Image quality was also significantly greater in the HASTE sequence (p<0.001). In quantitative terms, the TSE sequence is better than the breath-hold TSE and HASTE sequences, but there are no movement artifacts in the HASTE sequence, which is also significantly superior to TSE and breath-hold TSE sequences in qualitative terms and, thus, can be employed for T2-weighted images in liver studies. (Author) 17 refs.

  5. Multiple Roles of Specialized Literacy Professionals: The ILA 2017 Standards

    Science.gov (United States)

    Bean, Rita M.; Kern, Diane; Griffith, Robin; Lacina, Jan

    2018-01-01

    This article compares the ILA 2017 Standards for preparing specialized literacy professionals with the 2010 Standards. The authors also describe levels of emphases for each specialized literacy role and implications of the new Standards for those serving in the field and for those who prepare them.

  6. Retrospective study comparing low-dose versus standard dose of bortezomib in patients with multiple myeloma

    Directory of Open Access Journals (Sweden)

    Marcela Espinoza Zelada

    2015-03-01

    Full Text Available INTRODUCTION Bortezomib is a selective inhibitor of the proteosoma that is used in multiple myeloma. In combination with other antineoplastic drugs, it has a well-documented impact in progression-free survival rates and overall survival rates with standard doses (1.3-1.5 mg/m2. However, up to 88% of patients on standard doses have unwanted side effects (neutropenia, neuropathy or anemia. Standard dose (1.3 mg/m2 is used in almost all patients and low dose (0.7-0.8 mg/m2 is reserved for patients with kidney disease and neuropathy. OBJECTIVE We aim to describe clinical, cytological, and cytometric outcomes, as well as overall survival and side effects of low dose versus standard dose of bortezomib in our institution. METHODS Retrospective, descriptive study based on data recovered from clinical charts of 48 multiple myeloma patients treated in our hospital between 2011 and 2013. We included data on age, gender, type of multiple myeloma, serum albumin, serum creatinine, beta 2 microglobulin, calcemia, imaging studies, disease stage, pre-and post-therapy bone marrow studies, adverse events and rate of progression. We also recorded events like date of death or of the last medical appointment. RESULTS Forty-eight multiple myeloma patients were treated with bortezomib-cyclophosphamide-dexamethasone. Twenty-one patients received low dose and 27 patients were treated with the standard dose. No statistical differences between the two groups were found for clinical response (p=0.6, cytological response (p=0.28, flow cytometric response (p= 0.3, rate of adverse effects and overall survival rates. CONCLUSION This retrospective analysis suggests that lower doses of bortezomib have similar effects in disease control measured by flow cytometry and cytology compared to standard doses in multiple myeloma patients.

  7. SU-F-J-55: Feasibility of Supraclavicular Field Treatment by Investigating Variation of Junction Position Between Breast Tangential and Supraclavicular Fields for Deep Inspiration Breath Hold (DIBH) Left Breast Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, H; Sarkar, V; Paxton, A; Rassiah-Szegedi, P; Huang, Y; Szegedi, M; Huang, L; Su, F; Salter, B [University Utah, Salt Lake City, UT (United States)

    2016-06-15

    Purpose: To explore the feasibility of supraclavicular field treatment by investigating the variation of junction position between tangential and supraclavicular fields during left breast radiation using DIBH technique. Methods: Six patients with left breast cancer treated using DIBH technique were included in this study. AlignRT system was used to track patient’s breast surface. During daily treatment, when the patient’s DIBH reached preset AlignRT tolerance of ±3mm for all principle directions (vertical, longitudinal, and lateral), the remaining longitudinal offset was recorded. The average with standard-deviation and the range of daily longitudinal offset for the entire treatment course were calculated for all six patients (93 fractions totally). The ranges of average ± 1σ and 2σ were calculated, and they represent longitudinal field edge error with the confidence level of 68% and 95%. Based on these longitudinal errors, dose at junction between breast tangential and supraclavicular fields with variable gap/overlap sizes was calculated as a percentage of prescription (on a representative patient treatment plan). Results: The average of longitudinal offset for all patients is 0.16±1.32mm, and the range of longitudinal offset is −2.6 to 2.6mm. The range of longitudinal field edge error at 68% confidence level is −1.48 to 1.16mm, and at 95% confidence level is −2.80 to 2.48mm. With a 5mm and 1mm gap, the junction dose could be as low as 37.5% and 84.9% of prescription dose; with a 5mm and 1mm overlap, the junction dose could be as high as 169.3% and 117.6%. Conclusion: We observed longitudinal field edge error at 95% confidence level is about ±2.5mm, and the junction dose could reach 70% hot/cold between different DIBH. However, over the entire course of treatment, the average junction variation for all patients is within 0.2mm. The results from our study shows it is potentially feasible to treat supraclavicular field with breast tangents.

  8. Comparison of left and right ventricular ejection and filling parameters by fast cine MR imaging in breath-hold technique: clinical study of 42 patients with cardiomyopathy and coronary heart disease; Vergleich links- und rechtsventrikulaerer Auswurf- und Fuellungsparameter des Herzens mittels Cine MRT in Atemanhaltetechnik: klinische Studie an 42 Patienten mit Kardiomyopathie und koronarer Herzerkrankung

    Energy Technology Data Exchange (ETDEWEB)

    Rominger, M.B.; Bachmann, G.F.; Geuer, M.; Puzik, M.; Rau, W.S. [Giessen Univ. (Germany). Diagnostische Radiologie; Ricken, W.W. [Kerckhoff-Klinik GmbH, Bad Nauheim (Germany). Abt. Kardiologie

    1999-06-01

    Purpose: Quantification of left and right ventricular filling and ejection of localized and diffuse heart diseases with fast cine MR imaging in breath-hold technique. Methods: 42 patients (14 idiopathic dilated cardiomyopathies (DCM), 13 hypertrophic cardiomyopathies (HCM) and 15 coronary artery diseases (CAD)) and 10 healthy volunteers were examined. Time-volume-curves of three left ventricular and one right ventricular slices were evaluated and peak ejection and filling rates (PER, PFR end-diastolic volume (EDV)/s) time to PER and PFR (TPER, TPFR ms) and time of end-systole (TSYS in % RR-intervall) were calculated. Results: There were significant regional and left-/right-sided differences of the filling and ejection of both ventricles within and between the different groups. In DCM the left ventricular PFR was reduced (DCM 3.1 EDV/s; volunteers 4.9 EDV/s) and Z-SYS prolonged (DCM 50.1%; volunteers 35.4%). In CAD there were localized decreased filling rates in comparison to the normal volunteer group (left ventricle: basal: 2.9 and 6.3 EDV/s, apical: 4.4 and 6.3 EDV/s; right ventricle: 3.6 and 5.7 EDV/s). HCM typically showed an isovolumetric lengthening of the endsystole. Conclusions: Cardiac MR imaging in breath-hold technique is suitable for measuring contraction and relaxation disturbances of localized and diffuse heart diseases by means of ejection and filling volume indices. (orig.) [Deutsch] Ziel: Quantifizierung der links- und rechtsventrikulaeren Fuellung und des Auswurfs bei umschriebenen und diffusen Herzerkrankungen mittels schneller Cine MR Bildgebung in Atemanhaltetechnik. Methoden: Untersucht wurden 42 Patienten (14 dilatative Kardiomyopathien (DCM), 13 hypertrophe obstruktive Kardiomyopathien (HCM) und 15 koronare Herzerkrankungen (KHK)) und 10 Probanden. Von drei linksventrikulaeren und einer rechtsventrikulaeren Einzelschicht wurden Zeit-Volumen-Kurven erstellt, aus denen die maximale Auswurf- und Fuellrate (MAR) (MFR eddiastolisches Volumen (EDV

  9. Standard test method for nondestructive assay of plutonium by passive neutron multiplicity counting

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2008-01-01

    1.1 This test method describes the nondestructive assay of plutonium in forms such as metal, oxide, scrap, residue, or waste using passive neutron multiplicity counting. This test method provides results that are usually more accurate than conventional neutron coincidence counting. The method can be applied to a large variety of plutonium items in various containers including cans, 208-L drums, or 1900-L Standard Waste Boxes. It has been used to assay items whose plutonium content ranges from 1 g to 1000s of g. 1.2 There are several electronics or mathematical approaches available for multiplicity analysis, including the multiplicity shift register, the Euratom Time Correlation Analyzer, and the List Mode Module, as described briefly in Ref. (1). 1.3 This test method is primarily intended to address the assay of 240Pu-effective by moments-based multiplicity analysis using shift register electronics (1, 2, 3) and high efficiency neutron counters specifically designed for multiplicity analysis. 1.4 This tes...

  10. Latest developments in the iLids performance standard: from multiple standard camera views to new imaging modalities

    Science.gov (United States)

    Sage, K. H.; Nilski, A. J.; Sillett, I. M.

    2009-09-01

    The Imagery Library for Intelligent Detection Systems (iLids) is the UK Government's standard for Video Based Detection Systems (VBDS). The first four iLids scenarios were released in November 2006 and annual evaluations for these four scenarios began in 2007. The Home Office Scientific Development Branch (HOSDB), in partnership with the Centre for the Protection of National Infrastructure (CPNI), has also developed a fifth iLids Scenario; Multiple Camera Tracking (MCT). The fifth scenario data sets were made available in November 2008 to industry, academic and commercial research organizations The imagery contains various staged events of people walking through the camera views. Multiple Camera Tracking Systems (MCTS) are expected to initialise on a specific target and be able to track the target over some or all of the camera views. HOSDB and CPNI are now working on a sixth iLids dataset series. These datasets will cover several technology areas: • Thermal imaging systems • Systems that rely on active IR illumination The aim is to develop libraries that promote the development of systems that are able to demonstrate effective performance in the key application area of people and vehicular detection at a distance. This paper will: • Describe the evaluation process, infrastructure and tools that HOSDB will use to evaluate MCT systems. Building on the success of our previous automated tools for evaluation, HOSDB has developed the MCT evaluation tool CLAYMORE. CLAYMORE is a tool for the real-time evaluation of MCT systems. • Provide an overview of the new sixth scenario aims and objectives, library specifications and timescales for release.

  11. Multiplicative effects model with internal standard in mobile phase for quantitative liquid chromatography-mass spectrometry.

    Science.gov (United States)

    Song, Mi; Chen, Zeng-Ping; Chen, Yao; Jin, Jing-Wen

    2014-07-01

    Liquid chromatography-mass spectrometry assays suffer from signal instability caused by the gradual fouling of the ion source, vacuum instability, aging of the ion multiplier, etc. To address this issue, in this contribution, an internal standard was added into the mobile phase. The internal standard was therefore ionized and detected together with the analytes of interest by the mass spectrometer to ensure that variations in measurement conditions and/or instrument have similar effects on the signal contributions of both the analytes of interest and the internal standard. Subsequently, based on the unique strategy of adding internal standard in mobile phase, a multiplicative effects model was developed for quantitative LC-MS assays and tested on a proof of concept model system: the determination of amino acids in water by LC-MS. The experimental results demonstrated that the proposed method could efficiently mitigate the detrimental effects of continuous signal variation, and achieved quantitative results with average relative predictive error values in the range of 8.0-15.0%, which were much more accurate than the corresponding results of conventional internal standard method based on the peak height ratio and partial least squares method (their average relative predictive error values were as high as 66.3% and 64.8%, respectively). Therefore, it is expected that the proposed method can be developed and extended in quantitative LC-MS analysis of more complex systems. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Weak gravity conjecture, multiple point principle and the standard model landscape

    Science.gov (United States)

    Hamada, Yuta; Shiu, Gary

    2017-11-01

    The requirement for an ultraviolet completable theory to be well-behaved upon compactification has been suggested as a guiding principle for distinguishing the landscape from the swampland. Motivated by the weak gravity conjecture and the multiple point principle, we investigate the vacuum structure of the standard model compactified on S 1 and T 2. The measured value of the Higgs mass implies, in addition to the electroweak vacuum, the existence of a new vacuum where the Higgs field value is around the Planck scale. We explore two- and three-dimensional critical points of the moduli potential arising from compactifications of the electroweak vacuum as well as this high scale vacuum, in the presence of Majorana/Dirac neutrinos and/or axions. We point out potential sources of instability for these lower dimensional critical points in the standard model landscape. We also point out that a high scale AdS4 vacuum of the Standard Model, if exists, would be at odd with the conjecture that all non-supersymmetric AdS vacua are unstable. We argue that, if we require a degeneracy between three- and four-dimensional vacua as suggested by the multiple point principle, the neutrinos are predicted to be Dirac, with the mass of the lightest neutrino ≈ O(1-10) meV, which may be tested by future CMB, large scale structure and 21cm line observations.

  13. Medical students' attention to multiple risk behaviors: a standardized patient examination.

    Science.gov (United States)

    Prochaska, Judith J; Gali, Kathleen; Miller, Bernie; Hauer, Karen E

    2012-06-01

    Risk behaviors tend to cluster, particularly among smokers, with negative health effects. To optimize patients' health and wellbeing, health care providers ideally would assess and intervene upon the multiple risks with which patients may present. This study examined medical students' skills in assessing and treating multiple risk behaviors. Using a randomized experimental design, medical students' counseling interactions were evaluated with a standardized patient presenting with sexual health concerns and current tobacco use with varied problematic drinking status (alcohol-positive or alcohol-negative). One hundred and fifty-six third-year medical students. Student and standardized patient completed measures evaluated student knowledge, attitudes, and clinical performance. Overall, most students assessed tobacco use (85%); fewer assessed alcohol use (54%). Relative to the alcohol-negative case, students seeing the alcohol-positive case were less likely to assess sexually transmitted disease history (80% vs. 91%, p = 0.042), or patients' readiness to quit smoking (41% vs. 60%, p = 0.025), and endorsed greater attitudinal barriers to tobacco treatment (p = 0.030). Patient satisfaction was significantly lower for the alcohol-positive than the alcohol-negative case; clinical performance ratings moderated this relationship. When presented with a case of multiple risks, medical students performed less effectively and received lower patient satisfaction ratings. Findings were moderated by students' overall clinical performance. Paradigm shifts are needed in medical education that emphasize assessment of multiple risks, new models of conceptualizing behavior change as a generalized process, and treatment of the whole patient for optimizing health outcomes.

  14. Normalization method for metabolomics data using optimal selection of multiple internal standards

    Directory of Open Access Journals (Sweden)

    Yetukuri Laxman

    2007-03-01

    Full Text Available Abstract Background Success of metabolomics as the phenotyping platform largely depends on its ability to detect various sources of biological variability. Removal of platform-specific sources of variability such as systematic error is therefore one of the foremost priorities in data preprocessing. However, chemical diversity of molecular species included in typical metabolic profiling experiments leads to different responses to variations in experimental conditions, making normalization a very demanding task. Results With the aim to remove unwanted systematic variation, we present an approach that utilizes variability information from multiple internal standard compounds to find optimal normalization factor for each individual molecular species detected by metabolomics approach (NOMIS. We demonstrate the method on mouse liver lipidomic profiles using Ultra Performance Liquid Chromatography coupled to high resolution mass spectrometry, and compare its performance to two commonly utilized normalization methods: normalization by l2 norm and by retention time region specific standard compound profiles. The NOMIS method proved superior in its ability to reduce the effect of systematic error across the full spectrum of metabolite peaks. We also demonstrate that the method can be used to select best combinations of standard compounds for normalization. Conclusion Depending on experiment design and biological matrix, the NOMIS method is applicable either as a one-step normalization method or as a two-step method where the normalization parameters, influenced by variabilities of internal standard compounds and their correlation to metabolites, are first calculated from a study conducted in repeatability conditions. The method can also be used in analytical development of metabolomics methods by helping to select best combinations of standard compounds for a particular biological matrix and analytical platform.

  15. Next Generation Flow for highly sensitive and standardized detection of minimal residual disease in multiple myeloma.

    Science.gov (United States)

    Flores-Montero, J; Sanoja-Flores, L; Paiva, B; Puig, N; García-Sánchez, O; Böttcher, S; van der Velden, V H J; Pérez-Morán, J-J; Vidriales, M-B; García-Sanz, R; Jimenez, C; González, M; Martínez-López, J; Corral-Mateos, A; Grigore, G-E; Fluxá, R; Pontes, R; Caetano, J; Sedek, L; Del Cañizo, M-C; Bladé, J; Lahuerta, J-J; Aguilar, C; Bárez, A; García-Mateo, A; Labrador, J; Leoz, P; Aguilera-Sanz, C; San-Miguel, J; Mateos, M-V; Durie, B; van Dongen, J J M; Orfao, A

    2017-10-01

    Flow cytometry has become a highly valuable method to monitor minimal residual disease (MRD) and evaluate the depth of complete response (CR) in bone marrow (BM) of multiple myeloma (MM) after therapy. However, current flow-MRD has lower sensitivity than molecular methods and lacks standardization. Here we report on a novel next generation flow (NGF) approach for highly sensitive and standardized MRD detection in MM. An optimized 2-tube 8-color antibody panel was constructed in five cycles of design-evaluation-redesign. In addition, a bulk-lysis procedure was established for acquisition of ⩾107 cells/sample, and novel software tools were constructed for automatic plasma cell gating. Multicenter evaluation of 110 follow-up BM from MM patients in very good partial response (VGPR) or CR showed a higher sensitivity for NGF-MRD vs conventional 8-color flow-MRD -MRD-positive rate of 47 vs 34% (P=0.003)-. Thus, 25% of patients classified as MRD-negative by conventional 8-color flow were MRD-positive by NGF, translating into a significantly longer progression-free survival for MRD-negative vs MRD-positive CR patients by NGF (75% progression-free survival not reached vs 7 months; P=0.02). This study establishes EuroFlow-based NGF as a highly sensitive, fully standardized approach for MRD detection in MM which overcomes the major limitations of conventional flow-MRD methods and is ready for implementation in routine diagnostics.

  16. Solving standard traveling salesman problem and multiple traveling salesman problem by using branch-and-bound

    Science.gov (United States)

    Saad, Shakila; Wan Jaafar, Wan Nurhadani; Jamil, Siti Jasmida

    2013-04-01

    The standard Traveling Salesman Problem (TSP) is the classical Traveling Salesman Problem (TSP) while Multiple Traveling Salesman Problem (MTSP) is an extension of TSP when more than one salesman is involved. The objective of MTSP is to find the least costly route that the traveling salesman problem can take if he wishes to visit exactly once each of a list of n cities and then return back to the home city. There are a few methods that can be used to solve MTSP. The objective of this research is to implement an exact method called Branch-and-Bound (B&B) algorithm. Briefly, the idea of B&B algorithm is to start with the associated Assignment Problem (AP). A branching strategy will be applied to the TSP and MTSP which is Breadth-first-Search (BFS). 11 nodes of cities are implemented for both problem and the solutions to the problem are presented.

  17. Assisting People with Multiple Disabilities Improve Their Computer Pointing Efficiency with Thumb Poke through a Standard Trackball

    Science.gov (United States)

    Shih, Ching-Hsiang; Shih, Ching-Tien

    2010-01-01

    This study evaluated whether two people with multiple disabilities who could not easily use a computer through a standard input device (i.e., mouse or trackball) would be able to improve their pointing performance using thumb poke with a standard trackball through a Dynamic Trackball-Pointing Assistive Program (DTPAP) and a newly developed…

  18. Endocrine and cytokine responses to standardized physical stress in multiple sclerosis.

    Science.gov (United States)

    Heesen, Christoph; Gold, Stefan M; Hartmann, Sten; Mladek, Mila; Reer, Rüdiger; Braumann, Klaus-Michael; Wiedemann, Klaus; Schulz, Karl-Heinz

    2003-12-01

    Since the earliest descriptions psychological and physical stress has been considered a controversial but potentially important factor in the onset and course of multiple sclerosis (MS). During recent years it has become clear that MS patients benefit from physical exercise as performed in aerobic training. As acute exercise has profound effects on immune and endocrine parameters we studied endocrine and immune response to standardized physical stress in MS within a study of aerobic training. Fifteen MS patients completed an eight-week aerobic training program, 13 patients were part of a wait-control group. Twenty healthy controls were recruited as well. A step-by-step bicycle ergometry was performed to determine individual exertion levels. For the endurance test patients exercised at 60% VO2 max for 30 min. Blood samples were drawn before, directly after and 30 min after completion of the exercise. Heart rate and lactate increased in all groups (p<.0001). We furthermore saw significant increases in endocrine parameters (epinephrine, norepinephrine, ACTH, and beta-endorphin; all p<.0001) in healthy individuals and in MS patients but without a differential effect. Whole-blood stimulated production of IFN-gamma (IFNgamma) was induced similarly in all groups (p<.01). TNF-alpha (TNFalpha) and IL-10 were less inducible in MS patients (trend). From these data we could not demonstrate a proinflammatory immune deviation in response to physical stress in MS. The observed trend of hyporesponsive TNFalpha and IL-10 responses in MS warrants further investigation.

  19. Mechanical waves conceptual survey: Its modification and conversion to a standard multiple-choice test

    Directory of Open Access Journals (Sweden)

    Pablo Barniol

    2016-02-01

    Full Text Available In this article we present several modifications of the mechanical waves conceptual survey, the most important test to date that has been designed to evaluate university students’ understanding of four main topics in mechanical waves: propagation, superposition, reflection, and standing waves. The most significant changes are (i modification of several test questions that had some problems in their original design, (ii standardization of the number of options for each question to five, (iii conversion of the two-tier questions to multiple-choice questions, and (iv modification of some questions to make them independent of others. To obtain a final version of the test, we administered both the original and modified versions several times to students at a large private university in Mexico. These students were completing a course that covers the topics tested by the survey. The final modified version of the test was administered to 234 students. In this study we present the modifications for each question, and discuss the reasons behind them. We also analyze the results obtained by the final modified version and offer a comparison between the original and modified versions. In the Supplemental Material we present the final modified version of the test. It can be used by teachers and researchers to assess students’ understanding of, and learning about, mechanical waves.

  20. Reducing the number of options on multiple-choice questions: response time, psychometrics and standard setting.

    Science.gov (United States)

    Schneid, Stephen D; Armour, Chris; Park, Yoon Soo; Yudkowsky, Rachel; Bordage, Georges

    2014-10-01

    Despite significant evidence supporting the use of three-option multiple-choice questions (MCQs), these are rarely used in written examinations for health professions students. The purpose of this study was to examine the effects of reducing four- and five-option MCQs to three-option MCQs on response times, psychometric characteristics, and absolute standard setting judgements in a pharmacology examination administered to health professions students. We administered two versions of a computerised examination containing 98 MCQs to 38 Year 2 medical students and 39 Year 3 pharmacy students. Four- and five-option MCQs were converted into three-option MCQs to create two versions of the examination. Differences in response time, item difficulty and discrimination, and reliability were evaluated. Medical and pharmacy faculty judges provided three-level Angoff (TLA) ratings for all MCQs for both versions of the examination to allow the assessment of differences in cut scores. Students answered three-option MCQs an average of 5 seconds faster than they answered four- and five-option MCQs (36 seconds versus 41 seconds; p = 0.008). There were no significant differences in item difficulty and discrimination, or test reliability. Overall, the cut scores generated for three-option MCQs using the TLA ratings were 8 percentage points higher (p = 0.04). The use of three-option MCQs in a health professions examination resulted in a time saving equivalent to the completion of 16% more MCQs per 1-hour testing period, which may increase content validity and test score reliability, and minimise construct under-representation. The higher cut scores may result in higher failure rates if an absolute standard setting method, such as the TLA method, is used. The results from this study provide a cautious indication to health professions educators that using three-option MCQs does not threaten validity and may strengthen it by allowing additional MCQs to be tested in a fixed amount

  1. "MASSIVE" brain dataset: Multiple acquisitions for standardization of structural imaging validation and evaluation.

    Science.gov (United States)

    Froeling, Martijn; Tax, Chantal M W; Vos, Sjoerd B; Luijten, Peter R; Leemans, Alexander

    2017-05-01

    In this work, we present the MASSIVE (Multiple Acquisitions for Standardization of Structural Imaging Validation and Evaluation) brain dataset of a single healthy subject, which is intended to facilitate diffusion MRI (dMRI) modeling and methodology development. MRI data of one healthy subject (female, 25 years) were acquired on a clinical 3 Tesla system (Philips Achieva) with an eight-channel head coil. In total, the subject was scanned on 18 different occasions with a total acquisition time of 22.5 h. The dMRI data were acquired with an isotropic resolution of 2.5 mm3 and distributed over five shells with b-values up to 4000 s/mm2 and two Cartesian grids with b-values up to 9000 s/mm2 . The final dataset consists of 8000 dMRI volumes, corresponding B0 field maps and noise maps for subsets of the dMRI scans, and ten three-dimensional FLAIR, T1 -, and T2 -weighted scans. The average signal-to-noise-ratio of the non-diffusion-weighted images was roughly 35. This unique set of in vivo MRI data will provide a robust framework to evaluate novel diffusion processing techniques and to reliably compare different approaches for diffusion modeling. The MASSIVE dataset is made publically available (both unprocessed and processed) on www.massive-data.org. Magn Reson Med 77:1797-1809, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  2. Modeling freedom from progression for standard-risk medulloblastoma: a mathematical tumor control model with multiple modes of failure

    DEFF Research Database (Denmark)

    Brodin, Nils Patrik; Vogelius, Ivan R.; Bjørk-Eriksson, Thomas

    2013-01-01

    As pediatric medulloblastoma (MB) is a relatively rare disease, it is important to extract the maximum information from trials and cohort studies. Here, a framework was developed for modeling tumor control with multiple modes of failure and time-to-progression for standard-risk MB, using published...

  3. Using Robust Standard Errors to Combine Multiple Regression Estimates with Meta-Analysis

    Science.gov (United States)

    Williams, Ryan T.

    2012-01-01

    Combining multiple regression estimates with meta-analysis has continued to be a difficult task. A variety of methods have been proposed and used to combine multiple regression slope estimates with meta-analysis, however, most of these methods have serious methodological and practical limitations. The purpose of this study was to explore the use…

  4. Alignment of World Language Standards and Assessments: A Multiple Case Study

    Science.gov (United States)

    Kaplan, Carolyn Shemwell

    2016-01-01

    Previous research has examined world language classroom-based assessment practices as well as the impact of the Standards for Foreign Language Learning in the 21st Century (National Standards in Foreign Language Education Project, 1999) on practice. However, the extent to which K-12 teachers' assessment practices reflect national and state…

  5. Research and analyze of physical health using multiple regression analysis

    Directory of Open Access Journals (Sweden)

    T. S. Kyi

    2014-01-01

    Full Text Available This paper represents the research which is trying to create a mathematical model of the "healthy people" using the method of regression analysis. The factors are the physical parameters of the person (such as heart rate, lung capacity, blood pressure, breath holding, weight height coefficient, flexibility of the spine, muscles of the shoulder belt, abdominal muscles, squatting, etc.., and the response variable is an indicator of physical working capacity. After performing multiple regression analysis, obtained useful multiple regression models that can predict the physical performance of boys the aged of fourteen to seventeen years. This paper represents the development of regression model for the sixteen year old boys and analyzed results.

  6. Management Control in Major Brazilian Multiple Banks: the Impact of Internationalization and Convergence of Accounting Standards on the Control Systems

    Directory of Open Access Journals (Sweden)

    João Carlos Damasceno Reis

    2014-08-01

    Full Text Available This study verifies the impact caused by the processes of globalization and convergence to international accounting standards on the managerial control systems of the largest multiple banks that operate in Brazil. The study was exploratory in nature, with the use of the case study method and the application of questionnaires containing mostly open questions to upper tier executives of four major Brazilian banks. The analysis showed that globalization has resulted in improved control systems and widespread use of information technology. It was also found that the convergence to international accounting standards occurred properly, thanks to the steps taken by the Central Bank that aimed at an agile updating of the Brazilian accounting standards laid down for banks operating in Brazil, in line with international standards. In general, the researched banks did not report a significant impact of convergence to the IFRS on their management control systems; adherence to the international accounting standards has had more significant impacts on information systems, especially regarding the new reporting and transparency standards, rather than on management controls. This result signals that the management control systems of the four banks in the sample are in line with Anthony (1965’s vision, that is, that flexibility to adapt to every change in the external environment might actually increase risks of failure.

  7. A comparative appraisal of two equivalence tests for multiple standardized effects.

    Science.gov (United States)

    Shieh, Gwowen

    2016-04-01

    Equivalence testing is recommended as a better alternative to the traditional difference-based methods for demonstrating the comparability of two or more treatment effects. Although equivalent tests of two groups are widely discussed, the natural extensions for assessing equivalence between several groups have not been well examined. This article provides a detailed and schematic comparison of the ANOVA F and the studentized range tests for evaluating the comparability of several standardized effects. Power and sample size appraisals of the two grossly distinct approaches are conducted in terms of a constraint on the range of the standardized means when the standard deviation of the standardized means is fixed. Although neither method is uniformly more powerful, the studentized range test has a clear advantage in sample size requirements necessary to achieve a given power when the underlying effect configurations are close to the priori minimum difference for determining equivalence. For actual application of equivalence tests and advance planning of equivalence studies, both SAS and R computer codes are available as supplementary files to implement the calculations of critical values, p-values, power levels, and sample sizes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Mechanical waves conceptual survey: Its modification and conversion to a standard multiple-choice test

    OpenAIRE

    Pablo Barniol; Genaro Zavala

    2016-01-01

    In this article we present several modifications of the mechanical waves conceptual survey, the most important test to date that has been designed to evaluate university students’ understanding of four main topics in mechanical waves: propagation, superposition, reflection, and standing waves. The most significant changes are (i) modification of several test questions that had some problems in their original design, (ii) standardization of the number of options for each question to five, (iii...

  9. Estimates and Standard Errors for Ratios of Normalizing Constants from Multiple Markov Chains via Regeneration.

    Science.gov (United States)

    Doss, Hani; Tan, Aixin

    2014-09-01

    In the classical biased sampling problem, we have k densities π1(·), …, πk (·), each known up to a normalizing constant, i.e. for l = 1, …, k, πl (·) = νl (·)/ml , where νl (·) is a known function and ml is an unknown constant. For each l, we have an iid sample from πl ,·and the problem is to estimate the ratios ml/ms for all l and all s. This problem arises frequently in several situations in both frequentist and Bayesian inference. An estimate of the ratios was developed and studied by Vardi and his co-workers over two decades ago, and there has been much subsequent work on this problem from many different perspectives. In spite of this, there are no rigorous results in the literature on how to estimate the standard error of the estimate. We present a class of estimates of the ratios of normalizing constants that are appropriate for the case where the samples from the πl 's are not necessarily iid sequences, but are Markov chains. We also develop an approach based on regenerative simulation for obtaining standard errors for the estimates of ratios of normalizing constants. These standard error estimates are valid for both the iid case and the Markov chain case.

  10. Enabling Interoperability and Servicing Multiple User Segments Through Web Services, Standards, and Data Tools

    Science.gov (United States)

    Palanisamy, Giriprakash; Wilson, Bruce E.; Cook, Robert B.; Lenhardt, Chris W.; Santhana Vannan, Suresh; Pan, Jerry; McMurry, Ben F.; Devarakonda, Ranjeet

    2010-12-01

    metadata is published to several metadata repositories using the Open Archive Initiative Protocol for Metadata Handling (OAI-PMH), to increase the chances that users can find data holdings relevant to their particular scientific problem. ORNL also seeks to leverage technology across these various data projects and encourage standardization of processes and technical architecture. This standardization is behind current efforts involving the use of Drupal and Fedora Commons. This poster describes the current and planned approaches that the ORNL DAAC is taking to enable cost-effective interoperability among data centers, both across the NASA EOSDIS data centers and across the international spectrum of terrestrial ecology-related data centers. The poster will highlight the standards that we are currently using across data formats, metadata formats, and data protocols. References: [1]Devarakonda R., et al. Mercury: reusable metadata management, data discovery and access system. Earth Science Informatics (2010), 3(1): 87-94. [2]Devarakonda R., et al. Data sharing and retrieval using OAI-PMH. Earth Science Informatics (2011), 4(1): 1-5.

  11. Clinical presentation and blood gas analysis of multiple trauma patients for prediction of standard coagulation parameters at emergency department arrival.

    Science.gov (United States)

    Hilbert-Carius, P; Hofmann, G O; Lefering, R; Stuttmann, R; Struck, M F

    2016-04-01

    Trauma-induced coagulopathy (TIC) in multiple trauma patients is a potentially lethal complication. Whether quickly available laboratory parameters using point-of-care (POC) blood gas analysis (BGA) may serve as surrogate parameters for standard coagulation parameters is unknown. The present study evaluated TraumaRegister DGU® of the German Trauma Society for correlations between POC BGA parameters and standard coagulation parameters. In the setting of 197 trauma centres (172 in Germany), 86,442 patients were analysed between 2005 and 2012. Of these, 40,129 (72% men) with a mean age 46 ± 21 years underwent further analysis presenting with direct admission from the scene of the accident to a trauma centre, injury severity score (ISS) ≥ 9, complete data available for the calculation of revised injury severity classification prognosis, and blood samples with valid haemoglobin (Hb) measurements taken immediately after emergency department (ED) admission. Correlations between standard coagulation parameters and POC BGA parameters (Hb, base excess [BE], lactate) were tested using Pearson's test with a two-tailed significance level of p analysis including patients with ISS > 16, ISS > 25, ISS > 16 and shock at ED admission, and patients with massive transfusion was likewise carried out. Correlations were found between Hb and prothrombin time (r = 0.497; p blood pressure analysis. These correlations were particularly strong in multiple trauma patients presenting with ISS > 16 and shock at ED admission. This may be relevant for hospitals with delayed availability of coagulation studies and those without viscoelastic POC devices. Future studies may determine whether clinical presentation/BGA-oriented coagulation therapy is an appropriate tool for improving outcomes after major trauma.

  12. Standardization and validation of a cytometric bead assay to assess antibodies to multiple Plasmodium falciparum recombinant antigens

    Directory of Open Access Journals (Sweden)

    Ondigo Bartholomew N

    2012-12-01

    Full Text Available Abstract Background Multiplex cytometric bead assay (CBA have a number of advantages over ELISA for antibody testing, but little information is available on standardization and validation of antibody CBA to multiple Plasmodium falciparum antigens. The present study was set to determine optimal parameters for multiplex testing of antibodies to P. falciparum antigens, and to compare results of multiplex CBA to ELISA. Methods Antibodies to ten recombinant P. falciparum antigens were measured by CBA and ELISA in samples from 30 individuals from a malaria endemic area of Kenya and compared to known positive and negative control plasma samples. Optimal antigen amounts, monoplex vs multiplex testing, plasma dilution, optimal buffer, number of beads required were assessed for CBA testing, and results from CBA vs. ELISA testing were compared. Results Optimal amounts for CBA antibody testing differed according to antigen. Results for monoplex CBA testing correlated strongly with multiplex testing for all antigens (r = 0.88-0.99, P values from Conclusion With optimization, CBA may be the preferred method of testing for antibodies to P. falciparum antigens, as CBA can test for antibodies to multiple recombinant antigens from a single plasma sample and produces a greater range of values in positive samples and lower background readings for blank samples than ELISA.

  13. Simultaneous Determination of Multiple Sesquiterpenes in Curcuma wenyujin Herbal Medicines and Related Products with One Single Reference Standard

    Directory of Open Access Journals (Sweden)

    Zhi-Min Wang

    2013-02-01

    Full Text Available Some Curcuma species are widely used as herbal medicines. Sesquiterpenes are their important bioactive compounds and their quantitative analysis is generally accomplished by gas chromatography (GC or high performance liquid chromatography (HPLC, but the instability and high cost of some sesquiterpene reference standards have limited their application. It is necessary to find a practicable means to control the quality of herbal medicines. Using one stable component contained in Curcuma species to determine multiple analogues should be a practical option. In this study, a simple HPLC method for determination of sesquiterpenes using relative response factors (RRFs has been developed. The easily available and stable active component curdione was selected as the reference compound for calculating the RRFs of the other eight sesquiterpenes, including zedoarondiol (Zedo, isozedoarondiol (Isoz, aerugidiol (Aeru, (4S,5S-(+-germacrone-4,5-epoxide (Epox, curcumenone (Curc, neocurdione (Neoc, germacrone (Germ and furanodiene (Fura. Their RRFs against curdione were between 0.131–1.301, with a good reproducibility. By using the RRFs, the quantification of sesquiterpenes in Curcuma wenyujin herbal medicines and related products was carried out. The method is especially useful for the determination of (4S,5S-(+-germacrone-4,5-epoxide, curcumenone, germacrone and furanodiene, which often are regarded as the principle components in Curcuma species, but unstable when were purified. It is an ideal means to analyze the components for which reference standards are not readily available.

  14. Simultaneous determination of multiple sesquiterpenes in Curcuma wenyujin herbal medicines and related products with one single reference standard.

    Science.gov (United States)

    Zhu, Jing-Jing; An, Yue-Wei; Hu, Guang; Yin, Guo-Ping; Zhang, Qi-Wei; Wang, Zhi-Min

    2013-02-06

    Some Curcuma species are widely used as herbal medicines. Sesquiterpenes are their important bioactive compounds and their quantitative analysis is generally accomplished by gas chromatography (GC) or high performance liquid chromatography (HPLC), but the instability and high cost of some sesquiterpene reference standards have limited their application. It is necessary to find a practicable means to control the quality of herbal medicines. Using one stable component contained in Curcuma species to determine multiple analogues should be a practical option. In this study, a simple HPLC method for determination of sesquiterpenes using relative response factors (RRFs) has been developed. The easily available and stable active component curdione was selected as the reference compound for calculating the RRFs of the other eight sesquiterpenes, including zedoarondiol (Zedo), isozedoarondiol (Isoz), aerugidiol (Aeru), (4S,5S)-(+)-germacrone-4,5-epoxide (Epox), curcumenone (Curc), neocurdione (Neoc), germacrone (Germ) and furanodiene (Fura). Their RRFs against curdione were between 0.131-1.301, with a good reproducibility. By using the RRFs, the quantification of sesquiterpenes in Curcuma wenyujin herbal medicines and related products was carried out. The method is especially useful for the determination of (4S,5S)-(+)-germacrone-4,5-epoxide, curcumenone, germacrone and furanodiene, which often are regarded as the principle components in Curcuma species, but unstable when were purified. It is an ideal means to analyze the components for which reference standards are not readily available.

  15. Effects of a standard high-fat diet with or without multiple deficiencies on bone parameters in ovariectomized mature rat.

    Directory of Open Access Journals (Sweden)

    Ting Wang

    Full Text Available The aim of this study was to determine the effects of a standard high fat diet (D12451 with or without vitamin D3, phosphorus, and calcium (i.e., high-fat diet [HFD] or high-fat deficient diet [HFDD] on the bone parameters of ovariectomized female rats. Six-month-old of female Sprauge Dawley (SD rats were randomly divided into six study groups: sham operation with standard chow diet (SSCD, sham operation with a HFD (SHFD, sham operation with a HFDD (SHFDD, ovariectomized (OVX, OVX with a HFD (OVX-HFD, and OVX with a HFDD (OVX-HFDD. A bilateral ovariectomy was administered to the OVX, OVX-HFD, and OVX-HFDD rats, while the SSCD, SHFD, and SHFDD rats were only given a laparotomy. Multiple analyses concerning the glucose and insulin tolerance, structure, bone strength, bone matrix, and mineralization of the rats were conducted in order to produce a detailed characterization of the effects of a HFD and a HFDD on postmenopausal osteoporotic rats. Seven months of HFD and HFDD feeding resulted in obesity and insulin resistance in female SD rats. A standard HFD increased the bone calcium content and bone strength of OVX rats. Conversely, the serum N-mid osteocalcin (N-MID-OT and tartrate-resistant acid phosphatase (TRAP levels in the OVX-HFDD group were increased, accompanied by a clear decrease in the bone mineral density (BMD, bone mineral content (BMC, bone calcium and bone strength, as well as reduced osteocalcin expression. A HFDD weakened the activity of the osteoblasts while aggravating bone loss and decreasing bone strength in ovariectomized rats, which may be due to the calcium, phosphorus and vitamin D3 deficiencies in the diet.

  16. 20 Years of standard patch testing in an eczema population with focus on patients with multiple contact allergies

    DEFF Research Database (Denmark)

    Carlsen, Berit Christina; Menné, Torkil; Johansen, Jeanne Duus

    2007-01-01

    (Me)isothiazolinone, and primin and poor for paraben mix. 5.1% were multiple allergic, primarily women, and 90% got diagnosed by the first test. Frequency of multiple allergies increased with age. More multiple- than mono/double-allergic patients were tested multiple times. Persistency and sensitivity rates in a Danish eczema...

  17. A methodology to study multiple sclerosis (MS) based on distributions of standardized intensities in segmented tissue regions

    Science.gov (United States)

    Lei, T.; Udupa, J. K.; Odhner, D.; Mishra, S.; Wu, G.; Schwartz, E.; Ying, G.-S.; Iwanaga, T.; Desiderio, L.; Balcer, L.

    2006-03-01

    This paper presents (1) an improved hierarchical method for segmenting the component tissue regions in fast spin echo T2 and PD images of the brain of Multiple Sclerosis (MS) patients, and (2) a methodology to characterize the disease utilizing the distributions of standardized T2 and PD intensities in the segmented tissue regions. First, the background intensity inhomogeneities are corrected and the intensity scales are standardized for all acquired images. The segmentation method imposes a feedback-like procedure on our previously developed hierarchical brain tissue segmentation method. With gradually simplified patterns in images and stronger evidences, pathological objects are recognized and segmented in an interplay fashion. After the brain parenchymal (BP) mask is generated, an under-estimated gray matter mask (uGM) and an over-estimated white matter mask (oWM) are created. Pure WM (PWM) and lesion (LS) masks are extracted from the all-inclusive oWM mask. By feedback, accurate GM and WM masks are subsequently formed. Finally, partial volume regions of GM and WM as well as Dirty WM (DWM) masks are generated. Intensity histograms and their parameters (peak height, peak location, and 25th, 50th and 75th percentile values) are computed for both T2 and PD images within each tissue region. Tissue volumes are also estimated. Spearman correlation coefficient rank test is then utilized to assess if there exists a trend between clinical states and the image-based parameters. This image analysis method has been applied to a data set consisting of 60 patients with MS and 20 normal controls. LS related parameters and clinical Extended Disability Status Scale (EDSS) scores demonstrate modest correlations. Almost every intensity-based parameter shows statistical difference between normal control and patient groups with a level better than 5%. These results can be utilized to monitor disease progression in MS.

  18. Anaesthetic Management of A Child with Multiple Congenital Anomalies Scheduled for Cataract Extraction

    Directory of Open Access Journals (Sweden)

    Kalpana Kulkarni

    2009-01-01

    Full Text Available In infants& children variety of conditions and syndromes are associated with difficult Airway. Anaesthetic management becomes a challenge if it remains unrecognized until induction and sometimes results in disaster, leading to oropharyngeal trauma, laryngeal oedema, cardiovascular& neurological complications. A 4-month-old child with multiple congenital anomalies was posted for cataract extraction for early and better development of vision. He had history of post birth respiratory distress, difficulty in feeding, breath holding with delayed mile stones. He was treated as for Juvenile asthma. This child was induced with inhalation anaesthesia. There was difficulty in laryngoscopic intubation and could pass much smaller size of the tube than predicted. He developed post operative stridor and desaturation. The problems which we faced during the anaesthetic management and during postoperative period are discussed with this case.

  19. Fourier transform power spectrum is a potential measure of tissue alignment in standard MRI: A multiple sclerosis study.

    Directory of Open Access Journals (Sweden)

    Shrushrita Sharma

    Full Text Available Loss of tissue coherency in brain white matter is found in many neurological diseases such as multiple sclerosis (MS. While several approaches have been proposed to evaluate white matter coherency including fractional anisotropy and fiber tracking in diffusion-weighted imaging, few are available for standard magnetic resonance imaging (MRI. Here we present an image post-processing method for this purpose based on Fourier transform (FT power spectrum. T2-weighted images were collected from 19 patients (10 relapsing-remitting and 9 secondary progressive MS and 19 age- and gender-matched controls. Image processing steps included: computation, normalization, and thresholding of FT power spectrum; determination of tissue alignment profile and dominant alignment direction; and calculation of alignment complexity using a new measure named angular entropy. To test the validity of this method, we used a highly organized brain white matter structure, corpus callosum. Six regions of interest were examined from the left, central and right aspects of both genu and splenium. We found that the dominant orientation of each ROI derived from our method was significantly correlated with the predicted directions based on anatomy. There was greater angular entropy in patients than controls, and a trend to be greater in secondary progressive MS patients. These findings suggest that it is possible to detect tissue alignment and anisotropy using traditional MRI, which are routinely acquired in clinical practice. Analysis of FT power spectrum may become a new approach for advancing the evaluation and management of patients with MS and similar disorders. Further confirmation is warranted.

  20. Evaluation of the breath-hold approach in proton therapy of lung tumors

    DEFF Research Database (Denmark)

    Gorgisyan, Jenny

    Proton therapy has the potential to improve the treatment effect as compared to conventional radiation therapy for lung cancer patients. However, the proton therapy delivery is prone to uncertainties caused by anatomical changes and motion during the treatment and between the treatment fractions...

  1. Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer

    DEFF Research Database (Denmark)

    Josipovic, Mirjana; Persson, G F; Dueck, Jenny

    2016-01-01

    DIBH radiotherapy is highly reproducible provided an image-guidance strategy with tumour registration is performed. If the primary tumour is separated from the mediastinal lymph nodes, inter-fractional differential motion remains a challenge and margins must be adapted to reflect the image registration...

  2. Focal epilepsy presenting as a bath-induced paroxysmal event/breath-holding attack

    Directory of Open Access Journals (Sweden)

    C.J. Stutchfield

    2014-01-01

    Conclusion: Water reflex epilepsy can mimic a range of other conditions, and a high index of suspicion is required to establish the diagnosis. Children with water reflex epilepsy can achieve a good quality of life with modified bathing and appropriate antiepileptic medication.

  3. Detection of venous gas emboli after repetitive breath-hold dives: case report.

    Science.gov (United States)

    Cialoni, D; Pieri, M; Giunchi, G; Sponsiello, N; Lanzone, A M; Torcello, L; Boaretto, G; Marroni, A

    2016-01-01

    Neurological symptoms after breathhold (BH) diving are often referred to as "Taravana" and considered a form of decompression sickness. However, the presence of "high" gas embolism after BH diving has never been clearly shown. This study showed high bubble formation after BH diving. We performed transthoracic echocardiography on a 53-year-old male spearfishing diver (180 cm; 80 kg; BMI 24.7) 15 minutes before diving and at 15-minute intervals for 90 minutes after diving in a 42-meter-deep pool. Number of dives, bottom time and surface intervals were freely determined by the diver. Dive profiles were digitally recorded for depth, time and surface interval, using a freediving computer. Relative surface interval (surface interval/diving time) and gradient factor were calculated. High bubble grades were found in all the recorded echocardiograms. From the first to third recording (45 minutes), Grade 4 Eftedal-Brubakk (EB) bubbles were observed. The 60-, 75- and 90-minute recordings showed a reduction to Grades 3, 2 and 1 EB. Mean calculated GF for every BH dive was 0.22; maximum GF after the last dive was 0.33. High bubble grades can occur in BH diving, as confirmed by echocardiographic investigation. Ordinary methods to predict inert gas supersaturation may not able to predict Taravana cases.

  4. Compensation of matrix effects in gas chromatography-mass spectrometry analysis of pesticides using a combination of matrix matching and multiple isotopically labeled internal standards.

    Science.gov (United States)

    Tsuchiyama, Tomoyuki; Katsuhara, Miki; Nakajima, Masahiro

    2017-11-17

    In the multi-residue analysis of pesticides using GC-MS, the quantitative results are adversely affected by a phenomenon known as the matrix effect. Although the use of matrix-matched standards is considered to be one of the most practical solutions to this problem, complete removal of the matrix effect is difficult in complex food matrices owing to their inconsistency. As a result, residual matrix effects can introduce analytical errors. To compensate for residual matrix effects, we have developed a novel method that employs multiple isotopically labeled internal standards (ILIS). The matrix effects of ILIS and pesticides were evaluated in spiked matrix extracts of various agricultural commodities, and the obtained data were subjected to simple statistical analysis. Based on the similarities between the patterns of variation in the analytical response, a total of 32 isotopically labeled compounds were assigned to 338 pesticides as internal standards. It was found that by utilizing multiple ILIS, residual matrix effects could be effectively compensated. The developed method exhibited superior quantitative performance compared with the common single-internal-standard method. The proposed method is more feasible for regulatory purposes than that using only predetermined correction factors and is considered to be promising for practical applications. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Using GENOVA and FACETS to Set Multiple Standards on Performance Assessment for Certification in Medical Translation from Japanese into English

    Science.gov (United States)

    Kozaki ,Y.

    2004-01-01

    This article presents a standard-setting procedure for performance assessment in a foreign language, through which some of the major problems facing performance assessment in criterion-referenced testing can be addressed. The procedure, which was geared to revealing and accommodating inter-judge variability, employed the synergy of multiple…

  6. Comparison of Thromboemboli Prophylactic Effect of Aspirin and Low Dose Warfarin in Standard Risk Multiple Myeloma Patients that Treated with Regimens Containing Thalidomide

    Directory of Open Access Journals (Sweden)

    Seyed Amir Dadkhahi

    2017-05-01

    Full Text Available Abstract Background: Most of the current regimens in the treatment of multiple myeloma include thalidomide. Thalidomide is a modulator of the immune system and according to several studies, its main complication is thromboembolism. The aim of this study is to compare the thromboemboli prophylactic effect of aspirin and low dose warfarin in standard risk multiple myeloma patients that treated with regimens containing thalidomide. Materials and Methods: In this double- blind clinical trial study, sixty-six patients with multiple myeloma under treatment with thalidomide-containing regimens with standard risk for thromboembolism who were admitted to Khansari hospital, entered the study according to inclusion and exclusion criteria. The incidence of thromboembolism in these patients was evaluated. Results: Five patients in the warfarin group and 2 patients in the aspirin group had thromboemboli. Chi square analyses showed no significant difference between groups (p=0.635. Conclusion: The results showed that both drugs are effective in preventing thromboembolism and can be used as a prophylactic treatment.

  7. Reducing the Standard Deviation in Multiple-Assay Experiments Where the Variation Matters but the Absolute Value Does Not

    Science.gov (United States)

    Echenique-Robba, Pablo; Nelo-Bazán, María Alejandra; Carrodeguas, José A.

    2013-01-01

    When the value of a quantity for a number of systems (cells, molecules, people, chunks of metal, DNA vectors, so on) is measured and the aim is to replicate the whole set again for different trials or assays, despite the efforts for a near-equal design, scientists might often obtain quite different measurements. As a consequence, some systems’ averages present standard deviations that are too large to render statistically significant results. This work presents a novel correction method of a very low mathematical and numerical complexity that can reduce the standard deviation of such results and increase their statistical significance. Two conditions are to be met: the inter-system variations of matter while its absolute value does not, and a similar tendency in the values of must be present in the different assays (or in other words, the results corresponding to different assays must present a high linear correlation). We demonstrate the improvements this method offers with a cell biology experiment, but it can definitely be applied to any problem that conforms to the described structure and requirements and in any quantitative scientific field that deals with data subject to uncertainty. PMID:24205158

  8. Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls.

    Science.gov (United States)

    Gold, Stefan M; Schulz, Karl-Heinz; Hartmann, Sten; Mladek, Mila; Lang, Undine E; Hellweg, Rainer; Reer, Rüdiger; Braumann, Klaus-Michael; Heesen, Christoph

    2003-05-01

    Neurotrophins like brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are thought to play an important role in neuronal repair and plasticity. Recent experimental evidence suggests neuroprotective effects of these proteins in multiple sclerosis (MS). We investigated the response of serum NGF and BDNF concentrations to standardized acute exercise in MS patients and controls. Basal NGF levels were significantly elevated in MS. Thirty minutes of moderate exercise significantly induced BDNF production in MS patients and controls, but no differential effects were seen. We conclude that moderate exercise can be used to induce neutrophin production in humans. This may mediate beneficial effects of physical exercise in MS reported recently.

  9. Current Understanding on the Role of Standard and Immunoproteasomes in Inflammatory/Immunological Pathways of Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Elena Bellavista

    2014-01-01

    Full Text Available The ubiquitin-proteasome system is the major intracellular molecular machinery for protein degradation and maintenance of protein homeostasis in most human cells. As ubiquitin-proteasome system plays a critical role in the regulation of the immune system, it might also influence the development and progression of multiple sclerosis (MS. Both ex vivo analyses and animal models suggest that activity and composition of ubiquitin-proteasome system are altered in MS. Proteasome isoforms endowed of immunosubunits may affect the functionality of different cell types such as CD8+ and CD4+ T cells and B cells as well as neurons during MS development. Furthermore, the study of proteasome-related biomarkers, such as proteasome antibodies and circulating proteasomes, may represent a field of interest in MS. Proteasome inhibitors are already used as treatment for cancer and the recent development of inhibitors selective for immunoproteasome subunits may soon represent novel therapeutic approaches to the different forms of MS. In this review we describe the current knowledge on the potential role of proteasomes in MS and discuss the pro et contra of possible therapies for MS targeting proteasome isoforms.

  10. [The evaluation of bacteria penetration by medical textiles for multiple use and disposable multilayer surgical drapes, according to the PN-EN ISO 22610 standard].

    Science.gov (United States)

    Zareba, Tomasz; Zawistowska, Anna; Kruszewska, Hanna; Mrówka, Agnieszka; Tyski, Stefan

    2012-01-01

    Cotton as well as synthetic textile medical products are widely used as barrier materials and individual protection against displacement of biological infectious factors. The required level of protection of these products for multiple use and disposable multilayer laminates against the penetration of microbes depends on the risk connected with type of surgical procedure defined in normative documents. METHODS. Cotton and syntetic medical textiles for multiple use, 30-times subjected to processes simulating conditions of the use as well as disposable multilayer surgical drapes were tested. Resistance to microbial wet penetration was conducted according to the PN-EN ISO 22610: 2007 standard. The barrier of cotton fabrics was reduced after first washing and then systematically grew after each often cycles to the value close to the value at the beginning. From the twentieth cycle of simulated conditions of the use, barrier index was reduced. The barrier of the synthetic textile stayed on the average level, while multilayer disposable products ensured the full impermeability for the bacteria. Natural cotton textiles for multiple use could be apply on operative blocks in limited range because of the changes of the cotton structure caused by repeated laundering process and sterilization. Synthetic materials also have limited application, although are more resistant to cleaning and sterilization processes. Disposable synthetic laminates with many layers use guarantee impermeability for bacteria and may be applied in operative blocks without restrictions.

  11. Increased Depth and Breadth of Plasma Protein Quantitation via Two-Dimensional Liquid Chromatography/Multiple Reaction Monitoring-Mass Spectrometry with Labeled Peptide Standards.

    Science.gov (United States)

    Percy, Andrew J; Yang, Juncong; Chambers, Andrew G; Borchers, Christoph H

    2016-01-01

    Absolute quantitative strategies are emerging as a powerful and preferable means of deriving concentrations in biological samples for systems biology applications. Method development is driven by the need to establish new-and validate current-protein biomarkers of high-to-low abundance for clinical utility. In this chapter, we describe a methodology involving two-dimensional (2D) reversed-phase liquid chromatography (RPLC), operated under alkaline and acidic pH conditions, combined with multiple reaction monitoring (MRM)-mass spectrometry (MS) (also called selected reaction monitoring (SRM)-MS) and a complex mixture of stable isotope-labeled standard (SIS) peptides, to quantify a broad and diverse panel of 253 proteins in human blood plasma. The quantitation range spans 8 orders of magnitude-from 15 mg/mL (for vitamin D-binding protein) to 450 pg/mL (for protein S100-B)-and includes 31 low-abundance proteins (defined as being proteins for higher sample throughput. Also detailed here is the application of our recently developed software tool-Qualis-SIS-for protein quantitation (via regression analysis of standard curves) and quality assessment of the resulting data. Overall, this chapter provides the blueprint for the replication of this quantitative proteomic method by proteomic scientists of all skill levels.

  12. Implementation of the basic hazard index screening for health risks associated with simultaneous exposure to multiple chemicals using a standardized target organ and systems framework.

    Science.gov (United States)

    Adams, Valerie H; McAtee, Matthew J; Johnson, Mark S

    2017-09-01

    Environmental health risk assessments often involve assessing the potential health effects of exposure to multiple chemicals at once (i.e., complex mixtures). Because the possible number of chemical combinations is very large, few controlled in vivo toxicological studies with chemical mixtures are relevant or practical. In lieu of specific mixture toxicity data, the segregated hazard index (HI) approach has been used to determine whether simultaneous exposures may warrant further investigation due to their combined adverse effects. Each chemical is assigned to one or more target organs based on critical effects; HIs for each target organ are generated by summing the individual hazard quotients for each of the chemicals assigned to that organ or organ system. To conduct this phased risk assessment approach in a consistent manner, a comprehensive, systematized list of toxicity targets for implementing this approach is needed. We present a comprehensive and standardized list of toxicity target organs and systems (TTOS), with example data sets, for consistent implementation of the segregated HI method. This method is designed to facilitate the standardization of the widespread use of the basic segregated HI approach. The basic hazard index mixtures screening (BHIMS) tool allows for rapid identification of exposure concerns that may warrant further and more sophisticated assessment. Integr Environ Assess Manag 2017;13:852-860. Published 2017. This article is a US Government work and is in the public domain in the USA. Published 2017. This article is a US Government work and is in the public domain in the USA.

  13. Determination of additivity of apparent and standardized ileal digestibility of amino acids in diets containing multiple protein sources fed to growing pigs.

    Science.gov (United States)

    Xue, P C; Ragland, D; Adeola, O

    2014-09-01

    An experiment was conducted in growing pigs to investigate the additivity of apparent ileal digestibility (AID) or standardized ileal digestibility (SID) of CP and AA in mixed diets containing multiple protein sources. Using the determined AID or SID for CP and AA in corn, soybean meal (SBM), corn distillers' dried grains with solubles (DDGS), or canola meal (CM), the AID or SID for 4 mixed diets based on corn-SBM, corn-SBM-DDGS, corn-SBM-CM, or corn-SBM-DDGS-CM were predicted and compared with determined AID or SID, respectively. Eighteen growing pigs (initial BW = 61.3 ± 5.5 kg) were surgically fitted with T-cannulas and assigned to a duplicated 9 × 4 incomplete Latin square design with 9 diets and 4 periods. The 9 experimental diets consisted of a nitrogen-free diet (NFD) to estimate basal ileal endogenous loss (BEL) of AA, 4 semipurified diets to determine the AID and SID of CP and AA in the 4 ingredients, and 4 mixed diets to test the additivity of AID and SID. Chromic oxide was added as an indigestible marker. Pigs were fed 1 of the 9 diets during each 7-d period, and ileal digesta were collected on d 6 and 7, from 0800 to 1800 h. The analyzed AA levels for the mixed diets were close to the calculated values based on the AA composition of each ingredient. The results revealed that the predicted SID were consistent with determined values, except for Leu, Thr, Asp, Cys, Pro, and Ser in the corn-SBM diet and Met and Cys in the corn-SBM-DDGS diet. The determined AID for total AA and Arg, His, Trp, Gly, and Pro in the corn-SBM diet were greater (P digestibility of AA in mixed diets containing multiple protein sources. In addition, the lack of additivity of AID in mixed diets could be attributed to the intrinsic characteristics of the feed ingredient, especially its AA content.

  14. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker

    Directory of Open Access Journals (Sweden)

    Bruno Kolterer

    2015-01-01

    Conclusion: Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed.

  15. Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold

    DEFF Research Database (Denmark)

    Pedersen, Anders N; Korreman, Stine; Nyström, Håkan

    2004-01-01

    BACKGROUND AND PURPOSE: Adjuvant radiotherapy of breast cancer using wide tangential photon fields implies a risk of late cardiac and pulmonary toxicity. This CT-study evaluates the detailed potential dosimetric consequences of applying breathing adapted radiotherapy (BART), and the feasibility...

  16. Energetics of breath-hold hunting: modeling the effects of aging on foraging success in the Weddell seal.

    Science.gov (United States)

    Hindle, Allyson G; Horning, Markus

    2010-06-07

    A simulation model was developed to predict age-related changes in foraging energetics of individual Weddell seals, Leptonychotes weddellii. Aging in diving animals is interesting because their characteristic cyclic sequence of apneustic hunting and eupnea should elevate oxidative stress, possibly accelerating aging. Such a hypothesis can be evaluated by modeling energetics of constrained, time-partitioned activities with well-defined costs. Three possible consequences of physiological aging in divers were specified and appraised. The model examined the potential impacts of age-related decline in muscle contractile ability, increased buoyancy, and reduced aerobic dive limit, alone and in combination, on a daily energy budget. A uniform age effect evident in model outputs is reduced foraging efficiency. The components of this net effect are exacerbated for sub-optimal behavioral-response settings or environmental conditions. The model predicts that with advancing age, efficiency declines increase for aging scenarios in the following order: simulated 'young' adults; 'old' seals with increased buoyancy; 'old' seals with reduced aerobic dive limit; 'old' seals having reduced muscle contractile efficiency; and, 'old' seals with all three conditions. The model indicates narrowed behavioral options to maintain positive energy balance in older animals, suggesting that behavioral plasticity may not allow older animals to compensate for age-related performance constraints. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  17. Near-infrared measurements of hemodynamic and oxygenation changes on the frontal cortex during breath holding, hyperventilation, and natural sleep

    Science.gov (United States)

    Noponen, Tommi E.; Kotilahti, Kalle; Toppila, Jussi; Nissila, Ilkka T.; Salmi, Tapani; Kajava, Timo T.; Katila, Toivo E.

    2003-07-01

    We have developed a frequency-domain near-infrared device suitable for physiological studies in human. In this work, a four-channel configuration of the instrument is applied to monitor hemodynamic and oxygenation changes in the frontal cortex of volunteers during different ventilation tasks. We use four different source-receiver separations (2, 3, 4, and 5 cm) and three wavelengths (760, 808, and 830 nm) to test the sensitivity of these parameters to cardiovascular and metabolic changes. Low-frequency oscillations (~ 0.02 Hz) and variations in heart rate during different ventilation tasks are investigated as well. We also study physiological changes during natural sleep using the frequency-domain instrument simultaneously with a polysomnography system containing a pulse oximeter. Our results indicate that hemodynamic and oxygenation changes in the frontal cortex during natural sleep can be detected using near-infrared measurements.

  18. Systems for Lung Volume Standardization during Static and Dynamic MDCT-based Quantitative Assessment of Pulmonary Structure and Function

    Science.gov (United States)

    Fuld, Matthew K.; Grout, Randall; Guo, Junfeng; Morgan, John H.; Hoffman, Eric A.

    2013-01-01

    Rationale and Objectives Multidetector-row Computed Tomography (MDCT) has emerged as a tool for quantitative assessment of parenchymal destruction, air trapping (density metrics) and airway remodeling (metrics relating airway wall and lumen geometry) in chronic obstructive pulmonary disease (COPD) and asthma. Critical to the accuracy and interpretability of these MDCT-derived metrics is the assurance that the lungs are scanned during a breath-hold at a standardized volume. Materials and Methods A computer monitored turbine-based flow meter system was developed to control patient breath-holds and facilitate static imaging at fixed percentages of the vital capacity. Due to calibration challenges with gas density changes during multi-breath xenon-CT an alternative system was required. The design incorporated dual rolling seal pistons. Both systems were tested in a laboratory environment and human subject trials. Results The turbine-based system successfully controlled lung volumes in 32/37 subjects, having a linear relationship for CT measured air volume between repeated scans: for all scans, the mean and confidence interval of the differences (scan1-scan2) was −9 ml (−169, 151); for TLC alone 6 ml (−164, 177); for FRC alone, −23 ml (−172, 126). The dual-piston system successfully controlled lung volume in 31/41 subjects. Study failures related largely to subject non-compliance with verbal instruction and gas leaks around the mouthpiece. Conclusion We demonstrate the successful use of a turbine-based system for static lung volume control and demonstrate its inadequacies for dynamic xenon-CT studies. Implementation of a dual-rolling seal spirometer has been shown to adequately control lung volume for multi-breath wash-in xenon-CT studies. These systems coupled with proper patient coaching provide the tools for the use of CT to quantitate regional lung structure and function. The wash-in xenon-CT method for assessing regional lung function, while not

  19. Multiple myeloma.

    Science.gov (United States)

    Kumar, Shaji K; Rajkumar, Vincent; Kyle, Robert A; van Duin, Mark; Sonneveld, Pieter; Mateos, María-Victoria; Gay, Francesca; Anderson, Kenneth C

    2017-07-20

    Multiple myeloma is a malignancy of terminally differentiated plasma cells, and patients typically present with bone marrow infiltration of clonal plasma cells and monoclonal protein in the serum and/or urine. The diagnosis of multiple myeloma is made when clear end-organ damage attributable to the plasma cell proliferative disorder or when findings that suggest a high likelihood of their development are present. Distinguishing symptomatic multiple myeloma that requires treatment from the precursor stages of monoclonal gammopathy of undetermined significance and smouldering multiple myeloma is important, as observation is the standard for those conditions. Much progress has been made over the past decade in the understanding of disease biology and individualized treatment approaches. Several new classes of drugs, such as proteasome inhibitors and immunomodulatory drugs, have joined the traditional armamentarium (corticosteroids, alkylating agents and anthracyclines) and, along with high-dose therapy and autologous haemopoietic stem cell transplantation, have led to deeper and durable clinical responses. Indeed, an increasing proportion of patients are achieving lasting remissions, raising the possibility of cure for this disease. Success will probably depend on using combinations of effective agents and treating patients in the early stages of disease, such as patients with smouldering multiple myeloma.

  20. Standard high-resolution pelvic MRI vs. low-resolution pelvic MRI in the evaluation of deep infiltrating endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Scardapane, Arnaldo; Lorusso, Filomenamila; Ferrante, Annunziata; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe [University Hospital ' ' Policlinico' ' of Bari, Interdisciplinary Department of Medicine, Bari (Italy); Scioscia, Marco [Sacro Cuore Don Calabria General Hospital, Department of Obstetrics and Gynecology, Negrar, Verona (Italy)

    2014-10-15

    To compare the capabilities of standard pelvic MRI with low-resolution pelvic MRI using fast breath-hold sequences to evaluate deep infiltrating endometriosis (DIE). Sixty-eight consecutive women with suspected DIE were studied with pelvic MRI. A double-acquisition protocol was carried out in each case. High-resolution (HR)-MRI consisted of axial, sagittal, and coronal TSE T2W images, axial TSE T1W, and axial THRIVE. Low-resolution (LR)-MRI was acquired using fast single shot (SSH) T2 and T1 images. Two radiologists with 10 and 2 years of experience reviewed HR and LR images in two separate sessions. The presence of endometriotic lesions of the uterosacral ligament (USL), rectovaginal septum (RVS), pouch of Douglas (POD), and rectal wall was noted. The accuracies of LR-MRI and HR-MRI were compared with the laparoscopic and histopathological findings. Average acquisition times were 24 minutes for HR-MRI and 7 minutes for LR-MRI. The more experienced radiologist achieved higher accuracy with both HR-MRI and LR-MRI. The values of sensitivity, specificity, PPV, NPV, and accuracy did not significantly change between HR and LR images or interobserver agreement for all of the considered anatomic sites. LR-MRI performs as well as HR-MRI and is a valuable tool for the detection of deep endometriosis extension. (orig.)

  1. Coordination of International Standards with Implementation of the IECRE Conformity Assessment System to Provide Multiple Certification Offerings for PV Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, George; Haring, Adrian; Spooner, Ted; Ball, Greg; Kurtz, Sarah; Heinze, Matthias; Yamamichi, Masaaki; Eguchi, Yoshihito; Ramu, Govind

    2016-11-21

    To help address the industry's needs for assuring the value and reducing the risk of investments in PV power plants; the International Electrotechnical Commission (IEC) has established a new conformity assessment system for renewable energy (IECRE). There are presently important efforts underway to define the requirements for various types of PV system certificates, and publication of the international standards upon which these certifications will be based. This paper presents a detailed analysis of the interrelationship of these activities and the timing for initiation of IECRE PV system certifications.

  2. Multiple Pregnancy

    Science.gov (United States)

    ... multiple pregnancy affect fetal growth? Are tests for genetic disorders as accurate in multiple pregnancies? How can multiple pregnancy affect delivery? Can multiple pregnancy affect my risk of postpartum depression? Can I breastfeed if I have multiples? Glossary ...

  3. Molecular effects of fractional ablative erbium:YAG laser treatment with multiple stacked pulses on standardized human three-dimensional organotypic skin models.

    Science.gov (United States)

    Schmitt, Laurenz; Amann, P M; Marquardt, Y; Heise, R; Czaja, K; Gerber, P A; Steiner, T; Hölzle, F; Baron, Jens Malte

    2017-05-01

    The molecular changes in gene expression following ablative laser treatment of skin lesions, such as atrophic scars and UV-damaged skin, are not completely understood. A standardized in vitro model of human skin, to study the effects of laser treatment on human skin, has been recently developed. Therefore, the aim of the investigation was to examine morphological and molecular changes caused by fractional ablative erbium:YAG laser treatment on an in vitro full-thickness 3D standardized organotypic model of human skin. A fractional ablative erbium:YAG laser was used to irradiate organotypic human 3D models. Laser treatments were performed at four different settings using a variety of stacked pulses with similar cumulative total energy fluence (60 J/cm 2 ). Specimens were harvested at specified time points and real-time PCR (qRT-PCR) and microarray studies were performed. Frozen sections were examined histologically. Three days after erbium:YAG laser treatment, a significantly increased mRNA expression of matrix metalloproteinases and their inhibitors (MMP1, MMP2, MMP3, TIMP1, and TIMP2), chemokines (CXCL1, CXCL2, CXCL5, and CXCL6), and cytokines such as IL6, IL8, and IL24 could be detected. qRT-PCR studies confirmed the enhanced mRNA expression of IL6, IL8, IL24, CXCLs, and MMPs. In contrast, the mRNA expression of epidermal differentiation markers, such as keratin-associated protein 4, filaggrin, filaggrin 2, and loricrin, and antimicrobial peptides (S100A7A, S100A9, and S100A12) as well as CASP14, DSG2, IL18, and IL36β was reduced. Four different settings with similar cumulative doses have been tested (N10%, C10%, E10%, and W25%). These laser treatments resulted in different morphological changes and effects on gene regulations. Longer pulse durations (1000 μs) especially had the strongest impact on gene expression and resulted in an upregulation of genes, such as collagen-1A2, collagen-5A2, and collagen-6A2, as well as FGF2. Histologically, all treatment

  4. Multiple sclerosis; Multiple Sklerose

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Kuehn, A.L.; Backens, M.; Papanagiotou, P. [Universitaet des Saarlandes, Abteilung fuer Diagnostische und Interventionelle Neuroradiologie, Radiologische Klinik, Homburg/Saar (Germany); Shariat, K. [Universitaet des Saarlandes, Klinik fuer Neurochirurgie, Homburg/Saar (Germany); Kostopoulos, P. [Universitaet des Saarlandes, Klinik fuer Neurologie, Homburg/Saar (Germany)

    2008-06-15

    Multiple sclerosis is the most common chronic inflammatory disease of myelin with interspersed lesions in the white matter of the central nervous system. Magnetic resonance imaging (MRI) plays a key role in the diagnosis and monitoring of white matter diseases. This article focuses on key findings in multiple sclerosis as detected by MRI. (orig.) [German] Die Multiple Sklerose (MS) ist die haeufigste chronisch-entzuendliche Erkrankung des Myelins mit eingesprengten Laesionen im Bereich der weissen Substanz des zentralen Nervensystems. Die Magnetresonanztomographie (MRT) hat bei der Diagnosestellung und Verlaufskontrolle eine Schluesselrolle. Dieser Artikel befasst sich mit Hauptcharakteristika der MR-Bildbebung. (orig.)

  5. Standards not that standard.

    Science.gov (United States)

    Vilanova, Cristina; Tanner, Kristie; Dorado-Morales, Pedro; Villaescusa, Paula; Chugani, Divya; Frías, Alba; Segredo, Ernesto; Molero, Xavier; Fritschi, Marco; Morales, Lucas; Ramón, Daniel; Peña, Carlos; Peretó, Juli; Porcar, Manuel

    2015-01-01

    There is a general assent on the key role of standards in Synthetic Biology. In two consecutive letters to this journal, suggestions on the assembly methods for the Registry of standard biological parts have been described. We fully agree with those authors on the need of a more flexible building strategy and we highlight in the present work two major functional challenges standardization efforts have to deal with: the need of both universal and orthogonal behaviors. We provide experimental data that clearly indicate that such engineering requirements should not be taken for granted in Synthetic Biology.

  6. Multiple political identities: revisiting the 'maximum standard'

    NARCIS (Netherlands)

    Besselink, L.F.M.; Silveira, A.; Canotilho, M.; Madeira Froufe, P.

    2013-01-01

    This paper discusses the meaning of Art. 53 of the EU Charter of Fundamental Rights - which would seem to give priority to those fundamental rights which provide higher protection - from the perspective of fundamental rights as the expression of political and constitutional identity. In doing so, it

  7. Simultaneous multiple mycotoxin quantification in feed samples using three isotopically labeled internal standards applied for isotopic dilution and data normalization through ultra-performance liquid chromatography/electrospray ionization tandem mass spectrometry.

    Science.gov (United States)

    Jackson, Lewis C; Kudupoje, Manoj B; Yiannikouris, Alexandros

    2012-12-15

    Mycotoxins are typically present in grain and are also concentrated in distillers dried grains with solubles (DDGS), common feed ingredients for food animals. The diversity of mycotoxins and feed matrices has made the routine detection and quantification of mycotoxins in feed both complex and prohibitively expensive. Ultra-performance liquid chromatography/electrospray ionization triple quadrupole detection (UPLC/ESI-TQD) (tandem mass spectrometry, MS/MS) with (13) C-labeled isotopic dilution was used to analyze internal standard isotopologues of three mycotoxin molecules, as well as 29 other structurally differing mycotoxin molecules from four common feed matrices: corn, wheat, barley, or DDGS. Mycotoxins were extracted via a single-step procedure using a mixture of acetonitrile/water/formic acid. Labeled isotopologues were used as a surrogate to account for extraction quality and as internal standards for the evaluation of the feed matrix signal suppression/enhancement (SSE) contributed by each mycotoxin and by each matrix. The SSE was corrected by matrix-matched calibration with blank certified reference feed material. The limits of detection for individual mycotoxins in buffer ranged from 0.01 to 206.7 µg/mL but could increase by up to four times depending on the matrix effect. The accuracy and precision were enhanced by the use of isotopically labeled standards. The recoveries were somewhat negatively affected by the SSE contributed by each matrix. Each mycotoxin was successfully detected and assigned to one of four SSE categories: high (-66%), intermediate (-48%), low (-19%) signal suppression and signal enhancement (> +300%). An improved LC/MS method was validated, which offers a practical and economical means for large-scale detection and quantification of multiple mycotoxins in common animal-feed matrices, including DDGS. Copyright © 2012 John Wiley & Sons, Ltd.

  8. Parenting Multiples

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Parenting Multiples KidsHealth / For Parents / Parenting Multiples What's in ... your ability to take care of your babies. Parenting Issues With Multiples It may be difficult to ...

  9. Phase 1b study of safety, tolerability and efficacy of R1507, a monoclonal antibody to IGF-1R in combination with multiple standard oncology regimens in patients with advanced solid malignancies.

    Science.gov (United States)

    Mahadevan, Daruka; Sutton, Gregory Ryan; Arteta-Bulos, Rafael; Bowden, Chris J; Miller, Paul J E; Swart, Rachel Elizabeth; Walker, Mark S; Haluska, Paul; Munster, Pamela N; Marshall, John; Hamid, Omid; Kurzrock, Razelle

    2014-03-01

    R1507 is a human IgG1 Mab that binds to the insulin-like growth factor-1 receptor (IGF-1R) and inhibits IGF-1- or IGF-2-mediated anchorage-independent growth of malignant cells. A phase 1b study evaluated the safety, tolerability and efficacy of R1507 in combination with multiple standard oncology regimens. R1507 (3, 5, 9, 10 and 16 mg/kg IV, Q2 W or Q3 W) was added to six treatment regimens: gemcitabine + erlotinib (GE); paclitaxel + bevacizumab (PB); carboplatin + etoposide (CE); mFOLFOX6 + bevacizumab (FB); capecitabine + trastuzumab (CT); and sorafenib (S). If tolerable, R1507 dose was escalated utilizing a 3 + 3 + 6 and a 3 + 9 design. A total of 104 patients enrolled into regimens 1-6: 93 % were non-recent diagnoses. Eighteen withdrew for safety [one death, 17 adverse events (AEs)]. A total of 1,337 AEs any grade, across regimens and doses were nausea, vomiting and diarrhea. A total of 123 had grade ≥3 AEs (n = 28 dose level 1; n = 95 dose level 1) and in 60 patients were myelosuppression, fatigue and mucosal inflammation. ORR (PR plus SD) of evaluable patients across six regimens was 36 % with five PRs: regimens PB (non-small cell lung cancer, nasopharyngeal cancer), CE (melanoma), FB (colon cancer) and S (GIST). The GIST pt (>4 prior therapies) had a PR for 3 years. Three patients (breast cancer, melanoma and adenoid cystic carcinoma) were on study for >1 year; 76 % of patients had SD or better for 4 months. R1507 added to six standard oncology regimens was well tolerated with an ORR of 36 %.

  10. E-learning standards

    Directory of Open Access Journals (Sweden)

    2007-01-01

    Full Text Available E-learning standards refer to a system of common rules for content, authoring software and Learning Management Systems (LMSs - rules that specify how courses can be created and delivered over multiple platforms so that they all operate seamlessly together. Accredited standards ensure that the investment in time and intellectual capital could move from one system to the next. Currently, e-learning standards are being developed by four main organizations: AICC, IEEE, IMS, and ADL. The article presents some aspects of these standards.

  11. Multiple Perspectives / Multiple Readings

    Directory of Open Access Journals (Sweden)

    Simon Biggs

    2005-01-01

    Full Text Available People experience things from their own physical point of view. What they see is usually a function of where they are and what physical attitude they adopt relative to the subject. With augmented vision (periscopes, mirrors, remote cameras, etc we are able to see things from places where we are not present. With time-shifting technologies, such as the video recorder, we can also see things from the past; a time and a place we may never have visited.In recent artistic work I have been exploring the implications of digital technology, interactivity and internet connectivity that allow people to not so much space/time-shift their visual experience of things but rather see what happens when everybody is simultaneously able to see what everybody else can see. This is extrapolated through the remote networking of sites that are actual installation spaces; where the physical movements of viewers in the space generate multiple perspectives, linked to other similar sites at remote locations or to other viewers entering the shared data-space through a web based version of the work.This text explores the processes involved in such a practice and reflects on related questions regarding the non-singularity of being and the sense of self as linked to time and place.

  12. Multiple Sclerosis

    Science.gov (United States)

    Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin ... healthy cells in your body by mistake. Multiple sclerosis affects women more than men. It often begins ...

  13. ['Gold standard', not 'golden standard'

    NARCIS (Netherlands)

    Claassen, J.A.H.R.

    2005-01-01

    In medical literature, both 'gold standard' and 'golden standard' are employed to describe a reference test used for comparison with a novel method. The term 'gold standard' in its current sense in medical research was coined by Rudd in 1979, in reference to the monetary gold standard. In the same

  14. Artefactual multiplicity

    DEFF Research Database (Denmark)

    Bjørn, Pernille; Hertzum, Morten

    2011-01-01

    Whiteboards are highly important to the work in emergency departments (EDs). As a collaborative technology ED whiteboards are usually placed in the dynamic centre of the ED, and all ED staff will approach the whiteboard regularly to organize their individual yet interdependent work. Currently, di...... this characteristic of heterogeneous artefacts; namely artefactual multiplicity. Artefactual multiplicity identifies not only the multiple functions of heterogeneous artefacts but also the intricate relations between these multiple functionalities....

  15. Finger Multiplication

    Science.gov (United States)

    Simanihuruk, Mudin

    2011-01-01

    Multiplication facts are difficult to teach. Therefore many researchers have put a great deal of effort into finding multiplication strategies. Sherin and Fuson (2005) provided a good survey paper on the multiplication strategies research area. Kolpas (2002), Rendtorff (1908), Dabell (2001), Musser (1966) and Markarian (2009) proposed the finger…

  16. Summarizing multiple deprivation indicators

    OpenAIRE

    Cappellari, Lorenzo; Jenkins, Stephen P.

    2006-01-01

    Deprivation scales derived from multiple, typically dichotomous, indicators, are widely used to monitor households’ standards of living, and to complement measures of living standards based on income. We use an item response modelling (IRM) framework to address several issues concerning the derivation of deprivation scales in general and the use of sum-score deprivation indices in particular. Although we favour the IRM approach over the sum-score one in principle, we find in an illustrative...

  17. Multiplicity Counting

    Energy Technology Data Exchange (ETDEWEB)

    Geist, William H. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-12-01

    This set of slides begins by giving background and a review of neutron counting; three attributes of a verification item are discussed: 240Pueff mass; α, the ratio of (α,n) neutrons to spontaneous fission neutrons; and leakage multiplication. It then takes up neutron detector systems – theory & concepts (coincidence counting, moderation, die-away time); detector systems – some important details (deadtime, corrections); introduction to multiplicity counting; multiplicity electronics and example distributions; singles, doubles, and triples from measured multiplicity distributions; and the point model: multiplicity mathematics.

  18. Accounting standards

    NARCIS (Netherlands)

    Stellinga, B.; Mügge, D.

    2014-01-01

    The European and global regulation of accounting standards have witnessed remarkable changes over the past twenty years. In the early 1990s, EU accounting practices were fragmented along national lines and US accounting standards were the de facto global standards. Since 2005, all EU listed

  19. MULTIPLE OBJECTS

    Directory of Open Access Journals (Sweden)

    A. A. Bosov

    2015-04-01

    Full Text Available Purpose. The development of complicated techniques of production and management processes, information systems, computer science, applied objects of systems theory and others requires improvement of mathematical methods, new approaches for researches of application systems. And the variety and diversity of subject systems makes necessary the development of a model that generalizes the classical sets and their development – sets of sets. Multiple objects unlike sets are constructed by multiple structures and represented by the structure and content. The aim of the work is the analysis of multiple structures, generating multiple objects, the further development of operations on these objects in application systems. Methodology. To achieve the objectives of the researches, the structure of multiple objects represents as constructive trio, consisting of media, signatures and axiomatic. Multiple object is determined by the structure and content, as well as represented by hybrid superposition, composed of sets, multi-sets, ordered sets (lists and heterogeneous sets (sequences, corteges. Findings. In this paper we study the properties and characteristics of the components of hybrid multiple objects of complex systems, proposed assessments of their complexity, shown the rules of internal and external operations on objects of implementation. We introduce the relation of arbitrary order over multiple objects, we define the description of functions and display on objects of multiple structures. Originality.In this paper we consider the development of multiple structures, generating multiple objects.Practical value. The transition from the abstract to the subject of multiple structures requires the transformation of the system and multiple objects. Transformation involves three successive stages: specification (binding to the domain, interpretation (multiple sites and particularization (goals. The proposed describe systems approach based on hybrid sets

  20. Cardiac-sparing radiation therapy using positioning breast shell for patients with left-sided breast cancer who are ineligible for breath-hold techniques

    Directory of Open Access Journals (Sweden)

    Kurian Joseph, MD, FRCPC

    2017-10-01

    Conclusions: A positioning breast shell offers significant benefit in terms of sparing the heart for patients with LSBC who are ineligible for BH techniques. It also can be used as a simple cardiac-sparing alternative in centers without BH capability.

  1. SU-F-T-136: Breath Hold Lung Phantom Study in Using CT Density Versus Relative Stopping Power Ratio for Proton Pencil Beam Scanning System

    Energy Technology Data Exchange (ETDEWEB)

    Syh, J; Wu, H; Rosen, L [Willis-Knighton Medical Center, Shreveport, LA (United States)

    2016-06-15

    Purpose: To evaluate mass density effects of CT conversion table and its variation in current treatment planning system of spot scanning proton beam using an IROC proton lung phantom for this study. Methods: A proton lung phantom study was acquired to Imaging and Radiation Oncology Core Houston (IROC) Quality Assurance Center. Inside the lung phantom, GAF Chromic films and couples of thermal luminescent dosimeter (TLD) capsules embedded in specified PTV and adjacent structures to monitor delivered dosage and 3D dose distribution profiles. Various material such as cork (Lung), blue water (heart), Techron HPV (ribs) and organic material of balsa wood and cork as dosimetry inserts within phantom of solid water (soft tissue). Relative stopping power (RLSP) values were provided. Our treatment planning system (TPS) doesn’t require SP instead relative density was converted relative to water. However lung phantom was irradiated by planning with density override and the results were compared with IROC measurements. The second attempt was conducted without density override and compared with IROC’s. Results: The higher passing rate of imaging and measurement results of the lung phantom irradiation met the criteria by IROC without density override. The film at coronal plane was found to be shift due to inclined cylinder insertion. The converted CT density worked as expected to correlate relative stopping power. Conclusion: The proton lung phantom provided by IROC is a useful tool to qualify our commissioned proton pencil beam delivery with TPS within reliable confidence. The relative mass stopping power ratios of materials were converted from the relative physical density relative to water and the results were satisfied.

  2. Communications standards

    CERN Document Server

    Stokes, A V

    1986-01-01

    Communications Standards deals with the standardization of computer communication networks. This book examines the types of local area networks (LANs) that have been developed and looks at some of the relevant protocols in more detail. The work of Project 802 is briefly discussed, along with a protocol which has developed from one of the LAN standards and is now a de facto standard in one particular area, namely the Manufacturing Automation Protocol (MAP). Factors that affect the usage of networks, such as network management and security, are also considered. This book is divided into three se

  3. Multiple homicides.

    Science.gov (United States)

    Copeland, A R

    1989-09-01

    A study of multiple homicides or multiple deaths involving a solitary incident of violence by another individual was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during 1983-1987. A total of 107 multiple homicides were studied: 88 double, 17 triple, one quadruple, and one quintuple. The 236 victims were analyzed regarding age, race, sex, cause of death, toxicologic data, perpetrator, locale of the incident, and reason for the incident. This article compares this type of slaying with other types of homicide including those perpetrated by serial killers. Suggestions for future research in this field are offered.

  4. In vitro artefact assessment of a new MR-compatible microwave antenna and a standard MR-compatible radiofrequency ablation electrode for tumour ablation

    Energy Technology Data Exchange (ETDEWEB)

    Hoffmann, Ruediger; Rempp, Hansjoerg; Eibofner, Frank; Kessler, David-Emanuel; Weiss, Jakob; Nikolaou, Konstantin; Clasen, Stephan [Eberhard Karls University, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Blumenstock, Gunnar [Eberhard Karls University, Department of Clinical Epidemiology and Applied Biometry, Tuebingen (Germany); Pereira, Philippe L. [SLK-Kliniken Heilbronn GmbH, Department of Radiology, Minimally Invasive Therapies, and Nuclear Medicine, Heilbronn (Germany)

    2016-03-15

    To evaluate and compare artefact configuration and diameters in a magnetic resonance (MR)-compatible prototype microwave (MW) applicator and a standard MR-compatible radiofrequency (RF) applicator for MR-guided tumour ablation. Both applicators were tested in a phantom study at 1.5T with three sequences: T1-weighted three-dimensional volume interpolated breath-hold examination (VIBE), T1-weighted fast low angle shot (FLASH), T2-weighted turbo spin echo (TSE). Applicator orientation to main magnetic field (B{sub 0}) and slice orientation were varied. Needle tip location error (TLE) was assessed, and artefact diameters were calculated. Influence of imaging parameters on artefacts was assessed with analysis of variance (ANOVA) and post hoc testing. MW applicator: the shaft artefact diameter measured 2.3 +/- 0.8 mm. Tip artefact diameter and length measured 2.2 ± 0.8 mm and 2.4 ± 1.3 mm, respectively. A prominent oval artefact (diameter: 16.5 +/- 1.8 mm, length: 19.1 +/- 2.5 mm) appeared close to the tip. TLE: -.3 +/- 0.6 mm. RF applicator: shaft and tip diameter measured 8.9 +/- 4.7 mm and 9.0 +/-.0 mm, respectively. TLE: -0.1 +/- 0.8 mm. Minimal artefacts were measured with RF applicator orientation parallel to B{sub 0} (P < 0.0001), whereas no such influence was found for MW applicator. For both applicators, significantly large artefacts were measured with T1 FLASH (P = 0.03). The MW applicator's artefact is satisfactory and seems useable for MR-guided ablation procedures. (orig.)

  5. Multiple myeloma.

    LENUS (Irish Health Repository)

    Collins, Conor D

    2012-02-01

    Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.

  6. Multiple Sclerosis

    Science.gov (United States)

    ... SEARCH Definition Treatment Prognosis Clinical Trials Organizations Publications Definition An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the ...

  7. Multiple sclerosis

    Science.gov (United States)

    ... Bradley's Neurology in Clinical Practice . 7th ed. Philadelphia, PA: Elsevier; 2016:chap 80. Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple ...

  8. (Terminology standardization)

    Energy Technology Data Exchange (ETDEWEB)

    Strehlow, R.A.

    1990-10-19

    Terminological requirements in information management was but one of the principal themes of the 2nd Congress on Terminology and Knowledge Engineering. The traveler represented the American Society for Testing and Materials' Committee on Terminology, of which he is the Chair. The traveler's invited workshop emphasized terminology standardization requirements in databases of material properties as well as practical terminology standardizing methods. The congress included six workshops in addition to approximately 82 lectures and papers from terminologists, artificial intelligence practitioners, and subject specialists from 18 countries. There were approximately 292 registrants from 33 countries who participated in the congress. The congress topics were broad. Examples were the increasing use of International Standards Organization (ISO) Standards in legislated systems such as the USSR Automated Data Bank of Standardized Terminology, the enhanced Physics Training Program based on terminology standardization in Physics in the Chinese province of Inner Mongolia, and the technical concept dictionary being developed at the Japan Electronic Dictionary Research Institute, which is considered to be the key to advanced artificial intelligence applications. The more usual roles of terminology work in the areas of machine translation. indexing protocols, knowledge theory, and data transfer in several subject specialties were also addressed, along with numerous special language terminology areas.

  9. Skill Standards.

    Science.gov (United States)

    Glover, Robert W.

    1992-01-01

    Industry-based skill assessment and certification should (1) be independent of training providers; (2) use variety of instruments; (3) recognize multiple levels of mastery; (4) promote broad training and continuous learning; (5) be geared to high-performance work organizations; (6) be voluntary; and (7) be flexible to keep pace with technology.…

  10. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, Egon; Stenager, E N; Knudsen, Lone

    1994-01-01

    In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent......, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap...

  11. Frequency standards

    CERN Document Server

    Riehle, Fritz

    2006-01-01

    Of all measurement units, frequency is the one that may be determined with the highest degree of accuracy. It equally allows precise measurements of other physical and technical quantities, whenever they can be measured in terms of frequency.This volume covers the central methods and techniques relevant for frequency standards developed in physics, electronics, quantum electronics, and statistics. After a review of the basic principles, the book looks at the realisation of commonly used components. It then continues with the description and characterisation of important frequency standards

  12. Multiple sclerosis

    OpenAIRE

    Nicholas, Richard; Rashid, Waqar

    2012-01-01

    Multiple sclerosis is characterised by central nervous system lesions causing neurological dysfunction and other problems, such as fatigue, pain, depression, and anxiety. Early disease is usually relapsing and remitting, but most people develop secondary-progressive disease over time. No treatment has been shown to affect long-term outcome.Irreversible disability can occur, but life expectancy is generally not affected.

  13. Multiple Intelligences.

    Science.gov (United States)

    Laughlin, Janet

    1999-01-01

    Details the characteristics of Howard Gardner's seven multiple intelligences (MI): linguistic, logical-mathematical, bodily-kinesthetic, spatial, musical, interpersonal, and intrapersonal. Discusses the implications of MI for instruction. Explores how students can study using their preferred learning style - visual, auditory, and physical study…

  14. Multiple Leiomyoma

    Directory of Open Access Journals (Sweden)

    Nath Sarkar Jyotirindra

    1999-01-01

    Full Text Available A case of multiple cutaneous lelomyomas is reported for its uncommon occurrence. This cases was associated with osseous and soft tissue hamartoma of right thumb, lipoma on left side of chest and back, hoarseness of voice and lower motor neurone disorder in limbs.

  15. Multiple Sclerosis.

    Science.gov (United States)

    Plummer, Nancy; Michael, Nancy, Ed.

    This module on multiple sclerosis is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

  16. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1988-01-01

    Forty-two (12%) of a total of 366 patients with multiple sclerosis (MS) had psychiatric admissions. Of these, 34 (81%) had their first psychiatric admission in conjunction with or after the onset of MS. Classification by psychiatric diagnosis showed that there was a significant positive correlation...

  17. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1994-01-01

    In a cross-sectional study of 94 patients (42 males, 52 females) with definite multiple sclerosis (MS) in the age range 25-55 years, the correlation of neuropsychological tests with the ability to read TV-subtitles and with the use of sedatives is examined. A logistic regression analysis reveals...

  18. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    In a cross-sectional investigation of 116 patients with multiple sclerosis, the social and sparetime activities of the patient were assessed by both patient and his/her family. The assessments were correlated to physical disability which showed that particularly those who were moderately disabled...

  19. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1990-01-01

    An investigation on the correlation between ability to read TV subtitles and the duration of visual evoked potential (VEP) latency in 14 patients with definite multiple sclerosis (MS), indicated that VEP latency in patients unable to read the TV subtitles was significantly delayed in comparison...

  20. Achieving Standardization

    DEFF Research Database (Denmark)

    Henningsson, Stefan

    2016-01-01

    International e-Customs is going through a standardization process. Driven by the need to increase control in the trade process to address security challenges stemming from threats of terrorists, diseases, and counterfeit products, and to lower the administrative burdens on traders to stay...

  1. Achieving Standardization

    DEFF Research Database (Denmark)

    Henningsson, Stefan

    2014-01-01

    International e-Customs is going through a standardization process. Driven by the need to increase control in the trade process to address security challenges stemming from threats of terrorists, diseases, and counterfeit products, and to lower the administrative burdens on traders to stay...

  2. PKI standards

    OpenAIRE

    Mitchell, Chris J

    2000-01-01

    This paper provides a review of the current state of the art in standards for Public Key Infrastructures. The main focus of the paper is the recent work by the Internet Engineering Task Force, ITU-T, and ISO/IEC.

  3. Lung ventilation volumetry with same-breath acquisition of hyperpolarized gas and proton MRI.

    Science.gov (United States)

    Horn, F C; Tahir, B A; Stewart, N J; Collier, G J; Norquay, G; Leung, G; Ireland, R H; Parra-Robles, J; Marshall, H; Wild, J M

    2014-12-01

    The purpose of this work was to assess the reproducibility of percentage of ventilated lung volume (PV) measured from hyperpolarized (HP) (3)He and (1)H anatomical images acquired in the same breath-hold when compared with PV measured from (3)He and (1)H images from separate breath-holds. Volumetric (3)He ventilation and (1)H anatomical images of the same resolution were acquired during the same breath-hold. To assess reproducibility, this procedure was performed twice with a short gap between acquisitions. In addition, (1)H images were also acquired in a separate breath for comparison. PV ((3)He ventilated volume divided by (1)H total lung volume) was calculated using the single-breath-hold images (PV(single)) and the separate-breath-hold images (PV(separate)). Short-term reproducibility of PV measurement was assessed for both single- and separate-breath acquisitions. Dice similarity coefficients (DSCs) were calculated to quantify spatial overlap between (3)He and (1)H segmentations for the single- and separate-breath-hold acquisitions. The efficacy of using the separate-breath method combined with image registration was also assessed. The mean magnitude difference between the two sets of PV values (±standard deviation) was 1.49 ± 1.32% for PV(single) and 4.19 ± 4.10% for PV(separate), with a significant difference (p single-breath acquisitions was more repeatable than PV measured with separate-breath acquisitions, regardless of image registration. DSC values were significantly greater (p single-breath acquisition than for separate-breath acquisition. Acquisition of HP gas ventilation and (1)H anatomical images in a single breath-hold provides a more reproducible means of percentage lung ventilation volume measurement than the previously used separate-breath-hold scan approach, and reduces errors. Copyright © 2014 John Wiley & Sons, Ltd.

  4. Data converters for wireless standards

    CERN Document Server

    Shi, Chunlei

    2002-01-01

    Wireless communication is witnessing tremendous growth with proliferation of different standards covering wide, local and personal area networks (WAN, LAN and PAN). The trends call for designs that allow 1) smooth migration to future generations of wireless standards with higher data rates for multimedia applications, 2) convergence of wireless services allowing access to different standards from the same wireless device, 3) inter-continental roaming. This requires designs that work across multiple wireless standards, can easily be reused, achieve maximum hardware share at a minimum power consumption levels particularly for mobile battery-operated devices.

  5. Multiple sclerosis

    OpenAIRE

    Nylander, Alyssa; Hafler, David A.

    2012-01-01

    Multiple sclerosis (MS) is a multifocal demyelinating disease with progressive neurodegeneration caused by an autoimmune response to self-antigens in a genetically susceptible individual. While the formation and persistence of meningeal lymphoid follicles suggest persistence of antigens to drive the continuing inflammatory and humoral response, the identity of an antigen or infectious agent leading to the oligoclonal expansion of B and T cells is unknown. In this review we examine new paradig...

  6. Multiple Sclerosis

    OpenAIRE

    Gaby, Alan

    2013-01-01

    Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system. Common manifestations include paresthesias, diplopia, loss of vision, numbness or weakness of the limbs, bowel or bladder dysfunction, spasticity, ataxia, fatigue, and mental changes. Four main patterns of MS are recognized: relapsing remitting, primary progressive, secondary progressive, and progressive relapsing. The cause of MS is unknown, although it appears to be an autoimmune disease. M...

  7. Assessing Elementary Understanding of Multiplication Concepts

    Science.gov (United States)

    Smith, Stephanie Z.; Smith, Marvin E.

    2006-01-01

    This article summarizes the basic concepts of multiplication and provides some evidence that the traditional third-grade curriculum and instruction emphasizing memorization of multiplication facts produces much less understanding of the basic concepts of multiplication than a standards-based curriculum and instruction emphasizing construction of…

  8. Standard deviations

    CERN Document Server

    Smith, Gary

    2015-01-01

    Did you know that having a messy room will make you racist? Or that human beings possess the ability to postpone death until after important ceremonial occasions? Or that people live three to five years longer if they have positive initials, like ACE? All of these ‘facts' have been argued with a straight face by researchers and backed up with reams of data and convincing statistics.As Nobel Prize-winning economist Ronald Coase once cynically observed, ‘If you torture data long enough, it will confess.' Lying with statistics is a time-honoured con. In Standard Deviations, ec

  9. Spin multiplicities

    Energy Technology Data Exchange (ETDEWEB)

    Curtright, T.L., E-mail: curtright@miami.edu [Department of Physics, University of Miami, Coral Gables, FL 33124-8046 (United States); Van Kortryk, T.S., E-mail: vankortryk@gmail.com [Department of Physics, University of Miami, Coral Gables, FL 33124-8046 (United States); High Energy Physics Division, Argonne National Laboratory, Argonne, IL 60439-4815 (United States); Zachos, C.K., E-mail: zachos@anl.gov [Department of Physics, University of Miami, Coral Gables, FL 33124-8046 (United States); High Energy Physics Division, Argonne National Laboratory, Argonne, IL 60439-4815 (United States)

    2017-02-05

    The number of times spin s appears in the Kronecker product of n spin j representations is computed, and the large n asymptotic behavior of the result is obtained. Applications are briefly sketched. - Highlights: • We give a self-contained derivation of the spin multiplicities that occur in n-fold tensor products of spin-j representations. • We make use of group characters, properties of special functions, and asymptotic analysis of integrals. • We emphasize patterns that arise when comparing different values of j, and asymptotic behavior for large n. • Our methods and results should be useful for various statistical and quantum information theory calculations.

  10. Standardization work

    Science.gov (United States)

    Malavallon, Olivier

    1995-04-01

    For several years now, the main civil aircraft manufacturers (Airbus and its partners, Boeing, Fokker, McDonnell Douglas) have been working jointly on the writing of technical recommendations and the drawing up of an international standard. This work concerns the evaluation of the processes and products used to strip aeronautical paint systems. This procedure was initiated on request from the main airlines. In effect, the airlines are faced with situations in which the financial and operational objectives are becoming increasingly important. The need was felt to rationalize and, if possible, harmonize the criteria and technical requirements of the various civil aircraft manufacturers in order to facilitate in-service maintenance of the fleets of airlines operating Airbus, Boeing, Douglas aircraft, etc.

  11. [Multiple apheresis].

    Science.gov (United States)

    Coffe, C

    2007-05-01

    Multiple apheresis makes it possible to obtain at least two labile blood components from a single donor using a cell separator. It can be either multicomponent apheresis leading to the preparation of at least two different blood component types or red blood cell apheresis providing two identical red blood cell concentrates. These techniques available in addition to whole blood donation, are modifying collection strategies in many Etablissements Français du Sang and will contribute to improve stock logistics in the future. In areas with insufficient stock, these procedures will help achieve blood component self-sufficiency. The author first describes the principle underlying different--current or future--techniques as well as their advantages and drawbacks. He finally addresses the potential impact of these processes on the evolution of blood collection and the advantages to be gained.

  12. Rapid volumetric T1 mapping of the abdomen using three-dimensional through-time spiral GRAPPA.

    Science.gov (United States)

    Chen, Yong; Lee, Gregory R; Aandal, Gunhild; Badve, Chaitra; Wright, Katherine L; Griswold, Mark A; Seiberlich, Nicole; Gulani, Vikas

    2016-04-01

    To develop an ultrafast T1 mapping method for high-resolution, volumetric T1 measurements in the abdomen. The Look-Locker method was combined with a stack-of-spirals acquisition accelerated using three-dimensional (3D) through-time spiral GRAPPA reconstruction for fast data acquisition. A segmented k-space acquisition scheme was proposed and the time delay between segments for the recovery of longitudinal magnetization was optimized using Bloch equation simulations. The accuracy of this method was validated in a phantom experiment and in vivo T1 measurements were performed with 35 asymptomatic subjects on both 1.5 Tesla (T) and 3T MRI systems. Phantom experiments yielded close agreement between the proposed method and gold standard measurements for a large range of T1 values (200 to 1600 ms). The in vivo results further demonstrate that high-resolution T1 maps (2 × 2 × 4 mm(3)) for 32 slices can be achieved in a single clinically feasible breath-hold of approximately 20 s. The T1 values for multiple organs and tissues in the abdomen are in agreement with the published literature. A high-resolution 3D abdominal T1 mapping technique was developed, which allows fast and accurate T1 mapping of multiple abdominal organs and tissues in a single breath-hold. © 2015 Wiley Periodicals, Inc.

  13. The Dynamics of Standardization

    DEFF Research Database (Denmark)

    Brunsson, Nils; Rasche, Andreas; Seidl, David

    2012-01-01

    This paper suggests that when the phenomenon of standards and standardization is examined from the perspective of organization studies, three aspects stand out: the standardization of organizations, standardization by organizations and standardization as (a form of) organization. Following a comp...

  14. Towards Standardization: A Participatory Framework for Scientific Standard-Making

    Directory of Open Access Journals (Sweden)

    Lynn Yarmey

    2013-06-01

    Full Text Available In contemporary scientific research, standard-making and standardization are key processes for the sharing and reuse of data. The goals of this paper are twofold: 1 to stress that collaboration is crucial to standard-making, and 2 to urge recognition of metadata standardization as part of the scientific process. To achieve these goals, a participatory framework for developing and implementing scientific metadata standards is presented. We highlight the need for ongoing, open dialogue within and among research communities at multiple levels. Using the Long Term Ecological Research network adoption of the Ecological Metadata Language as a case example in the natural sciences, we illustrate how a participatory framework addresses the need for active coordination of the evolution of scientific metadata standards. The participatory framework is contrasted with a hierarchical framework to underscore how the development of scientific standards is a dynamic and continuing process. The roles played by ‘best practices’ and ‘working standards’ are identified in relation to the process of standardization.

  15. Exciton multiplication from first principles.

    Science.gov (United States)

    Jaeger, Heather M; Hyeon-Deuk, Kim; Prezhdo, Oleg V

    2013-06-18

    Third-generation photovolatics require demanding cost and power conversion efficiency standards, which may be achieved through efficient exciton multiplication. Therefore, generating more than one electron-hole pair from the absorption of a single photon has vast ramifications on solar power conversion technology. Unlike their bulk counterparts, irradiated semiconductor quantum dots exhibit efficient exciton multiplication, due to confinement-enhanced Coulomb interactions and slower nonradiative losses. The exact characterization of the complicated photoexcited processes within quantum-dot photovoltaics is a work in progress. In this Account, we focus on the photophysics of nanocrystals and investigate three constituent processes of exciton multiplication, including photoexcitation, phonon-induced dephasing, and impact ionization. We quantify the role of each process in exciton multiplication through ab initio computation and analysis of many-electron wave functions. The probability of observing a multiple exciton in a photoexcited state is proportional to the magnitude of electron correlation, where correlated electrons can be simultaneously promoted across the band gap. Energies of multiple excitons are determined directly from the excited state wave functions, defining the threshold for multiple exciton generation. This threshold is strongly perturbed in the presence of surface defects, dopants, and ionization. Within a few femtoseconds following photoexcitation, the quantum state loses coherence through interactions with the vibrating atomic lattice. The phase relationship between single excitons and multiple excitons dissipates first, followed by multiple exciton fission. Single excitons are coupled to multiple excitons through Coulomb and electron-phonon interactions, and as a consequence, single excitons convert to multiple excitons and vice versa. Here, exciton multiplication depends on the initial energy and coupling magnitude and competes with electron

  16. Effect of physiological heart rate variability on quantitative T2 measurement with ECG-gated Fast Spin Echo (FSE) sequence and its retrospective correction.

    Science.gov (United States)

    de Roquefeuil, Marion; Vuissoz, Pierre-André; Escanyé, Jean-Marie; Felblinger, Jacques

    2013-11-01

    Quantitative T2 measurement is applied in cardiac Magnetic Resonance Imaging (MRI) for the diagnosis and follow-up of myocardial pathologies. Standard Electrocardiogram (ECG)-gated fast spin echo pulse sequences can be used clinically for T2 assessment, with multiple breath-holds. However, heart rate is subject to physiological variability, which causes repetition time variations and affects the recovery of longitudinal magnetization between TR periods. The bias caused by heart rate variability on quantitative T2 measurements is evaluated for fast spin echo pulse sequence. Its retrospective correction based on an effective TR is proposed. Heart rate variations during breath-holds are provided by the ECG recordings from healthy volunteers. T2 measurements were performed on a phantom with known T2 values, by synchronizing the sequence with the recorded ECG. Cardiac T2 measurements were performed twice on six volunteers. The impact of T1 on T2 is also studied. Maximum error in T2 is 26% for phantoms and 18% for myocardial measurement. It is reduced by the proposed compensation method to 20% for phantoms and 10% for in vivo measurements. Only approximate knowledge of T1 is needed for T2 correction. Heart rate variability may cause a bias in T2 measurement with ECG-gated FSE. It needs to be taken into account to avoid a misleading diagnosis from the measurements. © 2013.

  17. Multiple System Atrophy

    Science.gov (United States)

    ... Home » Disorders » Patient & Caregiver Education » Fact Sheets Multiple System Atrophy Fact Sheet What is multiple system atrophy? ... can I get more information? What is multiple system atrophy? Multiple system atrophy (MSA) is a progressive ...

  18. Defining the clinical course of multiple sclerosis

    DEFF Research Database (Denmark)

    Lublin, Fred D; Reingold, Stephen C; Cohen, Jeffrey A

    2014-01-01

    Accurate clinical course descriptions (phenotypes) of multiple sclerosis (MS) are important for communication, prognostication, design and recruitment of clinical trials, and treatment decision-making. Standardized descriptions published in 1996 based on a survey of international MS experts provi...

  19. Biosensing in multiple sclerosis.

    Science.gov (United States)

    Yousef, Andrew; Jonzzon, Soren; Suleiman, Leena; Arjona, Jennifer; Graves, Jennifer S

    2017-10-23

    The goal of using wearable biosensors in multiple sclerosis (MS) is to provide outcome metrics with higher sensitivity to deficits and better inter-test and inter-rater reliability than standard neurological exam bedside maneuvers. A wearable biosensor not only has the potential to enhance physical exams, but also offers the promise of remote evaluations of the patient either at home or with local non-specialist providers. Areas covered: We performed a structured literature review on the use of wearable biosensors in studies of multiple sclerosis. This included accelerometers, gyroscopes, eye-trackers, grip sensors, and multi-sensors. Expert commentary: Wearable sensors that are sensitive to change in function over time have great potential to serve as outcome metrics in clinical trials. Key features of generalizability are simplicity in the application of the device and delivery of data to the provider. Another important feature to establish is best sampling rate. Having too high of a sampling rate can lead to over-interpretation of noisy data On the other hand, a low sampling rate can result in an insensitive test thus missing subtle changes of clinical interest. Of most importance is to establish metrics derived from wearable devices that provide meaningful data in longitudinal studies.

  20. Estimation of caries experience by multiple imputation and direct standardization

    NARCIS (Netherlands)

    Schuller, A.A.; Buuren, S. van

    2014-01-01

    Valid estimates of caries experience are needed to monitor oral population health. Obtaining such estimates in practice is often complicated by nonresponse and missing data. The goal of this study was to estimate caries experiences in a population of children aged 5 and 11 years, in the presence of

  1. Estimation of Caries Experience by Multiple Imputation and Direct Standardization

    NARCIS (Netherlands)

    Schuller, A. A.; van Buuren, S.

    2014-01-01

    Valid estimates of caries experience are needed to monitor oral population health. Obtaining such estimates in practice is often complicated by nonresponse and missing data. The goal of this study was to estimate caries experiences in a population of children aged 5 and 11 years, in the presence of

  2. Standards for Standardized Logistic Regression Coefficients

    Science.gov (United States)

    Menard, Scott

    2011-01-01

    Standardized coefficients in logistic regression analysis have the same utility as standardized coefficients in linear regression analysis. Although there has been no consensus on the best way to construct standardized logistic regression coefficients, there is now sufficient evidence to suggest a single best approach to the construction of a…

  3. Real-time cardiac magnetic resonance cine imaging with sparse sampling and iterative reconstruction for left-ventricular measures: Comparison with gold-standard segmented steady-state free precession.

    Science.gov (United States)

    Camargo, Gabriel C; Erthal, Fernanda; Sabioni, Leticia; Penna, Filipe; Strecker, Ralph; Schmidt, Michaela; Zenge, Michael O; Lima, Ronaldo de S L; Gottlieb, Ilan

    2017-05-01

    Segmented cine imaging with a steady-state free-precession sequence (Cine-SSFP) is currently the gold standard technique for measuring ventricular volumes and mass, but due to multi breath-hold (BH) requirements, it is prone to misalignment of consecutive slices, time consuming and dependent on respiratory capacity. Real-time cine avoids those limitations, but poor spatial and temporal resolution of conventional sequences has prevented its routine application. We sought to examine the accuracy and feasibility of a newly developed real-time sequence with aggressive under-sampling of k-space using sparse sampling and iterative reconstruction (Cine-RT). Stacks of short-axis cines were acquired covering both ventricles in a 1.5T system using gold standard Cine-SSFP and Cine-RT. Acquisition parameters for Cine-SSFP were: acquisition matrix of 224×196, temporal resolution of 39ms, retrospective gating, with an average of 8 heartbeats per slice and 1-2 slices/BH. For Cine-RT: acquisition matrix of 224×196, sparse sampling net acceleration factor of 11.3, temporal resolution of 41ms, prospective gating, real-time acquisition of 1 heart-beat/slice and all slices in one BH. LV contours were drawn at end diastole and systole to derive LV volumes and mass. Forty-one consecutive patients (15 male; 41±17years) in sinus rhythm were successfully included. All images from Cine-SSFP and Cine-RT were considered to have excellent quality. Cine-RT-derived LV volumes and mass were slightly underestimated but strongly correlated with gold standard Cine-SSFP. Inter- and intra-observer analysis presented similar results between both sequences. Cine-RT featuring sparse sampling and iterative reconstruction can achieve spatial and temporal resolution equivalent to Cine-SSFP, providing excellent image quality, with similar precision measurements and highly correlated and only slightly underestimated volume and mass values. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Standards 101: The ASA Standards program

    Science.gov (United States)

    Schomer, Paul

    2004-05-01

    ASA serves as a standards developer under the auspices of the American National Standards Institute (ANSI). The Standards Program is organized through four technical committees (S1, S2, S3, and S12) and one administrative committee (ASACOS). S1 deals with physical acoustics, S2 deals with shock and vibration, S3 deals with physiological and psychological acoustics and S12 deals with noise. ASACOS is the ASA Committee on Standards. The program has three primary tasks: (1) development of national standards (ANSI Standards), (2) national adoption of international standards (ANSI NAIS Standards), (3) providing the USA input to the development of international standards (ISO and IEC Standards). At every level the main work is accomplished in Working Groups (WG) that are staffed by hundreds of volunteers, mainly ASA members from its various technical committees such as Noise, Physical Acoustics, Architectural Acoustics, Physiological and Psychological Acoustics, etc. Overall, the Standards Program involves more ASA members than does any other single function of the society except meetings. It is the biggest outreach function of ASA affecting the health, welfare, and economic well-being of large sectors of society. It is a main way the ASA diffuses the knowledge of acoustics and its practical application, perhaps the main way.

  5. Standards 101; the ASA standards program

    Science.gov (United States)

    Schomer, Paul D.

    2002-11-01

    ASA supports the development of standards by serving as the secretariat for standards committees of the American National Standards Institute (ANSI). The program is organized through four ANSI technical committees (S1, S2, S3, and S12) and one administrative committee (ASACOS). S1 deals with physical acoustics, S2 deals with shock and vibration, S3 deals with physiological and psychological acoustics, and S12 deals with noise. ASACOS is the ASA Committee on Standards. The program has three primary tasks: (1) the development of National Standards (ANSI Standards), (2) the national adoption of an international standard (ANSI NAIS Standards), (3) providing the USA input to the development of International Standards (ISO and IEC Standards). At every level the main work is accomplished in Working Groups (WG) that are ''staffed'' by hundreds of volunteers--mainly ASA members from its various technical committees such as Noise, Physical Acoustics, Architectural Acoustics, Psychological and Physiological Acoustics, etc. Overall, the Standards Program involves more ASA members than does any other single function of the Society except meetings and it is the biggest outreach function of ASA affecting the health, welfare, and economic well-being of large segments of the population, the business and industrial community, and government at all levels.

  6. STRATEGIES FOR STANDARDIZING SPELLING OF SCHOLARLY TERMINOLOGY

    Directory of Open Access Journals (Sweden)

    Olga E. Ivanova

    2015-01-01

    Full Text Available The paper examines the spelling of scholarly terms from two points of view: as part of the terminology system and as part of common language. It is shown that multiple objective and subjective causes determine the inevitability of spelling variation in terminology and that all types of deviation from standards concern individual vocables, not rules. Particular attention is given to cases in which specialized terms enter common usage, sometimes leading to changes in their spelling and raising the need for standardization. We analyze previous standards of terminology in general spelling dictionaries, analyze them as part of common language norms and propose possible strategies for standardizing terminology. 

  7. Electromagnetic field standards and exposure systems

    CERN Document Server

    Grudzinski, Eugeniusz

    2013-01-01

    When measuring electromagnetic fields (EMF), there are multiple factors that affect accuracy. Everything from proper instrument calibration, to external environmental factors, and even the competence and training of the instrument operator can bring precision into question. This book discusses factors that limit accuracy of electromagnetic field standards. These standards are one of the least accurate among the standards of physical magnitudes. They limit the accuracy of the EMF measurements, as well as the accuracy of the standards' use as exposure systems in a wide range of experiments in el

  8. Standard Reference Tables -

    Data.gov (United States)

    Department of Transportation — The Standard Reference Tables (SRT) provide consistent reference data for the various applications that support Flight Standards Service (AFS) business processes and...

  9. Retrospective Reconstruction of High Temporal Resolution Cine Images from Real-Time MRI using Iterative Motion Correction

    DEFF Research Database (Denmark)

    Hansen, Michael Schacht; Sørensen, Thomas Sangild; Arai, Andrew

    2012-01-01

    Cardiac function has traditionally been evaluated using breath-hold cine acquisitions. However, there is a great need for free breathing techniques in patients who have difficulty in holding their breath. Real-time cardiac MRI is a valuable alternative to the traditional breath-hold imaging...... approach, but the real-time images are often inferior in spatial and temporal resolution. This article presents a general method for reconstruction of high spatial and temporal resolution cine images from a real-time acquisition acquired over multiple cardiac cycles. The method combines parallel imaging...... and motion correction based on nonrigid registration and can be applied to arbitrary k-space trajectories. The method is demonstrated with real-time Cartesian imaging and Golden Angle radial acquisitions, and the motion-corrected acquisitions are compared with raw real-time images and breath-hold cine...

  10. International Standardization of Bed Rest Standard Measures

    Science.gov (United States)

    Cromwell, Ronita L.

    2010-01-01

    This slide presentation gives an overview of the standardization of bed rest measures. The International Countermeasures Working Group attempted to define and agree internationally on standard measurements for spaceflight based bed rest studies. The group identified the experts amongst several stakeholder agencys. It included information on exercise, muscle, neurological, psychological, bone and cardiovascular measures.

  11. Calibrated permeation standards

    Energy Technology Data Exchange (ETDEWEB)

    Dameron, Arrelaine A.; Reese, Matthew O.; Kempe, Michael D.

    2017-11-21

    A permeation standard is provided. The permeation standard may include a substrate that is impermeable to an analyte, an orifice disposed in the substrate, and a permeable material filling the orifice. The orifice and the permeable material are configured to provide a predetermined transmission rate of the analyte through the permeation standard. Also provided herein are methods for forming the permeation standard.

  12. Creating standards: Creating illusions?

    DEFF Research Database (Denmark)

    Linneberg, Mai Skjøtt

    written standards may open up for the creation of illusions. These are created when written standards' content is not in accordance with the perception standard adopters and standard users have of the specific practice phenomenon's content. This general theoretical argument is exemplified by the specific...

  13. RAMESES publication standards: realist syntheses

    Directory of Open Access Journals (Sweden)

    Wong Geoff

    2013-01-01

    Full Text Available Abstract Background There is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy-relevant areas - for example, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards project. The project's aim is to produce preliminary publication standards for realist systematic reviews. Methods We (a collated and summarized existing literature on the principles of good practice in realist syntheses; (b considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigor may be lost and how existing methods could be improved; (c used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d provided real-time support to ongoing realist syntheses and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e synthesized expert input, evidence syntheses and real-time problem analysis into a definitive set of standards. Results We identified 35 published realist syntheses, provided real-time support to 9 on-going syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within three rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%. Conclusion This project used multiple

  14. ISET ORS Bus Standards and Prototype

    OpenAIRE

    Sandhoo, Gurpartap; Johnson, Mark; Raynor, William; Hurley, Michael; Stadter, Patrick; Marley, Michael; Apland, Clint; Lee, Robert; Bruzzi, Jonathan; Williams, Bruce; SCHAEFER, EDWARD, JAY; Vernon, Steven; Schwartz, Paul; Moretti, George; Doyne, Thomas

    2007-01-01

    Advancing sound and accepted spacecraft bus standards is the objective of the Office of the Secretary of Defense’s (OSD) Operationally Responsive Space (ORS) Bus Standards Initiative. This effort involves multiple government, industry, and academia participants assembled into an Integrated System Engineering Team (ISET). The core ISET industry team members include AeroAstro, Boeing, Design Net Engineering, General Dynamics Spectrum Astro, Loral, Microcosm, MicroSat, Orbital, Raytheon, and Swa...

  15. Herbal Medicine - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Herbal Medicine URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Herbal Medicine - Multiple Languages To use the sharing features on ...

  16. Oral Cancer - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Oral Cancer URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Oral Cancer - Multiple Languages To use the sharing features on ...

  17. Cosmetic Dentistry - Multiple Languages

    Science.gov (United States)

    ... Here: Home → Multiple Languages → All Health Topics → Cosmetic Dentistry URL of this page: https://medlineplus.gov/languages/ ... W XYZ List of All Topics All Cosmetic Dentistry - Multiple Languages To use the sharing features on ...

  18. Zika Virus - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Zika Virus URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Zika Virus - Multiple Languages To use the sharing features on ...

  19. Multiple System Atrophy (MSA)

    Science.gov (United States)

    Multiple system atrophy (MSA) Overview Multiple system atrophy (MSA) is a rare, degenerative neurological disorder affecting your body's involuntary (autonomic) functions, including blood pressure, breathing, bladder function and muscle ...

  20. Panic Disorder - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Panic Disorder URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Panic Disorder - Multiple Languages To use the sharing features ...

  1. Health Literacy - Multiple Languages

    Science.gov (United States)

    ... Here: Home → Multiple Languages → All Health Topics → Health Literacy URL of this page: https://medlineplus.gov/languages/ ... W XYZ List of All Topics All Health Literacy - Multiple Languages To use the sharing features on ...

  2. National Multiple Sclerosis Society

    Science.gov (United States)

    ... Have you met? d Our Healthcare Voice National Multiple Sclerosis Society International Progressive MS Alliance live from Paris ... Persist for Years October 25, 2017 View All Multiple Sclerosis News & Press View All Clinical Trial Alerts Every ...

  3. Diabetic Foot - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Diabetic Foot URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Diabetic Foot - Multiple Languages To use the sharing features on ...

  4. Smokeless Tobacco - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Smokeless Tobacco URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Smokeless Tobacco - Multiple Languages To use the sharing features on ...

  5. Acute Bronchitis - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Acute Bronchitis URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Acute Bronchitis - Multiple Languages To use the sharing features on ...

  6. Elder Abuse - Multiple Languages

    Science.gov (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Elder Abuse URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Elder Abuse - Multiple Languages To use the sharing features ...

  7. ALICE Forward Multiplicity Detector

    CERN Multimedia

    Christensen, C

    2013-01-01

    The Forward Multiplicity Detector (FMD) extends the coverage for multiplicity of charge particles into the forward regions - giving ALICE the widest coverage of the 4 LHC experiments for these measurements.

  8. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, Mohammad Akbar Hosain

    2014-12-04

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green\\'s function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green\\'s function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green\\'s function and renders the higher order internal multiple image for display on a display device.

  9. Multiple sclerosis - discharge

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000129.htm Multiple sclerosis - discharge To use the sharing features on this ... doctor has told you that you have multiple sclerosis (MS). This disease affects the brain and spinal ...

  10. Depression and Multiple Sclerosis

    Science.gov (United States)

    ... navigation Skip to content Menu Navigation National Multiple Sclerosis Society Sign In In Your Area Donate Donate ... MS What Causes MS? Who Gets MS? Multiple Sclerosis FAQs Types of MS Related Conditions Symptoms & Diagnosis ...

  11. Fatigue and Multiple Sclerosis

    Science.gov (United States)

    ... navigation Skip to content Menu Navigation National Multiple Sclerosis Society Sign In In Your Area Donate Donate ... MS What Causes MS? Who Gets MS? Multiple Sclerosis FAQs Types of MS Related Conditions Symptoms & Diagnosis ...

  12. Neutron Multiplicity Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Frame, Katherine Chiyoko [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-06-28

    Neutron multiplicity measurements are widely used for nondestructive assay (NDA) of special nuclear material (SNM). When combined with isotopic composition information, neutron multiplicity analysis can be used to estimate the spontaneous fission rate and leakage multiplication of SNM. When combined with isotopic information, the total mass of fissile material can also be determined. This presentation provides an overview of this technique.

  13. Multiple meningiomas CASE SERIES

    African Journals Online (AJOL)

    Multiple meningioma is a condition in which the patient has more than. 1 meningioma in several intracranial locations with or without signs of neurofibromatosis. The incidence of multiple intracranial meningiomas varies from 1% to 10% in different series. In this case series we report. 3 cases of female patients with multiple ...

  14. The Geometry of Enhancement in Multiple Regression

    Science.gov (United States)

    Waller, Niels G.

    2011-01-01

    In linear multiple regression, "enhancement" is said to occur when R[superscript 2] = b[prime]r greater than r[prime]r, where b is a p x 1 vector of standardized regression coefficients and r is a p x 1 vector of correlations between a criterion y and a set of standardized regressors, x. When p = 1 then b [is congruent to] r and…

  15. Multiplicative updates for the LASSO

    DEFF Research Database (Denmark)

    Mørup, Morten; Clemmensen, Line Katrine Harder

    2007-01-01

    .e. least squares minimization with $L_1$-norm regularization, since the multiplicative updates (MU) can efficiently exploit the structure of the problem traditionally solved using quadratic programming (QP). We derive an algorithm based on MU for the LASSO and compare the performance to Matlabs standard QP...... solver as well as the basis pursuit denoising algorithm (BP) which can be obtained from www.sparselab.stanford.edu. The algorithms were tested on three benchmark bio-informatic datasets: A small scale data set where the number of observations is larger than the number of variables estimated ($M...

  16. Standards, Standards, Standards: The Unintended Consequences of Widening Participation?

    Science.gov (United States)

    Stuart, Mary

    2002-01-01

    Debate over widening access to higher education is narrowing to a focus on preservation of standards. Examination of the discourses of school policy, classroom environment, and peer culture shows how these competing cultures can work against efforts to increase participation. (Contains 17 references.) (SK)

  17. Genetics Home Reference: multiple sclerosis

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Multiple sclerosis Multiple sclerosis Printable PDF Open All Close All Enable Javascript ... Profile National Multiple Sclerosis Society: What is Multiple Sclerosis? Orphanet: Multiple sclerosis Patient Support and Advocacy Resources (5 links) ...

  18. Agent Standards Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The innovation of the work herein proposed is the development of standards for software autonomous agents. These standards are essential to achieve software...

  19. Federal Standardization Manual

    Science.gov (United States)

    2000-01-01

    syllabication , etc. b. Abbreviations. The applicable standard abbreviations listed in FPDs and military specifications and standards are used, except...regulations that automatically apply to everyone need not be referenced. c. Non-Government documents! Reference may be made to specifications, standards

  20. Collaboration Between Multistakeholder Standards

    DEFF Research Database (Denmark)

    Rasche, Andreas; Maclean, Camilla

    responsibility is unlikely to support a great variety of partly competing and overlapping standards. Increased collaboration between these standards would enhance both their impact and their adoption by firms. This report examines the nature, benefits, and shortcomings of existing multistakeholder standards...

  1. Automotive Technology Skill Standards

    Science.gov (United States)

    Garrett, Tom; Asay, Don; Evans, Richard; Barbie, Bill; Herdener, John; Teague, Todd; Allen, Scott; Benshoof, James

    2009-01-01

    The standards in this document are for Automotive Technology programs and are designed to clearly state what the student should know and be able to do upon completion of an advanced high-school automotive program. Minimally, the student will complete a three-year program to achieve all standards. Although these exit-level standards are designed…

  2. [Ophthalmology and standardization].

    Science.gov (United States)

    Heitz, R

    1989-01-01

    The standards are the references for quality and safety of materials, instruments and devices in ophtalmological use. The French standardisation association, "Association Française de Normalisation" (AFNOR), drafts his standards in connection with the concerned professionals. The ophthalmologists are concerned by standards of diagnostic and therapeutic instruments, intraocular and orbital implants, contact lenses, spectacle frames and glasses, and ocular protectors.

  3. The IEEE 802.11a standards

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. The IEEE 802.11a standards. Provides higher data rate and system capacities and uses OFDM in Physical Layer to mitigate the multi path effects;. Supports multiple 20Mhz channel. Each channel being an OFDM Modulated;; 52 Carriers. 48 data carrier; 4 Carry pilot ...

  4. Physiological response of rats to delivery of helium and xenon: implications for hyperpolarized noble gas imaging

    Science.gov (United States)

    Ramirez, M. P.; Sigaloff, K. C.; Kubatina, L. V.; Donahue, M. A.; Venkatesh, A. K.; Albert, M. S.; ALbert, M. S. (Principal Investigator)

    2000-01-01

    The physiological effects of various hyperpolarized helium and xenon MRI-compatible breathing protocols were investigated in 17 Sprague-Dawley rats, by continuous monitoring of blood oxygen saturation, heart rate, EKG, temperature and endotracheal pressure. The protocols included alternating breaths of pure noble gas and oxygen, continuous breaths of pure noble gas, breath-holds of pure noble gas for varying durations, and helium breath-holds preceded by two helium rinses. Alternate-breath protocols up to 128 breaths caused a decrease in oxygen saturation level of less than 5% for either helium or xenon, whereas 16 continuous-breaths caused a 31.5% +/- 2.3% decrease in oxygen saturation for helium and a 30.7% +/- 1. 3% decrease for xenon. Breath-hold protocols up to 25 s did not cause the oxygen saturation to fall below 90% for either of the noble gases. Oxygen saturation values below 90% are considered pathological. At 30 s of breath-hold, the blood oxygen saturation dropped precipitously to 82% +/- 0.6% for helium, and to 76.5% +/- 7. 4% for xenon. Breath-holds longer than 10 s preceded by pre-rinses caused oxygen saturation to drop below 90%. These findings demonstrate the need for standardized noble gas inhalation procedures that have been carefully tested, and for continuous physiological monitoring to ensure the safety of the subject. We find short breath-hold and alternate-breath protocols to be safe procedures for use in hyperpolarized noble gas MRI experiments. Copyright 2000 John Wiley & Sons, Ltd.

  5. Optimizing antiemetic therapy in multiple-day and multiple cycles of chemotherapy

    DEFF Research Database (Denmark)

    Ellebaek, E.; Herrstedt, J.

    2008-01-01

    PURPOSE OF REVIEW: Only a few studies have investigated the effect of antiemetic therapy in patients treated with multiple-day or multiple cycles of chemotherapy. The present review will assess the available data, highlight the current recommendations and draw attention towards the remaining...... problems in this field of antiemetic treatment. RECENT FINDINGS: Evidence-based guidelines recommend a combination of a 5-HT3-receptor antagonist and dexamethasone in the prophylaxis of nausea and vomiting in multiple-day cisplatin-based chemotherapy. In patients treated with multiple cycles...... of chemotherapy the addition of a NK1-receptor antagonist aprepitant to standard antiemetic therapy has increased the antiemetic effect, and multiple cycle extension studies have demonstrated that this increment in effect is sustained during multiple cycles of chemotherapy. A recent study indicated...

  6. Multiple Intelligences: Its Tensions and Possibilities

    Science.gov (United States)

    Eisner, Elliot W.

    2004-01-01

    This article explores the tensions between Howard Gardner's theory of multiple intelligences and current educational policies emphasizing standardized and predictable outcomes. The article situates Gardner's theory within the historical interests among psychometricians in identifying those core processes that constitute human intelligence.…

  7. Assessing Students' Understanding of Fraction Multiplication

    Science.gov (United States)

    Rumsey, Chepina; Guarino, Jody; Beltramini, Jennie; Cole, Shelbi; Farmer, Alicia; Gray, Kristin; Saxby, Morgan

    2016-01-01

    In this article the authors describe a project during which they unpacked fraction standards, created rigorous tasks and lesson plans, and developed formative and summative assessments to analyze students' thinking about fraction multiplication. The purpose of this article is to (1) illustrate a process that can be replicated by educators…

  8. On Multiple Questions and Multiple WH Fronting.

    Science.gov (United States)

    Rudin, Catherine

    An analysis of languages with multiple fronting of WH words (who, what, whom, etc.) looks in detail at Polish, Serbo-Croatian, Czech, Bulgarian (Slavic languages), and Romanian (a Romance language). In spite of their superficial similarity, the Slavic and East European languages that normally put all WH words at the beginning of clauses fall into…

  9. Creating Multiple Processes from Multiple Intelligences.

    Science.gov (United States)

    Wolffe, Robert; Robinson, Helja; Grant, Jean Marie

    1998-01-01

    Howard Gardner's multiple-intelligences theory stresses that all humans possess the various intelligences (linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, and naturalist) to differing degrees, and most people can attain adequate competency levels. This article provides a sample checklist for…

  10. The multiple oral presentations of multiple myeloma.

    Science.gov (United States)

    Cardoso, Richard C; Gerngross, Peter J; Hofstede, Theresa M; Weber, Donna M; Chambers, Mark S

    2014-01-01

    The purpose of this case series is to show the varied oral presentations of multiple myeloma, illustrating the importance of carefully surveying the oral cavity for suspicious lesions that could be indicative of palpable disease and/or recurrence. The diagnostic criteria and prognostic features for multiple myeloma were also reviewed. This report focuses on five patients with myeloma manifestations involving the oral cavity, in which the oral presentation of multiple myeloma was an early indication of disease relapse. Although the clinical presentation may be variable, the majority of patients will develop lytic bone lesions and less commonly, extramedullary involvement during the course of their disease. The presentation of myeloma can be varied and the oral presentation, although rare, may be the sole manifestation or part of a group of signs of disease progression. Clinical presentations of patients with myelomatous lesions can mimic common dental pathologies, which then, in turn, can lead to delays in diagnosis and treatment. As members of an interdisciplinary oncology team, it is essential to be familiar with oral manifestations of multiple myeloma and proper diagnostic/biopsy techniques in order to avoid misdiagnosis and treatment delays.

  11. Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization.

    Directory of Open Access Journals (Sweden)

    Maurice E Pouw

    Full Text Available BACKGROUND: The hospital standardized mortality ratio (HSMR is developed to evaluate and improve hospital quality. Different methods can be used to standardize the hospital mortality ratio. Our aim was to assess the validity and applicability of directly and indirectly standardized hospital mortality ratios. METHODS: Retrospective scenario analysis using routinely collected hospital data to compare deaths predicted by the indirectly standardized case-mix adjustment method with observed deaths. Discharges from Dutch hospitals in the period 2003-2009 were used to estimate the underlying prediction models. We analysed variation in indirectly standardized hospital mortality ratios (HSMRs when changing the case-mix distributions using different scenarios. Sixty-one Dutch hospitals were included in our scenario analysis. RESULTS: A numerical example showed that when interaction between hospital and case-mix is present and case-mix differs between hospitals, indirectly standardized HSMRs vary between hospitals providing the same quality of care. In empirical data analysis, the differences between directly and indirectly standardized HSMRs for individual hospitals were limited. CONCLUSION: Direct standardization is not affected by the presence of interaction between hospital and case-mix and is therefore theoretically preferable over indirect standardization. Since direct standardization is practically impossible when multiple predictors are included in the case-mix adjustment model, indirect standardization is the only available method to compute the HSMR. Before interpreting such indirectly standardized HSMRs the case-mix distributions of individual hospitals and the presence of interactions between hospital and case-mix should be assessed.

  12. An Open Standard for Camera Trap Data

    Directory of Open Access Journals (Sweden)

    Tavis Forrester

    2016-12-01

    Full Text Available Camera traps that capture photos of animals are a valuable tool for monitoring biodiversity. The use of camera traps is rapidly increasing and there is an urgent need for standardization to facilitate data management, reporting and data sharing. Here we offer the Camera Trap Metadata Standard as an open data standard for storing and sharing camera trap data, developed by experts from a variety of organizations. The standard captures information necessary to share data between projects and offers a foundation for collecting the more detailed data needed for advanced analysis. The data standard captures information about study design, the type of camera used, and the location and species names for all detections in a standardized way. This information is critical for accurately assessing results from individual camera trapping projects and for combining data from multiple studies for meta-analysis. This data standard is an important step in aligning camera trapping surveys with best practices in data-intensive science. Ecology is moving rapidly into the realm of big data, and central data repositories are becoming a critical tool and are emerging for camera trap data. This data standard will help researchers standardize data terms, align past data to new repositories, and provide a framework for utilizing data across repositories and research projects to advance animal ecology and conservation.

  13. STANDARDIZATION AS A DILEMNATIC POLICY

    Directory of Open Access Journals (Sweden)

    Suatmo Pantja Putra

    2017-03-01

    Full Text Available Standard language is generally regarded as language well establishe by usage in the speech and writing of educated people. As a product of schooling, this learnt language has, in may societies, come to assume a special place and is looked upon as an authoritative model of correctness and quality and, at its best, perfection. In language conscious speech communities, standard language also serves as a reliable measure of language profeciency which is made use of by people in administrative or educational authority. Language planners and prcatitioners in particular are charged with the responsibility of upholding this language in its purest forms. Meanwhile, the learning and teaching of standard language have become accepted as an integral part of every national or state-level educational system�s long-term obligations. This paper presents the discussion on the innappropriateness of the use of them �standard� instead of �standardized� language. It also suggests that planning for language policy within a particular situation inevitably demands taking into account not only multiple social factors and goverment goals, but also the ways in which these conditions affect language and literary acquisition across segments of the population, otherwise it can be a dilemnatic and problematic policy.

  14. PV standards overview

    Science.gov (United States)

    DeBlasio, Richard

    1997-02-01

    A brief historical perspective and current status of the on going evolution of photovoltaic standards development and the use of these standards in promulgating accepted practices used in producing, measuring, and deploying Photovoltaic (PV) components and systems in the field. After nearly 20 years of experience in developing and writing domestic and international consensus PV standards the need and importance of standard methods and practices continues, as in the past, to be essential for a maturing PV industry. Part of this maturity has been in establishing and maintaining a common ground through the development of consensus standards and furthering the use of standards for PV commercialization in support of test facility accreditation, product certification, systems deployment, and safety code development to assure PV quality, performance, reliability, and safety.

  15. How many standards?

    DEFF Research Database (Denmark)

    Maegaard, Marie

    2009-01-01

    Discussions of standardisation and standard languages has a long history in linguistics. Tore Kristiansen has contributed to these discussions in various ways, and in this chapter I will focus on his claim that young Danes operate with two standards, one for the media and one for the school. This....... This ‘double standard model’ is disussed and developed in an analysis of results from a verbal guise experiment among Copenhagen adolescents....

  16. Standard Model processes

    CERN Document Server

    Mangano, M.L.; Aguilar Saavedra, J.A.; Alekhin, S.; Badger, S.; Bauer, C.W.; Becher, T.; Bertone, V.; Bonvini, M.; Boselli, S.; Bothmann, E.; Boughezal, R.; Cacciari, M.; Carloni Calame, C.M.; Caola, F.; Campbell, J.M.; Carrazza, S.; Chiesa, M.; Cieri, L.; Cimaglia, F.; Febres Cordero, F.; Ferrarese, P.; D'Enterria, D.; Ferrera, G.; Garcia i Tormo, X.; Garzelli, M.V.; Germann, E.; Hirschi, V.; Han, T.; Ita, H.; Jäger, B.; Kallweit, S.; Karlberg, A.; Kuttimalai, S.; Krauss, F.; Larkoski, A.J.; Lindert, J.; Luisoni, G.; Maierhöfer, P.; Mattelaer, O.; Martinez, H.; Moch, S.; Montagna, G.; Moretti, M.; Nason, P.; Nicrosini, O.; Oleari, C.; Pagani, D.; Papaefstathiou, A.; Petriello, F.; Piccinini, F.; Pierini, M.; Pierog, T.; Pozzorini, S.; Re, E.; Robens, T.; Rojo, J.; Ruiz, R.; Sakurai, K.; Salam, G.P.; Salfelder, L.; Schönherr, M.; Schulze, M.; Schumann, S.; Selvaggi, M.; Shivaji, A.; Siodmok, A.; Skands, P.; Torrielli, P.; Tramontano, F.; Tsinikos, I.; Tweedie, B.; Vicini, A.; Westhoff, S.; Zaro, M.; Zeppenfeld, D.; CERN. Geneva. ATS Department

    2017-06-22

    This report summarises the properties of Standard Model processes at the 100 TeV pp collider. We document the production rates and typical distributions for a number of benchmark Standard Model processes, and discuss new dynamical phenomena arising at the highest energies available at this collider. We discuss the intrinsic physics interest in the measurement of these Standard Model processes, as well as their role as backgrounds for New Physics searches.

  17. Airborne Network Camera Standard

    Science.gov (United States)

    2015-06-01

    Optical Systems Group Document 466-15 AIRBORNE NETWORK CAMERA STANDARD DISTRIBUTION A: APPROVED FOR PUBLIC RELEASE...Airborne Network Camera Standard 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER...without the focus of standardization for interoperable command and control, storage, and data streaming has been the airborne network camera systems used

  18. Standard NIM Instrumentation System

    Energy Technology Data Exchange (ETDEWEB)

    Costrell, Louis [National Inst. of Standards and Technology (NIST), Gaithersburg, MD (United States); Lenkszus, Frank R. [Argonne National Lab. (ANL), Argonne, IL (United States); Rudnick, Stanley J. [Argonne National Lab. (ANL), Argonne, IL (United States); Davey, Eric [Atomic Energy of Canada (AECL), Limited, Chalk River, ON (Canada); Gould, John [Brookhaven National Lab. (BNL), Upton, NY (United States); Rankowitz, Seymour [Brookhaven National Lab. (BNL), Upton, NY (United States); Sims, William P. [Brookhaven National Lab. (BNL), Upton, NY (United States); Whitney, R. Roy [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States). Continuous Electron Beam Accelerator Facility (CEBAF); Dobinson, Robert W. [European Organization for Nuclear Research (CERN), Geneva (Switzerland); Verweij, Henk [European Organization for Nuclear Research (CERN), Geneva (Switzerland); Latner, Norman [Environmental Measurements Lab., New York, NY (United States); Negro, Vincent C. [Environmental Measurements Lab., New York, NY (United States); Barsotti, Edward J. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Droege, Thomas E. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Kerns, Cordon [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Turner, Kathleen J. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Downing, Robert W. [Univ. of Illinois, Urbana, IL (United States); Kirsten, Frederick A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Larsh, A. E. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Loken, Stewart C. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mack, Dick A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wagner, Lee J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Lucena, Robert C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); O' Brien, Dennis W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gjovig, Allan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Naivar, Frank [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Nelson, Ronald O. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); White, D. Hywell [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Akerlof, Carl [Univ. of Michigan, Ann Arbor, MI (United States); Stilwell, Donald E. [National Aeronautics and Space Administration, Washington, DC (United States); Trainor, James H. [National Aeronautics and Space Administration, Washington, DC (United States); Gobbi, Bruno [Northwestern Univ., Evanston, IL (United States); Biggerstaff, John A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hill, Nat W. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Schulze, Gerald K. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Gustavson, David B. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Horelick, Dale [SLAC National Accelerator Lab., Menlo Park, CA (United States); Kunz, Paul F. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Paffrath, Leo [SLAC National Accelerator Lab., Menlo Park, CA (United States); Walz, Helmut V. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Dawson, W. Kenneth [TRIUMF, Vancouver, BC (Canada); Cresswell, John [TRIUMF, Vancouver, BC (Canada); Dhawan, Satish [Yale Univ., New Haven, CT (United States); Gingell, Charles E. L. [Yale Univ., New Haven, CT (United States)

    1990-05-01

    NIM is a standard modular instrumentation system that is in wide use throughout the world. As the NIM system developed and accommodations were made to a dynamic instrumentation field and a rapidly advancing technology, additions, revisions and clarifications were made. These were incorporated into the standard in the form of addenda and errata. This standard is a revision of the NIM document, AEC Report TID-20893 (Rev 4) dated July 1974. It includes all the addenda and errata items that were previously issued as well as numerous additional items to make the standard current with modern technology and manufacturing practice.

  19. Standard NIM instrumentation system

    CERN Document Server

    1990-01-01

    NIM is a standard modular instrumentation system that is in wide use throughout the world. As the NIM system developed and accommodations were made to a dynamic instrumentation field and a rapidly advancing technology, additions, revisions and clarifications were made. These were incorporated into the standard in the form of addenda and errata. This standard is a revision of the NIM document, AEC Report TID- 20893 (Rev 4) dated July 1974. It includes all the addenda and errata items that were previously issued as well as numerous additional items to make the standard current with modern technology and manufacturing practice.

  20. International hearing protector standardization

    DEFF Research Database (Denmark)

    Poulsen, Torben

    2002-01-01

    Hearing protectors shall fulfill some minimum requirements to their performance. As hearing protector manufacturers sell the products all over the world, the testing and certification of hearing protectors has become an international issue. The ISO working group WG17 under the headlines Acoustics......, Noise, produce hearing protector standards to be used at an international level. The presentation will cover the ongoing work in WG17, including the revision of existing standards (ISO 4869-1, ISO 4869-3), upcoming new standards (ISO 4869-7) and the plans and status for future standards (performance...

  1. Flight Standards Automation System -

    Data.gov (United States)

    Department of Transportation — FAVSIS supports Flight Standards Service (AFS) by maintaining their information on entities such as air carriers, air agencies, designated airmen, and check airmen....

  2. The Standard Model course

    CERN Multimedia

    CERN. Geneva HR-RFA

    2006-01-01

    Suggested Readings: Aspects of Quantum Chromodynamics/A Pich, arXiv:hep-ph/0001118. - The Standard Model of Electroweak Interactions/A Pich, arXiv:hep-ph/0502010. - The Standard Model of Particle Physics/A Pich The Standard Model of Elementary Particle Physics will be described. A detailed discussion of the particle content, structure and symmetries of the theory will be given, together with an overview of the most important experimental facts which have established this theoretical framework as the Standard Theory of particle interactions.

  3. Orchestrating Multiple Intelligences

    Science.gov (United States)

    Moran, Seana; Kornhaber, Mindy; Gardner, Howard

    2006-01-01

    Education policymakers often go astray when they attempt to integrate multiple intelligences theory into schools, according to the originator of the theory, Howard Gardner, and his colleagues. The greatest potential of a multiple intelligences approach to education grows from the concept of a profile of intelligences. Each learner's intelligence…

  4. Applying Multiple Intelligences

    Science.gov (United States)

    Christodoulou, Joanna A.

    2009-01-01

    The ideas of multiple intelligences introduced by Howard Gardner of Harvard University more than 25 years ago have taken form in many ways, both in schools and in other sometimes-surprising settings. The silver anniversary of Gardner's learning theory provides an opportunity to reflect on the ways multiple intelligences theory has taken form and…

  5. Constraining Multiple Grammars

    Science.gov (United States)

    Hopp, Holger

    2014-01-01

    This article offers the author's commentary on the Multiple Grammars (MG) language acquisition theory proposed by Luiz Amaral and Tom Roeper in the present issue. Multiple Grammars advances the claim that optionality is a constitutive characteristic of any one grammar, with interlanguage grammars being perhaps the clearest examples of a…

  6. ALICE Photon Multiplicity Detector

    CERN Multimedia

    Nayak, T

    2013-01-01

    Photon Multiplicity Detector (PMD) measures the multiplicity and spatial distribution of photons in the forward region of ALICE on a event-by-event basis. PMD is a pre-shower detector having fine granularity and full azimuthal coverage in the pseudo-rapidity region 2.3 < η < 3.9.

  7. Assessing Children's Multiplicative Thinking

    Science.gov (United States)

    Hurst, Chris; Hurrell, Derek

    2016-01-01

    Multiplicative thinking is a "big idea" of mathematics that underpins much of the mathematics learned beyond the early primary school years. This paper reports on a current study that utilises an interview tool and a written quiz to gather data about children's multiplicative thinking. The development of the tools and some of the…

  8. Multiple Frequency Parametric Sonar

    Science.gov (United States)

    2015-09-28

    300003 1 MULTIPLE FREQUENCY PARAMETRIC SONAR STATEMENT OF GOVERNMENT INTEREST [0001] The invention described herein may be manufactured and...a method for increasing the bandwidth of a parametric sonar system by using multiple primary frequencies rather than only two primary frequencies...2) Description of Prior Art [0004] Parametric sonar generates narrow beams at low frequencies by projecting sound at two distinct primary

  9. Hadron Multiplicities at HERMES

    CERN Document Server

    Hartig, M

    2005-01-01

    Hadron multiplicities of $\\pim$, $\\pip$, $\\km$ and $\\kp$ have been measured in the deep-inelastic scattering of 27.5 GeV positrons off a hydrogen target. The data used in this analysis have been collected during the 2000 HERA running period. The multiplicities were obtained for 0.15$$ = 2.5 GeV$^2$.

  10. Lethal multiple pterygium syndrome

    Directory of Open Access Journals (Sweden)

    Tulika Joshi

    2016-01-01

    Full Text Available The multiple pterygium syndrome is consist of wide range of fetal malformations which have a genetic linkage. A defect in embryonic acetylcholine receptor which can be inherited as autosomal recessive, autosomal dominant, or X-linked fashion is the cause of this syndrome. We present a sporadic case of lethal multiple pterygium syndrome.

  11. Multiple Stages 2

    DEFF Research Database (Denmark)

    Andreasen, John

    Multiple stages 2: theatrical futures, set design, community plays, cultural capitals, democracy & drama, WWII dramas, performance on adoption, promenade about emigration, qualities in political theatre, performance analysis, dramaturgical education, Toulmin Variations......Multiple stages 2: theatrical futures, set design, community plays, cultural capitals, democracy & drama, WWII dramas, performance on adoption, promenade about emigration, qualities in political theatre, performance analysis, dramaturgical education, Toulmin Variations...

  12. Multiple density layered insulator

    Science.gov (United States)

    Alger, Terry W.

    1994-01-01

    A multiple density layered insulator for use with a laser is disclosed wh provides at least two different insulation materials for a laser discharge tube, where the two insulation materials have different thermoconductivities. The multiple layer insulation materials provide for improved thermoconductivity capability for improved laser operation.

  13. Suicide and multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E N; Stenager, Egon; Koch-Henriksen, N

    1992-01-01

    In a nationwide investigation the risk of death by suicide for patients with multiple sclerosis (MS) was assessed using records kept at the Danish Multiple Sclerosis Registry (DMSR) and the Danish National Register of Cause of Death. The investigation covers all MS patients registered with DSMR w...

  14. Body Weight - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Body Weight URL of this page: https://medlineplus.gov/ ... V W XYZ List of All Topics All Body Weight - Multiple Languages To use the sharing features on this page, ...

  15. Suicide and multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E N; Stenager, Egon; Koch-Henriksen, Nils

    1992-01-01

    In a nationwide investigation the risk of death by suicide for patients with multiple sclerosis (MS) was assessed using records kept at the Danish Multiple Sclerosis Registry (DMSR) and the Danish National Register of Cause of Death. The investigation covers all MS patients registered with DSMR...

  16. Right-sided cardiac function in healthy volunteers measured by first-pass radionuclide ventriculography and gated blood-pool SPECT: comparison with cine MRI

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Lebech, Anne-Mette; Hesse, Birger

    2005-01-01

    and breath-hold cine MRI performed according to standard protocols. RESULTS: Normal ranges for RV ejection fraction (RVEF) defined as mean +/- 2SD were 0.49-0.72, 0.44-0.66 and 0.40-0.69 when measured by MRI, FP and GBPS respectively. Bland-Altman analysis showed a mean difference (bias) between MRI and FP...

  17. Multiples least-squares reverse time migration

    KAUST Repository

    Zhang, Dongliang

    2013-01-01

    To enhance the image quality, we propose multiples least-squares reverse time migration (MLSRTM) that transforms each hydrophone into a virtual point source with a time history equal to that of the recorded data. Since each recorded trace is treated as a virtual source, knowledge of the source wavelet is not required. Numerical tests on synthetic data for the Sigsbee2B model and field data from Gulf of Mexico show that MLSRTM can improve the image quality by removing artifacts, balancing amplitudes, and suppressing crosstalk compared to standard migration of the free-surface multiples. The potential liability of this method is that multiples require several roundtrips between the reflector and the free surface, so that high frequencies in the multiples are attenuated compared to the primary reflections. This can lead to lower resolution in the migration image compared to that computed from primaries.

  18. Grey matter damage in multiple sclerosis A pathology perspective

    NARCIS (Netherlands)

    Klaver, R.; de Vries, H.E.; Schenk, G.J.; Geurts, J.J.G.

    2013-01-01

    Over the past decade, immunohistochemical studies have provided compelling evidence that gray matter (GM) pathology in multiple sclerosis (MS) is extensive. Until recently, this GM pathology was difficult to visualize using standard magnetic resonance imaging (MRI ) techniques. However, with newly

  19. Exploring the New Standards

    Science.gov (United States)

    Willard, Ted; Pratt, Harold; Workosky, Cindy

    2012-01-01

    This is an exciting time to be in science education. New science standards are being developed by a group of science educators from across the country, working with 26 states in a process managed by Achieve, Inc., a non-profit education reform organization. The development of the "Next Generation Science Standards" (NGSS) promises to be the most…

  20. Weston Standard battery

    CERN Multimedia

    This is a Weston AOIP standard battery with its calibration certificate (1956). Inside, the glassware forms an "H". Its name comes from the British physicist Edward Weston. A standard is the materialization of a given quantity whose value is known with great accuracy.

  1. Workflow automation architecture standard

    Energy Technology Data Exchange (ETDEWEB)

    Moshofsky, R.P.; Rohen, W.T. [Boeing Computer Services Co., Richland, WA (United States)

    1994-11-14

    This document presents an architectural standard for application of workflow automation technology. The standard includes a functional architecture, process for developing an automated workflow system for a work group, functional and collateral specifications for workflow automation, and results of a proof of concept prototype.

  2. Minnesota Academic Standards: Kindergarten

    Science.gov (United States)

    Minnesota Department of Education, 2017

    2017-01-01

    This document contains all of the Minnesota kindergarten academic standards in the content areas of Arts, English Language Arts, Mathematics, Science and Social Studies. For each content area there is a short overview followed by a coding diagram of how the standards are organized and displayed. This document is adapted from the official versions…

  3. Standards and Professional Development

    Science.gov (United States)

    Zengler, Cynthia J.

    2017-01-01

    The purpose of this paper is to describe the professional development that has taken place in conjunction with Ohio adopting the College and Career Readiness (CCR) Standards. The professional development (PD) has changed over time to include not only training on the new standards and lesson plans but training on the concepts defined in the…

  4. Governing through standards

    DEFF Research Database (Denmark)

    Brøgger, Katja

    This abstract adresses the ways in which new education standards have become integral to new modes of education governance. The paper explores the role of standards for accelerating the shift from national to transnational governance in higher education. Drawing on the case of higher education...

  5. Revisiting Professional Teacher Standards

    Science.gov (United States)

    Watson, Amanda

    2016-01-01

    The Australian Society for Music Education's (ASME) involvement in the development of professional standards for music educators was a significant and active research time in the history of the Society. As ASME celebrates its golden jubilee, it is appropriate to revisit that history and consider the future prospects of subject-specific standards.…

  6. Standardizing visual display quality

    NARCIS (Netherlands)

    Besuijen, J.; Spenkelink, G.P.J.

    1998-01-01

    The current ISO 9241–3 standard for visual display quality and the proposed user performance tests are reviewed. The standard is found to be more engineering than ergonomic and problems with system configuration, software applications, display settings, user behaviour, wear and physical environment

  7. The Genomic Standards Consortium

    DEFF Research Database (Denmark)

    Field, Dawn; Amaral-Zettler, Linda; Cochrane, Guy

    2011-01-01

    Standards Consortium (GSC), an open-membership organization that drives community-based standardization activities, Here we provide a short history of the GSC, provide an overview of its range of current activities, and make a call for the scientific community to join forces to improve the quality...

  8. Evaluating Living Standard Indicators

    Directory of Open Access Journals (Sweden)

    Birčiaková Naďa

    2015-09-01

    Full Text Available This paper deals with the evaluation of selected available indicators of living standards, divided into three groups, namely economic, environmental, and social. We have selected six countries of the European Union for analysis: Bulgaria, the Czech Republic, Hungary, Luxembourg, France, and Great Britain. The aim of this paper is to evaluate indicators measuring living standards and suggest the most important factors which should be included in the final measurement. We have tried to determine what factors influence each indicator and what factors affect living standards. We have chosen regression analysis as our main method. From the study of factors, we can deduce their impact on living standards, and thus the value of indicators of living standards. Indicators with a high degree of reliability include the following factors: size and density of population, health care and spending on education. Emissions of carbon dioxide in the atmosphere also have a certain lower degree of reliability.

  9. Optimized simultaneous inversion of primary and multiple reflections; Inversion linearisee simultanee des reflexions primaires et des reflexions multiples

    Energy Technology Data Exchange (ETDEWEB)

    Pelle, L.

    2003-12-01

    The removal of multiple reflections remains a real problem in seismic imaging. Many preprocessing methods have been developed to attenuate multiples in seismic data but none of them is satisfactory in 3D. The objective of this thesis is to develop a new method to remove multiples, extensible in 3D. Contrary to the existing methods, our approach is not a preprocessing step: we directly include the multiple removal in the imaging process by means of a simultaneous inversion of primaries and multiples. We then propose to improve the standard linearized inversion so as to make it insensitive to the presence of multiples in the data. We exploit kinematics differences between primaries and multiples. We propose to pick in the data the kinematics of the multiples we want to remove. The wave field is decomposed into primaries and multiples. Primaries are modeled by the Ray+Born operator from perturbations of the logarithm of impedance, given the velocity field. Multiples are modeled by the Transport operator from an initial trace, given the picking. The inverse problem simultaneously fits primaries and multiples to the data. To solve this problem with two unknowns, we take advantage of the isometric nature of the Transport operator, which allows to drastically reduce the CPU time: this simultaneous inversion is this almost as fast as the standard linearized inversion. This gain of time opens the way to different applications to multiple removal and in particular, allows to foresee the straightforward 3D extension. (author)

  10. Standards for vision science libraries: 2014 revision.

    Science.gov (United States)

    Motte, Kristin; Caldwell, C Brooke; Lamson, Karen S; Ferimer, Suzanne; Nims, J Chris

    2014-10-01

    This Association of Vision Science Librarians revision of the "Standards for Vision Science Libraries" aspires to provide benchmarks to address the needs for the services and resources of modern vision science libraries (academic, medical or hospital, pharmaceutical, and so on), which share a core mission, are varied by type, and are located throughout the world. Through multiple meeting discussions, member surveys, and a collaborative revision process, the standards have been updated for the first time in over a decade. While the range of types of libraries supporting vision science services, education, and research is wide, all libraries, regardless of type, share core attributes, which the standards address. The current standards can and should be used to help develop new vision science libraries or to expand the growth of existing libraries, as well as to support vision science librarians in their work to better provide services and resources to their respective users.

  11. 30 CFR 75.1320 - Multiple-shot blasting.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Multiple-shot blasting. 75.1320 Section 75.1320... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1320 Multiple-shot blasting... first shot or shots fired in a round shall be initiated in the row nearest the kerf or the row or rows...

  12. Maternal Conjugal Multiplicity and Child Development in Rural Jamaica

    Science.gov (United States)

    Dreher, Melanie; Hudgins, Rebekah

    2010-01-01

    Using field-based observations and standardized measures of the home environment and child development, the authors followed 59 rural Jamaican women and their offspring from birth to age 5. The findings suggest that conjugal multiplicity, a female reproductive pattern characterized by multiple unions, maternal unmarried status, and absent father,…

  13. Very high multiplicity physics

    CERN Document Server

    Mandjavidze, I D

    2001-01-01

    The status of the programme of studying processes with high multiplicity, when inelasticity is close to unity, is considered. The definition of the processes under study is given, and the motivation of investigations and the experimentally observed predictions are discussed

  14. Connecting the Production Multiple

    DEFF Research Database (Denmark)

    Lichen, Alex Yu; Mouritsen, Jan

    This paper is about objects. It follows post ANT trajectories and finds that objects are multiple and fluid. Extant classic ANT inspired accounting research largely sees accounting inscriptions as immutable mobiles. Although multiplicity of objects upon which accounting acts has been explored......, there is much more. This paper takes a post ANT view arguing that accounting is a fluid mutable mobile and that such fluidity enacts new realities thus making the object it acts upon more multiple. This is in consistent with our finding that is contextualised in a large Swedish based manufacturing company which...... was implementing sales and operations planning (S&OP) process to foster integration on its demand chain. Although actors wanted to see what it is to produce, that is to say, the object Production, as a singular object that could be diffused across time and space, Production became more multiple because the S...

  15. The Future Multiple

    DEFF Research Database (Denmark)

    Spaniol, Matthew Jon; Rowland, Nicholas James

    2015-01-01

    ). Multiplicity, as a post-ANT sensibility, helps one make sense of the empirical materials. This paper examines the possibility that rather than being alternatives to one another, plural futures and the singular future might co-exist in practice, and, thus, constitute a multiplicity. Design...... number of futures seems to be a core function of planning for the future. The implication is that neither plural futures nor the singular future is – individually – satisfactory to capture what is found in practice. It is both plural and singular; ontologically, it is the future multiple. Originality......, if “the future” were so preposterous an idea, then “futures” would cease to be a critical alternative to it. Futures needs the future; they are relationally bound together in a multiplicity. This paper considers what such a logical reality implies for a field that distances itself from the future and self...

  16. Alzheimer's Disease - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Alzheimer's Disease URL of this page: https://medlineplus.gov/languages/alzheimersdisease.html Other topics A-Z Expand Section ...

  17. Advance Directives - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Advance Directives URL of this page: https://medlineplus.gov/languages/advancedirectives.html Other topics A-Z Expand Section ...

  18. Arrhythmia - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Arrhythmia URL of this page: https://medlineplus.gov/languages/arrhythmia.html Other topics A-Z Expand Section ...

  19. Animal Bites - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Animal Bites URL of this page: https://medlineplus.gov/languages/animalbites.html Other topics A-Z Expand Section ...

  20. Breast Diseases - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Breast Diseases URL of this page: https://medlineplus.gov/languages/breastdiseases.html Other topics A-Z Expand Section ...

  1. Angina - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Angina URL of this page: https://medlineplus.gov/languages/angina.html Other topics A-Z Expand Section ...

  2. Angioplasty - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Angioplasty URL of this page: https://medlineplus.gov/languages/angioplasty.html Other topics A-Z Expand Section ...

  3. Anal Disorders - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Anal Disorders URL of this page: https://medlineplus.gov/languages/analdisorders.html Other topics A-Z Expand Section ...

  4. Bipolar Disorder - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bipolar Disorder URL of this page: https://medlineplus.gov/languages/bipolardisorder.html Other topics A-Z Expand Section ...

  5. Bullying - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bullying URL of this page: https://medlineplus.gov/languages/bullying.html Other topics A-Z Expand Section ...

  6. Blood Sugar - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Sugar URL of this page: https://medlineplus.gov/languages/bloodsugar.html Other topics A-Z Expand Section ...

  7. Breathing Problems - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Breathing Problems URL of this page: https://medlineplus.gov/languages/breathingproblems.html Other topics A-Z Expand Section ...

  8. Bladder Diseases - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bladder Diseases URL of this page: https://medlineplus.gov/languages/bladderdiseases.html Other topics A-Z Expand Section ...

  9. Cataract - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Cataract URL of this page: https://medlineplus.gov/languages/cataract.html Other topics A-Z Expand Section ...

  10. Arthritis - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Arthritis URL of this page: https://medlineplus.gov/languages/arthritis.html Other topics A-Z Expand Section ...

  11. Brain Tumors - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Brain Tumors URL of this page: https://medlineplus.gov/languages/braintumors.html Other topics A-Z Expand Section ...

  12. Burns - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Burns URL of this page: https://medlineplus.gov/languages/burns.html Other topics A-Z Expand Section ...

  13. Anemia - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Anemia URL of this page: https://medlineplus.gov/languages/anemia.html Other topics A-Z Expand Section ...

  14. Bad Breath - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bad Breath URL of this page: https://medlineplus.gov/languages/badbreath.html Other topics A-Z Expand Section ...

  15. Allergy - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Allergy URL of this page: https://medlineplus.gov/languages/allergy.html Other topics A-Z Expand Section ...

  16. Bed Bugs - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bed Bugs URL of this page: https://medlineplus.gov/languages/bedbugs.html Other topics A-Z Expand Section ...

  17. Bone Cancer - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bone Cancer URL of this page: https://medlineplus.gov/languages/bonecancer.html Other topics A-Z Expand Section ...

  18. Blood Thinners - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Thinners URL of this page: https://medlineplus.gov/languages/bloodthinners.html Other topics A-Z Expand Section ...

  19. Anxiety - Multiple Languages

    Science.gov (United States)

    ... Anxiety URL of this page: https://medlineplus.gov/languages/anxiety.html Other topics A-Z Expand Section A ... V W XYZ List of All Topics All Anxiety - Multiple Languages To use the sharing features on this page, ...

  20. Rehabilitation and multiple sclerosis

    DEFF Research Database (Denmark)

    Dalgas, Ulrik

    2011-01-01

    In a chronic and disabling disease like multiple sclerosis, rehabilitation becomes of major importance in the preservation of physical, psychological and social functioning. Approximately 80% of patients have multiple sclerosis for more than 35 years and most will develop disability at some point...... of their lives, emphasising the importance of rehabilitation in order to maintain quality of life. An important aspect of multiple sclerosis rehabilitation is the preservation of physical functioning. Hot topics in the rehabilitation of physical function include (1) exercise therapy, (2) robot-assisted training...... and (3) pharmacological interventions. Exercise therapy has for many years been a controversial issue in multiple sclerosis rehabilitation and the advice generally given to patients was not to participate in physical exercise, since it was thought to lead to a worsening of symptoms or fatigue. However...

  1. Standard setting: Comparison of two methods

    Directory of Open Access Journals (Sweden)

    Oyebode Femi

    2006-09-01

    Full Text Available Abstract Background The outcome of assessments is determined by the standard-setting method used. There is a wide range of standard – setting methods and the two used most extensively in undergraduate medical education in the UK are the norm-reference and the criterion-reference methods. The aims of the study were to compare these two standard-setting methods for a multiple-choice question examination and to estimate the test-retest and inter-rater reliability of the modified Angoff method. Methods The norm – reference method of standard -setting (mean minus 1 SD was applied to the 'raw' scores of 78 4th-year medical students on a multiple-choice examination (MCQ. Two panels of raters also set the standard using the modified Angoff method for the same multiple-choice question paper on two occasions (6 months apart. We compared the pass/fail rates derived from the norm reference and the Angoff methods and also assessed the test-retest and inter-rater reliability of the modified Angoff method. Results The pass rate with the norm-reference method was 85% (66/78 and that by the Angoff method was 100% (78 out of 78. The percentage agreement between Angoff method and norm-reference was 78% (95% CI 69% – 87%. The modified Angoff method had an inter-rater reliability of 0.81 – 0.82 and a test-retest reliability of 0.59–0.74. Conclusion There were significant differences in the outcomes of these two standard-setting methods, as shown by the difference in the proportion of candidates that passed and failed the assessment. The modified Angoff method was found to have good inter-rater reliability and moderate test-retest reliability.

  2. Multiple indicators, multiple causes measurement error models.

    Science.gov (United States)

    Tekwe, Carmen D; Carter, Randy L; Cullings, Harry M; Carroll, Raymond J

    2014-11-10

    Multiple indicators, multiple causes (MIMIC) models are often employed by researchers studying the effects of an unobservable latent variable on a set of outcomes, when causes of the latent variable are observed. There are times, however, when the causes of the latent variable are not observed because measurements of the causal variable are contaminated by measurement error. The objectives of this paper are as follows: (i) to develop a novel model by extending the classical linear MIMIC model to allow both Berkson and classical measurement errors, defining the MIMIC measurement error (MIMIC ME) model; (ii) to develop likelihood-based estimation methods for the MIMIC ME model; and (iii) to apply the newly defined MIMIC ME model to atomic bomb survivor data to study the impact of dyslipidemia and radiation dose on the physical manifestations of dyslipidemia. As a by-product of our work, we also obtain a data-driven estimate of the variance of the classical measurement error associated with an estimate of the amount of radiation dose received by atomic bomb survivors at the time of their exposure. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Standard dilution analysis.

    Science.gov (United States)

    Jones, Willis B; Donati, George L; Calloway, Clifton P; Jones, Bradley T

    2015-02-17

    Standard dilution analysis (SDA) is a novel calibration method that may be applied to most instrumental techniques that will accept liquid samples and are capable of monitoring two wavelengths simultaneously. It combines the traditional methods of standard additions and internal standards. Therefore, it simultaneously corrects for matrix effects and for fluctuations due to changes in sample size, orientation, or instrumental parameters. SDA requires only 200 s per sample with inductively coupled plasma optical emission spectrometry (ICP OES). Neither the preparation of a series of standard solutions nor the construction of a universal calibration graph is required. The analysis is performed by combining two solutions in a single container: the first containing 50% sample and 50% standard mixture; the second containing 50% sample and 50% solvent. Data are collected in real time as the first solution is diluted by the second one. The results are used to prepare a plot of the analyte-to-internal standard signal ratio on the y-axis versus the inverse of the internal standard concentration on the x-axis. The analyte concentration in the sample is determined from the ratio of the slope and intercept of that plot. The method has been applied to the determination of FD&C dye Blue No. 1 in mouthwash by molecular absorption spectrometry and to the determination of eight metals in mouthwash, wine, cola, nitric acid, and water by ICP OES. Both the accuracy and precision for SDA are better than those observed for the external calibration, standard additions, and internal standard methods using ICP OES.

  4. Mobile multiple access study

    Science.gov (United States)

    1977-01-01

    Multiple access techniques (FDMA, CDMA, TDMA) for the mobile user and attempts to identify the current best technique are discussed. Traffic loading is considered as well as voice and data modulation and spacecraft and system design. Emphasis is placed on developing mobile terminal cost estimates for the selected design. In addition, design examples are presented for the alternative techniques of multiple access in order to compare with the selected technique.

  5. Hierarchical multiple peeling simulations

    OpenAIRE

    Bosia, F.; Colella, S; Mattoli, V.; Mazzolai, B; Pugno, N. M.

    2014-01-01

    The phenomenon of the exceptional dry adhesion achieved by some natural biological materials has been widely investigated in recent years. In particular, the analysis of the terminal elements of gecko pads and their specific structure and topology has led to the development of bioinspired synthetic fibrillar adhesives, including mushroom-shaped tips. To model the expected adhesion and detachment behaviour of multiple contacts, only recently the last author has derived a theory of multiple pee...

  6. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, M. A. H.

    2014-08-05

    Internal multiples deteriorate the image when the imaging procedure assumes only single scattering, especially if the velocity model does not have sharp contrasts to reproduce such scattering in the Green’s function through forward modeling. If properly imaged, internal multiples (internally scattered energy) can enhance the seismic image. Conventionally, to image internal multiples, accurate, sharp contrasts in the velocity model are required to construct a Green’s function with all the scattered energy. As an alternative, we have developed a generalized internal multiple imaging procedure that images any order internal scattering using the background Green’s function (from the surface to each image point), constructed from a smooth velocity model, usually used for conventional imaging. For the first-order internal multiples, the approach consisted of three steps, in which we first back propagated the recorded surface seismic data using the background Green’s function, then crosscorrelated the back-propagated data with the recorded data, and finally crosscorrelated the result with the original background Green’s function. This procedure images the contribution of the recorded first-order internal multiples, and it is almost free of the single-scattering recorded energy. The cost includes one additional crosscorrelation over the conventional single-scattering imaging application. We generalized this method to image internal multiples of any order separately. The resulting images can be added to the conventional single-scattering image, obtained, e.g., from Kirchhoff or reverse-time migration, to enhance the image. Application to synthetic data with reflectors illuminated by multiple scattering (double scattering) demonstrated the effectiveness of the approach.

  7. Multiple congenital cranial hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Koulouris, George [Alfred Hospital, Department of Radiology, Prahran, Victoria (Australia); Rao, Padma [Royal Children' s Hospital, Department of Radiology, Parkville, Victoria (Australia)

    2005-08-01

    Though cranial hemangiomas are second only to vertebral hemangiomas in frequency, such lesions are rarely congenital and multiple. It is probable that the true incidence of congenital calvarial hemangiomas is higher than that reported in the literature, as they are unlikely to undergo imaging, most being asymptomatic and without a significant soft tissue component. We present a case of multiple congenital calvarial and skull base cavernous-type hemangiomas, diagnosed in a 4-day-old female, involving the right zygoma, maxilla, frontal and petrous temporal bones and contralateral squamous temporal bone. Surgical biopsy confirmed the radiological diagnosis as well as the concomitant multiple subcutaneous capillary-type hemangiomas which were identified clinically. No specific clinical syndrome or chromosomal abnormality was identified and the underlying cerebral parenchyma was normal with no intra-axial involvement. With conservative treatment, two lesions completely resolved and a further two lesions subsequently decreased in both size and degree of enhancement. To the best of our knowledge, this is the first case of multiple congenital hemangiomas involving the calvarium and skull base. Despite this, the radiological features, combined with the clinical findings of multiple capillary hemangiomas, were characteristic enough to permit an accurate preoperative diagnosis. Osseous hemangiomas should feature prominently in any differential diagnosis of multiple hypervascular lesions, as they are common, more so when limited to an anatomical region, irrespective of site or age. (orig.)

  8. Breast-feeding multiples.

    Science.gov (United States)

    Flidel-Rimon, O; Shinwell, E S

    2002-06-01

    Human breast milk is the best nutrition for human infants. Its advantages over the milk of other species, such as cows, include both a reduced risk for infections, allergies and chronic diseases, together with the full nutritional requirements for growth and development. Breast-feeding is as important for multiples as for singletons. Despite the advantages, multiples receive less breast-feeding than singletons. Common reasons for not breast-feeding multiples include the fear of not fulfilling the infants' needs and the difficulty of coping with the demands on the mother's time. In addition, many multiples are delivered prematurely and by Caesarean section. Maternal pain and discomfort together with anxiety over the infants' condition are not conducive to successful breast-feeding. During lactation, the mother needs to add calories to her daily diet. It has been recommended to add approximately 500-600 kcal/day for each infant. Thus, between eating, nursing and sleeping, life is very busy for the mother of multiples. However, there is evidence that, with appropriate nutrition, one mother can nourish more than one infant. Also, simultaneous breast-feeding can save much time. Combined efforts of parents, close family, friends and the medical team can help to make either full or partial breast-feeding of multiples possible. However, when breast-feeding is not possible, health care workers need to carefully avoid judgmental approaches that may induce feelings of guilt.

  9. Science Standards, Science Achievement, and Attitudes about Evolution

    Science.gov (United States)

    Belin, Charlie M.; Kisida, Brian

    2015-01-01

    This article explores the relationships between (a) the quality of state science standards and student science achievement, (b) the public's belief in teaching evolution and the quality of state standards, and (c) the public's belief in teaching evolution and student science achievement. Using multiple measures, we find no evidence of a…

  10. FDA Recognized Consensus Standards

    Data.gov (United States)

    U.S. Department of Health & Human Services — This database consists of those national and international standards recognized by FDA which manufacturers can declare conformity to and is part of the information...

  11. Crew Transportation Operations Standards

    Science.gov (United States)

    Mango, Edward J.; Pearson, Don J. (Compiler)

    2013-01-01

    The Crew Transportation Operations Standards contains descriptions of ground and flight operations processes and specifications and the criteria which will be used to evaluate the acceptability of Commercial Providers' proposed processes and specifications.

  12. Standardization of hormone determinations.

    Science.gov (United States)

    Stenman, Ulf-Håkan

    2013-12-01

    Standardization of hormone determinations is important because it simplifies interpretation of results and facilitates the use of common reference values for different assays. Progress in standardization has been achieved through the introduction of more homogeneous hormone standards for peptide and protein hormones. However, many automated methods for determinations of steroid hormones do not provide satisfactory result. Isotope dilution-mass spectrometry (ID-MS) has been used to establish reference methods for steroid hormone determinations and is now increasingly used for routine determinations of steroids and other low molecular weight compounds. Reference methods for protein hormones based on MS are being developed and these promise to improve standardization. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Spectral transmittance reference standards

    Energy Technology Data Exchange (ETDEWEB)

    Kruglyakova, M.A.; Belyaeva, O.N.; Nikitin, M.V.

    1995-06-01

    This paper presents spectral transmittance reference standards for UV and IR spectrophotometers, developed, studied, and certified by a precision spectrophotometry laboratory (the RSP Complex). 8 refs., 3 figs., 3 tabs.

  14. FREIGHT CONTAINER LIFTING STANDARD

    Energy Technology Data Exchange (ETDEWEB)

    POWERS DJ; SCOTT MA; MACKEY TC

    2010-01-13

    This standard details the correct methods of lifting and handling Series 1 freight containers following ISO-3874 and ISO-1496. The changes within RPP-40736 will allow better reading comprehension, as well as correcting editorial errors.

  15. Ozone Standard Reference Photometer

    Data.gov (United States)

    Federal Laboratory Consortium — The Standard Reference Photometer (SRP) Program began in the early 1980s as collaboration between NIST and the U.S. Environmental Protection Agency (EPA) to design,...

  16. Fiber optics standard dictionary

    CERN Document Server

    Weik, Martin H

    1997-01-01

    Fiber Optics Vocabulary Development In 1979, the National Communications System published Technical InfonnationBulle­ tin TB 79-1, Vocabulary for Fiber Optics and Lightwave Communications, written by this author. Based on a draft prepared by this author, the National Communications System published Federal Standard FED-STD-1037, Glossary of Telecommunications Terms, in 1980 with no fiber optics tenns. In 1981, the first edition of this dictionary was published under the title Fiber Optics and Lightwave Communications Standard Dictionary. In 1982, the then National Bureau of Standards, now the National Institute of Standards and Technology, published NBS Handbook 140, Optical Waveguide Communications Glossary, which was also published by the General Services Admin­ istration as PB82-166257 under the same title. Also in 1982, Dynamic Systems, Inc. , Fiberoptic Sensor Technology Handbook, co-authored and edited by published the this author, with an extensive Fiberoptic Sensors Glossary. In 1989, the handbook w...

  17. State Air Quality Standards.

    Science.gov (United States)

    Pollution Engineering, 1978

    1978-01-01

    This article presents in tabular form the air quality standards for sulfur dioxide, carbon monoxide, nitrogen dioxide, photochemicals, non-methane hydrocarbons and particulates for each of the 50 states and the District of Columbia. (CS)

  18. Standards for new approaches

    NARCIS (Netherlands)

    Lemmen, C.H.J.; Van Oosterom, P.J.M.; Van der Molen, P.

    2013-01-01

    Th e new Land Administration Domain Model (LADM) has evolved as an ISO-recognised standard to provide a formal language for describing traditional land administration methods, spot the similarities and diff erences, and provide a way forward.

  19. AKRO: Standard Prices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Standard prices are generated for cost recovery programs in the Individual Fishing Quota (IFQ) halibut and sablefish, BSAI Rationalized crab, and Central Gulf of...

  20. [Standardization of hospital feeding].

    Science.gov (United States)

    Caracuel García, Ángel Manuel

    2015-05-07

    Normalization can be understood as the establishing measures against repetitive situations through the development, dissemination, and application of technical design documents called standards. In Andalusia there are 45 public hospitals with 14,606 beds, and in which 11,700 full pensions / day are served. The Working Group on Hospital Food Standardization of the Andalusian Society for Clinical Nutrition and Dietetics, started in 2010, working on the certification of suppliers, product specifications, and meals technical card. - Develop a specific tool to help improving food safety through the certification of their suppliers. - Develop a standardized technical specifications of foodstuffs necessary for the development of menus established codes diets Andalusian hospitals document. - Develop a catalog of data sheets plates of hospital meals, to homogenize menus, respecting local and unifying criteria for qualitative and quantitative ingredients. - Providing documentation and studying of several public hospitals in Andalusia: • Product specifications and certification of suppliers. • International standards certification and distribution companies. • Legislation. • Data sheets for the menu items. • Specifications of different product procurement procedures. - Development of the draft standard HOSPIFOOD®, and approval of the version “0.0”. - Training course for auditors to this standard. - Development of a raw materials catalog as technical cards. - Meals Technical cards review and election of the ones which will be part of the document. After nearly three years of work, we have achieved the following products: - Standardized database of technical specifications for the production of food dietary codes for: fish, seafood, meat and meat products, meats and pates, ready meals, bread and pastries, preserves, milk and dairy products, oils, cereals, legumes , vegetables, fruits, fresh and frozen vegetables, condiments and spices. - Standardized database of

  1. The Gold Standard Programme

    DEFF Research Database (Denmark)

    Neumann, Tim; Rasmussen, Mette; Ghith, Nermin

    2013-01-01

    To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates.......To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates....

  2. Evaluating Living Standard Indicators

    OpenAIRE

    Birčiaková Naďa; Stávková Jana; Antošová Veronika

    2015-01-01

    This paper deals with the evaluation of selected available indicators of living standards, divided into three groups, namely economic, environmental, and social. We have selected six countries of the European Union for analysis: Bulgaria, the Czech Republic, Hungary, Luxembourg, France, and Great Britain. The aim of this paper is to evaluate indicators measuring living standards and suggest the most important factors which should be included in the final measurement. We have tried to determin...

  3. Sequence Factorization with Multiple References.

    Directory of Open Access Journals (Sweden)

    Sebastian Wandelt

    Full Text Available The success of high-throughput sequencing has lead to an increasing number of projects which sequence large populations of a species. Storage and analysis of sequence data is a key challenge in these projects, because of the sheer size of the datasets. Compression is one simple technology to deal with this challenge. Referential factorization and compression schemes, which store only the differences between input sequence and a reference sequence, gained lots of interest in this field. Highly-similar sequences, e.g., Human genomes, can be compressed with a compression ratio of 1,000:1 and more, up to two orders of magnitude better than with standard compression techniques. Recently, it was shown that the compression against multiple references from the same species can boost the compression ratio up to 4,000:1. However, a detailed analysis of using multiple references is lacking, e.g., for main memory consumption and optimality. In this paper, we describe one key technique for the referential compression against multiple references: The factorization of sequences. Based on the notion of an optimal factorization, we propose optimization heuristics and identify parameter settings which greatly influence 1 the size of the factorization, 2 the time for factorization, and 3 the required amount of main memory. We evaluate a total of 30 setups with a varying number of references on data from three different species. Our results show a wide range of factorization sizes (optimal to an overhead of up to 300%, factorization speed (0.01 MB/s to more than 600 MB/s, and main memory usage (few dozen MB to dozens of GB. Based on our evaluation, we identify the best configurations for common use cases. Our evaluation shows that multi-reference factorization is much better than single-reference factorization.

  4. Teriflunomide for multiple sclerosis.

    Science.gov (United States)

    He, Dian; Zhang, Chao; Zhao, Xia; Zhang, Yifan; Dai, Qingqing; Li, Yuan; Chu, Lan

    2016-03-22

    This is an update of the Cochrane review "Teriflunomide for multiple sclerosis" (first published in The Cochrane Library 2012, Issue 12).Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system. It is clinically characterized by recurrent relapses or progression, or both, often leading to severe neurological disability and a serious decline in quality of life. Disease-modifying therapies (DMTs) for MS aim to prevent occurrence of relapses and disability progression. Teriflunomide is a pyrimidine synthesis inhibitor approved by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) as a DMT for adults with relapsing-remitting MS (RRMS). To assess the absolute and comparative effectiveness and safety of teriflunomide as monotherapy or combination therapy versus placebo or other disease-modifying drugs (DMDs) (interferon beta (IFNβ), glatiramer acetate, natalizumab, mitoxantrone, fingolimod, dimethyl fumarate, alemtuzumab) for modifying the disease course in people with MS. We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group Specialised Trials Register (30 September 2015). We checked reference lists of published reviews and retrieved articles and searched reports (2004 to September 2015) from the MS societies in Europe and America. We also communicated with investigators participating in trials of teriflunomide and the pharmaceutical company, Sanofi-Aventis. We included randomized, controlled, parallel-group clinical trials with a length of follow-up of one year or greater evaluating teriflunomide, as monotherapy or combination therapy, versus placebo or other approved DMDs for people with MS without restrictions regarding dose, administration frequency and duration of treatment. We used the standard methodological procedures of Cochrane. Two review authors independently assessed trial quality and extracted data. Disagreements were discussed and resolved by consensus among

  5. DOE technical standards list. Department of Energy standards index

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-08-01

    This document was prepared for use by personnel involved in the selection and use of DOE technical standards and other Government and non-Government standards. This TSL provides listing of current DOE technical standards, non-Government standards that have been adopted by DOE, other Government documents in which DOE has a recorded interest, and canceled DOE technical standards. Information on new DOE technical standards projects, technical standards released for coordination, recently published DOE technical standards, and activities of non-Government standards bodies that may be of interest to DOE is published monthly in Standards Actions.

  6. Multiple Adenomatous Duodenal Polyposis

    Directory of Open Access Journals (Sweden)

    Zdena Zádorová

    2013-01-01

    Full Text Available Multiple duodenal polyps are a relatively rare finding, usually co-occurrent with familial adenomatous polyposis (FAP.We report a patient with multiple duodenal adenomas and a negative examination for FAP: multiple flat polyps were detected endoscopically in a 37-year-old male patient, extending from the apex of the bulb to the end of the descending part of the duodenum. In terms of histology, they were tubular adenomas with moderate dysplasia. Colonoscopy and enteroclysis were normal. Both push and capsule enteroscopy only showed multiple polyps in the area of the descending duodenum. DNA analysis of the APC gene was as follows: DGGE, exon 1–15, deletion at codons 1309 and 1061 by means of PCR for attenuated APC were negative. Afterwards we screened the patient for germline MYH mutations using the denaturing high-performance liquid chromatography (DHPLC in combination with sequencing. No novel pathogenic mutation has been identified. Large polyps were removed by means of endoscopic polypectomy and mucosectomy, while small polyps were removed by means of argon plasma coagulation.We conduct yearly checkups, removing only sporadic polyps. The rare finding of duodenal polyposis not co-occurrent with FAP proves that multiple adenomas in the digestive tube need not necessarily co-occur with FAP.

  7. DOE technical standards list: Department of Energy standards index

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-05-01

    This Department of Energy (DOE) technical standards list (TSL) has been prepared by the Office of Nuclear Safety Policy and Standards (EH-31) on the basis of currently available technical information. Periodic updates of this TSL will be issued as additional information is received on standardization documents being issued, adopted, or canceled by DOE. This document was prepared for use by personnel involved in the selection and use of DOE technical standards and other Government and non-Government standards. This TSL provides listings of current DOE technical standards, non-Government standards that have been adopted by DOE, other standards-related documents in which DOE has a recorded interest, and canceled DOE technical standards. Information on new DOE technical standards projects, technical standards released for coordination, recently published DOE technical standards, and activities of non-Government standards bodies that may be of interest to DOE is published monthly in Standards Actions.

  8. Vaccines and multiple sclerosis

    DEFF Research Database (Denmark)

    Mailand, Mia Topsøe; Frederiksen, Jette Lautrup

    2017-01-01

    Vaccinations are often the most effective tool against some disease known to mankind. This study offers a literature review on the role of vaccines regarding the risk of developing multiple sclerosis (MS) and MS relapse. The method used in this study is a systematic literature review on the datab......Vaccinations are often the most effective tool against some disease known to mankind. This study offers a literature review on the role of vaccines regarding the risk of developing multiple sclerosis (MS) and MS relapse. The method used in this study is a systematic literature review...... on the database PubMed. The study found no change in risk of developing multiple sclerosis (MS) after vaccination against hepatitis B virus, human papillomavirus, seasonal influenza, measles-mumps-rubella, variola, tetanus, Bacillus Calmette-Guérin (BCG), polio, or diphtheria. No change in risk of relapse...

  9. Sports eyewear protective standards.

    Science.gov (United States)

    Dain, Stephen J

    2016-01-01

    Eye injuries sustained during sport comprise up to 20 per cent of all injuries to the eye serious enough for medical attention to be sought. The prevalence of eye injuries in sport is not easily assessed due to lack of authoritative participation rates, so most studies report total numbers in a time period. The evidence on the proportion of all ocular injuries that are from sport is reviewed. The relative frequencies in different sports are compared in a qualitative manner and the sports with greater numbers of ocular injuries are detailed. In common with occupational injuries to the eye, most sports eye injuries are considered preventable. The hierarchy of action for occupational risk is detailed and adapted to use in a sports scenario. All the available international, regional and national standards on sports eye protection are detailed and their provisions compared. The major function of the standards is to provide adequate protection against the hazard of the sport concerned. These are detailed and compared as a function of energy transfer. Eye protection must not introduce additional or secondary hazards (for instance, fracturing into sharp fragments on impact) and not introduce features that would deter the wearing of eye protection (for instance, restricting field of view to impede playing the sport). The provisions of the standards intended to limit secondary hazards are detailed and compared. The need for future work in standards writing and the activities of the International Standardization Organization in sports eye protection are detailed. © 2016 Optometry Australia.

  10. Numerical Simulation of Confined Multiple Transverse Jets

    Science.gov (United States)

    2012-06-01

    issuing into a fully-developed pipe flow with both fluids being air nominally at standard temperature and pressure. The purpose of this phase of...single or multiple jets, impinging on a wall or on other jets, swirling , homogeneous or heterogeneous cross flow , compressible or incompressible, etc...work performed by A. Strzelecki, et al. [2-3]. In these experiments, the mixing of eight isothermal jets issuing into a circular pipe flow is

  11. Dissimilarity-based multiple instance learning

    DEFF Research Database (Denmark)

    Sørensen, Lauge; Loog, Marco; Tax, David M. J.

    2010-01-01

    In this paper, we propose to solve multiple instance learning problems using a dissimilarity representation of the objects. Once the dissimilarity space has been constructed, the problem is turned into a standard supervised learning problem that can be solved with a general purpose supervised cla...... between distributions of within- and between set point distances, thereby taking relations within and between sets into account. Experiments on five publicly available data sets show competitive performance in terms of classification accuracy compared to previously published results....

  12. Multiple origins of life

    Science.gov (United States)

    Raup, D. M.; Valentine, J. W.

    1983-01-01

    There is some indication that life may have originated readily under primitive earth conditions. If there were multiple origins of life, the result could have been a polyphyletic biota today. Using simple stochastic models for diversification and extinction, we conclude: (1) the probability of survival of life is low unless there are multiple origins, and (2) given survival of life and given as many as 10 independent origins of life, the odds are that all but one would have gone extinct, yielding the monophyletic biota we have now. The fact of the survival of our particular form of life does not imply that it was unique or superior.

  13. Multiple Instance Fuzzy Inference

    Science.gov (United States)

    2015-12-02

    form is responsible for the molecule behaviour (label). Hence, 1Figure based on [36]. 10 the problem is better represented as a multiple instance... behaviour . However, this process is tedious. Hence, the problem is better represented as a multiple instance problem. Two versions of the dataset were...Buses 7.59 5 Dinosaurs 2.00 6 Elephants 3.02 7 Flowers 4.46 8 Horses 3.89 9 Mountains and glaciers 3.38 10 Food 7.24 11 Dogs 3.80 12 Lizards 2.80 13

  14. Pediatric Multiple sclerosis

    OpenAIRE

    Gkampeta, Anastasia; Pavlidou, Efterpi; Saravakos, Panagiotis; Pavlou, Evangelos

    2013-01-01

    Multiple sclerosis (MS) is considered as the major cause of acquired neurological insult in young adults and the most common demyelinating disease of the central nervous system (CNS). It is an inflammatory disease characterized by multiple areas of demyelination, rupture of the blood-brain barrier and diffused disorder of the white matter. MS is relatively rare in childhood. However, 3-10% of children develop the first episode of MS before the 16th year of age. Diagnosis of MS in childhood re...

  15. Multiple Sclerosis: Hope through Research

    Science.gov (United States)

    ... Disorders » Patient & Caregiver Education » Hope Through Research Multiple Sclerosis: Hope Through Research Download publication Introduction What is ... prevent MS from developing. top What is Multiple Sclerosis? Multiple sclerosis (MS) is a neuroinflammatory disease that ...

  16. Smoldering Multiple Myeloma: Emerging Concepts and Therapeutics.

    Science.gov (United States)

    Sundararajan, Srinath; Kumar, Abhijeet; Korde, Neha; Agarwal, Amit

    2016-04-01

    Smoldering multiple myeloma (SMM) is a pre-malignant condition with an inherent risk for progression to multiple myeloma (MM). The 2014 IMWG guidelines define smoldering multiple myeloma as a monoclonal gammopathy disorder with serum monoclonal protein (IgG or IgA) ≥30 g/L or urinary monoclonal protein ≥500 mg per 24 h and/or clonal bone marrow plasma cells 10-60 % without any myeloma-defining events or amyloidosis. The risk for progression of SMM to MM vary based on clinical, laboratory, imaging, and molecular characteristics. Observation, with periodic monitoring is the current standard of care for SMM. Over last few years, research advances in SMM have led to the delineation of newer risk factors for progression and identification of a "high-risk" group that would potentially benefit from early treatment. This review focuses on advances in the SMM risk-stratification model and recent clinical trials in this patient population.

  17. Islam, Standards, and Technoscience

    DEFF Research Database (Denmark)

    Fischer, Johan

    Halal (literally, "permissible" or "lawful") production, trade, and standards have become essential to state-regulated Islam and to companies in contemporary Malaysia and Singapore, giving these two countries a special position in the rapidly expanding global market for halal products......, this book provides an exploration of the role of halal production, trade, and standards. Fischer explains how the global markets for halal comprise divergent zones in which Islam, markets, regulatory institutions, and technoscience interact and diverge. Focusing on the "bigger institutional picture......" that frames everyday halal consumption, Fischer provides a multisited ethnography of the overlapping technologies and techniques of production, trade, and standards that together warrant a product as "halal," and thereby help to format the market. Exploring global halal in networks, training, laboratories...

  18. Standardization of depression measurement

    DEFF Research Database (Denmark)

    Wahl, Inka; Löwe, Bernd; Bjørner, Jakob

    2014-01-01

    OBJECTIVES: To provide a standardized metric for the assessment of depression severity to enable comparability among results of established depression measures. STUDY DESIGN AND SETTING: A common metric for 11 depression questionnaires was developed applying item response theory (IRT) methods. Data...... of 33,844 adults were used for secondary analysis including routine assessments of 23,817 in- and outpatients with mental and/or medical conditions (46% with depressive disorders) and a general population sample of 10,027 randomly selected participants from three representative German household surveys....... RESULTS: A standardized metric for depression severity was defined by 143 items, and scores were normed to a general population mean of 50 (standard deviation = 10) for easy interpretability. It covers the entire range of depression severity assessed by established instruments. The metric allows...

  19. Standards and quality

    CERN Document Server

    El-Tawil, Anwar

    2015-01-01

    The book brings together a number of subjects of prime importance for any practicing engineer and, students of engineering. The book explains the concepts and functions of voluntary standards, mandatory technical regulations, conformity assessment (testing and measurement of products), certification, quality and quality management systems as well as other management systems such as environmental, social responsibility and food safety management systems.The book also gives a comprehensive description of the role of metrology systems that underpin conformity assessment. A description is given of typical national systems of standards, quality and metrology and how they relate directly or through regional structures to international systems. The book also covers the relation between standards and trade and explains the context and stipulations of the Technical Barriers to Trade Agreement of the World Trade Organization (WTO).

  20. Ethics, standards, and TQM.

    Science.gov (United States)

    Botticelli, M G

    1995-04-01

    The most important ethical issue for our profession is the responsibility to assure the care delivered by our colleagues and ourselves meets a self-imposed standard of excellence. There is anecdotal and experimental evidence that we have not fulfilled this obligation. Peer review has proven, for a number of reasons, to be ineffective; however, improvements in the epidemiologic sciences should provide better standards and total quality management (TQM) might prove to be of value in monitoring, comparing and improving the decisions made by physicians. Its promise lies in its emphasis on statistical analysis, its focus on systematic rather than human error, and its use of outcomes as standards. These methods, however, should not diminish our other professional responsibilities: Altruism, peer review, and in Hippocrates' words "to prescribe regimens for the good of our patients-and never do harm to anyone."