INTRODUÇÃO: Existem poucos estudos na literatura sobre o efeito de drogas no posicionamento vertical das pálpebras. Esse assunto é importante na análise da dinâmica palpebral, principalmente em afecções como a blefaroptose. O objetivo deste estudo é determinar a ação de uma gota do colírio de fenilefrina a 10% sobre as pálpebras superior e inferior de indivíduos normais e portadores de blefaroptose adquirida involucional e verificar a ocorrência de alterações no posicionamento das pálpebras superior e inferior do olho contralateral. MÉTODOS: Realizou-se um estudo clínico, prospectivo e aberto com indivíduos normais e pacientes com blefaroptose adquirida involucional, que foram submetidos à instilação de uma gota do colírio de fenilefrina a 10% em um dos olhos. Todos os indivíduos foram filmados antes e após a instilação da medicação (3, 10, 15, 30, 45 e 60 minutos). As imagens foram submetidas ao processamento digital e editadas para análise das medidas palpebrais. Foi traçada uma linha horizontal a partir do canto medial em direção ao canto externo. Considerouse como altura da pálpebra superior a distância entre o ponto mais alto da margem palpebral superior e a linha horizontal traçada. A altura palpebral inferior foi avaliada como a distância entre o ponto mais baixo da margem palpebral inferior e a referida linha. RESULTADOS: Foram incluídos na pesquisa 70 indivíduos normais e 40 portadores de blefaroptose adquirida involucional. Em relação à blefaroptose, a maioria apresentava quadro bilateral (92,5%) e grau mínimo (45%). Em relação à resposta ao colírio de fenilefrina a 10%, a medida antes da instilação da medicação diferiu significativamente dos demais momentos (p< 0,001), com elevação média da pálpebra superior de 0,92 mm e retração de 0,40 mm na altura palpebral inferior em todos os grupos estudados. Em relação ao olho contralateral, observou-se queda da pálpebra superior em praticamente todos os momentos estudados, com o menor nível aos 3 minutos (queda média de 0,66 mm). A pálpebra inferior contralateral mostrou uma elevação média de 0,35 mm. CONCLUSÕES: A instilação de uma gota do colírio de fenilefrina a 10% em olhos de indivíduos normais e pacientes portadores de blefaroptose adquirida involucional altera a posição das pálpebras superior e inferior do olho testado, como também das pálpebras do olho contralateral / INTRODUCTION: There are few studies in the literature on the effect of drugs on the vertical positioning of the eyelids. This issue is important in the analysis of the eyelid dynamics mainly in disorders such as blepharoptosis. The aim of this study is to determine the action of a single drop of 10% phenylephrine on the upper and lower eyelids of healthy subjects and patients with acquired involutional blepharoptosis and observe the occurrence of changes in the positioning of the upper and lower eyelids of the contralateral eye. METHOD: A prospective clinical trial was done with healthy subjects and patients with acquired involutional blepharoptosis. The patients were submitted to the instillation of a single drop of 10% phenylephrine in one eye. All subjects were filmed before and after instillation of medication (3, 10, 15, 30, 45 and 60 minutes). The images were submitted to digital processing and edited to analyze lid measurements. A horizontal line was drawn from the medial canthus toward the outer. The upper eyelid height was measured as the distance between the highest point of the upper eyelid margin and the horizontal line drawn. The lower eyelid height was the distance between the lowest point of the margin lower eyelid and the drawn line. RESULTS: Seventy healthy subjects and 40 patients with acquired involutional blepharoptosis were included. Most patients had bilateral (92,5%) and mild blepharoptosis (45%). After 10% phenylephrine instillation, upper lid height showed a mean elevation of 0,92 mm, which was significantly different at all time measurements (p< 0,001). The lower eyelid height changed with a mean retraction of 0,40 mm. In the contralateral eye was observed a fall of upper eyelid in all most all times studied, with the lowest level observed at 3 minutes (with average fall of 0,66 mm). The contralateral lower eyelid showed an average elevation of 0,35 mm. CONCLUSION: Instillation of a single drop of 10% phenylephrine altered the position of upper and lower eyelids on the tested eye, as well as of the contralateral eye on both groups, healthy subjects and patients with acquired involutional blepharoptosis

Orientador: Manoel Barros Bértolo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:39:29Z (GMT). No. of bitstreams: 1 Mendonca_JoseAlexandre_D.pdf: 2535796 bytes, checksum: 374639057a45bad9800020693b3bc4de (MD5) Previous issue date: 2011 / Resumo: Objetivo: Avaliar sinovite pelo ultrassom (US) articular em pacientes com artrite reumatóide (AR) inicial e correlacionar com os dados clínicos, radiográficos e laboratoriais. Pacientes e Métodos: Este estudo avaliou 832 articulações de 32 pacientes (24 mulheres e 8 homens) com AR inicial selecionados no período de 2008 a 2010 do ambulatório de artrite da Universidade Estadual de Campinas, caracterizado por 20 (62.5%) caucasóides e 12 (37.5%) não caucasóides; um tempo médio de doença de 13 meses, com média de idade de 42 anos. Nesta amostra foram detectadas, pelas escalas semiquantitativas cinza (SG) e pelo power Doppler (PD), 173 articulações com sinovite de grau 0 a 3. Foi usado um ultrassom GE LOGIQ XP-linear de alta frequência (8-10 MHz). Todas as mãos foram radiografadas e analisadas pelo score de Larsen com variação de grau entre 0 a V. Resultados: Este estudo evidenciou correlações significativas e positivas entre os dados ultrassonográficos, clínicos e laboratoriais: SGUS e PDUS do punho D e PCR (r=0.41 a 0.42), SGUS do 3ªMTF D, 4ªMTF D com o HAQ - DI (r=0.37 a 0.38), SGUS do 4ªMTF E e o PCR (r=0.42), SGUS do 2ªMTF D e o FR (r=0.40), SGUS-Score 7mod com o DAS28 (PCR) (r=0.38) e o PDUS-Score 7mod com o PCR (r=0.39). Houve correlações significativas negativas com o SGUS 2ªMTCF D com a dose e o tempo de uso MTX (r=-0.36 a -0.37). O PCR nesta amostra pode ser considerado um indicador de atividade inflamatória quando existe sinovite detectada pelo US. Conclusão: A utilização do US mostrou ser uma importante ferramenta na avaliação de AR inicial e dá um suporte mais seguro no diagnóstico para iniciativas terapêuticas mais precisas e seletivas / Abstract: This study evaluated 832 joints of 32 patients (24 women and 8 men) with early RA enrolled for the period 2008 to 2010 of the arthritis clinic of the Universidade Estadual de Campinas (UNICAMP), characterized by 20 (62.5%) Caucasians, 12 (37.5%) non-Caucasians, an average disease was 13 months, with a mean age of 42 years. This sample was detected by semi-quantitative gray scale (GS) and power Doppler (PD) 173 joints with synovitis of degree 0 to 3. It was used a GE LOGIQ XP-linear ultrasound and high frequency (8-10 MHz) transducer. All hands were X-rayed and analyzed by the Larsen score, with grades ranging from 0 to V. This study showed positive and significant correlation between sonographic, clinical and laboratory data: GSUS/PDUS of right wrist and CRP (r = 0.41 to 0.42), GSUS of the right 3ºMTP, GSUS of the right 4ºMTP and HAQ - DI (r = 0.37 to 0.38), GSUS of the left 4ºMTP and CRP (r = 0.42), GSUS of the right 2ºMTP and FR (r = 0.40), GSUS 7mod-score with the DAS28 (CRP) (r = 0.38) and PDUS 7mod-Score to CRP (r = 0.39). There was a significant negative correlation with the right 2ºMCP with dose and duration of MTX use (r = -0.36 to -0.37). The CRP in this sample can be considered an indicator of inflammatory activity, when analyzed separately or with all the joints committed. Using the US was an important tool in the evaluation of RA and gives a more secure support for initiatives in the diagnosis and treatment more precise and selective / Doutorado / Clinica Medica / Doutor em Clínica Médica

Orientador: Solange Maria de Almeida / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T04:06:05Z (GMT). No. of bitstreams: 1 Matheus_RicardoAlves_M.pdf: 4181056 bytes, checksum: d24ad555925663db70e0245bc2ee4e9a (MD5) Previous issue date: 2005 / Resumo: O presente trabalho teve como finalidade avaliar a relação entre deslocamento de disco articular e os parâmetros utilizados para avaliar o posicionamento do crânio em relação à coluna cervical: ângulo crânio-cervical, espaço suboccipital entre C0-C1, curvatura cervical e posição do osso hióide em indivíduos sintomáticos e assintomáticos para disfunção temporomandibular. Para tanto foram realizados exames por ressonância magnéticas a fim de determinar a posição do disco articular nas articulações temporomandibulares (ATMs) de 30 voluntários assintomáticos para disfunção temporomandibular e 30 pacientes sintomáticos. Para a avaliação da posição do crânio em relação à coluna cervical foi utilizada a telerradiografia lateral, obtida com o indivíduo em posição natural da cabeça. Os dados obtidos foram submetidos à análise estatística pelo teste Exato de Fisher ao nível de 5% (p< 0,05). Avaliando-se os resultados observou-se que houve associação significativa entre espaço suboccipital e a curvatura da coluna comparadas com a posição do disco articular nos grupos sintomáticos e assintomáticos, enquanto não foi observada diferença entre posição do disco e ângulo crânio-cervical em sintomáticos e entre posição do disco e posição do osso hióide. Baseado nestes resultados pode-se concluir que não foi observado uma relação direta entre disfunção temporomandibular e disfunção crânio-cervical / Abstract: This study evaluated the relationship between disc displacement and parameters used for evaluation of skull positioning in relation to the cervical spine: craniocervical angle, suboccipital space between C0-C1, cervical curvature and position of the hyoid bone in individuals with and without symptoms of temporomandibular dysfunction. Evaluation was performed by magnetic resonance imaging for establishment of disc positioning in the temporomandibular joints (TMJs) of 30 volunteers patients without temporomandibular dysfunction symptoms and 30 patients with symptoms. Evaluation of skull positioning in relation to the cervical spine was performed on lateral cephalograms achieved with the individual in natural head position. The data achieved were submitted to statistical analysis by the Fisher¿s exact test at the 5% level (p<0.05). The results revealed a statistical difference in the variables suboccipital space and cervical spine curvature when compared to disc positioning in both groups with and without symptoms, whereas no differences were observed between disc positioning and craniocervical angle in symptomatic patients and between disc positioning and position of the hyoid bone. Based on the present results, it is concluded that no direct relationship could be observed between temporomandibular dysfunction and craniocervical dysfunction / Mestrado / Radiologia Odontologica / Doutor em Radiologia Odontológica

Orientador: Francisco Haiter Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T03:09:52Z (GMT). No. of bitstreams: 1 Melo_SauloLeonardoSousa_D.pdf: 2218152 bytes, checksum: 8cf34e11fc626dc8ea70836a2401feb5 (MD5) Previous issue date: 2013 / Resumo: As fraturas radiculares apresentam diagnóstico clínico limitado visto que os sinais e sintomas apresentados pelo paciente são inespecíficos. Como a maioria das fraturas leva à extração do dente, torna-se necessário um diagnóstico mais preciso. A tomografia computadorizada de feixe cônico (TCFC) é considerada um método de diagnóstico avançado na aquisição de imagens livres de sobreposições das estruturas orofaciais. Geralmente as imagens por TCFC são segmentadas e reconstruídas em DICOM, visto que existe uma grande disponibilidade de softwares que utilizam este formato. Por se tratar de uma tecnologia relativamente recente, e que rapidamente vem se difundindo no meio odontológico, o presente estudo avaliou a influência do uso de softwares com plataforma DICOM na capacidade de diagnóstico das imagens por TCFC na detecção de fraturas radiculares verticais induzidas experimentalmente. Foram utilizados cento e noventa dentes unirradiculares humanos, com os condutos radiculares modelados, divididos em 3 grupos, de acordo com a condição do canal radicular: não-preenchido (NP); preenchido com guta-percha (GP); e parcialmente preenchido por núcleo metálico fundido (NM). Metade dos elementos de cada grupo foi fraturada artificialmente, com posterior reposicionamento dos fragmentos. Um cone de guta-percha bem adaptado foi inserido no canal dos dentes do grupo GP e núcleos metálicos fundidos foram confeccionados nos dentes do grupo NM. Todos os dentes foram posicionados em um crânio seco humano e escaneados em um aparelho de TCFC, conforme o protocolo de escaneamento da maxila utilizando voxel de 0.2 mm. As imagens foram salvas no formato original (.xstd), assim como segmentadas e reconstruídas em DICOM. As imagens originais foram analisadas no software do tomógrafo (Xoran) e as imagens DICOM nos softwares Dolphin, InVivo e KDIS3D. Foram selecionados três cirurgiões-dentistas radiologistas para avaliar as imagens quanto à ausência ou presença de fratura radicular, em uma escala de 5 pontos. Sensibilidade, especificidade, acurácia e área sob a curva ROC foram calculadas. A influência do material intracanal e do software utilizado foi verificada por meio do modelo de análise de variância (ANOVA) e comparações pareadas realizadas por meio do teste de Tukey, considerando-se um nível de significância de 5%. Não houve diferença estatisticamente significativa entre os softwares quando a mesma condição era apresentada. No entanto, quando comparada com os grupos NP e GP, a acurácia de diagnóstico foi menor no grupo NM em qualquer software utilizado (p < 0,05). Concluiu-se que o diagnóstico de fratura radicular não depende do software, podendo o profissional utilizar o de sua preferência. Todavia, a presença de núcleo metálico diminui a possibilidade de um diagnóstico correto / Abstract: Root fractures have limited clinical diagnosis because signs and symptoms are nonspecific. However, an accurate diagnosis is necessary as most fractures result in tooth extraction. In the last years, Cone beam computed tomography (CBCT) technology has been considered an advanced procedure to obtain images free from overlaps of maxillofacial structures. Usually CBCT images are exported in DICOM format, since there is a wide availability of software that uses this format. Since it is a relatively new technology and that is spreading quickly among dental routine, this study evaluated the influence of segmentation and reconstruction of CBCT images in the diagnostic ability of experimentally induced vertical root fractures using software with DICOM platform. One hundred and ninety extracted, single-rooted, human teeth were included in the study. Each tooth had its root canal prepared, randomly coded and divided into 3 groups according to the pulp canal status: unrestored (UR); filled with gutta-percha (GP); and restored with a metallic custom post (Post). One-half of the samples of each group were artificially fractured and segments repositioned. The experimental sample was artificially fractured. A well-fitting gutta-percha cone was placed into the canal of GP group teeth, and a well-fitting post casted was placed into the canal of Post group ones. All teeth were placed in an empty maxillary anterior socket of a dentate dry human skull and scanned on a CBCT device according to the protocol recommended by the manufacturer for a 0.2-mm voxel resolution (8-cm FOV, 120kVp, 8mA, 40-sec). The images were converted to DICOM files, imported, reconstructed and analyzed into Dolphin, InVivo and KDIS3D software. The original images were also reconstructed and evaluated using the software of the scanner (Xoran). The images were coded and shown to three previously calibrated oral radiologist observers, who performed a dynamic evaluation. The observer's evaluation of the presence of root fracture was scored using a 5-point confidence rating scale. Sensitivity, specificity, and accuracy were calculated, and from the values found, ROC curves were constructed to assess the relationship between sensitivity and specificity (area under the ROC curve). The influence of intra-canal material and software used was verified by an analysis of variance model (ANOVA) and pairwise comparisons performed using Tukey test, considering a significance level of 5%. Overall, there was not a statistically significant difference between softwares. Thus, the efficiency of the software was similar among them when the same condition (type of material present inside the canal) was shown. However, there was a statistically significant difference between the materials, considering accuracy, sensitivity and area under the ROC curve. Compared with UR and GP groups, the accuracy of diagnosis was significantly lower in the Post group when any software was used (p <0.05). In conclusion, the diagnosis of root fracture does not depend on the software, which means that the professional should choose the one of his preference. However attention should be drawn to the fact that, regardless of the software used, the presence of metallic post decreases the chance of a correct diagnosis / Doutorado / Radiologia Odontologica / Doutor em Radiologia Odontológica

Popliteal artery entrapment syndrome has been reported to be a rare disease typically found in athletic and otherwise healthy young adults. It manifests as a temporary lower limb pain that occurs in connection with physical exercise. It is caused by an anatomic anomaly, usually anaberrant head of the gastrocnemius muscle that compresses the popliteal artery on the backside of the knee joint. The popliteal artery is the main vessel supplying blood to the lower part of the leg and the condition, if left untreated, can lead to serious complications such as thrombosis or aneurysm. If detected in time and surgically corrected patients can expect full recovery within weeks.The purpose of this study was to examine a group of healthy asymptomatic individuals (n=50)using ultrasound and a series of provocation to see if there was a possibility of entrapment. A secondary objective was to find which maneuvers during the ultrasound would provide the best results. They were subjected to ultrasound examinations at rest, during plantar flexion without resistance, against a light resistance and against substantial resistance.The results showed that most of the test subjects could temporarily constrict blood flow greatly although ultrasound imagery alone was not enough to confirm diagnosis. It seems that detected occlusion of the artery in conjunction with other diagnostic data such as AnkleBrachial Index and symptomatology can be useful both in confirming or ruling out PAESwithout the use of more expensive and invasive methods.

The detection of disease and abnormal pathology by magnetic resonance imaging (MRI) has been aided significantly by the use of gadolinium (Gd3+)-based contrast agents (CAs) over the past three decades. MRI and MRI CAs play a critical role in diagnosing tumors and diseases of the central nervous system. The agents used clinically have been shown to safely increase MRI contrast despite the toxicity of Gd3+, owing to the high kinetic and thermodynamic stability of these chelates. However, current CAs enhance contrast at a small fraction of what is theoretically possible. This leads to the necessity of introducing high CA doses in practice in order to afford sufficient contrast. Lanthanide (Ln3+) chelates based on 1,4,7,10–tetraazacyclododecane–1,4,7,10–tetraacetate (DOTA) have been shown to be particularly stable and effective. Chelates of DOTA exist in two interconverting coordination geometries which have varying water exchange rates. Researchers have envisioned a way to increase the per-dose efficacy both by control of the Gd3+–inner–sphere water exchange rate and via binding specificity (i.e. to tumors). The efficacy gains using these approaches have thus far been modest. A thorough structural characterization of europium (Eu3+) chelates of a DOTA-derivative which cannot undergo conformational exchange was carried out. These studies show that a single enantiomer of the ligand (S)–2–(4-nitrobenzyl)–1,4,7,10–tetraazacyclododecane–1,4,7,10–tetra(α–methyl)acetate (NB–DOTMA) can yield chelates which are both diastereoisomeric (previously reported) and regioisomeric (not previously speculated). Molecular mechanics simulations generated from the characterization data indicate that the nitrobenzyl (NB) substituent is oriented in different directions for the two possible regioisomers. The NB group can be chemically converted to confer macromolecular binding capability, and the orientation of the NB substituent may have a significant impact on the binding and/or relaxation behavior of a prototypical CA. The nuclear magnetic resonance (NMR) spectra of Eu–NB–DOTMA at various temperatures were compared. Unexpectedly, the chelates showed time-averaged structures which differ with a change in water exchange rate — the faster the rate, the greater the deviation from the expected structure. Consideration of the structures of Ln3+ chelates without accounting for their dynamic behavior does not yield an accurate value for the time-averaged hydration state. These observations suggest the "optimal" water exchange rate calculated using Solomon-Bloembergen-Morgan (SBM) theory may not lead to the highest-efficacy CAs. Binding and relaxometric studies of macromolecule-targeting derivatives of Gd–NB–DOTMA both by the author and in another lab showed that the coordination isomer with the slower water exchange rate should lead to more effective contrast, in direct opposition to the prevailing view of water exchange in the MRI community. Preliminary data do not indicate that regioisomeric chelates have significantly different relaxivity or macromolecular binding behavior. The ratios between regioisomeric Ln–NB–DOTMA chelates formed were shown to be dependent on the concentration and pH of the chelation reaction, but conditions were not found which led to the production of a single regioisomer. Attempts to carry out an efficient synthesis of a Ln3+ chelate with no potential for regioisomerism were unsuccessful.

Bakgrund: Antalet bilddiagnostiska undersökningar ökar. Behov finns att implementera riktlinjer för remisser till röntgenavdelningen. 20% av alla DT undersökningar bedöms inte vara berättigade. Under 2017 inleddes översättning till lokala förhållanden och implementering av iGuide på försök i en av Sveriges regioner. Syfte: Syftet är att studera röntgensjuksköterskors- och radiologers erfarenheter från berättigande av undersökningar på röntgenavdelningen. Metod: En empirisk studie med kvalitativ design. En induktiv ansats tillämpades. Semistrukturerade intervjuer utfördes med legitimerade radiologer och röntgensjuksköterskor. Intervjumaterialet analyserades med en manifest innehållsanalys. Resultat: Innehållsanalysen mynnade ut i följande subkategorier:  Innebörden av berättigande, Ansvarsfördelning vid berättigande, Oberättigade remisser och åtgärder, Remittent och patient inverkar på berättigandet, Organisationen inverkar på berättigandet, Tillgänglighet av olika modaliteter inverkar på berättigandet, IGuide är grundat i problemen med berättigande, samt Resultatet från iGuide-projektet. Subkategorierna bildar tre kategorier: Berättigande av undersökningar, Förekomst av oberättigade undersökningar, samt iGuide som ett sätt att uppnå ökat berättigande. Slutsats: Röntgenutnyttjandet ökar och därmed problemen med berättigande. Radiologerna upplever att brist på tid påverkar berättigandet negativt, också att remittenten ofta har svårt att neka patienter. Röntgensjuksköterskor upplever att kommunikationen avdelningar emellan är viktig för berättigande. Det ökade utbudet av modaliteter beskrivs påverka. IGuide ökar andelen berättigade undersökningar, och minskar antalet begärda bilddiagnostiska undersökningar, men systemet behöver få en ökad användarvänlighet. / Background:  The number of image diagnostic examinations is increasing. There is a need to implement guidelines for referrals to the X-ray department. 20% of all DT examinations are deemed not to be justified. In 2017, implementation and translation into local conditions of iGuide in trial was initiated in one of Sweden's regions. The aim: The aim is to study the experiences of radiographers and radiologists from the justification of examinations in the X-ray department. Method:  An empirical study with qualitative design. The inductive approach was applied. Semi-structured interviews were applied with licensed radiographers and radiologist. The interview material was analyzed with a manifesto content analysis.  Results:  The analysis resulted in the following subcategories: The meaning of justification, The shared responsibility in justification, Unjustified referrals and actions, Remittent and patient impact on justification, The organization impact on justification, The accessibility of various modalities affect justification, IGuide is based on the problems of justification, and The results of the iGuide-project. The subcategories form three categories: Justification of examinations, Existence of unjustified examinations, and IGuide as a means of achieving increased justification. Conclusion:  X-ray utilization is increasing and thus the problems with justification. The radiologists experience that the lack of time affects justification negatively, also that the remittance often has difficulty in denying patients. Radiographers experience that communication between departments is important for justification. The increased range of modalities is described as affecting. IGuide increases the proportion of justified examinations, and reduces the number of requested imaging examinations, but the system needs to be given a greater user-friendliness.

Magnetic Resonance Imaging (MR Imaging, or MRI) offers superior soft-tissue contrast compared to other medical imaging modalities. However, access to MRI across developing countries ranges from prohibitive to scarcely available. The lack of educational facilities and the excessive costs involved in imparting technical training have resulted in a lack of skilled human resources required to operate MRI systems in developing countries. While diagnostic medical imaging improves the utilization of facility-based rural health services and impacts management decisions, MRI requires technical expertise to set up the patient, acquire, visualize, and interpret data. The availability of such local expertise in underserved geographies is challenging. Inefficient workflows and usage of MRI result in challenges related to financial and temporal access in countries with higher scanner densities than the global average of 5.3 per million people. MRI is routinely employed for neuroimaging and, in particular, for dementia screening. Dementia affected 50 million people worldwide in 2018, with an estimated economic impact of US $1 trillion a year, and Alzheimer’s Disease (AD) accounts for up to 60–80% of dementia cases. However, AD-imaging using MRI is time-consuming, and protocol optimization to accelerate MR Imaging requires local expertise since each pulse sequence involves multiple configurable parameters that need optimization for acquisition time, image contrast, and image quality. The lack of this expertise contributes to the highly inefficient utilization of MRI services, diminishing their clinical value. Augmenting human capabilities can tackle these challenges and standardize the practice. Autonomous and time-efficient acquisition, reconstruction, and visualization schemes to maximize MRI hardware usage and solutions that reduce reliance on human operation of MRI systems could alleviate some of the challenges associated with the requirement/absence of skilled human resources. We first present a preliminary demonstration of AMRI that simplifies the end-to-end MRI workflow of registering the subject, setting up and invoking an imaging session, acquiring and reconstructing the data, and visualizing the images. Our initial implementation of AMRI separates the required intelligence and user interaction from the acquisition hardware. AMRI performs intelligent protocolling and intelligent slice planning. Intelligent protocolling optimizes contrast value while satisfying signal-to-noise ratio and acquisition time constraints. We acquired data from four healthy volunteers across three experiments that differed in acquisition time constraints. AMRI achieved comparable image quality across all experiments despite optimizing for acquisition duration, therefore indirectly optimizing for MR Value – a metric to quantify the value of MRI. We believe we have demonstrated the first Autonomous MRI of the brain. We also present preliminary results from a deep learning (DL) tool for generating first-read text-based radiological reports directly from input brain images. It can potentially alleviate the burden on radiologists who experience the seventh-highest levels of burnout among all physicians, according to a 2015 survey. Next, we accelerate the routine brain imaging protocol employed at the Columbia University Irving Medical Center and leverage DL methods to boost image quality via image-denoising. Since MR physics dictates that the volume of the object being imaged influences the amount of signal received, we also demonstrate subject-specific image-denoising. The accelerated protocol resulted in a factor of 1.94 gain in imaging throughput, translating to a 72.51% increase in MR Value. We also demonstrate that this accelerated protocol can potentially be employed for AD imaging. Finally, we present ArtifactID – a DL tool to identify Gibbs ringing in low-field (0.36 T) and high-field (1.5 T and 3.0 T) brain MRI. We train separate binary classification models for low-field and high-field data, and visual explanations are generated via the Grad-CAM explainable AI method to help develop trust in the models’ predictions. We also demonstrate detecting motion using an accelerometer in a low-field MRI scanner since low-field MRI is prone to artifacts. In conclusion, our novel contributions in this work include: i) a software framework to demonstrate an initial implementation of autonomous brain imaging; ii) an end-to-end framework that leverages intelligent protocolling and DL-based image-denoising that can potentially be employed for accelerated AD imaging; and iii) a DL-based tool for automated identification of Gibbs ringing artifacts that may interfere with diagnosis at the time of radiological reading. We envision AMRI augmenting human expertise to alleviate the challenges associated with the scarcity of skilled human resources and contributing to globally accessible MRI.

Yes / Acute kidney injury (AKI) can occur rarely in patients exposed to iodinated contrast and result in contrast-induced AKI (CI-AKI). A key risk factor is the presence of pre-existing chronic kidney disease (CKD), therefore it is important to assess patient risk and obtain kidney function measurement prior to administration. Point of care (PoC) testing provides an alternative strategy but there remains uncertainty, with respect to diagnostic accuracy and clinical utility. A device study compared three PoC analysers (Nova StatSensor, Abbott i-STAT, Radiometer ABL800 FLEX) with a reference laboratory standard (Roche Cobas 8000 series, enzymatic creatinine). Three hundred adult patients attending a UK hospital phlebotomy department were recruited to have additional blood samples for analysis on the PoC devices. The ABL800 FLEX had the strongest concordance with laboratory measured serum creatinine (mean bias=-0.86, 95% limits of agreement = -9.6 to 7.9) followed by the i-STAT (average bias=3.88, 95% limits of agreement = -8.8 to 16.6) and StatSensor (average bias=3.56, 95% limits of agreement = -27.7 to 34.8). In risk classification, the ABL800 FLEX and i-STAT identified all patients with an eGFR≤30, whereas the StatSensor resulted in a small number of missed high-risk cases (n=4/13) and also operated outside of the established performance goals. The screening of patients at risk of CI-AKI may be feasible with PoC technology. However in this study it was identified that the analyser concordance with the laboratory reference varies. It is proposed that further research exploring PoC implementation in imaging department pathways is needed. / Yorkshire and Humber Academic Health Science Network (Grant Number: YHP0318)

Submitted in fulfillment of the requirements of the degree of the Master of Technology : Radiography, Durban University of Technology, 2014. / Research Aims The purpose of this study is to compare 2D HDR Brachytherapy planning and 3D HDR Brachytherapy planning in terms of dose distribution in order to accurately determine bladder and rectal doses. Further research questions were explored to determine whether relationships existed between Computer Tomography volumes and bladder and rectum dose. Methodology The 30 female patients that volunteered for the study were conveniently selected. Their age and ethnic group did not contribute to their selection. All participants were prepared for cervical HDR Brachytherapy. The Brachytherapy templates were computer generated and treatments were given based on the templates. They then had a Computer Tomography (CT) scan (3D data set) of the pelvis. The computer generated templates for 2D Brachytherapy planning were applied to the CT data set i.e. 2DBP. The plans were optimised to take into consideration the dose to the bladder and the rectum i.e. 3DBP. The 2DBP and the 3DBP were then evaluated in order to determine which method of planning yielded more acceptable dose distributions to the bladder and rectum. Results Significant differences in dose distribution were noted on comparison of 2DBP and 3DBP. A significant relationship was noted in respect of bladder mean dose and rectum mean dose. 3DBP proved to be more efficient in yielding lower mean dose to the bladder and the rectum. Whilst a significant relationship was noted in respect of bladder maximum dose, an insignificant relationship was noted for rectum maximum dose. Therefore, the efficiency of 3DBP to yield lower bladder maximum dose was established but its efficiency to yield lower rectum maximum dose is questionable. This has implications for the management of patients’ with cervical cancer who require cervical Brachytherapy. Recommendations It is imperative that imaging modalities be used for the accurate planning of cervical Brachytherapy. This study recommends that CT be used for HDR Brachytherapy planning by proving its greater efficiency compared to template planning.