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The subject of this diploma thesis is design of X-ray apparatus for medical intention – an angiographic set which consists of a C-Arm and an angiographic table. The elaboration deals particularly with an attractive organic design, that is aimed to have a positive psychological effect, and with an innovation in construction of apparatus in order to be as various-purpose as possible, to conform to the most exacting requirements and procedures, and to advance diagnostic possibilities in the given category. In the thesis diagnostic procedures, which along with technical and ergonomical factors influence the shape and also the total set conception, are considered. This thesis does not contain a separate display system which is not a part of project.

published_or_final_version / Community Medicine / Master / Master of Public Health

Magnetic resonance imaging (MRI) is a highly exible and non-invasive medical imaging modality based on the concept of nuclear magnetic resonance (NMR). Compared to other imaging techniques, major limitation of MRI is the relatively long acquisition time. The slowness of acquisition makes MRI difficult to apply to time-sensitive clinical applications. Acquisition of MRA images with a spatial resolution close to conventional digital subtraction angiography is feasible, but at the expense of reduction in temporal resolution. Parallel MRI employs multiple receiver coils to speed up the MRI acquisition by reducing the number of data points collected. Although, the reconstructed images from undersampled data sets often suffer from different different types of degradation and artifacts. In contrast-enhanced magnetic resonance imaging, information is effectively measured in 3D k-space one line at a time therefore the 3D data acquisition extends over several minutes even using parallel receiver coils. This limits the assessment of high ow lesions and some vascular tumors in patients. To improve spatio-temporal resolution in contrast enhanced magnetic resonance angiography (CE-MRA), the use of incorporating prior knowledge in the image recovery process is considered in this thesis. There are five contributions in this thesis. The first contribution is the modification of generalized unaliasing using support and sensitivity encoding (GUISE). GUISE was introduced by this group to explore incorporating prior knowledge of the image to be reconstructed in parallel MRI. In order to provide improved time-resolved MRA image sequences of the blood vessels, the GUISE method requires an accurate segmentation of the relatively noisy 3D data set into vessel and background. The method that was originally used for definition of the effective region of support was primitive and produced a segmented image with much false detection because of the effect of overlying structures and the relatively noisy background in images. We proposed to use the statistical principle as employed for the modified maximum intensity projection (MIP) to achieve better 3D segmentation and optimal visualization of blood vessels. In comparison with the previous region of support (ROS), the new one enables higher accelerations MRA reconstructions due to the decreased volume of the ROS and leads to less computationally expensive reconstruction. In the second contribution we demonstrated the impact of imposing the Karhunen-Loeve transform (KLT) basis for the temporal changes, based on prior expectation of the changes in contrast concentration with time. In contrast with other transformation, KLT of the temporal variation showed a better contrast to noise ratio (CNR) can be achieved. By incorporating a data ordering step with compressed sensing (CS), an improvement in image quality for reconstructing parallel MR images was exhibited in prior estimate based compressed sensing (PECS). However, this method required a prior estimate of the image to be available. A singular value decomposition (SVD) modification of PECS algorithm (SPECS) to explore ways of utilising the data ordering step without requiring a prior estimate was extended as the third contribution. By employing singular value decomposition as the sparsifying transform in the CS algorithm, the recovered image was used to derive the data ordering in PECS. The preliminary results outperformed the PECS results. The fourth contribution is a novel approach for training a dictionary for sparse recovery in CE-MRA. The experimental results demonstrate improved reconstructions on clinical undersampled dynamic images. A new method recently has been developed to exploit the structure of the signal in sparse representation. Group sparse compressed sensing (GSCS) allows the efficient reconstruction of signals whose support is contained in the union of a small number of groups (sets) from a collection of pre-defined disjoint groups. Exploiting CS applications in dynamic MR imaging, a group sparse method was introduced for our contrast-enhanced data set. Instead of incorporating data ordering resulted from prior information, pre-defined sparsity patterns were used in the PECS recovery algorithm, resulting to a suppression of noise in the reconstruction.

This dissertation presents image processing methods designed to enhance images obtained by angiography, and applied image analysis methods to quantify the vascular diameter. An iterative, non-linear enhancement technique is described for enhancing the edges of blood vessels in unsubtracted angiographic images. The technique uses a median filter and the point spread function of the imaging system to increase the resolution of the image while keeping down noise. Evaluation of the images by radiologists showed that they preferred the processed images over the unprocessed images. Also described is a heuristic, recursive, vessel tracking algorithm. The tracker is intended for use with digital subtraction angiography images. The vascular system is characterized by a tree data structure. Tree structures are inherently recursive structures and thus recursive programming languages are ideally suited for building and describing them. The tracker uses a window to follow the centerlines of the vessels and stores parameters describing the vessels in nodes of a binary tree. Branching of the vascular tree is handled automatically. A least squares fit of a cylindrical model to intensity profiles of the vessel is used to estimate vessel diameter and other parameters. The tracker is able to successfully track vessels with signal-to-noise ratios down to about 4. Several criteria are applied to distinguish between vessel and noise. The relative accuracy of the diameter estimate is about 3% to 8% for a signal-to-noise ratio of 10; the absolute accuracy depends on the magnification (mm per sample). For the clinically significant case of a 25% stenosis (narrowing of the vessel), the absolute error in estimating the percent stenosis is 3.7% of the normal diameter and the relative error is 14.8%. This relative error of 14.8% is a substantial improvement over relative errors of 30% to 70% produced by other methods.

Approved for public release; distribution is unlimited / The connection between eye disease and diabetes is proven and is no longer a point of conjecture. In focusing attention on the retina, profound inroads have been made in the fight against this dreaded disorder of the blood. By carefully imaging the blood vessels in the eye, medical professionals can make accurate diagnoses based upon the changes and abnormalities observed. In addition, because the vasculature in the retina is extremely sensitive to fluctuations in normal bodily processes, often the first indication of diabetes and many other diseases manifest themselves here and are found during routine eye examinations. This thesis will explore the possibilities of a new method of retinal imaging by the blending and application of existing technologies. With the use of an automated, infrared-based imaging system, problems related to human error and the limitations of existing methods can be readily resolved and the groundwork can be laid for a new standard of accuracy in retinal imaging. Most importantly, it will automate the entire procedure providing medical specialists heretofore unavailable accuracy in their diagnoses. / http://archive.org/details/functionalspecif00domb / Lieutenant, United States Navy

OBJECTIVES The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. BACKGROUND Cohort studies have shown that 1 in 4 post-cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. METHODS Thirty-two swine (mean weight 35 +/- 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34 degrees C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. RESULTS At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 +/- 19.6% (p < 0.05). Group C had an intermediate infarct size at 29.5 +/- 20.2%, whereas groups B and D had the largest infarct sizes at 41.5 +/- 15.5% and 41.1 +/- 15.0%, respectively. CONCLUSIONS Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal. (J Am Coll Cardiol Intv 2016; 9: 2403-12)

Foram elaborados e implementados testes de controle de qualidade em equipamentos de angiografia por subtração digital. Estes testes foram baseados em normas nacionais e internacionais e foram implementados em cinco equipamentos de três instituições diferentes. Estes testes avaliam os parâmetros de desempenho dos equipamentos e são utilizados para a determinação da taxa de kerma no ar na entrada da pele do paciente e do corpo clínico. Os testes foram realizados utilizando dispositivos, simuladores de pacientes e câmaras de ionização. Os testes convencionais e do sistema de subtração digital indicaram que os equipamentos avaliados encontravam-se em bom estado de desempenho. Os testes para verificação da taxa de kerma no ar indicaram que um dos equipamentos avaliados apresentou altas taxas de kerma no ar na entrada da pele do paciente em modo fluoroscopia. Este problema foi notificado, e as devidas providências foram imediatamente tomadas pela gerência do hospital. / Quality control tests were elaborated and implementated in digital subtraction angiography equipments. These tests were elaborated based in national and international standards, and they were implementated in five equipments of three different institutions. These tests are utilized to evaluate the performance of these equipments and to determine the patient entrance and personnel air kerma rates. The tests were performed using test tools, patient phantoms e ionization chambers. The conventional tests and the tests of the digital subtraction systems indicated that the evaluated equipments presented a good performance. The tests implementated to determine the air kerma rates presented, in one case (fluoroscopy equipment), high patient entrance skin air kerma rate. This problem was notified, and the providences were promptly taken by the hospital administration.

Foram elaborados e implementados testes de controle de qualidade em equipamentos de angiografia por subtração digital. Estes testes foram baseados em normas nacionais e internacionais e foram implementados em cinco equipamentos de três instituições diferentes. Estes testes avaliam os parâmetros de desempenho dos equipamentos e são utilizados para a determinação da taxa de kerma no ar na entrada da pele do paciente e do corpo clínico. Os testes foram realizados utilizando dispositivos, simuladores de pacientes e câmaras de ionização. Os testes convencionais e do sistema de subtração digital indicaram que os equipamentos avaliados encontravam-se em bom estado de desempenho. Os testes para verificação da taxa de kerma no ar indicaram que um dos equipamentos avaliados apresentou altas taxas de kerma no ar na entrada da pele do paciente em modo fluoroscopia. Este problema foi notificado, e as devidas providências foram imediatamente tomadas pela gerência do hospital. / Quality control tests were elaborated and implementated in digital subtraction angiography equipments. These tests were elaborated based in national and international standards, and they were implementated in five equipments of three different institutions. These tests are utilized to evaluate the performance of these equipments and to determine the patient entrance and personnel air kerma rates. The tests were performed using test tools, patient phantoms e ionization chambers. The conventional tests and the tests of the digital subtraction systems indicated that the evaluated equipments presented a good performance. The tests implementated to determine the air kerma rates presented, in one case (fluoroscopy equipment), high patient entrance skin air kerma rate. This problem was notified, and the providences were promptly taken by the hospital administration.