As atividades de teste automatizado contribuem significativamente para a redução de custos e a produtividade do projeto durante o processo de desenvolvimento de software. O teste automatizado reduz o esforço humano e aumenta a qualidade do produto final. No entanto, a alta complexidade da saída produzida pelos SUT (do inglês, System Under Test) contemporâneos limita, em alguns casos, a aplicação de estratégias de teste automatizadas. Sistemas com saídas gráficas/áudio, imagens tridimensionais, interfaces gráficas com o usuário e alguns aplicativos da Web são exemplos de sistemas com saídas complexas. A falta de oráculos automatizados de teste leva à aplicação de testes executados manualmente pelo próprio testador (oráculo humano), de modo informal, ad-hoc e improdutivo. Uma possível contribuição para aliviar esforços do testador é a implementação de oráculos de teste baseados na extração de características das saídas do SUT. Resultados de trabalhos anteriores mostram que tal abordagem contribui para o aumento da produtividade do teste, mitigando e complementando os esforços manuais. Este trabalho de mestrado propõe e avalia oráculos de teste automatizados para sistemas cujas saídas consistem em imagens médicas tridimensionais. Para tanto, é explorado o framework O-FIm/CO (do inglês, Oracle for Images and Complex Outputs) que utiliza conceitos de Recuperação de Imagens Baseada em Conteúdo (do inglês, Content-Based Image Retrieval CBIR) como uma forma de automatizar oráculos de teste. Além de adaptações e extensões do framework, desenvolveram-se plug-ins que representam extratores de características de imagens médicas tridimensionais de vasos sanguíneos. Para evidenciar a eficácia da abordagem, foram conduzidos dois estudos experimentais objetivando avaliar a eficácia e a precisão dos oráculos de teste baseados em características na avaliação desse tipo de imagem. Além disso, realizou-se um estudo experimental comparando os oráculos de teste baseados em características e oráculos humanos. Os resultados evidenciam a eficácia da abordagem como uma estratégia promissora para automatizar atividades de teste, contribuindo para a redução de tempo e esforços gerados por abordagens manuais durante a avaliação da qualidade de sistemas geradores de imagens médicas tridimensionais. / Automated testing activities significantly contribute to cost reduction and project productivity during the software development process. Automated testing reduces human effort and increases the quality of the final product. However, the high complexity of contemporary SUT outputs limits, in some cases, the application of automated test strategies. Systems with graphical/audio outputs, three-dimensional imaging, graphical user interfaces and some web applications are examples of systems with complex outputs. The lack of automated test oracles leads to the application of manual tests performed by the tester (human oracle) in an informal, ad-hoc and unproductive manner. One possible contribution to alleviate the testers efforts is to implement test oracles based on the extraction of characteristics from the SUT outputs. Results from previous work show that such an approach contributes to increase test productivity, mitigating and complementing manual efforts. This dissertation proposes and evaluates automated test oracles for systems whose outputs consist of three-dimensional medical images. To do so, the framework O-FIm/CO (Oracle for Images and Complex Outputs) that uses CBIR (Content-Based Image Retrieval) concepts is explored as a strategy to automate test oracles. In addition to adaptations and extensions of the framework, plug-ins were developed which represent extractors of three-dimensional medical image characteristics of blood vessels. To demonstrate the efficacy of the approach, two experimental studies were conducted to evaluate the efficacy and accuracy of feature-based test oracles in the evaluation of such images. Moreover, an experimental study was conducted to compare feature-based test oracles with human oracles. The results show the efficacy of the approach as a promising strategy to automate testing activities, contributing to the reduction of time and effort generated by manual approaches during the quality assessment of three-dimensional medical imaging systems.

A insuficiência cardíaca congestiva (ICC) é uma condição em que o coração não consegue bombear o sangue de acordo com as necessidades metabólicas dos tecidos. Quando a ICC entra em seu estágio final, já refratária ao tratamento medicamentoso, ou outras opções terapêuticas, o transplante cardíaco constitui-se em medida salvadora destes pacientes. Após o primeiro ano de evolução do procedimento, a doença vascular do enxerto (DVE) é a complicação mais temida nestes pacientes. Esta doença caracteriza-se por aterosclerose acelerada, com acometimento concêntrico do vaso, predominando nos terços médios e distais. Sintomas isquêmicos geralmente não estão presentes devido ao coração denervado destes pacientes. Daí a importância em se ter um método com boa acurácia e que possibilite o diagnóstico da DVE em seus estágios iniciais, que, muitas vezes, não é demonstrado pela cineangiocoronariografia (CINE). O nosso trabalho teve como objetivo avaliar se o diagnóstico da DVE pela tomografia computadorizada por múltiplos detectores (TCMD) foi preditor de eventos maiores, definimos como: morte súbita, infarto, angioplastia, queda da fração de ejeção e retransplante. Em nossa amostra, selecionamos 59 pacientes transplantados que tinham sido submetidos à TCMD por indicação clínica. Encontramos idade média de 49 anos ± 11,36 anos e tempo médio de transplante na realização da TCMD de 82,67 ± 36,38 meses. A prevalência de hipertensão (HAS) foi de 59,32%, dislipidemia (DLP) 57,63% e diabetes mellitus (DM) 33,90%. Em relação à etilogia da ICC dos receptores, em primeiro lugar, tivemos doença isquêmica com 38,98%, seguida por doença chagásica com 33,90% e por miocardiopatia dilatada idiopática com 13,56% da amostra. Desta população, um subgrupo de 41 pacientes, além de ter feito a TCMD, fez também a CINE. A comparação dos dois métodos mostrou sensibilidade de 100%, especificidade de 77,27%, valor preditivo positivo (VPP) de 46,34% e valor preditivo negativo (VPN) de 100%. Os resultados mostraram que a presença de DVE pela tomografia foi preditora de eventos maiores no seguimento destes pacientes com significância estatística p 0,001. Outras variáveis analisadas que também tiveram impacto significativo foram escore de cálcio positivo (p< 0,05), piora da classe funcional na evolução para classe II e III, e os receptores que tinham o diagnóstico prévio de miocardiopatia dilatada. Concluímos que a TCMD é um exame que tem boa acurácia diagnóstica na DVE, podendo a CINE ficar restrita aos casos duvidosos. Além disso, alterações deste exame são preditoras de eventos adversos. O escore de cálcio e a piora da classe funcional também foram preditores de eventos. / Congestive heart failure (CHD) is a condition characterized by the heart inot meeting the body oxygen demands. For end-stage CHD, refractory to medical treatment, heart transplant is a lifesaver treatment, but its late results may suffer a negative impact if there is allograft vasculopathy, the main reason of late adverse outcome in this population. This condition is is characterized by accelarated atherosclerosis with concentric disease predominant at the mid and distal segments of the coronary arteries. Ischemic symptoms seldom happen for the heart is denervated, and thus, it would be highly desirable to possess a test that could accuratelly foretell the presence of such abnormality. Furthermore, a possible gold standard, invasive coronary angiography (ICA) has been show to lack sensivity. The aim of this study was to evaluate if multidetector computed tomography( MDCT) could identify and thus to predict patients at higher risk of presenting late adverse events. Major events were considered as: sudden cardiac death (SCD), Hear attack, angioplasty, left ventricle impairment and retransplant. Consulting medical records we selected 59 heart transplant patients that underwent MDCT at least 7 years by clinical discretion. Mean age at the time of the exam was 49 ± 11.36 years. Mean post heart transplantantion time was 82.67 ± 36.38 months. Hypertension (HAS) prevalence was 59,32%, hyperlipidemia 57,63% and diabetes was 33,90%. Main pre-transplant CHD cause was ischemic heart disease in 38,98%, followed by Chaga\'s disease, 33.90% and idiopathic dilated cardiomyoapthy. We had 41 patients that also underwent ICA. Comparing both methods we found that MDCT had a sensibility of 100%, a specificity of 77,27%, a positive preditive value of 46,34% and a negative preditive value of 100%. The diagnosis of CAV done by MDCT was a predictor of major events at the follow-up (p=0,001). Other predictors that achieved statistical significance were positive calcium score (p<0,05), class functional (p<0,001) and dilated cardimyopathy dilated as the CHD cause (p=0,027). So we conclude that MDCT has a good accuracy on the diagnosis of CAV, and is a predictor of adverse events. Higher than zero calcium score, lower functional class and dilated cardiomyopathy also related to patient\'s follow-up.

Wert der MR-angiographischen Technik für die Dignitätsbeurteilung von Ovarialraumforderungen Ziel der Studie war die Überprüfung der Wertigkeit der kontrastmittelunterstützten MRT und der Aussagekraft der arteriellen und venösen Phase in der Charakterisierung ovarieller Raumforderungen. 51 Patientinnen (97 Ovarien) mit ovariellen Raumforderungen in der klinischen und sonographischen Kontrolle wurden in einem 1,5 Tesla MRT mit einer Body-phased-array-Spule untersucht. Dabei kamen T1- und T2-gewichtete Sequenzen zur Anwendung (axiale, sagittale und coronare). Zusätzlich wurde eine MR-Angiographie mit Aufnahmen in der arteriellen und venösen Phase durchgeführt. Als Kontrastmittel kam Gadolinium-DTPA zur Anwendung. 43 Patientinnen wurden operiert, die übrigen Patientinnen mit als gutartig gewerteten Tumoren im Verlauf von 13 bis 23 Monaten klinisch kontrolliert. Die Histologische Untersuchung zeigte 21 bösartige (einschließlich 4 Borderline-Tumoren) und 43 gutartige Tumoren. Die Sensitivität, Spezifität und Treffsicherheit wurde mit Hilfe der folgenden Kriterien berechnet: Größe der Tumoren, Wand- und Septendicke, Vorhandensein solider Anteile und die Kontrastmittelanreicherung in der arteriellen und venösen Phase. Zusätzlich wurde die Aussagekraft der Substraktionsangiographie sowie der maximum intensity projections (MIP) überprüft. Die MRT war korrekt bei 17 von 21 malignen Tumoren und 73 von 76 benignen Tumoren bzw. unauffälligen Ovarien und hat somit eine Sensitivität von 81%, eine Spezifität von 96% und eine Treffsicherheit von 93%. Die Treffsicherheit der Kriterien für Malignität liegt bei 85% für die Kontrastmittelanreicherung in der arteriellen Phase, bei 86% für die soliden Anteile, bei 78% für die Wanddicke und bei 69% für die Septendicke. Die Ergebnisse zeigen, dass die kontrastmittelanreichernde MRT einen nützlichen zusätzlichen Faktor darstellt, um die Spezifität der MRT in der Charakterisierung gutartiger und bösartigen Tumoren zu erhöhen. / Role of MR Angiography in the Characterization of Ovarian Lesions The aim was to investigate the role of contrast-enhanced magnetic resonance (MR) angiography and the arterial and venous contrast medium enhancement for lesion characterization. Fifty-one patients (97 ovarian) with ovarian masses identified in the clinical examination and by endovaginal ultrasound underwent MR imaging on a 1.5-T scanner using a body phased-array coil. Images were acquired with T1- and T2-weighted sequences (axial, sagittal and coronal). An MR angiography sequence was performed before and after intravenous injection of Gd-DTPA during the arterial and venous phase after determination of the transit time of the contrast medium bolus. Forty-three patients were operated on; the remaining patients with benign lesions were followed up clinically for 13 to 23 months. Histology demonstrated 21 malignant lesions (including 4 borderline tumors) and 43 benign lesions. The sensitivity, specificity and diagnostic accuracy were calculated for the following criteria: size of ovarian mass, thickness of walls and septae, solid portions, and arterial and venous contrast medium enhancement. In addition, the diagnostic benefit of maximum intensity projections (MIP) and thin slices acquired with the MR angiography technique was evaluated. MRI correctly identified 17 of the 21 malignant tumors and 73 of the 76 benign findings (benign lesions or normal ovaries) and had a sensitivity of 81%, a specificity of 96%, and a diagnostic accuracy of 93%.The accuracies of the different malignancy criteria were 85% for arterial contrast medium, 86% for the solid portions, 78% for the wall thickness and 69% for septal thickness. The results presented show that arterial contrast medium enhancement is a useful criterion to improve the specificity of MRI in characterizing ovarian lesions.

Este trabalho descreve o desenvolvimento de um sistema integrado transdutor/bobinas de gradientes de alto desempenho para Imagens por Ressonância Magnética. Este sistema é composto por um transdutor de radiofreqüência tipo sela e um conjunto de 3 bobinas locais assimétricas. No desenho do transdutor foram otimizados os parâmetros: relação sinal ruído e uniformidade do campo magnético por ele gerado. A densidade de corrente de cada bobinas local foi otimizada mediante técnicas numéricas estocásticas para gerar um gradiente de campo magnético uniforme em cada uma das 3 direções do espaço numa região das dimensões do crânio. O conjunto de bobinas de gradientes construído possui um diâmetro livre de 31.5 cm e gera em média 25 mT/m/A por bobina, com indutâncias inferiores a 310 mH. São mostradas as aplicações clínicas desenvolvidas nas áreas de imagens tridimensionais e angiografia, a partir das seqüências de pulsos implementadas e aproveitando o uso do sistema integrado, em um tomógrafo de ressonância magnética de 0.5 Tesla. Imagens de phantom foram adquiridas em menos de 500 ms usando o conjunto integrado e técnicas do tipo Echo Planar Imaging. Aspectos referentes à caracterização e correção de campos magnéticos estáticos e homogêneos são também comentados. As soluções descritas nesta tese têm um amplo conteúdo tecnológico e beiram nas fronteiras da Física Aplicada e a Engenharia Biomédica. / Here we describe the development of a high performance radio-frequency/gradient coil integrated system for Magnetic Resonance Imaging. A saddle radio-frequency coil and a three-axis asymmetric local gradient coil composed this system. Two parameters were optimized in the RF coil design: signal-to-noise ratio and magnetic field uniformity. The current density of each local coil was optimized using stochastic numerical techniques, in order to generate a uniform magnetic field gradient by axis in a region representing a human head. The build gradient coil set has an inner diameter of 31 cm. The average gradient efficient of the three-axis is 25 mT/m/A and the maximum inductance is less than 310 mH. We show the clinical applications performed in three-dimensional and angiography imaging areas in a 0.5 Tesla magnetic resonance tomograph. These applications were optimized to taking advantage from the integrated system. Phantom images were acquired in less than 500 millisecond using echo planar techniques and the integrated set. Some aspects about static and homogeneous magnetic field characterization and correction are also commented. In this work we described solutions with wide technologic content close to the boundaries of the Applied Physics and Biomedical Engineering.

Fundamentos: Este estudo tem o objetivo de comparar os resultados clínicos e angiográficos de pacientes com infarto agudo do miocárdio(IAM) tratados com implante de stent revestido com paclitaxel (SRP) versus stent convencional. Métodos e população do estudo: Um grupo de 30 pacientes com infarto agudo do miocárdio foi tratados com stent revestido com paclitaxel (TaxusTM). Um grupo controle com 30 pacientes foi tratado com stent convencional (Express2 TM).Resultados: Aos 6,9±1,2 meses, não ocorreu morte, reinfarto ou trombose intra-stent. Entretanto, pacientes tratados com stent farmacológico tiveram um risco menor de reintervenção (3.3%% vs. 33.3%; p=0.006). A perda luminal tardia foi de 0.2±0.2 mm no grupo de SRP vs. 0.6±0.6 mm (p=0.03) no controle e a reestenose binária foi de 3.3% (RVP)vs. 33.3%(controle) (p=0.006). O percentual médio de obstrução neointimal em pacientes do grupo farmacológico foi de 4,7%±6,8%. Conclusões: O SRP se mostrou seguro e efetivo aos 7 meses em pacientes com IAM / This study aimed to compare the clinical and angiographic outcomes of patients with acute myocardial infarction (AMI) treated with paclitaxel eluting stent (PES) versus conventional stent implantation. Methods and Study Population: A group of 30 patients admitted with AMI was treated with PES (TaxusTM). A control group comprised 30 patients with a similar bare stent (Express IITM). Results: Baseline and procedural characteristics were similar between the PES and control groups. At 6.9±1.2 months, there were no deaths, re-AMI, or stent thrombosis. However, patients treated with PES had a lower risk of repeat revascularization (3.3%% vs. 33.3%; p=0.006). The angiographic late loss was 0.2±0.2 mm vs. 0.6±0.6 mm (p=0.03) and the binary restenosis rate was 3.3% vs. 33.3% (p=0.006) in the PES vs. controls respectively. The average percent neointimal obstruction in patients treated with PES was 4.7±6.8 %. Conclusions: PES appeared safe and effective at 7 months in patients AMI

Bakgrund: Kranskärlssjukdom (CAD) är en hjärtsjukdom som kan diagnostiseras med icke-invasiva metoder, såsom myocardial perfusion imaging med single-photon emission computed tomography (SPECT), och genom invasiva metoder, såsom invasiv koronarangiografi (ICA). ICA är den golden standardmetod för att diagnostisera CAD. Men å andra sidan är ICA mer kostsam än SPECT och kan orsaka många komplikationer. Metoder och resultat: det är en retrospektiv kohortstudie. Studien analyserade 62 patienter som har genomgått både SPECT och ICA under 2018 vid Universitetssjukhuset Örebro (USÖ). Av dessa 62 utförde 56 patienter SPECT först. Analyseringen gjordes för att undersöka hur väl resultatet av ICA-sjukdomsdetektering och lokalisering kunde bestämmas av SPECT. Aktiv CAD definierades som närvaron av en behandling-krävande signifikant stenos vid ICA. SPECT-resultaten visade att 91% av fallen var patologiska och 9% var icke-patologiska. Sensitivitet, specificitet och noggrannhet för SPECT för detektering av aktiv CAD var 89%, 7% respektive 47% vid referens till ICA. Medan positiva prediktiva värden (PV +) och negativa prediktiva värden (PV-) var 48% respektive 40%. SPECT sensitivitet för lokalisering av defekter i referens till ICA var 35% för LAD-defekter, 68% för LCX-defekter och 92% för RCA-defekter. Slutsats: Resultatet skilde sig från den ursprungliga hypotesen. SPECT anses fortfarande vara effektiv för att identifiera patienter med aktiv CAD. Därför kan SPECT användas som initial undersökningsmetod för utvärdering av CAD hos patienter med låg till måttlig risk. SPECT var inte optimalt för att lokalisera defekterna.

As atividades de teste automatizado contribuem significativamente para a redução de custos e a produtividade do projeto durante o processo de desenvolvimento de software. O teste automatizado reduz o esforço humano e aumenta a qualidade do produto final. No entanto, a alta complexidade da saída produzida pelos SUT (do inglês, System Under Test) contemporâneos limita, em alguns casos, a aplicação de estratégias de teste automatizadas. Sistemas com saídas gráficas/áudio, imagens tridimensionais, interfaces gráficas com o usuário e alguns aplicativos da Web são exemplos de sistemas com saídas complexas. A falta de oráculos automatizados de teste leva à aplicação de testes executados manualmente pelo próprio testador (oráculo humano), de modo informal, ad-hoc e improdutivo. Uma possível contribuição para aliviar esforços do testador é a implementação de oráculos de teste baseados na extração de características das saídas do SUT. Resultados de trabalhos anteriores mostram que tal abordagem contribui para o aumento da produtividade do teste, mitigando e complementando os esforços manuais. Este trabalho de mestrado propõe e avalia oráculos de teste automatizados para sistemas cujas saídas consistem em imagens médicas tridimensionais. Para tanto, é explorado o framework O-FIm/CO (do inglês, Oracle for Images and Complex Outputs) que utiliza conceitos de Recuperação de Imagens Baseada em Conteúdo (do inglês, Content-Based Image Retrieval CBIR) como uma forma de automatizar oráculos de teste. Além de adaptações e extensões do framework, desenvolveram-se plug-ins que representam extratores de características de imagens médicas tridimensionais de vasos sanguíneos. Para evidenciar a eficácia da abordagem, foram conduzidos dois estudos experimentais objetivando avaliar a eficácia e a precisão dos oráculos de teste baseados em características na avaliação desse tipo de imagem. Além disso, realizou-se um estudo experimental comparando os oráculos de teste baseados em características e oráculos humanos. Os resultados evidenciam a eficácia da abordagem como uma estratégia promissora para automatizar atividades de teste, contribuindo para a redução de tempo e esforços gerados por abordagens manuais durante a avaliação da qualidade de sistemas geradores de imagens médicas tridimensionais. / Automated testing activities significantly contribute to cost reduction and project productivity during the software development process. Automated testing reduces human effort and increases the quality of the final product. However, the high complexity of contemporary SUT outputs limits, in some cases, the application of automated test strategies. Systems with graphical/audio outputs, three-dimensional imaging, graphical user interfaces and some web applications are examples of systems with complex outputs. The lack of automated test oracles leads to the application of manual tests performed by the tester (human oracle) in an informal, ad-hoc and unproductive manner. One possible contribution to alleviate the testers efforts is to implement test oracles based on the extraction of characteristics from the SUT outputs. Results from previous work show that such an approach contributes to increase test productivity, mitigating and complementing manual efforts. This dissertation proposes and evaluates automated test oracles for systems whose outputs consist of three-dimensional medical images. To do so, the framework O-FIm/CO (Oracle for Images and Complex Outputs) that uses CBIR (Content-Based Image Retrieval) concepts is explored as a strategy to automate test oracles. In addition to adaptations and extensions of the framework, plug-ins were developed which represent extractors of three-dimensional medical image characteristics of blood vessels. To demonstrate the efficacy of the approach, two experimental studies were conducted to evaluate the efficacy and accuracy of feature-based test oracles in the evaluation of such images. Moreover, an experimental study was conducted to compare feature-based test oracles with human oracles. The results show the efficacy of the approach as a promising strategy to automate testing activities, contributing to the reduction of time and effort generated by manual approaches during the quality assessment of three-dimensional medical imaging systems.

O trauma pélvico apresenta alta morbi-mortalidade, especialmente nos casos de dupla ruptura do anel pélvico (AP), devido à hemorragia. O objetivo deste trabalho é observar o tempo transcorrido até a realização do tratamento endovascular (TE), a sua eficácia e a estratégia de exames complementares empregado. 53 pacientes com fratura de bacia póstraumática foram submetidos a embolização arterial num estudo retro e prospectivo, realizado no período de janeiro de 2000 e dezembro de 2005. A idade dos pacientes variou entre 93 e 17 anos, com média de 37,5 anos. Houve predomínio do sexo masculino, com cerca de 62,2%. A causa do trauma mais freqüente foi o acidente de moto em 36% dos casos. Predominaram as fraturas com dupla ruptura do AP em 71,6 % dos casos. 49 pacientes apresentavam instabilidade hemodinâmica, e desses, todos receberam derivados sanguíneos previamente à realização do TE. Neste estudo 38,7% (n = 19) dos pacientes instáveis foram submetidos ao exame de tomografia computadorizada (TC) antes do TE, o tempo médio desse grupo para atingir a sala de radiologia vascular foi de 230,45 minutos. Nos pacientes enviados diretamente à arteriografia com intenção terapêutica, o tempo médio até início da realização do tratamento foi de 146,77 minutos. A diferença entre as taxas de mortalidade precoce nos grupos de pacientes submetidos ou não a TC previamente ao TE foi de 5,63%. O choque hemorrágico foi à causa de óbito em 63,33% dos pacientes que apresentaram mortalidade precoce. Na conduta inicial desses pacientes preconiza-se realizar o menor número de intervenções até o controle da hemorragia. O tempo transcorrido até a chegada na sala de radiologia vascular é fator importante no prognóstico dos pacientes com fraturas hemorrágicas da bacia. O TE precoce é uma importante ferramenta nos pacientes hemodinamicamente instáveis inicialmente / Pelvic trauma presents high morbi-mortality specially in cases of double rupture of pelvic ring due to hemorrhages. The objective of this work is to observe the time period since the rupture till the execution of endovascular treatment (ET) as well as the effectiveness and strategy for the used complementary exam. 53 patients with pos-traumatic pelvic fracture were submitted to arterial embolization during retro and prospective study. Such study was executed during the period of January 2000 to December 2005. The age of the patients varied between 17 and 93 years old, average 37.5 year old and predominantly men at about 62.2% of the cases. The most frequent cause of the traumas, 36%, was motorcycle accident. Predominantly fractures with double rupture of the pelvic ring, that is 71.6% of the cases. 49 patients presented hemodynamic instability, all of them received blood derivatives previously to the ET execution. In this study 38.7% (n=19) of the unstable patients were submitted to computerized tomography exam (CT) before the ET. The average period of time for this group to reach the room of vascular radiology was 230.45 min. For patients sent straight to arteriography with therapeutic intention, the average period time was 146.77 min. The difference, between the early mortality rate of the group undertaken or not to the CT previously to the ET, was 5.63%. The hemorrhagic shock was the cause of death in 63.33% patients, who presented early mortality. For the initial on going study of these patients, we recommend to accomplish the least number of interventions until hemorrhage is controlled. The elapsed time till the arrival at the vascular radiology room is an important factor to make prognosis about patients with hemorrhagic pelvic fractures. The early ET is an important tool for patients with hemodynamic instability

<p>In unstable coronary artery disease (CAD) it still is a matter of debate which patients should undergo early revascularisation. In the FRISC II study (n=2457) an early invasive strategy was, compared to a primarily non-invasive strategy, associated with reduced mortality and myocardial infarction (MI) rates. However, in this heterogeneous group of patients, tools for an appropriate selection to revascularisation are needed.</p><p>From the FRISC II study we evaluated the prognosis, the angiographic extent of CAD and the effects of an early invasive strategy in relation to risk variables on admission.</p><p>The occurrence of ST depression and/or elevated levels of Troponin T were associated with a higher risk for death and MI, more severe CAD and also with a reduction of death or MI by the early invasive strategy.</p><p>Elevated levels of the inflammatory markers C-reactive protein (CRP) and interleukin-6 (Il-6) were associated with a higher mortality but an unchanged MI rate. Elevated levels of Il-6, but not CRP, identified patients with a large reduction of mortality by the invasive strategy.</p><p>Age ≥ 70 years, male gender, diabetes, previous MI, ST depression and elevated levels of troponin and markers of inflammation were independently associated with an adverse outcome. The FRISC-score was constructed using these 7 variables. At FRISC-score ≥ 5 an early invasive strategy markedly reduced mortality and MI, at FRISC–score 3-4 death/MI was reduced, whereas in patients with a FRISC-score 0-2 neither mortality nor death/MI was influenced.</p><p>In unstable CAD, a non-invasive strategy seems justified only for patients at low risk, i.e. FRISC score < 2. In patients with intermediate and high risk, i.e. FRISC-score ≥ 3, an early invasive strategy is recommended.</p>

<p>Three-dimensional rotational angiography (3D-RA) is an established method within the field of interventional neuroradiology. The method has also a great potential in other areas with a complicated arterial anatomy. The purpose of this study was firstly to develop an investigative protocol for 3D-RA in renal transplanted patients with threatening allograft failure in diagnosing stenosis in the transplanted renal artery; secondly the protocol was evaluated and compared with a modified protocol including reduced contrast medium load. Furthermore, the advantages of the 3D reconstructions compared to the angiographic images were evaluated, likewise if an extended angle of rotation reduced the artifacts in the 3D reconstructions. The two protocols were compared with regard to image quality and acute nephrotoxicity. The accuracy of Doppler ultrasonography and the result of percutaneous transluminal angioplasty (PTA) were also assessed.</p><p>3D-RA was consecutively performed in 57 renal transplanted patients with suspicion of renal artery stenosis. A significant stenosis was found in 49% of the patients. The 3D reconstructions profiled 43% of the transplant renal artery stenoses better than the angiographic images. An extended angle of rotation reduced the artifacts. There was no statistical difference regarding image quality between the two protocols, and the renal function was equally affected in both protocols. Doppler ultrasonography sensitivity was 100%; specificity was 48% and positive predictive value 67%. PTA had a technical success rate of 92% and a clinical success rate of 75% after 3 months.</p><p>3D-RA is a helpful supplement in cases with complicated vascular anatomy, especially when PTA may be indicated. The 3D reconstructions profile the course of the artery more frequently than the angiographic images and support PTA. The 3D reconstructions are degraded of artifacts. Sampling artifacts can be diminished by increased C-arm rotation and increased number of projections. The distortions caused by beam hardening remain to be solved.</p>