Thesis (M.Phil.)--Hong Kong University of Science and Technology, 2006. / Includes bibliographical references (leaves 73-78). Also available in electronic version.

As imagens de Angiografia por Ressonância Magnética (angio-RM) e Tomografia Computadorizada (angio-TC) são ferramentas amplamente usadas em processos de quantificação vascular e no diagnóstico de doenças cardiovasculares, as quais são consideradas entre as principais causas de morte. Contudo, a análise dos vasos em larga escala a partir das imagens é dificultada, tanto pela variabilidade natural dos vasos no corpo humano, quanto pela grande quantidade de dados disponíveis. Além disso, os métodos de quantificação existentes, usualmente extraem as características a partir dos esqueletos, ou até mesmo das próprias imagens de angiografia, razão pela qual tais métodos podem fazer necessária a reanálise das imagens repetidas vezes. Com o intuito de facilitar a análise e de fornecer uma ferramenta de apoio ao diagnóstico, neste trabalho são apresentados um modelo de representação textual de redes vasculares e uma metodologia de quantificação vascular automática, que é feita a partir dessa representação. A representação é obtida a partir da segmentação de imagens volumétricas de angio-RM e angio-TC, seguida da extração de trajetórias e diâmetros de redes vasculares. Tal representação é híbrida, combinando grafos e uma sequência textual de instruções, e permite não apenas a extração de caraterísticas morfológicas da rede vascular, como também a compressão das imagens e, ainda, a reconstrução de imagens similares às imagens originais. A partir das características extraídas, foram realizados estudos comparativos entre arquiteturas vasculares, o que é feito tanto por meio do uso de imagens sintéticas, como por meio de imagens reais, imagens nas quais foi possível encontrar diferenças entre arquiteturas, além de viabilizar a caracterização de aneurismas em um indivíduo. Paralelamente, desenvolvemos um método que permite identificar similaridade entre segmentos vasculares, o que por sua vez possibilita o reconhecimento e rotulação de segmentos em um conjunto de redes vasculares. A metodologia por nós desenvolvida deve também auxiliar no desenvolvimento de processos de classificação de vasos sanguíneos, de ferramentas para o diagnóstico automático de doenças vasculares, e para a melhora de técnicas utilizadas na prática clínica. / Magnetic Resonance Angiography (angio-MR) and Computed Tomography Angiography (angio-TC) are widely used imaging techniques used for vascular quantification and the diagnosis of cardiovascular diseases, considered one of the main causes of death. Blood vessel analysis using angiographic images is intrisically difficult because of the natural human vessel variability and the large amount of information. Additionally, most quantification methods perform the analysis of entire datasets, which can be very time consuming when they need to be reanalyzed. With the aim of reducing these problems and to provide a tool to aid diagnosis, we propose a textual representation model for vascular networks and an automatic vascular quantification methodology. The representation is obtained from volumetric image segmentation of angio-MR and angio-TC, followed by the extraction of the trajectory and the blood vessel diameters. This representation is hybrid in nature, combining graphs and a sequence of textual instructions, allowing for the extraction of morphological features, image compression, and the synthesis of angiographic images. Using extracted features derived from the model, comparative studies of vascular architecture can be performed. Experiments were made using synthetic and real images, in which was possible to find structural differences that make feasible to characterize abnormalities such as aneurysms. Also, a vessel similarity identification method was developed, which makes it possible to recognize vessel segments and label them in a set of vessel networks. The proposed methodology should aid in blood vessel classification processes, automatic diagnosis of cardiovascular diseases, and allow development of methods and applications that could be used in the clinical practice.

The professional work of a radiographer encompasses both patient care and the use of technology. The technology employed could either be analogue or digital technology. Since 1973, the analogue imaging system has slowly been replaced by digital radiography imaging systems. Despite the many advantages of digital imaging it does present the radiographer with added responsibilities. Furthermore, analogue-trained radiographers have found adjusting to digital imaging especially challenging. The aim of the study was to explore and describe the experiences of analogue-trained radiographers utilising digital imaging in projection radiography with the intention of developing guidelines to equip radiography managers to assist analogue-trained radiographers to better utilise digital imaging. The researcher used Schlossberg’s Transition Theory as a lens to look at the experiences of analogue-trained radiographers using digital imaging to produce radiographs. The research study used a qualitative design which was explorative, descriptive and contextual in nature. The target population included all diagnostic radiographers (public and private) in the local municipality who were registered with the Health Professions Council of South Africa. Purposive sampling was employed to select the radiographers that represented all radiographers in the Nelson Mandela Bay Health District. The sample included all radiographers who fulfilled the identified selection criteria. The selected participants were recruited to take part in in-depth, semi-structured individual interviews. The data was analysed using a computer-aided qualitative data analysis software package, ATLAS.ti. The trustworthiness of this study was ensured by applying Guba’s model of trustworthiness that includes credibility, transferability, dependability and confirmability. The ethical principles of respect for persons, beneficence and justice, as espoused by the Belmont Report, were adhered to in order to ensure that the study was conducted in an ethical manner. Two themes emanated from the data, namely the evolution of the radiographer when faced with the advances in technology as well the role that the work environment played in the manner that the participants experienced the change. The experiences of the participants were described using direct quotations from the interviews and a literature control was used to verify the participants’ experiences. Evidence was found of radiographer indifference towards exposure selection, dose optimisation and placement of anatomical side markers when utilising digital imaging. Finally, guidelines were developed to equip radiography managers to assist analogue-trained radiographers to better utilise digital imaging. In addition, the guidelines will assist all other radiographers to better utilise digital imaging.

A espécie asinina (E. asinus) teve sua origem há milhares de anos, se desenvolvendo a partir de um tronco comum ao do eqüino doméstico que conhecemos. Vem passando por um processo adaptativo, apresentando características distintas, quando os observamos em diversas partes do planeta. Na região nordeste do Brasil, desenvolve um papel fundamental, influenciando diretamente na renda das famílias locais. Tendo em vista o grande número de afecções locomotoras e a falta de cuidados a que estão submetidos, realizou-se um estudo anatômico e radiográfico da região distal de seus membros torácicos, buscando-se subsídios a prática clínica e cirúrgica dedicada a esses animais, bem como a compreensão de sua maior resistência a lesões locomotoras, quando comparado ao eqüino. A avaliação anatômica revelou características musculares semelhantes as já descritas para eqüinos. O exame radiográfico evidenciou lesões severas, caracterizadas por osteíte podal e áreas de reabsorção óssea e remodelamento na margem solear, associadas à rotação da falange distal. Ainda na avaliação radiográfica, caracterizaram-se os principais vasos arteriais dessa região através de técnica angiográfica. Não se observou correlação entre o ângulo de inclinação da muralha do casco e falange distal, com a área de secção transversal dos tendões dos músculos flexores. As maiores secções transversais para o tendão flexor digital superficial, profundo e interósseo, mostraram coincidência com os pontos de maior estresse articular, caracterizando, assim, a resistência dos asininos à lesões nestas estruturas em seu aparelho locomotor. / The asinine species was originated thousands of years ago from the same branch of the domestic equine. The asinine have been undergoing to a great adaptation resulting in different characteristics of each population of asinine around the world. In the northeast region of Brazil, they play an essential role in the income of the local families. Due to a large number of locomotor disorders and a lack of professional care, an anatomic and radiographic study of the distal forelimb region of the asinine was carried out in order to gather information to improve the clinical and surgical practice in this species, and to explain the less susceptibility to locomotor disorders compared to equines. The anatomical study showed that asinine have similar muscular characteristics already described for equines. The radiographic exam showed severe lesions, characterized by pedal osteitis, bone reabsorption areas and remodelling of sole margin associated to the distal phalanx rotation. The radiographic study also showed the characterization of the main arterial vessels. No significant correlation was observed between the angle of the hoof wall and the angle of the distal phalanx with the cross section area of the flexor tendons. The larger cross section areas of the superficial digital flexor tendon, deep digital flexor tendon and interosseus tendon were coincidental with the great articular stress, explaining the greater resistance of the asinines to lesions in those structures of their locomotor apparatus.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20283号 / 医博第4242号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 福原 俊一, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24498号 / 医博第4940号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中本 裕士, 教授 森本 尚樹, 教授 大森 孝一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No / Angiography is an important minimally invasive diagnostic procedure in endovascular interventions. Effective training for the procedure is expensive, time consuming and resource demanding. Realistic simulation has become a viable solution to addressing such challenges. However, much of previous work has been focused on software issues. In this paper, we present a novel hardware system-an interactive syringe device with haptics as an add-on hardware component to 3D VR angiography training simulator. Connected to a realistic 3D computer simulation environment, the hardware component provides injection haptic feedback effects for medical training. First, we present the design of corresponding novel electronic units consisting of many design modules. Second, we describe a curve fitting method to estimate injection dosage and injection speed of the contrast media based on voltage variation between the potentiometer to increase the realism of the simulated training. A stepper motor control method is developed to imitate the coronary pressure for force feedback of syringe. Experimental results show that the validity and feasibility of the new haptic syringe device for achieving good diffusion effects of contrast media in the simulation system. A user study experiment with medical doctors to assess the efficacy and realism of proposed simulator shows good outcomes. / National Natural Science Foundation of China (61402278), the Innovation Program of the Science and Technology Commission of Shanghai Municipality of China (16511101302), Research Program of Shanghai Engineering Research Center of Motion Picture Special Effects (16dz2251300)

Yes / Angiography is a minimally invasive diagnostic procedure in endovascular interventions. Training interventional procedures is a big challenge, due to the complexity of the procedures with the changes of measurement and visualization in blood flow rate, volume, and image contrast. In this paper, we present a novel virtual reality-based 3D interactive training platform for angiography procedure training. We propose a multi-fluid flow approach with a novel corresponding non-slip boundary condition to simulate the effect of diffusion between the blood and contrast media. A novel syringe device tool is also designed as an add-on hardware to the 3D software simulation system to model haptics through real physical interactions to enhance the realism of the simulation-based training. Experimental results show that the system can simulate realistic blood flow in complex blood vessel structures. The results are validated by visual comparisons between real angiography images and simulations. By combining the proposed software and hardware, our system is applicable and scalable to many interventional radiology procedures. Finally, we have tested the system with clinicians to assess its efficacy for virtual reality-based medical training. / National Natural Science Foundation of China grant number 61402278, the Shanghai Natural Science Foundation of China grant number 14ZR1415800, Research Program of Shanghai Engineering Research Center of Motion Picture Special Effects grant number 16dz2251300, Shanghai University Film Peak Discipline, and Shanxi Natural Science Technology Foundation grant number 2016JZ026.

Introdução. As artérias perfurantes comumente são evidenciadas durante a dissecção microcirúrgica para clipagem de aneurismas intracranianos. A oclusão de artérias perfurantes pode ser responsável por infarto encefálico isquêmico e resultados clínicos indesejáveis. O presente estudo objetiva descrever a utilidade da vídeo-angiografia intra-operatória com indocianina verde (VAIICG) na avaliação do fluxo sanguíneo em artérias perfurantes visibilizadas no campo microcirúrgico, durante a clipagem de aneurismas intracranianos. Secundariamente, foi analisada a incidência de artérias perfurantes envolvidas durante a cirurgia de aneurismas intracranianos, e a ocorrência de infarto encefálico isquêmico causado pelo comprometimento das artérias perfurantes. Método. Sessenta pacientes, com 64 aneurismas intracranianos foram tratados cirurgicamente, e prospectivamente incluídos neste estudo. A VAIICG intra-operatória foi realizada com o uso de microscópio neurocirúrgico (Carl Zeiss Co. Oberkochen, Germany) com a tecnologia VAIICG integrada. A presença e o envolvimento de artérias perfurantes foram analisados no campo microcirúrgico durante a dissecção cirúrgica, e durante a clipagem do aneurisma. A patência vascular após a clipagem também foi investigada. Apenas artérias pequenas que não foram visibilizadas nas imagens pré-operatórias de angiografia digital com subtração (ADS) foram consideradas para análise. Resultados. A VAIICG permitiu a visibilização do fluxo sanguíneo em todos os casos que apresentaram artérias perfurantes no campo microcirúrgico. Dentre 36 casos cujas artérias perfurantes estavam visíveis à VAIICG, 11 casos (30,5%) apresentaram relação próxima entre o aneurisma e artérias perfurantes. Em um paciente (9,0%), dentre os 11 casos com relação próxima, a VAIICG evidenciou oclusão de uma artéria perfurante de P1 após a aplicação do clipe, cujo reposicionamento correto restabeleceu imediatamente o fluxo sanguíneo, o qual foi visibilizado com a VAIICG, sem conseqüências clínicas. Quatro pacientes (6,7%) apresentaram infarto pós-operatório em território de artérias perfurantes, sendo que em três deles, as artérias perfurantes estavam ausentes ou distantes do aneurisma clipado. Conclusão. O envolvimento de artérias perfurantes durante a clipagem microcirúrgica de aneurismas intracranianos é comum. A VAIICG intra-operatória fornece informação visual do fluxo sanguíneo em artérias de calibre milimétrico, e seu uso possibilita evitar a oclusão de artérias perfurantes e subseqüente infarto encefálico. / Background. Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries may be responsible for ischemic infarction and poor outcome. The goal of this study was to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition we analyzed the incidence of perforating vessels involved during the aneurysms surgery and the incidence of ischemic infarct caused by compromising of these small arteries. Method. Sixty patients harboring 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co. Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries was analyzed in the microsurgical field, during surgical dissection, and during the clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography (DSA) were considered for analysis. Results. In all cases in which perforating vessels were found in the microscope field, the ICGA was able to visualize flow. Among 36 cases whose perforating vessels were visible on ICGA, 11 cases (30,5%) presented a close relation between the aneurysm and perforating arteries. In one patient (9,0%), among these 11 cases with close relation, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate re-establishment of flow visible with ICGA without clinical consequences. Four patients (6,7%) presented with postoperative perforating artery infarct of whom in 3 patients the perforating arteries were either not visible or distant from the aneurysm. Conclusion. The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA provide visual information with regard to patency of these milimetric vessels, which may avoid their occlusion and further ischemic infarction.

Introdução. As artérias perfurantes comumente são evidenciadas durante a dissecção microcirúrgica para clipagem de aneurismas intracranianos. A oclusão de artérias perfurantes pode ser responsável por infarto encefálico isquêmico e resultados clínicos indesejáveis. O presente estudo objetiva descrever a utilidade da vídeo-angiografia intra-operatória com indocianina verde (VAIICG) na avaliação do fluxo sanguíneo em artérias perfurantes visibilizadas no campo microcirúrgico, durante a clipagem de aneurismas intracranianos. Secundariamente, foi analisada a incidência de artérias perfurantes envolvidas durante a cirurgia de aneurismas intracranianos, e a ocorrência de infarto encefálico isquêmico causado pelo comprometimento das artérias perfurantes. Método. Sessenta pacientes, com 64 aneurismas intracranianos foram tratados cirurgicamente, e prospectivamente incluídos neste estudo. A VAIICG intra-operatória foi realizada com o uso de microscópio neurocirúrgico (Carl Zeiss Co. Oberkochen, Germany) com a tecnologia VAIICG integrada. A presença e o envolvimento de artérias perfurantes foram analisados no campo microcirúrgico durante a dissecção cirúrgica, e durante a clipagem do aneurisma. A patência vascular após a clipagem também foi investigada. Apenas artérias pequenas que não foram visibilizadas nas imagens pré-operatórias de angiografia digital com subtração (ADS) foram consideradas para análise. Resultados. A VAIICG permitiu a visibilização do fluxo sanguíneo em todos os casos que apresentaram artérias perfurantes no campo microcirúrgico. Dentre 36 casos cujas artérias perfurantes estavam visíveis à VAIICG, 11 casos (30,5%) apresentaram relação próxima entre o aneurisma e artérias perfurantes. Em um paciente (9,0%), dentre os 11 casos com relação próxima, a VAIICG evidenciou oclusão de uma artéria perfurante de P1 após a aplicação do clipe, cujo reposicionamento correto restabeleceu imediatamente o fluxo sanguíneo, o qual foi visibilizado com a VAIICG, sem conseqüências clínicas. Quatro pacientes (6,7%) apresentaram infarto pós-operatório em território de artérias perfurantes, sendo que em três deles, as artérias perfurantes estavam ausentes ou distantes do aneurisma clipado. Conclusão. O envolvimento de artérias perfurantes durante a clipagem microcirúrgica de aneurismas intracranianos é comum. A VAIICG intra-operatória fornece informação visual do fluxo sanguíneo em artérias de calibre milimétrico, e seu uso possibilita evitar a oclusão de artérias perfurantes e subseqüente infarto encefálico. / Background. Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries may be responsible for ischemic infarction and poor outcome. The goal of this study was to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition we analyzed the incidence of perforating vessels involved during the aneurysms surgery and the incidence of ischemic infarct caused by compromising of these small arteries. Method. Sixty patients harboring 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co. Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries was analyzed in the microsurgical field, during surgical dissection, and during the clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography (DSA) were considered for analysis. Results. In all cases in which perforating vessels were found in the microscope field, the ICGA was able to visualize flow. Among 36 cases whose perforating vessels were visible on ICGA, 11 cases (30,5%) presented a close relation between the aneurysm and perforating arteries. In one patient (9,0%), among these 11 cases with close relation, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate re-establishment of flow visible with ICGA without clinical consequences. Four patients (6,7%) presented with postoperative perforating artery infarct of whom in 3 patients the perforating arteries were either not visible or distant from the aneurysm. Conclusion. The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA provide visual information with regard to patency of these milimetric vessels, which may avoid their occlusion and further ischemic infarction.