Effectively incorporating selected multimedia content into medical publications

Until fairly recently, medical publications have been handicapped by being restricted to non-electronic formats, effectively preventing the dissemination of complex audiovisual and three-dimensional data. However, authors and readers could significantly profit from advances in electronic publishing that permit the inclusion of multimedia content directly into an article. For the first time, the de facto gold standard for scientific publishing, the portable document format (PDF), is used here as a platform to embed a video and an audio sequence of patient data into a publication. Fully interactive three-dimensional models of a face and a schematic representation of a human brain are also part of this publication. We discuss the potential of this approach and its impact on the communication of scientific medical data, particularly with regard to electronic and open access publications. Finally, we emphasise how medical teaching can benefit from this new tool and comment on the future of medical publishing

The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography.

Pocket-size imaging devices are a completely new type of echo machines which have recently reached the market. They are very cheap, smartphone-size hand-held echo machines with limited technical capabilities. The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo. EAE recommendations about pocket-size imaging devices can be summarized in: (1) pocket-size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited. (2) Imaging assessment with pocket-size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations. (3) With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket-size devices. (4) The patient has to be informed that an examination with the current generation of pocket-size imaging devices does not replace a complete echocardiogram.Peer reviewe

Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography.

BACKGROUND:A three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions (SPACE) has recently been used as a promising CMR imaging modality for evaluating extra-cranial and intra-cranial vessel walls. However, this technique is yet to be validated against the current diagnostic imaging standard. We therefore aimed to evaluate the diagnostic performance of 3D CMR VWI in characterizing carotid disease using intra-arterial digital subtraction angiography (DSA) as a reference. METHODS:Consecutive patients with at least unilateral > 50% carotid stenosis on ultrasound were scheduled to undergo interventional therapy were invited to participate. The following metrics were measured using 3D CMR VWI and DSA: lumen diameter of the common carotid artery (CCA) and segments C1-C7, stenosis diameter, reference diameter, lesion length, stenosis degree, and ulceration. We assessed the diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve of 3D CMR VWI, and used Cohen's kappa, the intraclass correlation coefficient (ICC), and Bland-Altman analyses to assess the diagnostic agreement between 3D CMR VWI and DSA. RESULTS:The ICC (all ICCs ≥0.96) and Bland-Altman plots indicated excellent inter-reader agreement in all individual morphologic measurements by 3D CMR VWI. Excellent agreement in all individual morphologic measurements were also found between 3D CMR VWI and DSA. In addition, 3D CMR VWI had high sensitivity (98.4, 97.4, 80.0, 100.0%), specificity (100.0, 94.5, 99.1, 98.0%), and Cohen's kappa (0.99, 0.89, 0.84, 0.96) for detecting stenosis > 50%, stenosis > 70%, ulceration, and total occlusion, respectively, using DSA as the standard. The AUC of 3D CMR VWI for predicting stenosis > 50 and > 70% were 0.998 and 0.999, respectively. CONCLUSIONS:The 3D CMR VWI technique enables accurate diagnosis and luminal feature assessment of carotid artery atherosclerosis, suggesting that this imaging modality may be useful for routine imaging workups and provide comprehensive information for both the vessel wall and lumen

Development of limb volume measuring system

The mechanisms underlying the reductions in orthostatic tolerance associated with weightlessness are not well established. Contradictory results from measurements of leg volume changes suggest that altered venomotor tone and reduced blood flow may not be the only contributors to orthostatic intolerance. It is felt that a more accurate limb volume system which is insensitive to environmental factors will aid in better quantification of the hemodynamics of the leg. Of the varous limb volume techniques presently available, the ultrasonic limb volume system has proven to be the best choice. The system as described herein is free from environmental effects, safe, simple to operate and causes negligible radio frequency interference problems. The segmental ultrasonic ultrasonic plethysmograph is expected to provide a better measurement of limb volume change since it is based on cross-sectional area measurements

Design of a Wearable Ultrasound System

Ultrasound imaging is a safe and powerful tool for providing detailed still and moving images of the human body. Most of today’s ultrasound systems are housed on a movable cart and designed for use within a clinical setting, such as in a hospital or doctor’s office. This configuration hinders its use in locations lacking controlled environments and stable power sources. Example locations include ambulances, disaster sights, war zones and rural medicine. A wearable ultrasound system, in the form of a vest worn by a sonographer, has been developed as a complete solution for performing untethered ultrasound examinations. The heart of the system is an enclosure containing an embedded computer running the Windows XP operating system, and a custom power supply. The power supply integrates a battery charger, a switching regulator, two linear regulators, a variable speed fan controller and a microcontroller providing an interface for monitoring and control to the embedded computer. Operation of the system is generally accomplished through the use of voice commands, but it may also be operated using a hand-held mouse. It is capable of operating for a full day, using two batteries contained in the vest. In addition, the system has the capability to wirelessly share live images with remote viewers in real-time, while also permitting full duplex voice communication. An integrated web-server also provides for the wireless retrieval of stored images, image loops and other information using a web-browser

Design of a Wearable Ultrasound System

Ultrasound imaging is a safe and powerful tool for providing detailed still and moving images of the human body. Most of today’s ultrasound systems are housed on a movable cart and designed for use within a clinical setting, such as in a hospital or doctor’s office. This configuration hinders its use in locations lacking controlled environments and stable power sources. Example locations include ambulances, disaster sights, war zones and rural medicine. A wearable ultrasound system, in the form of a vest worn by a sonographer, has been developed as a complete solution for performing untethered ultrasound examinations. The heart of the system is an enclosure containing an embedded computer running the Windows XP operating system, and a custom power supply. The power supply integrates a battery charger, a switching regulator, two linear regulators, a variable speed fan controller and a microcontroller providing an interface for monitoring and control to the embedded computer. Operation of the system is generally accomplished through the use of voice commands, but it may also be operated using a hand-held mouse. It is capable of operating for a full day, using two batteries contained in the vest. In addition, the system has the capability to wirelessly share live images with remote viewers in real-time, while also permitting full duplex voice communication. An integrated web-server also provides for the wireless retrieval of stored images, image loops and other information using a web-browser

Ballistic research techniques: visualizing gunshot wounding patterns

There are difficulties associated with mapping gunshot wound (GSW) patterns within opaque models. Depending on the damage measurement parameters required, there are multiple techniques that can provide methods of “seeing” the GSW pattern within an opaque model. The aim of this paper was to test several of these techniques within a cadaveric animal limb model to determine the most effective. The techniques of interest were flash X-ray, ultrasound, physical dissection, and computed-tomography (CT). Fallow deer hind limbs were chosen for the model with four limbs used for each technique tested. Quarantined 7.62 × 39 mm ammunition was used for each shot, and each limb was only shot once, on an outdoor range with shots impacting at muzzle velocity. Flash X-ray provided evidence of yaw within the limb during the projectile’s flight; ultrasound though able to visualise the GSW track, was too subjective and was abandoned; dissection proved too unreliable due to the tissue being cadaveric so also too subjective; and lastly, CT with contrast provided excellent imaging in multiple viewing planes and 3D image reconstruction; this allowed versatile measurement of the GSW pattern to collect dimensions of damage as required. Of the different techniques examined in this study, CT with contrast proved the most effective to allow precise GSW pattern analysis within a cadaveric animal limb model. These findings may be beneficial to others wishing to undertake further ballistic study both within clinical and forensic fields

An Inertial-Optical Tracking System for Quantitative, Freehand, 3D Ultrasound

Three dimensional (3D) ultrasound has become an increasingly popular medical imaging tool over the last decade. It offers significant advantages over Two Dimensional (2D) ultrasound, such as improved accuracy, the ability to display image planes that are physically impossible with 2D ultrasound, and reduced dependence on the skill of the sonographer. Among 3D medical imaging techniques, ultrasound is the only one portable enough to be used by first responders, on the battlefield, and in rural areas. There are three basic methods of acquiring 3D ultrasound images. In the first method, a 2D array transducer is used to capture a 3D volume directly, using electronic beam steering. This method is mainly used for echocardiography. In the second method, a linear array transducer is mechanically actuated, giving a slower and less expensive alternative to the 2D array. The third method uses a linear array transducer that is moved by hand. This method is known as freehand 3D ultrasound. Whether using a 2D array or a mechanically actuated linear array transducer, the position and orientation of each image is known ahead of time. This is not the case for freehand scanning. To reconstruct a 3D volume from a series of 2D ultrasound images, assumptions must be made about the position and orientation of each image, or a mechanism for detecting the position and orientation of each image must be employed. The most widely used method for freehand 3D imaging relies on the assumption that the probe moves along a straight path with constant orientation and speed. This method requires considerable skill on the part of the sonographer. Another technique uses features within the images themselves to form an estimate of each image\u27s relative location. However, these techniques are not well accepted for diagnostic use because they are not always reliable. The final method for acquiring position and orientation information is to use a six Degree-of-Freedom (6 DoF) tracking system. Commercially available 6 DoF tracking systems use magnetic fields, ultrasonic ranging, or optical tracking to measure the position and orientation of a target. Although accurate, all of these systems have fundamental limitations in that they are relatively expensive and they all require sensors or transmitters to be placed in fixed locations to provide a fixed frame of reference. The goal of the work presented here is to create a probe tracking system for freehand 3D ultrasound that does not rely on any fixed frame of reference. This system tracks the ultrasound probe using only sensors integrated into the probe itself. The advantages of such a system are that it requires no setup before it can be used, it is more portable because no extra equipment is required, it is immune from environmental interference, and it is less expensive than external tracking systems. An ideal tracking system for freehand 3D ultrasound would track in all 6 DoF. However, current sensor technology limits this system to five. Linear transducer motion along the skin surface is tracked optically and transducer orientation is tracked using MEMS gyroscopes. An optical tracking system was developed around an optical mouse sensor to provide linear position information by tracking the skin surface. Two versions were evaluated. One included an optical fiber bundle and the other did not. The purpose of the optical fiber is to allow the system to integrate more easily into existing probes by allowing the sensor and electronics to be mounted away from the scanning end of the probe. Each version was optimized to track features on the skin surface while providing adequate Depth Of Field (DOF) to accept variation in the height of the skin surface. Orientation information is acquired using a 3 axis MEMS gyroscope. The sensor was thoroughly characterized to quantify performance in terms of accuracy and drift. This data provided a basis for estimating the achievable 3D reconstruction accuracy of the complete system. Electrical and mechanical components were designed to attach the sensor to the ultrasound probe in such a way as to simulate its being embedded in the probe itself. An embedded system was developed to perform the processing necessary to translate the sensor data into probe position and orientation estimates in real time. The system utilizes a Microblaze soft core microprocessor and a set of peripheral devices implemented in a Xilinx Spartan 3E field programmable gate array. The Xilinx Microkernel real time operating system performs essential system management tasks and provides a stable software platform for implementation of the inertial tracking algorithm. Stradwin 3D ultrasound software was used to provide a user interface and perform the actual 3D volume reconstruction. Stradwin retrieves 2D ultrasound images from the Terason t3000 portable ultrasound system and communicates with the tracking system to gather position and orientation data. The 3D reconstruction is generated and displayed on the screen of the PC in real time. Stradwin also provides essential system features such as storage and retrieval of data, 3D data interaction, reslicing, manual 3D segmentation, and volume calculation for segmented regions. The 3D reconstruction performance of the system was evaluated by freehand scanning a cylindrical inclusion in a CIRS model 044 ultrasound phantom. Five different motion profiles were used and each profile was repeated 10 times. This entire test regimen was performed twice, once with the optical tracking system using the optical fiber bundle, and once with the optical tracking system without the optical fiber bundle. 3D reconstructions were performed with and without the position and orientation data to provide a basis for comparison. Volume error and surface error were used as the performance metrics. Volume error ranged from 1.3% to 5.3% with tracking information versus 15.6% to 21.9% without for the version of the system without the optical fiber bundle. Volume error ranged from 3.7% to 7.6% with tracking information versus 8.7% to 13.7% without for the version of the system with the optical fiber bundle. Surface error ranged from 0.319 mm RMS to 0.462 mm RMS with tracking information versus 0.678 mm RMS to 1.261 mm RMS without for the version of the system without the optical fiber bundle. Surface error ranged from 0.326 mm RMS to 0.774 mm RMS with tracking information versus 0.538 mm RMS to 1.657 mm RMS without for the version of the system with the optical fiber bundle. The prototype tracking system successfully demonstrated that accurate 3D ultrasound volumes can be generated from 2D freehand data using only sensors integrated into the ultrasound probe. One serious shortcoming of this system is that it only tracks 5 of the 6 degrees of freedom required to perform complete 3D reconstructions. The optical system provides information about linear movement but because it tracks a surface, it cannot measure vertical displacement. Overcoming this limitation is the most obvious candidate for future research using this system. The overall tracking platform, meaning the embedded tracking computer and the PC software, developed and integrated in this work, is ready to take advantage of vertical displacement data, should a method be developed for sensing it

Focal Spot, Spring 1995

https://digitalcommons.wustl.edu/focal_spot_archives/1069/thumbnail.jp