Diseases of the Chest, Breast, Heart and Vessels 2019-2022

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology

Diseases of the Chest, Breast, Heart and Vessels 2019-2022

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology

PadChest: A large chest x-ray image dataset with multi-label annotated reports

We present a labeled large-scale, high resolution chest x-ray dataset for the automated exploration of medical images along with their associated reports. This dataset includes more than 160,000 images obtained from 67,000 patients that were interpreted and reported by radiologists at Hospital San Juan Hospital (Spain) from 2009 to 2017, covering six different position views and additional information on image acquisition and patient demography. The reports were labeled with 174 different radiographic findings, 19 differential diagnoses and 104 anatomic locations organized as a hierarchical taxonomy and mapped onto standard Unified Medical Language System (UMLS) terminology. Of these reports, 27% were manually annotated by trained physicians and the remaining set was labeled using a supervised method based on a recurrent neural network with attention mechanisms. The labels generated were then validated in an independent test set achieving a 0.93 Micro-F1 score. To the best of our knowledge, this is one of the largest public chest x-ray database suitable for training supervised models concerning radiographs, and the first to contain radiographic reports in Spanish. The PadChest dataset can be downloaded from http://bimcv.cipf.es/bimcv-projects/padchest/

3-D lung deformation and function from respiratory-gated 4-D x-ray CT images : application to radiation treatment planning.

Many lung diseases or injuries can cause biomechanical or material property changes that can alter lung function. While the mechanical changes associated with the change of the material properties originate at a regional level, they remain largely asymptomatic and are invisible to global measures of lung function until they have advanced significantly and have aggregated. In the realm of external beam radiation therapy of patients suffering from lung cancer, determination of patterns of pre- and post-treatment motion, and measures of regional and global lung elasticity and function are clinically relevant. In this dissertation, we demonstrate that 4-D CT derived ventilation images, including mechanical strain, provide an accurate and physiologically relevant assessment of regional pulmonary function which may be incorporated into the treatment planning process. Our contributions are as follows: (i) A new volumetric deformable image registration technique based on 3-D optical flow (MOFID) has been designed and implemented which permits the possibility of enforcing physical constraints on the numerical solutions for computing motion field from respiratory-gated 4-D CT thoracic images. The proposed optical flow framework is an accurate motion model for the thoracic CT registration problem. (ii) A large displacement landmark-base elastic registration method has been devised for thoracic CT volumetric image sets containing large deformations or changes, as encountered for example in registration of pre-treatment and post-treatment images or multi-modality registration. (iii) Based on deformation maps from MOFIO, a novel framework for regional quantification of mechanical strain as an index of lung functionality has been formulated for measurement of regional pulmonary function. (iv) In a cohort consisting of seven patients with non-small cell lung cancer, validation of physiologic accuracy of the 4-0 CT derived quantitative images including Jacobian metric of ventilation, Vjac, and principal strains, (V?1, V?2, V?3, has been performed through correlation of the derived measures with SPECT ventilation and perfusion scans. The statistical correlations with SPECT have shown that the maximum principal strain pulmonary function map derived from MOFIO, outperforms all previously established ventilation metrics from 40-CT. It is hypothesized that use of CT -derived ventilation images in the treatment planning process will help predict and prevent pulmonary toxicity due to radiation treatment. It is also hypothesized that measures of regional and global lung elasticity and function obtained during the course of treatment may be used to adapt radiation treatment. Having objective methods with which to assess pre-treatment global and regional lung function and biomechanical properties, the radiation treatment dose can potentially be escalated to improve tumor response and local control

Pulmonary manifestations in smoking-related diseases : clinical studies with emphasis on chronic obstructive pulmonary disease and rheumatoid arthritis

Smoking is a risk factor for a number of diseases including chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis (RA). Cigarette smoke initiates an inflammatory response which leads to structural changes in the airways and in the lung parenchyma. The present work was undertaken in order to shed light on pulmonary manifestations of two common smoking-related diseases, COPD and RA. A retrospective review on bronchoalveolar lavage (BAL) constituents, encompassing 132 smokers with normal lung function and 44 ex-smokers, was performed. Two hundred and ninety- five neversmokers served as reference group. The median (5-95 percentile) cell concentration in smokers were 382.1 (189.7-864.3) X 106 /L which was higher compared to the neversmokers. The majority of cells were alveolar macrophages (median 96.7%; range 73.2-99.6%, lymphocytes (2%; range 0.2-26%) and neutrophils (0.6%; range 0-6%). Cell concentration was positively correlated to cumulative smoking history. One hundred and five patients with newly-diagnosed RA, (70% ACPA+), underwent high resolution computer tomography (HRCT) examination and a sub group of 23 patients also performed bronchoscopy and BAL. A group of 43 non-diseased smokers and never smokers were examined as control. Parenchymal lung abnormality on HRCT was found in 63% of ACPA+ compared to 37% ACPA- RA patients, 30% control regardless of smoking status. The level of ACPA was higher in BAL fluid than sera in ACPA+ RA patients. Forty smokers with normal lung function,(mean 35 pack-years), 40 healthy never-smokers, and 40 COPD-patients of GOLD,I-II, (38 PY), performed HRCT. In addition BAL was performed. Percentage of pixelsbetween -750- -900 HU (%HDS) was calculated. Lung density was increased in smokers (44.0% ± 5.8%) compared to never smokers (38.3 ± 5.8%), p<0.001. Cell concentration in BAL was positively correlated to lung density in smokers (r=0.50, p<0.001). Females had denser lungs than males. Regional air trapping was assessed on expiatory HRCT on 40 never-smokers, 40 smokers and 40 COPD-patients. Emphysema, micronoduli, bronchial wall thickening was determined on inspiratory HRCT. Air trapping index (AI) was quantified as the ratio of mean lung attenuation at expiration and inspiration. Regional air trapping was present in 63% of smokers and 45% of never smokers. Smokers with visible regional air trapping had an AI of 0.81, while smokers without visible air trapping had an AI of 0.91. A negative correlation between AI and neutrophils in BAL was observed. Smokers with regional air trapping had better lung function and less emphysema compared to smokers without. We demonstrate inflammatory and structural changes in the lungs in smokers by means of HRCT and BAL. These changes are apparent even before clinical symptoms occur. The studies highlight the heterogeneity in smoking-related diseases which may be of importance in terms of disease progression and patient phenotypes

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society