Air Fraction Correction Optimisation in PET Imaging of Lung Disease

Accurate quantification of radiopharmaceutical uptake from lung PET/CT is challenging due to large variations in fractions of tissue, air, blood and water. Air fraction correction (AFC) uses voxel-wise air fractions, which can be determined from the CT acquired for attenuation correction (AC). However, resolution effects can cause artefacts in either of these corrections. In this work, we hypothesise that the resolution of the CT image used for AC should match that of the intrinsic resolution of the PET scanner but should approximate the reconstructed PET image resolution for AFC. Simulations and reconstructions were performed with the Synergistic Image Reconstruction Framework (SIRF) using phantoms with inhomogeneous attenuation (mu) maps, mimicking the densities observed in lung pathologies. Poisson noise was added to the projection data prior to OSEM reconstruction. AC was performed with a smoothed mu-map, the full-width-half-maximum (FWHM) of the 3D Gaussian kernel was varied (0 - 10 mm). Post-filters were applied to the reconstructed AC images (FWHM: 0 - 8 mm). The simulated mu-map was independently convolved with another set of 3D Gaussian kernels, of varying FWHM (0 - 12 mm), for AFC. The coefficient of variation (CV) in the lung region, designed to be homogeneous post-AFC with optimised kernels, and the mean AFC-standardized uptake value (AFC-SUV) in the regions of simulated pathologies were determined. The spatial resolution of each post-filtered image was determined via a point-source insertion-and-subtraction method on noiseless data. Results showed that the CV was minimised when the kernel applied to the mu-map for AC matched that for the simulated PET scanner and the kernel applied to the mu-map for AFC matched the spatial resolution of the reconstructed PET image. This was observed for all post-reconstruction filters and supports the hypothesis. Initial results from Monte Carlo simulations validate these findings

Optimisation of the air fraction correction for lung PET/CT: addressing resolution mismatch

Background: Increased pulmonary 18 F-FDG metabolism in patients with idiopathic pulmonary fibrosis, and other forms of diffuse parenchymal lung disease, can predict measurements of health and lung physiology. To improve PET quantification, voxel-wise air fractions (AF) determined from CT can be used to correct for variable air content in lung PET/CT. However, resolution mismatches between PET and CT can cause artefacts in the AF-corrected image. Methods: Three methodologies for determining the optimal kernel to smooth the CT are compared with noiseless simulations and non-TOF MLEM reconstructions of a patient-realistic digital phantom: (i) the point source insertion-and-subtraction method, hpts ; (ii) AF-correcting with varyingly smoothed CT to achieve the lowest RMSE with respect to the ground truth (GT) AF-corrected volume of interest (VOI), hAFC ; iii) smoothing the GT image to match the reconstruction within the VOI, hPVC . The methods were evaluated both using VOI-specific kernels, and a single global kernel optimised for the six VOIs combined. Furthermore, hPVC was implemented on thorax phantom data measured on two clinical PET/CT scanners with various reconstruction protocols. Results: The simulations demonstrated that at < 200 iterations (200 i), the kernel width was dependent on iteration number and VOI position in the lung. The hpts method estimated a lower, more uniform, kernel width in all parts of the lung investigated. However, all three methods resulted in approximately equivalent AF-corrected VOI RMSEs (<10%) at ≥ 200i. The insensitivity of AF-corrected quantification to kernel width suggests that a single global kernel could be used. For all three methodologies, the computed global kernel resulted in an AF-corrected lung RMSE <10% at ≥ 200i, while larger lung RMSEs were observed for the VOI–specific kernels. The global kernel approach was then employed with the hPVC method on measured data. The optimally smoothed GT emission matched the reconstructed image well, both within the VOI and the lung background. VOI RMSE was <10%, pre-AFC, for all reconstructions investigated. Conclusions: Simulations for non-TOF PET indicated that around 200i were needed to approach image resolution stability in the lung. In addition, at this iteration number, a single global kernel, determined from several VOIs, for AFC, performed well over the whole lung. The hPVC method has the potential to be used to determine the kernel for AFC from scans of phantoms on clinical scanners

Feasibility of Image Reconstruction from Triple Modality Data of Yttrium-90

The recent implementation of the first clinical triple modality scanner in STIR enables investigation of the possibility of triple modality image reconstruction. Such a tool represents an important step toward the improvement of dosimetry for theranostics, where the exploitation of multi-modality imaging can have an impact on treatment planning and follow-up. To give a demonstration of triple modality image reconstruction we used data from a NEMA phantom that was filled with Yttrium-90 (90Y), which emits Bremsstrahlung photons detectable with SPECT as well as gamma rays that can go through pair production, therefore creating positrons that make PET acquisition possible. The data were acquired with the Mediso AnyScan SPECT/PET/CT. Different ways of including multiple side information using the kernelised expectation maximisation (KEM) and the Hybrid KEM (HKEM) were used and investigated in terms of ROI activity and noise suppression. This work presents an example of application with 90Y but it can be extended to any other radionuclide combination used in Theranostic applications

Clostridium difficile infection.

Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota

Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor

PURPOSE: To evaluate the clinical feature, operative method and prognosis of thoracic ossification of ligamentum flavum caused by skeletal fluorosis. METHODS: All the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993–2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated. RESULTS: 23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 ± 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003). CONCLUSION: Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome

Sex Differences in the Brain: A Whole Body Perspective

Most writing on sexual differentiation of the mammalian brain (including our own) considers just two organs: the gonads and the brain. This perspective, which leaves out all other body parts, misleads us in several ways. First, there is accumulating evidence that all organs are sexually differentiated, and that sex differences in peripheral organs affect the brain. We demonstrate this by reviewing examples involving sex differences in muscles, adipose tissue, the liver, immune system, gut, kidneys, bladder, and placenta that affect the nervous system and behavior. The second consequence of ignoring other organs when considering neural sex differences is that we are likely to miss the fact that some brain sex differences develop to compensate for differences in the internal environment (i.e., because male and female brains operate in different bodies, sex differences are required to make output/function more similar in the two sexes). We also consider evidence that sex differences in sensory systems cause male and female brains to perceive different information about the world; the two sexes are also perceived by the world differently and therefore exposed to differences in experience via treatment by others. Although the topic of sex differences in the brain is often seen as much more emotionally charged than studies of sex differences in other organs, the dichotomy is largely false. By putting the brain firmly back in the body, sex differences in the brain are predictable and can be more completely understood

Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia

<p>Abstract</p> <p>Background</p> <p>To date, the great majority of Russian HIV infections have been diagnosed among IDUs and concerns about the potential for a sexual transmission of HIV beyond the IDU population have increased. This study investigated differences in the prevalence of sexual risk behaviors between IDUs and non-IDUs in St. Petersburg, Russia and assessed associations between substance use patterns and sexual risks within and between those two groups.</p> <p>Methods</p> <p>Cross-sectional survey data and biological test results from 331 IDUs and 65 non-IDUs who have IDU sex partners were analyzed. Multivariate regression was employed to calculate measures of associations.</p> <p>Results</p> <p>IDUs were less likely than non-IDUs to report multiple sexual partners and unprotected sex with casual partners. The quantity, frequency and intensity of alcohol use did not differ between IDUs and non-IDUs, but non-IDUs were more likely to engage in alcohol use categorized as risky per the alcohol use disorders identification test (AUDIT-C). Risky sexual practices were independently associated with monthly methamphetamine injection among IDUs and with risky alcohol use among non-IDUs. Having sex when high on alcohol or drugs was associated with unprotected sex only among IDUs.</p> <p>Conclusions</p> <p>Greater prevalence of sexual risk among non-IDUs who have IDU sex partners compared to IDUs suggests the potential for sexual transmission of HIV from the high-prevalence IDU population into the general population. HIV prevention programs among IDUs in St. Petersburg owe special attention to risky alcohol use among non-IDUs who have IDU sex partners and the propensity of IDUs to have sex when high on alcohol or drugs and forgo condoms.</p

Do longer consultations improve the management of psychological problems in general practice? A systematic literature review

<p>Abstract</p> <p>Background</p> <p>Psychological problems present a huge burden of illness in our community and GPs are the main providers of care. There is evidence that longer consultations in general practice are associated with improved quality of care; but this needs to be balanced against the fact that doctor time is a limited resource and longer consultations may lead to reduced access to health care.</p> <p>The aim of this research was to conduct a systematic literature review to determine whether management of psychological problems in general practice is associated with an increased consultation length and to explore whether longer consultations are associated with better health outcomes for patients with psychological problems.</p> <p>Methods</p> <p>A search was conducted on Medline (Ovid) databases up to7 June 2006. The following search terms, were used:</p> <p>general practice or primary health care (free text) or family practice (MeSH)</p> <p>AND consultation length or duration (free text) or time factors (MeSH)</p> <p>AND depression or psychological problems or depressed (free text).</p> <p>A similar search was done in Web of Science, Pubmed, Google Scholar, and Cochrane Library and no other papers were found.</p> <p>Studies were included if they contained data comparing consultation length and management or detection of psychological problems in a general practice or primary health care setting. The studies were read and categories developed to enable systematic data extraction and synthesis.</p> <p>Results</p> <p>29 papers met the inclusion criteria. Consultations with a recorded diagnosis of a psychological problem were reported to be longer than those with no recorded psychological diagnosis. It is not clear if this is related to the extra time or the consultation style. GPs reported that time pressure is a major barrier to treating depression. There was some evidence that increased consultation length is associated with more accurate diagnosis of psychological problems.</p> <p>Conclusion</p> <p>Further research is needed to elucidate the factors in longer consultations that are associated with greater detection of psychological problems, and to determine the association between the detection of psychological problems and the attitude, gender, age or training of the GP and the age, gender and socioeconomic status of the patient. These are important considerations if general practice is to deal more effectively with people with psychological problems.</p

Individualism and stock price crash risk

Employing a sample of 26,473 firms across 42 countries from 1990 to 2013, we find that firms located in countries with higher individualism have higher stock price crash risk. Furthermore, individualism can be transmitted by foreign investors from overseas markets to influence local firms’ crash risk, and can exacerbate the impact of firm risk taking and earnings management on crash risk. Moreover, the positive relation between individualism and crash risk is amplified during the global financial crisis and attenuated by enhanced country-level financial information transparency and the adoption of International Financial Reporting Standards