Role of MDCT coronary angiography in the clinical setting: economic implications

PURPOSE:This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup.MATERIAL AND METHODS:Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary).RESULTS:Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol.CONCLUSIONS:The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile

Enhanced high-dispersion coronagraphy with KPIC phase II: design, assembly and status of sub-modules

The Keck Planet Imager and Characterizer (KPIC) is a purpose-built instrument for high-dispersion coronagraphy in the K and L bands on Keck. This instrument will provide the first high resolution (R>30,000) spectra of known directly imaged exoplanets and low-mass brown dwarf companions visible in the northern hemisphere. KPIC is developed in phases. Phase I is currently at Keck in the early operations stage, and the phase II upgrade will deploy in late 2021. The goal of phase II is to maximize the throughput for planet light and minimize the stellar leakage, hence reducing the exposure time needed to acquire spectra with a given signal-to- noise ratio. To achieve this, KPIC phase II exploits several innovative technologies that have not been combined this way before. These include a 1000-element deformable mirror for wavefront correction and speckle control, a set of lossless beam shaping optics to maximize coupling into the fiber, a pupil apodizer to suppress unwanted starlight, a pupil plane vortex mask to enable the acquisition of spectra at and within the diffraction limit, and an atmospheric dispersion compensator. These modules, when combined with the active fiber injection unit present in phase I, will make for a highly efficient exoplanet characterization platform. In this paper, we will present the final design of the optics and opto-mechanics and highlight some innovative solutions we implemented to facilitate all the new capabilities. We will provide an overview of the assembly and laboratory testing of the sub-modules and some of the results. Finally, we will outline the deployment timeline

Imaging of the Inner Zone of Blast Furnaces Using MuonRadiography: The BLEMAB Project

The aim of the BLEMAB project (BLast furnace stack density Estimation through online Muons ABsorption measurements) is the application of muon radiography techniques, to image a blast furnace’s inner zone. In particular, the goal of the study is to characterize the geometry and size of the so-called “cohesive zone”, i.e., the spatial region where the slowly downward-moving material begins to soften and melt, which plays such an important role in the performance of the blast furnace itself. Thanks to the high penetration power of natural cosmic-ray muon radiation, muon transmission radiography could be an appropriate non invasive methodology for the imaging of large high-density structures such as a blast furnace, whose linear dimensions can be up to a few tens of meters. A state-of-the-art muon tracking system is currently in development and will be installed at a blast furnace on the ArcelorMittal site in Bremen (Germany), where it will collect data for a period of various months. In this paper, the status of the project and the expectations based on preliminary simulations are presented and briefly discussed

Supramolecularly directed rotary motion in a photoresponsive receptor

Stimuli-controlled motion at the molecular level has fascinated chemists already for several decades. Taking inspiration from the myriad of dynamic and machine-like functions in nature, a number of strategies have been developed to control motion in purely synthetic systems. Unidirectional rotary motion, such as is observed in ATP synthase and other motor proteins, remains highly challenging to achieve. Current artificial molecular motor systems rely on intrinsic asymmetry or a specific sequence of chemical transformations. Here, we present an alternative design in which the rotation is directed by a chiral guest molecule, which is able to bind non-covalently to a light-responsive receptor. It is demonstrated that the rotary direction is governed by the guest chirality and hence, can be selected and changed at will. This feature offers unique control of directional rotation and will prove highly important in the further development of molecular machinery

Keck Planet Imager and Characterizer: demonstrating advanced exoplanet characterization techniques for future extremely large telescopes (Conference Presentation)

The Keck Planet Imager and Characterizer (KPIC) is an upgrade to the Keck II adaptive optics system enabling high contrast imaging and high-resolution spectroscopic characterization of giant exoplanets in the mid-infrared (2-5 microns). The KPIC instrument will be developed in phases. Phase I entails the installation of an infrared pyramid wavefront sensor (PyWFS) based on a fast, low-noise SAPHIRA IR-APD array. The ultra-sensitive infrared PyWFS will enable high contrast studies of infant exoplanets around cool, red, and/or obscured targets in star forming regions. In addition, the light downstream of the PyWFS will be coupled into an array of single-mode fibers with the aid of an active fiber injection unit (FIU). In turn, these fibers route light to Keck's high-resolution infrared spectrograph NIRSPEC, so that high dispersion coronagraphy (HDC) can be implemented for the first time. HDC optimally pairs high contrast imaging and high-resolution spectroscopy allowing detailed characterization of exoplanet atmospheres, including molecular composition, spin measurements, and Doppler imaging. We will provide an overview of the instrument, its science scope, and report on recent results from on-sky commissioning of Phase I. We will discuss plans for optimizing the instrument to seed designs for similar modes on extremely large telescopes

The BLEMAB European project: Muon radiography as an imaging tool in the industrial field

The European project called BLEMAB (BLast furnace stack density Estimation through on-line Muons ABsorption measurements), provides for the application of the muon radiography technique in the industrial environment. The project represents a non-invasive way of monitoring a blast furnace and in particular aims to study the geometric and density development of the so-called “cohesive zone”, which is important for the performance of the blast furnace itself. The installation of the detectors is expected in 2022 at the ArcelorMittal site in Bremen (Germany). This paper describes the status of the project, the experimental setup and the first results obtained with preliminary simulations. © 2022 Societa Italiana di Fisica. All rights reserved