Los médicos judíos de Huesca, según los protocolos notariales del siglo XV

Collection and analysis of the documentary evidence taken from the notarial records at the Archivo Histórico Provincial de Huesca, concerning Jewish physicians in the city throughout the 15th century. The unpublished evidence that has been collected from these sources does not provide us with an outstanding information, especially regarding medical aspects; however, it sheds some light on different aspects of the everyday life of 36 Jewish physicians documented in Huesca.Recopilación y ordenación de la documentación existente en el Archivo Histórico Provincial de Huesca referida a los médicos judíos de la ciudad desde fines del siglo xiv y durante casi todo el siglo XV. La información inédita recogida en los protocolos notariales (complementada con otra documentación ya publicada) no es extraordinaria, pero nos da una idea de algunas de las actividades desarrolladas por los 36 médicos judíos de Huesca. Los datos propiamente médicos son escasos, aunque permiten conocer otras facetas de sus actividades y vida cotidiana

Development and evaluation of a new fully automatic motion detection and correction technique in cardiac SPECT imaging

In cardiac SPECT perfusion imaging, motion correction of the data is critical to the minimization of motion introduced artifacts in the reconstructed images. Software-based (data-driven) motion correction techniques are the most convenient and economical approaches to fulfill this purpose. However, the accuracy is significantly affected by how the data complexities, such as activity overlap, non-uniform tissue attenuation, and noise are handled. We developed STASYS, a new, fully automatic technique, for motion detection and correction in cardiac SPECT. We evaluated the performance of STASYS by comparing its effectiveness of motion correcting patient studies with the current industry standard software (Cedars-Sinai MoCo) through blind readings by two readers independently. For 204 patient studies from multiple clinical sites, the first reader identified (1) 69 studies with medium to large axial motion, of which STASYS perfectly or significantly corrected 86.9% and MoCo 72.5%; and (2) 20 studies with medium to large lateral motion, of which STASYS perfectly or significantly corrected 80.0% and MoCo 60.0%. The second reader identified (1) 84 studies with medium to large axial motion, of which STASYS perfectly or significantly corrected 82.2% and MoCo 76.2%; and (2) 34 studies with medium to large lateral motion, of which STASYS perfectly or significantly corrected 58.9% and MoCo 50.0%. We developed a fully automatic software-based motion correction technique, STASYS, for cardiac SPECT. Clinical studies showed that STASYS was effective and corrected a larger percent of cardiac SPECT studies than the current industrial standard software

Quantitative evaluation of the effect of attenuation correction in SPECT images with CT-derived attenuation

In this study, we assessed the importance of attenuation correction by quantitative evaluation of errors associated with attenuation in myocardial SPECT in a phantom study. To do attenuation correction we use an attenuation map derived from X-ray CT data. The succession of attenuation correction highly depends on high quality of attenuation maps. CT derived attenuation map in related to non-uniform attenuation correction is used to do transmission dependent scatter correction. The OSEM algorithm with attenuation model was developed and used for attenuation correction during image reconstruction. Finally a comparison was done between reconstructed images using our OSEM code and analytical FBP method. The results of measurements show that: Our programs are capable to reconstruct SPECT images and correct the attenuation effects. Moreover to evaluate reconstructed image quality before and after attenuation correction we applied a famous approach using Image Quality Index. Attenuation correction increases the quality and quantity factors in both methods. This increasing is independent of activity in quantity factor and decrease with activity in quality factor. Both quantitative and qualitative of SPECT images were improved by attenuation correction. In both OSEM and FBP the activity ratio of heart phantom in comparison with the markers was very increased. So the attenuation correction in fat patients and low activity is recommended. Attenuation correction with CT images and OSEM reconstruction in the condition of complete registration yields superior results

Soft Tissue Attenuation Patterns Associated with Upright Acquisition SPECT Myocardial Perfusion Imaging: A Descriptive Study

Abstract: Purpose: Soft-tissue attenuation patterns in SPECT-myocardial perfusion imaging (MPI) of supine acquisition systems are well recognized. Their prevalence and interaction with body-habitus and gender are ill-defined, which we sought to describe in this study. Methods: In a cross-sectional study, we described the prevalence of soft-tissue attenuation patterns in normal SPECT-MPI studies acquired with a supine patient-position SPECT system. Results: In 263 normal, clinically-indicated, supine-acquisition SPECT-MPIs the attenuation patterns observed were: anterior (35.4%), inferior (41.8%) and lateral (13.3%). Anterior attenuation was more prevalent among women (50.7 % vs. 15.7%, P<0.001) and was associated with chest circumference among men. Conversely, inferior attenuation was more prevalent among men (78.3 % vs. 13.5%, P<0.001) and was not affected by body-habitus. Lateral attenuation was more common among women (19.6 % vs. 5.2%, p=0.001) and was associated with obesity (p=0.015). Conclusions: Soft-tissue attenuation artifacts are common in supine-acquisition SPECT-MPI. The recognition of their prevalence and association with body-habitus and gender is critical for the accurate interpretation of SPECT-MPI

Disappearance of myocardial perfusion defects on prone SPECT imaging: Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

<p>Abstract</p> <p>Background</p> <p>It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT) in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem.</p> <p>Methods</p> <p>In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR) with delayed-enhancement technique to confirm or exclude myocardial infarction.</p> <p>Results</p> <p>There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR.</p> <p>Conclusion</p> <p>Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.</p

Iodofiltic Acid I 123 (BMIPP) Fatty Acid Imaging Improves Initial Diagnosis in Emergency Department Patients With Suspected Acute Coronary Syndromes A Multicenter Trial

ObjectivesThe aim of this study was to assess the performance of β-methyl-p-[123I]-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) to detect acute coronary syndromes (ACS) in emergency department patients with chest pain.BackgroundEmergency department diagnosis of chest pain is problematic, often requiring prolonged observation and stress testing. BMIPP SPECT detects abnormalities in fatty acid metabolism resulting from myocardial ischemia, even many hours after symptom cessation.MethodsEmergency department patients with suspected ACS were enrolled at 50 centers. Patients received 5 mCi BMIPP within 30 h of symptom cessation. BMIPP SPECT images were interpreted semiquantitatively by 3 blinded readers. Initial clinical diagnosis was based on symptoms, initial electrocardiograms, and troponin, whereas the final diagnosis was based on all available data (including angiography and stress SPECT) but not BMIPP SPECT. Final diagnoses were adjudicated by a blinded committee as ACS, intermediate likelihood of ACS, or negative for ACS.ResultsA total of 507 patients were studied and efficacy was evaluated in 448 patients with sufficient data. The sensitivity of BMIPP by 3 blinded readers for a final diagnosis of ACS and intermediate likelihood of ACS was 71% (95% confidence interval [CI]: 64% to 79%), 74% (95% CI: 68% to 81%), and 69% (95% CI: 62% to 77%); the corresponding specificity of BMIPP was 67% (95% CI: 61% to 73%), 54% (95% CI: 48% to 60%), and 70% (95% CI: 64% to 76%). Compared with the initial diagnosis alone, BMIPP + initial diagnosis increased sensitivity from 43% to 81% (p < 0.001), negative predictive value from 62% to 83% (p < 0.001), and positive predictive value from 41% to 58% (p < 0.001), whereas specificity was unchanged (61% to 62%, p = NS).ConclusionsThe addition of BMIPP data to the initially available clinical information adds incremental value toward the early diagnosis of an ACS, potentially allowing determination of the presence or absence of ACS to be made earlier in the evaluation process. (Safety and Efficacy Iodofiltic Acid I 123 in the Treatment of Acute Coronary Syndrome [Zeus-ACS]; NCT00514501

Effectiveness of 99mTc-tetrofosmin for assessment of heart functions in micropigs

This study examined the suitability of a nuclear imaging technique using 99mTc-tetrofosmin as an agent to assess the heart functions of healthy micropigs. The mean age of the pigs was 360 days (male), and the mean body weight was 35.3 kg ranging from 34.5-36 kg. There were no significant perfusion defects in any of the reconstructed images. Gated single-photon emission computed tomography imaging can be used to calculate the ventricular volume and ejection fraction (EF). In this case, an EF of 79% was calculated from the ventricular volume of the end-systolic image (10 ml) subtracted from that of the end-diastolic volume (49 ml). A perfusion defect (particularly the apex, lateral wall) is unlikely because of the presence of a preserved wall motion in a segment with a defect. It is concluded that quantitative cardiac scintigraphy, using 99mTc-tetrofosmin is an adequate technique for estimating the heart functions of healthy micropigs