Rapid processing of PET list-mode data for efficient uncertainty estimation and data analysis

In this technical note we propose a rapid and scalable software solution for the processing of PET list-mode data, which allows the efficient integration of list mode data processing into the workflow of image reconstruction and analysis. All processing is performed on the graphics processing unit (GPU), making use of streamed and concurrent kernel execution together with data transfers between disk and CPU memory as well as CPU and GPU memory. This approach leads to fast generation of multiple bootstrap realisations, and when combined with fast image reconstruction and analysis, it enables assessment of uncertainties of any image statistic and of any component of the image generation process (e.g., random correction, image processing) within reasonable time frames (e.g., within five minutes per realisation). This is of particular value when handling complex chains of image generation and processing. The software outputs the following: (1) estimate of expected random event data for noise reduction; (2) dynamic prompt and random sinograms of span-1 and span-11 and (3) variance estimates based on multiple bootstrap realisations of (1) and (2) assuming reasonable count levels for acceptable accuracy. In addition, the software produces statistics and visualisations for immediate quality control and crude motion detection, such as: (1) count rate curves; (2) centre of mass plots of the radiodistribution for motion detection; (3) video of dynamic projection views for fast visual list-mode skimming and inspection; (4) full normalisation factor sinograms. To demonstrate the software, we present an example of the above processing for fast uncertainty estimation of regional SUVR (standard uptake value ratio) calculation for a single PET scan of ¹⁸F-florbetapir using the Siemens Biograph mMR scanner

Fast Quasi-Newton Algorithms for Penalized Reconstruction in Emission Tomography and Further Improvements via Preconditioning

OAPA This paper reports on the feasibility of using a quasi-Newton optimization algorithm, limited-memory Broyden- Fletcher-Goldfarb-Shanno with boundary constraints (L-BFGSB), for penalized image reconstruction problems in emission tomography (ET). For further acceleration, an additional preconditioning technique based on a diagonal approximation of the Hessian was introduced. The convergence rate of L-BFGSB and the proposed preconditioned algorithm (L-BFGS-B-PC) was evaluated with simulated data with various factors, such as the noise level, penalty type, penalty strength and background level. Data of three 18F-FDG patient acquisitions were also reconstructed. Results showed that the proposed L-BFGS-B-PC outperforms L-BFGS-B in convergence rate for all simulated conditions and the patient data. Based on these results, L-BFGSB- PC shows promise for clinical application

The languages of peace during the French religious wars

The desirability of peace was a common topos in sixteenth-century political rhetoric, and the duty of the king to uphold the peace for the benefit of his subjects was also a long-established tradition. However, the peculiar circumstances of the French religious wars, and the preferred royal policy of pacification, galvanized impassioned debate among both those who supported and those who opposed confessional coexistence. This article looks at the diverse ways in which peace was viewed during the religious wars through an exploration of language and context. It draws not only on the pronouncements of the crown and its officials, and of poets and jurists, but also on those of local communities and confessional groups. Opinion was not just divided along religious lines; political imperatives, philosophical positions and local conditions all came into play in the arguments deployed. The variegated languages of peace provide a social and cultural dimension for the contested nature of sixteenth-century French politics. However, they could not restore harmony to a war-torn and divided kingdom

An Investigation of Stochastic Variance Reduction Algorithms for Relative Difference Penalized 3D PET Image Reconstruction

Penalised PET image reconstruction algorithms are often accelerated during early iterations with the use of subsets. However, these methods may exhibit limit cycle behaviour at later iterations due to variations between subsets. Desirable converged images can be achieved for a subclass of these algorithms via the implementation of a relaxed step size sequence, but the heuristic selection of parameters will impact the quality of the image sequence and algorithm convergence rates. In this work, we demonstrate the adaption and application of a class of stochastic variance reduction gradient algorithms for PET image reconstruction using the relative difference penalty and numerically compare convergence performance to BSREM. The two investigated algorithms are: SAGA and SVRG. These algorithms require the retention in memory of recently computed subset gradients, which are utilised in subsequent updates. We present several numerical studies based on Monte Carlo simulated data and a patient data set for fully 3D PET acquisitions. The impact of the number of subsets, different preconditioners and step size methods on the convergence of regions of interest values within the reconstructed images is explored. We observe that when using constant preconditioning, SAGA and SVRG demonstrate reduced variations in voxel values between subsequent updates and are less reliant on step size hyper-parameter selection than BSREM reconstructions. Furthermore, SAGA and SVRG can converge significantly faster to the penalised maximum likelihood solution than BSREM, particularly in low count data

Correlation of Urinary Engrailed-2 Levels to Tumour Volume and Pathological Stage in Men Undergoing Radical Prostatectomy

yesThe aim of this study was to assess the relationship between pre-prostatectomy urinary Engrailed-2 (EN2), a transcription factor secreted by prostate cancer cells, with tumour volume and pathological characteristics in resected prostate specimens. First pass urine samples (10 ml) without prior prostatic massage were collected and stored at –80°C. EN2 levels were measured using an enzyme-linked immunoabsorbent assay. Tumour volume in the prostatectomy specimens was determined histologically. 57 men undergoing RP in one urological cancer network were evaluated. EN2 was detected in 85% of RP patients. EN2 correlated with tumour volume (but not total prostatic volume) in a linear regression analysis, with increasing pathological T stage and margin positivity. Using three “cutoff levels” of tumour volume (0.5 ml, 1.3 ml and 2.5 ml) to define “significant disease”, men with “significant disease” had markedly higher levels of urinary EN2 (p < 0.001 for each cut off level). Levels of urinary EN2 may be useful in predicting tumour volume in men with prostate cancer by potentially identifying men with small volume “insignificant” disease. This study justifies a larger multicentre evaluation of urinary EN2 levels as a biomarker of PC significance using cancer volume, pathological and PSA criteria

The paradox of tenant empowerment: regulatory and liberatory possibilities

Tenant empowerment has traditionally been regarded as a means of realising democratic ideals: a quantitative increase in influence and control, which thereby enables "subjects" to acquire the fundamental properties of "citizens". By contrast governmentality, as derived from the work of Michel Foucault, offers a more critical appraisal of the concept of empowerment by highlighting how it is itself a mode of subjection and a means of regulating human conduct towards particular ends. Drawing on particular data about how housing governance has changed in Glasgow following its 2003 stock transfer, this paper adopts the insights of governmentality to illustrate how the political ambition of "community ownership" has been realized through the mobilization and shaping of active tenant involvement in the local decision making process. In addition, it also traces the tensions and conflict inherent in the reconfiguration of power relations post-transfer for "subjects" do not necessarily conform to the plans of those that seek to govern them

Ethical issues in implementation research: a discussion of the problems in achieving informed consent

Background: Improved quality of care is a policy objective of health care systems around the world. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice, and hence to reduce inappropriate care. It includes the study of influences on healthcare professionals' behaviour and methods to enable them to use research findings more effectively. Cluster randomized trials represent the optimal design for evaluating the effectiveness of implementation strategies. Various codes of medical ethics, such as the Nuremberg Code and the Declaration of Helsinki inform medical research, but their relevance to cluster randomised trials in implementation research is unclear. This paper discusses the applicability of various ethical codes to obtaining consent in cluster trials in implementation research. Discussion: The appropriate application of biomedical codes to implementation research is not obvious. Discussion of the nature and practice of informed consent in implementation research cluster trials must consider the levels at which consent can be sought, and for what purpose it can be sought. The level at which an intervention is delivered can render the idea of patient level consent meaningless. Careful consideration of the ownership of information, and rights of access to and exploitation of data is required. For health care professionals and organizations, there is a balance between clinical freedom and responsibility to participate in research. Summary: While ethical justification for clinical trials relies heavily on individual consent, for implementation research aspects of distributive justice, economics, and political philosophy underlie the debate. Societies may need to trade off decisions on the choice between individualized consent and valid implementation research. We suggest that social sciences codes could usefully inform the consideration of implementation research by members of Research Ethics Committees