Digital mammography: current view and future applications

In digital mammography, imaging acquisition, display and storage processes are separated and individually optimized. Radiation transmitted through the breast is absorbed by an electronic detector with an accurate response over a wide range of intensities. Once these data are stored, they can be displayed by means of computer image-processing techniques to allow arbitrary settings of image brightness, contrast and magnification, without the need for further radiological exposure of the patient. In this article, the current state of the art in technology for digital mammography and clinical trials data supporting the use of this technology are reviewed. In addition, several potentially useful applications, currently under development with digital mammography, are described.Na mamografia digital, os processos de aquisição da imagem, demonstração e armazenamento são separados, o que leva à otimização de cada uma dessas etapas. A radiação transmitida através da mama é absorvida por um detector eletrônico, em resposta fiel a uma ampla variedade de intensidades. Uma vez que esta informação é armazenada, ela pode ser demonstrada usando técnicas computadorizadas de imagem, permitindo variações de brilho e contraste e ampliação, sem a necessidade de exposições radiológicas adicionais para a paciente. Neste artigo, o estado atual da tecnologia em mamografia digital e dados sobre testes clínicos que dão suporte ao uso dessa tecnologia são revistos. Além disso, algumas aplicações potencialmente utilizáveis que estão sendo desenvolvidas com a mamografia digital são descritas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemColégio Brasileiro de Radiologia e Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GinecologiaUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, EPM, Depto. de GinecologiaSciEL

The influence of viewing boxes luminance on the detectability of fibers and microcalcifications using simulated objects

Considering the subtle findings observed in mammography images, it is relevant to know how detectability of fibers and microcalcifications can be influenced by the luminance of the viewing boxes. Our goal was to determine the influence of the luminance on the detectability of tiny simulated objects. We obtained seven images with different exposure levels using a phantom that allows statistical analysis. The results were computed using a five point scale to report the confidence levels (100 if the evaluator was sure that the object is present; 75 if likely; 50 if uncertain; 25 if not likely; zero if definitely absent). The images were analyzed by specialists using a standard and a specific viewing box for mammography. The detectability was compared using the Pearson chi-square test (p < 0.05). The values varied from 0.79 to 0.87. We concluded that the detectability determined from simulated objects through readings on the specific viewing boxes is higher when compared with the readings using standard viewing boxes.Considerando a natureza sutil dos achados mamográficos, é importante conhecermos como a detectabilidade de pequenos objetos, como fibras e microcalcificações, normalmente presentes em imagens mamográficas, pode ser influenciada pela intensidade luminosa do negatoscópio utilizado nas leituras. Nosso objetivo foi verificar como a luminância pode alterar a detectabilidade de objetos simulados. Foram feitas sete imagens com diferentes intensidades de exposição em duas condições técnicas usando um simulador que permite avaliações estatísticas. Os resultados foram computados usando uma escala de cinco níveis de confiança (100 se o especialista tem certeza da presença do objeto; 75 se provável a presença do objeto; 50 se incerta; 25 se improvável; zero se definitivamente ausente). As imagens foram interpretadas por especialistas que utilizaram negatoscópios padrões e específicos para imagens mamográficas. As detectabilidades foram estatisticamente comparadas entre si para cada tipo de negatoscópio por meio do teste do qui-quadrado de Pearson (p < 0,05). A detectabilidade variou de 0,79 a 0,87. Pudemos concluir que a detectabilidade dos objetos, determinada por meio de objetos simulados, é superior para os negatoscópios específicos para mamografias quando comparada aos negatoscópios padrões amplamente utilizados na radiologia geral.EPM-UNIFESP Coordenadoria de Física e Higiene das RadiaçõesUNIFESP Mestre em Ciências RadiológicasUNIFESP Física EspecializandaEPM-UNIFESP Departamento de Diagnóstico por ImagemEPM-UNIFESP Departamento de Ginecologia Setor de MastologiaEPM-UNIFESP Departamento de Diagnóstico por Imagem Setor de MamografiaUNIFESP, EPM, UNIFESP, Coordenadoria de Física e Higiene das RadiaçõesUNIFESP, Mestre em Ciências RadiológicasUNIFESP, Física EspecializandaEPM-UNIFESP, Depto. de Diagnóstico por ImagemEPM-UNIFESP, Depto. de Ginecologia Setor de MastologiaEPM-UNIFESP, Depto. de Diagnóstico por Imagem Setor de MamografiaSciEL

BK Lyncis: The Oldest Old Nova?... And a Bellwether for Cataclysmic-Variable Evolution

We summarize the results of a 20-year campaign to study the light curves of BK Lyncis, a nova-like star strangely located below the 2-3 hour orbital period gap in the family of cataclysmic variables. Two apparent "superhumps" dominate the nightly light curves - with periods 4.6% longer, and 3.0% shorter, than P_orb. The first appears to be associated with the star's brighter states (V~14), while the second appears to be present throughout and becomes very dominant in the low state (V~15.7). Starting in the year 2005, the star's light curve became indistinguishable from that of a dwarf nova - in particular, that of the ER UMa subclass. Reviewing all the star's oddities, we speculate: (a) BK Lyn is the remnant of the probable nova on 30 December 101, and (b) it has been fading ever since, but has taken ~2000 years for the accretion rate to drop sufficiently to permit dwarf-nova eruptions. If such behavior is common, it can explain other puzzles of CV evolution. One: why the ER UMa class even exists (because all members can be remnants of recent novae). Two: why ER UMa stars and short-period novalikes are rare (because their lifetimes, which are essentially cooling times, are short). Three: why short-period novae all decline to luminosity states far above their true quiescence (because they're just getting started in their postnova cooling). Four: why the orbital periods, accretion rates, and white-dwarf temperatures of short-period CVs are somewhat too large to arise purely from the effects of gravitational radiation (because the unexpectedly long interval of enhanced postnova brightness boosts the mean mass-transfer rate). These are substantial rewards in return for one investment of hypothesis: that the second parameter in CV evolution, besides P_orb, is time since the last classical-nova eruption.Comment: PDF, 46 pages, 4 tables, 10 figures; in preparation; more info at http://cbastro.org

Clinical prediction rules for abusive head trauma: a systematic review

Objective: Misdiagnosis of abusive head trauma (AHT) has serious consequences for children and families. This systematic review identifies and compares clinical prediction rules (CPredRs) assisting clinicians in assessing suspected AHT. Design: We searched MEDLINE, Embase, PubMed and Cochrane databases (January 1996–August 2016). Externally validated CPredRs focusing on the detection of AHT in the clinical setting were included. Results: Of 110 potential articles identified, three studies met the inclusion criteria: the Pediatric Brain Injury Research Network (PediBIRN) 4-Variable AHT CPredR, the Predicting Abusive Head Trauma (PredAHT) tool and the Pittsburgh Infant Brain Injury Score (PIBIS). The CPredRs were designed for different populations and purposes; PediBIRN: intensive care unit admissions (<3 years) with head injury, to inform early decisions to launch or forego an evaluation for abuse (sensitivity 0.96), PredAHT: hospital admissions (<3 years) with intracranial injury, to assist clinicians in discussions with child abuse specialists (sensitivity 0.72), and PIBIS: well-appearing children (<1 year) in the emergency department with no history of trauma, temperature <38.3°, and ≥1 symptom associated with high risk of AHT, to determine the need for a head CT scan (sensitivity 0.93). There was little overlap between the predictive variables. Conclusion: Three CPredRs for AHT were relevant at different stages in the diagnostic process. None of the CPredRs aimed to diagnose AHT but to act as aids/prompts to clinicians to seek further clinical, social or forensic information. None were widely validated in multiple settings. To assess safety and effectiveness in clinical practice, impact analyses are required and recommended

Glucocorticoids regulate mitochondrial fatty acid oxidation in fetal cardiomyocytes

Abstract: The late gestational rise in glucocorticoids contributes to the structural and functional maturation of the perinatal heart. Here, we hypothesized that glucocorticoid action contributes to the metabolic switch in perinatal cardiomyocytes from carbohydrate to fatty acid oxidation. In primary mouse fetal cardiomyocytes, dexamethasone treatment induced expression of genes involved in fatty acid oxidation and increased mitochondrial oxidation of palmitate, dependent upon a glucocorticoid receptor (GR). Dexamethasone did not, however, induce mitophagy or alter the morphology of the mitochondrial network. In vivo, in neonatal mice, dexamethasone treatment induced cardiac expression of fatty acid oxidation genes. However, dexamethasone treatment of pregnant C57Bl/6 mice at embryonic day (E)13.5 or E16.5 failed to induce fatty acid oxidation genes in fetal hearts assessed 24 h later. Instead, at E17.5, fatty acid oxidation genes were downregulated by dexamethasone, as was GR itself. PGC-1α, required for glucocorticoid-induced maturation of primary mouse fetal cardiomyocytes in vitro, was also downregulated in fetal hearts at E17.5, 24 h after dexamethasone administration. Similarly, following a course of antenatal corticosteroids in a translational sheep model of preterm birth, both GR and PGC-1α were downregulated in heart. These data suggest that endogenous glucocorticoids support the perinatal switch to fatty acid oxidation in cardiomyocytes through changes in gene expression rather than gross changes in mitochondrial volume or mitochondrial turnover. Moreover, our data suggest that treatment with exogenous glucocorticoids may interfere with normal fetal heart maturation, possibly by downregulating GR. This has implications for clinical use of antenatal corticosteroids when preterm birth is considered a possibility. Key points: Glucocorticoids are steroid hormones that play a vital role in late pregnancy in maturing fetal organs, including the heart. In fetal cardiomyocytes in culture, glucocorticoids promote mitochondrial fatty acid oxidation, suggesting they facilitate the perinatal switch from carbohydrates to fatty acids as the predominant energy substrate. Administration of a synthetic glucocorticoid in late pregnancy in mice downregulates the glucocorticoid receptor and interferes with the normal increase in genes involved in fatty acid metabolism in the heart. In a sheep model of preterm birth, antenatal corticosteroids (synthetic glucocorticoid) downregulates the glucocorticoid receptor and the gene encoding PGC-1α, a master regulator of energy metabolism. These experiments suggest that administration of antenatal corticosteroids in anticipation of preterm delivery may interfere with fetal heart maturation by downregulating the ability to respond to glucocorticoids

Quantitative imaging reveals steatosis and fibro-inflammation in multiple organs in people with type 2 diabetes: a real-world study.

We aimed to determine the extent of multi-organ fat accumulation and fibro-inflammation in individuals living with type 2 diabetes. We deeply phenotyped individuals with type 2 diabetes (134 from secondary care, 69 from primary care) with multi-organ, quantitative multi-parametric MRI and compared with 134 matched controls and 92 normal weight controls. We examined the impact of diabetes duration, obesity status and glycemic control. Ninety-three of the individuals with type 2 diabetes were re-evaluated at 7 months (median). Multi-organ abnormalities were more common in individuals with type 2 diabetes (94%) than in age, BMI-matched healthy or healthy normal weight people. We demonstrated a high burden of combined steatosis and fibro-inflammation, within the liver, pancreas and kidneys (41, 17 and 10%), associated with visceral adiposity (73%) and poor vascular health (82%). Obesity was most closely associated with advanced liver disease, renal and visceral steatosis, and multi-organ abnormalities whilst poor glycaemic control was associated with pancreatic fibro-inflammation. Pharmacological therapies with proven cardiorenal protection improved liver and vascular health unlike conventional glucose-lowering treatments, whilst weight loss or improved glycaemic control reduced multi-organ adiposity (p≤0.01). Quantitative imaging in people with type 2 diabetes highlights widespread organ abnormalities and may provide useful risk and treatment stratification

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program