MammoApplet: an interactive Java applet tool for manual annotation in medical imaging

Web-based applications in computational medicine have become increasingly important during the last years. The rapid growth of the World Wide Web supposes a new paradigm in the telemedicine and eHealth areas in order to assist and enhance the prevention, diagnosis and treatment of patients. Furthermore, training of radiologists and management of medical databases are also becoming increasingly important issues in the field. In this paper, we present MammoApplet , an interactive Java applet interface designed as a web-based tool. It aims to facilitate the diagnosis of new mammographic cases by providing a set of image processing tools that allow a better visualization of the images, and a set of drawing tools, used to annotate the suspicious regions. Each annotation allows including the attributes considered by the experts when issuing the final diagnosis. The overall set of overlays is stored in a database as XML files associated with the original images. The final goal is to obtain a database of already diagnosed cases for training and enhancing the performance of novice radiologistsPeer ReviewedPostprint (author's final draft

Texture descriptors applied to digital mammography

Breast cancer is the second cause of death among women cancers. Computer Aided Detection has been demon- strated an useful tool for early diagnosis, a crucial as- pect for a high survival rate. In this context, several re- search works have incorporated texture features in mam- mographic image segmentation and description such as Gray-Level co-occurrence matrices, Local Binary Pat- terns, and many others. This paper presents an approach for breast density classi¯cation based on segmentation and texture feature extraction techniques in order to clas- sify digital mammograms according to their internal tis- sue. The aim of this work is to compare di®erent texture descriptors on the same framework (same algorithms for segmentation and classi¯cation, as well as same images). Extensive results prove the feasibility of the proposed ap- proach.Postprint (published version

On the Use of XML in Medical Imaging Web-Based Applications

The rapid growth of digital technology in medical fields over recent years has increased the need for applications able to manage patient medical records, imaging data, and chart information. Web-based applications are implemented with the purpose to link digital databases, storage and transmission protocols, management of large volumes of data and security concepts, allowing the possibility to read, analyze, and even diagnose remotely from the medical center where the information was acquired. The objective of this paper is to analyze the use of the Extensible Markup Language (XML) language in web-based applications that aid in diagnosis or treatment of patients, considering how this protocol allows indexing and exchanging the huge amount of information associated with each medical case. The purpose of this paper is to point out the main advantages and drawbacks of the XML technology in order to provide key ideas for future web-based applicationsPeer ReviewedPostprint (author's final draft

Colonic content: effect of diet, meals, and defecation

This is the peer reviewed version of the following article: Bendezú, Á., Mego, M., Monclús, E., Merino, X., Accarino, A., Malagelada, J., Navazo, I., Azpiroz, F. Colonic content: effect of diet, meals, and defecation. "Neurogastroenterology and motility", Febrer 2017, vol. 29, núm. 2, which has been published in final form at [http://onlinelibrary.wiley.com.recursos.biblioteca.upc.edu/doi/10.1111/nmo.12930/full]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.The metabolic activity of colonic microbiota is influenced by diet; however, the relationship between metabolism and colonic content is not known. Our aim was to determine the effect of meals, defecation, and diet on colonic content. Methods: In 10 healthy subjects, two abdominal MRI scans were acquired during fasting, 1 week apart, and after 3 days on low- and high-residue diets, respectively. With each diet, daily fecal output and the number of daytime anal gas evacuations were measured. On the first study day, a second scan was acquired 4 hours after a test meal (n=6) or after 4 hours with nil ingestion (n=4). On the second study day, a scan was also acquired after a spontaneous bowel movement. Results: On the low-residue diet, daily fecal volume averaged 145 ± 15 mL; subjects passed 10.6 ± 1.6 daytime anal gas evacuations and, by the third day, non-gaseous colonic content was 479 ± 36 mL. The high-residue diet increased the three parameters to 16.5 ± 2.9 anal gas evacuations, 223 ± 19 mL fecal output, and 616 ± 55 mL non-gaseous colonic content (P<.05 vs low-residue diet for all). On the low-residue diet, non-gaseous content in the right colon had increased by 41 ± 11 mL, 4 hours after the test meal, whereas no significant change was observed after 4-hour fast (-15 ± 8 mL; P=.006 vs fed). Defecation significantly reduced the non-gaseous content in distal colonic segments. Conclusion & inferences: Colonic content exhibits physiologic variations with an approximate 1/3 daily turnover produced by meals and defecation, superimposed over diet-related day-to-day variations.Peer ReviewedPostprint (author's final draft

Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction

Constipation; Intestinal manometry; Intestinal neuropathyRestrenyiment; Manometria intestinal; Neuropatia intestinalEstreñimiento; Manometría intestinal; Neuropatía intestinalIntroduction Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns. Methods Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018. Results The minute rhythm (MRP) or prolonged simultaneous contractions (PSC) postprandial patterns were detected in 61 of 488 patients (55 MRP and 6 PSC). Clinical work-up detected a previously non-diagnosed partial mechanical obstruction of the distal intestine in 10 (16%) and a systemic disorder causing intestinal neuropathy in 32 (53%). In the remaining 19 patients (31%, all with MRP), the origin of the contractile pattern was undetermined, but in 16, substantial fecal retention was detected within 7 days of the manometric procedure by abdominal imaging, and in 6 of them colonic cleansing completely normalized intestinal motility on a second manometry performed within 39 ± 30 days. Conclusion and Inference Currently, the most frequent origin of MRP and PSC encountered on small bowel manometry is intestinal neuropathy, while a previously undetected mechanical obstruction is rare. Still, in a substantial proportion of patients, no underlying disease can be identified, and in them, colonic fecal retention might play a role, because in a subgroup of these patients, manometry normalized after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry.This work was supported by the Instituto de Salud Carlos III and co-financed by the European Union (FEDER/FSE) [PI17/01794]; Spanish Ministry of Economy and Competitiveness (Dirección General de Investigación Científica y Técnica) [SAF 2016-76648-R]; Ciberehd is funded by the Instituto de Salud Carlos III. LA was supported by the Instituto de Salud Carlos III (CM20/00182)

Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction

Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns. Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018. The minute rhythm (MRP) or prolonged simultaneous contractions (PSC) postprandial patterns were detected in 61 of 488 patients (55 MRP and 6 PSC). Clinical work-up detected a previously non-diagnosed partial mechanical obstruction of the distal intestine in 10 (16%) and a systemic disorder causing intestinal neuropathy in 32 (53%). In the remaining 19 patients (31%, all with MRP), the origin of the contractile pattern was undetermined, but in 16, substantial fecal retention was detected within 7 days of the manometric procedure by abdominal imaging, and in 6 of them colonic cleansing completely normalized intestinal motility on a second manometry performed within 39 ± 30 days. Currently, the most frequent origin of MRP and PSC encountered on small bowel manometry is intestinal neuropathy, while a previously undetected mechanical obstruction is rare. Still, in a substantial proportion of patients, no underlying disease can be identified, and in them, colonic fecal retention might play a role, because in a subgroup of these patients, manometry normalized after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry. Minute rhythm (or clustered contractions) in postprandial small bowel manometry can be produced by intestinal neuropathy or mechanical occlusion, but in some patients, the minute rhythm pattern is associated with colonic fecal retention, and resolves after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry

The Development of a Digital Dysphagia Guide with Care Homes: Co-Production and Evaluation of a Nutrition Support Tool

Good nutrition is a recognised outcome in the health and well-being of older care home residents and dysphagia is a known risk factor associated with under nutrition and poor outcomes. The study co-produced a digital Dysphagia Guide with Care Homes using a consensus method with interviews and focus groups to prioritise the need for information and explore acceptability of an educational tool for care home workers. Evaluation of use, acceptability of design, and content of the guide were completed via remote monitoring. The workforce prioritised the need for training as well as the knowledge and skills in relation to planning resident-centred care and advice on textured diets. The technology was a means of offering ‘bite-size’ learning to enhance planning for nutrition across the whole organisation including managers, kitchen staff, and care workers. The Guide to Dysphagia was produced on a tablet and piloted in four care homes over 12 weeks, by 57 staff. Integrated analytics allowed user activity to be monitored. Findings showed that 73% of respondents reported the guide helped them in their job. Additionally, 88% of respondents stated they would recommend the guide to other staff, with 90% reporting it was easy to use. Engagement with staff and managers in four homes resulted in a co-designed, dysphagia guide

Colonic content in health and its relation to functional gut symptoms

This is the peer reviewed version of the following article: Bendezú, R. A., Barba, E., Burri, E., Cisternas, D., Accarino, A., Quiroga, S., Monclus, E., Navazo, I., Malagelada, J.-R. and Azpiroz, F. (2016), Colonic content in health and its relation to functional gut symptoms. Neurogastroenterol. Motil., 28: 849–854, which has been published in final form at [doi:10.1111/nmo.12782]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-ArchivingGut content may be determinant in the generation of digestive symptoms, particularly in patients with impaired gut function and hypersensitivity. Since the relation of intraluminal gas to symptoms is only partial, we hypothesized that non-gaseous component may play a decisive role. Methods: Abdominal computed tomography scans were evaluated in healthy subjects during fasting and after a meal (n = 15) and in patients with functional gut disorders during basal conditions (when they were feeling well) and during an episode of abdominal distension (n = 15). Colonic content and distribution were measured by an original analysis program. Key results: In healthy subjects both gaseous (87 ± 24 mL) and non-gaseous colonic content (714 ± 34 mL) were uniformly distributed along the colon. In the early postprandial period gas volume increased (by 46 ± 23 mL), but non-gaseous content did not, although a partial caudad displacement from the descending to the pelvic colon was observed. No differences in colonic content were detected between patients and healthy subjects. Symptoms were associated with discrete increments in gas volume. However, no consistent differences in non-gaseous content were detected in patients between asymptomatic periods and during episodes of abdominal distension. Conclusions & inferences: In patients with functional gut disorders, abdominal distension is not related to changes in non-gaseous colonic content. Hence, other factors, such as intestinal hypersensitivity and poor tolerance of small increases in luminal gas may be involved.Peer ReviewedPostprint (author's final draft

Usefulness of collaborative work in the evaluation of prostate cancer from MRI

The aim of this study is to show the usefulness of collaborative work in the evaluation of prostate cancer from T2-weighted MRI using a dedicated software tool. The variability of annotations on images of the prostate gland (central and peripheral zones as well as tumour) by two independent experts was firstly evaluated, and secondly compared with a consensus between these two experts. Using a prostate MRI database, experts drew regions of interest (ROIs) corresponding to healthy prostate (peripheral and central zones) and cancer. One of the experts then drew the ROI with knowledge of the other expert’s ROI. The surface area of each ROI was used to measure the Hausdorff distance and the Dice coefficient was measured from the respective contours. They were evaluated between the different experiments, taking the annotations of the second expert as the reference. The results showed that the significant differences between the two experts disappeared with collaborative work. To conclude, this study shows that collaborative work with a dedicated tool allows consensus between expertise in the evaluation of prostate cancer from T2-weighted MRI.Peer ReviewedPostprint (published version