Towards a First-Person Perspective Mixed Reality Guidance System for Needle Interventions

While ultrasound (US) guidance has been used during central venous catheterization to reduce complications, including the puncturing of arteries, the rate of such problems remains non-negligible. To further reduce complication rates, mixed-reality systems have been proposed as part of the user interface for such procedures. We demonstrate the use of a surgical navigation system that renders a calibrated US image, and the needle and its trajectory, in a common frame of reference. We compare the effectiveness of this system, whereby images are rendered on a planar monitor and within a head-mounted display (HMD), to the standard-of-care US-only approach, via a phantom-based user study that recruited 31 expert clinicians and 20 medical students. These users performed needle-insertions into a phantom under the three modes of visualization. The success rates were significantly improved under HMD-guidance as compared to US-guidance, for both expert clinicians (94% vs. 70%) and medical students (70% vs. 25%). Users more consistently positioned their needle closer to the center of the vessel’s lumen under HMD-guidance compared to US-guidance. The performance of the clinicians when interacting with this monitor system was comparable to using US-only guidance, with no significant difference being observed across any metrics. The results suggest that the use of an HMD to align the clinician’s visual and motor fields promotes successful needle guidance, highlighting the importance of continued HMD-guidance research

Diagnostic quality assessment of compressed sensing accelerated magnetic resonance neuroimaging.

PURPOSE: To determine the efficacy of compressed sensing (CS) reconstructions for specific clinical magnetic resonance neuroimaging applications beyond more conventional acceleration techniques such as parallel imaging (PI) and low-resolution acquisitions. MATERIALS AND METHODS: Raw k-space data were acquired from five healthy volunteers on a 3T scanner using a 32-channel head coil using T2 -FLAIR, FIESTA-C, time of flight (TOF), and spoiled gradient echo (SPGR) sequences. In a series of blinded studies, three radiologists independently evaluated CS, PI (GRAPPA), and low-resolution images at up to 5× accelerations. Synthetic T2 -FLAIR images with artificial lesions were used to assess diagnostic accuracy for CS reconstructions. RESULTS: CS reconstructions were of diagnostically acceptable quality at up to 4× acceleration for T2 -FLAIR and FIESTA-C (average qualitative scores 3.7 and 4.3, respectively, on a 5-point scale at 4× acceleration), and at up to 3× acceleration for TOF and SPGR (average scores 4.0 and 3.7, respectively, at 3× acceleration). The qualitative scores for CS reconstructions were significantly better than low-resolution images for T2 -FLAIR, FIESTA-C, and TOF and significantly better than GRAPPA for TOF and SPGR (Wilcoxon signed rank test, P \u3c 0.05) with no significant difference found otherwise. Diagnostic accuracy was acceptable for both CS and low-resolution images at up to 3× acceleration (area under the ROC curve 0.97 and 0.96, respectively.) CONCLUSION: Mild to moderate accelerations are possible for those sequences by a combined CS and PI reconstruction. Nevertheless, for certain sequences/applications one might mildly reduce the acquisition time by appropriately reducing the imaging resolution rather than the more complicated CS reconstruction. J. Magn. Reson. Imaging 2016;44:433-444

Cathepsin L Regulates CD4+ T Cell Selection Independently of Its Effect on Invariant Chain: A Role in the Generation of Positively Selecting Peptide Ligands

CD4+ T cells are positively selected in the thymus on peptides presented in the context of major histocompatibility complex class II molecules expressed on cortical thymic epithelial cells. Molecules regulating this peptide presentation play a role in determining the outcome of positive selection. Cathepsin L mediates invariant chain processing in cortical thymic epithelial cells, and animals of the I-Ab haplotype deficient in this enzyme exhibit impaired CD4+ T cell selection. To determine whether the selection defect is due solely to the block in invariant chain cleavage we analyzed cathepsin L–deficient mice expressing the I-Aq haplotype which has little dependence upon invariant chain processing for peptide presentation. Our data indicate the cathepsin L defect in CD4+ T cell selection is haplotype independent, and thus imply it is independent of invariant chain degradation. This was confirmed by analysis of I-Ab mice deficient in both cathepsin L and invariant chain. We show that the defect in positive selection in the cathepsin L−/− thymus is specific for CD4+ T cells that can be selected in a wild-type and provide evidence that the repertoire of T cells selected differs from that in wild-type mice, suggesting cortical thymic epithelial cells in cathepsin L knockout mice express an altered peptide repertoire. Thus, we propose a novel role for cathepsin L in regulating positive selection by generating the major histocompatibility complex class II bound peptide ligands presented by cortical thymic epithelial cells