Low CT temporal sampling rates result in a substantial underestimation of myocardial blood flow measurements

The purpose of this study was to evaluate the effect of temporal sampling rate in dynamic CT myocardial perfusion imaging (CTMPI) on myocardial blood flow (MBF). Dynamic perfusion CT underestimates myocardial blood flow compared to PET and SPECT values. For accurate quantitative analysis of myocardial perfusion with dynamic perfusion CT a stable calibrated HU measurement of MBF is essential. Three porcine hearts were perfused using an ex-vivo Langendorff model. Hemodynamic parameters were monitored. Dynamic CTMPI was performed using third generation dual source CT at 70 kVp and 230-350 mAs/rot in electrocardiography(ECG)-triggered shuttle-mode (sampling rate, 1 acquisition every 2-3 s; z-range, 10.2 cm), ECG-triggered non-shuttle mode (fixed table position) with stationary tube rotation (1 acquisition every 0.5-1 s, 5.8 cm), and non-ECG-triggered continuous mode (1 acquisition every 0.06 s, 5.8 cm). Stenosis was created in the circumflex artery, inducing different fractional flow reserve values. Volume perfusion CT Myocardium software was used to analyze ECG-triggered scans. For the non-ECG triggered scans MASS research version was used combined with an in-house Matlab script. MBF (mL/g/min) was calculated for non-ischemic segments. True MBF was calculated using input flow and heart weight. Significant differences in MBF between shuttle, non-shuttle and continuous mode were found, with median MBF of 0.87 [interquartile range 0.72-1.00], 1.20 (1.07-1.30) and 1.65 (1.40-1.88), respectively. The median MBF in shuttle mode was 56% lower than the true MBF. In non-shuttle and continuous mode, the underestimation was 41% and 18%. Limited temporal sampling rate in standard dynamic CTMPI techniques contributes to substantial underestimation of true MBF

Evaluation of the Performance of Coordinate Measuring Machines in the Industry, Using Calibrated Artefacts

AbstractThe coordinate measuring machines (CMM's) has given a new impulse in the field of geometrical and dimensional metrology. The CMM's in industrial environments have become an important resource for the quality systems, monitoring manufacturing processes, reduction errors during the manufacturing process, inspection of product specifications and in continuous quality improvement. However, there is a need to evaluate, through practical, fast, effective and low cost methods, the CMM metrological specifications. Using calibrated artefacts, able to reproduce the geometric elements frequently measured, it seeks to ensure stability of the functional and metrological characteristics between calibrations and simultaneously knowing the errors. With better monitoring of the control parameters it is possible evaluate and optimize the calibration set deadlines, timely detection of faults and failures, detect structural changes and changes in environmental conditions of the laboratories, thus seeking to conduct a more detailed assessment of the stability of metrological characteristics of a CMM in industrial environments

Elizabeth Irene Reiser, By And Through Her Guardian, Richard E. Reiser And Eleanor Reiser v. Richard Lohner And Howard Francis, Medical Doctors, And Provo Obstetrical And Gynecology Clinic, Inc., A Professional Corporation : Brief of Defendants-Respondents

Appeal from a Verdict of the Fourth Judicial District Court of Utah County, State of Utah Honorable James S. Sawaya, Presidin

Optimization of Suture-Free Laser-Assisted Vessel Repair by Solder-Doped Electrospun Poly(ε-caprolactone) Scaffold

Poor welding strength constitutes an obstacle in the clinical employment of laser-assisted vascular repair (LAVR) and anastomosis. We therefore investigated the feasibility of using electrospun poly(ε-caprolactone) (PCL) scaffold as reinforcement material in LAVR of medium-sized vessels. In vitro solder-doped scaffold LAVR (ssLAVR) was performed on porcine carotid arteries or abdominal aortas using a 670-nm diode laser, a solder composed of 50% bovine serum albumin and 0.5% methylene blue, and electrospun PCL scaffolds. The correlation between leaking point pressures (LPPs) and arterial diameter, the extent of thermal damage, structural and mechanical alterations of the scaffold following ssLAVR, and the weak point were investigated. A strong negative correlation existed between LPP and vessel diameter, albeit LPP (484 ± 111 mmHg) remained well above pathophysiological pressures. Histological analysis revealed that thermal damage extended into the medial layer with a well-preserved internal elastic lamina and endothelial cells. Laser irradiation of PCL fibers and coagulation of solder material resulted in a strong and stiff scaffold. The weak point of the ssLAVR modality was predominantly characterized by cohesive failure. In conclusion, ssLAVR produced supraphysiological LPPs and limited tissue damage. Despite heat-induced structural/mechanical alterations of the scaffold, PCL is a suitable polymer for weld reinforcement in medium-sized vessel ssLAVR

Arterial pulsatility under phasic left ventricular assist device support

The aim of this study is to understand whether the phasic Continuous Flow Left Ventricular Assist Device (CF-LVAD) support would increase the arterial pulsatility. A Micromed DeBakey CF-LVAD was used to apply phasic support in an ex-vivo experimental platform. CF-LVAD was operated over a cardiac cycle by phase-shifting the pulsatile pump control with respect to the heart cycle, in 0.05 s increments in each experiment. The pump flow rate was selected as the control variable and a reference model was used to operate the CF-LVAD at a pulsatile speed. Arterial pulse pressure was the highest (9 mmHg) when the peak pump flow is applied at the peak systole under varying speed CF-LVAD support over a cardiac cycle while it was the lowest (2 mmHg) when the peak pump flow was applied in the diastolic phase. The mean arterial pressure and mean CF-LVAD output were the same in each experiment while arterial pulse pressure and pulsatility index varied depending on the phase of reference pump flow rate signal. CF-LVAD speed should be synchronized considering the timing of peak systole over a cardiac cycle to increase the arterial pulsatility. Moreover, it is possible to decrease the arterial pulsatility under counter-pulsating CF-LVAD support

Arterial pulsatility under phasic left ventricular assist device support

The aim of this study is to understand whether the phasic Continuous Flow Left Ventricular Assist Device (CF-LVAD) support would increase the arterial pulsatility. A Micromed DeBakey CF-LVAD was used to apply phasic support in an ex-vivo experimental platform. CF-LVAD was operated over a cardiac cycle by phase-shifting the pulsatile pump control with respect to the heart cycle, in 0.05 s increments in each experiment. The pump flow rate was selected as the control variable and a reference model was used to operate the CF-LVAD at a pulsatile speed. Arterial pulse pressure was the highest (9 mmHg) when the peak pump flow is applied at the peak systole under varying speed CF-LVAD support over a cardiac cycle while it was the lowest (2 mmHg) when the peak pump flow was applied in the diastolic phase. The mean arterial pressure and mean CF-LVAD output were the same in each experiment while arterial pulse pressure and pulsatility index varied depending on the phase of reference pump flow rate signal. CF-LVAD speed should be synchronized considering the timing of peak systole over a cardiac cycle to increase the arterial pulsatility. Moreover, it is possible to decrease the arterial pulsatility under counter-pulsating CF-LVAD support

Arterial pulsatility improvement in a feedback-controlled continuous flow left ventricular assist device: An ex-vivo experimental study

Continuous flow left ventricular assist devices (CF-LVADs) reduce arterial pulsatility, which may cause long-term complications in the cardiovascular system. The aim of this study is to improve the pulsatility by driving a CF-LVAD at a varying speed, synchronous with the cardiac cycle in an ex-vivo experiment. A Micromed DeBakey pump was used as CF-LVAD. The heart was paced at 140 bpm to obtain a constant cardiac cycle for each heartbeat. First, the CF-LVAD was operated at a constant speed. At varying-speed CF-LVAD assistance, the pump was driven such that the same mean pump output was generated. For synchronization purposes, an algorithm was developed to trigger the CF-LVAD each heartbeat. The pump flow rate was selected as the control variable and a reference model was used for regulating the CF-LVAD speed. Continuous and varying-speed CF-LVAD assistance provided the same mean arterial pressure and flow rate, while the index of pulsatility doubled in both arterial pressure and pump flow rate signals under pulsatile pump speed support. This study shows the possibility of improving the pulsatility in CF-LVAD support by regulating pump speed over a cardiac cycle without compromising the overall level of support