QRS classification and spatial combination for robust heart rate detection in low-quality fetal ECG recordings

Non-invasive fetal electrocardiography (ECG) can be used for prolonged monitoring of the fetal heart rate (FHR). However, the signal-to-noise-ratio (SNR) of non-invasive ECG recordings is often insufficient for reliable detection of the FHR. To overcome this problem, source separation techniques can be used to enhance the fetal ECG. This study uses a physiology-based source separation (PBSS) technique that has already been demonstrated to outperform widely used blind source separation techniques. Despite the relatively good performance of PBSS in enhancing the fetal ECG, PBSS is still susceptible to artifacts. In this study an augmented PBSS technique is developed to reduce the influence of artifacts. The performance of the developed method is compared to PBSS on multi-channel non-invasive fetal ECG recordings. Based on this comparison, the developed method is shown to outperform PBSS for the enhancement of the fetal ECG

Reliability of spectral analysis of fetal heart rate variability

Spectral analysis of fetal heart rate variability could provide information on fetal wellbeing. Unfortunately, fetal heart rate recordings are often contaminated by artifacts. Correction of these artifacts affects the outcome of spectral analysis, but it is currently unclear what level of artifact correction facilitates reliable spectral analysis. In this study, a method is presented that estimates the error in spectral powers due to artifact correction, based on the properties of the Continuous Wavelet Transformation. The results show that it is possible to estimate the error in spectral powers. The information about this error makes it possible for clinicians to assess the reliability of spectral analysis of fetal heart rate recordings that are contaminated by artifacts

Actief verwijderen van nier-en ureterstenen: Stand van zaken

Niersteenlijden is een vaak voorkomend probleem in Nederland. De incidentie van urolithiasis bedraagt ongeveer twee op duizend patiënten per jaar. De hoogste incidentie ligt bij mensen tussen twintig en veertig jaar, met een man/vrouwratio van twee op één. De prevalentie van urolithiasis in Nederland ligt op ongeveer 5,5%. Niet iedere nier- of uretersteen heeft een actieve behandeling nodig. Er bestaan drie groepen behandelopties voor urolithiasis naast de medicamenteuze therapie: de extracorporele schokgolflithotripsie (“extracorporeal shock wave therapy” – ESWL), de uretero(reno)scopie (URS) en de percutane lithotripsie (“percutaneous nephrolithotripsy” – PNL). Rekening houdend met de anatomie, de lokalisatie van de steen, de grootte van de steen, de kosten, de verwachte “stone free rate” (SFR) en de verwikkelingsratio moet bij iedere patiënt de meest geschikte behandelingsmodaliteit worden gekozen. De steenvrijpercentages voor nierstenen liggen lager dan voor ureterstenen. Met de modernisering van de flexibele scopes, de dunnere werkschachten en de verbeterde lasers wint de minimaal invasieve URS terrein ten koste van de PNL

Treatment options for active removal of renal stones

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from the PubMed database and the European Association of Urology (EAU) guidelines. ESWL remains the option of choice for stones with diameter = 20 mm due to its low invasive character, whereas PCNL is the standard for stones with diameter > 20 mm because of its high stone-free rates. Although ESWL treatment has become more patient friendly, its efficacy has not improved. On the other hand, URS has gained renewed interest due to new technological developments and improved treatment methods

An open-source 2D/3D-image-registration algorithm : cranial image guided radiotherapy

Purpose: To determine the robustness and accuracy of an open source 2D/3D GPU accelerated image registration algorithm in the context of cranial image guided radiotherapy. Methods: The open source 2D/3D image registration algorithm, Reg23, has been released under the GNU license. The algorithm utilizes an iterative digitally reconstructed radiograph (DRR) approach to the image registration problem. The DRR generator is accelerated on a GPU to rapidly iterate the optimization process. Multiple cost functions are supported and were analyzed. Robustness was determined by comparing a baseline set of orthogonal kV images of a cranial phantom with a predetermined isocenter to the planned isocenter in the CT image set and introducing more than 6000 combinations of rotations and translation to the position of the isocenter in the CT. Accuracy and time efficiency of various cost function were analyzed for the virtual patient shifts. Furthermore, a set of 43 experimental orthogonal images were acquired with a linac mounted kV imaging system of predetermined physical shifts which were compared to the results of the Reg23 algorithm. Results: The Reg23 algorithm was found to be accurate to 0.04±0.02mm for the virtual isocenter shifts and 0.23±0.40mm for real images compared to the CBCT registration results. Time to solution could be reduced from >70 s to <40 s without a significant change in the algorithm accuracy depending upon the cost function employed. Conclusions: The Reg23 algorithm is robust and sensitive to sub-mm variations of virtual shifts of the isocenter position. The Normalized Cross Correlation (NCC) cost function was determined to be most accurate and fastest for cranial image registration. For real experimental data, the Gradent Difference (GD) cost function was most accurate and both GD and NCC delivered results accurate to within 0.5 mm and 0.4° when compared to CBCT/CT registrations. © 2012 American Association of Physicists in Medicin

A fixed-lag Kalman smoother to filter power line interference in electrocardiogram recordings

Objective: Filtering power line interference (PLI) from electrocardiogram (ECG) recordings can lead to significant distortions of the ECG and mask clinically relevant features in ECG waveform morphology. The objective of this study is to filter PLI from ECG recordings with minimal distortion of the ECG waveform. Methods: In this paper, we propose a fixed-lag Kalman smoother with adaptive noise estimation. The performance of this Kalman smoother in filtering PLI is compared to that of a fixed-bandwidth notch filter and several adaptive PLI filters that have been proposed in the literature. To evaluate the performance, we corrupted clean neonatal ECG recordings with various simulated PLI. Furthermore, examples are shown of filtering real PLI from an adult and a fetal ECG recording. Results: The fixed-lag Kalman smoother outperforms other PLI filters in terms of step response settling time (improvements that range from 0.1 to 1 s) and signal-to-noise ratio (improvements that range from 17 to 23 dB). Our fixed-lag Kalman smoother can be used for semi real-time applications with a limited delay of 0.4 s. Conclusion and Significance: The fixed-lag Kalman smoother presented in this study outperforms other methods for filtering PLI and leads to minimal distortion of the ECG waveform

QRS classification and spatial combination for robust heart rate detection in low-quality fetal ECG recordings

Non-invasive fetal electrocardiography (ECG) can be used for prolonged monitoring of the fetal heart rate (FHR). However, the signal-to-noise-ratio (SNR) of non-invasive ECG recordings is often insufficient for reliable detection of the FHR. To overcome this problem, source separation techniques can be used to enhance the fetal ECG. This study uses a physiology-based source separation (PBSS) technique that has already been demonstrated to outperform widely used blind source separation techniques. Despite the relatively good performance of PBSS in enhancing the fetal ECG, PBSS is still susceptible to artifacts. In this study an augmented PBSS technique is developed to reduce the influence of artifacts. The performance of the developed method is compared to PBSS on multi-channel non-invasive fetal ECG recordings. Based on this comparison, the developed method is shown to outperform PBSS for the enhancement of the fetal ECG