Comparaison entre les modes d’acquisition 2D et 3D en TEP au FDG

AimSome positron emission tomography (PET) cameras offer the possibility of choosing between the 2D and 3D acquisition modes. Due to the lack of comparative and objective data in the litterature between the two modes in clinical routine conditions, we have performed a comparative study based on the assessment of qualitative and quantitative parameters.Materials and methodsA series of 33 FDG PET studies has been prospectively selected in the nuclear medicine department. All studies have been performed with a Discovery ST^® camera (GE healthcare) first in the 2D or 3D mode according to the usual criteria of the department. Then a new single step was acquired on a pathological region using the other mode. The same single slice was chosen and analyzed in the two modes (blindly and in random order) by seven nuclear physicians in terms of qualitative and quantitative parameters.ResultsThe 2D mode is significantly better than 3D concerning the overall image quality for patients with a body mass index (BMI) > 27.5 (p = 0.006) and concerning the confidence in lesion reporting for patients with a BMI > 25 (p = 0.01). The mean number of detected lesions is not affected by the acquisition mode but it is significantly correlated with the image quality and the confidence in lesion reporting (p = 0.07 and p = 0.013, respectively).ConclusionWith the Discovery ST PET-CT, the 2D mode gives better results than 3D for overweight and obese patients in terms of image quality and confidence in lesion reporting.     

Analyse comparative de 3 logiciels de reconstruction itérative de tomoscintigraphie monophotonique myocardique

ObjectiveThis study makes a comparative analysis of the quality reconstruction of three software: 2D ordered subset expectation maximisation (2D OSEM), 3D ordered subsets expectation maximisation (Flash 3D) and Wallis.Patients and methodsThe data from myocardial scintigraphy acquisitions of 50 patients (38 men and 12 women; average age 61 ± 9 years) were successively reconstructed using three myocardial perfusion SPECT algorithms (Flash 3D, OSEM 2D and Wallis). Different combinations of iterations and subsets were considered. For Wallis, only the cut-off frequency was considered. The image's quality was assessed by determining the maximum contrast and the signal to noise ratio.ResultsThe Wallis software provided a higher signal to noise ratio compared to Flash 3D and OSEM 2D at stress and rest. The Wallis signal to noise ratio increased by a factor 1.93 (P = 0.0010) and 2.28 at stress (P = 0.0009); 1.50 (P = 0.0011) and 2.84 at rest (P = 0.0024) compared to respectively Flash 3D and OSEM 2D. Flash 3D provided better signal to noise ratio than OSEM 2D at stress and at rest. The difference in medians and interquartile ranges of the signal-to-noise ratio in post-stress were 22 % and 54 %, respectively between Flash 3D and OSEM 2D. At rest, the difference between the two methods in signal to noise ratio was 32 % ± 0.,29.ConclusionWallis algorithm was improve image quality with better signal to noise ratio compared to the reference method of Siemens Flash 3D. For both Flash 3D and OSEM 2D methods, the combination with 8 subsets and 12 iterations provided the best contrast and signal to noise ratio.     

Validation of a method for “dose of the day” calculation in head-neck tomotherapy by using planning ct-to-MVCT deformable image registration

PurposeThe aim of this study was to test the feasibility and dosimetric accuracy of a method that employs planning CT-to-MVCT deformable image registration (DIR) for calculation of the daily dose for head and neck (HN) patients treated with Helical Tomotherapy (HT).MethodsFor each patient, the planning kVCT (CTplan) was deformably registered to the MVCT acquired at the 15th therapy session (MV15) with a B-Spline Free Form algorithm using Mattes mutual information (open-source software 3D Slicer), resulting in a deformed CT (CTdef). On the same day as MVCT15, a kVCT was acquired with the patient in the same treatment position (CT15). The original HT plans were recalculated both on CTdef and CT15, and the corresponding dose distributions were compared; local dose differences <2% of the prescribed dose (DD2%) and 2D/3D gamma-index values (2%-2 mm) were assessed respectively with Mapcheck SNC Patient software (Sun Nuclear) and with 3D-Slicer.ResultsOn average, 87.9% ± 1.2% of voxels were found for DD2% (on average 27 slices available for each patient) and 94.6% ± 0.8% of points passed the 2D gamma analysis test while the 3D gamma test was satisfied in 94.8% ± 0.8% of body’s voxels.ConclusionsThis study represents the first demonstration of the dosimetric accuracy of kVCT-to-MVCT DIR for dose of the day computations. The suggested method is sufficiently fast and reliable to be used for daily delivered dose evaluations in clinical strategies for adaptive Tomotherapy of HN cancer.     

Evaluation of automatic image quality assessment in chest CT – A human cadaver study

PurposeThe evaluation of clinical image quality (IQ) is important to optimize CT protocols and to keep patient doses as low as reasonably achievable. Considering the significant amount of effort needed for human observer studies, automatic IQ tools are a promising alternative. The purpose of this study was to evaluate automatic IQ assessment in chest CT using Thiel embalmed cadavers.MethodsChest CT’s of Thiel embalmed cadavers were acquired at different exposures. Clinical IQ was determined by performing a visual grading analysis. Physical-technical IQ (noise, contrast-to-noise and contrast-detail) was assessed in a Catphan phantom. Soft and sharp reconstructions were made with filtered back projection and two strengths of iterative reconstruction. In addition to the classical IQ metrics, an automatic algorithm was used to calculate image quality scores (IQs). To be able to compare datasets reconstructed with different kernels, the IQs values were normalized.ResultsGood correlations were found between IQs and the measured physical-technical image quality: noise (ρ = −1.00), contrast-to-noise (ρ = 1.00) and contrast-detail (ρ = 0.96). The correlation coefficients between IQs and the observed clinical image quality of soft and sharp reconstructions were 0.88 and 0.93, respectively.ConclusionsThe automatic scoring algorithm is a promising tool for the evaluation of thoracic CT scans in daily clinical practice. It allows monitoring of the image quality of a chest protocol over time, without human intervention. Different reconstruction kernels can be compared after normalization of the IQs.     

Imaging performance of phase-contrast breast computed tomography with synchrotron radiation and a CdTe photon-counting detector

PurposeWithin the SYRMA-CT collaboration based at the ELETTRA synchrotron radiation (SR) facility the authors investigated the imaging performance of the phase-contrast computed tomography (CT) system dedicated to monochromatic in vivo 3D imaging of the female breast, for breast cancer diagnosis.MethodsTest objects were imaged at 38 keV using monochromatic SR and a high-resolution CdTe photon-counting detector. Signal and noise performance were evaluated using modulation transfer function (MTF) and noise power spectrum. The analysis was performed on the images obtained with the application of a phase retrieval algorithm as well as on those obtained without phase retrieval. The contrast to noise ratio (CNR) and the capability of detecting test microcalcification clusters and soft masses were investigated.ResultsFor a voxel size of (60 μm)³, images without phase retrieval showed higher spatial resolution (6.7 mm⁻¹ at 10% MTF) than corresponding images with phase retrieval (2.5 mm⁻¹). Phase retrieval produced a reduction of the noise level and an increase of the CNR by more than one order of magnitude, compared to raw phase-contrast images. Microcalcifications with a diameter down to 130 μm could be detected in both types of images.ConclusionsThe investigation on test objects indicates that breast CT with a monochromatic SR source is technically feasible in terms of spatial resolution, image noise and contrast, for in vivo 3D imaging with a dose comparable to that of two-view mammography. Images obtained with the phase retrieval algorithm showed the best performance in the trade-off between spatial resolution and image noise.     

Role of “the frame cycle time” in portal dose imaging using an aS500-II EPID

IntroductionThis paper evaluates the role of an acquisition parameter, the frame cycle time “FCT”, in the performance of an aS500-II EPID.Materials and methodsThe work presented rests on the study of the Varian EPID aS500-II and the image acquisition system 3 (IAS3). We are interested in integrated acquisition using asynchronous mode. For better understanding the image acquisition operation, we investigated the influence of the “frame cycle time” on the speed of acquisition, the pixel value of the averaged gray-scale frame and the noise, using 6 and 15 MV X-ray beams and dose rates of 1–6 Gy/min on 2100 C/D Linacs.ResultsIn the integrated mode not synchronized to beam pulses, only one parameter the frame cycle time “FCT” influences the pixel value. The pixel value of the averaged gray-scale frame is proportional to this parameter. When the FCT <55 ms (speed of acquisition V_f/s > 18 frames/s), the speed of acquisition becomes unstable and leads to a fluctuation of the portal dose response. A timing instability and saturation are detected when the dose per frame exceeds 1.53 MU/frame. Rules were deduced to avoid saturation and to optimize this dosimetric mode.ConclusionThe choice of the acquisition parameter is essential for the accurate portal dose imaging.     

Translational and rotational localization errors in cone-beam CT based image-guided lung stereotactic radiotherapy

PurposeAccurate localization is crucial in delivering safe and effective stereotactic body radiation therapy (SBRT). The aim of this study was to analyse the accuracy of image-guidance using the cone-beam computed tomography (CBCT) of the VERO system in 57 patients treated for lung SBRT and to calculate the treatment margins.Materials and methodsThe internal target volume (ITV) was obtained by contouring the tumor on maximum and mean intensity projection CT images reconstructed from a respiration correlated 4D-CT. Translational and rotational tumor localization errors were identified by comparing the manual registration of the ITV to the motion-blurred tumor on the CBCT and they were corrected by means of the robotic couch and the ring rotation. A verification CBCT was acquired after correction in order to evaluate residual errors.ResultsThe mean 3D vector at initial set-up was 6.6 ± 2.3 mm, which was significantly reduced to 1.6 ± 0.8 mm after 6D automatic correction. 94% of the rotational errors were within 3°. The PTV margins used to compensate for residual tumor localization errors were 3.1, 3.5 and 3.3 mm in the LR, SI and AP directions, respectively.ConclusionsOn-line image guidance with the ITV–CBCT matching technique and automatic 6D correction of the VERO system allowed a very accurate tumor localization in lung SBRT.     

CT dose reduction using Automatic Exposure Control and iterative reconstruction: A chest paediatric phantoms study

PurposeTo evaluate the impact of Automatic Exposure Control (AEC) on radiation dose and image quality in paediatric chest scans (MDCT), with or without iterative reconstruction (IR).MethodsThree anthropomorphic phantoms representing children aged one, five and 10-year-old were explored using AEC system (CARE Dose 4D) with five modulation strength options. For each phantom, six acquisitions were carried out: one with fixed mAs (without AEC) and five each with different modulation strength. Raw data were reconstructed with Filtered Back Projection (FBP) and with two distinct levels of IR using soft and strong kernels. Dose reduction and image quality indices (Noise, SNR, CNR) were measured in lung and soft tissues. Noise Power Spectrum (NPS) was evaluated with a Catphan 600 phantom.ResultsThe use of AEC produced a significant dose reduction (p < 0.01) for all anthropomorphic sizes employed. According to the modulation strength applied, dose delivered was reduced from 43% to 91%. This pattern led to significantly increased noise (p < 0.01) and reduced SNR and CNR (p < 0.01). However, IR was able to improve these indices. The use of AEC/IR preserved image quality indices with a lower dose delivered. Doses were reduced from 39% to 58% for the one-year-old phantom, from 46% to 63% for the five-year-old phantom, and from 58% to 74% for the 10-year-old phantom. In addition, AEC/IR changed the patterns of NPS curves in amplitude and in spatial frequency.ConclusionsIn chest paediatric MDCT, the use of AEC with IR allows one to obtain a significant dose reduction while maintaining constant image quality indices.     

Quantification and monitoring of PET/CT data in multicentre trials: The Swiss SAKK 56/07 trial experience

AimTo outline the importance of continuous monitoring of quantitative positron emission tomography (PET) data in multicentre trials to minimize quantitative bias in longitudinal intra-patient PET studies in light of the multicentre SAKK 56/07 experience in quantification and monitoring ¹⁸F-FDG PET/CT data.Patients and methodsWe collected 64 uniform phantom ¹⁸F-FDG PET acquisitions periodically at the enrolling centres (12 European institutions). A core-laboratory analysed them for standard uptake value (SUV) accuracy (desired 1.00 ± 10%) and acceptable image noise was defined by a coefficient of variation (COV) less than 15%. In total, 151 patients ¹⁸F-FDG PET acquisitions (baseline and follow-up) were also collected and analysed to verify longitudinal coherence of main acquisition/reconstruction parameters (DICOM tags verification) and patient preparation, in particular the uptake time (desired uptake time [UT] = 60 ± 10 min).ResultsUniform phantom PET acquisition satisfied the inclusion criteria in 58/64 (89%) examinations. All PET scanner exhibited comparable SUV quantification, but we found large dispersion in terms of noise, with COV ranging 3–15%. Only 1 phantom PET acquisition was out of range with COV = 21.5%. Patient data exhibited important variation in uptake time with UT = 65 ± 10 min (mean ± SD), with only 111/151 (74%) patients’ examinations satisfying inclusion criteria while 26% were out of range.ConclusionsRegular monitoring of PET data in multicentre trials is capital to ensure longitudinal intra-patient PET data consistence and minimize quantitative bias while it helps to spread the culture of quality in participating centre. Recent EARL (EANM Research Ltd) standardization and unification of procedures is a welcome step in this direction.     

Design and development of a dedicated portable gamma camera system for intra-operative imaging

PurposeWe developed a high performance portable gamma camera platform dedicated to identification of sentinel lymph nodes (SLNs) and radio-guided surgery for cancer patients. In this work, we present the performance characteristics of SURGEOSIGHT-I, the first version of this platform that can intra-operatively provide high-resolution images of the surveyed areas.MethodsAt the heart of this camera, there is a 43 × 43 array of pixelated sodium-activated cesium iodide (CsI(Na)) scintillation crystal with 1 × 1 mm² pixel size and 5 mm thickness coupled to a Hamamatsu H8500 flat-panel multi-anode (64 channels) photomultiplier tube. The probe is equipped with a hexagonal parallel-hole lead collimator with 1.2 mm holes. The detector, collimator, and the associated front-end electronics are encapsulated in a common housing referred to as head.ResultsOur results show a count rate of ∼41 kcps for 20% count loss. The extrinsic energy resolution was measured as 20.6% at 140 keV. The spatial resolution and the sensitivity of the system on the collimator surface was measured as 2.2 mm and 142 cps/MBq, respectively. In addition, the integral and differential uniformity, after uniformity correction, in useful field-of-view (UFOV) were measured 4.5% and 4.6%, respectively.ConclusionsThis system can be used for a number of clinical applications including SLN biopsy and radiopharmaceutical-guided surgery.     

Effect of diagnostic cone-beam computed tomography protocols on image quality,patient dose,and lesion detection

ObjectiveTo evaluate the effect of cone-beam computed tomography (CBCT) image acquisition protocols on image quality, lesion detection, delineation, and patient dose.Methods100-patients and a CTDI phantom combined with an electron density phantom were examined using four different CBCT-image acquisition protocols during image-guided transarterial chemoembolization (TACE). Protocol-1 (time: 6 s, tube rotation: 360°), protocol-2 (5 s, 300°), protocol-3 (4 s, 240°) and protocol-4 (3 s, 180°) were used. The protocols were first investigated using a phantom. The protocols that were found to be clinically appropriate in terms of image quality and radiation dose were then assessed on patients. A higher radiation dose and/or a poor image quality were inappropriate for the patient imaging. Patient dose (patient-entrance dose and dose-area product), image quality (Hounsfield Unit, noise, signal-to-noise ratio and contrast-to-noise ratio), and lesion delineation (tumor-liver contrast) were assessed and compared using appropriate statistical tests. Lesion detectability, sensitivity, and predictive values were estimated for CBCT-image data using pre-treatment patient magnetic resonance imaging.ResultsThe estimated patient dose showed no statistical significance (p > 0.05) between protocols-2 and -3; the assessed image quality between these protocols manifested insignificant difference (p > 0.05). Two other phantom protocols were not considered for patient imaging due to significantly higher dose (protocols-1) and poor image quality (protocol-4). Lesion delineation and detection were insignificant (p > 0.05) between protocols-2 and -3. Lesion sensitivities generated were 81–89% (protocol-2) and 81–85% (protocol-3) for different lesion types.ConclusionData acquisition using protocols-2 and -3 provided good image quality, lesion detection and delineation with acceptable patient dose during CBCT-imaging mainly due to similar frame numbers acquired.     

Variable angle stereo imaging for rapid patient position correction in an in-house real-time position monitoring system

PurposeTo develop and validate a variable angle stereo image based position correction methodology in an X-ray based in-house online position monitoring system.Materials and methodsA stereo imaging module that enables 3D position determination and couch correction of the patient based on images acquired at any arbitrary angle and arbitrary angular separation was developed and incorporated to the in-house SeedTracker real-time position monitoring system. The accuracy of the developed system was studied by imaging an anthropomorphic phantom implanted with radiopaque markers set to known offset positions from its reference position in an Elekta linear accelerator (LA) and associated XVI imaging system. The accuracy of the system was further validated using CBCT data set from 10 prostate SBRT patients. The time gains achieved with the stereo image based position correction was compared with the manual matching of seed positions in Digitally Reconstructed Radiographs (DRRs) and kV images in the Mosaiq record and verify system.ResultsBased on phantom and patient CBCT dataset study stereo imaging module implemented in the SeedTracker shown to have an accuracy of 0.1(σ = 0.5) mm in detecting the 3D position offset. The time comparison study showed that stereo image based methodology implemented in SeedTracker was a minimum of 80(4) s faster than the manual method implemented in Mosaiq R&V system with a maximum time saving of 146(6) s.ConclusionThe variable angle stereo image based position correction method was shown to be accurate and faster than the standard manual DRR–kV image based correction approach, leading to more efficient treatment.     

Achievement of therapeutic targets in Mexican patients with diabetes mellitus

Background and aimComplications of diabetes comprise the leading cause of death in Mexico. We aimed to describe the characteristics of management and achievement of therapeutic targets in Mexican patients with diabetes mellitus.MethodsWe analyzed data from 2642 Mexican patients with type 1 (T1D, n = 203, 7.7%) and type 2 diabetes (T2D, n = 2439, 92.3%) included in the third wave of the International Diabetes Management Practices Study.ResultsOf T2D patients, 63% were on oral glucose-lowering drugs (OGLD) exclusively (mostly metformin), 11% on insulin, 22% on OGLD plus insulin, and 4% on diet and exercise exclusively. T2D patients on insulin were more likely to be trained on diabetes, but they were older, had worse control, longer disease duration and more chronic complications than patients on OGLD only. Glycated hemoglobin (HbA1c) < 7% was achieved by 21% and 37% of T1D and T2D patients, respectively. Only 5% of T1D and 3% of T2D attained the composite target of HbA1c < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl. T1D patients had less macrovascular but more microvascular complications, compared with T2D patients. Late complications increased with disease duration, so that about 80% of patients after 20 years of diagnosis have at least one late complication. Reaching the target HbA1c < 7% was associated with a reduced number of microvascular but not with less macrovascular complications.ConclusionA great proportion of these Mexican patients with diabetes did not reach therapeutic targets. Insulin was used mostly in complicated cases with advanced disease.     

Influencia del inmunoensayo empleado en la determinación de vitamina D sérica

IntroductionSerum 25-hydroxyvitamin D [25(OH)D] levels are the best indicator of vitamin D levels in the body. Precision, reproducibility, and lack of standardization are the main problems in such measurements. The aim of this study was to compare the 25(OH)D levels measured using Elecsys Vitamin D Total (Roche) and ADVIA Centaur Vitamin D Total (Siemens).Material and methods25(OH)D levels were tested in 166 patients using both methods. Patients were subsequently divided into two groups: a «supplemented group» consisting of patients receiving vitamin D supplements, and an «untreated group» consisting of the rest of patients.Results25(OH)D mean levels measured by the Roche and Siemens methods in the overall group were 33.6 ± 16.0 and 19.8 ± 12.4 ng/mL respectively. 54.2% of patients were receiving vitamin D supplements. In this group, mean 25(OH)D levels measured by the Roche and Siemens methods were 40.6 ± 14.5 and 25.4 ± 13.1 ng/mL respectively. In the untreated group, the respective values were 24.9 ± 13.2 and 12.8 ± 6.6 ng/mL. Prevalence of vitamin D deficiency (serum 25(OH)D levels less than 20 ng/mL) was higher in samples analyzed using the Siemens method (60.2%) as compared to those tested using the Roche method (23.5%).ConclusionThe assays evaluated are not comparable to each other. Laboratory specialists should inform clinicians of the features of the method used for measuring 25(OH)D because this will have a direct impact on interpretation of the results and medical decisions.     

EPID-based in vivo dosimetry for stereotactic body radiotherapy of non-small cell lung tumors: Initial clinical experience

PurposeEPID-based in vivo dosimetry (IVD) has been implemented for stereotactic body radiotherapy treatments of non-small cell lung cancer to check both isocenter dose and the treatment reproducibility comparing EPID portal images.Methods15 patients with lung tumors of small dimensions and treated with volumetric modulated arc therapy were enrolled for this initial experience. IVD tests supplied ratios R between in vivo reconstructed and planned isocenter doses. Moreover a γ-like analysis between daily EPID portal images and a reference one, in terms of percentage of points with γ-value smaller than 1, P_γ<1, and mean γ-values, γ_mean, using a local 3%–3 mm criteria, was adopted to check the treatment reproducibility. Tolerance levels of 5% for R ratio, P_γ<1 higher than 90% and γ_mean lower than 0.67 were adopted.ResultsA total of 160 EPID images, two images for each therapy session, were acquired during the treatment of the 15 patients. The overall mean of the R ratios was equal to 1.005 ± 0.014 (1 SD), with 96.9% of tests within ± 5%. The 2 D image γ-like analysis showed an overall γ_mean of 0.39 ± 0.12 with 96.1% of tests within the tolerance level, and an average P_γ<1 value equal to 96.4 ± 3.6% with 95.4% of tests with P_γ<1 > 90%. Paradigmatic discrepancies were observed in three patients: a set-up error and a patient morphological change were identified thanks to CBCT image analysis whereas the third discrepancy was not fully justified.ConclusionsThis procedure can provide improved patient safety as well as a first step to integrate IVD and CBCT dose recalculation.     

Influence of calcium (0.6 or 1.2%) and phosphorus (0.3 or 0.6%) content and ratio on the formation of urolithogenic compounds in the urine of Boer-cross goats fed high-concentrate diets

The population of meat goats in the U.S. increased dramatically between 2002 and 2007. With this increase has come an increase in the number of cases of obstructive urolithiasis being seen by veterinarians. Since this condition is often associated with imbalances in dietary Ca and P, the goal of this project was to investigate the influence of concentration and ratio of Ca and P in diets for meat goats on the formation of urolithogenic precursors. Using 8 Boer-cross, wether goats in replicated Latin squares, 4 diets containing either 0.3 or 0.6% P, 0.6 or 1.2% Ca, 0 or 2% added salt, and Ca:P ratios of 1:1 or 2:1 were offered (0.3% P, 2:1; 0.6% P, 1:1; 0.6% P, 2:1; and 0.6% P, 2:1 + salt). Serum, urine, and feces were collected in conjunction with water and feed intake measurements. All treatment groups had similar dry matter intakes (DMI; 838–887 g/d, P = 0.19) and N retention rates (6.2–7.0 g/d, P = 0.54). Water consumption per unit DMI was similar for goats eating both Ca:P = 2:1 diets without 2% added salt (2.06 g/g DMI and 1.89 g/g DMI for 0.6% P and 0.3% P, respectively). Water consumption was also similar for goats receiving the Ca:P = 1:1 (2.50 g water/g DMI) and 2% added salt diet (2.79 g water/g DMI); and, these levels were higher than those for the lower salt, 2:1 diets (P = 0.0002). Serum Ca, PO₄, Mg, K, Na, Cl, HCO₃, and anion gap all fell within normal ranges throughout the trial, as did serum urea N and glucose. Fecal DM was 10% lower in goats consuming 0.6% P, 1:1 than when other diets were offered (32% vs. 42%, P < 0.0001), possibly the result of changes in Na and water absorption in the gastrointestinal tract caused by high P and Ca:P imbalance. Goats consuming the 0.3% P, 2:1 diet had similar urinary crystal density scores (2.47 out of 3) to goats receiving the 0.6% P, 1:1 diet with Ca:P = 0.81 (2.31 out of 3). The 0.6% P, 2:1 diets without and with 2% added salt also had similar, but lower crystal density scores (1.50 for 0.6% P, 2:1 and 1.06 for 0.6% P, 2:1 + salt; P = .002). Goats with high crystal density scores had higher urinary P, Mg, or both. Our results suggested that the formation of urolithogenic compounds is highly complex and is the result of an interrelationship between multiple minerals in the diet, not only Ca and P. Mineral concentrations may interact with mineral imbalance to impact overall mineral and water absorption from the intestines. We also demonstrated that urolithogenic precursor crystals may easily be observed using light microscopy and suggested that the crystal precursors may provide a useful predictor of which goats may be prone to developing clinical urolithiasis.     

Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the Community of Madrid (Spain)

BackgroundOur aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain).MethodsFrom 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period.ResultsA significant decrease in serum glucose levels (143 ± 42 mg/dl vs 137 ± 43 mg/dl, p < 0.00), HbA1c (7.09 ± 1.2% vs 7.02 ± 1.2%, p < 0.00), total cholesterol (191.4 ± 38 mg/dl vs 181.5 ± 36 mg/dl, p < 0.00), LDL cholesterol (114.7 ± 31 mg/dl vs 105.5 ± 30 mg/dl, p < 0.00) and triglyceride levels (144.5 ± 93 mg/dl vs 138 ± 84 mg/dl, p < 0.00) during study period was documented. On the contrary, a significant elevation in HDL cholesterol levels was observed (49.2 ± 14 mg/dl vs 49.9 ± 16 mg/dl, p < 0.00). The incidence of diabetic complications throughout the study period was low, with a incidence of coronary heart disease of 6.2%, peripheral arterial disease 3%, ischemic stroke 2.8%, diabetic foot 11.2%, nephropathy 5.9%, retinopathy 4.5%, and neuropathy 3%.ConclusionMetabolic control in T2D patients attended in primary care in the Community of Madrid throughout 3 years is adequate and is accompanied by low percent of chronic diabetic complications during this period of follow-up.     

Hippocampal dose during Linac-based stereotactic radiotherapy for brain metastases: An observational study

IntroductionAim of the present study is to evaluate homolateral and contralateral hippocampus (H-H, C-H, respectively) dose during Fractionated Stereotactic Radiotherapy (FSRT) or Radiosurgery (SRS) for brain metastases (BM).Materials & methodsPatients with BM < 5, size ≤ 30 mm, KPS ≥ 80 and a life expectancy > 3 months, were considered for SRS/FSRT (total dose 15–30 Gy, 1–5 fractions). For each BM, a Flattening Filter Free (FFF) Volumetric Modulated Arc Therapy (VMAT) plan was generated with one or two arcs. Hippocampi were not considered during optimizations phase and were contoured and evaluated retrospectively in terms of dose: the Dmedian, Dmean, D0.1cc and the V1Gy, V2Gy, V5Gy and V10Gy were analyzed.ResultsFrom April 2014 to December 2015, 81 BM were treated with FFF-FSRT/SRS. For the H-H, the average values of Dmedian, Dmean and D0.1cc were 1.5Gy, 1.54Gy and 2.2Gy, respectively, while the V1Gy, V2Gy, V5Gy and V10Gy values were 25%, 8.9%, 8.9% and 2.1%, respectively. For the C–H, the average Dmedian, Dmean and D0.1 cc were 0.7Gy, 0.7Gy, 0.9Gy, respectively, while the average values of V1Gy, V2Gy, V5Gy and V10Gy were 18%, 10.2%, 2.8% and 1.4%, respectively. Tumor dimension, tumor cranial-caudal length and the distance between BM and H-H were correlated to Dmedian, Dmean and D0.1cc. For C-H, only the distance from PTV was correlated with a dose reduction.ConclusionDuring FFF-FSRT/SRS, hippocampus received a negligible dose. Despite its clinical significance is still under evaluation, in patients with a long life expectancy, H-H should be considered during Linac-based FSRT/SRS.     

Few-view CT reconstruction via a novel non-local means algorithm

PurposeNon-local means (NLM) based reconstruction method is a promising algorithm for few-view computed tomography (CT) reconstruction, but often suffers from over-smoothed image edges. To address this problem, an adaptive NLM reconstruction method based on rotational invariance (ART-RIANLM) is proposed.MethodsThe method consists of four steps: 1) Initializing parameters; 2) ART reconstruction using raw data; 3) Positivity constraint of the reconstructed image; 4) Image updating by RIANLM filtering. In RIANLM, two kinds of rotational invariance measures which are average gradient (AG) and region homogeneity (RH) are proposed to calculate the distance between two patches and a novel NLM filter is developed to avoid over-smoothed image. Moreover, the parameter h in RIANLM which controls the decay of the weights is adaptive to avoid over-smoothness, while it is constant in NLM during the whole reconstruction process. The proposed method is validated on two digital phantoms and real projection data.ResultsIn our experiments, the searching neighborhood size is set as 15 × 15 and the similarity window is set as 3 × 3. For the simulated case of Shepp-Logan phantom, ART-RIANLM produces higher SNR (36.23 dB > 24.00 dB) and lower MAE (0.0006 < 0.0024) reconstructed images than ART-NLM. The visual inspection demonstrated that the proposed method could suppress artifacts or noises more effectively and recover image edges better. The result of real data case is also consistent with the simulation result.ConclusionsA RIANLM based reconstruction method for few-view CT is presented. Compared to the traditional ART-NLM method, SNR and MAE from ART-RIANLM increases 51% and decreases 75%, respectively.