Calf blood flow and posture: Doppler ultrasound calibrated by plethysmography.

A procedure was developed that enables measurement of rapid variations in calf blood flow during voluntary rhythmic contraction of the calf muscles in supine, sitting, and standing positions. During the exercise, maximum blood velocity is measured by Doppler ultrasound equipment in the popliteal artery. The Doppler signals are calibrated by plethysmography to enable calculation of blood flow during exercise in ml.100 ml-1.min-1. Knowledge of the cross-sectional area of the vessel and the angle of insonation is not required in this procedure. Evaluation of the calibration method with 10 healthy volunteers showed that for each subject a new calibration was necessary after a change in posture; the relationship between the blood flow and the maximum Doppler frequency averaged over one heart cycle was linear for each calibration.     

Doppler Optical Coherence Tomography of Retinal Circulation

Noncontact retinal blood flow measurements are performed with a Fourier domain optical coherence tomography (OCT) system using a circumpapillary double circular scan (CDCS) that scans around the optic nerve head at 3.40 mm and 3.75 mm diameters. The double concentric circles are performed 6 times consecutively over 2 sec. The CDCS scan is saved with Doppler shift information from which flow can be calculated. The standard clinical protocol calls for 3 CDCS scans made with the OCT beam passing through the superonasal edge of the pupil and 3 CDCS scan through the inferonal pupil. This double-angle protocol ensures that acceptable Doppler angle is obtained on each retinal branch vessel in at least 1 scan. The CDCS scan data, a 3-dimensional volumetric OCT scan of the optic disc scan, and a color photograph of the optic disc are used together to obtain retinal blood flow measurement on an eye. We have developed a blood flow measurement software called "Doppler optical coherence tomography of retinal circulation" (DOCTORC). This semi-automated software is used to measure total retinal blood flow, vessel cross section area, and average blood velocity. The flow of each vessel is calculated from the Doppler shift in the vessel cross-sectional area and the Doppler angle between the vessel and the OCT beam. Total retinal blood flow measurement is summed from the veins around the optic disc. The results obtained at our Doppler OCT reading center showed good reproducibility between graders and methods (<10%). Total retinal blood flow could be useful in the management of glaucoma, other retinal diseases, and retinal diseases. In glaucoma patients, OCT retinal blood flow measurement was highly correlated with visual field loss (R²>0.57 with visual field pattern deviation). Doppler OCT is a new method to perform rapid, noncontact, and repeatable measurement of total retinal blood flow using widely available Fourier-domain OCT instrumentation. This new technology may improve the practicality of making these measurements in clinical studies and routine clinical practice.     

Nontraumatic aortic blood flow sensing by use of an ultrasonic esophageal probe.

The measurement of blood velocity fields, volume flow, and arterial wall motion in the descending thoracic aorta provides essential hemodynamic information for both research and clinical diagnosis. The close proximity of the esophagus to the aorta in the dog makes it possible to obtain such data nonsurgically using an ultrasonic esophageal probe; however, the accuracy of such a probe is limited if the angle between the sound beam and the flow axis, known as the Doppler angle, is not precisely known. By use of a pulsed Doppler velocity meter (PUDVM) and a triangulation procedure, accurate empirical measurement of the Doppler angle has been obtained, allowing quantification of blood velocity scans across the aorta. Volume flow is obtained by integration of blood velocity profiles and arterial wall motion is measured with an ultrasonic echo tracking device. Accuracy of the probe was substantiated by comparison with ultrasonic and electromagnetic implanted flow cuff measurements. Use of the probe in measurement of blood velocity, volume flow and arterial wall motion at various locations along the 8- and 10-cm length of the descending thoracic aorta in adult beagle dogs is detailed. The simplicity, accuracy, and nontraumatic aspect of the technique should allow increasing use of such a probe in numerous research and clinical applications.     

Stimulus features relevant to the perception of sharpness and mechanically evoked cutaneous pain

Mechanical probes of various sizes and shapes were used to determine thresholds for the perception of pressure, sharpness, and pain on the human finger. As force increased, perception changed from dull pressure to sharp pressure to sharp pain. With the smallest probe (0.01 mm2), sharpness threshold was very close to pressure threshold. As probe size increased, sharpness and pain threshold expressed in terms of force) increased in proportion to probe circumference (not probe area), whereas pressure threshold increased relatively little. Pain and sharpness thresholds also increased as probe angle became obtuse. There was a statistically significant increase in both thresholds with a probe angle change of 15 degrees. Thus, both size and shape are necessary to describe a mechanical stimulus adequately, and pressure (force/area) is not a sufficient metric for pain studies. Thresholds varied at different skin sites on the finger. The dorsal surface had lower thresholds than the volar surface, but the difference between the two areas was not always statistically significant. The compliance of the skin (e.g., the amount of indentation produced by a given force) exhibited no relation to sharpness or pain threshold, whether considered within subjects at various skin sites, or across subjects at the same skin site. Comparison of the perceptual thresholds with the thresholds for nociceptors determined in electrophysiological studies indicates that the sensation of nonpainful sharpness is likely to be mediated by nociceptors. Furthermore, considerably more than threshold activation of nociceptors is necessary for normal pain perception.     

Pulse-Doppler Ultrasound and Its Clinical Application

Doppler devices can provide clinically useful information about blood flow. This paper describes how a pulse-Doppler instrument has been linked to a B-scan machine so that flow patterns in any ultrasonically accessible vessel can be monitored from the skin surface. The same transducer is used for both modes of investigation to enable accurate and reliable positioning of the sample-volume. After briefly summarizing the principles of continuous-wave and pulse-Doppler operation, the concepts and relative advantages of coherent and non-coherent detection are explained. The potential clinical uses of the pulse-echo-Doppler hybrid and Doppler devices in general are then discussed.     

Noninvasive ultrasonic measurement of arterial wall motion in mice

Despite the extensive use of genetically altered mice to study cardiovascular physiology and pathology, it remains difficult to quantify arterial function noninvasively in vivo. We have developed a noninvasive Doppler method for quantifying vessel wall motion in anesthetized mice. A 20-MHz probe was held by an alligator clip and positioned over the carotid arteries of 16 mice, including six 3- to 5-mo-old wild-type (WT), four 30-mo-old senescent (old), two apolipoprotein E null (ApoE), and four alpha-smooth muscle actin null (alpha-SMA) mice. Doppler signals were obtained simultaneously from both vessel walls and from blood flow. The calculated displacement signals from the near and far walls were subtracted to generate a diameter signal from which the excursion and an augmentation index were calculated. The excursion ranged between 13 microm (in ApoE) and 95 microm (in alpha-SMA). The augmentation index was lowest in the WT mice (0.06) and highest in the old mice (0.29). We conclude that Doppler signal processing may be used to measure vessel wall motion in mice with high spatial and temporal resolution and that diameter signals can replace pressure signals for calculating the augmentation index. This noninvasive method is able to identify and confirm characteristic changes in arterial properties previously associated with age, atherosclerosis, and the absence of vascular tone.     

Transcranial Doppler ultrasonography: stereotactically guided examinations using magnetic resonance angiography]

The accurate localization of specific intracranial blood vessels is a major difficulty with transcranial Doppler sonography (TCD). It was the purpose of this study to develop a system enabling stereotactic navigation during a TCD examination on the basis of high-resolution three-dimensional magnetic resonance angiographic (MRA) data. During TCD, the examiner is provided--on a computer screen--with a projected view of the respective intracranial vessel anatomy. With the aid of an optoelectronic localization system, the spatial orientation and localization of the US probe is determined in real time, and correlated with the patient's MRA data using a dedicated stereotactic mask. Subsequently, the US beam and the points of insonation are displayed on the screen overlaid on the vessel anatomy. In this way the examiner gains real time control of the localization of the respective intracranial vessel insonated. Points of insonation can be stored and recalled for follow-up examinations. In addition to the successful verification of the system, it was shown that, in comparison with conventional TCD, stereotactic navigation distinctly improves the reproducibility of repeat TCD examinations.     

Measurement of human fetal blood flow.

Real-time B-mode ultrasonography was combined with a pulsed Doppler ultrasound technique for transcutaneous measurement of human fetal blood flow in the aorta and intra-abdominal part of the umbilical vein. The target vessel was located and its diameter measured in the two-dimensional real-time image. The pulsed Doppler transducer was attached to the real-time transducer at a fixed angle. By processing the Doppler shift signals the instrument estimated the mean and maximum blood velocities and the integral under the velocity curves. This permitted calculation of the blood flow. The method was applied to 26 fetuses in normal late pregnancies. Mean blood flow in the descending part of the fetal aorta based on maximum velocity was 191 ml/kg/min. Mean flow in the intra-abdominal part of the umbilical vein was 110 ml/kg/min. This method of measurement is non-invasive and opens new perspectives in studying fetal haemodynamics.     

Controlled trial of plasma exchange in treatment of Raynaud's syndrome.

Twenty-seven patients with Raynaud''s syndrome had their digital vessel patency assessed by Doppler ultrasound after different thermal stresses. Digital vessel patency rates differed significantly after stresses at 15 degrees C and 45 degrees C. In a randomised controlled trial placebo and heparin had no effect either on patients'' symptoms or on the patency of their digital vessels. Plasma exchange improved both symptoms and vessel patency rates at 15 degrees C and 21 degrees C. Improvement in seven out of eight of these patients has been maintained for six months. Assessing digital vessel patency by Doppler techniques allow continuous, atraumatic, and safe evaluation of the effects of different methods of treatment on the patency of the digital vessels and has helped to indicate that plasma exchange is a useful adjunct in the management of patients with severe Raynaud''s syndrome.     

TRAM flap safety optimized with intraoperative Doppler

Anatomic studies have clearly documented the variable position of the deep superior epigastric vessels in the rectus abdominis muscle. In our opinion, only that part of the rectus abdominis muscle containing the vascular pedicle should be transposed with the TRAM flap. The Doppler probe provides a simple method of identifying the dominant intramuscular vascular axis. It consistently alerts the surgeon to any unusual position of a vessel at the costal margin or within the rectus abdominis muscle. This knowledge enables a conservative yet safe dissection of the vascular pedicle, rectus abdominis muscle, and its sheath. This in turn will enable a competent abdominal closure. The Doppler technique is safe, simple, quick, noninvasive, familiar to most surgeons, and applicable to all patients.     

Response of Retinal Blood Flow to Systemic Hyperoxia as Measured with Dual-Beam Bidirectional Doppler Fourier-Domain Optical Coherence Tomography

Purpose

There is a long-standing interest in the study of retinal blood flow in humans. In the recent years techniques have been established to measure retinal perfusion based on optical coherence tomography (OCT). In the present study we used a technique called dual-beam bidirectional Doppler Fourier-domain optical coherence tomography (FD-OCT) to characterize the effects of 100% oxygen breathing on retinal blood flow. These data were compared to data obtained with a laser Doppler velocimeter (LDV).

Methods

10 healthy subjects were studied on 2 study days. On one study day the effect of 100% oxygen breathing on retinal blood velocities was studied using dual-beam bidirectional Doppler FD-OCT. On the second study day the effect of 100% oxygen breathing on retinal blood velocities was assessed by laser Doppler velocimetry (LDV). Retinal vessel diameters were measured on both study days using a commercially available Dynamic Vessel Analyzer. Retinal blood flow was calculated based on retinal vessel diameters and red blood cell velocity.

Results

As expected, breathing of pure oxygen induced a pronounced reduction in retinal vessel diameters, retinal blood velocities and retinal blood flow on both study days (p<0.001). Blood velocity data correlated well between the two methods applied under both baseline as well as under hyperoxic conditions (r = 0.98 and r = 0.75, respectively). Data as obtained with OCT were, however, slightly higher.

Conclusion

A good correlation was found between red blood cell velocity as measured with dual-beam bidirectional Doppler FD-OCT and red blood cell velocity assessed by the laser Doppler method. Dual-beam bidirectional Doppler FD-OCT is a promising approach for studying retinal blood velocities in vivo.     

Dermography in humans: dependence of skin vessel reactions on stimulus strength

Application of measured skin stimulation (contrary to classic dermographism) revealed a microcirculation variety of changes and restoration (skin vessel selfregulation). The reaction phases were measured versus classic dermographism. The types of skin vessel reactions is found to depend upon the stimulus strength. The dynamics of pattern change of skin vessels is described to differentiate hatched zone (central) and surrounding ones. A tendency of appearing of the surrounding zone before the central those was found. Restoration of the microcirculation after skin stimulation (the period of vessel reaction disappearance) is detected by 3 factor relations: latency of appearance of the 1st phase reaction, phase quantity, and skin color. Dependence of parameters (vessel dilatation or constriction; pressure threshold evoking skin vessel reaction; latency of appearance and of restoration of the background color) is described to correlate with skin color (2nd, 4th, and 5th phototypes of the Fitz-Patrick classification).     

Influences of probe application on the measurement of subcutaneous thickness using A-mode ultrasonography

The purpose of the present study was to investigate the effects of the way of probe application on the values of subcutaneous fat thickness by use of A-mode ultrasonography . Subjects were six healthy male adults ranging in age from 19 to 35 years. Scapular, triceps, supra-iliac, abdomen, and thigh were chosen for the measurement sites. Observed values of subcutaneous fat decreased with the increase of pressure at scapular, supra-iliac, and abdomen for relatively fatty subjects, but not for lean subjects. However, the values showed little change at triceps and thigh for all subjects. There was no relation between the pressure of probe and the stability of the value. The values were also influenced by the displacement of the probe on skin. Moreover, it was shown that the difference of the angle between probe and skin influenced the values of subcutaneous fat thickness. A-mode ultrasonography++ has many advantages, if it is properly operated considering the above problems.     

Oxygenation and microcirculation during skin stretching in undermined and nonundermined skin

The aim of this experimental study was to assess the skin microcirculation of undermined and nonundermined wound edges closed with a skin-stretching device. In eight piglets, 9 x 9-cm wounds were created on both flanks by excision of the skin and the subcutaneous layer down to the muscular fascia, with general anesthesia. On one flank, the surrounding skin was completely undermined. For a period of 30 minutes, wound closure was performed with a stretching device, using the principle of load cycling. The device stretched the skin and moved the opposing wound edges toward each other. During this period, laser Doppler flowmetry and transcutaneous oximetry were simultaneously used to monitor microcirculation and oxygenation in the stretched skin of both flanks. Undermining of the surrounding skin produced a 12 percent decrease in the laser Doppler flowmetry signal and a 21 percent decrease in the transcutaneous oximetry value. Skin stretching resulted in decreases in the laser Doppler flowmetry signals and the transcutaneous oximetry values, whether or not the skin was undermined. Releasing the stretching device resulted in rapid normalization of the laser Doppler flowmetry values in undermined and nonundermined skin and a slow return of the transcutaneous oximetry values to close to baseline levels in nonundermined skin. The transcutaneous oximetry values in undermined skin did not return to baseline levels; each period of skin stretching resulted in an additional decrease in the transcutaneous oximetry values. Stretching of undermined skin for 30 minutes produced a significant (p < 0.0001) decrease in skin oxygenation. As a result, 50 percent of the undermined stretched skin demonstrated skin necrosis at the wound edges, which was still present after 1 week. Wound healing in the nonundermined stretched skin proceeded without problems. It is concluded from these experiments that the viability of undermined skin becomes compromised as a result of significantly decreased oxygen availability in the skin during and after stretching. Consequently, it is recommended that skin stretching be performed on nonundermined skin, rather than undermined skin. In addition, when skin is stretched to close a large defect, it is logical to use cyclic loading, so that recuperation of the skin circulation can occur. Furthermore, laser Doppler flowmetry seemed to produce atypical signals in monitoring of skin viability of wound edges closed with a skin-stretching device.     

Technique and strategy in anterolateral thigh perforator flap surgery,based on an analysis of 15 complete and partial failures in 439 cases

The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue defect reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used in 660 patients in Chang Gung Memorial Hospital. A total of 439 flaps were cutaneous or fasciocutaneous flaps based on musculocutaneous perforators. The analysis of the flap failures was done only in this perforator series. In six cases, no suitable skin vessel was found during the dissection of the flaps. The complete success rate was 96.58 percent (424 of 439). Of the 15 failure cases, eight were complete and seven were partial (10 percent to 60 percent of the flap). Thirty-four flaps were reexplored, and 19 (56 percent) were salvaged. In this study, some of the reasons for the flap failure, unique to the anterolateral thigh perforator flap, were identified. They include inadvertent division of perforator at the fascial plane as a result of inadequate knowledge of perforator anatomy, inadvertent injury to the perforator during intramuscular dissection (noted by the surgeon or ignored) as a result of inexperience, and twisting of the pedicle during inset of the flap at the recipient site. Technical pearls in the harvest of the anterolateral thigh perforator flap are as follows: mapping of the skin vessels with a Doppler probe before flap design, meticulous dissection of the perforator under surgical loupe or even lower-magnification microscope, inclusion of a small fascia cuff around the perforator, and intermittent topical use of Xylocaine during the intramuscular dissection of the perforators. During reexploration, one must search for twisting of the pedicle and small bleeders from the branches of the intramuscular perforators.     

Assessment of skin flaps using optically based methods for measuring blood flow and oxygenation

The objective of this study was to compare two noninvasive techniques, laser Doppler and optical spectroscopy, for monitoring hemodynamic changes in skin flaps. Animal models for assessing these changes in microvascular free flaps and pedicle flaps were investigated. A 2 x 3-cm free flap model based on the epigastric vein-artery pair and a reversed MacFarlane 3 x 10-cm pedicle flap model were used in this study. Animals were divided into four groups, with groups 1 (n = 6) and 2 (n = 4) undergoing epigastric free flap surgery and groups 3 (n = 3) and 4 (n = 10) undergoing pedicle flap surgery. Groups 1 and 4 served as controls for each of the flap models. Groups 2 and 3 served as ischemia-reperfusion models. Optical spectroscopy provides a measure of hemoglobin oxygen saturation and blood volume, and the laser Doppler method measures blood flow. Optical spectroscopy proved to be consistently more reliable in detecting problems with arterial in flow compared with laser Doppler assessments. When spectroscopy was used in an imaging configuration, oxygen saturation images of the entire flap were generated, thus creating a visual picture of global flap health. In both single-point and imaging modes the technique was sensitive to vessel manipulation, with the immediate post operative images providing an accurate prediction of eventual outcome. This series of skin flap studies suggests a potential role for optical spectroscopy and spectroscopic imaging in the clinical assessment of skin flaps.     

不同坡位水曲柳木质部解剖特征及其与气候关系

随着气候变暖,东北地区暖干化加剧。为了解干旱胁迫对小兴安岭地区不同坡位水曲柳径向生长的影响,采用木材解剖学方法,分析了水曲柳木质部解剖特征对不同坡位水分变化的响应。结果表明: 上、下坡位水曲柳木质部解剖参数整体上变化趋势一致,导管数量呈线性分布,最大导管面积和总导管面积总体上呈对数分布,平均导管面积总体上呈偏正态分布。不同坡位多个解剖参数均存在显著差异,下坡位导管数量、导管面积总体上大于上坡位。大部分解剖参数与日积温呈显著正相关,但存在一定差异,上坡位水曲柳总导管面积与日均温呈正相关,导管数量、总导管面积与相对湿度呈正相关,相关性均大于下坡位。上坡位最小导管面积与日积温和相对湿度呈显著负相关;而下坡位,总导管面积与相对湿度呈显著正相关。气候暖干化会导致水曲柳导管面积和导管数量相对减少,但基本上不影响导管分布状况,上、下坡位导管分布基本一致。目前,气候暖干化未限制而是促进了水曲柳的径向生长。     

Assessment of skin dose in breast cancer radiotherapy: on-phantom measurement and Monte Carlo simulation

AimThe main purpose of the present study is assessment of skin dose in breast cancer radiotherapy.BackgroundAccurate assessment of skin dose in radiotherapy can provide useful information for clinical considerations.Materials and methodsA RANDO phantom was irradiated using a 6 MV Siemens Primus linac with medial and tangential radiotherapy fields for simulating breast cancer treatment. Dosimetry was also performed on various positions across the fields using an EBT3 radiochromic film. Similar conditions of measurement on the RANDO phantom including field size, irradiation angle, number of fields, etc. were subsequently simulated via the Monte Carlo N-Particle Transport code (MCNP). Ultimately, dose values for corresponding points from both methods were compared.ResultsConsidering dosimetry using radiochromic films on the RANDO phantom, there were points having underdose and overdose based on the prescribed dose and skin tolerance levels. In this respect, 81.25% and 18.75% of the points had underdose and overdose, respectively. In some cases, several differences were observed between the measurement and the MCNP simulation results associated with skin dose.ConclusionBased on the results of the points which had underdose, it was suggested that a bolus should be used for the given points. With regard to overdose points, it was advocated to consider skin tolerance dose in treatment planning. Differences between the measurement and the MCNP simulation results might be due to voxel size of tally cells in simulations, effect of beam’s angle of incidence, validation time of linac’s head, lack of electronic equilibrium in the build-up region, as well as MCNP tally type.     

Measurement of Thermal Effects of Doppler Ultrasound: An In Vitro Study

Objective

Ultrasound is considered a safe imaging modality and is routinely applied during early pregnancy. However, reservations are expressed concerning the application of Doppler ultrasound in early pregnancy due to energy emission of the ultrasound probe and its conversion to heat. The objective of this study was to evaluate the thermal effects of emitted Doppler ultrasound of different ultrasound machines and probes by means of temperature increase of in-vitro test-media.

Methods

We investigated the energy-output of 5 vaginal and abdominal probes of 3 ultrasound machines (GE Healthcare, Siemens, Aloka). Two in-vitro test objects were developed at the Center for Medical Physics and Biomedical Engineering, Medical University Vienna (water bath and hydrogel bath). Temperature increase during Doppler ultrasound emission was measured via thermal sensors, which were placed inside the test objects or on the probes’ surface. Each probe was emitting for 5 minutes into the absorbing test object with 3 different TI/MI settings in Spectral Doppler mode.

Results

During water bath test, temperature increase varied between 0.1 and 1.0°C, depending on probe, setting and focus, and was found highest for spectral Doppler mode alone. Maximum temperature increase was found during the surface heating test, where values up to 2.4°C could be measured within 5 minutes of emission.

Conclusions

Activation of Doppler ultrasound in the waterbath model causes a significant increase of temperature within one minute. Thermally induced effects on the embryo cannot be excluded when using Doppler ultrasound in early pregnancy.     

Skin dose in radiation treatment of the left breast: Analysis in the context of prone versus supine treatment technique

PurposeTo determine how the skin dose varies in patients receiving radiation treatment for breast cancer in the prone and supine positions.MethodsFifty patients were scanned in the prone and supine positions. A radiation treatment plan was created for the left breast using a 6-MV beam for a prescribed dose of 42.66 Gy in 16 fractions. The dose was calculated using 1- and 2.5-mm calculation grid sizes and the surface dose was compared in both techniques.ResultsThe median gantry angles relative to the skin surface at the central axis were 8 and 52 degrees for treatment in the prone and supine positions, respectively. The mean dose difference between the prone and supine techniques was statistically significant from 3- to 5-mm depth for both grid sizes. For the 1-mm calculation grid size, the doses at 3-, 4-, and 5-mm depths in the prone and supine techniques were 87.80% and 89.10% (P < 0.003), 91.92% and 94.50% (P < 0.00), and 95.30% and 98.20% (P < 0.00), respectively; for the 2.5-mm grid size, the respective doses were 87.10% and 88.59% (P < 0.00), 91.60% and 94.63% (P < 0.00), and 95.10% and 97.80% (P < 0.00), respectively.ConclusionsThis study demonstrates that the prone technique facilitates a relatively lower skin dose than the supine technique. This observation is probably due to the beam angle. The beam is more perpendicular to the skin surface in the prone technique, whereas it is more tangential in the supine technique, which may deliver a higher skin dose. Thus, the dose to the skin should be evaluated in the prone technique, and if desired, the skin dose could be carefully augmented via a bolus or beam spoiler.