INVESTIGATION OF A PRACTICAL PATIENT DOSE INDEX FOR ASSESSMENT OF PATIENT ORGAN DOSE FROM CONE-BEAM COMPUTED TOMOGRAPHY IN RADIATION THERAPY USING A MONTE CARLO SIMULATION

The purpose of this study was to investigate a practical patient dose index for assessing the patient organ dose from a cone-beam computed tomography (CBCT) scan by comparing eight dose indices, i.e. CTDI100, CTDIIEC, CTDI∞, midpoint doses f(0)PMMA for a cylindrical polymethyl methacrylate (PMMA) phantom, f(0)Ap for an anthropomorphic phantom and f(0)Pat for a prostate cancer patient, as well as the conventional size specific dose estimations (SSDEconv) and modified SSDE (SSDEmod), with organ dose for the prostate (ODprost) obtained via Monte Carlo (MC) simulation. The ODprost was the reference dose used to find the practical dose index at the center of the pelvic region of a prostate cancer patient. The smallest error rate with respect to the ODprost of 19.3 mGy (reference) among eight dose indices was 5% for f(0)Pat. The practical patient dose index was the f(0)Pat, which showed the smallest error with respect to the reference dose.

SU-E-I-92: Accuracy Evaluation of Depth Data in Microsoft Kinect

PURPOSE

Microsoft Kinect has potential for use in real-time patient position monitoring in diagnostic radiology and radiotherapy. We evaluated the accuracy of depth image data and the device-to-device variation in various conditions simulating clinical applications in a hospital.

METHODS

Kinect sensor consists of infrared-ray depth camera and RGB camera. We developed a computer program using OpenNI and OpenCV for measuring quantitative distance data. The program displays depth image obtained from Kinect sensor on the screen, and the cartesian coordinates at an arbitrary point selected by mouse-clicking can be measured. A rectangular box without luster (300 × 198 × 50 mm³ ) was used as a measuring object. The object was placed on the floor at various distances ranging from 0 to 400 cm in increments of 10 cm from the sensor, and depth data were measured for 10 points on the planar surface of the box. The measured distance data were calibrated by using the least square method. The device-to-device variations were evaluated using five Kinect sensors.

RESULTS

There was almost linear relationship between true and measured values. Kinect sensor was unable to measure at a distance of less than 50 cm from the sensor. It was found that distance data calibration was necessary for each sensor. The device-to-device variation error for five Kinect sensors was within 0.46% at the distance range from 50 cm to 2 m from the sensor. The maximum deviation of the distance data after calibration was 1.1 mm at a distance from 50 to 150 cm. The overall average error of five Kinect sensors was 0.18 mm at a distance range of 50 to 150 cm.

CONCLUSIONS

Kinect sensor has distance accuracy of about 1 mm if each device is properly calibrated. This sensor will be useable for positioning of patients in diagnostic radiology and radiotherapy.

Performance evaluation of radiologists with artificial neural network for differential diagnosis of intra-axial cerebral tumors on MR images

BACKGROUND AND PURPOSE

Previous studies have suggested that use of an artificial neural network (ANN) system is beneficial for radiological diagnosis. Our purposes in this study were to construct an ANN for the differential diagnosis of intra-axial cerebral tumors on MR images and to evaluate the effect of ANN outputs on radiologists' diagnostic performance.

MATERIALS AND METHODS

We collected MR images of 126 patients with intra-axial cerebral tumors (58 high-grade gliomas, 37 low-grade gliomas, 19 metastatic tumors, and 12 malignant lymphomas). We constructed a single 3-layer feed-forward ANN with a Levenberg-Marquardt algorithm. The ANN was designed to differentiate among 4 categories of tumors (high-grade gliomas, low-grade gliomas, metastases, and malignant lymphomas) with use of 2 clinical parameters and 13 radiologic findings in MR images. Subjective ratings for the 13 radiologic findings were provided independently by 2 attending radiologists. All 126 cases were used for training and testing of the ANN based on a leave-one-out-by-case method. In the observer test, MR images were viewed by 9 radiologists, first without and then with ANN outputs. Each radiologist's performance was evaluated through a receiver operating characteristic (ROC) analysis on a continuous rating scale.

RESULTS

The averaged area under the ROC curve for ANN alone was 0.949. The diagnostic performance of the 9 radiologists increased from 0.899 to 0.946 (P < .001) when they used ANN outputs.

CONCLUSIONS

The ANN can provide useful output as a second opinion to improve radiologists' diagnostic performance in the differential diagnosis of intra-axial cerebral tumors seen on MR imaging.

SET binding factor 2 (SBF2) mutation causes CMT4B with juvenile onset glaucoma

The authors report a Japanese family segregating autosomal recessive Charcot-Marie-Tooth disease (CMT) with focally folded myelin, juvenile-onset glaucoma, and a nonsense mutation of SET binding factor 2 (SBF2). The consistent phenotypic features associated with SBF2 mutations are early-onset demyelinating neuropathy, myelin folding, and markedly decreased motor nerve conduction velocities; glaucoma associates with SBF2 nonsense mutations.

[Development of computerized method for automated classification of the body parts in digital radiographs]

PURPOSE

In picture archiving and communication systems (PACS), the information on the body parts included in radiographs is often not or incorrectly recorded in an image header. In order to apply the computer-aided diagnosis (CAD) system in the PACS environment, the body parts in radiographs need to be recognized correctly by computer. The purpose of this study is to develop a computerized method for correctly classifying the body parts in digital radiographs based on a template matching technique.

METHODS/MATERIALS

The image database used in this study was 1032 digital radiographs (14 x 17 inches) obtained with a computed radiography, and included 505 chest of postetroanterior view, 39 chest of lateral view, 241 abdomen, 108 pelvis, 10 upper limbs, 125 lower limbs, and 4 thoracic spine. In this method, test images were classified into four body parts, i.e., (1) chest, (2) abdomen, (3) pelvis, and (4) upper/lower limbs and thoracic spine. This computerized method was tested with 852 images, since 180 images were employed for creation of 98 templates, which represented the average radiographs for various body parts. Our approach was to examine the similarity of a given test image with templates by use of the cross-correlation values as the similarity measures. The body part of the test image was identified as the body part in the template yielding the maximum correlation value. Our method consisted of the following five steps. First, test images were classified into one of three groups; i.e. 1) chest and abdomen, 2) pelvis, and 3) upper/lower limbs and thoracic spine by using the templates obtained from images with the average size and position. Second, the remaining uncertain images were classified by using additional templates in various directions. Third, the chest and abdomen group was separated into two subgroups; i.e.chest and abdomen. Fourth, in order to classify some uncertain images, templates were shifted horizontally and vertically. Fifth, outer pixels of templates were eliminated to avoid the misclassification due to x-ray collimation.

RESULTS

Our preliminary results indicated that the body parts for 850 cases (99.8%) were correctly classified with our method.

CONCLUSIONS

This method would be useful for automated identification of the body parts in radiographs when various CAD systems would be implemented in the PACS environment.

Expression and purification of cytokine receptor homology domain of human granulocyte-colony-stimulating factor receptor fusion protein in Escherichia coli

Direct expression of the cytokine receptor homology (CRH) domain of granulocyte-colony-stimulating factor (G-CSF) receptor is lethal to Escherichia coli. For the efficient and stable production of an active CRH domain in E. coli, we fused the CRH domain with different proteins, such as maltose-binding protein (MalE), glutathione S-transferase, and thioredoxin (Trx). Among these, Trx appeared to be the best in terms of the protein expression level, purification efficiency by affinity chromatography, and binding activity to its ligand, G-CSF. The yield of active Trx-CRH fusion protein increased about 200-fold compared to that of previously reported MalE-CRH fusion.

Hereditary motor and sensory neuropathy with myelin folding and juvenile onset glaucoma

OBJECTIVE

We describe three patients from a family with motor and sensory neuropathy accompanied by open-angle glaucoma.

BACKGROUND

Autosomal recessive demyelinating hereditary motor and sensory neuropathies (HMSN) include different disorders. To our knowledge, autosomal recessive HMSN has not been associated with juvenile onset glaucoma.

METHODS

Sural nerve pathology of the three patients were examined, and genetic analysis of the family was performed.

RESULT

- The most prominent pathologic finding was a highly unusual myelin abnormality consisting of irregular redundant loops and folding of the myelin sheath. The family survey supports autosomal recessive inheritance. The molecular analysis failed to demonstrate either linkage of the disease to MPZ gene, PMP22 gene, Cx32 gene, orEGR2 gene. Analysis did not establish linkage of the disease to the locus of CMT4A, 4B, and 4C genes.

CONCLUSION

The present cases may represent a new type of HMSN accompanied by juvenile onset glaucoma.

[A family with probable autosomal dominant bulbospinal muscular atrophy with gynecomastia]

We reported a 52-year-old man and his family with bulbospinal muscle atrophy (BSMA) and gynecomastia. The propositus presented with the clinical picture of late onset progressive bulbospinal muscular atrophy including postural tremor, general hyporeflexia, mild maturity onset diabetes, gynecomastia and sexual impotence. One of his brother and his two sons had gynecomastia. His elder son had ocular movement abnormality, associated movement of facial muscle and finger tremor. One of his brothers showed tongue fasciculation without gynecomastia. None of members examined had abnormal expansion of CAG repeats in the androgen receptor gene. We speculate that this family has a new clinical entity characterized by bulbospinal muscular atrophy with an autosomal dominant inheritance.

Proportionality between Wiener spectra of quantum mottle and the squares of modulation transfer functions

Rossmann proposed that the Wiener spectra of the quantum mottle of radiographs made using screen-film systems were proportional to the squares of the modulation transfer functions (MTFs) of the screen-film systems. On the other hand, Lubberts theoretically pointed out that the shape of the Wiener spectrum of the quantum mottle depended on the sum of the squares of the MTFs for different depths in the screen phosphor layer, rather than the square of the sum of the MTFs for the different depths, i.e. the square of the MTF of the screen-film systems. The purpose of this study is to experimentally investigate the proportionality between the Wiener spectra of the quantum mottle and the squares of the MTFs of screen-film systems using two screen-film systems having different screen thicknesses. For this purpose, we determined correction factors for the square of the MTF of the screen-film system in the Wiener spectrum of the quantum mottle at each spatial frequency when the Wiener spectral values of the screen mottle were separated into those of the quantum mottle and structure mottle. The correction factor is the ratio of the normalized Wiener spectrum of the quantum mottle to the square of the MTF of the screen-film system. As a result, for a thin screen, the correction factors were unity for all spatial frequencies; on the contrary, for a thick screen, the factor increased with spatial frequency. By calculating the theoretical correction factors using the models for the MTF and Wiener spectrum of the quantum mottle of Nishikawa and Yaffe based on Lubberts' theory, we verified that our experimental results agreed with Lubberts' theory. Furthermore, by obtaining the screen thickness dependence of the theoretical correction factors for the two screens, we showed that, for screens thinner than 0.02 mm, Rossmann's theory can be applied to the relationship between the Wiener spectrum of the quantum mottle and the MTF of the screen-film system, whereas for screens thicker than 0.02 mm, Lubberts' theory should be applied.

Overproduction of vascular endothelial growth factor/vascular permeability factor is causative in Crow-Fukase (POEMS) syndrome

Crow-Fukase or POEMS syndrome of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes is a rare multisystem disorder of obscure pathogenesis that is associated with microangiopathy, neovascularization, and accelerated vasopermeability. We examined the levels of the vascular endothelial growth factor/vascular permeability factor (VEGF) in the serum and cerebrospinal fluid (CSF) from 10 patients with this syndrome. Serum VEGF levels were about 15-30 times those in control subjects or patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and other neurological disorders. The CSF VEGF levels, however, were similar to those found in GBS and CIDP. Elevated VEGF levels in the serum decreased in 7 patients with Crow-Fukase syndrome after conventional therapy. The principal isoform of VEGF in Crow-Fukase syndrome was VEGF165. Elevated VEGF was independent of M-protein. Our results suggest that the overproduction of VEGF is important in the pathogenesis of this disorder.

Relation between radiographic mottle for double and single emulsions

The radiographic density fluctuations produced by using dual screen-film systems are designated as the radiographic mottle. The density fluctuation of the radiographic mottle for the double emulsions at a density of the double emulsions consists of those for the front and back emulsions on a radiograph. However, the relation between the Wiener spectra of the radiographic mottle for the double and single emulsions had not been studied. Hence we compared the Wiener spectra of the radiographic mottle for the double emulsions with the sum of those for the front and back emulsions on the same radiographs and with the sum of those for the emulsions at the same densities. At all densities of more than 0.62 for lower spatial frequencies (< or = 1 mm-1), the Wiener spectral values of the radiographic mottle for the double emulsions were greater than the sum of those for the front and back emulsions for both comparisons on the same radiographs and at the same densities. In order to investigate the reason of the above phenomena, we separated the Wiener spectral values of the radiographic mottle for various densities into those of the three factors, i.e., quantum mottle, structure mottle, and film granularity, and performed the same comparisons as the radiographic mottle. Also, to explain the results for the three factors, we obtained the Wiener spectral values of the spatial fluctuations of the light exposure or the fluorescence intensity and the gradients of the characteristic curves of the film for the double and single emulsions of the x-ray film. As a result of the investigation, we found that the phenomena on the radiographic mottle were caused by that (1) on the same radiographs the squares of the gradients of the characteristic curves for the double emulsions were about 5.3 times as great as those for the single emulsion at densities of more than 0.62 of the double emulsions, and (2) at the same density of more than 0.62 those were more than about 2.2 times as great as those for the single emulsion.

[Two cases of POEMS syndrome with increased vascular endothelial growth factor (VEGF)]

We report a greatly increased amount of vascular endothelial growth factor (VEGF) in sera of two cases with POEMS syndrome. They had solitary myelomas in the cervical (case 1) and lumbar vertebrae (case 2). In both cases, serum VEGF decreased after steroid therapy. Sural nerve biopsy in case 1 showed marked subperineurial edema. The pathomechanism of polyneuropathy in POEMS syndrome may be due to involvement of the blood-nerve barrier by way of increased microvascular permeability induced by VEGF. VEGF is therefore not only a useful diagnostic marker for POEMS syndrome, but may also be a marker of clinical improvement.